American Journal of Medicine最新文献

Background: Over 90% of U.S. physicians are currently board certified. Although the American Board of Medical Specialties (ABMS) has established standards for physicians to acquire and maintain board certification, a comprehensive description of this process and its associated costs has not been performed.

Methods: Population-level data of currently active diplomates was extracted from published ABMS reports. Examination characteristics of the initial and continuing certification process were extracted from each member board website. Revenue, expenditures, liabilities, and assets of each board for the latest tax year were extracted from published IRS Form 990s.

Results: Between 2016 to 2023, the number of physicians with active and continuous certification increased by 14% and 33%, respectively. Initial certification had a mean of 300 questions over 6 hours, an 89% pass rate, and a cost of $2,942. Continuous certification had a mean of 49 questions with 4 minutes per question, a 93% pass rate, and a cost of $263 annually. Total industry costs were estimated as $2,908,864,254 for initial certification and $9,101,324,085 for continuing certification. For the tax year 2022, this certification process generated $47 million in surplus and yielded $839 million net balance for all ABMS member boards.

Conclusions and relevance: ABMS board certification costs nearly $3 billion for initial certification and an additional $9 billion for continuing certification for currently practicing physicians over their careers. Ongoing research should evaluate the utility of the board certification system and explore ways to add value to this process.

Background: Patients with chronic obstructive pulmonary disease (COPD) have elevated cardiopulmonary and mortality risk, particularly following exacerbations. While single inhaler triple therapies (SITTs), such as budesonide/glycopyrrolate/formoterol fumarate (BGF), reduce cardiopulmonary risk versus dual bronchodilator therapy, there is limited evidence comparing outcomes with SITTs versus multiple inhaler triple therapies (MITTs).

Methods: SKOPOS-MAZI was a retrospective comparative effectiveness study in patients with COPD aged ≥40 years using US administrative claims data from Optum's deidentified Clinformatics® Data Mart Database. The primary and secondary endpoints were time to all-cause mortality and time to first severe cardiopulmonary event following initiation of BGF or MITT (identification period: October 1, 2020-June 30, 2023; index date: first prescription fill). Relative hazards of outcomes were assessed until a censoring event using Cox proportional hazards models, with inverse propensity treatment weighting accounting for between-group imbalances (standardized mean difference >0.1) in baseline characteristics.

Results: In the primary cohort, risk (hazard ratio [95% confidence intervals]) of all-cause mortality and a first severe cardiopulmonary event were 18% (0.82 [0.75, 0.91]) and 12% (0.88 [0.83, 0.93]) lower in patients initiating BGF versus MITT; results were consistent across censoring definitions, landmark periods, and sensitivity cohorts.

Conclusion: In this real-world comparative effectiveness study of patients with COPD initiating BGF or MITT, BGF was associated with lower all-cause mortality and severe cardiopulmonary event risk versus MITT after accounting for between-group differences in baseline sociodemographic and clinical characteristics. This study supports the benefits of BGF over MITT and the need to consider proactive use of SITTs in COPD management.

Vertebral fractures are a common cause of back pain and pain-related functional impairments in elderly patients. Despite their widespread occurrence, vertebral fractures frequently remain underdiagnosed, often leading to suboptimal management and poor clinical outcomes. This review specifically examines the role of physical therapy (PT) in managing vertebral fractures, describing current literature and evidence-based guidelines from the American Physical Therapy Association and the American Academy of Orthopaedic Surgeons. PT following vertebral fractures has been shown to significantly improve back pain and patient-reported outcomes, with studies even showing a correlation between resistance and aerobic training with improved bone mineral density. These findings highlight the need for interdisciplinary care and comprehensive PT interventions to address the growing burden of vertebral fractures as their incidence rises with the aging population.