Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2021
This study randomized 8511 patients aged 60-80 to an intensive (systolic BP 110 to (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 30, 2022 Category: General Medicine Authors: Majken T. Wingo, Jill M. Huber, Shari L. Bornstein, Karna K. Sundsted, Karen F. Mauck, Jason H. Szostek, Jason A. Post, Mark L. Wieland Source Type: research

Pimping Socrates
Everything we know about Socrates comes from his student, Plato, as Socrates left no written record. According to Plato, Socrates practiced a type of pedagogy (or what is now called andragogy as per the adult learning theory of Malcolm Knowles). The Socratic practice involved engaging in a dialogue or debate between the teacher and student which iteratively excludes unlikely concepts leaving the likely correct answer. When I was at Williams College I was regaled with a quotation from James A. Garfield, later a US President, but then a college student, about Mark Hopkins, the eminent teacher and president of the College, wh...
Source: The American Journal of Medicine - March 26, 2022 Category: General Medicine Authors: Martin A. Samuels Tags: Commentary Source Type: research

The Usefulness of Playing ‘Non-Medical’ Roles
It's helpful to be attuned to the non-medical roles patients need us to play. Familiar roles —such as listener, problem solver, prescriber—are often sufficient, but sometimes we need to at least briefly be something else and yet remain professional. Recognizing and responding to this need facilitates clinical engagement, especially with behaviorally challenging patients. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 24, 2022 Category: General Medicine Authors: Michael W. Kahn Tags: Commentary Source Type: research

Variations on a theme
One of the enduring memories from my first year of medical school in the late 1970s was a series of lectures given by a visiting professor of anatomy. He had an accomplished career documenting some of the many anatomic variants seen in autopsy studies. His talks were given as we progressed through our gross anatomy dissection, to provide a flavor for the potential surprises we might find. The number and breadth of these aberrations in human structure really fascinated me. As a neophyte to the world of medicine, I was absolutely amazed that human anatomy could contain so many inartful discrepancies. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 24, 2022 Category: General Medicine Authors: Peter S. Stack Tags: Personomics Source Type: research

Opioid and benzodiazepine substitutes: Impact on drug overdose mortality in Medicare population
Gabapentinoids (GABAs) and serotonergic drugs (SSRIs/SNRIs) are increasingly being prescribed as potential substitutes to opioids and benzodiazepines (benzos), respectively, to treat co-occurring pain and anxiety disorders. The toxicities of these drug classes and their combinations are not well-understood. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 24, 2022 Category: General Medicine Authors: Yong-Fang Kuo, Victor Liaw, Xiaoying Yu, Mukaila A Raji Source Type: research

The Usefulness of Playing “Non-Medical” Roles
It's helpful to be attuned to the non-medical roles patients need us to play. The familiar roles —listener, problem solver, prescriber—are often sufficient, but sometimes we need to at least briefly be something else and yet remain professional. Recognizing and responding to this need facilitates clinical engagement, especially with behaviorally challenging patients. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 24, 2022 Category: General Medicine Authors: Michael W. Kahn Tags: Commentary Source Type: research

Type 1, Type 2 myocardial infarction and non-ischemic myocardial injury —opinion from the front lines
Differentiating patients with type 1 and type 2 myocardial infarction (MI) and an acute non-ischemic myocardial injury continues to be a problem for many clinicians. Type 1 MI is the most easily defined. It involves the rise and fall (only falling values if the patient arrives late) of blood troponin measurements with an appropriate clinical observation consistent with myocardial ischemia. Diagnosis and therapy of type 1 MI are well understood and usually present no problem to the physician. The clinical scenarios leading to type 2 MI and non-ischemic myocardial injury are, however, often fraught with greater degrees of un...
Source: The American Journal of Medicine - March 24, 2022 Category: General Medicine Authors: Joseph S. Alpert, Allan S. Jaffe, Harvey D. White, Kristian A. Thygesen Tags: Review Source Type: research

Expanding Penicillin Allergy Evaluation in Hospitalized Patients
Around 15% of hospitalized patients report a penicillin allergy, yet less than 3% of individuals are found to have a significant immune-mediated allergy on testing. 1-3 Furthermore, at least 80% of individuals with IgE-mediated allergy to penicillin lose their allergy after 10 years of avoidance of the drug. 1-3 Despite low likelihood of significant risk, most adults labeled with penicillin allergy go on to lifelong avoidance of the drug class, driving unnecessary use of alternative antibiotics which may be less effective, have greater associated adverse events and cost more to the medical system. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 22, 2022 Category: General Medicine Authors: Martha T. DesBiens, Michael S. Calderwood, Erin L. Reigh Tags: Advancing High Value Health Care Source Type: research

