Category Archives: Internal Medicine

Internal Medicine

‘Sluggish’ Hospital Uptake of Newer Antibiotics for Gram-Negative Infections – Medpage Today

Hospital uptake of newer antibiotics to treat multidrug-resistant gram-negative bacteria was low over a 5-year period, according to a retrospective cohort study.

Fully 41.5% of episodes of difficult-to-treat resistant (DTR) gram-negative infections were treated exclusively with older, generic agents, which were largely ones with suboptimal safety-efficacy profiles, Sameer Kadri, MD, of the National Institutes of Health Clinical Center in Bethesda, Maryland, and colleagues, reported in the Annals of Internal Medicine. The findings were also presented at the American College of Physicians meeting in Boston.

Use of new antibiotics gradually increased across the study period from January 2016 to June 2021, but gains were uneven across agents. The most commonly used next-generation antibiotics during that time frame were ceftolozane-tazobactam (Zerbaxa) and ceftazidime-avibactam (Avycaz).

Other more recently approved antibiotics -- cefiderocol (Fetroja), eravacycline (Fetroja), imipenem-cilastatin-relebactam (Recarbrio), and meropenem-vaborbactam (Vabomere) -- had more sluggish uptake, Kadri and colleagues wrote. And not even a single hospital used plazomicin (Zemdri) after its FDA approval in 2018 for complicated gram-negative urinary tract infections.

"The two most used 'new' antibiotics, ceftazidime-avibactam and ceftolozane-tazobactam, are themselves a decade old and have largely occupied the carbapenem-resistant Enterobacterales and multidrug-resistant [Pseudomonas] aeruginosa niches," the authors wrote. "On the other hand, the five subsequently approved gram-negative antibiotics with partially overlapping pathogen spectrums were markedly underutilized."

Of concern, 79.3% of DTR gram-negative infections were treated with traditional agents known to have suboptimal safety or efficacy, such as polymyxins, aminoglycosides, tigecycline, and chloramphenicol.

"Given the high mortality risk associated with DTR infections, such treatment gaps could risk patient lives," Kadri's group wrote.

They suggested policy change: "Few overall treatment opportunities in the U.S. market and sluggish utilization trajectories for recently approved antibiotics observed in our study reinforce the need for pull incentives," such as subscription models for new antibiotics piloted in the United Kingdom, they suggested, pointing to the PASTEUR bill as a potential solution to provide that funding.

"Why are these next-generation antibiotics not being used more often?" wrote Jessica Howard-Anderson, MD, of Emory University School of Medicine in Atlanta, and Helen Boucher, MD, of Tufts Medical Center in Boston. "Antimicrobial stewardship is frequently cited -- however, this represents a fundamental misunderstanding of stewardship, which aims to use the right drug, for the right patient, at the right time," they wrote in an accompanying editorial.

Cost may be one factor, the editorialists posited. Mean wholesale price for a day's dosage averaged across the seven new antibiotics noted in the study was $1,036.69 versus $173.41 for traditional agents.

Another factor may be that clinical trials that evaluated the new antibiotics did not always enroll patients that would need the drugs in practice, Howard-Anderson and Boucher wrote. "Clinicians are therefore left wondering whether these new antibiotics are applicable to their patients."

The study analyzed inpatient admissions from a large retrospective administrative database. Between January 2019 and June 2021, 362,142 inpatient encounters occurred across 299 hospitals that indicated one or more cultures with a gram-negative organism. Of these, 0.7% (2,551) were hospitalizations for DTR gram-negative infections. Overall, the DTR infection prevalence among hospitalized patients was 72.7 episodes per 10,000 inpatient encounters.

P. aeruginosa was the most common DTR pathogen, occurring in 48.2% of infections, followed by Acinetobacter baumannii complex (22%). Enterobacterales species accounted for 23% of infections and other gram-negative pathogens accounted for the remaining 6.8%. Of DTR infections, 42.9% were respiratory tract infections and 8.36% were bloodstream infections.

Several patient factors were associated with increased probability of being one of the 58.8% who were treated with newer, next-generation antibiotics. DTR bloodstream infection was a big factor, with newer agents used for about 72% of these compared with 57% of non-bloodstream infections. Patients presenting with do-not-resuscitate status, acute liver failure, and with pathogenic A. baumannii complex or infections caused by other non-pseudomonal non-fermenters were less likely to receive newer antibiotics.

