Annals of Internal Medicine最新文献

{"title":"Annals Graphic Medicine - Matters of the Heart.","authors":"C Divyash Chhetri","doi":"10.7326/G24-0020","DOIUrl":"https://doi.org/10.7326/G24-0020","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"eG240020"},"PeriodicalIF":19.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051389","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":"Health Expenditures of Patients With Diabetes After Bariatric Surgery: Comparing Gastric Bypass and Sleeve Gastrectomy.","authors":"Matthew L Maciejewski, Lindsay Zepel, Valerie A Smith, David E Arterburn, Mary K Theis, Aileen Baecker, Caroline Sloan, Amy G Clark, Ryan M Kane, Christopher R Daigle, Karen J Coleman, Aniket A Kawatkar","doi":"10.7326/ANNALS-24-00480","DOIUrl":"https://doi.org/10.7326/ANNALS-24-00480","url":null,"abstract":"<p><strong>Background: </strong>Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) differ in their effects on body weight and risk for reoperation. However, it is unclear whether long-term health expenditures differ by procedure type in patients with diabetes.</p><p><strong>Objective: </strong>To compare health expenditures 3 years before and 5.5 years after bariatric surgery between patients with diabetes undergoing RYGB versus SG.</p><p><strong>Design: </strong>Retrospective cohort study using target trial emulation principles.</p><p><strong>Setting: </strong>Integrated health system.</p><p><strong>Patients: </strong>Patients with diabetes undergoing RYGB (<i>n</i> = 3147) or SG (<i>n</i> = 3510) from 2012 to 2019.</p><p><strong>Measurements: </strong>Total, inpatient, outpatient, and medication expenditures.</p><p><strong>Results: </strong>Characteristics of patients undergoing RYGB and SG were well balanced after weighting; 73% were female, average body mass index was 43.8 kg/m², and average age was 50 years. Expenditures per 6-month period decreased by about 30% for both groups, from $4039.06 (95% CI, $3770.88 to $4326.31) 3 years before to $2441.13 (CI, $2151.07 to $2770.30) 5.5 years after RYGB and from $3918.37 (CI, $3658.75 to $4196.40) 3 years before to $2658.15 (CI, $2279.17 to $3100.16) 5.5 years after SG. Total expenditures after surgery did not differ between groups through 5.5 years (difference at 5.5 years, -$217.02 [CI, -$671.29 to $201.96]) except for the first 6 months, when expenditures were transiently higher in the RYGB group (difference, $564.32 [CI, $232.60 to $895.20]), driven by a higher inpatient admission rate. Otherwise, postsurgical outpatient and medication expenditures did not appear to differ between RYGB and SG.</p><p><strong>Limitation: </strong>Unobserved confounding.</p><p><strong>Conclusion: </strong>Overall expenditures decreased substantially in the postsurgical period, primarily due to reductions in pharmacy expenditures, with no differences between RYGB and SG except in the first 6 months after surgery.</p><p><strong>Primary funding source: </strong>National Institute of Diabetes and Digestive and Kidney Diseases.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051392","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 Association of Epstein-Barr Virus Donor and Recipient Serostatus With Outcomes After Kidney Transplantation : A Retrospective Cohort Study.","authors":"Vishnu S Potluri, Siqi Zhang, Douglas E Schaubel, Salma Shaikhouni, Emily A Blumberg, Sunita D Nasta, Roy D Bloom, Massiel Cruz-Peralta, Rajil B Mehta, Nikhil R Lavu, Bereket Getachew, Srijan Tandukar, Peter P Reese, Chethan M Puttarajappa","doi":"10.7326/ANNALS-24-00165","DOIUrl":"https://doi.org/10.7326/ANNALS-24-00165","url":null,"abstract":"<p><strong>Background: </strong>Prior studies indicate that 1% to 4% of Epstein-Barr virus (EBV)-seronegative recipients of EBV-seropositive donor (EBV D+/R-) kidneys develop posttransplant lymphoproliferative disorder (PTLD). However, these estimates are based on limited data that lack granularity.</p><p><strong>Objective: </strong>To determine the associations between pretransplant EBV D+/R- and recipient EBV-seropositive status (R+) and the outcomes of PTLD and graft and patient survival among adult kidney transplant recipients.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Two large U.S. transplant centers.</p><p><strong>Participants: </strong>Epstein-Barr virus D+/R- and EBV R+ recipients matched 1:3 on donor, recipient, and transplant characteristics between 1 January 2010 and 30 June 2022.