JAMA Internal Medicine最新文献

{"title":"Transplanted-Harvesting Lessons in Uncertainty.","authors":"Teva D Brender","doi":"10.1001/jamainternmed.2025.8252","DOIUrl":"10.1001/jamainternmed.2025.8252","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"507-508"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326111","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":"Cost-Related Medication Nonadherence Before and After the 2024 Inflation Reduction Act Provisions.","authors":"Anna Hung, Timothy S Anderson","doi":"10.1001/jamainternmed.2026.0021","DOIUrl":"10.1001/jamainternmed.2026.0021","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"515-516"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377381","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":"Cannabis and Mental Health: A Review.","authors":"Devan Kansagara, Garth E Terry, Chelsea K Ayers, Deepak C D'Souza","doi":"10.1001/jamainternmed.2025.8215","DOIUrl":"10.1001/jamainternmed.2025.8215","url":null,"abstract":"<p><strong>Importance: </strong>Cannabis use is common among those with mental health conditions, and many people report using cannabis to manage mental health symptoms. It is important for clinicians to understand the lack of clear benefits of cannabis for mental health conditions and the potential for substantial adverse effects.</p><p><strong>Observations: </strong>Overall, the potential benefits of cannabis for mental health conditions remain poorly studied. There is low-certainty evidence that Δ-9-tetrahydrocannabinol (THC)-predominant cannabis may not improve symptoms of posttraumatic stress disorder, and there is largely insufficient evidence to characterize the effects of long-term THC-predominant cannabis use on anxiety, depression, and attention-deficit/hyperactivity disorder. There is emerging low-certainty evidence that the cannabis constituent cannabidiol alone may reduce anxiety in patients with anxiety disorders. THC-predominant cannabis use holds substantial risk for adverse mental health effects, and counseling patients about these risks is crucial to promote safety. These risks include worsening mania symptoms and function in those with bipolar disorder and an increase in psychotic symptoms in those with psychotic spectrum disorders. Among people with past-year cannabis use, about 3 in 10 have cannabis use disorder (CUD), and about one-half those with CUD have moderate or severe disease with negative social, employment, or other adverse outcomes. Regular use of high THC-content products by adolescents and young adults is associated with several concerning risks, including an increased risk of psychosis (estimates range from about 2-fold to 11-fold increased risk), a higher risk of CUD, and self-harm in those with mood disorders. Cannabis use should be avoided in individuals at elevated risk of harms, including adolescents and young adults, those with bipolar or psychotic disorders, pregnant individuals, and those at risk for substance use disorders.</p><p><strong>Conclusions and relevance: </strong>The current evidence base is not sufficient to support the use of cannabis for the treatment of mental health conditions and demonstrates substantial risks of adverse effects. Clinicians should engage patients with mental health conditions in discussions about cannabis use because use is common, has an influence on mental health symptoms, and is likely an important modifiable risk factor for mental health conditions in some populations.</p>","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"618-628"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377409","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 Night I Begin to Become a Physician.","authors":"Mohammad Jay","doi":"10.1001/jamainternmed.2025.8349","DOIUrl":"10.1001/jamainternmed.2025.8349","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"509-510"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377483","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":"Error in Figure 1.","authors":"","doi":"10.1001/jamainternmed.2026.0434","DOIUrl":"10.1001/jamainternmed.2026.0434","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"646"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12973211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377439","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":"Error in Text.","authors":"","doi":"10.1001/jamainternmed.2026.0516","DOIUrl":"10.1001/jamainternmed.2026.0516","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"646"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12993728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147467994","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":"Important Lessons Learned From Eliminating Race-Based Medicine in Kidney Care-Praxis and Policy Matter.","authors":"L Ebony Boulware, Dinushika Mohottige, Tanjala S Purnell","doi":"10.1001/jamainternmed.2026.0009","DOIUrl":"10.1001/jamainternmed.2026.0009","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"531-532"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377511","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":"Wait Time Modifications for Black Transplant Candidates Affected by Race-Based Kidney Function Estimation.","authors":"Rohan Khazanchi, Aaron Fleishman, Nwamaka D Eneanya, Kenneth A Michelson, James A Diao, Michelle Morse, Martha Pavlakis","doi":"10.1001/jamainternmed.2026.0001","DOIUrl":"10.1001/jamainternmed.2026.0001","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Until 2021, national guidelines upheld race-based equations that assigned higher kidney function estimates to Black patients, delaying subspecialist referral and transplant waitlisting. In 2023, the Organ Procurement and Transplantation Network (OPTN) mandated that US kidney transplants programs submit wait time modifications for Black candidates who were disadvantaged by these equations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate whether implementation of the OPTN wait time modification policy was associated with changes in kidney transplant rates by race and ethnicity in the US.