PET/CT with Myocardial Blood Flow Assessment Is Prognostic of Cardiac Allograft Vasculopathy Progression and Clinical Outcomes.

Cardiac allograft vasculopathy (CAV) causes impaired blood flow in both epicardial vessels and microvasculature and remains a leading cause of posttransplant morbidity and mortality. This study examined the prognostic value and outcomes of CAV, assessed by N-ammonia PET/CT myocardial perfusion imaging in heart transplant recipients. PET/CT and invasive coronary angiography (ICA) were graded using validated scales.

Direct Oral Anticoagulants in Patients With ESRD and Kidney Transplantation.

Direct oral anticoagulant (DOAC) use has significantly increased because major medical organizations endorse their role for conditions in which anticoagulation is indicated. Owing to important pharmacokinetic properties, the use of apixaban and rivaroxaban requires careful consideration in at-risk populations such as those with kidney disease. Both apixaban and rivaroxaban undergo some degree of renal elimination, and thus total drug exposure is increased in patients with renal insufficiency and/or those undergoing renal replacement therapy (RRT).

"The Environment Fostered True Growth": Harnessing Coaching on an Innovative Medicine Sub-internship.

Background: Medicine sub-internships aim to prepare students for residency. However, the traditional sub-internship structure, with multiple learners at varied levels, poses obstacles to providing the clinical exposure, learning environment, and direct observation and feedback necessary to develop essential skills.

Aim: Investigate the educational experience of learners on a coaching-centered sub-internship (CCSI) on a resident uncovered ward service.

Patterns of Weight Change Trajectories and Treatment Response in an Integrated Adult Primary Care Weight Management Practice.

Introduction: Given the significant interindividual variable responses to interventions for obesity, the early identification of factors associated with a differential in weight loss would benefit real-world approaches in clinical practice.

Objective: This study evaluated the factors associated with individual variability in response to enrolling in a weight management program integrated into an academic-based primary care practice.

Methods: Data were retrospectively collected and analyzed for patients referred to a primary care-based weight management practice between 2012 and 2020.

State of the Art in Left Atrial Appendage Occlusion.

Left atrial appendage occlusion (LAAO) has become an important therapeutic target for stroke prevention in patients with nonvalvular atrial fibrillation. Over the past 2 decades, several advancements in LAAO devices (percutaneous and surgical) have been made for stroke prevention and arrhythmia therapy. However, there are several unanswered questions regarding optimal patient selection, the preferred LAAO approach and device, the management of periprocedural and postprocedural complications, including pericardial effusion, device-related thrombus, and device leaks.

Estimating Visual Acuity With Spectacle Correction From Fundus Photos Using Artificial Intelligence.

Importance: Determining spectacle-corrected visual acuity (VA) is essential when managing many ophthalmic diseases. If artificial intelligence (AI) evaluations of macular images estimated this VA from a fundus image, AI might provide spectacle-corrected VA without technician costs, reduce visit time, or facilitate home monitoring of VA from fundus images obtained outside of the clinic.

Objective: To estimate spectacle-corrected VA measured on a standard eye chart among patients with diabetic macular edema (DME) in clinical practice settings using previously validated AI algorithms evaluating best-corrected VA from fundus photographs in eyes with DME.

Long-Term Trajectories of Older Adults Served by an Emergency Department/Hospital-Based Elder Mistreatment Response Program.

Background: An emergency department (ED) visit or hospitalization provides an opportunity to identify elder mistreatment and initiate intervention, but this seldom occurs. To address this, we developed the Vulnerable Elder Protection Team (VEPT), a novel interdisciplinary consultation service. We explored the long-term trajectories of patients receiving VEPT evaluation and intervention.

Ascertaining provider-level implicit bias in electronic health records with rules-based natural language processing: A pilot study in the case of prostate cancer.

Purpose: Implicit, unconscious biases in medicine are personal attitudes about race, ethnicity, gender, and other characteristics that may lead to discriminatory patterns of care. However, there is no consensus on whether implicit bias represents a true predictor of differential care given an absence of real-world studies. We conducted the first real-world pilot study of provider implicit bias by evaluating treatment parity in prostate cancer using unstructured data-the most common way providers document granular details of the patient encounter.

Direct oral anticoagulants or warfarin in patients with left ventricular thrombus after ST-elevation myocardial infarction: a pilot trial and a prespecified meta-analysis of randomised trials.

Background: The role of direct oral anticoagulants (DOACs) in the treatment of left ventricular thrombus (LVT) after ST-elevation myocardial infarction (STEMI) remains uncertain.

Aims: We aimed to compare the effect of rivaroxaban versus warfarin in patients with STEMI complicated by LVT.

Methods: Adult patients with STEMI and two-dimensional transthoracic echocardiography showing LVT were assigned to rivaroxaban (15 mg once daily) or warfarin (international normalised ratio goal of 2.

