Annals of Internal Medicine最新文献

{"title":"In COVID-19 acute hypoxemic respiratory failure, awake prone positioning vs. supine positioning increases survival without intubation.","authors":"Erica Crosley, Greg S Martin","doi":"10.7326/ANNALS-25-02004-JC","DOIUrl":"10.7326/ANNALS-25-02004-JC","url":null,"abstract":"<p><strong>Clinical impact ratings: </strong>GIM/FP/GP: [Formula: see text] Critical Care: [Formula: see text] Pulmonology: [Formula: see text].</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"JC79"},"PeriodicalIF":19.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526159","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":"GRADE Certainty Ratings: Thresholds Rather Than Categories of Contextualization (GRADE Guidance 41).","authors":"Monica Hultcrantz, Holger J Schünemann, Reem A Mustafa, David M Rind, M Hassan Murad, Martin Mayer, David Tovey, Brian S Alper, Elie A Akl, K M Saif-Ur-Rahman, Bernardo Sousa-Pinto, Ignacio Neumann, Ariel Izcovich, Gordon Guyatt","doi":"10.7326/ANNALS-25-00548","DOIUrl":"https://doi.org/10.7326/ANNALS-25-00548","url":null,"abstract":"<p><p>In 2017, the GRADE (Grading of Recommendations Assessment, Development and Evaluation) working group defined the certainty of evidence as the certainty that the true effect lies on one side of a threshold or in a particular range. This definition has proved useful as the basis for rating certainty, facilitating the interpretation of the results for the target audience. However, the categorization of suggested thresholds and ranges as levels of contextualization led to inconsistencies between the initial and subsequent papers and has proved confusing for some GRADE users.</p><p><p>Although considering context in choosing thresholds remains worthwhile, the GRADE working group will no longer use the categorization of contextualization. It will instead refer simply to chosen thresholds or ranges for determining the target of certainty rating.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526155","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 Significant Benefits of Ablation for Rhythm Control of Atrial Fibrillation.","authors":"Jonathan W Waks, Peter Zimetbaum","doi":"10.7326/ANNALS-25-02222","DOIUrl":"https://doi.org/10.7326/ANNALS-25-02222","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526169","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":"Medical, Societal, and Ethical Considerations for Directed Blood Donation in 2025.","authors":"Jeremy W Jacobs, Garrett S Booth, Mithya Lewis-Newby, Nabiha H Saifee, Eamonn Ferguson, Claudia S Cohn, Meghan Delaney, Sarah Morley, Stephen Thomas, Rachel Thorpe, Sheharyar Raza, Meaghann S Weaver, Jennifer S Woo, Deva Sharma, Cynthia So-Osman, Nalan Yurtsever, Christopher A Tormey, Allison Waters, Mindy Goldman, Matthew T S Yan, Ross M Fasano, Laura D Stephens, Elizabeth S Allen, Christian Erikstrup, Laura Infanti, Timothy D Schlafer, Matthew A Warner, Jeffrey L Winters, Aaron A R Tobian, Evan M Bloch","doi":"10.7326/ANNALS-25-00815","DOIUrl":"10.7326/ANNALS-25-00815","url":null,"abstract":"<p><p>In the United States and other high-income countries, blood donation primarily relies on anonymous, voluntary donors. However, directed blood donation-where people donate for a specific recipient-has resurged, particularly due to misinformation surrounding COVID-19 vaccination. Requests for \"nonvaccinated\" blood, driven by misconceptions about vaccine safety, have led to legislative attempts to mandate compliance. Historically, directed donation was used to mitigate the risk for transfusion-related infections before modern screening techniques rendered it largely unnecessary. Today, it presents important patient safety risks, including increased infectious disease transmission, immunologic complications, and logistic burdens. Directed donations also introduce inefficiencies, diverting resources from the community blood supply and exacerbating shortages. Moreover, directed donation for nonmedical indications lacks scientific justification. Blood safety is ensured through rigorous donor screening, pathogen testing, and processing measures. There is no evidence that blood from vaccinated donors poses risk. Requests for nonvaccinated blood, as well as other directed donation preferences based on personal beliefs, introduce biases that are not grounded in medical necessity. Accommodating such requests undermines public trust in blood safety protocols and legitimizes unfounded fears. Ethical concerns arise as non-medically justified requests reinforce discriminatory practices, such as selecting donors based on race or gender. Allowing such preferences risks politicizing blood donation, spreading misinformation, and straining health care systems. Although autonomy is a core ethical principle in medicine, it does not justify non-evidence-based interventions. Given the potential harm and societal impact, directed blood donations should be limited to rare, medically necessary cases. Ongoing legislative efforts to mandate these requests require unified opposition from the medical and scientific community to uphold ethical, evidence-based, blood allocation practices.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"1021-1026"},"PeriodicalIF":19.