JAMA Internal Medicine最新文献

{"title":"From Positive FIT Result to Colonoscopy-Closing a Gap in Care.","authors":"Cary P Gross, Ilana B Richman","doi":"10.1001/jamainternmed.2026.4836","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4836","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":"149109789","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":"Expiration of COVID-19 Pandemic Food Assistance and Food Insufficiency in Adults With Disabilities.","authors":"Banushree Jawaharlal Nehru, Tarang Parekh","doi":"10.1001/jamainternmed.2026.4583","DOIUrl":"10.1001/jamainternmed.2026.4583","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109799","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":"Temporary Cessation of DMARD Therapy and COVID-19 Supplemental Dose Vaccine Immunogenicity in Patients With Inflammatory Arthritis: The COVER Randomized Clinical Trial.","authors":"Jeffrey R Curtis, Amy S Mudano, Gary Cutter, Ted R Mikuls, Michael D George, Geoffrey M Thiele, Mark Law, Kelly Y Chun, Monique Bastidas, Michael Zikry, Sandeep K Sodhi, Jayashree Sinha, John Tesser, Naiara Alvarez, Kevin L Winthrop","doi":"10.1001/jamainternmed.2026.4894","DOIUrl":"10.1001/jamainternmed.2026.4894","url":null,"abstract":"<p><strong>Importance: </strong>The COVID-19 pandemic disproportionately affected patients with autoimmune and rheumatic diseases. Understanding whether certain medications affect the response to a SARS-CoV-2 supplemental dose vaccination is critical for counseling and treating patients receiving targeted immunomodulatory medications. The effect of holding these medications around the time of COVID-19 vaccination on immunogenicity and rheumatic disease outcomes has not been well studied.</p><p><strong>Objective: </strong>To assess whether temporarily holding biologic or targeted synthetic disease-modifying antirheumatic drug therapy improves humoral immunogenicity following COVID-19 supplemental dose vaccination in patients with inflammatory arthritis as well as evaluate whether such interruption worsened disease activity.</p><p><strong>Design, setting, and participants: </strong>The COVID-19 Vaccine Response (COVER) trial was a multicenter randomized clinical pragmatic trial conducted from November 2021 to May 2024 of patients with rheumatoid arthritis, psoriatic arthritis, and axial spondylarthritis who were receiving care in the Excellence Network in Rheumatology to Innovate Care and High-Impact Research (ENRICH) practice-based network. Data were analyzed from June 2024 to April 2026.</p><p><strong>Interventions: </strong>Patients had received a primary messenger RNA COVID-19 vaccine series and were receiving stable immunomodulatory therapy with anti-tumor necrosis factor, anti-interleukin-17, abatacept, and a Janus kinase inhibitor (JAKi). Patients were randomized to continue or hold therapy for 2 weeks following their next COVID-19 supplemental dose administration.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was change in immunoglobulin G levels against the SARS-CoV-2 spike protein from baseline to 6-week follow-up, expressed as the geometric mean fold rise (GMFR). The primary analysis followed an intention-to-treat (ITT) principle, with missing outcomes addressed through multiple imputations. A per-protocol sensitivity analysis was also conducted. Secondary outcomes included disease flares and vaccine-related adverse events.</p><p><strong>Results: </strong>Among 840 randomized participants (continue group: 319 female individuals [76%]; mean [SD] age, 60.0 [12.9] years; hold group: 336 female individuals [80%]; mean [SD] age, 59.1 [12.9] years), substantial increases in SARS-CoV-2 spike immunoglobulin G antibody levels were observed across all groups from baseline to the postdose visit. In the primary ITT analysis, the GMFR ratio (hold/continue) was 0.96 (95% CI, 0.36-2.56), indicating no significant difference in humoral immunogenicity between arms. Results were consistent across drug subgroups and drug half-life categories. Holding therapy significantly increased disease flare risk (odds ratio, 2.27; 95% CI, 1.41-3.65), which was most pronounced among those who used JAKi; the Outcome Measures in Rheumatology RA F","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109728","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":"Landmark Significance and