JAMA Internal Medicine最新文献

{"title":"From a Viral Application to a Clinical Imperative-Dying Alone.","authors":"Xiang Qi, Julianne Holt-Lunstad","doi":"10.1001/jamainternmed.2026.2775","DOIUrl":"10.1001/jamainternmed.2026.2775","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"1191-1192"},"PeriodicalIF":26.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701501","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":"Coding Errors in Study of Alcohol Use and Obesity.","authors":"Bryant Shuey, Eden Y Bernstein","doi":"10.1001/jamainternmed.2026.3788","DOIUrl":"10.1001/jamainternmed.2026.3788","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"1283-1284"},"PeriodicalIF":26.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701448","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":"Errors in Text, Table, and Figure.","authors":"","doi":"10.1001/jamainternmed.2026.3979","DOIUrl":"10.1001/jamainternmed.2026.3979","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/PMC13458935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701484","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":"Use of Race in Clinical Algorithms-Reply.","authors":"James A Diao, Emma Pierson","doi":"10.1001/jamainternmed.2026.3628","DOIUrl":"10.1001/jamainternmed.2026.3628","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"1283"},"PeriodicalIF":26.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701418","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":"Epidemiologic Study of Transfusion-Related Alpha-Gal Syndrome.","authors":"Richard M Kaufman, Anne G Hoen, Jenna Khan, C Michael Knudson, Ryan A Metcalf, Andres E Mindiola Romero, Allison Mo, Richard Schäfer, Minoko Takanashi, Nancy M Dunbar, Richard M Kaufman, Anne G Hoen, Jenna Khan, C Michael Knudson, Ryan A Metcalf, Andres E Mindiola Romero, Allison Mo, Richard Schäfer, Minoko Takanashi, Sajjad Afraz, Elizabeth S Allen, Jennifer Andrews, Konstanze Aurich, John Casey, Claudia S Cohn, Jensyn K Cone Sullivan, Clara C Cousins, Elizabeth P Crowe, Valeria De Giorgi, Meghan Delaney, Regina M DelBaugh, Colleen W Gilstad, Alexander Gofton, Jeanne E Hendrickson, Kate Hill, Keenan O Hogan, Catherine Humbrecht, Kazuhiko Ikeda, Cyril Jacquot, Ayda Javanbakht, Justin E Juskewitch, Wen Lu, Monique M Menzies Wojtowicz, Maureen J Miller, Georgia Mills, Anna C Nelson, Monica B Pagano, Marie C Pauly, Jessica L Poisson, Jay S Raval, Nabiha H Saifee, Nikitha Samy, Tomohiko Sato, Yoshinori Takeda, Suzanne R Thibodeaux, Pierre Tiberghien, Sheryl van Nunen, Mrigender S Virk, Kamille West-Mitchell, Erica M Wood, Jun Yamanouchi, Satoshi Yoshihara, X Long Zheng, Alyssa Ziman, Nancy M Dunbar","doi":"10.1001/jamainternmed.2026.3983","DOIUrl":"10.1001/jamainternmed.2026.3983","url":null,"abstract":"<p><strong>Importance: </strong>Recent case reports suggest that B antigen-containing blood products may be associated with anaphylactic transfusion reactions in recipients with preformed immunoglobulin E to galactose-α-1,3-galactose (alpha-gal).</p><p><strong>Objective: </strong>To test the association of local alpha-gal syndrome (AGS) prevalence and allergic transfusion reaction (ATR) in patients with blood type O.</p><p><strong>Design, setting, and participants: </strong>In this international, multicenter, retrospective cohort study at academic medical centers, sites were assigned to AGS high- or low-prevalence clusters based on the known geographic distribution of AGS. Data were collected on platelet or plasma transfusions and ATRs during 2020 to 2024. Consecutive patients receiving platelet or plasma transfusions were included.</p><p><strong>Exposures: </strong>Patients with blood type O who received B or AB units and patients with blood type O who received O units (reference group) in AGS high- and low-prevalence clusters were compared.</p><p><strong>Main outcomes and measures: </strong>Before data collection, the hypothesis was that if transfusion-related alpha-gal syndrome (TRAGS) is a true clinical entity, excess ATRs to group B or AB units would be detected in AGS high-prevalence regions exclusively. The main measure was the overall risk ratio (RR) for ATRs to B or AB plasma or platelets in AGS high- vs low-prevalence clusters.</p><p><strong>Results: </strong>In total, 558 823 platelet and plasma transfusions at 40 sites in 5 countries were analyzed, of which ATRs occurred in 1744 transfusions (0.3%). In the US AGS high-prevalence cluster (9 sites), significantly more ATRs of any severity occurred among patients with blood type O who received B or AB units vs patients with blood type O who received O units (overall RR, 3.93; 95% CI, 2.96-5.21; P < .001). In contrast, in the primary analysis of the AGS low-prevalence cluster (15 sites), excess ATRs to B or AB units were not detected. In subgroup analyses among patients with blood type O receiving B units, the RR for moderate to severe ATRs was 9.14 (95% CI, 5.39-15.52; P < .001) in the AGS high-prevalence cluster vs 2.15 (95% CI, 1.34-3.47; P = .002) in the AGS low-prevalence cluster. Outside the US, a signal consistent with TRAGS was not detected.