American journal of medicine open最新文献_第5页

Gun-related mortality in children- seeing past geography 儿童与枪支有关的死亡率——看过去的地理

American journal of medicine open

Pub Date : 2024-12-01 DOI: 10.1016/j.ajmo.2022.100021

Stuart R. Chipkin MD

引用次数: 0

Use of a Nutritional Risk Assessment Tool to Guide Early Enteral Nutrition among Mechanically Ventilated Trauma Patients 使用营养风险评估工具指导机械通气创伤患者早期肠内营养。

American journal of medicine open

Pub Date : 2024-11-22 DOI: 10.1016/j.ajmo.2024.100080

Julia Heizmann , Christopher Gross , Chelsea Yap , Mary Anne Walling , Moya Reid , Albert Hsu , Marie Crandall , Jin Ra

Background

The Modified Nutritional Risk in Critically Ill (mNUTRIC) score has been proposed as a tool to identify hospitalized patients at risk for malnutrition who may benefit from early enteral nutrition (EN) therapy.

Objective

Our goal was to determine if mNUTRIC scores could predict, at time of intensive care unit admission, which mechanically ventilated trauma patients were at risk for malnutrition and might benefit from early EN, as indicated by reduced mortality.

Methods

We conducted a retrospective chart review of all adult trauma patients requiring mechanical ventilation for at least 48 hours between 01/21/2012 and 12/31/2016, reviewing inpatient medical records, demographic data, disease markers, injury severity, and comorbidities. Bivariate statistics and multivariate regression analyses were used to investigate the correlation between time of EN initiation and mortality rates, as well as the relationship of mNUTRIC scores with EN commencement with early EN initiation being ≤48 hours and malnutrition risk mNUTRIC ≥5.

Results

Among 931 patients reviewed, bivariate analysis showed higher mNUTRIC scores correlated with older, sicker patients and higher mortality. However, multivariate analysis revealed no significant association between higher mNUTRIC scores and increased mortality (OR 1.2, 95% CI 0.7-2.1, p=0.52). Although most patients received EN within 48 hours, there was no association between mNUTRIC score and timing of EN initiation after adjusting for demographic variables and illness severity.

Conclusions

Our findings indicate that while the mNUTRIC score can effectively identify malnutrition risk, it does not meaningfully inform early EN initiation timing nor predict mortality in mechanically ventilated trauma patients.

背景：危重症患者改良营养风险（mNUTRIC）评分已被提出作为一种工具来识别有营养不良风险的住院患者，这些患者可能受益于早期肠内营养（EN）治疗。目的：我们的目的是确定在重症监护病房入院时，mNUTRIC评分是否可以预测机械通气创伤患者是否有营养不良的风险，并可能从早期EN中获益，这表明死亡率降低。方法：回顾性分析2012年1月21日至2016年12月31日期间所有需要机械通气至少48小时的成人创伤患者，回顾住院病历、人口统计资料、疾病标志物、损伤严重程度和合并症。采用双变量统计和多变量回归分析，探讨EN起始时间与死亡率的相关性，以及EN起始时间≤48小时、营养不良风险mNUTRIC≥5分与EN起始时间的关系。结果：在931例患者中，双变量分析显示，较高的mNUTRIC评分与年龄较大、病情较重的患者和较高的死亡率相关。然而，多变量分析显示较高的mNUTRIC评分与死亡率增加之间没有显著关联（OR 1.2, 95% CI 0.7-2.1, p=0.52）。虽然大多数患者在48小时内接受了EN，但在调整人口统计学变量和疾病严重程度后，mNUTRIC评分与EN开始时间之间没有关联。结论：我们的研究结果表明，尽管mNUTRIC评分可以有效地识别营养不良风险，但它并不能为机械通气创伤患者的早期EN起始时间提供有意义的信息，也不能预测死亡率。

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引用次数: 0

Lessons Learned From the Liver About the Undergraduate to Graduate Medical Education Transition 从肝脏学到的关于本科到研究生医学教育转型的经验教训。

