Pub Date : 2024-10-01Epub Date: 2024-05-13DOI: 10.1016/j.ejim.2024.05.004
Francesco M Galassi, Elena Varotto, Domenico Ribatti
{"title":"Self-publishing in the history of medicine: The paradoxical case of Edward Jenner's science-changing monograph (1798).","authors":"Francesco M Galassi, Elena Varotto, Domenico Ribatti","doi":"10.1016/j.ejim.2024.05.004","DOIUrl":"10.1016/j.ejim.2024.05.004","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-05-23DOI: 10.1016/j.ejim.2024.05.024
Ilaria Bassi, Stefania Pastorello, Aldo Guerrieri, Gilda Giancotti, Anna Maria Cuomo, Chiara Rizzelli, Maria Coppola, Danila Valenti, Stefano Nava
Background: Idiopathic Pulmonary Fibrosis (IPF) is a lethal disease; most patients die in hospitals because palliative care (PC) is not wildly and early available. We aimed to determine the impact of an early PC program in IPF patients on place of death, emergency department (ED) admission, unplanned medical visits and survival before and after its implementation at our clinic.
Methods: IPF patients from our ILD clinic who died between January 1st, 2018 and December 31th, 2023 were included in the analysis. Primary outcomes were location of death, number of ED access and unplanned medical visits; secondary outcomes was survival from diagnosis.
Results: A total of 46 decedents between 2018 and 2023 were analysed: (median age 71,5 ± 5,5 years, 89 % male): 26 died before the implementation of the early PC program and 20 after. Through χ2 test, location of death resulted significantly different in the two groups, showing the capacity of early PC to favor at home or in hospice death (p = 0,02); similarly, the number of unplanned visits was significantly lower (p = 0,03). Finally, survival was significantly lower in patients not receiving the early PC program (p = 0,01).
Conclusion: The availability of an early PC program since the diagnosis significantly reduced both the death rate in hospital settings, favoring dying in hospice or at home, and the number of unplanned medical visits. Furthermore, IPF patients receiving early PC showed a longer survival than those who did not.
{"title":"Early palliative care program in idiopathic pulmonary fibrosis patients favors at-home and hospice deaths, reduces unplanned medical visits, and prolongs survival: A pilot study.","authors":"Ilaria Bassi, Stefania Pastorello, Aldo Guerrieri, Gilda Giancotti, Anna Maria Cuomo, Chiara Rizzelli, Maria Coppola, Danila Valenti, Stefano Nava","doi":"10.1016/j.ejim.2024.05.024","DOIUrl":"10.1016/j.ejim.2024.05.024","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic Pulmonary Fibrosis (IPF) is a lethal disease; most patients die in hospitals because palliative care (PC) is not wildly and early available. We aimed to determine the impact of an early PC program in IPF patients on place of death, emergency department (ED) admission, unplanned medical visits and survival before and after its implementation at our clinic.</p><p><strong>Methods: </strong>IPF patients from our ILD clinic who died between January 1st, 2018 and December 31th, 2023 were included in the analysis. Primary outcomes were location of death, number of ED access and unplanned medical visits; secondary outcomes was survival from diagnosis.</p><p><strong>Results: </strong>A total of 46 decedents between 2018 and 2023 were analysed: (median age 71,5 ± 5,5 years, 89 % male): 26 died before the implementation of the early PC program and 20 after. Through χ<sup>2</sup> test, location of death resulted significantly different in the two groups, showing the capacity of early PC to favor at home or in hospice death (p = 0,02); similarly, the number of unplanned visits was significantly lower (p = 0,03). Finally, survival was significantly lower in patients not receiving the early PC program (p = 0,01).</p><p><strong>Conclusion: </strong>The availability of an early PC program since the diagnosis significantly reduced both the death rate in hospital settings, favoring dying in hospice or at home, and the number of unplanned medical visits. Furthermore, IPF patients receiving early PC showed a longer survival than those who did not.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-06-08DOI: 10.1016/j.ejim.2024.05.023
