NEJM evidence最新文献

{"title":"Pharmacogenetic Testing - Evidence, Challenges, and Pathways to Adoption.","authors":"Nihal El Rouby, Julie A Johnson","doi":"10.1056/EVIDra2400343","DOIUrl":"https://doi.org/10.1056/EVIDra2400343","url":null,"abstract":"<p><p>AbstractGenetics plays an important role in the response to some drugs. Clinical pharmacogenetic testing can be used to guide pharmacotherapy selection or dosing to optimize outcomes. Growing evidence over the past decade has led to the identification of numerous pharmacogenetic associations, which have been integrated across multiple clinical areas, including cardiology, primary care, pain management, surgery, and oncology. Increased access to pharmacogenetic testing via national laboratories and pharmacogenetic testing companies has facilitated uptake and heightened public interest. While clinical adoption of pharmacogenetics has increased, challenges remain, including a lack of clinician confidence in navigating the logistics of testing and applying pharmacogenetics results in patient care; limited reimbursement for testing in some cases; the need for extensive outcomes and economic data; and limited inclusion of testing in clinical guidelines. Future opportunities include the broader use of multigene panels, enhanced clinician training, the integration of pharmacogenetic data within electronic health records, and increased documentation of outcomes data from real-world implementation to support insurance coverage.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"4 10","pages":"EVIDra2400343"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dissemination Feasibility Follows Robust Informed Consent.","authors":"Katrina E Hauschildt","doi":"10.1056/EVIDe2500233","DOIUrl":"https://doi.org/10.1056/EVIDe2500233","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"4 10","pages":"EVIDe2500233"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular-Focused Messaging to Improve Influenza Vaccination Rates.","authors":"Ankeet S Bhatt, Natalia C Berry, Rishi V Parikh, Zoe Ballance, Thida C Tan, Ben J Marafino, Haihong Hu, Mark Mummert, Andrew P Ambrosy, Gerardo Hernandez-Diaz, Rebecca Fitch, Svasti Patel, Tor Biering-Sørensen, Brian L Claggett, Niklas Dyrby Johansen, Alexis Jones, Ivy A Ku, Scott D Solomon, Muthiah Vaduganathan, Benjamin Z Galper, Kristine L Lee, Alan S Go","doi":"10.1056/EVIDoa2500208","DOIUrl":"10.1056/EVIDoa2500208","url":null,"abstract":"<p><strong>Background: </strong>Influenza vaccination rates remain suboptimal despite strong evidence of benefit. Electronic letters emphasizing the cardiovascular benefits of vaccination increased uptake in Denmark; whether this strategy is effective in a diverse U.S. population is unknown.</p><p><strong>Methods: </strong>In this prospective, randomized, open, blinded end point trial involving a multiregional health care system, adults were randomly assigned 1:1:1:1 to receive cardiovascular-focused messaging versus usual care messaging to encourage influenza vaccination at two trial time points, yielding four groups, with each in receipt of either two rounds of cardiovascular-focused nudges; a cardiovascular-focused nudge followed by usual care communication; usual care communication followed by a cardiovascular-focused nudge; or two rounds of usual care communication. The primary end point was influenza vaccination receipt through January 1, 2025. Outcomes were assessed across six coprimary comparisons.</p><p><strong>Results: </strong>Overall, 3,668,428 adults were randomly assigned across three U.S. states and Washington, DC. Participants had a mean (±SD) age of 48.36 (±18.11) years, 52.87% (n=1,939,352) were women, 10.53% (n=386,393) were Black, and 702,493 (19.15%) had cardiovascular disease. Overall vaccination rate at the end of the trial was 32.46%. Compared with participants who received two rounds of usual care communication, those receiving cardiovascular-focused messaging at any time point had similar vaccination rates (32.41% vs. 32.60%; absolute change, -0.19 percentage points; 99.2% confidence interval, -0.34 to -0.04). Time to vaccination did not differ.