American journal of medicine open

Pub Date : 2024-11-05 DOI: 10.1016/j.ajmo.2024.100079

Alexander Y. Pan , Pedram J. Khorsandi , Jeanne M. Farnan , Margarita N. German , Pranab M. Barman , Madeline A. Berschback , Michael Kriss , Ross McMillan , Omar Mousa , Frederick B. Peng , Tejinder Randhawa , Kamilah Scales , Adam E. Mikolajczyk

The burden of cirrhosis and chronic liver disease is growing, yet there is a projected worsening deficit in hepatology providers. As such, cirrhosis and liver disease have been important inclusions within the core curricula of Internal Medicine. Formal assessments of provider preparedness resulting from the curriculum are lacking though. Prior studies have demonstrated that exposure to cirrhosis in undergraduate medical education is insufficient, as are learner comfort and self-reported knowledge levels. These findings are further corroborated by a multicenter survey of incoming Internal Medicine interns showing that subjective comfort with and objective knowledge of various liver disease topics are lacking compared to other common Internal Medicine topics. This paper also demonstrates how similar surveys may be used to identify additional topics that may require adjustments for curricular improvement.

肝硬化和慢性肝病的负担正在增加，但肝病提供者的预期赤字正在恶化。因此，肝硬化和肝病已成为内科核心课程的重要内容。然而，缺乏对课程所产生的提供者准备情况的正式评估。先前的研究表明，在本科医学教育中，肝硬化的曝光是不够的，学习者的舒适度和自我报告的知识水平也是不够的。这些发现得到了一项多中心调查的进一步证实，该调查显示，与其他常见的内科主题相比，内科实习生缺乏对各种肝病主题的主观舒适度和客观知识。本文还演示了如何使用类似的调查来确定可能需要调整课程改进的其他主题。

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引用次数: 0

Postacute Sequelae of COVID-19 in Pediatric Patients Within the United States: A Scoping Review 美国儿童患者 COVID-19 后遗症：范围审查

American journal of medicine open

Pub Date : 2024-09-26 DOI: 10.1016/j.ajmo.2024.100078

Christine M. Miller , Carla Borre , Alex Green , Melissa Funaro , Carlos R Oliveira , Akiko Iwasaki

A subset of children and adolescents experience recurrent or persistent symptoms following SARS-CoV-2 infection, known as postacute sequelae of COVID-19 (PASC), however, the clinical epidemiology within the United States (US) is not yet well understood. This scoping review aims to synthesize the clinical epidemiology of pediatric PASC in the US. A comprehensive literature search was conducted and databases were queried from inception until January 29, 2024. Studies including US children and adolescents <21 years old were considered. From 1028 studies identified, 29 met the inclusion criteria. Prevalence of PASC ranged from less than 1%-27%. Risk factors included older age, female sex, asthma, obesity, and severe initial infection. Common symptoms were dyspnea, fatigue, headaches, and chest pain. A multidisciplinary approach for diagnosis and management was common across studies. Most studies had a high risk of bias and were limited by a lack of standardized definitions and short follow-up duration. This review establishes a foundation for understanding pediatric PASC and highlights the critical need for continued research to optimize prevention and treatment strategies.

一部分儿童和青少年在感染 SARS-CoV-2 后会出现反复或持续性症状，即 COVID-19 急性后遗症 (PASC)，但美国的临床流行病学尚不十分清楚。本范围综述旨在总结美国儿科 PASC 的临床流行病学。我们进行了全面的文献检索，并查询了从开始到 2024 年 1 月 29 日的数据库。研究对象包括美国 21 岁的儿童和青少年。在确定的 1028 项研究中，有 29 项符合纳入标准。PASC的发病率从不到1%到27%不等。风险因素包括年龄偏大、性别为女性、哮喘、肥胖和初期严重感染。常见症状为呼吸困难、疲劳、头痛和胸痛。各研究均采用多学科方法进行诊断和管理。大多数研究存在较高的偏倚风险，并因缺乏标准化定义和随访时间较短而受到限制。本综述为了解儿科 PASC 奠定了基础，并强调了继续开展研究以优化预防和治疗策略的迫切需要。

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引用次数: 0

Coaching People with Cardiovascular Disease to Close Their “Treatment Gaps” Reduces Hospital Utilization, Saves Lives, and Delivers Net Cost Savings Over 10 Years 指导心血管疾病患者缩小 "治疗差距"，可降低医院使用率、挽救生命，并在 10 年内实现净成本节约