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This quasi-experimental study analyzed an OPTN database of all US adult kidney candidates actively waitlisted between January 2022 and June 2025. Interrupted time series analysis evaluated the association of policy implementation with changes in transplant rates using generalized estimating equations adjusted for secular trends, time-varying and time-invariant confounding factors, and a first-order autoregressive covariance structure. Data analyses were performed from July 2024 to July 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Implementation of the OPTN wait time modification policy in January 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Kidney transplant rates by race/ethnicity and dialysis status, with outcome stratification by living and deceased donor kidney transplant (LDKT and DDKT).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The analysis included 181 314 kidney transplant candidates (mean [SD] age, 52.8 [13.1] years; 68 517 females [37.8%] and 112 797 males [62.2%]), including 56 344 Black candidates (31.1%) and 124 970 candidates of all other racial and ethnic groups (68.9%; including American Indian/Alaska Native, Asian, Hispanic/Latino, Native Hawaiian/Other Pacific Islander, White, multiracial, and unknown). From January 2023 through June 2025, 21 119 transplant candidates received wait time modifications, which added a median (IQR; range) of 1.7 (0.9-3.0; 0-21.2) years, and a total of 51 061 person-years of waitlist time. In interrupted time series analyses, among Black candidates, policy implementation was associated with an increase of 5.3 transplants per 1000 listings (95% CI, 3.5 to 7.0), with decreasing transplant rates thereafter (-0.10 transplants per 1000 listings per month; 95% CI, -0.17 to -0.03). Among all other candidates, implementation was associated with no significant change in overall transplant (0.6 transplants per 1000 listings; 95% CI, -1.8 to 0.7) and a parallel decreasing trend thereafter (-0.10 transplants per 1000 listings per month; 95% CI, -0.15 to -0.05). In secondary analyses, policy implementation was associated with increased overall and DDKT rates among Black preemptive and postdialysis candidates, no significant changes in LDKT for either group or DDKT for non-Black and/or Hispanic candidates, and a small secular increase in overall ","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"517-530"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12973219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377548","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":"Holding vs Continuing GLP-1/GIP Agonists Before Upper Endoscopy: The OCULUS Randomized Clinical Trial.","authors":"Akram I Ahmad, Samita Garg, Jeffrey Jacobs, Zaid Ansari, Tasneem Jamal Al-Din, Ashraf Almomani, Sara Valencia, John Vargo, Arjun Chatterjee, Hassan Siddiki, Liang Hong, Michael A Nicolas, Alaina Miller, Tilak Shah","doi":"10.1001/jamainternmed.2026.0027","DOIUrl":"10.1001/jamainternmed.2026.0027","url":null,"abstract":"<p><strong>Importance: </strong>Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are known to increase the risk of retained gastric contents. High-quality data are lacking to guide periprocedure management of GLP-1 and GIP agonists.</p><p><strong>Objective: </strong>To compare the risk of clinically significant residual gastric volume (RGV) in patients who continue vs hold 1 dose of weekly or daily GLP-1 and GIP agonists prior to sedation.</p><p><strong>Design, setting, and participants: </strong>This randomized, single-masked clinical trial conducted at 2 large tertiary referral centers in the US included patients undergoing elective upper endoscopy (EGD) who were receiving GLP-1 or GLP-1/GIP agonists between July 2024 and May 2025. Eligible participants were adults aged 18 years or older, scheduled for EGD with or without colonoscopy, under moderate sedation or monitored anesthesia care, and taking a stable dose of a GLP-1 or GLP-1/GIP agonist for at least 1 month. Exclusion criteria were prior foregut surgery, achalasia, documented gastroparesis, RGV on previous endoscopy, gastric outlet obstruction, planned general anesthesia, or recent opioid use. Data were analyzed May 2025.</p><p><strong>Intervention: </strong>Participants were randomized to either continue their medication or hold 1 dose prior to the procedure.</p><p><strong>Main outcomes and measures: </strong>Clinically significant RGV, a composite of gastric contents that (1) precludes endoscopic examination, (2) requires premature termination or endotracheal intubation, and/or (3) results in an aspiration event that necessitates extended observation or monitoring, unplanned therapeutics, or hospital admission.</p><p><strong>Results: </strong>There were 60 patients (32 holding 1 dose, 28 continuing medication) in the preplanned interim analysis (median [IQR] age, 62.5 [55.5-67.5] years; 30 female [50.0%]). Clinically significant RGV occurred in 3.1% in the hold group vs 25.0% in the continue group (absolute difference, 21.9% [90% CI, 7.0%-36.7%]; P = .003). The trial was terminated early as risk exceeded the preestablished O'Brien-Fleming stopping boundary. In the EGD-only subgroup (35 patients), clinically significant RGV occurred in 46.7% in the continue vs 5.0% in the hold groups (absolute difference, 41.7% [90% CI, 17.9%-65.4%]; P = .001). In the EGD plus colonoscopy subgroup (25 patients), who were on clear liquids the day prior, no patients had clinically significant RGV.</p><p><strong>Conclusions and relevance: </strong>This randomized clinical trial found that continuing GLP-1 or GIP agonist in the preprocedural period increased clinically significant RGV but did not increase the risk of other adverse events. Clear liquids the day prior to the procedure may mitigate the risk of clinically significant RGV regardless of GLP-1/GIP use.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT06533527.</p>","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"578-584"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12993733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468015","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":"JAMA Internal Medicine-The Year in Review, 2025.","authors":"Sharon K Inouye","doi":"10.1001/jamainternmed.2026.0201","DOIUrl":"10.1001/jamainternmed.2026.0201","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"511-513"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468009","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}