JAMA Internal Medicine最新文献

{"title":"Emergency Department Hepatitis C Virus Testing-To Do or Not to Do?","authors":"Edouard Coupet, Kathryn F Hawk, Gail D'Onofrio","doi":"10.1001/jamainternmed.2026.5172","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.5172","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Effectiveness of Phenobarbital vs Diazepam for Alcohol Withdrawal Syndrome.","authors":"Tess Bradley, Megan Feeney, Anica C Law, Alyssa F Peterkin, Kathryn L Fantasia, Allan J Walkey, Nicholas A Bosch","doi":"10.1001/jamainternmed.2026.4939","DOIUrl":"10.1001/jamainternmed.2026.4939","url":null,"abstract":"<p><strong>Importance: </strong>Phenobarbital use for alcohol withdrawal syndrome is increasing, but its effectiveness and safety have largely been compared with lorazepam rather than against more pharmacokinetically similar long-acting, self-tapering benzodiazepines such as diazepam.</p><p><strong>Objective: </strong>To emulate a clinical trial comparing patients randomized to phenobarbital vs diazepam for alcohol withdrawal syndrome.</p><p><strong>Design, setting, and participants: </strong>This multicenter comparative effectiveness research study analyzed data from the Premier Healthcare Database (October 2022 to August 2024), representing 754 US acute care hospitals. Adult inpatients with a primary diagnosis of alcohol withdrawal syndrome present on admission who initiated phenobarbital or diazepam on the day of hospital admission were included.</p><p><strong>Exposures: </strong>Initiation of phenobarbital or diazepam on the day of hospital admission.</p><p><strong>Main outcomes and measures: </strong>The primary effectiveness outcome was hospital length of stay in days. The primary safety outcome was invasive mechanical ventilation use. Secondary outcomes assessed treatment escalation, complications of severe alcohol withdrawal syndrome, and resource utilization. Targeted maximum likelihood estimation with ensemble machine learning was used to estimate marginal mean differences and risk differences between exposure groups.</p><p><strong>Results: </strong>Among 24 643 patients (median [IQR] age, 45 [35-56] years; 18 511 male [75.1%]), 11 919 (48.4%) received phenobarbital and 12 724 (51.6%) received diazepam on the day of admission. There were no differences in hospital length of stay (marginal mean, 4.1 vs 4.3 days; marginal mean difference, -0.21 [95% CI, -0.42 to 0.00] days) or invasive mechanical ventilation use (marginal risk, 3.1% vs 2.7%; marginal risk difference, 0.4% [95% CI, -0.7% to 1.4%]) between initiation of phenobarbital vs diazepam. Secondary outcomes were also not different between phenobarbital and diazepam, except for self-directed discharge, which was more frequent among those initiated on diazepam (marginal risk, 9.5% vs 12.6%; marginal risk difference, -3.1% [95% CI, -4.9% to -1.3%]).</p><p><strong>Conclusions and relevance: </strong>In this multicenter study of patients hospitalized for alcohol withdrawal syndrome, there were no differences in hospital length of stay or the need for invasive mechanical ventilation between initiation of phenobarbital vs diazepam. These results may suggest near therapeutic equivalence between phenobarbital and long-acting benzodiazepines.</p>","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morning Stiffness as a Sentinel Symptom-Refining Inflammatory Arthritis Screening in Older Adults-Reply.","authors":"Justin B Levinson, Jiha Lee, Una E Makris","doi":"10.1001/jamainternmed.2026.4684","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4684","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Communicating Uncertainty and Influence on Treatment Decision-Making by Patients.","authors":"Alexander Chaitoff, Sharon K Inouye, Ilana B Richman","doi":"10.1001/jamainternmed.2026.4982","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4982","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Growing Role of Phenobarbital in Managing Inpatient Alcohol Withdrawal Syndrome.","authors":"Timothy M Dempsey, Timothy S Anderson","doi":"10.1001/jamainternmed.2026.4946","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4946","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Framework for Durable Genomic