However, age, gender, race/ethnicity, and ICU admissions were not associated with the probability of receiving newer versus traditional antibiotics, nor were mechanical ventilation or presentation at the hospital with neurologic, renal, or respiratory failure.

Of 299 study hospitals, 107 did not prescribe any of the newer antibiotics for DTR infections over the study period. However, only 3.9% of all DTR episodes occurred in the non-prescribing hospitals, most of which were relatively small, with fewer than 100 beds.

Researchers also found that geographical region mattered. For example, in the Midwest, the marginally adjusted probability of hospitals using newer antibiotics was about 61% versus 34% in the Western states. Also, hospitals that reported susceptibility of the infection to newer agents were more likely to use those agents (60% vs 54% for those with no reporting of susceptibility to the agents). However, urban location, teaching status, and technological or bed capacity did not appear to affect patients' probability of receiving newer antibiotics.

Hospital bed capacity was "the strongest factor associated with nonuse" of newer agents: hospitals with fewer than 100 beds had a 28% probability of using new antibiotics, whereas those with 300 or more beds had a 95% probability of using new antibiotics. In particular, smaller rural hospitals and smaller urban hospitals with low baseline prevalence of antibiotic resistance were less likely to use newer antibiotics.

At baseline, the median age of patients with DTR gram-negative infections was 61 years, 58.5% were men, and 49.1% were non-Hispanic whites. The median Elixhauser Comorbidity Index was 5. About one-third of patients were admitted to the ICU, 22.2% required mechanical ventilation, and 17.6% needed vasopressors. Approximately one in five patients with DTR gram-negative infections died. Mortality was higher in patients with DTR bloodstream infections (32%) compared with a 20% mortality rate among those without bloodstream infections.

"The study did have limitations," Howard-Anderson and Boucher cautioned, noting that "medical records were not reviewed to determine the rationale for antibiotic therapy or to determine if the antibiotic was intended to treat the DTR pathogen."

Also, the study didn't cover a period recent enough to have seen the full effects of Infectious Diseases Society of America guidelines on antimicrobial resistance first published in September 2020, they added.

Katherine Kahn is a staff writer at MedPage Today, covering the infectious diseases beat. She has been a medical writer for over 15 years.

Disclosures

The study was funded by the FDA Center for Drug Evaluation and Research.

Kadri reported no ties to industry. One study served on a clinical advisory board for Beckman Coulter.

Howard-Anderson and Boucher reported no relationships with industry.

Primary Source

Annals of Internal Medicine

Source Reference: Strich JR, et al "Assessing clinician utilization of next-generation antibiotics against resistant gram-negative infections in U.S. hospitals" Ann Intern Med 2024; DOI: 10.7326/M23-2309.

Secondary Source

Annals of Internal Medicine

Source Reference: Howard-Anderson J, Boucher HW "New antibiotics for resistant infections: What happens after approval?" Ann Intern Med 2024; DOI: 10.7326/M24-0192.

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'Sluggish' Hospital Uptake of Newer Antibiotics for Gram-Negative Infections - Medpage Today

Internal Medicine

Elizabeth Cerceo, MD, on How to Address Health Care’s Impact on Climate Change – MD Magazine

The health care industry accounts for approximately 5% of total greenhouse gas and toxic air emissions, coming primarily from the United States and contributing directly to the ongoing climate crisis.1

Given the health care sectors notable contributions to climate change, mitigation and adaptation efforts fall heavily on physicians and key stakeholders, a topic Elizabeth Cerceo, MD, associate internal medicine program director and director of environmental health in the division of hospital medicine at Cooper University Health Care, discussed in her session at the 2024 American College of Physicians (ACP) Internal Medicine Meeting in Boston.

Specifically, she referenced the importance of leveraging direct patient education, noting Health care providers, health care professionals, whether it's nurses, physicians, we are all very trusted messengers by the public, so when they hear a message that comes from us about climate-related health factors or impacts of climate change, they will listen to us much more than they'll listen to politicians or other places where they may be hearing messages.

Although Cerceo described how physicians generally like to be fully educated on a topic before they discuss it with their patients, she said the strength of the current data should make health care providers feel empowered and like opening up that conversation will ultimately benefit the patient, regardless of how up-to-date you are on the most recent climate-related information.

Beyond ensuring that physicians themselves are educated on climate change and its link to health care, Cerceo also emphasized the importance of educating trainees and perhaps other physicians who may not yet be aware of or well-versed on the health consequences associated with climate change.

