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Elevated Lp(a): Guidance for Identifying and Managing Patients. 脂蛋白(a)升高:识别和管理患者指南》。
IF 1.1 4区 医学 Q3 Medicine Pub Date : 2024-04-01 DOI: 10.14423/SMJ.0000000000001675
Daniel E Hilleman, James L Vacek, James M Backes
Lipoprotein(a) (Lp(a)) is a unique low-density lipoprotein-like lipoprotein that is considered an independent and causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis. The Lp(a) molecule also contains apolipoprotein A and apolipoprotein B, which collectively promote atherosclerosis, thrombosis, and inflammation. Lp(a) is highly genetic and minimally responsive to nonpharmacological measures. Lp(a) serum levels ≥125 nmol/L are associated with increased ASCVD risk, but this threshold has not been accepted universally. Elevated Lp(a) is the most common genetic dyslipidemia affecting approximately 20% of the general population. Certain currently available lipid-lowering drugs, including the proprotein convertase subtilisin/kexin type 9 therapies, produce moderate reductions in Lp(a); however, none are indicated for the treatment of elevated Lp(a). There are currently four investigational RNA-based therapeutic agents that reduce Lp(a) by 70% to 100%. Two of these agents are being evaluated for ASCVD risk reduction in adequately powered outcomes trials, with results expected in 2 to 3 years. Until such therapies become available and demonstrate favorable clinical outcomes, strategies for elevated Lp(a) primarily involve early and intensive ASCVD risk factor management.
脂蛋白(a)(Lp(a))是一种独特的低密度脂蛋白样脂蛋白,被认为是动脉粥样硬化性心血管疾病(ASCVD)和钙化性主动脉瓣狭窄的独立致病危险因素。脂蛋白(a)分子还含有载脂蛋白 A 和载脂蛋白 B,它们共同促进动脉粥样硬化、血栓形成和炎症。脂蛋白(a)具有高度遗传性,对非药物措施的反应微弱。脂蛋白(a)血清水平≥125 nmol/L 与 ASCVD 风险增加有关,但这一阈值尚未被普遍接受。脂蛋白(a)升高是最常见的遗传性血脂异常,约占总人口的 20%。目前可用的某些降脂药物,包括 9 型丙蛋白转化酶枯草酶/kexin疗法,可适度降低脂蛋白(a),但没有一种适用于治疗脂蛋白(a)升高。目前有四种正在研究的基于 RNA 的治疗药物可使脂蛋白(a)降低 70% 至 100%。其中两种药物正在充分支持的结果试验中进行降低 ASCVD 风险的评估,预计将在 2 到 3 年内得出结果。在此类疗法问世并显示出良好的临床效果之前,针对脂蛋白(a)升高的策略主要涉及早期和强化的 ASCVD 危险因素管理。
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引用次数: 0
Utilization of Mental Health Services Within 1 Year of Delivery among Different Language Groups. 不同语言群体在分娩后一年内使用心理健康服务的情况。
IF 1.1 4区 医学 Q3 Medicine Pub Date : 2024-04-01 DOI: 10.14423/SMJ.0000000000001671
Minsu Kwak, Joshua Fogel, M. Tetrokalashvili
OBJECTIVESCultural differences can affect postpartum mental health disorders and the utilization of mental health services. We compared women speaking English, Spanish, Russian, and Urdu/Bengali/Punjabi from postpartum through 1 year after delivery.METHODSThis was a retrospective study of 3478 pregnant women from a public hospital in New York City. The primary outcome was a composite outcome of the presence of any of the following: diagnosis of depressive disorder, diagnosis of anxiety disorder, visit to a behavioral health service provider, and/or psychiatric admission. The secondary outcome was healthcare provider referral to a behavioral health service provider.RESULTSLanguages spoken were English (n = 1881), Spanish (n = 694), Russian (n = 600), and Urdu/Bengali/Punjabi (n = 303). The language groups differed significantly (P = 0.02) for the composite outcome, with English having the greatest percentage (3.5%) and Russian the lowest percentage (1.2%). The language groups significantly differed for referral to behavioral health (P = 0.04), with Spanish having the greatest percentage (1.6%) and Russian the lowest percentage (0.2%). Anxiety disorder history (odds ratio [OR] 10.43, 95% confidence interval [CI] 4.75-22.91, P < 0.001) and psychiatric disorder history (OR 5.26, 95% CI 2.13-8.49, P < 0.001) were each significantly associated with increased odds for the composite outcome. Anxiety disorder history (OR 6.42, 95% CI 1.92-21.45, P = 0.003) and elevated depressive symptoms (OR 4.92, 95% CI 2.04-11.83, P < 0.001) each were significantly associated with increased odds for referral to behavioral health.CONCLUSIONSRussian language was associated with lower utilization of mental health services postpartum. These findings can help clinicians determine among postpartum women who will be affected with mental health concerns and who will seek treatment for mental health concerns.