</p><p><strong>Conclusions: </strong>In a large individually randomized trial embedded in routine care across a national U.S. health system, a cardiovascular-focused nudge intervention did not increase influenza vaccination rates on a background of low uptake. Nevertheless, this trial illustrates the feasibility of conducting large care-embedded trials of nudges in U.S. health systems. (Funded by Kaiser Permanente's Garfield Memorial Fund; trial registration, ClinicalTrials.gov NCT06571747.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDoa2500208"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Communicating Results of a Critical Care Trial - A Survey of Participants and Family Members.","authors":"Julie Ménard, Dian Cohen, Marie-Hélène Masse, Neill K J Adhikari, Deborah Cook, Diane Heels-Ansdell, Sheila Sprague, Frédérick D'Aragon, Michelle Kho, François Lamontagne, Annabelle Cumyn","doi":"10.1056/EVIDoa2500056","DOIUrl":"10.1056/EVIDoa2500056","url":null,"abstract":"<p><strong>Background: </strong>Research participants have expressed a clear preference for receiving research results. Although researchers have many obligations toward research participants, these do not typically include disclosure of research results. The primary objective of this survey was to describe the opinions of participants or their substitute decision-makers regarding the communication of results from a trial conducted in the intensive care unit.</p><p><strong>Methods: </strong>A recent international randomized trial of vitamin C versus placebo for sepsis showed harm from vitamin C in the primary analysis. We sent Canadian participants in this trial a letter offering a lay summary of the trial results. If the participant had died or lacked capacity, the letter was sent to their substitute decision-maker. The primary outcome was the proportion of recipients who opted out of receiving the trial summary. Recipients who agreed to receive trial results were invited to complete a survey afterward. Respondents could request to know their treatment assignment; if they did, they were invited to complete the same survey after unblinding.</p><p><strong>Results: </strong>Of 340 potential respondents, 24 (7%) declined to receive trial results (13 participants, 11 substitute decision-makers). Of 316 individuals who received the summary, 139 (44%) completed the survey and, of those, 98 (71%) requested information on treatment assignment. Many did not remember the initial trial (40 out of 93 [43%] participants and 21 out of 31 [68%] substitute decision-makers), but 85% of respondents (118 out of 139) thought that the trial was necessary. The most common views after receiving the trial results were satisfaction (n=52, 37%) and surprise (n=40, 29%). Most respondents stated that researchers should systematically disclose trial results (n=127, 91%) and treatment assignment (n=111, 80%) to participants or substitute decision-makers.</p><p><strong>Conclusions: </strong>Participants and their substitute decision-makers in a critical care trial who responded to our survey largely favored being informed of trial results, and they expressed understanding of the value of research, even when experimental interventions prove harmful. (Funded by the Lotte and John Hecht Foundation and the Canadian Critical Care Research Coordinators Group.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDoa2500056"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eosinophil in EOE - Not Everything That Counts Can Be Counted and Not Everything That Can Be Counted Counts.","authors":"Alex Straumann, Luc Biedermann","doi":"10.1056/EVIDe2500231","DOIUrl":"https://doi.org/10.1056/EVIDe2500231","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"4 10","pages":"EVIDe2500231"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Propensity Scores Work.","authors":"Michael Fralick, C Corey Hardin, Daniel Müller, Stacy Cheavens, Adam Straus, Sharon-Lise Normand, Chana A Sacks","doi":"10.1056/EVIDstat2500246","DOIUrl":"https://doi.org/10.1056/EVIDstat2500246","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"4 10","pages":"EVIDstat2500246"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 40-Year-Old Woman with Pain in the Chest, Hands, and Feet.","authors":"Imran Naeem Aziz, Kirtan Patolia, Arfa Imran, Seba Qaddorah, Marlon Garcia","doi":"10.1056/EVIDmr2500216","DOIUrl":"https://doi.org/10.1056/EVIDmr2500216","url":null,"abstract":"<p><p>AbstractMorning Report is a time-honored tradition where physicians-in-training present cases to their colleagues and clinical experts to collaboratively examine an interesting patient presentation. The Morning Report section seeks to carry on this tradition by presenting a patient's chief concern and story, inviting the reader to develop a differential diagnosis and discover the diagnosis alongside the authors of the case. This report examines the story of a 40-year-old woman who presented to the emergency department for evaluation of chest pain and pain in the joints of her hands and feet. Using questions, physical examination, and testing, an illness script for the presentation emerges; the differential is refined until a final diagnosis is made.