Annals of Internal Medicine最新文献

{"title":"Assessment and Management of Patients at Risk for Suicide: Synopsis of the 2024 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines.","authors":"Lisa A Brenner, Vince Capaldi, Joseph Constans, Steven Dobscha, Matthew Fuller, Bridget Matarazzo, Kate McGraw, Kenneth Richter, James Sall, Derek Smolenski, Scott Williams, Sarah Davis-Arnold, Nazanin Bahraini","doi":"10.7326/ANNALS-24-01938","DOIUrl":"10.7326/ANNALS-24-01938","url":null,"abstract":"<p><strong>Description: </strong>The U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DOD) updated the 2019 joint clinical practice guideline (CPG) for assessing and managing patients who are at risk for suicide. This synopsis provides primary care physicians with a summary of the updated 2024 recommendations regarding evaluation and management of military members and veterans at risk for suicide.</p><p><strong>Methods: </strong>In 2023, the VA/DOD Evidence-Based Practice Work Group convened to develop a joint VA/DOD guideline, including clinical stakeholders, which conformed to the National Academy of Medicine's tenets for trustworthy CPGs. The Work Group drafted 12 key questions, reviewed systematically identified literature (1 April 2018 to 15 March 2023), evaluated the evidence, created algorithms, and advanced 24 recommendations in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.</p><p><strong>Recommendations: </strong>Despite insufficient evidence to recommend for or against suicide risk screening programs as a means for reducing suicide attempts or deaths, the VA/DOD Work Group identified validated tools that could be used to identify populations at higher risk for suicide-related behaviors. Cognitive behavioral therapy was also recommended for reducing the risk for suicide attempts and decreasing suicidal ideation among those with a history of suicidal behavior or a history of self-directed violence. Periodic communications after previous suicide attempts were also recommended as a prevention strategy. Pharmacologic treatments, such as clozapine or ketamine infusion, also have a role in the management of suicide risk among those with schizophrenia or major depressive disorder, respectively.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"416-425"},"PeriodicalIF":19.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188043","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":"Molecular Imaging Versus Adrenal Vein Sampling for the Detection of Surgically Curable Primary Aldosteronism : A Prospective Within-Patient Trial.","authors":"Emily Goodchild, Xilin Wu, Russell Senanayake, James MacFarlane, Giulia Argentesi, Kate Laycock, Waiel A Bashari, Claudia P Cabrera, Samuel M O'Toole, Jackie Salsbury, Daniela Benu, Yun-Ni Lee, Aldons C N Chua, Matthew Matson, Brendan Koo, Laila Parvanta, Nicholas Hilliard, Vasilis Kosmoliaptsis, Alison Marker, Daniel M Berney, Kiera Drew, Wilson Tan, Roger Foo, Charles A Mein, Eva Wozniak, Jessica Kearney, Emanuel Savage, Anju Sahdev, Nicholas Bird, Graham Smith, Matthew Hird, Victoria Warnes, Daniel Gillett, Anne Dawnay, Elizabeth Adeyeye, Franklin Aigbirhio, Alasdair McIntosh, Alex McConnachie, J Kennedy Cruickshank, Heok Cheow, Mark Gurnell, William M Drake, Morris J Brown","doi":"10.7326/ANNALS-24-00761","DOIUrl":"10.7326/ANNALS-24-00761","url":null,"abstract":"<p><strong>Background: </strong>Primary aldosteronism (PA) causes hypertension and is potentially surgically curable when it is caused by a unilateral aldosterone-producing adrenal adenoma (APA). Adrenal vein sampling (AVS) is required to guide surgery, but it is invasive, is technically difficult, and has limited availability.</p><p><strong>Objective: </strong>To determine whether the accuracy of post-dexamethasone [¹¹C]metomidate ([¹¹C]MTO) positron emission tomography-computed tomography, a diagnostic test for APAs, is superior or noninferior to the accuracy of AVS in predicting outcomes from unilateral adrenalectomy, and whether [¹¹C]MTO is interchangeable with its longer-half-life analogue, para-chloro-2-[¹⁸F]fluoroethyletomidate ([¹⁸F]CETO).</p><p><strong>Design: </strong>Prospective within-patient comparison of diagnostic interventions. (ClinicalTrials.gov: NCT02945904).</p><p><strong>Setting: </strong>Three referral centers.</p><p><strong>Participants: </strong>174 patients with PA desiring surgery if a unilateral source of PA was diagnosed.</p><p><strong>Intervention: </strong>[¹¹C]MTO and AVS in 169 patients, plus [¹⁸F]CETO in the final 31.</p><p><strong>Measurements: </strong>International consensus criteria for biochemical and clinical success at 6 and 24 months after surgery; κ statistic and Bland-Altman analyses comparing predictions of surgical outcomes by [¹¹C]MTO and [¹⁸F]CETO.</p><p><strong>Results: </strong>Eighty-nine of 169 (52.7%), 78 of 169 (46.2%), and 43 of 169 (25.4%) patients were predicted to have unilateral PA by [¹¹C]MTO, AVS, or both, respectively. One hundred of 169 (59.1%) were assigned to adrenalectomy by the multidisciplinary team; primary outcome data were available for 156 of 169. Predictions were most accurate for complete or partial biochemical success ([¹¹C]MTO, 71.3% [95% CI, 61.0% to 80.1%]; AVS, 62.8% [CI, 52.2% to 72.6%]) and least accurate for complete clinical success (home blood pressure <135/85 mm Hg off treatment). The 95% CIs around differences between accuracies crossed zero, excluding superiority for [¹¹C]MTO, but not the prespecified lower bound of -17%, allowing [¹¹C]MTO to be declared noninferior to AVS. [¹⁸F]CETO and [¹¹C]MTO agreed in 29 of 31 patients (κ = 0.85 [CI, 0.68 to 1.00]).