</p><p><strong>Conclusions and relevance: </strong>This cohort study provides provocative epidemiologic evidence that TRAGS may be a unique manifestation of AGS and a previously unrecognized risk associated with transfusion. In AGS high-prevalence regions, blood collectors and hospital transfusion services should consider approaches to preventing severe ATRs from B or AB plasma or platelet units.</p>","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"1202-1211"},"PeriodicalIF":26.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812978","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":"Autonomous Oxygen Titration for Maintaining Normoxemia in Acutely Ill Adults: The SAVE-O2 AI Randomized Clinical Trial.","authors":"David J Douin, John D Rice, Mengli Xiao, Laurel E Beaty, Claire J Guo, Cori Withers, Amy Sullivan, Erin L Anderson, Alex C Cheng, Mary K Banasiewicz, Matthew W Semler, Bradley D Lloyd, Amelia W Maiga, Kevin W Gibbs, Gregory R Stettler, Akram Khan, Mitchell B Sally, Franklin L Wright, Arek J Wiktor, Neil R Aggarwal, Vikhyat S Bebarta, Adit A Ginde","doi":"10.1001/jamainternmed.2026.4023","DOIUrl":"10.1001/jamainternmed.2026.4023","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;For acutely ill adults who are hospitalized with hypoxemia, supplemental oxygen is titrated to maintain normoxemia. In current practice, clinicians intermittently titrate oxygen, potentially exposing patients to hypoxemia and hyperoxemia between assessments. Autonomous oxygen titration may address these challenges by independently titrating supplemental oxygen flow to maintain peripheral oxygen saturation (Spo2) within a predefined range.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine whether autonomous oxygen titration increases the proportion of time spent in a targeted normoxemia range compared with usual care in acutely ill adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This multicenter, unblinded, parallel-group, randomized clinical trial was conducted at 4 US hospitals from May 6, 2024, to November 17, 2025, among adults hospitalized for acute respiratory illness, trauma, burn, or acute care surgery who were receiving supplemental oxygen.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Patients were randomly assigned to receive oxygen titration via either autonomous oxygen titration or usual care (manual oxygen titration by clinicians) during the first 72 hours after randomization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was the proportion of time spent within the targeted normoxemia range (Spo2 90%-96%). The key secondary outcome was the proportion of time spent in hypoxemia (Spo2 &lt;88%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 300 patients randomized and included in the trial population (median [IQR] age, 66 (55-75) years; 162 [54%] female), 152 were assigned to autonomous oxygen titration and 148 to usual care. Participants represented a range of skin pigmentation categories defined by the Monk Skin Tone Scale, including 67 (22%) categorized as light, 168 (56%) as medium, and 65 (22%) as dark. The mean (SE) proportion of time spent in normoxemia was greater in the autonomous oxygen titration group than in the usual care group (85% [1%] vs 63% [2%]; adjusted risk difference [RD], 21 percentage points [pp]; 95% CI, 18-25 pp; P &lt; .001). The mean (SE) proportion of time spent in hypoxemia was lower in the autonomous oxygen titration group than in the usual care group (2.0% [0.2%] vs 3.6% [0.4%]; adjusted RD, -1.3 pp; 95% CI, -2.0 to -0.5 pp; P = .002). The mean (SE) proportion of time spent in hyperoxemia (Spo2 &gt;96%) was 9.2% (1.0%) in the autonomous oxygen titration group and 29.1% (1.7%) in the usual care group. The mean (SE) proportion of time spent in borderline hypoxemia (Spo2 88%-89%) was 3.4% (0.3%) in the autonomous oxygen titration group and 4.0% (0.4%) in the usual care group. Results were consistent across prespecified subgroups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this randomized clinical trial among adults hospitalized with an acute illness or injury and receiving supplemental oxygen, autonomous oxygen titration substantially increased the propo","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"1224-1233"},"PeriodicalIF":26.