Future Directions of the RAPID-TEST Trial-Core Limitations and Advanced Pathways-Reply.","authors":"Alastair D Hay","doi":"10.1001/jamainternmed.2026.4678","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4678","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":"149109806","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":"Landmark Significance and Future Directions of the RAPID-TEST Trial-Core Limitations and Advanced Pathways.","authors":"Weifeng Yang, Yaling Li, Jun Li","doi":"10.1001/jamainternmed.2026.4675","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4675","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":"149109731","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":"Evaluation of Intervention Strategies to Improve Follow-Up Colonoscopy After Abnormal FIT/FOBT Result: A Systematic Review and Meta-Analysis.","authors":"Wei Yu Chua, Luke Xavier Chew, Claire K M Chan, Zoe Tong, Lok Pui Ng, Cheng Ean Chee, Dawn Chong, Ravindran Kanesvaran, Priyanka Rajendram, Clarence K W Kwan, Andrew B E Kwek, Emile K W Tan, Sze Huey Tan, Lian Leng Low, Michael Pignone, Kennedy Y Y Ng","doi":"10.1001/jamainternmed.2026.4827","DOIUrl":"10.1001/jamainternmed.2026.4827","url":null,"abstract":"<p><strong>Importance: </strong>Colorectal cancer is the second leading cause of cancer mortality worldwide. Early detection through screenings has been shown to improve morbidity and mortality. While fecal immunochemical test (FIT) or fecal occult blood test (FOBT) are established cost-effective screening modalities for colorectal cancer, follow-up colonoscopy screening rates remain suboptimal.</p><p><strong>Objective: </strong>To evaluate interventions targeting colonoscopy completion and the prevalence of colonoscopy completion after an abnormal FIT/FOBT result.</p><p><strong>Data sources: </strong>MEDLINE, Embase, and Cochrane databases were searched from inception to May 9, 2026, and the bibliographies of relevant studies were screened.</p><p><strong>Study selection: </strong>Original studies, published in English, examining nonrandomized interventional studies or randomized clinical trials comparing interventions to improve follow-up colonoscopy after an abnormal FIT/FOBT result were included. Prevalence and risk ratios (RRs) with accompanying 95% CIs for each study were computed, and the results were pooled using a random-effects meta-analysis.</p><p><strong>Data extraction and synthesis: </strong>This study was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Two authors reviewed each study and extracted the data independently, with discrepancies referred to a third independent author.</p><p><strong>Main outcomes and measures: </strong>Outcomes included prevalence and RR of various interventions.</p><p><strong>Results: </strong>A total of 21 studies involving 19 613 patients (8101 female individuals [41.3%] and 11 512 male individuals [58.7%]; age range, 50-75 years) evaluating interventions to improve colonoscopy completion after an abnormal FIT/FOBT result were included. Patient navigation (RR, 1.24; 95% CI, 1.15-1.33; I2 = 57.1), patient reminders (RR, 1.32; 95% CI, 1.04-1.67; I2 = 89.9), clinician reminders (RR, 1.36; 95% CI, 1.12-1.65; I2 = 94.4), and automated referrals to gastrointestinal consult (RR, 1.68; 95% CI, 1.09-2.60; I2 = 91.9) were effective in increasing follow-up colonoscopy completion with moderate to high heterogeneity detected within and across intervention types. Sensitivity analyses excluding outliers resulted in low heterogeneity for patient navigation, patient reminders (messaging), and clinician reminders, while moderate heterogeneity remained for automated referrals. Follow-up colonoscopy increased from 4755 of 10 263 in control to 6272 of 9350 after interventions; pooled prevalence estimates were 47.8% and 69.1%, respectively.