The American journal of medicine
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We examined data from 17,498 physicians-in-training who reported on 92,662 months of work over a 20 year study interval that included three major revisions to work hour limits. Extended duration shifts (≥24 hours; EDS) are much less common than they used to be. On average, first-year resident physicians (PGY1s) currently work a total of 4 EDS per year and 3 EDS per month during months in which any EDS are worked. ⋯ More senior resident physicians (PGY2+) have observed concurrent reductions despite their exclusion from the ACGME guidelines limiting EDS. Resident physicians across all levels of training in surgical programs continue to work more EDS than those in medical programs. Similarly, resident physicians on Intensive Care Unit (ICU) rotations work these shifts more frequently compared to other rotations.
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Gastrointestinal (GI) cancers account for one-third of global cancer mortality, with nearly half being preventable. This study updates the global burden of GI cancers attributed to major risk factors: smoking, alcohol, and metabolic disturbances. ⋯ From 2000 to 2021, GI cancer mortality increased substantially, driven primarily by obesity and alcohol. Lower SDI countries are increasingly contributing to the global GI cancer mortality burden. Immediate interventions are necessary to mitigate this growing burden.
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A wide array of products in the category of complementary or alternative medicine for cardiovascular disease and prevention are readily available on online retail platforms. However, a critical assessment of these products, including their therapeutic claims, has not been previously performed. ⋯ Given the popularity of complementary and alternative medicine and their easy accessibility through online retailing, and the fact that prior studies suggest a minority of patients discuss use with their providers, further study is needed to evaluate the extent of and the potential for both undiagnosed drug-drug interactions and replacement of guideline-directed medical treatment for heart failure with unapproved products.
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Persistence of COVID-19 symptoms may follow severe acute respiratory syndrome coronavirus 2 infection. The incidence of long COVID increases with the severity of acute disease, but even mild disease can be associated with sequelae. ⋯ Elevated levels of complement are present in acute COVID-19 patients and may persist at lower levels in long COVID. Evidence supports complement activation, with endotheliopathy-associated disease as the molecular mechanism causing both acute and long COVID.