Annals of Internal Medicine最新文献

{"title":"Fecal Microbiota Transplantation Versus Vancomycin for Primary <i>Clostridioides difficile</i> Infection : A Randomized Controlled Trial.","authors":"Frederik Emil Juul, Michael Bretthauer, Peter H Johnsen, Faye Samy, Kristian Tonby, Jan Erik Berdal, Dag Arne L Hoff, Eirik H Ofstad, Awet Abraham, Birgitte Seip, Håvard Wiig, Øyvind Bakken Rognstad, Ida F Glad, Jørgen Valeur, Axel E Nissen-Lie, Eivind Ness-Jensen, Kristine M A Lund, Linn K Skjevling, Kurt Hanevik, Hilde Skudal, Ellen J Melsom, Raziye Boyar, Trond J Cooper, Trond E Ranheim, Esben M Riise, Hans-Olov Adami, Mette Kalager, Magnus Løberg, Kjetil K Garborg","doi":"10.7326/ANNALS-24-03285","DOIUrl":"https://doi.org/10.7326/ANNALS-24-03285","url":null,"abstract":"<p><strong>Background: </strong>Fecal microbiota transplantation (FMT) is recommended for recurrent <i>Clostridioides difficile</i> infection (CDI), but its role in primary CDI is unclear.</p><p><strong>Objective: </strong>To investigate the efficacy and safety of FMT in primary CDI.</p><p><strong>Design: </strong>Randomized, open-label, noninferiority, multicenter trial. (ClinicalTrials.gov: NCT03796650).</p><p><strong>Setting: </strong>Hospitals and primary care facilities in Norway.</p><p><strong>Patients: </strong>Adults with CDI (<i>C difficile</i> toxin in stool and ≥3 loose stools daily) and no previous CDI within 365 days before enrollment.</p><p><strong>Intervention: </strong>FMT without antibiotic pretreatment versus oral vancomycin, 125 mg 4 times daily for 10 days.</p><p><strong>Measurements: </strong>The primary end point was clinical cure (firm stools or <3 bowel movements daily) at day 14 and no disease recurrence within 60 days with the assigned treatment alone.</p><p><strong>Results: </strong>Of 104 randomly assigned patients, 100 received FMT or the first dose of vancomycin and were eligible for analysis. Clinical cure and no disease recurrence within 60 days without additional treatment was observed in 34 of 51 patients (66.7%) with FMT versus 30 of 49 (61.2%) with vancomycin (difference, 5.4 percentage points [95.2% CI, -13.5 to 24.4 percentage points]; <i>P</i> for noninferiority < 0.001, rejecting the hypothesis that response to FMT is 25 percentage points lower than response to vancomycin). Eleven patients in the FMT group and 4 in the vancomycin group had additional <i>C difficile</i> treatment. Clinical cure at day 14 and no recurrence with or without additional treatment was observed in 40 of 51 patients (78.4%) with FMT and 30 of 49 (61.2%) with vancomycin (difference, 17.2 percentage points [95.2% CI, -0.7 to 35.1 percentage points]). No significant differences in adverse events were observed between groups.</p><p><strong>Limitations: </strong>Open-label design and reliance on clinical end points.</p><p><strong>Conclusion: </strong>FMT may be considered as first-line therapy in primary CDI.</p><p><strong>Primary funding source: </strong>South-East Norway Health Trust.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309464","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":"Summary for Patients: Semaglutide or Dulaglutide Versus Empagliflozin for Risk for Death and Cardiovascular Outcomes Among Patients With Type 2 Diabetes.","authors":"","doi":"10.7326/ANNALS-24-00775-PS","DOIUrl":"https://doi.org/10.7326/ANNALS-24-00775-PS","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309426","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":"Projected Effects of Proposed Cuts in Federal Medicaid Expenditures on Medicaid Enrollment, Uninsurance, Health Care, and Health.","authors":"Adam Gaffney, David U Himmelstein, Steffie Woolhandler","doi":"10.7326/ANNALS-25-00716","DOIUrl":"https://doi.org/10.7326/ANNALS-25-00716","url":null,"abstract":"<p><p>In January 2025, the Republican majority in the House of Representatives' Budget Committee offered a list of possible spending reductions to offset revenue losses from proposed tax cuts. In May, the Committee advanced a bill incorporating several reductions on the list. The Committee estimated that the 6 largest potential Medicaid cuts (for example, work requirements for some Medicaid enrollees) would each reduce the federal government's Medicaid outlays by at least $100 billion over 10 years. On the basis of the Committee's estimates of savings; Congressional Budget Office analyses; and peer-reviewed studies of the coverage, financial, and health impacts of past Medicaid expansions and contractions, the authors project the likely effects of each option and of the House bill advanced by the Budget Committee in May.