American journal of medicine open

Pub Date : 2024-08-16 DOI: 10.1016/j.ajmo.2024.100075

Joshua Byrnes , Margarite J. Vale , Clifford Afoakwah , Pippa Grant , Sharmani Barnard

Background

Disease management programs are an essential tool in the fight against rising prevalence and costs associated with cardiovascular disease (CVD). However, there is a lack of evidence on the long-term impact of these programs on clinical outcomes, healthcare utilization, and cost. This study presents a long-term follow up of clinical, healthcare utilization and cost, and mortality consequences of The COACH Program, a 6-month telephone delivered CVD prevention program.

Methods

We conducted 10-year retrospective propensity score matched cohort study of potentially eligible participants comparing individuals that participated to those that did not receive the Program. Primary outcomes of interest were differences in mortality, private healthcare utilization and cost of private healthcare utilization sourced from private health insurance claims data.

Results

Of the 24,932 potentially eligible participants, 11,988 were invited to participate in The COACH Program between July 1, 2010, and December 31, 2020. The COACH Program participants (n = 2,271) were 1:1 matched with individuals who did not participate in the Program. Participation in The COACH Program was associated with a 34% reduction in the risk of mortality (HR: 0.66, 95% CI: 0.54, 0.79), an 8% reduction in the number of hospitalizations (IRR: 0.92, 95% CI: 0.85, 0.98), and an annual reduction in healthcare costs of $1,499 (95% CI: $1,909, $1,087). Results were robust to sensitivity analyses.

Conclusions

A structured 6-month telephone delivered coaching program focused on closing “treatment gaps” in people with a history of CVD saves lives and reduces hospital utilization, health care costs over 10-years follow-up.

背景疾病管理计划是应对心血管疾病（CVD）发病率和相关费用上升的重要手段。然而，关于这些项目对临床结果、医疗利用率和成本的长期影响却缺乏证据。本研究对 COACH 计划（一项为期 6 个月的电话心血管疾病预防计划）的临床结果、医疗保健利用率和成本以及死亡率进行了长期跟踪研究。方法我们对可能符合条件的参与者进行了为期 10 年的回顾性倾向得分匹配队列研究，比较了参与该计划的个人与未参与该计划的个人。研究的主要结果是死亡率、私人医疗保健使用率和私人医疗保健使用成本的差异，这些数据来源于私人医疗保险理赔数据。结果在 24932 名可能符合条件的参与者中，有 11988 人受邀在 2010 年 7 月 1 日至 2020 年 12 月 31 日期间参加 COACH 计划。COACH 计划参与者（n = 2,271 人）与未参加该计划的个人进行了 1:1 匹配。参加 COACH 计划可使死亡风险降低 34%（HR：0.66，95% CI：0.54, 0.79），住院次数减少 8%（IRR：0.92，95% CI：0.85, 0.98），每年医疗费用减少 1,499 美元（95% CI：1,909 美元，1,087 美元）。结论一项为期 6 个月的结构化电话指导计划侧重于缩小有心血管疾病史者的 "治疗差距"，在 10 年的随访过程中，可挽救生命并降低医院使用率和医疗费用。

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引用次数: 0

Characterization of Change in Cognition Before and After COVID-19 Infection in Essential Workers at Midlife 中年基本劳动者感染 COVID-19 前后认知变化的特点

American journal of medicine open

Pub Date : 2024-08-13 DOI: 10.1016/j.ajmo.2024.100076

Zennur Sekendiz , Olga Morozova , Melissa A. Carr , Ashley Fontana , Nikhil Mehta , Alina Ali , Eugene Jiang , Tesleem Babalola , Sean A.P. Clouston , Benjamin J. Luft

Background

Research into COVID-19-related cognitive decline has focused on individuals who are cognitively impaired following hospitalization for COVID-19. Our objective was to determine whether cognitive decline emerged after the onset of COVID-19 and was more pronounced in patients with postacute sequelae of SARS-CoV-2 infection (PASC).

