Internal Medicine

Health Equity in the 2024 U.S. Presidential Election | New England Journal of Medicine (nejm.org)

The article outlines how the next U.S. president will face multiple severe epidemics, including maternal mortality, firearm-related deaths, opioid addiction, and obesity. These crises disproportionately affect marginalized groups, with significant disparities in health outcomes between Black and White populations. Kamala Harris and Donald Trump offer starkly different policy approaches, rooted in ideologies of structural inequity versus personal responsibility. Harris supports expanded government intervention, such as extending Medicare and ACA subsidies, while Trump emphasizes deregulation and individual choice. Policies on gun control, reproductive rights, and mental health would also diverge significantly, affecting vulnerable populations differently. Despite these ideological contrasts, the Supreme Court and potential legislative obstacles may constrain either candidate's ability to fully implement their agenda.

Please read the study before answering the poll question!

In a randomized study of 2880 low-income participants, a monthly cash benefit significantly reduced emergency department (ED) visits from 317.5 to 217.1 per 1000 persons, including fewer ED visits leading to hospital admissions and those related to behavioral health and substance use. Outpatient visits to subspecialists increased, especially for those without a car. These findings suggest that poverty alleviation policies, such as cash benefits, may enhance health and access to care.

Effect of Cash Benefits on Health Care Utilization and Health: A Randomized Study | Emergency Medicine | JAMA | JAMA Network

Good article on value-based care!

Types of Evidence Needed to Assess the Clinical Value of Diagnostic Imaging | NEJM Evidence

Despite extensive clinical experience, evidence of competence, and willingness to practice in underserved communities, IMGs experience multiple barriers to entry in the US, including the immigration process, the pathways available for certification and licensing, and institutional reluctance to consider non–US-trained candidates. International medical graduates applying to postgraduate training programs compare favorably with US-trained candidates in terms of clinical experience, prior formal postgraduate training, and research, but have higher application withdrawal rates and significantly lower residency and fellowship match rates, a disparity that may be exacerbated by the recent elimination of objective performance metrics, such as the US Medical Licensing Examination Step 1 score. Once legally in the US, IMGs encounter additional obstacles to board eligibility, research funding, and career progression.

https://jamanetwork.com/journals/jama/article-abstract/2821148

Oral Sebetralstat for On-Demand Treatment of Hereditary Angioedema Attacks

Population:

• Patients with type 1 or type 2 hereditary angioedema (HAE) aged 12 years or older.

• Total of 136 participants were enrolled, with 110 participants included in the full analysis population.

Intervention:

• Oral administration of sebetralstat at doses of 300 mg or 600 mg.

Importance  Youth (those aged <18 years) parental death has been associated with negative health outcomes. Understanding the burden of parental death due to drug poisoning (herein, drugs) and firearms is essential for informing interventions.

Objective  To estimate the incidence of youth parental death due to drugs, firearms, and all other causes.

Design, Setting, and Participants  This cross-sectional observational study was conducted using vital registration, including all US decedents, and census data from January 1990 through December 2020. Data were analyzed from May 30, 2023, to March 28, 2024.

Exposures  Parental death due to drug poisoning or firearms.

Main Outcomes and Measures  A demographic matrix projection model was used to estimate the number and incidence of youth experiencing parental death, defined as the death of 1 or more parents, per 1000 population aged less than 18 years. Analyses evaluated parental deaths by drugs, firearms, and all other causes from 1999 through…

This population-based cohort study in Denmark, examining individuals born between 1977-2018 and followed up to 40 years, found tooth agenesis associated with increased risks of several cancers before 40 years, notably neuroblastoma, nephroblastoma, hepatoblastoma, osteosarcoma, colorectal carcinomas, and bladder carcinomas, with HRs ranging from 2.19 to 7.10. The study highlights the need for further research on the clinical implications of these findings.

Congenital Tooth Agenesis and Risk of Early-Onset Cancer | Oncology | JAMA Network Open | JAMA Network

Excellent presentation and very inspirational!

https://www.vumedi.com/video/finding-joy-in-medical-practice/?token=25a6e358-4f38-4227-8216-eac27822

A nice summary of appetite stimulant therapies in patients with Cachexia

Polypharmacy, which is defined as regular use of five or more medications, increases the risk of adverse medical outcomes.

Patients who take five or more medications can find it difficult to understand and adhere to the complicated regimens.

Risk factors for polypharmacy include having multiple medical conditions that are managed by multiple specialist or subspecialist physicians, residing in a long-term care facility, having poorly updated medical records, and using automated refill services. Inappropriate prescribing of drugs that are not discontinued after their usual effective or recommended period is known as legacy prescribing and can contribute to inappropriate polypharmacy.

According to the Choosing Wisely campaign, any prescriptions beyond a threshold of five medications should trigger a thorough review of the patient’s complete regimen, including over-the- counter medications and dietary supplements, to determine if any of the medications can be discontinued. Tools such as the Beers criteria list and the Medication

Appropriateness…

What are the indications for starting Allopurinol in patients with gout?