目的文化差异会影响产后心理健康障碍和心理健康服务的使用。我们比较了讲英语、西班牙语、俄语和乌尔都语/孟加拉语/旁遮普语的妇女从产后到产后 1 年的情况。主要结果是以下任何一项的综合结果:抑郁障碍诊断、焦虑障碍诊断、行为健康服务提供者就诊和/或精神病入院。次要结果是医疗服务提供者转诊至行为健康服务提供者。结果所使用的语言包括英语(n = 1881)、西班牙语(n = 694)、俄语(n = 600)和乌尔都语/孟加拉语/旁遮普语(n = 303)。在综合结果方面,各语言组之间存在明显差异(P = 0.02),其中英语组所占比例最高(3.5%),俄语组所占比例最低(1.2%)。在行为健康转诊方面,语言组之间存在明显差异(P = 0.04),其中西班牙语转诊比例最高(1.6%),俄语转诊比例最低(0.2%)。焦虑症病史(几率比 [OR] 10.43,95% 置信区间 [CI]4.75-22.91,P <0.001)和精神疾病病史(OR 5.26,95% CI 2.13-8.49,P <0.001)均与综合结果的几率增加显著相关。焦虑症病史(OR 6.42,95% CI 1.92-21.45,P = 0.003)和抑郁症状升高(OR 4.92,95% CI 2.04-11.83,P <0.001)均与转诊至行为健康部门的几率增加显著相关。这些发现有助于临床医生确定哪些产后妇女会受到心理健康问题的影响,以及哪些妇女会寻求心理健康方面的治疗。
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引用次数: 0
Barriers to Medical Student Scholarly Activities: A Call to Action. 医学生学术活动的障碍:行动呼吁。
IF 1.1 4区 医学 Q3 Medicine Pub Date : 2024-04-01 DOI: 10.14423/SMJ.0000000000001668
Leo Meller, Trent Percy, Mackenzie Pargeon
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引用次数: 0
Improving Communication with Family Members during a Global Pandemic: Effect on Patient Experience. 在全球大流行期间改善与家庭成员的沟通:对患者体验的影响。
IF 1.1 4区 医学 Q3 Medicine Pub Date : 2024-04-01 DOI: 10.14423/SMJ.0000000000001670
Gregory N. Orewa, Sue S. Feldman, K. Kennedy, Allyson G. Hall, Yu H Cheng, Arnaz A Malone, Ernest O Grimes, K. R. Hearld
OBJECTIVESCommunication with patients and their families/caregivers to facilitate informed decision making is an integral part of patient/family-centered care. Due to the high coronavirus disease 2019 (COVID-19) infection rates and limited personal protective equipment, healthcare systems were forced to restrict patient visitors, limit patient-provider interactions, and implement other changes in treatment protocols that disturbed traditional communications and risked eroding patient/family-centered care and adversely affected patient satisfaction. This article focuses on changes in patient experience in two dedicated COVID-19 units of an academic medical center located in the US South as a result of the enhanced communication process implemented specifically during the COVID-19 pandemic.METHODSThis retrospective quality improvement project used data from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, fielded between January 1, 2021 and August 31, 2021, to understand the role of a proactive communication initiative in patient satisfaction.RESULTSOur results show that HCAHPS scores for hospital unit hospital unit 4 (HSP4) in all categories increased over time, with the greatest improvements seen in the responsiveness of staff and care transition; however, HCAHPS scores for hospital unit HSP3 remained stable, with a small increase in responsiveness of staff.CONCLUSIONSOur findings suggest that communication is a critical factor in patient satisfaction, demonstrating the efficacy of a swift and innovative initiative to improve communication with family/caregivers, which may have been linked to better patient experiences. Developing communication strategies is crucial for enhancing patient satisfaction.
