Annals of Internal Medicine最新文献

{"title":"Correction: Hypertension.","authors":"","doi":"10.7326/ANNALS-26-04207","DOIUrl":"https://doi.org/10.7326/ANNALS-26-04207","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223103","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":"Bemotrizinol Approval: A Step Toward U.S. Sunscreen Modernization.","authors":"Aaron D Smith, Micaela A Shulman","doi":"10.7326/ANNALS-26-02686","DOIUrl":"https://doi.org/10.7326/ANNALS-26-02686","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223067","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":"Iron Deficiency in Women: A Silent Pandemic With Consequences That May Reach the Classroom.","authors":"Michael Auerbach, Malcolm G Munro","doi":"10.7326/ANNALS-26-03091","DOIUrl":"https://doi.org/10.7326/ANNALS-26-03091","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223128","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":"We Need to Evaluate the Benefits and Harms of Clinical AI: This Is a Start.","authors":"Deborah Korenstein, Daniel J Morgan","doi":"10.7326/ANNALS-26-03798","DOIUrl":"https://doi.org/10.7326/ANNALS-26-03798","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223002","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":"Medicare Advantage Diagnoses at Home: Two Questions, One Answer.","authors":"Richard Kronick","doi":"10.7326/ANNALS-26-03680","DOIUrl":"https://doi.org/10.7326/ANNALS-26-03680","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223077","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":"Q&A: ACP's new leader plans change and growth.","authors":"Jennifer Kearney-Strouse","doi":"10.7326/ANNALS-26-04297-IM","DOIUrl":"https://doi.org/10.7326/ANNALS-26-04297-IM","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223032","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":"Management of Menopausal Symptoms.","authors":"Christine Laine, Amir Qaseem, Barbara J Turner","doi":"10.7326/ANNALS-26-04121","DOIUrl":"https://doi.org/10.7326/ANNALS-26-04121","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223069","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":"Overuse and False Restraint in Large Language Model Recommendations for Choosing Wisely Scenarios.","authors":"Dean Ariel, Stav Endelman, Guy Laban","doi":"10.7326/ANNALS-26-01667","DOIUrl":"https://doi.org/10.7326/ANNALS-26-01667","url":null,"abstract":"<p><strong>Background: </strong>The Choosing Wisely initiative made recommendations where screening, testing, or treatment may be overused, with caveats around appropriate use. Clinicians are increasingly using large language models (LLMs).</p><p><strong>Objective: </strong>To evaluate whether commercial LLMs appropriately call for restraint or action from scenarios based on Choosing Wisely recommendations.</p><p><strong>Design: </strong>Benchmark evaluation. Fifteen Choosing Wisely recommendations were used to develop 225 scenarios (per recommendation, 10 in which restraint was appropriate and 5 in which action was appropriate). Six commercial LLMs (3 runs each) generated 4050 responses to the 225 scenarios, using a prompt from the clinician perspective.</p><p><strong>Setting: </strong>Production application programming interfaces of OpenAI, Anthropic, and Google from February to March 2026.</p><p><strong>Participants: </strong>No human participants were involved.</p><p><strong>Measurements: </strong>Co-primary outcomes were the overuse rate (endorsing action when restraint was appropriate) and the false restraint rate (withholding an appropriate action).</p><p><strong>Results: </strong>The rate of LLM-recommended overuse was 5.4% (95% CI, 0.6% to 12.2%); LLMs did not recommend overuse in 8 of 15 recommendations. Two recommendations accounted for most LLM-recommended overuse: thyroid ultrasound for an incidental subcentimeter nodule (overuse recommended in 42.8% of LLM responses) and routine electrocardiography in low-risk adults (overuse recommended in 28.3% of LLM responses). The LLMs recommended overuse in 0.6% to 3.3% of responses for the remaining 5 recommendations. False restraint was rare (0.6% [CI, 0.1% to 1.2%]), was absent for 11 of 15 recommendations, and was highest for prostate-specific antigen screening (3.3%).</p><p><strong>Limitations: </strong>Single prompts without follow-up; a benchmark rather than real-world use; responses classified by LLM judge with physician adjudication. Findings may not extend to consumer-facing use.</p><p><strong>Conclusion: </strong>The LLMs rarely withheld recommendations for treatment when it was appropriate. Overuse was concentrated in 2 recommendations.</p><p><strong>Primary funding source: </strong>None.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223082","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":"Diagnosis and Treatment of Cardiovascular Conditions in Medicare Advantage In-Home Health Risk Assessments.","authors":"Andrew S Oseran, Michael Liu-Hass, Bassel M Shanab, Zhaonian Zheng, Christina Lalani, Robert W Yeh, Rishi K Wadhera","doi":"10.7326/ANNALS-26-01366","DOIUrl":"https://doi.org/10.7326/ANNALS-26-01366","url":null,"abstract":"<p><strong>Background: </strong>Medicare Advantage insurers conduct in-home health risk assessments (HRAs) to identify high-risk patients and facilitate appropriate care. Critics argue this practice increases risk-adjusted payments without improving quality. Comprehensive data on use of in-home HRAs and downstream treatment are lacking.