</p><p><strong>Conclusions and relevance: </strong>In this systematic review and meta-analysis, patient-level and system-level interventions, including patient navigation, patient reminders, and clinician reminders, are associated with increased completion of follow-up colonoscopy after an abnormal FIT/FOBT result.","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109652","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":"Not All Immunosuppressive Agents Need to Be Interrupted During COVID-19 Vaccination.","authors":"Jin Kyun Park, Eun Bong Lee","doi":"10.1001/jamainternmed.2026.4891","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4891","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":"149109775","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":"Medicare Advantage and Type 2 Diabetes Outcomes.","authors":"Seth A Berkowitz, Myklynn LaPoint, Marlena L Kuhn, Sanjay Basu, Michael G Hudgens, Rachel Gold, Sungchul Park","doi":"10.1001/jamainternmed.2026.3332","DOIUrl":"10.1001/jamainternmed.2026.3332","url":null,"abstract":"<p><strong>Importance: </strong>Medicare Advantage (MA) costs 22% more than original Medicare (OM) for a given individual ($83 billion in annual excess public costs). However, MA may improve type 2 diabetes (T2D) outcomes compared with OM by providing financial protections (eg, annual out-of-pocket spending caps) and supplemental benefits (eg, healthy food assistance) that OM cannot.</p><p><strong>Objective: </strong>To determine whether MA coverage is associated with better T2D outcomes than OM.</p><p><strong>Design, setting, and participants: </strong>A longitudinal cohort study using target trial emulation principles for design and analysis in adults aged 18 years or older receiving OM or MA with T2D, followed up before and after Medicare coverage in community-based health centers (January 2021 to June 2024) across 44 states. Analyses were conducted from September 2025 to May 2026.</p><p><strong>Exposures: </strong>MA or OM coverage.</p><p><strong>Main outcomes and measures: </strong>Hemoglobin A1c (HbA1c) (primary outcome), systolic blood pressure (SBP) and diastolic blood pressure (DBP), low-density lipoprotein (LDL) cholesterol, food insecurity, housing instability, and transportation barriers at 12 months after Medicare coverage (primary time point) and at 6, 18, and 24 months. Statistical analysis accounted for pre-Medicare coverage factors that may influence selection of MA vs OM using targeted minimum loss estimation. Covariates were age, sex, race and ethnicity, comorbidities, income, Social Vulnerability Index, pre-Medicare insurance, Medicaid coverage, and pre-Medicare coverage values for HbA1c, SBP, DBP, LDL cholesterol, body mass index, food insecurity, housing instability, and transportation barriers.</p><p><strong>Results: </strong>In this study in 34 648 adults (19 054 in OM, 15 594 in MA) with T2D, followed up before and after Medicare coverage, the mean (SD) age was 65.24 (9.73) years and 53.42% were women. Twelve months after Medicare coverage, MA was not associated with better HbA1c (mean difference, 0.01; 95% CI, -0.04 to 0.05, P = .74), SBP (-0.15; 95% CI, -0.54 to 0.24; P = .44), DBP (0.06; 95% CI, -0.15 to 0.27; P = .58), or LDL cholesterol (-0.41; 95% CI, -1.24 to 0.42; P = .33), with similar results at other time points. MA was also not associated with a lower risk of food insecurity (relative risk [RR], 1.00; 95% CI, 0.94-1.05), housing instability (RR, 1.00; 95% CI, 0.91-1.09), or transportation barriers (RR, 1.00; 95% CI, 0.93-1.07) at 12 months or any other time point.</p><p><strong>Conclusions and relevance: </strong>In this study, when accounting for factors that may drive MA selection, MA was not associated with better T2D outcomes or fewer health-related social needs than OM. Given substantially higher spending for MA, it is important to ensure this spending is being used effectively to improve health.</p>","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"1246-1255"},"PeriodicalIF":26.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701490","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":"Errors in Discussion and References.","authors":"","doi":"10.1001/jamainternmed.2026.4020","DOIUrl":"10.1001/jamainternmed.2026.4020","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"1284"},"PeriodicalIF":26.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864886","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":"Ticks and Transfusion at the Crossroads-Alpha-Gal Syndrome.","authors":"Marie A Hollenhorst, Jacob R Anderson, Walter Dzik","doi":"10.1001/jamainternmed.2026.3993","DOIUrl":"10.1001/jamainternmed.2026.3993","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"1211-1212"},"PeriodicalIF":26.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813044","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}