目的与患者及其家属/护理人员沟通以促进知情决策是以患者/家属为中心的护理不可或缺的一部分。由于 2019 年冠状病毒病(COVID-19)的高感染率和有限的个人防护设备,医疗保健系统不得不限制患者探视、限制患者与医护人员的互动,并对治疗方案进行其他改变,这些改变扰乱了传统的沟通方式,有可能削弱以患者/家属为中心的护理,并对患者满意度产生不利影响。本文重点介绍了美国南部一家学术医疗中心的两个 COVID-19 专用病房在 COVID-19 大流行期间实施强化沟通流程后患者体验发生的变化。方法该回顾性质量改进项目使用了 2021 年 1 月 1 日至 2021 年 8 月 31 日期间进行的 "医院医疗保健提供者和系统消费者评估"(HCAHPS)调查数据,以了解主动沟通措施在提高患者满意度方面的作用。结果我们的研究结果表明,医院第四病房(HSP4)所有类别的 HCAHPS 分数都随着时间的推移而增加,其中员工的响应速度和护理过渡方面的改进最大;然而,医院第三病房(HSP3)的 HCAHPS 分数保持稳定,员工的响应速度略有增加。制定沟通策略对于提高患者满意度至关重要。
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引用次数: 0
Broadening the Use of "Doctor" in the Clinical Setting: A Danger to Patient Decision Making and Informed Consent. 在临床环境中扩大 "医生 "的使用范围:病人决策和知情同意的危险。
IF 1.1 4区 医学 Q3 Medicine Pub Date : 2024-04-01 DOI: 10.14423/SMJ.0000000000001666
Forrest Bohler
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引用次数: 0
Know Your Guidelines Series: Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings. 了解您的指南系列:非酒精性脂肪肝在初级保健和内分泌临床环境中的诊断和管理。
IF 1.1 4区 医学 Q3 Medicine Pub Date : 2024-04-01 DOI: 10.14423/SMJ.0000000000001669
Desirée C Burroughs-Ray, Samantha Whitwell, Nathan Williams, Hira Imran, Christopher D Jackson
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引用次数: 0
Type 2 Diabetes Mellitus and Helicobacter pylori Eradication in a Clinical Population. 临床人群中的 2 型糖尿病和幽门螺杆菌根除情况
IF 1.1 4区 医学 Q3 Medicine Pub Date : 2024-04-01 DOI: 10.14423/SMJ.0000000000001672
Grace Sekaya, Frances Wang, H. Brown, Priya Alagesan, Bryan C Batch, Katherine S Garman, M. Epplein
OBJECTIVESEradication of Helicobacter pylori reduces the risk of gastric cancer (GC). Individuals with type 2 diabetes mellitus (T2DM) are known to be at increased risk for GC. In a cohort of H. pylori-positive individuals, we assessed whether those with T2DM were at risk of persistent infection following H. pylori treatment compared with individuals without T2DM.METHODSA random subset of all individuals diagnosed as having H. pylori without intestinal metaplasia at endoscopy from 2015 to 2019 were stratified evenly by race (Black and White). After excluding those with T1DM and those without eradication testing after H. pylori treatment, logistic regression analysis was used to determine the association of T2DM with the risk of persistent H. pylori infection following treatment.RESULTSIn 138 patients, H. pylori eradication rates did not differ between the 27% of individuals with T2DM compared to those without (81.1% vs 81.2%). After adjusting for age, race, and insurance status, we found no significant increased risk of persistent H. pylori infection for individuals with T2DM (odds ratio 1.40; 95% confidence interval 0.49-3.99).CONCLUSIONSH. pylori eradication rates do not differ by T2DM status, providing support for clinical trials of H. pylori eradication to reduce GC incidence among high-risk populations in the United States, such as individuals with T2DM.