</p><p><strong>Objective: </strong>To examine trends in cardiovascular conditions diagnosed during in-home HRAs, characteristics associated with HRA-based diagnoses, and treatment rates after diagnoses.</p><p><strong>Design: </strong>Cohort study.</p><p><strong>Setting: </strong>Population-based.</p><p><strong>Participants: </strong>Medicare Advantage beneficiaries.</p><p><strong>Measurements: </strong>Using 100% Medicare claims, trends in the proportion of cardiovascular conditions diagnosed during in-home HRAs (vs. facility-based visits) were examined. Multivariable logistic regression models were fit to estimate the association between beneficiary- and plan-level characteristics and HRA-based diagnoses and compare treatment rates across settings.</p><p><strong>Results: </strong>Among 21 496 506 Medicare Advantage beneficiaries diagnosed with a cardiovascular risk factor or disease, the proportion diagnosed during in-home HRAs increased between 2018 and 2022 for hypertension (45.9% to 47.7%), hyperlipidemia (57.8% to 66.7%), diabetes (47.8% to 51.6%), atrial fibrillation (30.0% to 36.0%), ischemic heart disease (37.2% to 41.6%), peripheral vascular disease (64.5% to 73.9%), and heart failure (34.7% to 42.6%). Racial and ethnic minority beneficiaries and those enrolled in lower-rated plans were more likely to receive HRA-based diagnoses. Treatment rates were substantially lower after HRA-based diagnoses across all conditions.</p><p><strong>Limitations: </strong>Differences in the severity of conditions between groups could not be assessed. Prescription fills were used as a proxy for management. Observed differences in the diagnosis and treatment of conditions across encounter settings may be susceptible to unmeasured confounding.</p><p><strong>Conclusion: </strong>Among Medicare Advantage beneficiaries, an increasingly large share of cardiovascular conditions are being diagnosed through in-home HRAs, but treatment rates after these diagnoses are consistently lower than after facility-based encounters.</p><p><strong>Primary funding source: </strong>National Heart, Lung, and Blood Institute.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223135","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 Effect of 2026 Federal Changes to the Childhood Immunization Schedule on Chronic Hepatitis B Virus Infections in the United States.","authors":"Amir M Mohareb, Lakshmi Ganapathi, Caitlin M Dugdale, Ruma Rajbhandari, Andrea Ciaranello, Anne M Neilan, Ravi Jhaveri, Arthur Y Kim, Emily P Hyle","doi":"10.7326/ANNALS-26-02135","DOIUrl":"https://doi.org/10.7326/ANNALS-26-02135","url":null,"abstract":"<p><strong>Background: </strong>The United States recently proposed changes to the recommendations for childhood hepatitis B virus (HBV) vaccination.</p><p><strong>Objective: </strong>To project the effect of vaccine policy changes, if fully implemented, on chronic HBV infections.</p><p><strong>Design: </strong>Markov cohort state transition model of perinatal and childhood HBV infection.</p><p><strong>Data sources: </strong>Published data on maternal HBV prevalence (0.4%) and hepatitis B surface antigen testing (99.5% sensitivity), childhood vaccine completion (universal birth-dose strategy: 91.1%; deferred strategy: 87.1%; shared decision-making strategy: 50.0%), and age-stratified risk for chronic HBV infection.</p><p><strong>Target population: </strong>One-year birth cohort of U.S.-born infants (<i>n</i> = 3.6 million).</p><p><strong>Time horizon: </strong>20 years.</p><p><strong>Intervention: </strong>Universal birth-dose vaccination, deferred (2-month) vaccination, and vaccination through shared decision making.</p><p><strong>Outcome measures: </strong>Numbers with chronic HBV infection and susceptibility to HBV, with 95% uncertainty intervals (UIs) derived from probabilistic sensitivity analysis.</p><p><strong>Results of base-case analysis: </strong>Compared with the universal birth-dose strategy (255 childhood infections [95% UI, 130 to 530]), the deferred and shared decision-making strategies would increase chronic HBV infections in the 2026 birth cohort by 19% to 303 (95% UI, 155 to 610) and by 83% to 467 (95% UI, 209 to 1032), respectively. These strategies would also increase the number of HBV-susceptible people at year 20 (474 000 and 1 806 000) compared with the universal birth-dose strategy (232 000).</p><p><strong>Results of sensitivity analysis: </strong>In a scenario with lower vaccine coverage (84.5%) and higher HBV prevalence (maternal prevalence of 0.72% and higher risk for horizontal infection), chronic HBV infections would increase to 1700 and 2192, respectively, with the deferred and shared decision-making strategies.</p><p><strong>Limitation: </strong>Uncertainty in horizontal HBV infection risk.</p><p><strong>Conclusion: </strong>Proposed policy changes for vaccination through shared decision making are projected to result in an 83% increase in childhood HBV infections, and between 50% and 70% of children entering adulthood annually would be susceptible to HBV infection. Policymakers should reimplement recommendations for universal birth-dose vaccination.</p><p><strong>Primary funding source: </strong>National Institute of Allergy and Infectious Diseases.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223062","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}