</p><p><p>Each option individually would reduce federal Medicaid outlays by between $100 billion and $900 billion over a decade, increase the ranks of the uninsured by between 600 000 and 3 900 000 and the annual number of persons forgoing needed medical care by 129 060 to 838 890, and result in 651 to 12 626 medically preventable deaths annually. Enactment of the House bill advanced in May would increase the number of uninsured persons by 7.6 million and the number of deaths by 16 642 annually, according to a mid-range estimate. These figures exclude harms from lowering provider payments and shrinking benefits, as well as possible repercussions from states increasing taxes or shifting expenditures from other needs to make up for shortfalls in federal Medicaid funding.</p><p><p>Policy makers should weigh the likely health and financial harms to patients and providers of reducing Medicaid expenditures against the desirability of tax reductions, which would accrue mostly to wealthy Americans.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309466","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":"Comparison of Semaglutide or Dulaglutide Versus Empagliflozin for Risk for Death and Cardiovascular Outcomes Among Patients With Type 2 Diabetes : Two Target Trial Emulation Studies.","authors":"Anum Saeed, Suresh R Mulukutla, Floyd Thoma, Lara Lemon, Agnes Koczo, Steven Reis, Oscar Marroquin, Kevin Kip","doi":"10.7326/ANNALS-24-00775","DOIUrl":"https://doi.org/10.7326/ANNALS-24-00775","url":null,"abstract":"<p><strong>Background: </strong>Reduction of premature death and adverse cardiovascular outcomes is a key goal in type 2 diabetes management.</p><p><strong>Objective: </strong>To compare mortality and cardiovascular event risks in patients treated with semaglutide versus empagliflozin and, secondarily, dulaglutide versus empagliflozin.</p><p><strong>Design: </strong>Target trial emulation studies from observational data comparing semaglutide- or dulaglutide-treated patients with propensity score-matched patients treated with empagliflozin.</p><p><strong>Setting: </strong>Health care system of 703 academic and community clinical practices.</p><p><strong>Participants: </strong>Patients aged 45 years or older with type 2 diabetes treated from 1 January 2019 to 31 December 2024 with semaglutide, dulaglutide, or empagliflozin.</p><p><strong>Intervention: </strong>Initial treatment with semaglutide, dulaglutide, or empagliflozin. At baseline, concomitant treatment with other diabetes medication was permitted, excluding other glucagon-like peptide-1 receptor agonists or sodium-glucose cotransporter-2 inhibitors.</p><p><strong>Measurements: </strong>A composite of death, myocardial infarction (MI), or stroke was the primary outcome, and secondary composite outcomes included death or MI, MI or stroke, and individual cardiac events.</p><p><strong>Results: </strong>Patients treated with semaglutide (<i>n</i> = 7899) versus empagliflozin (<i>n</i> = 7899) were followed for a median of 2.2 years; the respective rates of the composite of death, MI, or stroke were 3.7% versus 4.5% at 2 years and 5.9% versus 6.9% at 3 years. Corresponding incidence rates for the composite outcome were 20.99 versus 23.56 per 1000 person-years, with a hazard ratio (HR) of 0.89 (95% CI, 0.78 to 1.02). The HRs for the individual outcomes were 0.97 (CI, 0.81 to 1.15) for death, 0.85 (CI, 0.68 to 1.05) for MI, and 0.62 (CI, 0.43 to 0.89) for stroke. Risks for dulaglutide- and empagliflozin-treated patients were similar for the composite outcome (HR, 1.03 [CI, 0.90 to 1.16]) and for death, MI, and stroke separately.</p><p><strong>Limitation: </strong>Observational study design, lack of data on cause-specific mortality, and residual confounding.</p><p><strong>Conclusion: </strong>Semaglutide treatment seems to confer some advantage over empagliflozin. This advantage was not observed for dulaglutide.</p><p><strong>Primary funding source: </strong>American Heart Association.