目的根除幽门螺杆菌可降低胃癌(GC)的发病风险。众所周知,2 型糖尿病(T2DM)患者罹患胃癌的风险会增加。在幽门螺杆菌阳性者的队列中,我们评估了与无 T2DM 的个体相比,T2DM 患者在接受幽门螺杆菌治疗后是否有持续感染的风险。方法将 2015 年至 2019 年期间在内镜检查中被诊断为幽门螺杆菌感染且无肠化生的所有个体随机分组,并按种族(黑人和白人)均匀分层。在排除T1DM患者和幽门螺杆菌治疗后未进行根除检测的患者后,采用逻辑回归分析确定T2DM与幽门螺杆菌治疗后持续感染风险的关联。在对年龄、种族和保险状况进行调整后,我们发现 T2DM 患者持续感染幽门螺杆菌的风险没有显著增加(几率比 1.40;95% 置信区间 0.49-3.99)。
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引用次数: 0
Unresolvable Moral Disagreements and the Ethical Integrity of the Medical Profession. 无法解决的道德分歧与医学界的道德诚信。
IF 1.1 4区 医学 Q3 Medicine Pub Date : 2024-04-01 DOI: 10.14423/SMJ.0000000000001667
Frederick Adolf Paola, Stephanie Lolita Anderson, Kristin M Collier, Jack Coulehan
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引用次数: 0
Matching Against Men: 5 Years of Residency Match Data Show Disparities Still Exist. 针对男性的匹配:5 年的住院医生匹配数据显示差异依然存在。
IF 1.1 4区 医学 Q3 Medicine Pub Date : 2024-04-01 DOI: 10.14423/SMJ.0000000000001673
Ashley Mason, Zeegan George, K. Khatskevich, Xiaoxiao Gao, Kira K. Zwygart, Danielle Gulick
OBJECTIVESDespite progress toward equal representation by sex in medical practice, women remain underrepresented in many specialties. This study sought to examine the current state of gender equality among recently graduated doctors in multiple specialties.METHODSDeidentified demographics, standardized examination scores, and Match results were gathered for 829 graduates. Participants were selected from an allopathic medical school between 2016 and 2020. Nineteen students (2.29%) were excluded from the study. Descriptive statistics were calculated, and χ2 tests for independence were used to compare proportions between reported sex and specialty and program Match results. One-way analysis of variance was then performed to test for differences in US Medical Licensing Examination Step 1 and Step 2 scores between sexes. P < 0.05 was considered statistically significant.RESULTSOf the 829 individuals studied, 44.6% were women. A significantly smaller proportion of women matched into the most competitive specialties, despite no significant difference in US Medical Licensing Examination Step 1 scores between sexes. Furthermore, there was an overall significant trend of women matching into more competitive programs for any given specialty.CONCLUSIONSIn this study, we found that men matched into more highly competitive specialties, whereas women matched into more competitive residency program locations. Further research is needed to determine why women matched into specific specialties at lower rates than their male peers and seek to understand how sex affects the narrative of specialty choice.
