Advancing the Care of Severe Asthma: Differential Diagnosis, Multidisciplinary Management, and Patient Engagement
This CME-accredited CME Snapshot ™ four-part series is intended for primary care providers, including internists, family physicians, nurse practitioners, and physician assistants involved in the ongoing management of patients with severe asthma. The faculty will review freely available patient- and caregiver-directed educational resources that seek to improve shared decision-making and multidisciplinary care.). (Online access: https://asthmacmepcp.elsevierresource.com/). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 20, 2019 Category: General Medicine Authors: Jonathan Corren, Barbara P. Yawn Tags: CME Multimedia Activity Source Type: research

Injecting New Ideas Into Managing Type 2 Diabetes: Evolving Roles of GLP-1 Receptor Agonists
Type 2 diabetes is a progressive disease that often requires therapeutic intensification. Patients with type 2 diabetes frequently experience complications related to hyperglycemia, treatment-induced hypoglycemia, and comorbidities. Management of patients with type 2 diabetes is complicated and must be individualized, though guidelines from both the American Diabetes Association and the American Association of Clinical Endocrinologists/American College of Endocrinology provide treatment algorithms detailing therapeutic escalation with both oral and injectable therapies according to glycated hemoglobin (A1c) level. (Source:...
Source: The American Journal of Medicine - February 16, 2019 Category: General Medicine Authors: John E. Anderson, John L. Leahy Tags: CME Multimedia Activity Source Type: research

Effectiveness and safety of off-label dose-reduced direct oral anticoagulants in atrial fibrillation
Direct oral anticoagulants (DOACs) reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation but may result in serious bleeding complications. Off-label dose-reduced use of DOAC to mitigate bleeding is common in routine clinical practice although data regarding its consequences on patient outcomes is limited. Therefore, our objective was to evaluate the effectiveness and safety of off-label dose-reduced versus per-label standard-dose DOAC treatment. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 15, 2019 Category: General Medicine Authors: Ronen Arbel, Ruslan Sergienko, Ariel Hammerman, Sari Greenberg-Dotan, Erez Batat, Orly Avnery, Martin H. Ellis Source Type: research

New Approaches for Delirium: A Case for Robotic Pets
Delirium is highly prevalent in hospitalized patients and is a strong and consistent negative predictor length of stay, mortality, and long-term cognitive outcomes.1. Symptoms commonly associated with delirium include reduced ability to focus, sleep disturbances, psychomotor agitation, and emotional disturbances. The management of the behavioral disturbances of delirium is challenging. Although non-pharmacologic means to reduce the duration or severity of delirium are advocated, there are limited established therapies beyond early physical mobilization, reorientation, attempting to enhance natural sleep patterns, and bedsi...
Source: The American Journal of Medicine - February 7, 2019 Category: General Medicine Authors: Joshua Schulman-Marcus, Sulagna Mookherjee, Lisa Rice, Radmila Lyubarova Tags: Commentary Source Type: research

Body Mass Index, Intensive Blood Pressure Management, and Cardiovascular Events in the Systolic Blood Pressure Intervention Trial (SPRINT)
It is unclear whether intensive blood pressure management is well-tolerated and affects risk uniformly across the body mass index (BMI) spectrum. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 2, 2019 Category: General Medicine Authors: Christina Stolzenburg Oxlund, Manan Pareek, Benjamin Schnack Brandt Rasmussen, Muthiah Vaduganathan, Tor Biering-S ørensen, Christina Byrne, Zaid Almarzooq, Michael Hecht Olsen, Deepak L. Bhatt Tags: Clinical Research Article Source Type: research

The State of Ambulatory Undergraduate Internal Medicine Medical Education: Results of the 2016 Clerkship Directors in Internal Medicine Annual Survey
Ambulatory care is qualitatively different and valuable to the health system. Given the shifts in health care that prioritize ambulatory care, internal medicine educators see benefits to learning in this environment. Internal medicine education teaches the skills necessary for managing complex patients, including those with multiple illnesses, medications, and social needs, all of which are encountered in the practice of ambulatory internal medicine.1 (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 2, 2019 Category: General Medicine Authors: Amy W. Shaheen, Irene Alexandraki, Sara B. Fazio, Margaret C. Lo, Clifford D. Packer, Harish Jasti, Michael Kisielewski, Susan T. Hingle Tags: AAIM Perspectives Source Type: research