New research is coming down the pike fast and furious, she added. We're seeing studies where you can demonstrate the path of physiologic linkages. We don't just have correlation, association studies anymore, but we have that more foundational data that shows that these are real effects that are happening, and we can demonstrate why.

Despite the mounting body of evidence supporting the growing climate crisis, Cerceo explained that patients receptiveness toward climate-related topics when discussing their health tends to depend on how the conversation is framed. Beyond counseling her patients on the need to be careful about their exposure to certain environmental factors like air pollution, she also described the importance of providing them with tangible things they should be doing or a linkage that appeals to their direct experiences.

Although Cerceo described the expansion of the conversation and research surrounding climate change as encouraging, she was also careful to note that it is not enough, saying Things really need to accelerate, and we need to keep our foot on the gas pedal. Now is not the time to sit back and think, oh, you know, there's been a few positive steps, let's rest on our accolades It has to be all physicians recognizing the inter-linkages between us and our environment, and that we need to be mindful of this and incorporating it into our daily practice.

Reference:

1. Eckelman MJ, Huang K, Lagasse R, et al. Health Care Pollution And Public Health Damage In The United States: An Update. Health Affairs. https://doi.org/10.1377/hlthaff.2020.01247

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Elizabeth Cerceo, MD, on How to Address Health Care's Impact on Climate Change - MD Magazine

Internal Medicine

Melanie Jay, MD: Advancing Equitable Approaches to Improve Obesity Care – MD Magazine

During recent years, it is evident that there has been a shift among health care providers towards understanding the value of equitable approaches in obesity care. This shift reflects a growing awareness of the various types of factors impacting weight management and the necessity for tailored strategies to address such a complex issue.

In this interview segment with Melanie Jay, MD, MS, the editorial team at HCPLive spoke with Jay regarding her presentation at the 2024 American College of Physicians Internal Medicine Meeting titled Advancing Equitable Approaches to Improve Obesity Care. Jay is a general internist and is board-certified in obesity medicine, serving as an associate professor for NYU Langone Health.

This was a topic that's near and dear to my heart, addressing health equity and health disparities, Jay explained. At the intro, we discussed what happened at that session and then I introduced the concept of disparities in obesity care, disparities, health disparities around obesity. Then we also talked about different strategies to address health disparities and health equity and obesity, and really touched on four or five major areas, one of them being to really address obesity stigma.

Jay noted that obesity is a stigmatized condition, adding that over 40% of people with class 2 and class 3 obesity say that they have experienced weight discrimination. Jay added that patients say that they have experienced obesity-related discrimination and bias even in health care settings.

So we talk about how we can provide more compassionate care, not blame the patient, and recognize that obesity is a disease and that it is a chronic disease, Jay said. It's an interplay between our genes and our environment. Personal choices, while important, play a very small role. Things like our food environment, stress levels, our physical activity opportunities, and medications we give our patients can cause weight gain.

Jay explained that when a patient enters the office and they feel blamed, this can impact feelings of stigma. She also noted the importance of advocacy.

As physicians, we have a lot of opportunities to really advocate for our patients, she said. So we can advocate for policies such as Medicaid expansion of obesity care, such as Medicare expansion, as well. There are federal policies right now with the Treat and Reduce Obesity Act. We can locally make sure that our residents and our medical students get adequate training to be able to compassionately and proficiently address obesity. Then we can make sure that we provide interdisciplinary care and that we work with each other.

Jay explained that she believes it is important to engage with patients, adding that research in the space is also essential.

For any further information from this conference interview segment, view the video posted above.

The quotes contained in this discussion were edited for the purposes of clarity. Jay had no relevant disclosures.

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Melanie Jay, MD: Advancing Equitable Approaches to Improve Obesity Care - MD Magazine

Internal Medicine

What We Would Be If We Weren’t Doctors – Medpage Today

In this video, Mikhail Varshavski, DO -- who goes by "Dr. Mike" on social media -- asks 20 physicians what their alternate career path would be. Let us know what yours would be in the comments!

Following is a partial transcript of the video (note that errors are possible):

Varshavski: I asked 20 doctors to tell me what they would do for work if they weren't a doctor. I'll go first. Obviously a detective. Right now, instead of solving crimes, I'm solving complex medical cases. I'm no Dr. House, but I may be a Sherlock Holmes in my past life.

