Study findings do not support the treatment of elevated inpatient blood pressures in hospitalized older adults without evidence of end organ damage and highlight the need for randomized clinical trials of inpatient blood pressure treatment targets.
JAMA Internal Medicine introduces a new series, the Guide to Statistics and Methods, to be accessible to clinicians and researchers contextualizing and interpreting statistical methods applied in studies published in JAMA Internal Medicine.
Findings suggest that older patients, particularly those with limited autonomy, who spend the night in the ED awaiting hospital admission may have a higher risk of in-hospital mortality and morbidity; they should be prioritized for admission to a ward.
#Hypertension
is common in the inpatient setting, but antihypertensive intensification is not. Intensification of therapy without signs of end-organ damage is associated with worse outcomes
Defecation-induced cardiac arrest is an unrecognized cause of sudden cardiac death in patients with advanced cardiomyopathy. An increase in parasympathetic tone with sympathetic withdrawal is suggested. In contrast to atropine, epinephrine should be used
In this randomized clinical trial, a 5-day course of oral ivermectin administered during the first week of
#COVID19
illness did not reduce the risk of developing severe disease, when compared with standard of care alone.
Topical NSAIDs are associated with greater pain relief without increase in adverse events when treating musculoskeletal conditions such as sprains, strains, and contusions.
This study found that 46% of all meta-analysis publications of the ARISTOTLE clinical trial had conclusions altered by publications with falsified data, and 32% of all the analyses had a considerable change in the outcome.
Findings of this meta-analysis suggest that colorectal cancer screening with sigmoidoscopy may extend life by approximately 3 months; lifetime gain for other screening tests appears to be unlikely or uncertain.
An AI chatbot generated quality & empathetic responses to patient questions posed in an online forum, finds study. Chatbot-generated responses were preferred to physician responses. Further exploration of this tech is necessary.
#artificialintelligence
Study suggests that the Epic Sepsis Model poorly predicts
#sepsis
; its widespread adoption despite poor performance raises fundamental concerns about sepsis management on a national level
Dr.
@sharon_inouye
will become the Editor in Chief of JAMA Internal Medicine. Dr. Inouye is an internationally recognized leader in geriatric medicine and aging research.
In this randomized clinical trial of overweight adults who habitually sleep <6.5 hours per night, sleep extension reduced daily energy intake by ~270 kcal. Maintaining adequate sleep duration could be a viable intervention to prevent or reverse obesity.
2017 Hypertension Guideline
Begin meds if
- Clinical CVD or
- 10y ASCVD risk >= 10% AND SBP >=130 mm Hg / DBP >= 80 mm Hg or
- 10y ASCVD risk >= 10% AND SBP >=140 mm Hg / DBP >= 90 mm Hg or
1st-line meds =
- Thiazides
- CCBs
- ACE inhibitors or ARBs
Over the course of AY2016-2017, some internal medicine residents in a single academic medical center ordered an astonishing 7-8 times more diagnostic tests than their peers. Read the details here
#lessismore
After 14 years, JAMA Internal Medicine Editor
@RFRedberg
stepping down June 2023. Editorial milestones include
#impactfactor
44.46; 15M+ annual article downloads;
#LessIsMore
series discussing unnecessary medical tests;
#research
on important topics like health care reform.
2017 Hypertension Guideline
Begin meds if
- Clinical CVD or
- 10y ASCVD risk >= 10% AND SBP >=130 mm Hg / DBP >= 80 mm Hg or
- 10y ASCVD risk >= 10% AND SBP >=140 mm Hg / DBP >= 90 mm Hg or
1st-line meds =
- Thiazides
- CCBs
- ACE inhibitors or ARBs
The AST and ALT are a little elevated - now what? When the test of time may be a more useful and less harmful diagnostic tool: a Teachable Moment on the step-wise evaluation of mildly elevated transaminases.
@grammargandhi
@NilooLatifi
#highvaluecare
A form of intermittent fasting called early time-restricted feeding (eTRE) was more effective for losing weight, lowering diastolic blood pressure, and improving mood than eating over a ≥12-hour window.
Did You Know? New studies indicate that the gut
#microbiome
can influence the effectiveness of
#cancer
immunotherapy and manipulating gut bacteria might expand the population of patients who benefit from treatment
#PD1Inhibitors
Except for anosmia, persistent symptoms after COVID-19 may be more related to the belief of having had
#COVID19
than to actual SARS-Co-V2 infection. Clinicians and researchers should also consider general mechanisms that may not be specific to
#SARSCoV2
Recurrent UTI pose unique management challenges in older women. Rather than testing and treating liberally, clinicians should focus on acute, localizing urinary symptoms, use clinical tests judiciously, and consider the risks of antibiotic overtreatment.