</p><p><strong>Limitation: </strong>The accuracy of [¹¹C]MTO could be assessed only in the surgical group.</p><p><strong>Conclusion: </strong>Molecular imaging is an accurate, noninvasive alternative to AVS.</p><p><strong>Primary funding source: </strong>National Institute for Health and Care Research.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"336-347"},"PeriodicalIF":19.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603450","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 Target Trial Framework for Causal Inference From Observational Data: Why and When Is It Helpful?","authors":"Miguel A Hernán, Issa J Dahabreh, Barbra A Dickerman, Sonja A Swanson","doi":"10.7326/ANNALS-24-01871","DOIUrl":"10.7326/ANNALS-24-01871","url":null,"abstract":"<p><p>When randomized trials are not available to answer a causal question about the comparative effectiveness or safety of interventions, causal inferences are drawn using observational data. A helpful 2-step framework for causal inference from observational data is 1) specifying the protocol of the hypothetical randomized pragmatic trial that would answer the causal question of interest (the target trial), and 2) using the observational data to attempt to emulate that trial. The target trial framework can improve the quality of observational analyses by preventing some common biases. In this article, we discuss the utility and scope of applications of the framework. We clarify that target trial emulation resolves problems related to incorrect design but not those related to data limitations. We also describe some settings in which adopting this approach is advantageous to generate effect estimates that can close the gaps that randomized trials have not filled. In these settings, the target trial framework helps reduce the ambiguity of causal questions.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"402-407"},"PeriodicalIF":19.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439747","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":"Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder: A Living Clinical Guideline From the American College of Physicians (Version 1, Update Alert 2, Surveillance Note 1).","authors":"Amir Qaseem, Douglas K Owens, Itziar Etxeandia-Ikobaltzeta, J Thomas Cross, Jennifer Yost, Carolyn J Crandall, Carolyn J Crandall, Lauri A Hicks, Ethan M Balk, Thomas G Cooney, J Thomas Cross, Nick Fitterman, Johanna Lewis, Amy M Linsky, Michael Maroto, Matthew C Miller, Adam J Obley, Douglas K Owens, Paul G Shekelle, Jeffrey A Tice, Itziar Etxeandia-Ikobaltzeta, Curtis S Harrod, Amir Qaseem, Jennifer Yost","doi":"10.7326/ANNALS-24-03549","DOIUrl":"10.7326/ANNALS-24-03549","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"e2403549"},"PeriodicalIF":19.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143121956","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":"Prevention of Episodic Migraine Headache Using Pharmacologic Treatments in Outpatient Settings: A Clinical Guideline From the American College of Physicians.","authors":"Amir Qaseem, Thomas G Cooney, Itziar Etxeandia-Ikobaltzeta, Timothy J Wilt, Curtis S Harrod, Jeffrey A Tice, Carolyn J Crandall, Lauri A Hicks, J Thomas Cross, Nick Fitterman, Johanna Lewis, Amy M Linsky, Michael Maroto, Matthew C Miller, Adam J Obley, Douglas K Owens, Paul G Shekelle, Tatyana Shamliyan, Jennifer Yost","doi":"10.7326/ANNALS-24-01052","DOIUrl":"10.7326/ANNALS-24-01052","url":null,"abstract":"<p><strong>Description: </strong>The American College of Physicians (ACP) developed this clinical guideline for clinicians caring for adults with episodic migraine headache (defined as 1 to 14 headache days per month) in outpatient settings.</p><p><strong>Methods: </strong>ACP based these recommendations on systematic reviews of the comparative benefits and harms of pharmacologic treatments to prevent episodic migraine, patients' values and preferences, and economic evidence. ACP evaluated the comparative effectiveness of the following interventions: angiotensin-converting enzyme inhibitors (lisinopril), angiotensin II-receptor blockers (candesartan and telmisartan), antiseizure medications (valproate and topiramate), β-blockers (metoprolol and propranolol), calcitonin gene-related peptide (CGRP) antagonist-gepants (atogepant or rimegepant), CGRP monoclonal antibodies (eptinezumab, erenumab, fremanezumab, or galcanezumab), selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors (fluoxetine and venlafaxine), and a tricyclic antidepressant (amitriptyline). ACP used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to analyze the effects of pharmacologic treatment on the following outcomes: migraine frequency and duration, number of days medication was taken for acute treatment of migraine, frequency of migraine-related emergency department visits, migraine-related disability, quality of life and physical functioning, and discontinuations due to adverse events. In addition, adverse events were captured through U.S. Food and Drug Administration medication labels and eligible studies.