Annals of Internal Medicine最新文献

{"title":"Comparison of Initial Artificial Intelligence (AI) and Final Physician Recommendations in AI-Assisted Virtual Urgent Care Visits.","authors":"Dan Zeltzer, Zehavi Kugler, Lior Hayat, Tamar Brufman, Ran Ilan Ber, Keren Leibovich, Tom Beer, Ilan Frank, Ran Shaul, Caroline Goldzweig, Joshua Pevnick","doi":"10.7326/ANNALS-24-03283","DOIUrl":"https://doi.org/10.7326/ANNALS-24-03283","url":null,"abstract":"<p><strong>Background: </strong>Whether artificial intelligence (AI) assistance is associated with quality of care is uncertain.</p><p><strong>Objective: </strong>To compare initial AI recommendations with final recommendations of physicians who had access to the AI recommendations and may or may not have viewed them.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Cedars-Sinai Connect, an AI-assisted virtual urgent care clinic with intake questions via structured chat. When confidence is sufficient, AI presents diagnosis and management recommendations (prescriptions, laboratory tests, and referrals).</p><p><strong>Patients: </strong>461 physician-managed visits with AI recommendations of sufficient confidence and complete medical records for adults with respiratory, urinary, vaginal, eye, or dental symptoms from 12 June to 14 July 2024.</p><p><strong>Measurements: </strong>Concordance of diagnosis and management recommendations of initial AI recommendations and final physician recommendations. Physician adjudicators scored all nonconcordant and a sample of concordant recommendations as optimal, reasonable, inadequate, or potentially harmful.</p><p><strong>Results: </strong>Initial AI and final physician recommendations were concordant for 262 visits (56.8%). Among the 461 weighted visits, AI recommendations were more frequently rated as optimal (77.1% [95% CI, 72.7% to 80.9%]) compared with treating physician decisions (67.1% [CI, 62.9% to 71.1%]). Quality scores were equal in 67.9% (CI, 64.8% to 70.9%) of cases, better for AI in 20.8% (CI, 17.8% to 24.0%), and better for treating physicians in 11.3% (CI, 9.0% to 14.2%), respectively.</p><p><strong>Limitations: </strong>Single-center retrospective study. Adjudicators were not blinded to the source of recommendations. It is unknown whether physicians viewed AI recommendations.</p><p><strong>Conclusion: </strong>When AI and physician recommendations differed, AI recommendations were more often rated better quality. Findings suggest that AI performed better in identifying critical red flags and supporting guideline-adherent care, whereas physicians were better at adapting recommendations to changing information during consultations. Thus, AI may have a role in assisting physician decision making in virtual urgent care.</p><p><strong>Primary funding source: </strong>K Health.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778777","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 Dose Escalation Versus Switching to Tirzepatide Among People With Type 2 Diabetes Inadequately Controlled on Lower Doses of Dulaglutide : A Randomized Clinical Trial.","authors":"Liana K Billings, Linsey Winne, Palash Sharma, Elisa Gomez-Valderas, K Karthik Chivukula, Anita Y M Kwan","doi":"10.7326/ANNALS-24-03849","DOIUrl":"https://doi.org/10.7326/ANNALS-24-03849","url":null,"abstract":"<p><strong>Background: </strong>Tirzepatide, a once-weekly glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist approved for the treatment of adults with type 2 diabetes or obesity, showed clinically meaningful reductions in hemoglobin A_1c (HbA_1c) and body weight in the SURPASS phase 3 clinical trial program.</p><p><strong>Objective: </strong>To compare efficacy and safety of escalation of dulaglutide dose versus switching to tirzepatide in inadequately controlled type 2 diabetes.</p><p><strong>Design: </strong>Multicenter, randomized, open-label, phase 4 trial (SURPASS-SWITCH [A Phase 4, Randomized, Open-Label, Active-Controlled Study to Investigate the Efficacy and Safety of Switching from Weekly Dulaglutide to Weekly Tirzepatide in Adults with Type 2 Diabetes], ClinicalTrials.gov: NCT05564039).</p><p><strong>Setting: </strong>38 sites across 5 countries.</p><p><strong>Participants: </strong>Adults with HbA_1c 7.0% or greater to 9.5% or less, stable body weight, body mass index of 25 kg/m² or greater, receiving a stable dose of dulaglutide (0.75 or 1.5 mg) for at least 6 months and 0 to 3 oral antihyperglycemic medications for at least 3 months.</p><p><strong>Intervention: </strong>Escalation of dulaglutide to 4.5 mg or maximum tolerated dose (MTD) or switching to tirzepatide.</p><p><strong>Measurements: </strong>The primary end point was change from baseline in HbA_1c at week 40. The key secondary end point was change from baseline in weight at week 40.