Methods

We analyzed longitudinal cognitive data collected during a cohort study of essential workers at midlife that continued through the COVID-19 pandemic. We used longitudinal discontinuity models, a form of causal modeling, to examine the change in cognitive performance among 276 participants with COVID-19 in comparison to contemporaneously-collected information from 217 participants who did not have COVID-19. Cognitive performance across four domains was measured before and after the pandemic. Eligible study participants were those with validated COVID-19 diagnoses who were observed before having a verified COVID-19 infection who survived their initial infection, and for whom post-COVID-19 information was also available.

Results

The mean age of the COVID-19 group was 56.0 ± 6.6 years old, while the control group was 58.1 ± 7.3 years old. Longitudinal models indicated a significant decline in cognitive throughput (β = -0.168, P = .001) following COVID-19, after adjustment for pre-COVID-19 functioning, demographics, and medical factors. Associations were larger in those with more severe COVID-19 and those who reported PASC. Observed changes in throughput were equivalent to 10.6 years of normal aging.

Conclusion

Findings from this longitudinal causal modeling study revealed that COVID-19 and PASC appeared to cause clincially relevant cognitive deterioration.

背景对COVID-19相关认知功能下降的研究主要集中在因COVID-19住院后认知功能受损的患者身上。我们的目的是确定认知能力下降是否在 COVID-19 爆发后出现，以及是否在 SARS-CoV-2 感染急性后遗症（PASC）患者中更为明显。方法我们分析了在一项针对中年基本工人的队列研究中收集的纵向认知数据，该研究一直持续到 COVID-19 大流行期间。我们使用纵向不连续性模型（一种因果建模形式）研究了 276 名感染 COVID-19 的参与者与 217 名未感染 COVID-19 的参与者的同期资料相比认知能力的变化。研究人员对大流行前后四个领域的认知能力进行了测量。符合条件的研究参与者是那些在感染 COVID-19 病毒之前就已被确诊为 COVID-19 病毒的人，他们在最初感染 COVID-19 病毒后存活了下来，而且还能获得 COVID-19 病毒感染后的信息。结果COVID-19病毒感染组的平均年龄为（56.0 ± 6.6）岁，而对照组为（58.1 ± 7.3）岁。纵向模型显示，在对 COVID-19 前的功能、人口统计学和医疗因素进行调整后，COVID-19 后认知吞吐量明显下降（β = -0.168，P = .001）。在 COVID-19 更严重和报告 PASC 的人群中，相关性更大。观察到的吞吐量变化相当于正常衰老 10.6 年。结论这项纵向因果建模研究的结果显示，COVID-19 和 PASC 似乎会导致与临床相关的认知功能退化。

{"title":"Characterization of Change in Cognition Before and After COVID-19 Infection in Essential Workers at Midlife","authors":"Zennur Sekendiz , Olga Morozova , Melissa A. Carr , Ashley Fontana , Nikhil Mehta , Alina Ali , Eugene Jiang , Tesleem Babalola , Sean A.P. Clouston , Benjamin J. Luft","doi":"10.1016/j.ajmo.2024.100076","DOIUrl":"10.1016/j.ajmo.2024.100076","url":null,"abstract":"<div><h3>Background</h3><div>Research into COVID-19-related cognitive decline has focused on individuals who are cognitively impaired following hospitalization for COVID-19. Our objective was to determine whether cognitive decline emerged after the onset of COVID-19 and was more pronounced in patients with postacute sequelae of SARS-CoV-2 infection (PASC).</div></div><div><h3>Methods</h3><div>We analyzed longitudinal cognitive data collected during a cohort study of essential workers at midlife that continued through the COVID-19 pandemic. We used longitudinal discontinuity models, a form of causal modeling, to examine the change in cognitive performance among 276 participants with COVID-19 in comparison to contemporaneously-collected information from 217 participants who did not have COVID-19. Cognitive performance across four domains was measured before and after the pandemic. Eligible study participants were those with validated COVID-19 diagnoses who were observed before having a verified COVID-19 infection who survived their initial infection, and for whom post-COVID-19 information was also available.</div></div><div><h3>Results</h3><div>The mean age of the COVID-19 group was 56.0 ± 6.6 years old, while the control group was 58.1 ± 7.3 years old. Longitudinal models indicated a significant decline in cognitive throughput (β = -0.168, P = .001) following COVID-19, after adjustment for pre-COVID-19 functioning, demographics, and medical factors. Associations were larger in those with more severe COVID-19 and those who reported PASC. Observed changes in throughput were equivalent to 10.6 years of normal aging.</div></div><div><h3>Conclusion</h3><div>Findings from this longitudinal causal modeling study revealed that COVID-19 and PASC appeared to cause clincially relevant cognitive deterioration.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"12 ","pages":"Article 100076"},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Closing the Gaps in Hepatitis C Knowledge Among Internal Medicine Residents in the United States 缩小美国内科住院医生在丙型肝炎知识方面的差距