Alok Patel, MD: How's it going? I'm Dr. Alok Patel. I'm a pediatric hospitalist, so if a child is hospitalized, count on me to coordinate care. I like action, mystery, suspense, believing that my work is making a difference. Put that together, I think I'd be working with the FBI or the CIA. Maybe forensic science, global anti-terrorism, or missing and endangered children. I'm not really sure, but in general fighting crime.

Siobhan Deshauer, MD: Hi, I'm Dr. Siobhan Deshauer, also known as Violin MD. I'm an internal medicine and rheumatology specialist. In medicine, I really love digging into mystery cases and looking at problems from different angles. If I wasn't a doctor or a violinist, then I'd probably be an investigative journalist.

Jake Goodman, MD: What's up everyone? My name is Jake Goodman and I'm a psychiatry resident doctor in my third year of residency training. Fun fact, I actually graduated from the College of Agriculture and Environmental Sciences at the University of Georgia, which means that I took classes in botany, horticulture, herbs, and medicinal plants, and I'm a huge plant dad. This is one of my favorite plants right now. Her name is Ava. I found her as an avocado seed in a trash can and grew her into this beautiful plant right here. One man's trash is another man's avocado seed that they turn into a friend. If I wasn't a doctor, I'd probably be a botanist.

Alok Kanojia, MD: My name is Alok Kanojia, but the internet knows me as Dr. K. I'm a psychiatrist, which means that I'm a medical doctor that focuses on the mind. If I wasn't a medical doctor, chances are I would have become a monk, and that's actually what I ended up doing for a long time. I spent 7 years studying to become a monk and then decided to go to medical school. I was fascinated with the mind to begin with and I think that the Eastern monks, like yogis and Buddhist monks, have a really, really interesting perspective on the mind which medical science could learn a lot from.

Anthony Youn, MD: My name is Dr. Anthony Youn and I'm a board-certified plastic surgeon. If I weren't a doctor, I would be an unemployed rock star. Back when I was younger and going through my residency training, I was in a band and we kind of toured locally. We played a lot of gigs and we made a little bit of money. But the problem is that we were really not that good. I was a three-chord warrior and we pretty much maxed out what we could do in this field of rock and roll. You'd probably see me performing at the bar at the Holiday Inn Express outside the Boise Airport.

Ed Hope, MBBS: Hello, my name is Ed Hope. I'm a doctor working in the emergency department over in the U.K. If I wasn't a doctor, I would want to be a musician. I actually paid a lot of my way through medical school by busking on the weekends. On the surface, you might think the two are pretty different, but they are not a million miles away. You have to study the theory, there is a big practical element involved, and ultimately you can have a huge positive impact on people's lives. Lying heavy in the sky, woo.

Benjamin Winters, DDS: Hi, my name is Dr. Winters a.k.a. The Bentist online, and I am an orthodontist. Dentistry and orthodontics has a lot of art-related things. In fact, dentistry is a lot like being a sculptor, painter, and artist. That being said, as much as I love art, I would probably rather use these hands to play video games actually. I've played video games my entire life, and if I could, I'd probably be a professional video game player or a streamer.

Dana Brems, DPM: I'm Dr. Dana Brems and I'm a podiatrist, which is a foot and ankle specialist and surgeon. When I was a kid, I always wanted to be an artist because I love putting things together and being creative.

Karan Rajan, MBBS: If I wasn't a doctor, I have always thought I'd probably be a chef because I like eating food and I like traveling, so maybe a food critic maybe. But if I was a chef, I can see lots of parallels between surgery and cooking. I mean, for starters you need to know the recipe, the steps of the operation. You can't burn your meat. You need to please people and you can't pick things up after being dropped on the floor.

John W. Patton III, MD: What up? My name is Dr. John Patton, Doc JP3, and I'm a board-certified anesthesiologist and a regional anesthesia and acute pain medicine specialist. A lot of people don't know this about me, but I love to cook. I think it's the alpha personality inside me that makes me believe I could be a Michelin chef. I just love the experience and the artistic nature, and to be able to take people on a culinary journey every single night would be a lot of fun. Anesthesiologist by day, chef by night. Doc JP3 chef day cuisine. Love it.

Danielle Jones, MD: I'm Dr. Danielle Jones -- some of you may know me as MDJ -- and I am an ob/gyn. That means I take care of anything having to do with periods, pregnancy, and the female reproductive tract. Honestly, I am so glad I get to do this job because I love being an obstetrician and gynecologist, but if I wasn't, I think I could see myself as a politician or maybe a public health professional. Maybe in another life, even a professional skier would have been fun.