Burden of Thirty-Day Readmissions Associated with Discharge Against Medical Advice Among Inpatients in the United States
Discharges against medical advice are common among inpatients in the United States. The impact of discharge against medical advice on readmission rates and subsequent hospitalization outcomes is uncertain. We sought to ascertain the effect of discharge against medical advice on 30-day readmission rates and outcomes of readmission. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 1, 2019 Category: General Medicine Authors: Nilay Kumar Tags: Clinical Research Study Source Type: research

Graduate Medical Education's Tower of Babel
Discussions about using public funds to support graduate medical education (GME) have used conflicting financial terms and measures. The resulting confusion makes it difficult for policy makers to determine how best to address GME funding priorities. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 1, 2019 Category: General Medicine Authors: David W Young Tags: Commentary Source Type: research

Chronic Myocardial Injury and Risk for Stroke
This study aimed to investigate the association between chronic myocardial injury and stroke. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 1, 2019 Category: General Medicine Authors: Linda Ryd én, Andreas Roos, Martin J Holzmann Tags: Clinical Research Study Source Type: research

Creating a culture of micro-affirmations to overcome gender-based micro-inequities in academic medicine
A woman physician meets with the department chairperson and colleagues to discuss her project ideas. The group agrees that they have transformative potential. The chairperson says to her in front of the group, “With your looks and my brain, we'll be a great team.” Unable to muster a response to him, she laughs uncomfortably and changes the subject. Several weeks later, the physician presents a patient case at medical rounds. A new colleague mistakes her for a medical student and after realizing the mi stake comments, “As a woman, you should be grateful to look so young!” As the physician's career pr...
Source: The American Journal of Medicine - February 1, 2019 Category: General Medicine Authors: Rose L. Molina, Hope Ricciotti, Lucy Chie, Rebecca Luckett, Blair J. Wylie, Ebonie Woolcock, Jennifer Scott Tags: Commentary Source Type: research

A New Gender Neutral Honorific: “RP”
Healthcare providers are increasingly aware of the challenges that transgender patients face in accessing quality and compassionate healthcare. 1 Physicians should strive to reduce barriers to access by creating a welcoming and safe environment in their practices and improve their own understanding of the terminologies (Table 1) and health related issues that such patients may have. 1 –7 Even the act of checking into the waiting room of a medical office can become a negative and humiliating experience if staff and providers are unfamiliar with basic principles of transgender care. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 1, 2019 Category: General Medicine Authors: Alexander Ladenheim, Gary P. Wormser Tags: Commentary Source Type: research

Clinician's Guide to the Updated ABCs of Cardiovascular Disease Prevention: A Review Part 2
Efforts to better control risk factors for cardiovascular disease and prevent the development of subsequent cardiovascular events are crucial to maintaining healthy populations. In today's busy practice environment and with the overwhelming pace of new research findings, ensuring appropriate emphasis and implementation of evidence-based preventive cardiovascular care can be challenging. The ABCDEF approach to cardiovascular disease prevention is intended to improve dissemination of contemporary best practices and ease the implementation of comprehensive preventive strategies for clinicians. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 1, 2019 Category: General Medicine Authors: Kelly Arps, Vincent A. Pallazola, Rhanderson Cardoso, Joseph Meyer, Richard Jones, Jacqueline Latina, Ty J. Gluckman, Neil J. Stone, Roger S. Blumenthal, John W. McEvoy Tags: Review Source Type: research

Aortic root abscess in a patient with Marfan's syndrome
We present a case of aortic root abscess where infection had arisen from an infected aortic valve graft replacement in a patient with Marfan's syndrome. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 30, 2019 Category: General Medicine Authors: Eamon P McCarron, Glenn Clarke, Shiva Sreenivasan, Monica Monaghan Tags: Case Report Source Type: research

