The American journal of medicine
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Multicenter Study
End-of-Life Spending and Healthcare Utilization Among Older Adults with Chronic Obstructive Pulmonary Disease.
End-of-life spending and healthcare utilization among older adults with COPD have not been previously described. ⋯ End-of-life spending and healthcare utilization among older adults with COPD varied substantially nationwide. Decedents with COPD frequently utilized acute care near the end of life. Hospice utilization was higher than expected, with significant geographic disparities.
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Some patients are at higher risk for recurrent cardiovascular events following a myocardial infarction because of their clinical characteristics and comorbidities. Still, they are less often treated with guideline-recommended therapies. We examined trends for more than a decade in the treatment and outcome of patients with myocardial infarction according to the risk for recurrent cardiovascular events, using the Thrombolysis in Myocardial Infarction (TIMI) risk score for secondary prevention. ⋯ Despite greater application of guideline-recommended therapies, patients at high risk after myocardial infarction are still relatively undertreated, which may adversely affect their prognosis. Nevertheless, they demonstrated the most notable improvement in clinical outcomes over time.
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Lung injury associated with cannabinoid oil vaping is rapidly becoming a serious public health concern. We describe the clinical and radiographic presentations of 5 patients with lung injury associated with vaping cannabinoid oils seen at a single institution. ⋯ We report the clinical and radiographic presentation of 5 patients at our institution with cannabinoid oil vaping-associated lung injury. All patients displayed a consistent chest radiographic pattern of injury. Most responded to supportive care, although one required the addition of corticosteroids. Bronchoalveolar lavage results suggest that this injury may related to a toxic form of lipoid pneumonia.
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Embolic stroke of unknown source (ESUS) is currently thought to represent a subpopulation of cryptogenic strokes defined by its embolic stroke pattern on imaging, and if after a carefully performed diagnostic evaluation, a specific, well-recognized cause of stroke has not been identified. The concept was primarily established to justify and enable the conduct of the ESUS trials, such as Randomized, Double-Blind, Evaluation in Secondary Stroke Prevention Comparing the Efficacy and Safety of the Oral Thrombin Inhibitor Dabigatran Etexilate versus Acetylsalicylic Acid in Patients with Embolic Stroke of Undetermined Source (RESPECT-ESUS) and New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial versus aspirin to Prevent Embolism in Embolic Stroke of Undetermined Source (NAVIGATE-ESUS). With both studies having neutral results, the question arises if the ESUS concept is misleading or rather a gateway for a modern understanding of stroke etiology. This review will analyze the background of the ESUS concept, overview the results and the impact of the recent multicenter trials and cohort studies, and discuss the definition, etiology, and diagnosis of ESUS.
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Review
Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2019.
Clinicians are challenged to stay informed of new and changing medical literature. To facilitate knowledge updates and synthesis of practice-changing information, a group of 6 internists reviewed the titles and abstracts in the 7 outpatient general internal medicine journals with the highest impact factors and relevance to outpatient internal medicine physicians: New England Journal of Medicine (NEJM), Lancet, Annals of Internal Medicine, Journal of the American Medical Association (JAMA), JAMA Internal Medicine, British Medical Journal (BMJ), and Public Library of Science (PLoS) Medicine. The following collections of article synopses and databases were also reviewed: American College of Physicians Journal Club, NEJM Journal Watch, BMJ Evidence-Based Medicine, McMaster/DynaMed Evidence Alerts, and Cochrane Reviews. ⋯ Article qualities and importance were debated until consensus was reached. Clusters of articles pertaining to the same topic were considered together. In total, 7 practice-changing articles were included.