Benjamin Schmidt, MD: Hi, I'm Dr. Benjamin Schmidt, also known as Doc Schmidt, and I'm a GI doctor, which means that I specialize in gastroenterology. Now, I'm not sure if this is even an entire job by itself, but if I wasn't a doctor, I would love to edit movie trailers. I love the idea of trying to synthesize down a whole movie into a couple of minutes and finding cool new songs to get people excited about the movie. Plus, you get to see most of the footage from movies way in advance, so that would be pretty cool too.

Brian Boxer Wachler, MD: Hi, I am Dr. Brian Boxer Wachler and I'm an eye surgeon a.k.a. ophthalmologist. If I wasn't a doctor, I would probably be a film director because I loved making movies when I was in high school and college. As a matter of fact, I made a feature-length Batman movie, an hour-long one, that we screened on campus at UCLA [University of California Los Angeles]. And yes, I was running around in tights.

Ricky Brown, MD: My name is Ricky Brown and I'm a board-certified plastic surgeon in Scottsdale, Arizona. What would I be if I wasn't a plastic surgeon? I think I'd be a voice actor. I'd probably crush that.

Rena Malik, MD: Hi, I'm Dr. Rena Malik, urologist and pelvic surgeon, and a urologist is essentially a surgical and medical doctor of the genitourinary tract. If I wasn't a medical doctor, I'd probably be the CEO of a company. My superpower is being organized. It's what helps me take care of patients and do everything else I do. If I wasn't a medical doctor, I'd probably be organizing a whole bunch of people in a company somewhere.

Sanjay Juneja, MD: My name is Dr. Sanjay Juneja. I'm a hematologist and medical oncologist basically specializing in blood disorders as well as cancers and how to treat them. If I wasn't a doctor, I'd be a teacher. It's not just because doctor stands for teacher in Latin, but I really enjoy being able to make sense of something or make someone appreciate how something works. It would probably be physics or chemistry.

Antonio Webb, MD: Hi, my name is Dr. Antonio Webb. I'm an orthopedic spine surgeon here in San Antonio, Texas. I would probably do something in real estate. I have a passion for real estate and buying residential properties, and hopefully commercial properties in the future, buying a property and renting it out or rehabbing it and reselling it. If I wasn't a spine surgeon, I would be a real estate investor.

Varshavski: You know, I'm not only a doctor, but also professional boxer and Air Force pilot. Click here to see me fly an F16 with the U.S. Air Force Thunderbirds. And as always, stay happy and healthy.

Mike Varshavski, DO, is a board-certified family physician and social media influencer with more than 11 million subscribers.

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What We Would Be If We Weren't Doctors - Medpage Today

Internal Medicine

Dual-Tasking: Spotlighting the Impacts on Individuals with Dementia – MD Magazine

Ryan Langston

Credit: Geriatric Assessment, Intervention, & Technologies Laboratory (GAIT Lab)

Dual-tasking among adults living with dementia is more sensitive to the detection of impairments in these individuals gait, posture, and functional mobility compared to single-task assessments, according to recent findings in Dual-tasks and dementia severity impact postural stability and gait among people living with dementia in residential care facilities: A cross sectional pilot study.1

This research was presented by Ryan Langston from the Medical College of Georgia at Augusta University, at the 2024 American College of Physicians (ACP) Internal Medicine Meeting in Boston, Massachusetts. Langston and colleagues additionally noted in their findings presented at ACP that dual-tasking performance interference may be affected by individuals dementia severity.

Prior to their description of their new data, the research team suggested that individuals who live with dementia are known to have mobility and cognition which is relatively worse than individuals who do not live with dementia. They also added that dementia tends to increase such individuals fall risk, basing their information on the study The Lived Experience of Healthcare Workers in Preventing Falls in Community Dwelling Individuals with Dementia.2

In the study cited, it had been noted that combining physical and cognitive strategies was not widely practiced as part of a falls prevention strategy, and that this approach has potential benefits but was highlighted as being complex and needs to be person-centered.2 Such findings highlight the importance of fall risk awareness and its connection to dementia.

In another cited study, Langston and colleagues noted that the research had indicated that dual-tasking had the potential to be utilized for screening fall risk, though they highlighted that additional evidence may be necessary.3 This study had highlighted gait changes during dual-task testing and their link with future risk of falling, adding that the association was shown to be stronger than the same link for conditions which were single-task conditions.