Animals in the Hospital
I like the concept of “thinking outside the box”. What is meant by this little phrase is the idea that one envisions concepts or approaches to a problem in an unconventional or highly original manner. In other words, one's thinking is not constrained inside a conventional “box”. The term is believed to have origi nated with management consultants in the 1970s and 80s when they sought clients who were innovative and original in their thinking. During my tenure as chairman of medicine at the University of Arizona College of Medicine, I cherished faculty members who would come to me with new and origin...
Source: The American Journal of Medicine - January 30, 2019 Category: General Medicine Authors: Joseph S. Alpert Source Type: research

Pearls and Myths in the Evaluation of Patients with Suspected Acute Pulmonary Embolism
Significant improvement has been achieved in diagnostic accuracy, validation of probability scores and standardized treatment algorithms for patients with suspected acute pulmonary embolism. These developments have provided the tools for a safe and cost-effective management for most of these patients. To our experience, however, the presence of medical myths and ongoing controversies appear to hinder the implementation of these tools in everyday clinical practice.  This review provides a selection of such dilemmas and controversies and discusses the published evidence beyond them. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 30, 2019 Category: General Medicine Authors: Melina St üssi-Helbling, Mattia Arrigo, Lars C. Huber Tags: Review Source Type: research

New Treatment Options for Depression: A Primer for Internists
Depression continues to be a challenging condition to treat despite the myriad treatment options available. Primary care providers are increasingly tasked with providing second- and third-line treatments for major depressive disorder and, thus, should be familiar with newer medication therapies that are available. In this article, we aim to provide the general internist and other providers who treat depression in their practice with a succinct review of recent developments in the treatment of depression. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 30, 2019 Category: General Medicine Authors: Tina H. Byun, Swarna S. Chaliki, Kenneth G. Poole Tags: Review Source Type: research

Spontaneous Pneumothorax in a Young Woman
Presentation: A 37-year-old female presented to the emergency department with the acute onset of shortness of breath and chest discomfort. The patient was a never-smoker with no significant past medical history. Physical examination was remarkable for tachypnea and decreased right-sided breath sounds. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 30, 2019 Category: General Medicine Authors: Charles J. Van Hook, Paul R. Sullivan, Michael Seymour Tags: Images in Radiology Source Type: research

A Case of Miller Fisher Syndrome
Miller Fisher Syndrome is a rare variant of a heterogeneous group of immune-mediated polyneuropathies broadly called Guillain-Barre Syndrome. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 30, 2019 Category: General Medicine Authors: Hunter Mwansa, Obinna Obikiezie, Samir Kaneria Tags: Clinical Communication to the Editor (Case report) Source Type: research

Clinician's Guide to the Updated ABCs of Cardiovascular Disease Prevention: A Review Part 1
Efforts to better control risk factors for cardiovascular disease and prevent the development of subsequent events are crucial to maintaining healthy populations. In today's busy practice environment and with the overwhelming pace of new research findings, ensuring appropriate emphasis and implementation of evidence-based preventive cardiovascular care can be challenging. The ABCDEF approach to cardiovascular disease prevention is intended to improve dissemination of contemporary best practices and facilitate the implementation of comprehensive preventive strategies for clinicians. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 30, 2019 Category: General Medicine Authors: Kelly Arps, Vincent A. Pallazola, Rhanderson Cardoso, Joseph Meyer, Richard Jones, Jacqueline Latina, Ty J. Gluckman, Neil J. Stone, Roger S. Blumenthal, John W. McEvoy Tags: Review Source Type: research

Artificial Intelligence Transforms the Future of Healthcare
Life sciences researchers using Artificial Intelligence are under pressure to innovate faster than ever. Large, multilevel, and integrated datasets offer the promise of unlocking novel insights and accelerating breakthroughs. Although more data are available than ever, only a fraction is being curated, integrated, understood, and analyzed. Artificial Intelligence focuses on how computers learn from data and mimic human thought processes. Artificial Intelligence increases learning capacity and provides decision support system at scales that are transforming the future of healthcare. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 30, 2019 Category: General Medicine Authors: Nariman Noorbakhsh-Sabet, Ramin Zand, Yanfei Zhang, Vida Abedi Source Type: research