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309461","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":"How and When to Use Microbial Restoration Therapies for <i>Clostridioides difficile</i> Infection.","authors":"Elizabeth Hohmann","doi":"10.7326/ANNALS-25-01868","DOIUrl":"https://doi.org/10.7326/ANNALS-25-01868","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309465","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":"Screening for Anal Cancer Among Men Who Have Sex With Men With HIV: Benefits, Harms, and Cost-Effectiveness Analyses.","authors":"Ashish A Deshmukh, Haluk Damgacioglu, Keith Sigel, Joel M Palefsky, Megan A Clarke, Nicolas Wentzensen, Alan G Nyitray, Ana Patricia Ortiz, Yueh-Yun Lin, Elizabeth Y Chiao, Elizabeth Stier, Naomi Jay, Michael Gaisa, Yuxin Liu, Eric G Meissner, Gweneth Lazenby, Anna R Giuliano, Stephen E Goldstone, Gary M Clifford, Kalyani Sonawane, Jagpreet Chhatwal","doi":"10.7326/ANNALS-24-01426","DOIUrl":"https://doi.org/10.7326/ANNALS-24-01426","url":null,"abstract":"<p><strong>Background: </strong>Following the success of the ANCHOR (Anal Cancer-HSIL Outcomes Research) trial, the U.S. Department of Health and Human Services recommends anal cancer screening for high-risk persons, particularly men who have sex with men (MSM) with HIV.</p><p><strong>Objective: </strong>To quantify the cost-effectiveness and benefits versus harms of different anal cancer screening strategies.</p><p><strong>Design: </strong>Microsimulation model.</p><p><strong>Data sources: </strong>The ANCHOR trial and published literature.</p><p><strong>Target population: </strong>MSM with HIV.</p><p><strong>Time horizon: </strong>Lifetime.</p><p><strong>Perspective: </strong>Health care sector.</p><p><strong>Intervention: </strong>Cytology alone and human papillomavirus (HPV) testing (high-risk HPV [hrHPV], HPV16/18, and HPV16), co-testing, and triage options; ages at which to begin screening (≥35, ≥40, or ≥45 years); screening interval (annual, biennial, triennial, or quadrennial).</p><p><strong>Outcome measures: </strong>Incremental cost-effectiveness ratios (ICERs) of dollars per quality-adjusted life-year (QALY) and the tradeoff of harms (high-resolution anoscopies [HRAs]) versus benefits (cancer cases averted and life-years gained).</p><p><strong>Results of base-case analysis: </strong>Screening initiation at age 35 years or older using cytology dominated initiation at ages 40 and 45 years or older, with ICERs ranging from $87 731 for a quadrennial interval to $350 100 for an annual interval. In the comparative analysis, the following unique strategies were on the cost-effectiveness frontier: quadrennial HPV16, quadrennial HPV16/18, triennial HPV16/18, triennial hrHPV, biennial HPV16/18, biennial hrHPV, annual cytology with hrHPV triage, and annual hrHPV; ICERs ranged from $81 341 to $2 510 847. In the harm-to-benefit analysis, triage options offered the most efficient HRA use.</p><p><strong>Results of sensitivity analysis: </strong>ICERs decreased for newly eligible persons. For 35-year-old newly eligible MSM with HIV, ICERs for cytology ranged from $70 750 (quadrennial) to $223 895 (annual).</p><p><strong>Limitation: </strong>Findings are not generalizable to other high-risk populations.</p><p><strong>Conclusion: </strong>Anal cancer screening among MSM with HIV aged 35 years or older is cost-effective, but value-based prioritization of strategies is needed to optimize screening use.</p><p><strong>Primary funding source: </strong>National Cancer Institute.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309425","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":"Correction: Vitamin D Deficiency Increases Mortality Risk in the UK Biobank.","authors":"","doi":"10.7326/ANNALS-25-02471","DOIUrl":"https://doi.org/10.7326/ANNALS-25-02471","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309463","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":"Correction: Reducing the Over-Diagnosis of Thyroid Disease.","authors":"","doi":"10.7326/ANNALS-25-02450","DOIUrl":"https://doi.org/10.7326/ANNALS-25-02450","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309462","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":"Precision Social Care Delivery.","authors":"Sahil Sandhu, Michael Liu, Laura M Gottlieb, Rishi Manchanda","doi":"10.7326/ANNALS-25-00323","DOIUrl":"https://doi.org/10.7326/ANNALS-25-00323","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257165","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":"Skeletal Muscle Mass Loss and Glucagon-Like Peptide-1 Receptor Agonists: Are Older Patients at Risk?","authors":"Anjali P Kakkar, Eric Ravussin, Thierry H Le Jemtel","doi":"10.7326/ANNALS-24-03950","DOIUrl":"https://doi.org/10.7326/ANNALS-24-03950","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257170","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}