Sophie Georgin-Lavialle, Marion Delplanque, Claude Bachmeyer, Léa Savey, Harry Sokol
{"title":"Clostridioides difficile infection as a potential trigger for Familial Mediterranean Fever attacks and fecal transplantation as a rescue.","authors":"Sophie Georgin-Lavialle, Marion Delplanque, Claude Bachmeyer, Léa Savey, Harry Sokol","doi":"10.1016/j.ejim.2024.05.023","DOIUrl":"10.1016/j.ejim.2024.05.023","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-07-27DOI: 10.1016/j.ejim.2024.07.008
Agostino Di Ciaula, Mohamad Khalil, Gyorgy Baffy, Piero Portincasa
Bile acid malabsorption (BAM) is an important disorder of digestive pathophysiology as it generates chronic diarrhoea. This condition originates from intricate pathways involving bile acid synthesis and metabolism in the liver and gut, the composition of gut microbiota, enterohepatic circulation and key receptors as farnesoid X receptor (FXR), fibroblast growth factor receptor 4 (FGFR4), and the G-protein bile acid receptor-1 (GPBAR-1). Although symptoms can resemble those related to disorders of gut brain interaction, accurate diagnosis of BAM may greatly benefit the patient. The empiric diagnosis of BAM is primarily based on the clinical response to bile acid sequestrants. Specific tests including the 48-hour fecal bile acid test, serum levels of 7α-hydroxy-4-cholesten-3-one (C4) and fibroblast growth factor 19 (FGF19), and the 75Selenium HomotauroCholic Acid Test (SeHCAT) are not widely available. Nevertheless, lack of diagnostic standardization of BAM may account for poor recognition and delayed management. Beyond bile acid sequestrants, therapeutic approaches include the use of FXR agonists, FGF19 analogues, glucagon-like peptide-1 (GLP-1) receptor agonists, and microbiota modulation. These novel agents can best make their foray into the therapeutic armamentarium if BAM does not remain a diagnosis of exclusion. Ignoring BAM as a specific condition may continue to contribute to increased healthcare costs and reduced quality of life. Here, we aim to provide a comprehensive review of the pathophysiology, diagnosis, and management of BAM.
{"title":"Advances in the pathophysiology, diagnosis and management of chronic diarrhoea from bile acid malabsorption: a systematic review.","authors":"Agostino Di Ciaula, Mohamad Khalil, Gyorgy Baffy, Piero Portincasa","doi":"10.1016/j.ejim.2024.07.008","DOIUrl":"10.1016/j.ejim.2024.07.008","url":null,"abstract":"<p><p>Bile acid malabsorption (BAM) is an important disorder of digestive pathophysiology as it generates chronic diarrhoea. This condition originates from intricate pathways involving bile acid synthesis and metabolism in the liver and gut, the composition of gut microbiota, enterohepatic circulation and key receptors as farnesoid X receptor (FXR), fibroblast growth factor receptor 4 (FGFR4), and the G-protein bile acid receptor-1 (GPBAR-1). Although symptoms can resemble those related to disorders of gut brain interaction, accurate diagnosis of BAM may greatly benefit the patient. The empiric diagnosis of BAM is primarily based on the clinical response to bile acid sequestrants. Specific tests including the 48-hour fecal bile acid test, serum levels of 7α-hydroxy-4-cholesten-3-one (C4) and fibroblast growth factor 19 (FGF19), and the <sup>75</sup>Selenium HomotauroCholic Acid Test (SeHCAT) are not widely available. Nevertheless, lack of diagnostic standardization of BAM may account for poor recognition and delayed management. Beyond bile acid sequestrants, therapeutic approaches include the use of FXR agonists, FGF19 analogues, glucagon-like peptide-1 (GLP-1) receptor agonists, and microbiota modulation. These novel agents can best make their foray into the therapeutic armamentarium if BAM does not remain a diagnosis of exclusion. Ignoring BAM as a specific condition may continue to contribute to increased healthcare costs and reduced quality of life. Here, we aim to provide a comprehensive review of the pathophysiology, diagnosis, and management of BAM.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-07-27DOI: 10.1016/j.ejim.2024.07.031