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963557","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":"Quality Indicators for Diabetes in Adults: A Review of Performance Measures by the American College of Physicians.","authors":"Amir Qaseem, Peter Basch, Karen Campos, Scott T MacDonald, Cristin A Mount, Samantha Tierney, Rebecca A Andrews, Nick Fitterman, Elisa I Choi, Roger S Khetan, Nancy L Miller, Nicole J Van Groningen, Brook Watts","doi":"10.7326/ANNALS-24-03770","DOIUrl":"10.7326/ANNALS-24-03770","url":null,"abstract":"<p><p>Type 1 and type 2 diabetes are prevalent chronic illnesses, are leading causes of mortality and morbidity, and result in substantial public health burden. Timely identification and appropriate management of diabetes can help reduce adverse consequences of diabetes. The American College of Physicians (ACP) embraces performance measurement as a means to improve quality of care but believes that a performance measure must be methodologically sound and evidence-based in order to be considered for inclusion in payment, accountability, or reporting programs. These principles are critical given the potential impact on physician administrative work, reputation, and reimbursement and to prevent unintended consequences for patient care. To help improve performance measurement and reduce burden, the ACP Performance Measurement Committee (PMC) reviews performance measures using a rigorous process to recognize high-quality measures and address gaps and areas for improvement. In this article, the PMC presents its review of 14 current performance measures for diabetes that are relevant to internal medicine. The PMC supports kidney health evaluation at the individual and group practice levels, hemoglobin A_1c control at the health plan level, eye examination at the health plan level, and angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker therapy at the individual physician level.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"1012-1020"},"PeriodicalIF":19.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973357","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":"Moderate- to Long-Term Effect of Dietary Interventions for Depression and Anxiety : A Systematic Review and Meta-analysis.","authors":"Eman Abukmail, Neeraj Koloth Pradeep, Samantha Ahmed, Loai Albarqouni","doi":"10.7326/ANNALS-24-03016","DOIUrl":"10.7326/ANNALS-24-03016","url":null,"abstract":"<p><strong>Background: </strong>Dietary interventions are a potential alternative treatment of depression and anxiety.</p><p><strong>Purpose: </strong>To evaluate the effects of dietary interventions on depression and anxiety.</p><p><strong>Data sources: </strong>PubMed, Cochrane CENTRAL, EMBASE, CINAHL, and PsycINFO searched from inception until 12 December 2024. Trial registries and forward and backward citation analysis done on 3 January 2025.</p><p><strong>Study selection: </strong>Randomized controlled trials (RCTs) evaluated the effect of dietary advice with or without food provision compared with no specific dietary advice or active interventions for 3 months or longer on depression and/or anxiety.</p><p><strong>Data extraction: </strong>Two authors independently screened articles, extracted data, and assessed risk of bias. Primary outcomes included depression and anxiety symptoms at 3 months or longer. Random-effects meta-analyses were done, and the certainty of evidence was assessed.</p><p><strong>Data synthesis: </strong>Twenty-five RCTs were included. Compared with no specific dietary advice, depressive symptoms might be improved in adults with elevated cardiometabolic risk by dietary advice on calorie restriction (standardized mean difference [SMD], -0.23 [95% CI, -0.38 to -0.09]; low certainty). Low-fat diets may also have very small effects on depressive symptoms in adults with elevated cardiometabolic risk (SMD, -0.03 [CI, -0.04 to -0.01]; low certainty). Evidence on other diets, comparing diets with active comparisons, and on anxiety was limited by study limitations and clinical or methodological heterogeneity.</p><p><strong>Limitation: </strong>Limited studies did not allow for adequate exploration of heterogeneity.</p><p><strong>Conclusion: </strong>Calorie restrictions and low-fat diets might reduce depressive symptoms among adults with elevated cardiometabolic risk, but the differences were small and confidence in the findings was low. Evidence on other diets, comparisons to active interventions, and other outcomes is limited.</p><p><strong>Primary funding source: </strong>None. (PROSPERO: CRD42023485953).</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"987-999"},"PeriodicalIF":19.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101328","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":"ACP provided strong and conditional recommendations for drug treatment in outpatients with acute episodic migraine.","authors":"John R Absher","doi":"10.7326/ANNALS-25-02422-JC","DOIUrl":"10.7326/ANNALS-25-02422-JC","url":null,"abstract":"<p><strong>Clinical impact ratings: </strong>GIM/FP/GP: [Formula: see text] Neurology: [Formula: see text].</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"JC74"},"PeriodicalIF":19.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526149","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":"Associations Between Unconditional Cash Transfers and Postpartum Outcomes in the United States : A Systematic Review.","authors":"Sahar A Choudhry, G Saradjha Brédy, Cyerra Cruise, Qai Hinds, Margaret A McConnell, Sumit Agarwal, David B Flynn, Mara E Murray Horwitz","doi":"10.7326/ANNALS-24-03495","DOIUrl":"10.7326/ANNALS-24-03495","url":null,"abstract":"<p><strong>Background: </strong>Unconditional cash transfers (UCTs) through social programs or direct cash transfers (DCTs) may address drivers of pregnancy-related morbidity and mortality.</p><p><strong>Purpose: </strong>To summarize evidence on UCTs and postpartum outcomes in the United States.