American journal of medicine open

Pub Date : 2024-08-13 DOI: 10.1016/j.ajmo.2024.100077

Lucy X. Li , Jessica S. Lin , Sean Tackett , Amanda Bertram , Stephen D. Sisson , Darius Rastegar , Megan E. Buresh

Background

The introduction of direct-acting antivirals (DAA) has revolutionized hepatitis C virus (HCV) treatment but has not translated into an appreciable decline in HCV prevalence, which is estimated to be 2.4 million in the United States. Efforts are thought to be limited by the lack of experience among nonspecialist providers in managing HCV. However, there have been no comprehensive surveys assessing HCV knowledge among medical trainees to determine if trends have shifted since the discovery of DAAs.

Methods

We performed a retrospective observational study of internal medicine (IM) residents in the United States (n = 1763) who completed the Physician Education and Assessment Center HCV learning module between 2021 and 2022. Participant pre- and post-test performance was compared with further stratified analysis by training year, geography, training program type, and local HCV prevalence using ANOVA and Chi-squared tests of proportions, respectively.

Results

IM residents universally lacked baseline HCV knowledge (average score ± standard deviation, 43% ± 19%); less than 50% of participants answered correctly in the majority of tested domains. There were no consistent trends in performance regardless of resident characteristic used to stratify the participants. Knowledge gaps improved after completing an online educational training module (P < .001).

Conclusions

HCV knowledge remains limited among IM residents despite expansion of treatment options. Addressing these gaps during clinical training may substantially increase the availability of HCV treatment in the community, and online modules may be one means by which to integrate these efforts into medical training.

背景直接作用抗病毒药物（DAA）的引入彻底改变了丙型肝炎病毒（HCV）的治疗，但并没有明显降低 HCV 的发病率，据估计美国的发病率为 240 万。人们认为，非专业医疗服务提供者在管理 HCV 方面缺乏经验，从而限制了这方面的努力。我们对 2021 年至 2022 年期间完成医生教育和评估中心 HCV 学习模块的美国内科住院医师（n = 1763）进行了一项回顾性观察研究。结果IM住院医师普遍缺乏HCV基础知识（平均分±标准差，43%±19%）；在大多数测试领域中，只有不到50%的参与者回答正确。无论采用哪种居民特征对参与者进行分层，结果都没有一致的趋势。完成在线教育培训模块后，知识差距有所改善（P < .001）。在临床培训过程中弥补这些不足可能会大大增加社区中 HCV 治疗的可用性，而在线模块可能是将这些努力纳入医学培训的一种手段。

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引用次数: 0

Functional Assessment of >18 Years Old Patients at Internal Medicine Ward—Relationship with In-Hospital and 30-Day Mortality 内科病房 18 岁以上患者的功能评估--与住院和 30 天死亡率的关系

American journal of medicine open

Pub Date : 2024-07-30 DOI: 10.1016/j.ajmo.2024.100074

Heloísa Ribeiro , Yolanda Martins , Isabel Natário , Luís Pedro Tavares

Objective

To evaluate the connection between the items included in the AVD-DezIs score (a questionnaire about basic and instrumental activities of daily living and other topics related to social and personal life) and in-hospital and 30-day mortality after discharge.

Methods

Prospective cohort study of hospitalizations in the Internal Medicine ward from 2014 to 2020, including >18 years old patients with a fully completed AVD-DezIs. To identify in-hospital and 30 days mortality, univariate and multivariate logistic models were applied, including random effects if justified.

