1061. After PCI in older adults, DAPT for 3 vs. 6 or 12 mo reduces bleeding without increasing NACE or MACE.
Park DY, Hu JR, Jamil Y, et al. Shorter dual antiplatelet therapy for older adults after percutaneous coronary intervention: a systematic review and network meta-analysis. JAMA Netw Open. 2024;7:e244000. 38546647.
1062. The Ethics of Cancer Screening Based on Race and Ethnicity.
作者: Duco T Mülder.;James F O'Mahony.;Chyke A Doubeni.;Iris Lansdorp-Vogelaar.;Maartje H N Schermer.
来源: Ann Intern Med. 2024年177卷9期1259-1264页
Racial and ethnic disparities in incidence and mortality are well documented for many types of cancer. As a result, there is understandable policy and clinical interest in race- and ethnicity-based clinical screening guidelines to address cancer health disparities. Despite the theoretical benefits, such proposals do not typically address associated ethical considerations. Using the examples of gastric cancer and esophageal adenocarcinoma, which have demonstrated disparities according to race and ethnicity, this article examines relevant ethical arguments in considering screening based on race and ethnicity. Race- and ethnicity-based clinical preventive care services have the potential to improve the balance of harms and benefits of screening. As a result, programs focused on high-risk racial or ethnic groups could offer a practical alternative to screening the general population, in which the screening yield may be too low to demonstrate sufficient effectiveness. However, designing screening according to socially based categorizations such as race or ethnicity is controversial and has the potential for intersectional stigma related to social identity or other structurally mediated environmental factors. Other ethical considerations include miscategorization, unintended negative effects on health disparities, disregard for underlying risk factors, and the psychological costs of being assigned higher risk. Given the ethical considerations, the practical application of race and ethnicity in cancer screening is most relevant in multicultural countries if and only if alternative proxies are not available. Even in those instances, policymakers and clinicians should carefully address the ethical considerations within the historical and cultural context of the intended population. Further research on alternative proxies, such as social determinants of health and culturally based characteristics, could provide more adequate factors for risk stratification.
1063. In ASCVD, an inclisiran-first strategy reduced LDL-C levels and statin discontinuation at 330 d.
Koren MJ, Rodriguez F, East C, et al. An "inclisiran first" strategy vs usual care in patients with atherosclerotic cardiovascular disease. J Am Coll Cardiol. 2024;83:1939-1952. 38593947.
1064. Trends and Disparities in Ambulatory Follow-Up After Cardiovascular Hospitalizations : A Retrospective Cohort Study.
作者: Timothy S Anderson.;Robert W Yeh.;Shoshana J Herzig.;Edward R Marcantonio.;Laura A Hatfield.;Jeffrey Souza.;Bruce E Landon.
来源: Ann Intern Med. 2024年177卷9期1190-1198页
Timely follow-up after cardiovascular hospitalization is recommended to monitor recovery, titrate medications, and coordinate care.
1065. Acetaminophen use during pregnancy was not linked to autism, ADHD, or intellectual disability in offspring.
Ahlqvist VH, Sjöqvist H, Dalman C, et al. Acetaminophen use during pregnancy and children's risk of autism, ADHD, and intellectual disability. JAMA. 2024;331:1205-1214. 38592388.
1066. In MI with preserved LVEF, long-term β-blocker use vs. no use did not reduce all-cause death or MI at 3.5 y.
Yndigegn T, Lindahl B, Mars K, et al; REDUCE-AMI Investigators. Beta-blockers after myocardial infarction and preserved ejection fraction. N Engl J Med. 2024;390:1372-1381. 38587241.
1068. Pain Reduction With Oral Methotrexate in Knee Osteoarthritis : A Randomized, Placebo-Controlled Clinical Trial.
作者: Sarah R Kingsbury.;Puvan Tharmanathan.;Ada Keding.;Fiona E Watt.;David L Scott.;Edward Roddy.;Fraser Birrell.;Nigel K Arden.;Mike Bowes.;Catherine Arundel.;Michelle Watson.;Sarah J Ronaldson.;Catherine Hewitt.;Michael Doherty.;Robert J Moots.;Terence W O'Neill.;Michael Green.;Gulam Patel.;Toby Garrood.;Christopher J Edwards.;Phil J Walmsley.;Tom Sheeran.;David J Torgerson.;Philip G Conaghan.
来源: Ann Intern Med. 2024年177卷9期1145-1156页
Treatments for osteoarthritis (OA) are limited. Previous small studies suggest that the antirheumatic drug methotrexate may be a potential treatment for OA pain.
1069. Physician Humility: A Review and Call to Revive Virtue in Medicine.
作者: Caroline L Matchett.;Ellen L Usher.;John T Ratelle.;Diego A Suarez.;Andrea N Leep Hunderfund.;Ana M Aragon Sierra.;Adam P Sawatsky.