The investigators set out to assess and compare the impacts of single-task and dual-task conditions on subjects functional mobility, gait, and posture, specifically looking at participants who had been living with all-cause dementia and living in residential care facilities. Additionally, the study aimed to assess how the severity of dementia might influence performance and interference in dual-task scenarios.

The research team had used Montreal Cognitive Assessment (MoCA) score assessments for dementia. A score on the MoCA assessment of 26 or below is considered to be an indicator of the presence of cognitive impairment.4

As stated previously, among adults with dementia, dual-tasking was shown by the team to be more sensitive to the impairment detection as far as subjects gait, functional mobility, and posture compared to single-task.1 They also noted that several responses during dual-tasks had been higher among subjects with moderate-to-severe dementia compared to mild dementia, including the following:

The investigators also concluded in their research that dual-tasking may be necessary for consideration in evaluations routinely made on individuals living with dementia, the purpose being to monitor any declines in cognitive abilities. Additionally, dual-tasking could help to identify adults with impairment increases in their gait, functional mobility, and posture.

References

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Dual-Tasking: Spotlighting the Impacts on Individuals with Dementia - MD Magazine

Internal Medicine

American College of Physicians issues clinical recommendations for newer pharmacological treatments of adults with … – InvestorsObserver

Reviews evidence of newer medications, recommends adding to metformin

BOSTON , April 19, 2024 /PRNewswire/ --The American College of Physicians (ACP) today released an update of its 2017 guideline with clinical recommendations for the use of newer pharmacological treatments of adults with Type 2 diabetes. The clinical guideline is based on the best available evidence for effectiveness, comparative benefits and harms, consideration of patients' values and preferences, and costs. Newer Pharmacological Treatments in Adults with Type 2 Diabetes: A Clinical Guideline from the American College of Physicians was published today in Annals of Internal Medicine .

In the updated clinical guideline, ACP recommends adding a sodium-glucose cotransporter-2 (SGLT-2) inhibitor or glucagon-like peptide-1 (GLP-1) agonist to metformin and lifestyle interventions in patients with Type 2 diabetes and inadequate glycemic control. Use SGLT-2 inhibitor to reduce the risk of all-cause mortality, major adverse cardiovascular events, progression of chronic kidney disease, and hospitalization due to congestive heart failure or use GLP-1 agonist to reduce the risk of all-cause mortality, major adverse cardiovascular events, and stroke.

ACP, however, recommends against adding a dipeptidyl peptidase-4 (DPP-4) inhibitor to metformin and lifestyle modifications in adults with Type 2 diabetes and inadequate glycemic control because high-certainty evidence showed that adding a DPP-4 inhibitor does not reduce morbidity or all-cause mortality.

"As additional pharmacological treatments become available for the treatment of Type 2 diabetes, it's critical for us to examine their effectiveness, the harms and benefits as well as costs in order to provide the best treatment for our patients," said Carolyn J. Crandall , M.D., MS, MACP, Chair, Guidelines Committee. "Adding a second medication to metformin for patients with inadequate glycemic controlmay provide additional benefits but the added benefit on important clinical outcomes may be minimal in relation to the high cost, particularly for the more expensive, newer medications."

This clinical guideline is based on a systematic review of the effectiveness and harms of newer pharmacological treatments for Type 2 diabetes.ACP prioritized the following outcomes, which were evaluated using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach: all-cause mortality, major adverse cardiovascular events, myocardial infarction, stroke, hospitalization for congestive heart failure, progression of chronic kidney disease, serious adverse events, and severe hypoglycemia. Weight loss, as measured by percentage of participants who achieved at least 10% total body weight loss, was a prioritized outcome, but data were insufficient for network meta-analysis and not rated with GRADE.

The updated ACP guideline did not look at the effects of treatment for glycemic control, though this is a common treatment goal. It is known that all included treatments can improve glycemic control in adults with Type 2 diabetes. Instead, the guideline focuses on clinical benefit outcomes, such as whether the treatments improve cardiovascular outcomes.

ACP guidelines emphasize shared decision-making, recognizing that each patient's needs and circumstances are unique. ACP encourages physicians to consider individual patient characteristics like age, comorbidities, and personal preferences when discussing a treatment plan for Type 2 diabetes.SGLT-2s and GLP-1s are costly, but lower cost options (like sulfonylureas) were inferior in reducing all-cause mortality and morbidity.There are currently no generic formulations for GLP-1s and SGLT-2.

TheACP clinical guideline is published with an accompanying visual clinical guideline where a person can interact and visualize the data supporting these recommendations.

