Annals of Internal Medicine最新文献

{"title":"Summary for Patients: Fluvoxamine and Metformin for Fatigue in Patients With Long COVID.","authors":"","doi":"10.7326/ANNALS-26-02144-PS","DOIUrl":"https://doi.org/10.7326/ANNALS-26-02144-PS","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103209","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":"Pharmacologic Treatments for Females With Menopausal Vasomotor Symptoms: A Clinical Guideline From the American College of Physicians.","authors":"Amir Qaseem, Katherine Mackey, Jennifer Yost, Paul G Shekelle, Tatyana A Shamliyan, J Thomas Cross","doi":"10.7326/ANNALS-26-01205","DOIUrl":"https://doi.org/10.7326/ANNALS-26-01205","url":null,"abstract":"<p><strong>Description: </strong>The American College of Physicians (ACP) developed this clinical guideline on pharmacologic treatments for internal medicine physicians and other clinicians caring in outpatient settings for females with menopausal vasomotor symptoms.</p><p><strong>Methods: </strong>The ACP Clinical Guidelines Committee developed this guideline based on systematic reviews on effectiveness, comparative effectiveness, harms, public and patient values and preferences, and economic evidence of pharmacologic treatments for females with menopausal vasomotor symptoms using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.</p><p><strong>Recommendation: </strong><i>In females who are seeking treatment of vasomotor symptoms</i>.</p><p><p><i>First-line treatments</i>.</p><p><p>\u0000 <i>ACP recommends that clinicians initiate one of the following (strong recommendation): estrogen in combination with progestogen in females with a uterus (high-certainty evidence) or estrogen monotherapy in females without a uterus (high-certainty evidence).</i>\u0000 </p><p><p><i>Second-line treatments</i>.</p><p><p>\u0000 <i>ACP suggests that clinicians use one of the following in females who have contraindications to or do not tolerate first-line treatment (conditional recommendation): serotonin-norepinephrine reuptake inhibitors, either desvenlafaxine or venlafaxine (moderate-certainty evidence).</i>\u0000 </p><p><p><i>Third-line treatments</i>.</p><p><p>\u0000 <i>ACP suggests that clinicians use one of the following in females who have contraindications to or do not tolerate first-line or second-line treatment (conditional recommendation): selective serotonin reuptake inhibitors, either escitalopram or paroxetine (low-certainty evidence); the gabapentinoid gabapentin (low-certainty evidence); or neurokinin receptor antagonists, either elinzanetant or fezolinetant (moderate-certainty evidence).</i>\u0000 </p><p><p>\u0000 <i>When selecting a treatment of vasomotor symptoms, clinicians should use an informed decision-making approach and discuss benefits, harms, contraindications, comorbid conditions, values and preferences, financial burden, and access to and availability of treatments.</i>\u0000 </p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103211","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 New ACP Clinical Guideline for the Pharmacologic Treatment of Menopausal Vasomotor Symptoms: Where Do We Go From Here?","authors":"Regina Castaneda, Stephanie S Faubion","doi":"10.7326/ANNALS-26-03184","DOIUrl":"https://doi.org/10.7326/ANNALS-26-03184","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103201","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":"Visual Guideline - Pharmacologic Treatments for Females With Menopausal Vasomotor Symptoms: A Visual Clinical Guideline From the American College of Physicians.","authors":"","doi":"10.7326/ANNALS-26-01205-VG","DOIUrl":"https://doi.org/10.7326/ANNALS-26-01205-VG","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"e2601205VG"},"PeriodicalIF":17.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103195","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":"Growth in the Share of Advanced Practice Registered Nurses Educated at For-Profit Programs in Four U.S. States.","authors":"Hannah T Neprash, Ellen Latsko, Brianna Hardy, Hilary Barnes, Elizabeth M White, Michael L Barnett","doi":"10.7326/ANNALS-26-01211","DOIUrl":"https://doi.org/10.7326/ANNALS-26-01211","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103162","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":"Pharmacologic Treatments for Female Menopausal Vasomotor Symptoms: A Systematic Review and Meta-analysis for the American College of Physicians.","authors":"Susan Diem, Adrienne Landsteiner, Lisa Langsetmo, Kristen Ullman, Nicholas Zerzan, Elisheva Danan, Roderick MacDonald, Nancy Greer, Kristine Ensrud, John Schousboe, Tyler Drake, Anjum S Kaka, Timothy J Wilt","doi":"10.7326/ANNALS-26-00943","DOIUrl":"https://doi.org/10.7326/ANNALS-26-00943","url":null,"abstract":"<p><strong>Background: </strong>Vasomotor symptoms (VMS) are common in perimenopausal and postmenopausal females.