Who needs a nutritional
#supplement
? Almost no one. Yet millions of Americans spend $$$ on vitamins & supplements without any
#evidence
of benefit. Read our patient page on the subject for more information & help deciding if you can toss that multivitamin
Bariatric surgery was associated with a reduced risk of breast cancer in women with obesity. The risk reduction was strongest in women with high insulin levels at baseline.
Among patients with suspected sepsis and no clear indication for antianaerobic coverage, administration of piperacillin-tazobactam was associated with higher mortality and increased duration of organ dysfunction compared with cefepime.
Delirium associated with accelerated cognitive decline that continued for 72 months following the index delirium episode; it's uncertain if delirium causes cognitive decline or if pts with preclinical brain disease are more likely to develop delirium.
Many patients are on multiple medications. Over time, some medications that were once helpful may no longer be needed. Safely lowering or stopping unnecessary medications is called deprescribing. Find out more with this JAMA Patient Page.
2017 Hypertension Guideline
Begin meds if
- Clinical CVD or
- 10y ASCVD risk >= 10% AND SBP >=130 mm Hg / DBP >= 80 mm Hg or
- 10y ASCVD risk >= 10% AND SBP >=140 mm Hg / DBP >= 90 mm Hg or
1st-line meds =
- Thiazides
- CCBs
- ACE inhibitors or ARBs
2017 Hypertension Guideline
Begin meds if
- Clinical CVD or
- 10y ASCVD risk >= 10% AND SBP >=130 mm Hg / DBP >= 80 mm Hg or
- 10y ASCVD risk >= 10% AND SBP >=140 mm Hg / DBP >= 90 mm Hg or
1st-line meds =
- Thiazides
- CCBs
- ACE inhibitors or ARBs
#Hydroxychloroquine
taken daily by hospital-based health care providers over 8 weeks did not prevent
#SARSCoV2
infection, in a double-blind randomized placebo-controlled trial performed at 2 University of Pennsylvania hospitals
In this randomized clinical trial, a hospital ward-based improvement program did not result in a reduction in most hospital-associated complications in older adults, although there was a significant reduction in delirium.
#Hydroxychloroquine
taken daily by hospital-based health care providers over 8 weeks did not prevent
#SARSCoV2
infection, in a double-blind randomized placebo-controlled trial performed at 2 University of Pennsylvania hospitals
Topical NSAIDs are associated with greater pain relief without increase in adverse events when treating musculoskeletal conditions such as sprains, strains, and contusions.
Comparison of patients just either side of the +ve D-dimer cutoff - who differ markedly in their probability of CTPA scan but are otherwise similar - found no eGFR difference up to 6 mths later, suggesting IV contrast is not linked w/long-term renal injury
Did You Know? New studies indicate that the gut
#microbiome
can influence the effectiveness of
#cancer
immunotherapy and manipulating gut bacteria might expand the population of patients who benefit from treatment
#PD1Inhibitors
To decrease antibiotic treatment related to asymptomatic bacteriuria, hospitals should prioritize reducing unnecessary urine cultures (ie, diagnostic stewardship).
Largest
#smoking
cessation clinical trial (EAGLES) found anti-smoking medications (
#varenicline
,
#bupropion
, and nicotine patch) don't increase risk of serious
#CV
events in a general population of smokers
2017 Hypertension Guideline
Begin meds if
- Clinical CVD or
- 10y ASCVD risk >= 10% AND SBP >=130 mm Hg / DBP >= 80 mm Hg or
- 10y ASCVD risk >= 10% AND SBP >=140 mm Hg / DBP >= 90 mm Hg or
1st-line meds =
- Thiazides
- CCBs
- ACE inhibitors or ARBs
In-hospital exercise can reverse the functional and cognitive impairment associated with acute hospitalization in older adults. Watch this
#video
or visit to learn more.
Fewer internal medicine residents nationally are planning a career in general internal medicine than 2011. Based on 2019-2021 in-training exam data, less than 10% of IM residents are now reporting GIM career plans.
Older women taking 4,400 steps/day have lower mortality than those taking 2,700; "more is better" up to 7,500 steps/day, when mortality rates level
#ACSM19