About the American College of Physicians The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 161,000 internal medicine physicians, related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on X , Facebook , Instagram and LinkedIn .

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American College of Physicians issues clinical recommendations for newer pharmacological treatments of adults with ... - InvestorsObserver

Internal Medicine

Scientists unveil new remote-controlled ‘pillbot’ a microrobot that you can swallow for early disease detection – Good Good Good

Internal medicine has advanced in leaps and bounds throughout the 19th and 20th century, as doctors implemented X-rays, endoscopes, ultrasounds, and MRIs into daily care.

But checking the human body for cysts, tumors, and other predictors for a range of diseases is not an easy undertaking and often involves multiple referrals, appointments, and health insurance hoops.

Physician scientist Vivek Kumbhari, chairman of Gastroenterology at the Mayo Clinic, explained a common scenario that he encounters at his clinic.

A patient, whos generally in good health, comes to see me because they have abdominal pain, and I suspect its coming from the stomach. Now, I need to precisely understand what the problem is, but I cant just pop my head in and take a look, Kumbhari said in a TED Talk in Vancouver earlier this week.

Despite that patient sitting right in front of me, I have to ask them to go back home and come back to the hospital on another occasion, so I can put them to sleep with anesthesia, insert a long tube with a camera at the tip through the mouth and into the stomach, Kumbhari continued.

This is an endoscopy, a relatively expensive and invasive procedure and were on a mission to do better.

That same mission is one that engineer Alex Luebke has been undertaking for years. Luebke comes from a long background in astronautics and aeronautics, but in the last decade hes turned his attention inward to the human body.

Like Kumbhari, Luebke imagines a future that forgoes anesthesia and expensive procedures, one where a patient could come in with an issue and be taken care of right then and there, and possibly be diagnosed in the same sitting. A future thats possible with a microrobot named PillBot.

PillBot is a small wireless robot that is remotely controlled, and it swims around in three dimensions in a water-filled human stomach, Luebke said in the same TED Talk, where they debuted the new invention.

The PillBot is outfitted with a data transceiver, a lithium battery, a camera that can capture a live video feed, three pump-jet thrusters that allow it to move, and miniscule LED lights because of course, Luebke explains, the inside of the human body is quite dark.

The first model of the PillBot was enormous, approaching a football in size.

Over the course of five years, Luebke and his team worked on getting the microrobot smaller and smaller. Todays model is no bigger than a multivitamin, but its still equipped with all the necessary circuitry and tools.

Kumbhari explained that the PillBot can be remotely operated by a game controller, tablet, or smartphone. He piloted the PillBot in a small aquarium tank to show how it operates, but then he and Luebke took the presentation one step further.

We developed PillBot to allow for direct visualization of internal organs, anywhere and any time, Kumbhari teased. This is our goal: be anywhere in the world, whether youre at home sitting on your couch, visiting space, or right here on stage at TED.

Right on cue, Luebke swallowed PillBot with a smile, and downed it with a swig of water.

Within seconds, the microrobot entered Luebkes stomach, and a live feed was streamed on stage as Kumbhari maneuvered it with his controller.

Im carefully moving around, looking for changes in surface architecture that might represent an ulcer, or a cancer, or any other pathology, Kumbhari explained. And Im able to get very similar views as I would if I used a conventional endoscope.

Kumbhari went on to say that the experience could be further enhanced if he were to use an augmented reality headset for 3D visualization or the assistance of artificial intelligence for early detection of abnormalities.

Fortunately for Alex, from this brief review, everything is looking normal here, Kumbhari said. Though if there were a problem, being able to show and discuss this with Alex in real time, elevates his understanding of himself.

As for extraction or retrieval after the procedure? No need. Kumbhari explained that PillBot would then take its natural course through and out of the body, likely without Luebke even knowing when it passes.

This robot was designed for the stomach, but the entire body needs this capability, Kumbhari said. Parts of the body, such as the colon, the heart, and the brain should be made accessible through specialized robots that are just as easy to use.

Luebke jumped in to build on Kumbharis statement, saying that PillBot was only the beginning.

Future and emerging adaptations for PillBot include lab-on-chip capabilities that would allow doctors to analyze material from within the body, sensors to monitor disease regression, and the potential to cauterize incisions and inject medicine without invasive procedures.

Ive dreamt of the day when I could explore the inside of the human body with robots, Kumbhari said. Recognizing that it would be an inflection point on my ability to help people live longer and healthier lives.