</p><p><strong>Purpose: </strong>To evaluate benefits, harms, patient values and preferences, and cost-effectiveness of pharmacologic treatments for VMS.</p><p><strong>Data sources: </strong>MEDLINE ALL, Embase, and Cochrane Central Register of Controlled Trials from inception to 3 March 2026.</p><p><strong>Study selection: </strong>Randomized trials of at least 8 weeks' duration of eligible medications in females with VMS reporting VMS frequency and severity, menopause-related quality of life (QoL), sleep quality, endometrial hyperplasia or cancer, and/or serious adverse events (SAEs); U.S. Food and Drug Administration and European Medicines Agency labels for additional harms.</p><p><strong>Data extraction: </strong>Data were abstracted by 1 reviewer and verified by a second reviewer. Independent, dual risk-of-bias assessments were performed. Certainty of evidence (COE) was assessed by 1 reviewer and overread by a second reviewer.</p><p><strong>Data synthesis: </strong>Ninety trials were included. COE was low to moderate for most comparisons. Compared with placebo, estrogens with or without progestogens, conjugated estrogen with bazedoxifene (CE/BZA), and oxybutynin reduced VMS frequency and severity. Compared with placebo, neurokinin receptor antagonists (NKRAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs), gabapentin, and progestogens reduced VMS frequency but not severity. Estrogen efficacy varied by dose but not route. Estrogens with and without progestogens, CE/BZA, NKRAs, SNRIs, and SSRIs improved menopause-related QoL; gabapentin, NKRAs, oxybutynin, SNRIs, and SSRIs improved sleep quality. Few SAEs were reported. Evidence was insufficient for patient values and preferences. Estrogens with or without progestogens are of high economic value (high COE). The NKRA fezolinetant has low value (moderate COE).</p><p><strong>Limitations: </strong>Most studies were short-term and were not designed to evaluate SAEs or long-term harms. Observational studies that could address long-term harms were not included.</p><p><strong>Conclusion: </strong>Estrogens reduced VMS frequency and severity and improved QoL (with or without progestogens and with BZA). NKRAs, SNRIs, and SSRIs improved VMS frequency, QoL, and sleep. Estrogens with and without progestogens were of high economic value. Harms data were limited. Little comparative information exists.</p><p><strong>Primary funding source: </strong>American College of Physicians. (PROSPERO: CRD42024558116).</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103122","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 advises on managing menopause.","authors":"Jennifer Kearney-Strouse","doi":"10.7326/ANNALS-26-04122-IM","DOIUrl":"https://doi.org/10.7326/ANNALS-26-04122-IM","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103213","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":"Effect of Fluvoxamine and Metformin for Fatigue in Patients With Long COVID : An Adaptive Randomized Trial.","authors":"Gilmar Reis, Eduardo Augusto Dos Santos Moreira Silva, Daniela Carla Medeiros Silva, Lehana Thabane, Thiago Santiago Ferreira, Luiza Lanna França Reis, Ana Paula Figueiredo Guimaraes Almeida, Marcela Menezes Amaral, Leonardo Cançado Monteiro Savassi, Vitoria Helena de Souza Campos, Maria Izabel Campos Simplicio, Luciene Barra Ribeiro, Thalyne de Souza Medeiros, Thais Campos Siqueira, Taynara Silva Vieira, Nayara Drumond Rausse, Tereza Cristina Garofolo, Eliane Carreiro Fagundes Silva, Ofir Harari, Gennaro D'Urso, Jamie I Forrest, Jay Park, Jean B Nachega, Christopher Lindsell, Jeffrey S Glenn, Kristian Thorlund, Mark Dybul, Edward J Mills","doi":"10.7326/ANNALS-26-02144","DOIUrl":"https://doi.org/10.7326/ANNALS-26-02144","url":null,"abstract":"<p><strong>Background: </strong>Postacute sequelae of SARS-CoV-2 infection (long COVID) presents a therapeutic challenge, with fatigue being a common, debilitating symptom.</p><p><strong>Objective: </strong>To assess the efficacy of fluvoxamine and metformin to treat long COVID fatigue.</p><p><strong>Design: </strong>Randomized, placebo-controlled, adaptive trial. (ClinicalTrials.gov: NCT06128967).</p><p><strong>Setting: </strong>Outpatient sites in Brazil.</p><p><strong>Participants: </strong>399 adults with fatigue 90 days to 24 months after confirmed SARS-CoV-2 infection.