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13434968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148669572","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":"Telehealth Treatment of Anxiety in Patients With Low-Risk Chest Pain in the Emergency Department: The PACER Randomized Clinical Trial.","authors":"Paul I Musey, Kurt Kroenke, Jill Nault Connors, Timothy E Stump, Yelena Chernyak, Kevin Prather, Chet Montgomery, Patrick O Monahan","doi":"10.1001/jamainternmed.2026.4225","DOIUrl":"10.1001/jamainternmed.2026.4225","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Chest pain is a leading reason for emergency department (ED) visits, with most cases classified as low-risk chest pain (LRCP) after excluding acute coronary syndrome. Many patients with LRCP experience undiagnosed or undertreated anxiety.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine if 2 types of telehealth-delivered cognitive behavioral therapy (CBT) interventions were superior to primary care referral for patients with LRCP and anxiety.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;The Patient-Centered Treatment of Anxiety After Low-Risk Chest Pain in the Emergency Room (PACER) trial was a randomized, 3-group comparative effectiveness trial conducted across 6 university health systems EDs that enrolled adults with LRCP who were discharged from the ED and had at least moderate anxiety (Generalized Anxiety Disorder-7 [GAD-7] score ≥8 or Patient Health Questionnaire [PHQ] panic screener score ≥2) from April 2021 to July 2024 (12-month follow-up was completed by July 2025). Data analysis began in July 2025 and was completed by January 2026.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;All 3 groups received psychoeducation. The 3 interventions compared were (1) recommended primary care follow-up, (2) peer-supported internet-based CBT (iCBT), and (3) therapist-delivered CBT via telehealth.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was change over 12 months in the GAD-7 anxiety score. Secondary outcomes included global anxiety improvement, PHQ-8 depression scores, PHQ-14 somatization scores, and Sheehan Disability Scale scores. Outcomes were assessed at 3, 6, 9, and 12 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 375 patients were enrolled (265 female individuals [70.7%] and 109 male individuals [29.1%]; 125 Black individuals [33.3%], 28 Hispanic individuals [7.5%], 226 White individuals [60.3%], and 22 individuals [5.9%] of other race; mean [SD] age, 39.9 [13.1] years). Adjusted mean improvement in GAD-7 over 12 months was significant within all arms (4.32, 5.54, and 5.13 points in the primary care referral, peer-supported iCBT, and therapist-delivered CBT groups, respectively, for which the baseline SD pooled over groups that was used to calculate all effect sizes was 4.83). Improvement with peer-supported iCBT was 1.22 points greater (95% CI, 0.01-2.43; effect size = 0.25) than primary care referral, and this effect was strongest (2.8 points) among patients with severe anxiety. Depression, somatization, and disability improved moderately within groups, with no significant between-group differences. Odds of patient-reported global anxiety improvement were 3 times higher in the 2 CBT groups compared with primary care referral. Higher engagement was associated with greater anxiety reduction. Therapeutic alliance and program satisfaction were high in both CBT groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;The results of this randomized clinical trial suggest that peer-","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074368","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":"Time to Stop Fasting Before Blood Sampling.","authors":"Liv Tybjærg Nordestgaard, Mie Balling, Børge Grønne Nordestgaard","doi":"10.1001/jamainternmed.2026.4726","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4726","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074382","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":"Policy and Design Considerations for Most-Favored-Nation Drug Pricing.","authors":"Matthew Vogel, Olivier J Wouters","doi":"10.1001/jamainternmed.2026.4520","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4520","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074149","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":"Anxiety and Chest Pain-Taming the Other Elephant.","authors":"Jeffrey A Kline","doi":"10.1001/jamainternmed.2026.4237","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4237","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074830","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}