来源: Ann Intern Med. 2024年177卷9期1251-1258页
Physician virtues, including humility, are crucial for shaping a physician's identity and practice. The health care literature offers varied views on humility, and the rising call for discussing virtues as a framing for professional identity formation underscores the need for a clearer understanding of physician humility. This review aimed to develop a cohesive conceptualization of physician humility and to define how it functions in medical practice. To achieve this, a comprehensive search was done across PubMed, Ovid MEDLINE, Web of Science, Embase, ERIC, and PsycInfo, covering all records up to 30 October 2023. Articles were included if they discussed physician humility and excluded if they were unrelated to physician humility, focused on nonphysician health professionals, lacked conceptual depth, or focused solely on cultural humility. An applied thematic analysis was conducted. The results provide a synthesized conceptualization of physician humility across stances toward self, others, and the profession. The included articles identified the pivotal role of physician humility within the following 5 domains of medical practice: learning and professional growth, navigating error, uncertainty tolerance, trust and entrustment, and teamwork and communication. The authors highlight some of the intrapersonal, interpersonal, and sociocontextual challenges to cultivating and practicing physician humility. These findings highlight the importance of promoting humility in shaping physicians' actions, thoughts, and relationships with patients, colleagues, and their profession. Integrating such virtues as humility into medical education is essential for upholding the ideals of the medical profession and cultivating moral agents who engage in self-reflection and embody the principles of exemplary physicians.
1071. Fatal and Nonfatal Firearm Injury Rates by Race and Ethnicity in the United States, 2019 to 2020.
作者: Elinore J Kaufman.;Jamie Song.;Ruiying Xiong.;Mark J Seamon.;M Kit Delgado.
来源: Ann Intern Med. 2024年177卷9期1157-1169页
Racial disparities in firearm injury death in the United States are well established. Less is known about the magnitude of nonfatal and total firearm injury.
1073. Association of Semaglutide With Tobacco Use Disorder in Patients With Type 2 Diabetes : Target Trial Emulation Using Real-World Data.
作者: William Wang.;Nora D Volkow.;Nathan A Berger.;Pamela B Davis.;David C Kaelber.;Rong Xu.
来源: Ann Intern Med. 2024年177卷8期1016-1027页
Reports of reduced desire to smoke in patients treated with semaglutide, a glucagon-like peptide receptor agonist (GLP-1RA) medication for type 2 diabetes mellitus (T2DM) and obesity, have raised interest about its potential benefit for tobacco use disorders (TUDs).
1074. Ethics and Academic Discourse, Scientific Integrity, Uncertainty, and Disinformation in Medicine: An American College of Physicians Position Paper.
作者: Lois Snyder Sulmasy.;Joel R Burnett.;Jan K Carney.;Matthew DeCamp.; .
来源: Ann Intern Med. 2024年177卷9期1244-1250页
Respect for the scientific process and a diversity of views; open discourse and debate based on principles of ethics, best available evidence, and scientific inquiry and integrity; and an understanding of evidence gaps and uncertainty and how to communicate about them are important values in the advancement of science and the practice of medicine. Physicians often must make decisions about their recommendations to patients in the face of scarce or conflicting data. Are these characteristics of medicine and science widely understood and effectively communicated among members of the profession and to patients and the public? Issues of scientific integrity are longstanding, but COVID-19 brought them to the forefront, in an environment that was sometimes characterized by communication missteps as guidance came and went-or changed-quickly. Today, is open debate flourishing? Have some debates shed more heat than light? Are people losing confidence in science and medicine? In health care institutions? The American College of Physicians explores these issues and offers guidance in this position paper.
1078. Clinical and Adverse Outcomes Associated With Concomitant Use of CYP2D6-Metabolized Opioids With Antidepressants in Older Nursing Home Residents : A Target Trial Emulation Study.
作者: Yu-Jung Jenny Wei.;Almut G Winterstein.;Siegfried Schmidt.;Roger B Fillingim.;Michael J Daniels.;Steven T DeKosky.;Stephan Schmidt.
来源: Ann Intern Med. 2024年177卷8期1058-1068页
Limited evidence exists on the safety of pharmacokinetic interactions of cytochrome P450 (CYP) 2D6 (CYP2D6)-metabolized opioids with antidepressants among older nursing home (NH) residents.
1079. Shifting Trends in the Indication of Glucagon-like Peptide-1 Receptor Agonist Prescriptions: A Nationwide Analysis.
作者: Yee Hui Yeo.;Ali Rezaie.;Tina Yi-Jin Hsieh.;Xiaoqin Hu.;Srinivas Gaddam.;Kevin Sheng-Kai Ma.; .;Ghada Mohamed.;Gin Yi Lee.;Pin-Chia Huang.;Rabindra Watson.
来源: Ann Intern Med. 2024年177卷9期1289-1291页 |