</p><p><strong>Intervention: </strong>Participants were randomly assigned to fluvoxamine (100 mg twice daily [BID]), extended-release metformin (750 mg BID [<i>n</i> = 71] from October 2023 to April 2024; reduced to 500 mg BID [<i>n</i> = 40] in May 2024 after a protocol amendment until the group was stopped for futility in September 2024), or a matching placebo, each for 60 days with follow-up to day 90.</p><p><strong>Measurements: </strong>Change in Fatigue Severity Scale (FSS) score.</p><p><strong>Results: </strong>Median baseline FSS scores ranged from 5.6 to 5.9 across all study groups. The treatment effect on FSS score for fluvoxamine versus placebo showed a mean difference of -0.43 at day 60 and -0.58 at day 90; both had a posterior probability of superiority of 99%. Fluvoxamine also improved quality-of-life scores with a high posterior probability of superiority. Findings for metformin were inconclusive. Incidence of adverse events was lower for fluvoxamine (24.0%) than for metformin, 750 mg BID (45.1%); metformin, 500 mg BID (42.5%); and placebo (35.5%). Grade 3 or higher adverse events were rare (≤2.7%), with no treatment-related deaths.</p><p><strong>Limitations: </strong>The results were inconclusive for metformin because of a dose change recommended by the data safety and monitoring committee due to adverse effects causing study withdrawal and early termination. The benefit of fluvoxamine after 90 days is unknown. The trial did not address other long COVID symptoms.</p><p><strong>Conclusion: </strong>Fluvoxamine shows potential for improving long COVID-associated fatigue and quality of life.</p><p><strong>Primary funding source: </strong>The Latona Foundation.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103159","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":"Notice of Retraction and Republication: Summary for Patients: Fluvoxamine and Metformin for Fatigue in Patients with Long COVID.","authors":"","doi":"10.7326/ANNALS-26-03295","DOIUrl":"https://doi.org/10.7326/ANNALS-26-03295","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":17.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103203","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":"International Medical Graduates in America: Navigating a Winding History of Immigration Laws and Licensure Requirements.","authors":"Humayun J Chaudhry, David A Johnson, George M Abraham","doi":"10.7326/ANNALS-26-01555","DOIUrl":"10.7326/ANNALS-26-01555","url":null,"abstract":"<p><p>State legislative initiatives that were started in 2023 to streamline the licensing of internationally trained physicians (ITPs) have garnered bipartisan interest and support across the country. The new approach, more broadly applicable than previous efforts, precludes a requirement for Accreditation Council for Graduate Medical Education-accredited graduate medical education conducted in the United States. The change is the most recent development in our nation's long and winding history of licensing international medical graduates (IMGs). At the turn of the 20th century, only about 100 IMGs presented to state medical boards each year for licensure. Medical graduates around the world who sought quality postgraduate training opportunities, including those from the United States, looked to Europe. Nativist sentiment and state and federal laws in the 1920s discouraged or prohibited immigration for many internationally educated or trained physicians. That changed substantially during and after World War II when a population surge, an increase in physician refugees, and, later in the 1960s, relaxed immigration laws combined with a robust expansion of hospitals to shift the medical regulatory landscape. The result was greater receptivity to IMGs, with concerns about prevailing credentialing models predicated on recognition by state medical boards of \"approved\" international medical schools. The establishment of the Educational Commission for Foreign Medical Graduates in the 1950s mirrored a broader shift toward evaluation of persons and their capabilities. Recent demographic pressures (for example, a growing and aging patient population and a maldistributed and insufficient physician workforce) are prompting a flurry of state legislative initiatives to improve access to care and welcome more IMGs, especially ITPs, in a trend that runs counter to growing federal restrictions on immigrants and international workers.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"1482-1488"},"PeriodicalIF":17.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597822","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}