</p><p><strong>Measurements: </strong>Exposure was pretransplant donor and recipient EBV serostatus. The primary outcome was biopsy-proven PTLD. Secondary outcomes were all-cause graft loss (death, retransplant, or graft failure) and death. Follow-up was truncated to 3 years after transplant.</p><p><strong>Results: </strong>The final cohort comprised 104 EBV D+/R- recipients matched to 312 EBV R+ recipients. The mean age was 42 years (SD, 17.1), 59% were living donor transplants, and 95% received thymoglobulin induction. Among EBV D+/R- recipients, 50 (48.1%) developed EBV DNAemia, with a median time of 198 days (IQR, 110 to 282 days) after transplantation. Posttransplant lymphoproliferative disorder occurred in 23 (22.1%) EBV D+/R- recipients at a median of 202 days (IQR, 118 to 317 days) after transplantation. Epstein-Barr virus D+/R- recipients had higher all-cause graft failure (hazard ratio, 2.21 [95% CI, 1.06 to 4.63]); mortality was higher but not statistically significant (hazard ratio, 2.19 [CI, 0.94 to 5.13]).</p><p><strong>Limitation: </strong>Two-center study.</p><p><strong>Conclusion: </strong>Compared with previous studies, this study showed that EBV D+/R- kidney recipients face a 5- to 10-fold higher cumulative incidence of PTLD. Strategies to mitigate the PTLD risk are urgently needed.</p><p><strong>Primary funding source: </strong>National Institutes of Health.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051393","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":"Guidelines International Network: Principles for Use of Artificial Intelligence in the Health Guideline Enterprise.","authors":"Bernardo Sousa-Pinto, Manuel Marques-Cruz, Ignacio Neumann, Yuan Chi, Artur J Nowak, Marge Reinap, Mariette Awad, Monika Nothacker, Milana Trucl, Jan Brozek, Pablo Alonso-Coello, Wojtek Wiercioch, Amir Qaseem, Elie A Akl, Holger J Schünemann","doi":"10.7326/ANNALS-24-02338","DOIUrl":"https://doi.org/10.7326/ANNALS-24-02338","url":null,"abstract":"<p><strong>Description: </strong>Artificial intelligence (AI) has been defined by the High-Level Expert Group on AI of the European Commission as \"systems that display intelligent behaviour by analysing their environment and taking actions-with some degree of autonomy-to achieve specific goals.\" Artificial intelligence has the potential to support guideline planning, development and adaptation, reporting, implementation, impact evaluation, certification, and appraisal of recommendations, which we will refer to as \"guideline enterprise.\" Considering this potential, as well as the lack of guidance for the use of AI in guidelines, the Guidelines International Network (GIN) proposes a set of principles for the development and use of AI tools or processes to support the health guideline enterprise.</p><p><strong>Methods: </strong>A GIN working group on AI developed these principles, informed by the results of a scoping review and practical examples, through iterative discussion.</p><p><strong>Recommendations: </strong>Eight principles were identified to adhere to when using AI in the guideline context: transparency, preplanning, additionality, credibility, ethics, accountability, compliance, and evaluation. These complementary principles are described in a comprehensive way, but they do not provide detailed instructions on how to use specific AI tools. Although these principles are expected to apply across different contexts and stages of the guideline enterprise, details on their implementation have some degree of flexibility. Guideline development groups choosing to use AI will be able to adequately implement the principles if they ensure aspects such as structured reporting on the use of AI tools, involvement of experts in AI, and allocation of funding for the adequate use of AI tools. The GIN principles may support guideline developers in the responsible and transparent use of AI to ensure trustworthy guidelines.