Results

A total of 19,771 episodes of hospitalization were included. In the univariate analysis, except for the presence of isolation and financial insufficiency, all the items were predictors of mortality in-hospital or within 30 days after discharge. In multivariate analysis, older age, male sex, longer hospital stay, higher Charlson score, deficiency in all four activities of daily living, deficiency in meal preparation and housekeeping, presence of pain/depression, immobility, and malnutrition are associated with a higher probability of in-hospital death whereas older age, male gender, higher Charlson score, longer length of hospital stay, deficiency in personal hygiene, ambulation, and eating habits, as well as the presence of incontinence and malnutrition, are associated with a higher probability of 30 days after discharge death.

Discussion/Conclusion

Except for isolation and financial insufficiency, all items were individually associated with the outcomes. When they are considered in conjunction and taking into account sex, age, comorbidities and length of stay, the predictive ability of in-hospital and 30 days mortality differed.

目的评估AVD-DezIs评分（一份关于日常生活基本活动和工具性活动以及其他与社会和个人生活相关的主题的问卷）所包含的项目与住院及出院后30天死亡率之间的联系。方法对2014年至2020年期间在内科病房住院的患者进行前瞻性队列研究，其中包括>18岁且完全完成AVD-DezIs评分的患者。为了确定院内死亡率和30天死亡率，研究人员采用了单变量和多变量逻辑模型，并在合理的情况下加入了随机效应。在单变量分析中，除了存在孤独感和经济能力不足外，所有项目均可预测住院或出院后 30 天内的死亡率。在多变量分析中，年龄较大、性别为男性、住院时间较长、Charlson评分较高、缺乏所有四项日常生活活动、缺乏膳食准备和家务管理、存在疼痛/抑郁、行动不便和营养不良与较高的院内死亡概率相关，而年龄较大、性别为男性、Charlson评分较高、住院时间较长、缺乏个人卫生、行走和饮食习惯以及存在大小便失禁和营养不良与较高的出院后30天内死亡概率相关。讨论/结论除孤立无援和经济不充裕外，所有项目都单独与结果相关。如果将这些项目结合起来考虑，并将性别、年龄、合并症和住院时间考虑在内，则对院内死亡率和出院 30 天死亡率的预测能力有所不同。

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引用次数: 0

Current Communication Practices Between Internal Medicine Subspecialty Fellowship Applicants and Program Directors: A National Survey 目前内科亚专科奖学金申请人与项目主任之间的沟通方式：全国调查

American journal of medicine open

Pub Date : 2024-07-10 DOI: 10.1016/j.ajmo.2024.100073

Rahul Kumar Thakur , Charan Thej Reddy Vegivinti , Barun Kumar Ray , Hasiya Yusuf , Abhishek Kumar

Purpose

As fellowship applications increasingly transition to virtual interviews, the role of social media in this process remains uncertain. This study explores internal medicine subspecialty program directors' (PDs) perspectives on current communication practices, including the use of social media and email, between applicants and programs.

Method

A national survey was conducted among U.S. internal medicine subspecialty fellowship PDs from November to December 2023. The survey collected demographic information about PDs, program-level information, and their views on using social media platforms (Twitter/X and Instagram) and email for program promotion and application review.

Results

Out of 297 PDs who responded (18.5% response rate), 52% were male, 69% identified as White/Caucasian, majority from age group 46-50 years. The subspecialties with the highest representation were infectious disease (15%), pulmonology and critical care (14%), and cardiology (12%). Among respondents, 41% used Twitter/X and 24% used Instagram for program promotion. A smaller fraction reviewed applicants through these platforms for interview invitations (14% via Twitter/X and 7% via Instagram). PDs reported receiving an average of 35 letters of intent emails and calling 36% of applicants for interviews.

Conclusions

This study is the first to assess the value PDs place on social media and email in the fellowship application review process across various internal medicine subspecialties. While social media is a valuable tool for program promotion and engagement, traditional email outreach remains crucial in the interview selection process.