</p><p><strong>Results: </strong>A total of 282 adults were randomly assigned to tirzepatide (<i>n</i> = 139) or dulaglutide (<i>n</i> = 143). Change from baseline in HbA_1c at week 40 was -1.44% (SE, 0.07) with tirzepatide, 15 mg or MTD, and -0.67% (SE, 0.08) with dulaglutide, 4.5 mg or MTD (estimated treatment difference, -0.77% [95% CI, -0.98% to -0.56%; <i>P</i> < 0.001]). Change from baseline in weight at week 40 was -10.5 kg (SE, 0.5) with tirzepatide and -3.6 kg (SE, 0.5) with dulaglutide (estimated treatment difference, -6.9 kg [CI, -8.3 to -5.5 kg; <i>P</i> < 0.001]). Serious adverse events were reported by 10 (7.2%) tirzepatide and 10 (7.0%) dulaglutide participants. The most common treatment-emergent adverse events were nausea and diarrhea.</p><p><strong>Limitation: </strong>Open-label design.</p><p><strong>Conclusion: </strong>In SURPASS-SWITCH, switching treatment to tirzepatide provided additional HbA_1c reduction and weight loss compared with escalating treatment with dulaglutide.</p><p><strong>Primary funding source: </strong>Eli Lilly and Company.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778775","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":"Artificial Intelligence in Medical Practice: Is It Ready?","authors":"Jerome P Kassirer","doi":"10.7326/ANNALS-25-00472","DOIUrl":"https://doi.org/10.7326/ANNALS-25-00472","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778717","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":"Cannabis or Cannabinoids for the Management of Chronic Noncancer Pain: Best Practice Advice From the American College of Physicians.","authors":"Devan Kansagara, Kevin P Hill, Jennifer Yost, Linda L Humphrey, Beth Shaw, Adam J Obley, Ray Haeme, Elie A Akl, Amir Qaseem, Andrew S Dunn, Christopher D Jackson, Janet A Jokela, Rachael A Lee, Katherine Mackey, Sameer D Saini, Mark P Tschanz, Timothy J Wilt, Itziar Etxeandia-Ikobaltzeta, Tatyana Shamliyan, Chelsea Vigna","doi":"10.7326/ANNALS-24-03319","DOIUrl":"https://doi.org/10.7326/ANNALS-24-03319","url":null,"abstract":"<p><strong>Description: </strong>The American College of Physicians' Population Health and Medical Science Committee (PHMSC) developed this best practice advice to inform clinicians about what is currently known about the benefits and harms of cannabis or cannabinoids in the management of chronic noncancer pain and to provide advice for clinicians counseling patients seeking this therapy.</p><p><strong>Methods: </strong>The PHMSC considers areas where evidence is uncertain or emerging or practice does not follow the evidence to provide clinical advice based on a review and assessment of scientific work, including systematic reviews and individual studies. Sources of evidence included a living systematic review on cannabis and cannabinoid treatments for chronic noncancer pain and a series of living systematic reviews and primary studies.</p><p><strong>Best practice advice 1a: </strong>Clinicians should counsel patients about the benefits and harms of cannabis or cannabinoids when patients are considering whether to start or continue to use cannabis or cannabinoids to manage their chronic noncancer pain.</p><p><strong>Best practice advice 1b: </strong>Clinicians should counsel the following subgroups of patients that the harms of cannabis or cannabinoid use for chronic noncancer pain are likely to outweigh the benefits: young adult and adolescent patients, patients with current or past substance use disorder, patients with serious mental illness, and frail patients and those at risk for falling.</p><p><strong>Best practice advice 2: </strong>Clinicians should advise against starting or continuing to use cannabis or cannabinoids to manage chronic noncancer pain in patients who are pregnant or breastfeeding or actively trying to conceive.</p><p><strong>Best practice advice 3: </strong>Clinicians should advise patients against the use of <i>inhaled</i> cannabis to manage chronic noncancer pain.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778723","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 Effect of 4:3 Intermittent Fasting on Weight Loss at 12 Months : A Randomized Clinical Trial.","authors":"Victoria A Catenacci, Danielle M Ostendorf, Zhaoxing Pan, Laura K Kaizer, Seth A Creasy, Adnin Zaman, Ann E Caldwell, Jared Dahle, Bryan Swanson, Matthew J Breit, Kristen Bing, Liza T Wayland, Shelby L Panter, Jared J Scorsone, Daniel H Bessesen, Paul MacLean, Edward L Melanson","doi":"10.7326/ANNALS-24-01631","DOIUrl":"https://doi.org/10.7326/ANNALS-24-01631","url":null,"abstract":"<p><strong>Background: </strong>Long-term (≥12 months) randomized trials evaluating the efficacy of intermittent fasting (IMF) as a dietary weight loss strategy are limited. Furthermore, no studies have compared IMF versus daily caloric restriction (DCR) when both interventions are provided in the context of a guidelines-based behavioral weight loss program.</p><p><strong>Objective: </strong>To compare the effects of 4:3 IMF versus DCR on changes in weight at 12 months, with comprehensive behavioral support provided to both groups.</p><p><strong>Design: </strong>Randomized clinical trial. (ClinicalTrials.gov: NCT03411356).</p><p><strong>Setting: </strong>Denver, Colorado, and surrounding metropolitan area.