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051391","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":"ACP Updates Family and Medical Leave Policy.","authors":"Renee Butkus","doi":"10.7326/ANNALS-24-03993","DOIUrl":"https://doi.org/10.7326/ANNALS-24-03993","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051387","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":"ACP Updates Family and Medical Leave Policy.","authors":"Renee Butkus","doi":"10.7326/ANNALS-24-03994","DOIUrl":"https://doi.org/10.7326/ANNALS-24-03994","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051388","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":"Effects of Noise and Public Setting on Blood Pressure Readings : A Randomized Crossover Trial.","authors":"Junichi Ishigami, Hairong Liu, Di Zhao, Ahmed Sabit, Chathurangi H Pathiravasan, Jeanne Charleston, Edgar R Miller, Kunihiro Matsushita, Lawrence J Appel, Tammy M Brady","doi":"10.7326/ANNALS-24-00873","DOIUrl":"https://doi.org/10.7326/ANNALS-24-00873","url":null,"abstract":"<p><strong>Background: </strong>Guidelines emphasize quiet settings for blood pressure (BP) measurement.</p><p><strong>Objective: </strong>To determine the effect of noise and public environment on BP readings.</p><p><strong>Design: </strong>Randomized crossover trial of adults in Baltimore, Maryland. (ClinicalTrials.gov: NCT05394376).</p><p><strong>Setting: </strong>Study measures were obtained in a clinical research office and a public food market near Johns Hopkins University School of Medicine in Baltimore, Maryland.</p><p><strong>Participants: </strong>108 community-dwelling adults from the Baltimore, Maryland, area recruited through measurement-screening campaigns, mailings to previous study participants, and referrals from hypertension clinics.</p><p><strong>Intervention: </strong>Participants were randomly assigned to the order in which they had triplicate BP measurements in each of 3 settings: 1) private quiet office (private quiet [reference]); 2) noisy public space (public loud); and 3) noisy public space plus earplugs (public quiet).</p><p><strong>Measurements: </strong>Differences in mean BP readings obtained in public loud and public quiet versus private quiet, overall and stratified by baseline systolic BP (SBP), age, and recent health care utilization.</p><p><strong>Results: </strong>Of the 108 randomly assigned participants, mean age was 56 years (SD, 17), 84% were self-reported Black, 41% were female, and 45% had an SBP of 130 mm Hg or more. The average noise level in public loud was 74 dB and in private quiet was 37 dB. Mean SBPs were: 128.9 mm Hg (SD, 22.3) in private quiet, 128.3 mm Hg (SD, 21.7) in public loud, and 129.0 mm Hg (SD, 22.2) in public quiet. Corresponding diastolic BPs (DBPs) were 74.2 mm Hg (SD, 11.4), 75.9 mm Hg (SD, 11.6), and 75.7 mm Hg (SD, 12.0), respectively. Public-loud and public-quiet BPs had minimal, non-clinically important differences from private quiet BPs: public loud: ΔSBP, -0.66 mm Hg (95% CI, -2.25 to 0.93 mm Hg) and ΔDBP, 1.65 mm Hg (CI, 0.77 to 2.54 mm Hg); public quiet: ΔSBP, 0.09 mm Hg (-1.53 to 1.72 mm Hg) and ΔDBP, 1.45 mm Hg (0.64 to 2.27 mm Hg). The patterns were generally consistent across subgroups.</p><p><strong>Limitations: </strong>Single-center trial. Imbalance in the numbers and characteristics across the randomly assigned groups.</p><p><strong>Conclusion: </strong>The BP readings obtained in public spaces were minimally different from BPs obtained in a private office, suggesting that public spaces are reasonable settings to screen for hypertension.</p><p><strong>Primary funding source: </strong>Resolve to Save Lives.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051390","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 Promise and Challenges of Genomic Classifiers in Localized Prostate Cancer.","authors":"Syed Arsalan Ahmed Naqvi, Irbaz Bin Riaz","doi":"10.7326/ANNALS-24-03630","DOIUrl":"https://doi.org/10.7326/ANNALS-24-03630","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142997963","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":"Impact of Genomic Classifiers on Risk Stratification and Treatment Intensity in Patients With Localized Prostate Cancer : A Systematic Review.","authors":"Amir Alishahi Tabriz, Matthew J Boyer, Adelaide M Gordon, David J Carpenter, Jeffrey R Gingrich, Sudha R Raman, Deepika Sirohi, Alexis Rompre-Brodeur, Joseph Lunyera, Fahmin Basher, Rhonda L Bitting, Andrzej S Kosinski, Sarah Cantrell, Belinda Ear, Jennifer M Gierisch, Morgan Jacobs, Karen M Goldstein","doi":"10.7326/ANNALS-24-00700","DOIUrl":"https://doi.org/10.7326/ANNALS-24-00700","url":null,"abstract":"<p><strong>Background: </strong>Tissue-based genomic classifiers (GCs) have been developed to improve prostate cancer (PCa) risk assessment and treatment recommendations.