目的随着研究金申请越来越多地过渡到虚拟面试，社交媒体在这一过程中的作用仍不确定。本研究探讨了内科亚专科项目主任（PDs）对当前沟通方式的看法，包括在申请人和项目之间使用社交媒体和电子邮件的情况。方法在 2023 年 11 月至 12 月期间对美国内科亚专科研究金项目主任进行了一次全国性调查。调查收集了PD的人口统计学信息、项目层面的信息，以及他们对使用社交媒体平台（Twitter/X和Instagram）和电子邮件进行项目推广和申请审核的看法。结果在297名回复的PD中（回复率为18.5%），52%为男性，69%被认定为白人/高加索人，年龄大多在46-50岁之间。代表性最高的亚专科是传染病学（15%）、肺病学和重症监护（14%）以及心脏病学（12%）。在受访者中，41% 的人使用 Twitter/X，24% 的人使用 Instagram 进行项目推广。通过这些平台审查申请人面试邀请的比例较低（14% 通过 Twitter/X，7% 通过 Instagram）。该研究首次评估了各内科亚专科的项目主任在奖学金申请审核过程中对社交媒体和电子邮件的重视程度。虽然社交媒体是项目推广和参与的重要工具，但传统的电子邮件推广在面试遴选过程中仍然至关重要。

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引用次数: 0

Post-Acute Sequelae of Covid-19: A System-wise Approach on the Effects of Long-Covid-19 Covid-19 的急性后遗症：长Covid-19影响的系统方法

American journal of medicine open

Pub Date : 2024-06-08 DOI: 10.1016/j.ajmo.2024.100071

The SARS-CoV-2 virus responsible for the COVID-19 pandemic has profoundly impacted global health, economics, and society. This review seeks to encompass an overview of current knowledge on COVID-19, including its transmission, pathogenesis, and clinical presentation related to various systems within the human body. COVID-19 is a highly contagious illness that has rapidly spread worldwide. As of August 4, 2023, the WHO reported over 570 million confirmed cases of COVID-19 and over 6.3 million deaths. Although the virus is most common in adults, children can also be infected. Respiratory droplets that are produced when an infected person coughs or sneezes are the primary transmission mode for COVID-19. Additionally, the virus can be disseminated via contact with contaminated surfaces or objects, as it can remain viable for several hours or days. SARS-CoV-2 is a respiratory virus that enters cells by bonding with the angiotensin-converting enzyme 2 (ACE2) receptor. Once inside the cell, the virus replicates and produces new particles that can infect other cells. Interestingly, the effects of post-acute sequelae of SARS-CoV-2 infection (PASC) encompass more than just respiratory system. The findings presented in the data suggest that PASC significantly impacts multiple organs and their respective physiological processes. In light of these observations, we aim to provide a detailed discussion of the relevant findings in this paper. Through our review, we hope to provide healthcare professionals with a deeper understanding of the effects of PASC on the human body, which could ultimately lead to improved patient outcomes and treatment strategies.

导致 COVID-19 大流行的 SARS-CoV-2 病毒对全球健康、经济和社会产生了深远影响。本综述旨在概述目前有关 COVID-19 的知识，包括其传播、发病机制以及与人体各系统相关的临床表现。COVID-19 是一种高度传染性疾病，已在全球范围内迅速蔓延。截至 2023 年 8 月 4 日，世卫组织报告的 COVID-19 确诊病例超过 5.7 亿例，死亡病例超过 630 万例。虽然这种病毒最常见于成年人，但儿童也可能感染。感染者咳嗽或打喷嚏时产生的呼吸道飞沫是 COVID-19 的主要传播方式。此外，病毒还可通过接触受污染的表面或物体传播，因为病毒可存活数小时或数天。SARS-CoV-2 是一种呼吸道病毒，通过与血管紧张素转换酶 2（ACE2）受体结合进入细胞。一旦进入细胞，病毒就会复制并产生新的颗粒，从而感染其他细胞。有趣的是，SARS-CoV-2 感染后急性后遗症（PASC）的影响不仅仅涉及呼吸系统。数据中的研究结果表明，PASC 会对多个器官及其各自的生理过程产生重大影响。鉴于这些观察结果，我们希望在本文中对相关研究结果进行详细讨论。我们希望通过我们的综述，让医护人员更深入地了解 PASC 对人体的影响，从而最终改善患者的治疗效果和治疗策略。

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