Never Too Old: A Case of Chicken Pox in an Eighty-One-Year-Old Patient
Varicella-zoster virus is a human herpes virus that can present in either an acute (varicella) or latent form (herpes zoster). Varicella is rarely encountered in immunocompetent adults. Since the introduction of the varicella vaccine in 1995 as a part of the standard childhood vaccination program, primary Varicella-zoster virus infection has become rare.1,2 (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 20, 2022 Category: General Medicine Authors: Marjan Haider, Taylor Novice, Drew Engers, Irina Burman Tags: Images in Dermatology Source Type: research

Never Too Old; A Case of Chicken Pox in an Eighty-One-Year-Old Patient
Varicella-zoster virus is a human herpes virus which can present in either an acute (varicella) or latent form (herpes zoster). Varicella is rarely encountered in immunocompetent adults. Since the introduction of the varicella vaccine in 1995 as a part of the standard childhood vaccination program, primary Varicella-zoster virus infection has become rare. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 20, 2022 Category: General Medicine Authors: Marjan Haider, Taylor Novice, Drew Engers, Irina Burman Tags: Images in Dermatology Source Type: research

Hemothorax and bloody ascites caused by vascular Ehlers-Danlos syndrome
Clinical communication to the editor (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 19, 2022 Category: General Medicine Authors: Shuichi Tanaka, Hiroyuki Honda, Kou Hasegawa, Koji Tomita, Reimi Sogawa, Hideki Yamamoto, Takao Hiraki, Akira Hirasawa, Fumio Otsuka Tags: Clinical Communication to the Editor Source Type: research

Lung abscess in adult with foreign body (tooth)
Lung abscess due to foreign body aspiration in adults is relatively rare and is more common in childhood. The number of patients with lung abscess has recently decreased due to antibiotic therapy, and chest X-ray exams in these cases of abscesses have therefore decreased 1. Chest computed tomography (CT) examination allows for an improved study of lesions and other associated findings, and when cavitation is present, it allows evaluation of the walls, the content with necrotic fluid, and gas 2. In the presence of a foreign body, in addition to axial scans, multiplanar reconstructions and the virtual bronchoscopy technique ...
Source: The American Journal of Medicine - March 18, 2022 Category: General Medicine Authors: Juliana Garcia Alves da Trindade, Mary L úcia Bedran Ananias, Cristina Asvolinsque Pantaleão Fontes Tags: Images in Radiology Source Type: research

Clinician attitudes and beliefs associated with more aggressive diagnostic testing
Variation in clinicians ’ diagnostic test utilization is incompletely explained by demographics and likely relates to cognitive characteristics. We explored clinician factors associated with diagnostic test utilization (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 17, 2022 Category: General Medicine Authors: Deborah Korenstein, Laura D. Scherer, Andrew Foy, Lisa Pineles, Alison D. Lydecker, Jill Owczarzak, Larry Magder, Jessica P. Brown, Christopher D. Pfeiffer, Christopher Terndrup, Luci Leykum, Deborah Stevens, David A. Feldstein, Scott A. Weisenberg, Jonat Source Type: research

Diagnosis and Management of Vertebral Compression Fracture
Vertebral compression fractures (VCFs) are the most common complication of osteoporosis, with 700,000 cases reported every year in the United States. Vertebral compression fractures typically present with abrupt onset low back pain with or without a history of trauma, although more than two-thirds are detected incidentally. Diagnosis is confirmed using plain radiographs, while CT and MRI imaging may be required to evaluate for a malignant cause or if there are neurological deficits on examination. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 17, 2022 Category: General Medicine Authors: Daniel Alsoof, George Anderson, Christopher L McDonald, Bryce Basques, Eren Kuris, Alan H. Daniels Tags: Review Source Type: research

Tik Tok Tics
Recently, an epidemic of motor tics erupted among teenage girls who were users of Tik Tok. The press reported that the doctors were “stumped” and wondered what could have caused a cluster of Gilles de la Tourette cases. I had to wonder: “Who were these doctors?” Occasionally, a person turns up in a city having forgotten his own identity. Again, the newspapers report the doctors were “mystified” by the “strange” c ase of amnesia. Later he is traced to another town where he had left his wife and a list of creditors behind. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 17, 2022 Category: General Medicine Authors: Martin A. Samuels Source Type: research