</p><p><strong>Participants: </strong>Adults aged 18 to 60 years with body mass index (BMI) of 27 to 46 kg/m².</p><p><strong>Intervention: </strong>The IMF group was instructed to restrict energy intake by 80% on 3 nonconsecutive days per week, with ad libitum intake (no restriction) the other 4 days (4:3 IMF). The DCR group was instructed to reduce daily energy intake by 34% to match the weekly energy deficit of 4:3 IMF. Both groups received a high-intensity comprehensive behavioral weight loss program that included group-based behavioral support and a recommendation to increase moderate-intensity physical activity to 300 minutes per week.</p><p><strong>Measurements: </strong>The primary outcome was change in body weight (in kilograms) at 12 months.</p><p><strong>Results: </strong>Of the 165 (4:3 IMF, <i>n</i> = 84; DCR, <i>n</i> = 81) randomly assigned participants (mean age, 42 years [SD, 9]; mean BMI, 34.1 kg/m² [SD, 4.4]; 73.9% female), 125 completed the trial. In an intention-to-treat analysis, 4:3 IMF showed greater reductions in weight than DCR at 12 months (mean difference, 2.89 kg [95% CI, 5.65 to 0.14 kg]; <i>P</i> = 0.040).</p><p><strong>Limitation: </strong>Limited generalizability.</p><p><strong>Conclusion: </strong>Compared with DCR, 4:3 IMF resulted in modestly greater weight loss among adults with overweight or obesity enrolled in a 12-month, high-intensity, comprehensive behavioral weight loss program.</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":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750412","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":"What You May Have Missed in 2024: Navigating New Medical Evidence.","authors":"Alfonso Iorio, Christine Laine","doi":"10.7326/ANNALS-25-01164","DOIUrl":"https://doi.org/10.7326/ANNALS-25-01164","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750487","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":"In adults with HF with preserved ejection fraction and obesity, tirzepatide reduced a composite of CV death or worsening HF at 2 y.","authors":"Leslie A Ynalvez, Anita Deswal","doi":"10.7326/ANNALS-25-00468-JC","DOIUrl":"https://doi.org/10.7326/ANNALS-25-00468-JC","url":null,"abstract":"<p><strong>Clinical impact ratings: </strong>GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text] Endocrinology: [Formula: see text].</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750750","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":"In critical illness with suspected sepsis, PCT-guided antibiotics vs. standard care reduced antibiotic duration and was noninferior for 28-d mortality.","authors":"Jack McHugh, Jack O'Horo","doi":"10.7326/ANNALS-25-00906-JC","DOIUrl":"https://doi.org/10.7326/ANNALS-25-00906-JC","url":null,"abstract":"<p><strong>Clinical impact ratings: </strong>GIM/FP/GP: [Formula: see text] Infectious Disease: [Formula: see text] Critical Care: [Formula: see text].</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750767","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":"In men and gender-diverse persons, twice-yearly subcutaneous lenacapavir vs. daily oral F/TDF reduced HIV incidence.","authors":"Fred Arthur Zar","doi":"10.7326/ANNALS-25-00552-JC","DOIUrl":"https://doi.org/10.7326/ANNALS-25-00552-JC","url":null,"abstract":"<p><strong>Clinical impact ratings: </strong>GIM/FP/GP: [Formula: see text] Infectious Disease: [Formula: see text] Public Health: [Formula: see text].</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750769","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":"Infectious Diseases: What You May Have Missed in 2024.","authors":"Heba K A Hamed, Alex Nachman, Nick Riopel, Mindy Schuster","doi":"10.7326/ANNALS-25-00925","DOIUrl":"https://doi.org/10.7326/ANNALS-25-00925","url":null,"abstract":"<p><p>In 2024, infectious disease literature focused on advancements in the treatment of severe infections and prevention of high-burden diseases. Building on prior data, further evidence supports both the use of shorter courses of antibiotics and the earlier transition to oral antibiotics, including for severe infections, such as bacteremia. A new medication has demonstrated significant, high-impact findings in the long-acting category of drugs for the prevention of HIV infection. Antibiotic resistance continues to be a growing threat, and research this year has demonstrated significant advances for new agents helping to combat resistant gram-negative organisms. Research on the long-term sequelae of COVID-19 continues to expand, with a living systematic review providing us a better understanding of symptom management. Novel treatment regimens for <i>Helicobacter pylori</i> infection are being studied, and the evidence is reviewed for these new regimens. Finally, several emerging infections are highlighted to raise awareness of new or concerning outbreaks that may cause significant effects in the coming year.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750772","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}