</p><p><strong>Recommendations: </strong>In this guideline, ACP makes recommendations for clinicians to initiate monotherapy for episodic migraine prevention in nonpregnant adults in the outpatient setting as well as alternative approaches if initial treatments are not tolerated or result in an inadequate response. All 3 ACP recommendations have conditional strength and low-certainty evidence. Clinical considerations provide additional context for physicians and other clinicians.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"426-433"},"PeriodicalIF":19.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143121966","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":"Surveillance Note 1: Nonpharmacologic and Pharmacologic Treatments of Adult Patients With Major Depressive Disorder: A Systematic Review and Network Meta-analysis for a Clinical Guideline by the American College of Physicians.","authors":"Andreea Iulia Dobrescu, Isabel Moser, Irma Klerings, Gerald Gartlehner","doi":"10.7326/ANNALS-24-03637","DOIUrl":"10.7326/ANNALS-24-03637","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"e2403637"},"PeriodicalIF":19.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143121972","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 OHCA, IO-first and IV-first vascular access strategies did not differ for sustained ROSC or 30-d survival.","authors":"Sheldon Cheskes","doi":"10.7326/ANNALS-25-00160-JC","DOIUrl":"10.7326/ANNALS-25-00160-JC","url":null,"abstract":"<p><strong>Clinical impact ratings: </strong>Emergency Med: [Formula: see text].</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"JC31"},"PeriodicalIF":19.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603409","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":"Diagnostic Strategy Using Color Doppler Ultrasound of Temporal Arteries in Patients With High Clinical Suspicion of Giant Cell Arteritis.","authors":"Anne I van Gessel, Arie M van Roon, Kornelis S M van der Geest, Douwe J Mulder","doi":"10.7326/ANNALS-24-02867","DOIUrl":"https://doi.org/10.7326/ANNALS-24-02867","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":"178 3","pages":"454-455"},"PeriodicalIF":19.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699355","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":"A Calling No Longer? When Medicine Is Redefined as a Job.","authors":"Paul B Brandfonbrener, Daniel H Lowenstein","doi":"10.7326/ANNALS-24-02654","DOIUrl":"10.7326/ANNALS-24-02654","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"434-435"},"PeriodicalIF":19.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143121720","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":"Glucagon-Like Peptide-1 Receptor Agonists and Risk for Depression in Older Adults With Type 2 Diabetes : A Target Trial Emulation Study.","authors":"Huilin Tang, Ying Lu, William T Donahoo, Sarah C Westen, Yong Chen, Jiang Bian, Jingchuan Guo","doi":"10.7326/ANNALS-24-01347","DOIUrl":"10.7326/ANNALS-24-01347","url":null,"abstract":"<p><strong>Background: </strong>Although glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown potential antidepressant effects, population studies yield inconsistent results.</p><p><strong>Objective: </strong>To compare the risk for depression in older adults with type 2 diabetes (T2D) initiating treatment with GLP-1RAs versus sodium-glucose cotransporter-2 inhibitors (SGLT2is) or dipeptidyl peptidase-4 inhibitors (DPP4is).</p><p><strong>Design: </strong>Target trial emulation study.</p><p><strong>Setting: </strong>U.S. National Medicare administrative data from January 2014 to December 2020.</p><p><strong>Patients: </strong>Adults aged 66 years or older with T2D initiating treatment with a GLP-1RA were matched 1:1 on propensity score with those initiating treatment with either an SGLT2i or a DPP4i.</p><p><strong>Measurements: </strong>The primary end point was incident depression. Cox proportional hazards regression models were used to estimate the hazard ratio (HR) with 95% CI within matched groups.</p><p><strong>Results: </strong>A total of 14 665 matched pairs of older adults were included in the cohort for GLP-1RAs versus SGLT2is; the rate difference of depression between GLP-1RA users and SGLT2i users was 3.48 (95% CI, -0.81 to 7.78) per 1000 person-years, with an HR of 1.07 (CI, 0.98 to 1.18). In the cohort for GLP-1RAs versus DPP4is (13 711 matched pairs), the rate difference was -5.78 (CI, -10.49 to -1.07) per 1000 person-years, with an HR of 0.90 (CI, 0.82 to 0.98).</p><p><strong>Limitation: </strong>Unmeasured confounders (such as hemoglobin A_1c levels and body mass index), outcome misclassification, and limited generalizability to all GLP-1RA users (for example, younger populations or those without T2D receiving the drug for obesity treatment).</p><p><strong>Conclusion: </strong>Among older adults with T2D, the incidence of depression was relatively low. Use of GLP-1RAs was associated with a modestly lower risk for depression compared with use of DPP4is, but not SGLT2is.</p><p><strong>Primary funding source: </strong>National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"315-326"},"PeriodicalIF":19.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490529","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}