JAMA Internal Medicine最新文献

{"title":"Fasting Duration and Differences Across Routine Laboratory Tests.","authors":"Sunghwan Shin, Sollip Kim, Shinae Yu, Soo Jin Yoo, Kuenyoul Park, Jeonghyun Chang, Tae-Hyun Um, Chong Rae Cho, Dong Hee Whang","doi":"10.1001/jamainternmed.2026.4718","DOIUrl":"10.1001/jamainternmed.2026.4718","url":null,"abstract":"<p><strong>Importance: </strong>Fasting before blood collection is widely practiced to reduce preanalytical variability, yet whether fasting-related differences are clinically meaningful across a broad panel of routine analytes has not been systematically evaluated using clinical data.</p><p><strong>Objective: </strong>To evaluate whether fasting duration is associated with routine laboratory test results and whether observed differences exceed established analytical performance specifications (APS).</p><p><strong>Design, setting, and participants: </strong>Retrospective single-center cross-sectional study using laboratory information system data collected between February 2021 and December 2023 from a single 670-bed secondary-care university hospital in the Seoul metropolitan area, Republic of Korea. All samples were drawn from outpatients at the institution's central phlebotomy unit. Participants were adult outpatients (≥18 years) with documented fasting duration. Data were analyzed from January 1, 2024, to July 24, 2026.</p><p><strong>Exposure: </strong>Fasting duration derived from the time elapsed between the patient's last meal and blood collection, categorized as less than 8 hours, 8 to 12 hours, and more than 12 hours.</p><p><strong>Main outcomes and measures: </strong>Adjusted means across fasting groups were estimated using linear mixed-effects models with patient-level random intercepts, adjusting for age, sex, and department. Paired within-person analyses among repeatedly tested patients were performed to minimize between-patient confounding. Differences were compared with the European Federation of Clinical Chemistry and Laboratory Medicine biological variation-based total allowable error. Postprandial trends within the subgroup fasting less than 8 hours were assessed at 30-minute intervals.</p><p><strong>Results: </strong>The final dataset comprised 9 755 547 test results from 101 148 patients across 372 test items. Between-group comparisons identified APS-exceeding differences for 27 analytes. However, only 10 were confirmed in paired within-person analyses, suggesting confounding. Glucose (10.8%), triglycerides (20.1%), γ-glutamyl transferase (14.8%), and lipase (36.4%) were higher with less than 8 hours fasting. No analyte exceeded APS between the 8- to 12-hour and more than 12-hour groups. Within the less than 8-hour subgroup, glucose and lactate decreased significantly with increasing fasting duration, whereas lipid concentrations showed no significant linear trend.</p><p><strong>Conclusions and relevance: </strong>This cross-sectional study found that fasting duration was associated with differences exceeding analytical performance specifications for only a few analytes, mainly glucose, triglycerides, γ-glutamyl transferase, and lipase. No estimable within-person difference between the 8- to 12-hour and more than 12-hour groups exceeded an available APS. These findings support analyte-specific rather than uniform fasting requi","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/PMC13621304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074769","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":"Women, Medicine, and AI.","authors":"Rochelle P Walensky, Nicole C McCann","doi":"10.1001/jamainternmed.2026.4880","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4880","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":"149074394","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":"Concern Regarding Reported Testosterone Measurements-Reply.","authors":"Shalender Bhasin, Arthur L Burnett, Karol M Pencina","doi":"10.1001/jamainternmed.2026.4672","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4672","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":"149074816","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":"Concern Regarding Reported Testosterone Measurements.","authors":"Ricardo Branezi Tiraboschi, Cristiano Mendes Gomes, José de Bessa Júnior","doi":"10.1001/jamainternmed.2026.4669","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4669","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":"149074824","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":"Prostate Cancer Screening and Likelihood of Benefit in Veterans Affairs and Fee-for-Service Medicare.","authors":"Alex K Bryant, Adam VanDeusen, Mandi L Klamerus, Brent S Rose, Krithika Suresh, Timothy P Hofer, Sameer D Saini, Tanner J Caverly","doi":"10.1001/jamainternmed.2026.4660","DOIUrl":"10.1001/jamainternmed.2026.4660","url":null,"abstract":"<p><strong>Importance: </strong>Routine prostate-specific antigen (PSA) screening in men with limited life expectancy is low-value care, yet US Department of Veterans Affairs (VA) PSA testing and biopsy rates have not been benchmarked against non-VA care.</p><p><strong>Objective: </strong>To determine whether PSA testing and prostate biopsy rates are associated with likelihood of benefit from screening in VA or fee-for-service (FFS) Medicare primary care.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study used national linked VA-Medicare data for fiscal years 2004 to 2023, with up to 20 years of follow up. A 30% random sample of male veterans 65 years or older who were dually enrolled in VA and FFS Medicare Parts A and B were included; men with prior prostate cancer or only Medicare Advantage enrollment were excluded.</p><p><strong>Exposures: </strong>Time-varying predominant primary care setting (VA, FFS Medicare, or dual use), assigned from primary care visit distribution across systems over a rolling 36-month window.</p><p><strong>Main outcomes and measures: </strong>PSA testing and prostate biopsy rates per 1000 person-years. Contemporary incidence rate ratios (IRRs) were estimated with covariate-adjusted Poisson regression and stratified by age and predicted life expectancy.