Interventions.","authors":"Eric D Smith, Venkatesh L Murthy","doi":"10.1001/jamainternmed.2026.4690","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4690","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morning Stiffness as a Sentinel Symptom-Refining Inflammatory Arthritis Screening in Older Adults.","authors":"Qingfei Kong, Wen Xiao","doi":"10.1001/jamainternmed.2026.4681","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4681","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in US Life Expectancy From 2019 to 2024.","authors":"Deborah Dowell, Fang Xu, Xinyi Jiang, Gery Guy, Nisha Nataraj, Jean Ko, Grant Baldwin","doi":"10.1001/jamainternmed.2026.4589","DOIUrl":"10.1001/jamainternmed.2026.4589","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Communicating Uncertainties About the Benefits and Risks of New Cancer Drugs: Two Randomized Clinical Trials.","authors":"Avi Cherla, Anita K Wagner, Steven Woloshin, Courtney Davis, Florence T Bourgeois, Elias Mossialos, Huseyin Naci","doi":"10.1001/jamainternmed.2026.4969","DOIUrl":"10.1001/jamainternmed.2026.4969","url":null,"abstract":"<p><strong>Importance: </strong>Cancer drugs are frequently approved based on uncertain benefits and risks that are not communicated to patients.</p><p><strong>Objective: </strong>To evaluate the effect of communicating uncertainties about the benefits and risks of new cancer drugs on changes in individuals' hypothetical decisions to take the drug.</p><p><strong>Design, setting, and participants: </strong>Two randomized clinical trials recruited online a demographically diverse sample of US adults (census matched for age, sex, education, income, and race and ethnicity) from May 9 to July 26, 2025.</p><p><strong>Intervention: </strong>Plain-language statements describing uncertainties about drug benefits and risks. Trial 1 randomized participants to 1 of 5 uncertainties: (1) single-arm trial design, (2) unrepresentative population in terms of race and ethnicity, (3) short study duration, (4) surrogate end point, or (5) no noticeable improvement. Trial 2 randomized participants to 1, 2, 3, or 4 uncertainties or to a control group.</p><p><strong>Main outcomes and measures: </strong>The primary outcome in trial 1 was changes in hypothetical decisions to take a new cancer drug (within-group difference), while in trial 2 the primary outcome was the change in between-group differences in hypothetical decisions (control vs intervention groups). Secondary outcomes included perceived treatment effectiveness, worry associated with taking the drug, and trust in the information and the US Food and Drug Administration.</p><p><strong>Results: </strong>A total of 6272 adults were included in the primary analysis (3102 [49.5%] women). In trial 1, learning about uncertainties reduced hypothetical decisions to take the drug by a mean of 10.1 percentage points (pp; 95% CI, -11.7 to -8.5 pp; P < .001). The reduction in hypothetical decisions to take the drug was observed for all uncertainties, including among those in the group that learned that it was unknown whether patients would notice an improvement with the drug (-14.1 pp; 95% CI, -17.9 to -10.4 pp; P < .001) and those who learned that the drug was not studied in patients of similar race or ethnicity (-12.8 pp; 95% CI, -16.4 to -9.2; P < .001). In trial 2, hypothetical decisions to take the drug decreased with each additional uncertainty, demonstrating a dose-dependent effect. Learning about uncertainties reduced perceived effectiveness and trust but did not affect worry.</p><p><strong>Conclusions and relevance: </strong>In 2 randomized clinical trials including a demographically diverse sample of US adults, learning about common uncertainties with a new cancer drug's benefits and risks reduced hypothetical decisions to take the drug.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifiers: NCT06997185 and NCT07110597.</p>","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The UK Delivers a Tobacco-Free Generation-But Is the Real Prize Global?","authors":"Sarah E Jackson, Hazel Cheeseman, Jamie Brown","doi":"10.1001/jamainternmed.2026.4687","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4687","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}