American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

How Well Are Pulses Measured?

Although taking a radial pulse is considered to be an essential clinical skill, there have been few reports on how well it is measured in clinical practice, and how its accuracy and precision are influenced by rate, rhythm, and blood pressure. Methods This study is a retrospective quality audit carried out as part of a […]

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Incidence, Frequency, and Clinical Characteristics of Type 3 Myocardial Infarction in Clinical Practice

Cardiac death in a patient with symptoms and electrocardiographic changes indicative of myocardial ischemia but without available measurements of cardiac biomarkers is designated a type 3 myocardial infarction. We wanted to investigate the incidence, the frequency, and the characteristics of patients diagnosed as type 3 myocardial infarction. Methods The occurrence of deaths in a well-defined […]

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False and Misleading Information About Lyme Disease

  Recently, there has been considerable interest in the topic of fake news. For infectious diseases physicians, false and misleading information about the diagnosis and treatment of Lyme disease is not new. It is increasing in frequency and prominence, creating much confusion among primary care physicians and their patients. Persistent, unexplained subjective symptoms such as […]

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Necrotizing Sarcoid Granulomatosis: Clinico-Radio-Pathologic Diagnosis

A 30-year-old man was referred to the rheumatology outpatient department and seen urgently after developing diplopia over a 4- to 8-hour period and an isolated left fourth cranial nerve palsy associated with a bifrontal and left temporal headache and episodic vertigo. Magnetic resonance imaging of the brain at that time was unremarkable. The following week […]

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doctor putting on gloves

Digital Rectal Exam: Still Relevant After All These Years (video)

In the world of high-tech medicine, the digital rectal exam still has a place. In this current study, researchers showed that performing the digital rectal exam on patients with acute gastrointestinal bleeding provided valuable clinical information. American Journal of Medicine Editor-in-Chief Dr. Joseph S. Alpert explains the clinical implications of this research. (Get out your exam […]

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Osteoporosis

Western Osteoporosis Alliance Clinical Practice Series: Evaluating the Balance of Benefits and Risks of Long-Term

Osteoporosis is a chronic disease that requires life-long strategies to reduce fracture risk. Few trials have investigated the balance of benefits and risk with long-term use of osteoporosis therapies, and fewer still have investigated the consequences of treatment discontinuation. The best available evidence suggests that up to 10 years of treatment with an oral bisphosphonate […]

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Life with One Kidney: Primary Care and the Living Kidney Donor

Living donor kidney transplantation is an excellent option for those with end-stage renal disease, and there have been 133,000 living donors in the US since 1988.1 Donor nephrectomy is considered low-risk surgery, with a perioperative mortality of 0.03% and few major complications. Donors generally fare well after nephrectomy, with most studies showing no increase in long-term […]

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doctor holds tablet and talks to patient

Urine Tests for Chronic Hypokalemia: When in Doubt, Check Urine-Sodium-to-Chloride Ratio

Urine tests are very helpful for the diagnosis of renal and electrolyte disorders. However, ordering and interpreting urine tests properly have been an Achilles heel for many primary care physicians and residents. It is particularly difficult for chronic hypokalemia because the pathophysiological mechanisms behind it can be rather complicated. Traditionally, we use transtubular K+ gradient (TTKG) […]

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The Intention-to-Treat Analysis Is Not Always the Conservative Approach

The randomized trial design can be thought of as a means to answer 2 types of general questions: 1) what is the effect of assigning a treatment?; or 2) what is the effect of receiving a treatment? In public health, we are normally concerned with the first question—the effect of assigning a treatment. If we […]

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Time to Clinically Relevant Fracture Risk Scores in Postmenopausal Women

Clinical practice guidelines recommend use of fracture risk scores for screening and pharmacologic treatment decisions. The timing of occurrence of treatment-level (according to 2014 National Osteoporosis Foundation guidelines) or screening-level (according to 2011 US Preventive Services Task Force guidelines) fracture risk scores has not been estimated in postmenopausal women. Methods We conducted a retrospective competing […]

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