Diffuse vascular FDG uptake in late onset Takayasu arteritis
To the Editor: (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 30, 2019 Category: General Medicine Authors: Ko Harada, Kou Hasegawa, Fumio Otsuka Tags: Clinical Communications to the Editor Source Type: research

More martial than arts: Coronary artery dissection after chest kick
A 40-year-old male smoker without relevant medical history reported to the emergency department two days after a kick to his unprotected chest during a karate training session. The day before, he had presented with severe chest pain and his general practitioner had prescribed ibuprofen. No ECG had been done. At the emergency department, the patient complained of severe chest pain with breathing or touching the left hemithorax. Vital signs and physical exploration were normal. The 12-lead ECG showed ST-segment elevation in the inferolateral leads (II, III, aVF, V4-V6, Fig. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 30, 2019 Category: General Medicine Authors: Markus Linhart, Walter Bragagnini, Ander Regueiro, Eduardo Flores, Guiomar Mendieta, Antonio Mart ínez-Rubio Source Type: research

Recurrent Abdominal Pain in Systemic Lupus Erythematosus: Concurrent Lupus Enteritis and Lupus Cystitis
A 44-year-old woman was admitted to the hospital in March 2017 with a 5-day history of abdominal pain, vomiting, diarrhea, dysuria and urinary frequency. She was afebrile, normotensive and in sinus tachycardia. Her abdomen was distended and diffusely tender. Bowel sounds were hyperactive. No abdominal guarding or rebound pain in response to deep palpation was elicited. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 30, 2019 Category: General Medicine Authors: Pablo Andr és Castaño-González, Luis Alonso González Tags: Clinical Communication to the Editor Source Type: research

Presumed Pancreatitis in the Setting of Renal Impairment
We present a patient misdiagnosed with acute pancreatitis in the setting of  acute kidney injury. Misdiagnosis delayed the treatment of his underlying illness and resulted in misuse of resources and prolonged hospital stay. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 30, 2019 Category: General Medicine Authors: Muhammad Khan, Abdurraoof Patel, Reza Samad Tags: Clinical Communication to the Editor Source Type: research

Altruism – A Quality Required of Medical School Applicants
We read with interest the recent article by Tammaro et al1 Altruism: A Story in Three Acts and were truly moved by the actions of the residents and their colleagues. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 25, 2019 Category: General Medicine Authors: Thomas W. Grother, David J. Wilson Tags: Letter Source Type: research

High-Density Lipoprotein Cholesterol and Hyponatremia: An Unsolved Gordian Knot
In a previous issue of The American Journal of Medicine, Israel and Grossman1 reported that high levels of high-density lipoprotein cholesterol (HDL-C) are associated with hyponatremia in hypertensive and normotensive individuals. Considering the fact that these findings were derived from the prospective Systolic Blood Pressure Intervention Trial (SPRINT) and a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) datasets, respectively, their analyses had a few limitations. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 25, 2019 Category: General Medicine Authors: Fotios Barkas, Moses Elisaf, George Liamis Tags: Letter Source Type: research

The Reply
We are grateful to Drs. Grother and Wilson for their comments on review of our recent article on altruism in internal medicine residents at Brown University.1 Their survey reporting UK undergraduate medical students feeling less able to engage in altruistic activities after entering medical school, despite a desire to do so, is important to our work as educators. We presume that altruism and the desire to help others begins prior to entry into medical school, and their survey suggests it may also play a role in prompting teens to enter the medical field. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 25, 2019 Category: General Medicine Authors: Dominick Tammaro, James Arrighi, Ross Hilliard, Elizabeth Toll Tags: Letter Source Type: research

The Reply
We thank Dr. Barkas and colleagues for sharing the retrospective study performed in their centre and for their interesting comments. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 25, 2019 Category: General Medicine Authors: Ariel Israel, Ehud Grossman Tags: Letter Source Type: research

