Annals of Internal Medicine最新文献

{"title":"Q&A: Intervening for knee pain in young adults.","authors":"Gianna Melillo","doi":"10.7326/ANNALS-26-03984-IM","DOIUrl":"https://doi.org/10.7326/ANNALS-26-03984-IM","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073422","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":"Exercise Therapy and Education for Young Adults With Persistent Knee Problems After Anterior Cruciate Ligament Reconstruction : A Randomized Clinical Trial.","authors":"Adam G Culvenor, Andrea M Bruder, Thomas J West, Christian J Barton, Ewa M Roos, Edwin H Oei, Steven M McPhail, Richard B Souza, Jusuk Lee, Brooke E Patterson, Michael A Girdwood, Jamon L Couch, Mark J Scholes, Kay M Crossley","doi":"10.7326/ANNALS-26-02460","DOIUrl":"https://doi.org/10.7326/ANNALS-26-02460","url":null,"abstract":"<p><strong>Background: </strong>Chronic knee symptoms and early-onset osteoarthritis are common after anterior cruciate ligament reconstruction (ACLR). Evidence to inform management is needed.</p><p><strong>Objective: </strong>To evaluate whether physiotherapist-supervised exercise therapy with education is superior to a single education session and self-directed exercise resource for young adults with persistent knee problems after ACLR.</p><p><strong>Design: </strong>Parallel-group randomized trial. (Australian New Zealand Clinical Trials Registry: ACTRN12620001164987).</p><p><strong>Setting: </strong>Community.</p><p><strong>Participants: </strong>184 young adults (aged 18 to 40 years) with persistent knee problems 9 to 36 months after ACLR.</p><p><strong>Intervention: </strong>A 4-month twice-weekly physiotherapist-supervised exercise therapy program with education (SUPER [SUpervised exercise-therapy and Patient Education Rehabilitation]; <i>n</i> = 92) and a single physiotherapist-delivered education session and self-directed exercise resource (control; <i>n</i> = 92).</p><p><strong>Measurements: </strong>Primary outcome was 4-month change in the composite Knee injury and Osteoarthritis Outcome Score (KOOS₄; 0= worst, 100= best). Secondary outcomes included KOOS₄ at 12 months and thigh muscle strength, patient-perceived global rating of change, and cartilage thickness and composition on magnetic resonance imaging at 4 and 12 months.</p><p><strong>Results: </strong>184 participants were randomly assigned (mean age, 30 years [SD, 6]; 2.2 years [SD, 0.7] after ACLR); 178 (97%) and 174 (95%) completed 4-month and 12-month follow-up, respectively. At 4 months, KOOS₄ scores improved more in the SUPER group than in the control group (14.1 vs. 9.4; adjusted mean difference, 4.8 [95% CI, 1.4 to 8.2]). At 4 months, SUPER resulted in greater muscle strength gains and higher rates of success on global rating of change (for example, pain 73% vs. 40%). Between-group differences narrowed at 12 months as the control group continued to improve, whereas SUPER gains were sustained. There were no between-group differences seen in cartilage thickness or composition.</p><p><strong>Limitation: </strong>Unblinded participants.</p><p><strong>Conclusion: </strong>For young adults with persistent knee problems after ACLR, physiotherapist-supervised exercise therapy with education improved patient-reported outcomes compared with a single education session and self-directed exercise resource, but these between-group differences may not be sustained over time.</p><p><strong>Primary funding source: </strong>National Health and Medical Research Council.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073384","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: Tobacco Use Treatment: Synopsis of the 2026 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline.","authors":"","doi":"10.7326/ANNALS-26-01499-PS","DOIUrl":"https://doi.org/10.7326/ANNALS-26-01499-PS","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015449","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":"Serving Those Who Served: Tobacco Cessation for Veterans and Active-Duty Service Members.","authors":"Michael B Steinberg, Lauren R Pacek","doi":"10.7326/ANNALS-26-03290","DOIUrl":"https://doi.org/10.7326/ANNALS-26-03290","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015444","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":"Tobacco Use Treatment: Synopsis of the 2026 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline.","authors":"Mark G Myers, Patricia A Vu, Patrick S Calhoun, Timothy Chen, Jessica W Cook, Steven S Fu, Mark C Geraci, Jackie A Hayes, James L Sall, Scott E Sherman, James A Stewart, Linda Valles-Gutierrez, Taylor E Zurlinden, Aggee Loblack, Dana E Christofferson","doi":"10.7326/ANNALS-26-01499","DOIUrl":"https://doi.org/10.7326/ANNALS-26-01499","url":null,"abstract":"<p><strong>Description: </strong>A work group representing the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) prepared a new VA/DoD clinical practice guideline (CPG) for tobacco use treatment. This article provides a synopsis of the 2026 CPG, which addresses use of commercially available tobacco and nicotine products.</p><p><strong>Methods: </strong>A multidisciplinary work group developed 19 key questions on clinical topics of highest priority for the VA and DoD populations. Published literature from 1 January 2014 to 10 December 2024 was systematically reviewed using the PICOTS (population, intervention, comparator, outcomes, timing of outcomes measurement, and setting) framework. Recommendations were made by consensus and informed by evaluation using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method, which assesses quality of evidence and balances benefits and harms, patient preferences, and feasibility. The final document incorporated input from peer review by an external group of experts.</p><p><strong>Recommendations: </strong>The 2026 guideline includes 32 recommendations across 10 topic areas. Key recommendations for increasing abstinence from combustible tobacco include recommending motivational interviewing to increase engagement in treatment of tobacco and nicotine use (strong) and use of U.S. Food and Drug Administration-approved pharmacotherapies (strong), with varenicline recommended over monotherapy with other agents (strong), combination nicotine replacement therapy ([NRT] for example, patch plus lozenge) recommended over NRT monotherapy (single agent) (strong), and extending use of bupropion sustained release beyond 12 weeks (weak). Other key recommendations include varenicline for increasing abstinence from smokeless tobacco (strong) and electronic nicotine delivery systems (weak) and use of NRT or varenicline to increase quit attempts and abstinence in patients not ready to quit in the next 30 days (weak).</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015494","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":"Summit sees solutions to workforce woes.","authors":"Jennifer Kearney-Strouse","doi":"10.7326/ANNALS-26-03913-IM","DOIUrl":"https://doi.org/10.7326/ANNALS-26-03913-IM","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015431","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":"Alcohol Use Between 2018 and 2024: A National Cross-Sectional Study.","authors":"Divya Ayyala-Somayajula, Jennifer L Dodge, Brian P Lee","doi":"10.7326/ANNALS-26-01824","DOIUrl":"https://doi.org/10.7326/ANNALS-26-01824","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015473","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":"Navigating Medicaid's new work requirements.","authors":"Janet Colwell","doi":"10.7326/ANNALS-26-03791-IM","DOIUrl":"https://doi.org/10.7326/ANNALS-26-03791-IM","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966157","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":"Medetomidine Exposure in a Shifting Drug Landscape: Insights From Patient Experiences.","authors":"Catherine Pressimone, Lisandra Alfaro, Ilana Hull, Raagini Jawa, Payel Roy, Jane Liebschutz, Margaret Shang","doi":"10.7326/ANNALS-26-02480","DOIUrl":"10.7326/ANNALS-26-02480","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disclosure Without Context: The Case for More Transparent Clinical Practice Guidelines.","authors":"Jonathan D Alpern, David J Satin","doi":"10.7326/ANNALS-26-02051","DOIUrl":"https://doi.org/10.7326/ANNALS-26-02051","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966203","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}