The American journal of medicine
-
Since its introduction in the US market in 2007, the use of electronic nicotine delivery systems, colloquially referred to as e-cigarettes or "vaping" products, has increased substantially, particularly among high school children and young men. With the legalization of marijuana within multiple states in the United States and thus, coincident change in the public perception of its risk, the availability of multiple tetrahydrocannabinol (the psychoactive agent in marijuana)- and cannabidiol (a nonpsychogenic agent in marijuana)- containing vaping products has also increased tremendously. Since March 2019, there has been an ongoing epidemic of acute lung injury secondary to the use of e-cigarettes, with over 2600 cases and 60 deaths reported all over the United States; the term e-cigarette- or vaping product-associated lung injury is used. ⋯ Corticosteroids, supportive care, and further avoidance of vaping products remain the cornerstone of treatment. Although generally associated with an excellent prognosis, older patients and patients with underlying cardiac and pulmonary conditions are at risk for higher mortality and morbidity. This review article aims to describe e-cigarette- or vaping product-associated lung injury, its pathogenesis, clinical and radiological manifestations, and management.
-
In 2019, the US Food and Drug Administration (FDA) approved 48 novel drugs. Thirty of the 48 (62.5%) novel drug approvals were reviewed and approved through an expedited review pathway while 20 of the 48 (41.7%) were approved for treatment of a rare disease. This review includes a summary of the novel drugs approved by the FDA in 2019.
-
It is acknowledged that empathy plays a critical role in the physician-patient relationship and has a positive impact on health outcomes. However, as the field of empathy expands, the lack of conceptual coherence challenges advances in medicine. In fact, in some medical settings, there is little added theoretical or clinical value in applying the all-encompassing term of empathy, which is by nature multidimensional, interpersonal, and modulated by context. ⋯ These components are relatively independent but often interact and are deeply interwoven in the fabric of the brain. Nevertheless, it seems clear from this review that cultivating empathic concern or compassion in today's medicine is more important than other aspects of empathy, like vicariously experiencing and introspecting about patients' emotions. Specific neurobiological mechanisms explain the benefit to patients of their physicians' perceived empathy.
-
As the incidence of acute kidney injury (AKI) increases, prevention strategies are needed across the health care continuum, which begins in the community. Recognizing this knowledge gap, the 22nd Acute Disease Quality Initiative (ADQI) was tasked to discuss the evidence for quality-of-care measurement and care processes to prevent AKI and its consequences in the community. ⋯ This assessment should include blood pressure, serum creatinine, and urine dipstick, followed by a Kidney Health Response to prevent AKI that encompasses cessation of unnecessary medications, minimization of nephrotoxins, patient education, and ongoing monitoring until the exposure resolves. These recommendations give community health care providers and health systems a starting point for quality improvement initiatives to prevent AKI and its consequences in the community.
-
Cough is one of the most common complaints encountered in every setting; however, complications associated with coughing have received relatively little attention. An exhaustive systematic review of the English literature revealed an exceedingly large and varied spectrum of cough-induced complications affecting many systems, including upper airways, chest wall and thorax, abdominal wall, heart and aorta, central nervous system, eye, gastrointestinal tract, urogenital system, and emotional and psychological harm. Prospective studies and prevalence data are conspicuously missing. ⋯ A substantial proportion of patients experience anxiety and insomnia, and their quality of life is affected. Thus, the wide spectrum of cough-induced pathology need to be recognized and considered in patients complaining of cough. Suppression of cough must not be neglected in patients at risk, and areas of uncertainty need to be clarified by future prospective studies.