</p><p><strong>Results: </strong>Among 1.41 million dually enrolled male veterans (mean [SD] age, 71.3 [7.1] years), 8.67 million person-years were observed. PSA testing declined across settings from 2008 to 2017, with steeper declines in the VA system. From 2018 to 2023, among men 80 years or older, adjusted PSA testing rates were 187.9 vs 267.9 per 1000 person-years in VA primary care vs FFS Medicare (IRR, 0.70; 95% CI, 0.69-0.71), and biopsy rates were 3.38 vs 5.05 (IRR, 0.67; 95% CI, 0.60-0.75). Among men with fewer than 5 years predicted life expectancy, PSA testing in the VA setting was lower (IRR, 0.84; 95% CI, 0.82-0.86). Age- and life expectancy-based differences persisted across sensitivity analyses. In contrast, in the primary analysis, PSA testing in the VA setting was higher among men aged 65 to 69 years (IRR, 1.10; 95% CI, 1.09-1.11).</p><p><strong>Conclusions and relevance: </strong>In this cohort study, compared with FFS Medicare, VA primary care was associated with lower PSA testing and biopsy rates among veterans least likely to benefit, suggesting closer alignment of testing intensity with likelihood of benefit.</p>","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/PMC13621314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074091","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":"Dexmedetomidine Use and Intensive Care Unit Admissions for Patients With Medetomidine Withdrawal.","authors":"Tyler G Boyce, Ashish P Thakrar, Bridget R Durkin, Emily R Casey, Lin Xu, Margaret Lowenstein","doi":"10.1001/jamainternmed.2026.4568","DOIUrl":"10.1001/jamainternmed.2026.4568","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074811","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":"Buprenorphine via Telehealth-Closing the Gap for Pregnant and Postpartum Women With Opioid Use Disorder.","authors":"Rachel K Landis, Mishka Terplan, Barbara Andraka-Christou, Jonathan Cantor","doi":"10.1001/jamainternmed.2026.4106","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4106","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016808","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":"Antidiscrimination Laws and Kidney Transplant for Patients With Developmental Disabilities.","authors":"Brittany N Hand, J Madison Hyer, Melica Nikahd, Andrew Gothard, Guy Brock, John Gardner, Lauren Bishop, Lindsay Shea, Lauren Wang, Austin D Schenk","doi":"10.1001/jamainternmed.2026.4392","DOIUrl":"10.1001/jamainternmed.2026.4392","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016733","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":"Steatotic Liver Disease Risk Scores to Predict Cirrhosis and Hepatocellular Carcinoma.","authors":"Catherine Mezzacappa, Janet P Tate, Jessie Torgersen, Melissa Skanderson, Tamar H Taddei, Amy C Justice","doi":"10.1001/jamainternmed.2026.4110","DOIUrl":"10.1001/jamainternmed.2026.4110","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Most individuals with steatotic liver disease (SLD) do not develop advanced liver disease. Multiple risk scores for SLD-associated cirrhosis and hepatocellular carcinoma (HCC) have been proposed, but their utility to inform decisions about surveillance for advanced liver disease is unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the clinical utility of SLD risk scores for predicting cirrhosis and hepatocellular carcinoma in patients with noncirrhotic steatotic liver disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cohort study used data from the national US Veterans Affairs health system of adults with imaging-confirmed SLD without viral hepatitis or primary liver disease from 2008 and 2020. Nine clinical risk scores were calculated at the time of the first imaging results that demonstrated hepatic steatosis. Individuals were followed up until cirrhosis, HCC, death, or 6 months after last follow-up visit. Data were analyzed between November 1, 2025, and May 11, 2026.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Nine risk scores evaluated for prediction of cirrhosis or HCC within 10 years were: (1) ALBI, albumin-bilirubin; (2) aMAP, age-male-albumin-bilirubin-platelet; (3) APRI, the aspartate aminotransferase-to-platelet ratio; (4) BARD, body mass index, age, alanine aminotransferase-to-aspartate aminotransferase ratio, and diabetes; (5) FIB-4, fibrosis-4 index; (6) NFS, nonalcoholic fatty liver disease fibrosis; (7) SAFE, steatosis-associated fibrosis estimator; and 2 additional scores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;First diagnosis of cirrhosis and first diagnosis of HCC identified using VA and Medicare diagnosis codes and data from the VA Cancer Registry. Cox proportional hazards models were used to calculate time-dependent 10-year probabilities of each outcome predicted by 9 risk scores. Decision curves were generated for each outcome by calculating the net benefit, a weighted measure of true and false positives over a prespecified range of risk thresholds at which a clinician may reasonably recommend intervention. Nine risk scales were used to quantify the risk of cirrhosis or HCC within 10 years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The analysis included 853 131 patients (median [IQR] age, 61 [51-68] years; 62 168 females [7.3%] and 790 965 males [92.7%]) whose median (IQR) BMI was 31.3 (27.6-35.5) and 275 898 (32.3%) had diabetes; of these, 33 794 (3.96%) developed cirrhosis and 2978 (0.35%) developed HCC within 10 years. The FIB-4, APRI, and SAFE scores demonstrated the greatest discrimination of cirrhosis risk, while the SAFE, Tate, and FIB-4 scores demonstrated the greatest discrimination of HCC risk. The SAFE score demonstrated the greatest net benefit predicting cirrhosis. A score of 29.5 corresponded to a 10-year cirrhosis risk of 2.5% and yielded a net benefit of 0.019, or 1.9 additional individuals who develop cirrhosis per 100 individuals classified as at-risk patient","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016759","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":"Risk Stratification in Steatotic Liver Disease.","authors":"Melinda Wang","doi":"10.1001/jamainternmed.2026.4120","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4120","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016729","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}