Eva Soler-Espejo, José Miguel Rivera-Caravaca
{"title":"Navigating the bleeding risk dilemma in patients with atrial fibrillation on therapy with direct-acting oral anticoagulants: Comparing the HAS-BLED vs. DOAC Score.","authors":"Eva Soler-Espejo, José Miguel Rivera-Caravaca","doi":"10.1016/j.ejim.2024.07.031","DOIUrl":"10.1016/j.ejim.2024.07.031","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-28DOI: 10.1016/j.ejim.2024.09.017
Alessandro Giaj Levra, Mauro Gatti, Roberto Mene, Dana Shiffer, Giorgio Costantino, Monica Solbiati, Raffaello Furlan, Franca Dipaola
Differentiation of syncope from transient loss of consciousness can be challenging in the emergency department (ED). Natural Language Processing (NLP) enables the analysis of free text in the electronic medical records (EMR). The present paper aimed to develop a large language models (LLM) for syncope recognition in the ED and proposed a framework for model integration within the clinical workflow. Two models, based on both the Italian and Multilingual Bidirectional Encoder Representations from Transformers (BERT) language model, were developed using consecutive EMRs. The "triage" model was only based on notes contained in the "triage" section of the EMR. The "anamnesis" model added data contained in the "medical history" section. Interpretation and calibration plots were generated. The Italian and Multi BERT models were developed and tested on both 15,098 and 15,222 EMRs, respectively. The triage model had an AUC of 0·95 for the Italian BERT and 0·94 for the Multi BERT. The anamnesis model had an AUC of 0·98 for the Italian BERT and 0·97 for Multi BERT. The LLM identified syncope when not explicitly mentioned in the EMR and also recognized common prodromal symptoms preceding syncope. Both models identified syncope patients in the ED with a high discriminative capability from nurses and doctors' notes, thus potentially acting as a tool helping physicians to differentiate syncope from others transient loss of consciousness.
{"title":"A large language model-based clinical decision support system for syncope recognition in the emergency department: A framework for clinical workflow integration.","authors":"Alessandro Giaj Levra, Mauro Gatti, Roberto Mene, Dana Shiffer, Giorgio Costantino, Monica Solbiati, Raffaello Furlan, Franca Dipaola","doi":"10.1016/j.ejim.2024.09.017","DOIUrl":"https://doi.org/10.1016/j.ejim.2024.09.017","url":null,"abstract":"<p><p>Differentiation of syncope from transient loss of consciousness can be challenging in the emergency department (ED). Natural Language Processing (NLP) enables the analysis of free text in the electronic medical records (EMR). The present paper aimed to develop a large language models (LLM) for syncope recognition in the ED and proposed a framework for model integration within the clinical workflow. Two models, based on both the Italian and Multilingual Bidirectional Encoder Representations from Transformers (BERT) language model, were developed using consecutive EMRs. The \"triage\" model was only based on notes contained in the \"triage\" section of the EMR. The \"anamnesis\" model added data contained in the \"medical history\" section. Interpretation and calibration plots were generated. The Italian and Multi BERT models were developed and tested on both 15,098 and 15,222 EMRs, respectively. The triage model had an AUC of 0·95 for the Italian BERT and 0·94 for the Multi BERT. The anamnesis model had an AUC of 0·98 for the Italian BERT and 0·97 for Multi BERT. The LLM identified syncope when not explicitly mentioned in the EMR and also recognized common prodromal symptoms preceding syncope. Both models identified syncope patients in the ED with a high discriminative capability from nurses and doctors' notes, thus potentially acting as a tool helping physicians to differentiate syncope from others transient loss of consciousness.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.1016/j.ejim.2024.09.014
Ombretta Para, Joel Byju Valuparampil, Alberto Parenti, Carlo Nozzoli, Alessandro Della Puppa
