The American journal of medicine
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Review
Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2023.
The expansive scope of internal medicine can make it challenging for clinicians to stay informed about new literature that changes practice. Guideline updates and synthesis of relevant evidence can facilitate incorporation of advancements into clinical practice. The titles and abstracts from the seven general medicine journals with highest impact factors and relevance to outpatient internal medicine were reviewed by six internal medicine physicians. ⋯ Article qualities and importance were debated until consensus was reached. Clusters of articles pertinent to the same topic were considered together. In total, seven practice-changing articles were included.
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Comparative Study Observational Study
Comparative safety and effectiveness of reduced doses of direct acting oral anticoagulants for stroke prevention in atrial fibrillation.
This Nordic observational cohort study aims to assess the effectiveness and safety of reduced-dose direct-acting oral anticoagulants (DOACs) dabigatran, rivaroxaban, and apixaban compared to standard warfarin for stroke prevention in nonvalvular atrial fibrillation. ⋯ In this study, atrial fibrillation patients initiating reduced-dose rivaroxaban and dabigatran exhibited incidences of ischemic stroke and systemic embolism similar to warfarin, and for apixaban, even lower. Rates of intracranial hemorrhage were comparable to or lower for patients on DOACs compared to warfarin.
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Comparative Study Observational Study
The Ultrasound Hepato-Jugular Reflux: Measuring the Hepato-Jugular Reflux with Ultrasound with Comparison to Invasive Right Heart Catheterization.
Ultrasound can overcome barriers to visualizing the internal jugular vein, allowing hepato-jugular reflux and jugular venous pressure measurement. We aimed to determine operating characteristics of the ultrasound hepato-jugular reflux and ultrasound jugular venous pressure predicting right atrial and pulmonary capillary occlusion pressures. ⋯ In patients undergoing right heart catheterization, the ultrasound hepato-jugular reflux is reproducible, has modest impact on the probability of a normal pulmonary capillary occlusion pressure when 0 cm, and more substantial impact on the probability of an elevated pulmonary capillary occlusion pressure when ≥ 1.5 cm.
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Long COVID is a multisystemic condition that affects the lives of millions of people globally, yet factors associated with it are poorly defined. Our purpose in this study was to identify factors associated with long COVID. ⋯ Several demographic features were associated with long COVID, which may be the result of social, clinical, or biological influences.
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Although cardiovascular disease mortality rates in the United States declined from the 1970s to 2010s, they have now plateaued. The independent effects of age, period, and birth year (cohort) on cardiovascular disease mortality have not previously been defined. ⋯ Although cardiovascular disease mortality rates declined rapidly among those born between 1919 and 1974, improvements plateaued in birth cohorts thereafter even adjusted for period effects.