</p><p><strong>Data sources: </strong>PubMed, Embase, Web of Science, Social Science Research Network, and structured internet searches through 28 January 2025.</p><p><strong>Study selection: </strong>Primary research reporting associations between UCTs and postpartum outcomes (0 to 2 years after delivery) in the United States.</p><p><strong>Data extraction: </strong>Dual data extraction with predefined outcomes: infant or child care, reproductive health, substance use, other mental health outcomes, and other outcomes. Study quality was assessed using the Cochrane Risk of Bias 2 and ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tools. Strength of evidence (SOE) was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.</p><p><strong>Data synthesis: </strong>Eleven reports from 6 studies were identified. Four quasi-experimental (QE) studies examined 3 different social programs, 2 of which targeted populations with low incomes. Seven reports from 2 randomized controlled trials (RCTs) examined DCTs to postpartum persons with low incomes. The evidence on UCTs showed an increase in breastfeeding (high SOE [2 RCTs, 2 QE studies]), little or no difference in postpartum mood (high SOE [1 RCT, 2 QE studies]), and low SOE or insufficient evidence for all other associations.</p><p><strong>Limitations: </strong>Unpublished studies and those not published in English may have been missed. Nonrandomized studies were subject to reporting or recall bias, reducing SOE. Study heterogeneity prevented meta-analysis.</p><p><strong>Conclusion: </strong>Unconditional cash transfers increase breastfeeding in diverse settings and populations and result in little or no difference in postpartum mood specifically in persons with low incomes. No studies examined DCTs given during pregnancy. More evidence is needed on associations between UCTs and key clinical outcomes, such as postpartum maternal morbidity and mortality.</p><p><strong>Primary funding source: </strong>None. (Registered on Open Science Framework [https://osf.io/4c3nx]).</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"1000-1011"},"PeriodicalIF":19.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148933","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 Doctors Made the Difference.","authors":"Katherine C McKenzie","doi":"10.7326/ANNALS-25-01217","DOIUrl":"10.7326/ANNALS-25-01217","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"1029-1030"},"PeriodicalIF":19.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207459","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":"Comparison of Semaglutide or Dulaglutide Versus Empagliflozin for Risk for Death and Cardiovascular Outcomes Among Patients With Type 2 Diabetes : Two Target Trial Emulation Studies.","authors":"Anum Saeed, Suresh R Mulukutla, Floyd Thoma, Lara Lemon, Agnes Koczo, Steven Reis, Oscar Marroquin, Kevin Kip","doi":"10.7326/ANNALS-24-00775","DOIUrl":"10.7326/ANNALS-24-00775","url":null,"abstract":"<p><strong>Background: </strong>Reduction of premature death and adverse cardiovascular outcomes is a key goal in type 2 diabetes management.</p><p><strong>Objective: </strong>To compare mortality and cardiovascular event risks in patients treated with semaglutide versus empagliflozin and, secondarily, dulaglutide versus empagliflozin.</p><p><strong>Design: </strong>Target trial emulation studies from observational data comparing semaglutide- or dulaglutide-treated patients with propensity score-matched patients treated with empagliflozin.</p><p><strong>Setting: </strong>Health care system of 703 academic and community clinical practices.</p><p><strong>Participants: </strong>Patients aged 45 years or older with type 2 diabetes treated from 1 January 2019 to 31 December 2024 with semaglutide, dulaglutide, or empagliflozin.</p><p><strong>Intervention: </strong>Initial treatment with semaglutide, dulaglutide, or empagliflozin. At baseline, concomitant treatment with other diabetes medication was permitted, excluding other glucagon-like peptide-1 receptor agonists or sodium-glucose cotransporter-2 inhibitors.</p><p><strong>Measurements: </strong>A composite of death, myocardial infarction (MI), or stroke was the primary outcome, and secondary composite outcomes included death or MI, MI or stroke, and individual cardiac events.</p><p><strong>Results: </strong>Patients treated with semaglutide (<i>n</i> = 7899) versus empagliflozin (<i>n</i> = 7899) were followed for a median of 2.2 years; the respective rates of the composite of death, MI, or stroke were 3.7% versus 4.5% at 2 years and 5.9% versus 6.9% at 3 years. Corresponding incidence rates for the composite outcome were 20.99 versus 23.56 per 1000 person-years, with a hazard ratio (HR) of 0.89 (95% CI, 0.78 to 1.02). The HRs for the individual outcomes were 0.97 (CI, 0.81 to 1.15) for death, 0.85 (CI, 0.68 to 1.05) for MI, and 0.62 (CI, 0.43 to 0.89) for stroke. Risks for dulaglutide- and empagliflozin-treated patients were similar for the composite outcome (HR, 1.03 [CI, 0.90 to 1.16]) and for death, MI, and stroke separately.</p><p><strong>Limitation: </strong>Observational study design, lack of data on cause-specific mortality, and residual confounding.</p><p><strong>Conclusion: </strong>Semaglutide treatment seems to confer some advantage over empagliflozin. This advantage was not observed for dulaglutide.</p><p><strong>Primary funding source: </strong>American Heart Association.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"930-939"},"PeriodicalIF":19.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309461","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}