Original post:

Scientists unveil new remote-controlled 'pillbot' a microrobot that you can swallow for early disease detection - Good Good Good

Internal Medicine

New Professors in the Department of Internal Medicine – Yale School of Medicine

Education:

BS, Pennsylvania State University

MD, Sidney Kimmel Medical College at Thomas Jefferson University

This is truly an honor and a culmination of decades of work dedicated to advance the field of cancer genetics. To have this appointment at an esteemed place such as Yale is even more meaningful, which has global reach and impact. I think the work I have done in collaboration with so many colleagues nationally and globally regarding cancer genetics, cancer disparities, and access to genetics care is critical at this time in oncology. Having the appointment based on this work really feels fulfilling and inspiring to continue this important work.

I contacted my husband, young adult kids, and parents who all congratulated me. Having that level of appreciation from my family, especially my children, was so moving.

I have been blessed to work with so many expert colleagues this really is a team approach to advance cancer care! I am honored to have mentored and continue to mentor the next generation of physicians and physician-scientists. Ultimately, I am deeply grateful to all of my patients who inspire my work. When I hear of even one patient who has been touched by my work, that is all I need to feel that it is all worth it.

I truly enjoy the opportunities to work with colleagues across disciplines, geographic regions, and expertise. I appreciate the ability to have creative freedom to explore new lines of research based on patient needs, which have led to some of the most impactful contributions. I also enjoy teaching and mentorship to build a legacy to carry forward for generations.

My high school mascot was the bulldog and now my career mascot is also the bulldog! I have come full circle here at Yale.

BA, BS, Trinity University

MD, PhD, University of Texas Southwestern Medical School

It is helpful to contextualize the promotion by placing it into a sequence of ~100-month blocks from (1) grade school through middle school, (2) high school and college, (3) MD-PhD education, (4) internship, residency, and fellowship training into K08 award, (5) first R01 grant through associate professorship, and (6) tenure until professorship. It is with a gentle sigh of relief, as I approach my 660th month on this planet, that I have at long last completed my "official" training. It is with much excitement, humility, and sentimentality that I look forward to the centennial blocks to follow this time without training wheels or institutionalized goals. It is in these segments where I hope finally to perform what I have been educated to do. I am told it is during these times when wisdom starts to engraft. Fingers crossed.

It still hasnt quite hit that I have been promoted. Seriously. I am actually a bit afraid to do or say anything for fear that it is just a dream and will disappear when I awake. While I had a perfect evening getting takeout with my lovely wife, Ania (I got to choose the pizza toppings!), I wont let loose until after learning the secret handshake and receiving the key to the clubhouse. That said, we did pop some bubbly with our neighbor Katie, who, coincidentally, was promoted to professor the same day big news for our block!

An awkward and stubborn persistence. Somewhere along the way, my great discovery was an internal doggedness that was supported by a loving family and absolutely amazing team. This doggedness was woven into a network of remarkable colleague-friends and sustained by sage mentors, serene gurus, and sentient leaders. Everything else follows.

The science, equations, and relationships.

Both my parents have full heads of hair.

The Department of Internal Medicine at Yale School of Medicine is among the nation's premier departments, bringing together an elite cadre of clinicians, investigators, educators, and staff in one of the world's top medical schools. To learn more, visit Internal Medicine.

Excerpt from:

New Professors in the Department of Internal Medicine - Yale School of Medicine

Internal Medicine

Nephrologist Choudhry now part of GGH team | Health | fltimes.com – Finger Lakes Times

GENEVA UR Medicine Finger Lakes Health has announced that Dr. Wajid Choudhry, FACP, FASN, has joined the medical staff of Geneva General Hospital, specializing in nephrology.

His office is located in Geneva Primary Care, 200 North St,, Suite 102.

Dr. Choudhry is double board-certified in Internal Medicine by the American Board of Internal Medicine and in Nephrology by the American Board of Nephrology.

He completed his fellowship in Nephrology at the University of Rochester. He did his residency in Internal Medicine at The Brooklyn Hospital Center. He earned his medical degree at King Edward Medical College in Lahore, Pakistan.

Dr. Choudhry, who has more than 30 years experience, most recently served as head of the Department of Nephrology at Unity Hospital in Rochester.

To schedule an appointment will Dr. Choudhry, call 315-787-5400.

See the rest here:

Nephrologist Choudhry now part of GGH team | Health | fltimes.com - Finger Lakes Times