The Reply
We appreciate the comments of Dr. Greenough regarding our recent editorial regarding the 50th Anniversary of the CCU at New York Hospital - Cornell.1 (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 25, 2019 Category: General Medicine Authors: William H. Frishman Tags: LETTER Source Type: research

Table of Contents
(Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 25, 2019 Category: General Medicine Source Type: research

Underutilization of aspirin in patients with advanced colorectal polyps
Colorectal cancer is the third most common cause of cancer deaths in the United States and advanced colorectal polyps are a major risk factor. Although there are no large-scale individual trials designed a priori to test the hypothesis, in meta-analyses of trials in primary prevention of cardiovascular disease aspirin reduces risk of colorectal cancer. The United States Preventive Services Task Force utilized a micro-simulation model including baseline risk factors and concluded that aspirin reduces risk of colorectal cancer by 40%. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 23, 2019 Category: General Medicine Authors: Benjamin Fiedler, Lawrence Fiedler, Michael DeDonno, Kosi Anago, Leonie de la Cruz, George R Luck, Charles H. Hennekens Tags: Brief Observation Source Type: research

Heart failure with preserved ejection fraction: Is ischemia due to coronary microvascular dysfunction a mechanistic factor?
Heart failure with preserved ejection fraction (HFpEF) is increasing in prevalence and has no guideline recommended therapy, related in part to a lack of mechanism. Traditionally, HFpEF was thought to be secondary to afterload overload due to systemic hypertension, however, accumulating evidence suggests that HFpEF continues to worsen despite adequate blood pressure control. Emerging data support the suggestion that myocardial ischemia secondary to coronary microvascular dysfunction could be the new paradigm pathophysiology. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 23, 2019 Category: General Medicine Authors: Islam Y. Elgendy, Carl J. Pepine Tags: Review Source Type: research

An Alternative to ‘Medicare for All’
Two facts about US health care are beyond dispute. First, US health care is the most expensive in the world; twice as expensive as the average industrial nation.1 (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 23, 2019 Category: General Medicine Authors: James E. Dalen, Jennifer L Plitt, Neha Jaswal, Joseph S. Alpert Tags: Commentary Source Type: research

How accurate are the findings noted during a physical examination?
When I was in training, it was common knowledge that the observations we made when examining patients were important observations that enabled us to diagnose with accuracy the patient's disease. Over the years since then, a number of physical findings have been shown to be either inaccurate or less than helpful in diagnosing disease states. For example, I was taught a number of maneuvers to determine if abdominal ascites were present. Carefully controlled studies, however, have in recent years demonstrated that the accuracy of physical exam findings predicting the presence of ascites are less accurate than I was taught. (S...
Source: The American Journal of Medicine - January 23, 2019 Category: General Medicine Authors: Joseph S. Alpert Source Type: research

Take it from Sammy
I took care of Sammy 41 years ago when I was an intern. After knowing him for almost 4 weeks, I faced the dilemma of whether to tell him goodbye: Sammy, you see, was dying. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 21, 2019 Category: General Medicine Authors: David B. Hellmann Tags: Personomics Source Type: research

Net Clinical Benefit of Non-Vitamin K Antagonist vs Vitamin K Antagonist Anticoagulants in Elderly Patients with Atrial Fibrillation
The risks of thromboembolic and hemorrhagic events in patients with atrial fibrillation both increase with age; therefore, net clinical benefit analyses of anticoagulant treatments in the elderly population are crucial to guide treatment. We evaluated the 1-year clinical outcomes with non-vitamin-K antagonist and vitamin K antagonist oral anticoagulants (NOACs vs VKAs) in elderly ( ≥75 years) patients with atrial fibrillation in a prospective registry setting. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 18, 2019 Category: General Medicine Authors: Giuseppe Patti, Ladislav Pecen, Markus Lucerna, Kurt Huber, Miklos Rohla, Giulia Renda, Jolanta Siller-Matula, Fabrizio Ricci, Paulus Kirchhof, Raffaele De Caterina Tags: Clinical Research Study Source Type: research