{"title":"Co-management hospitalist services for neurosurgery. Where are we?","authors":"Ombretta Para, Joel Byju Valuparampil, Alberto Parenti, Carlo Nozzoli, Alessandro Della Puppa","doi":"10.1016/j.ejim.2024.09.014","DOIUrl":"https://doi.org/10.1016/j.ejim.2024.09.014","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1016/j.ejim.2024.09.011
Wanyi Lin, Chenhan Jia, Hanlin Yin, Liangjing Lu
{"title":"Clinical significance of the anti-Nucleolar Organizer Region 90 antibodies (NOR90) in systemic sclerosis.","authors":"Wanyi Lin, Chenhan Jia, Hanlin Yin, Liangjing Lu","doi":"10.1016/j.ejim.2024.09.011","DOIUrl":"https://doi.org/10.1016/j.ejim.2024.09.011","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-25DOI: 10.1016/j.ejim.2024.09.006
Giacomo Buso, Claudia Agabiti-Rosei, Maria Lorenza Muiesan
{"title":"Putting frailty at the forefront of hypertension management in the elderly.","authors":"Giacomo Buso, Claudia Agabiti-Rosei, Maria Lorenza Muiesan","doi":"10.1016/j.ejim.2024.09.006","DOIUrl":"https://doi.org/10.1016/j.ejim.2024.09.006","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-21DOI: 10.1016/j.ejim.2024.09.009
Edoardo Gronda, Massimo Iacoviello, Arduino Arduini, Manuela Benvenuto, Domenico Gabrielli, Mario Bonomini, Luigi Tavazzi
Use of type 2 sodium-glucose cotransporter inhibitors (SGLT2i) gliflozines have first been applied to treatment of diabetic patients. In this setting, unexpected benefits on concomitant heart failure (HF) were seen in large trials. This clinical benefit was initially traced back to their natriuretic properties and as such they were also included in the therapeutic armamentarium of HF treatment. However, further insight into their mechanism of action has clarified their complex interaction with kidney function which better explains their prompt effectiveness in ameliorating HF outcome in the long-term, independent of left ventricular ejection fraction (LVEF) phenotype and concomitant presence of diabetes and/or chronic renal disease. This mainly results from the ability of SGLT2i to counteract the HF-associated hyperactivity of the sympathetic system and neurohormonal activation by modifying the pattern of renal tubular sodium and glucose reabsorption which results in curbing the overall sodium reabsorption. Their action results in decreased kidney workload and related oxygen consumption thus indirectly reducing sympathetic activity. The complex renal functional changes associated with HF and their modifications during SGLT2i administration will be reviewed.
{"title":"Gliflozines use in heart failure patients. Focus on renal actions and overview of clinical experience.","authors":"Edoardo Gronda, Massimo Iacoviello, Arduino Arduini, Manuela Benvenuto, Domenico Gabrielli, Mario Bonomini, Luigi Tavazzi","doi":"10.1016/j.ejim.2024.09.009","DOIUrl":"https://doi.org/10.1016/j.ejim.2024.09.009","url":null,"abstract":"<p><p>Use of type 2 sodium-glucose cotransporter inhibitors (SGLT2i) gliflozines have first been applied to treatment of diabetic patients. In this setting, unexpected benefits on concomitant heart failure (HF) were seen in large trials. This clinical benefit was initially traced back to their natriuretic properties and as such they were also included in the therapeutic armamentarium of HF treatment. However, further insight into their mechanism of action has clarified their complex interaction with kidney function which better explains their prompt effectiveness in ameliorating HF outcome in the long-term, independent of left ventricular ejection fraction (LVEF) phenotype and concomitant presence of diabetes and/or chronic renal disease. This mainly results from the ability of SGLT2i to counteract the HF-associated hyperactivity of the sympathetic system and neurohormonal activation by modifying the pattern of renal tubular sodium and glucose reabsorption which results in curbing the overall sodium reabsorption. Their action results in decreased kidney workload and related oxygen consumption thus indirectly reducing sympathetic activity. The complex renal functional changes associated with HF and their modifications during SGLT2i administration will be reviewed.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}