Role of Antiplatelets and Anticoagulation Therapies in Pregnancy.

Thrombosis is an important cause of morbidity and mortality worldwide. Pregnancy is a hypercoagulable state, and thrombotic complications in pregnancy are a major cause of maternal and fetal morbidity and mortality. Current guidelines support the selective use of aspirin, heparin, and warfarin in pregnant women.

Consensus review and considerations on TMS to treat depression: A comprehensive update endorsed by the National Network of Depression Centers, the Clinical TMS Society, and the International Federation of Clinical Neurophysiology.

This article updates the prior 2018 consensus statement by the National Network of Depression Centers (NNDC) on the use of transcranial magnetic stimulation (TMS) in the treatment of depression, incorporating recent research and clinical developments. Publications on TMS and depression between September 2016 and April 2024 were identified using methods informed by PRISMA guidelines. The NNDC Neuromodulation Work Group met monthly between October 2022 and April 2024 to define important clinical topics and review pertinent literature.

Can the grading of mild cardiac allograft vasculopathy be further refined? An angiographic and physiologic assessment of heart transplant recipients with ISHLT CAV 1.

Background: Cardiac allograft vasculopathy (CAV) results in impaired blood flow in both epicardial vessels and the microvasculature and is a leading cause of poor outcomes in heart transplant (HT) recipients. Most patients have mild (International Society for Heart and Lung Transplantation [ISHLT] CAV 1) disease. This study examined outcomes among those with ISHLT CAV 1 and investigated the value of physiologic assessment via cardiac positron emission tomography/computed tomography (PET/CT) for added risk stratification.

Transjugular Intrahepatic Portosystemic Shunt (TIPS) Check and Revision in a Freestanding Outpatient Facility: Safety and Efficacy.

Aim This study aims to evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) check and revision procedures performed in a freestanding interventional radiology (IR) outpatient facility. Methodology A total of 40 patients (male 31:female 9, median age 60 years old) underwent a TIPS check and/or revision at a freestanding IR outpatient facility between 2009 and 2017. Procedures were performed using a mobile C-arm unit under intravenous (IV) moderate sedation, with the patient discharged home on the same day.

Impact of the CAPTURE COPD Screening Tool in US Primary Care: A Cluster Randomized Trial.

The impact of COPD screening on US primary care clinician behavior and patient outcomes is unclear. Assess the impact of receiving CAPTURE (COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk) screening scores on clinical and patient outcomes. Cluster randomized trial included 49 usual care (COPD education only) and 51 intervention (COPD and CAPTURE education plus screening scores) primary care practices.

Long non-coding RNA fine-tunes bone homeostasis and repair by orchestrating cellular crosstalk and β-catenin-OPG/Jagged1 pathway.

The IncRNA was initially believed to be dispensable for physiology due to the lack of observable phenotypes in knockout (KO) mice. However, our study challenges this conclusion. We found that both KO and conditional KO mice in the osteoblast lineage exhibit significant osteoporosis.

Novel cardiac CT method for identifying the atrioventricular conduction axis by anatomic landmarks.

Background: Understanding the conduction axis location aids in avoiding iatrogenic damage and guiding targeted heart rhythm therapy.

Objective: Cardiac structures visible with clinical imaging have been demonstrated to correlate with variability in the conduction system course. We aimed to standardize and assess the reproducibility of predicting the location of the atrioventricular conduction axis by cardiac computed tomography.

Focusing on Caregiver Neglect: A Novel Strategy for Mistreatment of Older Adults Screening and Intervention.

Mistreatment of older adults is common and has serious health consequences but is under-recognized and under-reported. Screening for mistreatment of older adults and initiation of intervention in primary care clinics may be helpful, but the value of existing tools is not supported by evidence. We argue that shifting the focus to individual sub-types of mistreatment of older adults can provide improved approaches to screening and ultimately to intervention.

Access to Primary Care Telemedicine and Visit Characterization in a Pediatric, Low-Income, Primarily Latino Population: Retrospective Study.

Background: Since the COVID-19 pandemic, telemedicine has been widely integrated into primary care pediatrics. While initial studies showed some concern for disparities in telemedicine use, telemedicine uptake for pediatric patients in a low-income, primarily Latino community over a sustained period has yet to be described.

Objective: We aimed to assess the relationship between demographics, patient portal activation, and telemedicine visits, as well as characterize diagnoses addressed in telemedicine, in a low-income, primarily Latino population over time.

Beyond Do No Harm: Introduction to Green Radiology.

In 2021, the Human Rights Council declared that having a clean, healthy, and sustainable environment is a human right. According to the WHO, 24% of deaths are attributable to environmental health risks and are largely preventable. Current predictions show that rising emissions will be linked to an enormous healthcare burden, especially for high-risk populations and historically disadvantaged communities.