Annals of Internal Medicine最新文献

{"title":"Ethical Oversight of Randomized Quality Improvement Trials: A Pragmatic Approach.","authors":"Stephanie R Morain","doi":"10.7326/ANNALS-26-02980","DOIUrl":"10.7326/ANNALS-26-02980","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"1504-1505"},"PeriodicalIF":17.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787113","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":"Annals On Call - Tirzepatide Versus Intensified Conventional Care for Poorly Controlled Type 2 Diabetes.","authors":"Robert M Centor, Bryan C Batch","doi":"10.7326/ANNALS-26-03906-OC","DOIUrl":"10.7326/ANNALS-26-03906-OC","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"e2603906OC"},"PeriodicalIF":17.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103164","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":"Randomized Quality Improvement Trials: An Overview and Proposed Framework for Ethical Oversight.","authors":"Mark J Pletcher, Bernard Lo, Deborah Grady","doi":"10.7326/ANNALS-26-00221","DOIUrl":"10.7326/ANNALS-26-00221","url":null,"abstract":"<p><p>Quality improvement (QI) is a routine part of health care delivery, but ineffective QI can have unintended consequences, waste resources, and paradoxically worsen health care quality. Randomized QI (RQI) trials use randomization to assign the QI intervention to some but not all patients or clinicians. An RQI trial can provide strong evidence to health care leaders making decisions about whether to scale up, modify, or abandon a QI intervention, but such trials are infrequently used due primarily to a lack of clarity about how regulations and ethical principles apply to these studies. We propose a definition for RQI trials and a streamlined, fit-for-purpose approach to ethical oversight that is consistent with federal regulations. Conducting RQI trials requires careful ethical justification as informed consent is generally impracticable. For this reason, we argue that ethical oversight is needed, even if the project does not qualify as research, and that regular monitoring should be conducted to help decide when the trial should end. Installing technical systems and processes for internal registration, point-of-care randomization, and standardized statistical analyses will help health systems use RQI trials routinely to learn what works to improve the quality of care they deliver for patients.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"1444-1452"},"PeriodicalIF":17.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787264","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: Vitamins and Birth Defects.","authors":"","doi":"10.7326/ANNALS-25-05243-PS","DOIUrl":"10.7326/ANNALS-25-05243-PS","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"I14"},"PeriodicalIF":17.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863422","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":"Doctors seek offices-on Capitol Hill.","authors":"Stacey Butterfield","doi":"10.7326/ANNALS-26-03516-IM","DOIUrl":"10.7326/ANNALS-26-03516-IM","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"IMN98-IMN100"},"PeriodicalIF":17.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811824","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 chronic HBV infection receiving nucleos(t)ide therapy, bepirovirsen vs. placebo increased treatment-free functional cure at 72 wk.","authors":"Sana A Pirzada, Averell H Sherker","doi":"10.7326/ANNALS-26-03671-JC","DOIUrl":"10.7326/ANNALS-26-03671-JC","url":null,"abstract":"<p><strong>Clinical impact ratings: </strong>GIM/FP/GP: [Formula: see text] Gastroenterology: [Formula: see text] Infectious Disease: [Formula: see text].</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"JC119"},"PeriodicalIF":17.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103169","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 methicillin-susceptible <i>S aureus</i> bacteremia, cefazolin was noninferior to flucloxacillin or cloxacillin for 90-d mortality.","authors":"Dennis G Maki","doi":"10.7326/ANNALS-26-03497-JC","DOIUrl":"10.7326/ANNALS-26-03497-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":"JC110"},"PeriodicalIF":17.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103182","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":"\"When I Was a Resident …\".","authors":"David H Johnson","doi":"10.7326/ANNALS-26-01732","DOIUrl":"https://doi.org/10.7326/ANNALS-26-01732","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":"179 10","pages":"1508"},"PeriodicalIF":17.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223007","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":"Annals On Call - Carvedilol Versus Other Nonselective β-Blockers in Cirrhosis.","authors":"Robert M Centor, Kueiyu Joshua Lin, Tracey G Simon","doi":"10.7326/ANNALS-26-03907-OC","DOIUrl":"https://doi.org/10.7326/ANNALS-26-03907-OC","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":"179 10","pages":"e2603907OC"},"PeriodicalIF":17.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223109","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":"Interventions to Improve Outpatient Follow-up for Hospitalized Patients With Alcohol Use Disorder : A Systematic Review.","authors":"Eden Y Bernstein, Kelsey Hills-Dunlap, Ariyani Challapalli, Lisa Bero, Susan L Calcaterra, E Jennifer Edelman, Gina R Kruse, Ben Harnke, Vineet Chopra","doi":"10.7326/ANNALS-26-01312","DOIUrl":"10.7326/ANNALS-26-01312","url":null,"abstract":"<p><strong>Background: </strong>Hospitalizations for alcohol use disorder (AUD) are common and morbid. Outpatient follow-up after discharge is critical for reducing alcohol use and subsequent readmissions, but effective interventions to support this transition are unknown.</p><p><strong>Purpose: </strong>To summarize evidence on the effectiveness of hospital-based interventions to improve outpatient follow-up for AUD.</p><p><strong>Data sources: </strong>Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycInfo, and CINAHL (January 2000 to February 2025).</p><p><strong>Study selection: </strong>Two authors independently reviewed abstracts and full-text articles to identify hospital-based trials and cohort studies that evaluated interventions to improve outpatient AUD follow-up versus usual care or an active comparator.</p><p><strong>Data extraction: </strong>Study data were extracted by 2 authors using a standardized template. Risk of bias and certainty of evidence were assessed using the Cochrane Risk of Bias Tool, Newcastle-Ottawa Scale, and GRADE (Grading of Recommendations Assessment, Development and Evaluation).</p><p><strong>Data synthesis: </strong>Seventeen studies of 21 interventions (12 randomized clinical trials [RCTs] [<i>n</i> = 1917], 3 nonrandomized trials [<i>n</i> = 459], and 2 cohort studies [<i>n</i> = 9974]) were included. Interventions were heterogeneous, and most (85%) included several components: behavioral (76%), care coordination (76%), medication management (14%), and social support (33%). Eight interventions (38%) reported improved linkage to outpatient follow-up. Effective interventions generally combined behavioral and care coordination with AUD medications or social support. Effect sizes across RCTs ranged from an 8% absolute decrease to a 30% absolute increase in outpatient follow-up. The certainty of evidence was low due to the high risk of bias and imprecision of results.</p><p><strong>Limitation: </strong>Only English-language publications were included.</p><p><strong>Conclusion: </strong>Few intervention studies of low certainty improved posthospitalization follow-up for patients with AUD. Given the substantial morbidity associated with untreated AUD, high-quality RCTs testing various components of interventions are needed.</p><p><strong>Primary funding source: </strong>None. (PROSPERO: CRD42025636943).</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"1430-1443"},"PeriodicalIF":17.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904987","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}