Net Clinical Benefit of Non-Vitamin K Antagonist Versus Vitamin K Antagonist Anticoagulants in Elderly Patients With Atrial Fibrillation
The risks of thromboembolic and hemorrhagic events in patients with atrial fibrillation both increase with age; therefore, net clinical benefit analyses of anticoagulant treatments in the elderly population are crucial to guide treatment. We evaluated the 1-year clinical outcomes with non-vitamin K antagonist and vitamin K antagonist oral anticoagulants (NOACs versus VKAs) in elderly ( ≥75 years) patients with atrial fibrillation in a prospective registry setting. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 18, 2019 Category: General Medicine Authors: Giuseppe Patti, Ladislav Pecen, Markus Lucerna, Kurt Huber, Miklos Rohla, Giulia Renda, Jolanta Siller-Matula, Fabrizio Ricci, Paulus Kirchhof, Raffaele De Caterina Source Type: research

Real-life benefits of statins for cardiovascular prevention in elderly subjects: a population-based cohort study
The benefits of initiating statins in the elderly remains debated. We evaluated the effects of initiating statins in the elderly, according to cardiovascular risk. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 17, 2019 Category: General Medicine Authors: Julien Bezin, Nicholas Moore, Yohann Mansiaux, Philippe Gabriel Steg, Antoine Pariente Tags: Clinical Research Study Source Type: research

Anticoagulation therapy in patients with liver cirrhosis is associated with an increased risk of variceal hemorrhage
The belief that cirrhotic patients are “auto-anticoagulated” often results in anticoagulation therapy being withheld in these patients. We aimed to understand patterns of use of anticoagulation and to determine the risk of bleeding complications in cirrhotic patient. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 17, 2019 Category: General Medicine Authors: Roula Sasso, Don C. Rockey Tags: Original research Source Type: research

Pulse Pressure, Cardiovascular Events, and Intensive Blood-Pressure Lowering in the Systolic Blood Pressure Intervention Trial (SPRINT)
The efficacy and tolerability of intensive blood-pressure lowering may vary by pulse pressure (systolic minus diastolic blood pressure). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 16, 2019 Category: General Medicine Authors: Manan Pareek, Muthiah Vaduganathan, Tor Biering-S ørensen, Christina Byrne, Arman Qamar, Zaid Almarzooq, Ambarish Pandey, Michael Hecht Olsen, Deepak L. Bhatt Tags: Clinical Research Study Source Type: research

ABC (Atrial fibrillation Better Care) Pathway and Healthcare Costs in Atrial Fibrillation: The ATHERO-AF Study
Patients with atrial fibrillation are often elderly and have multiple comorbidities, leading to a high risk of cardiovascular events1,2,3 despite the use of oral anticoagulants, whether with vitamin K antagonists (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 16, 2019 Category: General Medicine Authors: Daniele Pastori, Alessio Farcomeni, Pasquale Pignatelli, Francesco Violi, Gregory YH Lip Tags: Clinical Research Study Source Type: research

Clinical Characteristics and Etiologies of Miliary Nodules in the US: A Single-Center Study
Miliary nodules have been typically described as a radiological manifestation of disseminated tuberculosis. However, miliary nodules are known to occur in a wide variety of conditions. The primary objective of the study was to identify clinical characteristics and etiologies of miliary nodules within our institution. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 16, 2019 Category: General Medicine Authors: Moiz Salahuddin, Siddharth Karanth, Daniel Ocazionez, Rosa M Estrada-Y-Martin, Sujith V. Cherian Tags: Brief Observation Source Type: research

The Reply
Regarding the insertion of inferior vena cava (IVC) filters in patients with recurrent pulmonary embolism during the first 3 months after an index pulmonary embolism, those who received IVC filters and those who did not were the same age and similar in gender.1 Drs. Nazare and Goldstein suggest those who received IVC filters and those who did not should have been matched for a history of gastrointestinal or intracranial bleeds, chronic kidney disease, hypercoagulable states and use of antiplatelet agents. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 16, 2019 Category: General Medicine Authors: Paul D. Stein, Fadi Matta, Frank R. Lawrence, Mary J Hughes Tags: LETTER Source Type: research