目的尽管在实现医疗实践中的性别平等方面取得了进展,但女性在许多专业中的代表性仍然不足。方法收集了 829 名毕业生的人口统计学特征、标准化考试成绩和比赛结果。参与者选自 2016 年至 2020 年间的一所对抗疗法医学院。研究中排除了 19 名学生(2.29%)。研究人员计算了描述性统计数字,并使用χ2独立性检验比较了报告性别与专业和课程匹配结果之间的比例。然后进行单因素方差分析,检验不同性别在美国医学执业资格考试步骤 1 和步骤 2 分数上的差异。结果 在研究的 829 人中,44.6% 为女性。尽管不同性别在美国医学执照考试步骤 1 分数上没有明显差异,但进入竞争最激烈专业的女性比例明显较低。结论 在这项研究中,我们发现男性匹配到竞争更激烈的专业,而女性匹配到竞争更激烈的住院医师培训项目地点。还需要进一步的研究来确定为什么女性进入特定专业的匹配率低于男性,并试图了解性别如何影响专业选择的叙述。
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引用次数: 0
Eccentric Hamstring Strength Imbalance among Football and Soccer Athletes. 足球运动员偏心腘绳肌力量失衡。
IF 1.1 4区 医学 Q3 Medicine Pub Date : 2024-04-01 DOI: 10.14423/SMJ.0000000000001674
Elizabeth M Benson, J. Elphingstone, Kyle D. Paul, Sam Schick, Yazen A. Shihab, Dan Barlow, Brent A. Ponce, E. Brabston, Amit M. Momaya
OBJECTIVESHamstring strain injuries (HSI) are common among football and soccer athletes. Eccentric strength imbalance is considered a contributing factor for HSI. There is, however, a paucity of data on hamstring imbalances of soccer and American football athletes as they age and advance in skill level. High school athletes will display greater interlimb discrepancies compared with collegiate and professional athletes. In addition, soccer athletes will exhibit greater hamstring asymmetry than American football athletes.METHODSHamstring testing was performed on soccer and American football athletes using the NordBord Hamstring Testing System (Vald Performance, Albion, Australia). Age, sex, weight, sport specialization, and sport level were recorded. Maximum hamstring forces (N), torque (N · m), and work (N · s) were measured. Hamstring imbalance (%) was calculated by dividing the absolute value of the difference in leg forces divided by their sum. One-way analysis of variance and independent sample t tests compared measurements between athlete groups.RESULTSA total of 631 athletes completed measurements, including 88 high school male soccer, 25 college male soccer, 23 professional male soccer, 83 high school female soccer, 28 college female soccer, 288 high school football, and 96 college football athletes. High school soccer players displayed significantly greater imbalances for torque (P = 0.03) and work (P < 0.01) than football athletes. Imbalances for maximum force (P = 0.035), torque (P = 0.018), and work (P = 0.033) were significantly higher for male soccer athletes in high school compared with college- and professional-level athletes. Female high school soccer players had significantly higher imbalance in torque (P = 0.045) and work (P = 0.001) compared with female collegiate soccer players. Football athletes did not experience significant changes in force imbalances between skill levels.CONCLUSIONSHigh school soccer athletes exhibit greater hamstring imbalances than football athletes. Higher levels of play in soccer, for both male and female athletes, correlate with less hamstring asymmetry.
目的腘绳肌拉伤(HSI)在足球运动员中很常见。偏心力量失衡被认为是导致 HSI 的一个因素。然而,关于足球和美式橄榄球运动员随着年龄增长和技术水平提高而出现的腿筋不平衡的数据却很少。与大学和职业运动员相比,高中运动员会表现出更大的肢间差异。方法使用 NordBord 腿筋测试系统(澳大利亚阿尔比恩 Vald Performance 公司)对足球和美式橄榄球运动员进行腿筋测试。记录了年龄、性别、体重、运动专长和运动水平。测量了腘绳肌的最大力量(牛顿)、扭矩(牛顿-米)和功(牛顿-秒)。腘绳肌不平衡(%)的计算方法是用腿部力量差异的绝对值除以它们的总和。结果共有 631 名运动员完成了测量,其中包括 88 名高中男子足球运动员、25 名大学男子足球运动员、23 名职业男子足球运动员、83 名高中女子足球运动员、28 名大学女子足球运动员、288 名高中足球运动员和 96 名大学足球运动员。与足球运动员相比,高中足球运动员在扭矩(P = 0.03)和功(P < 0.01)方面表现出明显的不平衡。与大学和职业运动员相比,高中男子足球运动员在最大力(P = 0.035)、扭矩(P = 0.018)和功(P = 0.033)方面的不平衡性明显更高。与大学女足球运动员相比,高中女足球运动员在扭矩(P = 0.045)和功(P = 0.001)方面的不平衡程度明显更高。结论高中足球运动员比足球运动员表现出更大的腿筋不平衡。无论男女运动员,足球运动水平越高,腘绳肌不对称程度越低。
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引用次数: 0
期刊
Southern Medical Journal
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