</p><p><strong>Purpose: </strong>To summarize the impact of the Decipher, Oncotype DX Genomic Prostate Score (GPS), and Prolaris GCs on risk stratification and patient-clinician decisions on treatment choice among patients with localized PCa considering first-line treatment.</p><p><strong>Data sources: </strong>MEDLINE, EMBASE, and Web of Science published from January 2010 to August 2024.</p><p><strong>Study selection: </strong>Two investigators independently identified studies on risk classification and treatment choice after GC testing for patients with localized PCa considering first-line treatment.</p><p><strong>Data extraction: </strong>Relevant data extracted by 1 researcher and overread by a second. Risk of bias (ROB) was assessed in duplicate.</p><p><strong>Data synthesis: </strong>Ten studies reported risk reclassification after GC testing. In low ROB observational studies, very low- or low-risk patients with PCa were more likely to have their risk levels classified as the same or lower (GPS, 100% to 88.1%; Decipher, 87.2% to 82.9%; Prolaris, 76.9%). However, 1 randomized trial found that GC testing with GPS reclassified 34.5% of very low-risk and 29.4% of low-risk patients to a higher risk category. Twelve observational studies indicated that treatment decisions after GC testing either remained unchanged or slightly favored active surveillance. In contrast, analyses from a single randomized trial found fewer choices for active surveillance after GPS testing.</p><p><strong>Limitations: </strong>Heterogeneity in screening patterns, risk-determination cutoffs, pathology, and clinical practices. Studies on treatment choice were moderate to high ROB.</p><p><strong>Conclusion: </strong>Although GC tests do not consistently influence risk classification or treatment decisions, the differences observed between observational and randomized studies highlight a need for well-designed trials to explore the role of GC tests in patients with newly diagnosed PCa considering first-line treatment.</p><p><strong>Primary funding source: </strong>U.S. Department of Veterans Affairs. (PROSPERO: CRD42022347950).</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998815","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":"Stroke Rehabilitation: Synopsis of the 2024 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines.","authors":"Blessen C Eapen, Johanna Tran, Jennifer Ballard-Hernandez, Andrew Buelt, Carrie W Hoppes, Christine Matthews, Svetlana Pundik, James Reston, Zahari Tchopev, Lisa M Wayman, Tyler Koehn","doi":"10.7326/ANNALS-24-02205","DOIUrl":"https://doi.org/10.7326/ANNALS-24-02205","url":null,"abstract":"<p><strong>Description: </strong>In July 2024, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DOD) released a joint update of their 2019 clinical practice guideline (CPG) for the management of stroke rehabilitation. This synopsis is a condensed version of the 2024 CPG, highlighting the key aspects of the guideline development process and describing the major recommendations.</p><p><strong>Methods: </strong>The VA/DOD Evidence-Based Practice Work Group convened a joint VA/DOD guideline development work group (WG) that included clinical stakeholders and conformed to the Institute of Medicine's tenets for trustworthy CPGs. The guideline WG conducted a patient focus group, developed key questions, and systematically searched and evaluated the literature (English-language publications from 1 July 2018 to 2 May 2023). The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to evaluate the evidence. The WG developed 47 recommendations along with algorithms for stroke rehabilitation in the inpatient and outpatient settings. Stakeholders outside the WG reviewed the CPG before approval by the VA/DOD Evidence-Based Practice Work Group.</p><p><strong>Recommendations: </strong>This synopsis summarizes where evidence is strongest to support guidelines in crucial areas relevant to primary care physicians: transition to community (case management, psychosocial or behavioral interventions); motor therapy (task-specific practice, mirror therapy, rhythmic auditory stimulation, electrical stimulation, botulinum toxin for spasticity); dysphagia, aphasia, and cognition (chin tuck against resistance, respiratory muscle strength training); and mental health (selective serotonin reuptake inhibitor use, psychotherapy, mindfulness-based therapies for treatment but not prevention of depression).</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142997837","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}