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"4 10","pages":"EVIDmr2500216"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nudging the Needle - Strategies to Boost Influenza Vaccination Uptake.","authors":"Kaustav P Shah, Srinath Adusumalli","doi":"10.1056/EVIDe2500230","DOIUrl":"10.1056/EVIDe2500230","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDe2500230"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Exchange about \"A Randomized Trial of Shared Decision-Making in Code Status Discussions\".","authors":"","doi":"10.1056/EVIDe2500134","DOIUrl":"https://doi.org/10.1056/EVIDe2500134","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"4 10","pages":"EVIDe2500134"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peri-Covid-19 Antibiotic Use and Antimicrobial Resistance in Older Adults.","authors":"Derek R MacFadden, Colleen Maxwell, Dawn Bowdish, Susan Bronskill, James Brooks, Kevin Brown, Lori L Burrows, Anna E Clarke, Bradley J Langford, Elizabeth Leung, Valerie Leung, Doug Manuel, Allison McGeer, Sharmistha Mishra, Andrew M Morris, Caroline Nott, Sumit Raybardhan, Mia E Sapin, Kevin L Schwartz, Miranda So, Jean-Paul R Soucy, Nick Daneman","doi":"10.1056/EVIDoa2400108","DOIUrl":"https://doi.org/10.1056/EVIDoa2400108","url":null,"abstract":"<p><strong>Background: </strong>Antibiotic use during the coronavirus disease 2019 (Covid-19) pandemic was common in the outpatient setting, but was not supported by guidelines. We sought to evaluate the role of this antibiotic use on downstream antibiotic resistance.</p><p><strong>Methods: </strong>We performed a population-wide cohort study of all nonhospitalized adults 66 years of age or older in Ontario, Canada, from January 1, 2020, to June 30, 2021, with a first identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We evaluated the relationship between outpatient peri-Covid-19 antibiotic exposure (within a period of 7 days before or after index SARS-CoV-2 reporting) and downstream isolation of an antibiotic-resistant organism from clinical culture within 6 months. We calculated adjusted odds ratios of the association between peri-Covid-19 prescribing and antibiotic-resistant organism detection, as well as the adjusted attributable fractions of downstream antibiotic-resistant organisms.</p><p><strong>Results: </strong>Of the 53,533 eligible individuals included, 8228 (15%) were prescribed a peri-Covid-19 antibiotic, and 1477 (3%) had a downstream antibiotic-resistant organism identified. The adjusted odds ratio for the presence of any antibiotic-resistant organism with peri-Covid-19 antibiotic use was 1.24 (95% confidence interval [CI], 1.09 to 1.41), while the adjusted odds ratio for the presence of gram-negative antibiotic-resistant organisms was 1.27 (95% CI, 1.11 to 1.46) and for gram-positive antibiotic-resistant organisms it was 1.02 (95% CI, 0.70 to 1.48). Among all individuals who received an antibiotic within 7 days of SARS-CoV-2 diagnosis, the attributable fraction of downstream antimicrobial resistance related to peri-Covid-19 antibiotic use was 17% (95% CI, 7 to 26%). Among all individuals with a SARS-CoV-2 diagnosis, the population-attributable fraction of downstream antimicrobial resistance related to peri-Covid-19 antibiotic use was 4% (95% CI, 2 to 7%).</p><p><strong>Conclusions: </strong>Peri-Covid-19 antibiotic use was associated with downstream antimicrobial resistance, and particularly the presence of gram-negative antibiotic-resistant organisms. (Funded by the Canadian Institutes of Health Research Operating Grant [grant number 179461] and others).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"4 10","pages":"EVIDoa2400108"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}