Short-TErm Psychotherapy IN Acute Myocardial Infarction (STEP-IN-AMI) TRIAL: Final results
To assess whether a short-term psychotherapy enhances long-term clinical outcomes in patients with a recent acute myocardial infarction (AMI). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 16, 2019 Category: General Medicine Authors: Christian Pristipino, Adriana Roncella, Vincenzo Pasceri, Giulio Speciale Tags: Clinical Research Study Source Type: research

Pneumocystis pneumonia complicated by extensive diffuse pneumatoceles
A 60-year-old male presented to the outpatient clinic with shortness of breath, subjective fevers, and night sweats of one month duration. Initial chest X-ray revealed new bilateral perihilar consolidations. He was treated with a 5-day course of levofloxacin 750 mg daily without improvement. Therefore, he underwent a chest CT scan which showed extensive bilateral pneumatoceles (Figure 1, A). Bronchoscopy with BAL was positive for Pneumocystis jirovecii on PCR. Laboratory workup revealed lymphopenia with lymphocyte count of 0.41  × 10(9)/L and CD4 count of 40 cells/mm3. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 16, 2019 Category: General Medicine Authors: Hasan Ahmad Hasan Albitar, Omar M. Abu Saleh Tags: Letter to the Editor Source Type: research

Clinical characteristics and etiologies of miliary nodules in the US; A single center study
Miliary nodules have been typically described as a radiological manifestation of disseminated tuberculosis. However, miliary nodules are known to occur in a wide variety of conditions. The primary objective of the study was to identify clinical characteristics and etiologies of miliary nodules within our institution. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 16, 2019 Category: General Medicine Authors: Moiz Salahuddin, Siddharth Karanth, Daniel Ocazionez, Rosa M Estrada-Y-Martin, Sujith V. Cherian Tags: Brief Observation Source Type: research

Consumer-Directed Health Care: The Uncertain Future of Price Transparency Initiatives
CompareCare, Massachusetts ’ online price transparency initiative, was recently launched by the Center for Health Information and Analysis.1 Designed with the public in mind, CompareCare is home to in-state cost, quality, and safety data on multiple medical procedures.1 The latest state to institute an online consumer-direc ted resource, Massachusetts is but one of many entrants into a rapidly expanding national field. A total of 28 states enacted statutes mandating health care price transparency tools. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 16, 2019 Category: General Medicine Authors: Eli Y. Adashi, Kevin S. Tang Tags: Commentary Source Type: research

Pulse Pressure, Cardiovascular Events, and Intensive Blood Pressure Lowering in the Systolic Blood Pressure Intervention Trial (SPRINT)
The efficacy and tolerability of intensive blood pressure lowering may vary by pulse pressure (systolic minus diastolic blood pressure). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 16, 2019 Category: General Medicine Authors: Manan Pareek, Muthiah Vaduganathan, Tor Biering-S ørensen, Christina Byrne, Arman Qamar, Zaid Almarzooq, Ambarish Pandey, Michael Hecht Olsen, Deepak L. Bhatt Tags: Clinical Research Study Source Type: research

The Luckiest Man on the Face of the Earth
It was 80 years ago, on May 2, 1939, when Lou Gehrig (1903-1941), the legendary baseball player, took himself out of the New York Yankees lineup unable to perform well due to progressive motor weakness. Thus ended Gehrig's 2,130 consecutive game playing streak, which had begun on June 1, 1925. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 16, 2019 Category: General Medicine Authors: Leonard J. Hoenig Tags: Medical Humanities Source Type: research

ABC (Atrial fibrillation Better Care) pathway and healthcare costs in atrial fibrillation. The ATHERO-AF study
Patients with atrial fibrillation are often elderly and have multiple comorbidities, leading to a high risk of cardiovascular events1,2,3 despite the use of oral anticoagulants, whether with the vitamin K antagonists (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 16, 2019 Category: General Medicine Authors: Daniele Pastori, Alessio Farcomeni, Pasquale Pignatelli, Francesco Violi, Gregory YH Lip Tags: Clinical Research Study Source Type: research