Annals of Internal Medicine最新文献

{"title":"Pharmacologic Treatment of Acute Attacks of Episodic Migraine: A Systematic Review and Network Meta-analysis for the American College of Physicians.","authors":"Gerald Gartlehner, Andreea Dobrescu, Gernot Wagner, Andrea Chapman, Emma Persad, Claus Nowak, Irma Klerings, Camilla Neubauer, Johanna Feyertag, Arianna Gadinger, Kylie Thaler","doi":"10.7326/ANNALS-24-02034","DOIUrl":"https://doi.org/10.7326/ANNALS-24-02034","url":null,"abstract":"<p><strong>Background: </strong>Migraine is common, affecting 15% of Americans.</p><p><strong>Purpose: </strong>To compare benefits and harms of pharmacologic treatments for acute attacks of episodic migraine in adults and assess cost-effectiveness.</p><p><strong>Data sources: </strong>Three electronic databases searched to October 2024, gray literature, and reference lists.</p><p><strong>Study selection: </strong>Two investigators independently selected English-language randomized trials.</p><p><strong>Data extraction: </strong>Single reviewer data extraction with second review. Dual independent risk of bias and certainty of evidence (COE) assessment.</p><p><strong>Data synthesis: </strong>Twenty-one head-to-head and 165 placebo-controlled trials were included in meta-analyses and network meta-analyses. Triptans were more effective than acetaminophen (low COE) and nonsteroidal anti-inflammatory drugs (NSAIDs) (high COE) for pain outcomes at 2 hours and pain freedom up to 48 hours. Triptan and acetaminophen combinations were more effective than acetaminophen alone (moderate COE) for pain outcomes at 2 hours and pain freedom up to 48 hours but not more than triptans alone (low COE). Triptan and NSAID combinations were more effective for pain outcomes at 2 hours and pain freedom up to 48 hours compared with acetaminophen (low COE), gepants (low COE), NSAIDs (high COE), and triptan monotherapy (moderate COE). Triptan regimens, however, often had a higher risk for adverse events. One study found triptans more cost-effective than ditans and gepants.</p><p><strong>Limitations: </strong>Harms assessment was limited to randomized trials. Many comparisons lacked sufficient evidence to draw conclusions.</p><p><strong>Conclusion: </strong>Triptans and combinations of triptans were more effective than NSAID and acetaminophen alone.</p><p><strong>Primary funding source: </strong>American College of Physicians. (PROSPERO: CRD42023441146).</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647146","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 Treatment of Acute Migraine: Considering Guideline Recommendations While Keeping the Individual Patient in Mind.","authors":"Marianna Shnayderman Yugrakh","doi":"10.7326/ANNALS-25-00372","DOIUrl":"https://doi.org/10.7326/ANNALS-25-00372","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647148","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 of Acute Episodic Migraine Headache in Outpatient Settings: A Clinical Guideline From the American College of Physicians.","authors":"Amir Qaseem, Jeffrey A Tice, Itziar Etxeandia-Ikobaltzeta, Timothy J Wilt, Curtis S Harrod, Thomas G Cooney, Carolyn J Crandall, Lauri A Hicks, Ethan Balk, 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-24-03095","DOIUrl":"https://doi.org/10.7326/ANNALS-24-03095","url":null,"abstract":"<p><strong>Description: </strong>The American College of Physicians (ACP) developed this guideline based on the best available evidence on the comparative benefits and harms of pharmacologic treatments of acute episodic migraine headache, patients' values and preferences, and economic evidence about these pharmacologic treatments.</p><p><strong>Methods: </strong>This guideline is based on a systematic review and network meta-analysis of the comparative benefits and harms of pharmacologic treatments of acute episodic migraine headaches, as well as systematic reviews of patients' values and preferences and comparative cost-effectiveness analyses. The Clinical Guidelines Committee evaluated the following clinical outcomes using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach: pain freedom and pain relief at 2 hours; sustained pain freedom and sustained pain relief up to 48 hours; need for rescue medication within 24 hours; nausea, vomiting, and restored physical function at 2 hours; and overall and serious adverse events (AEs). Additional data on AEs were captured through U.S. Food and Drug Administration medication labels.</p><p><strong>Audience and population: </strong>The audience for this clinical guideline is physicians and other clinicians. The population is adults with acute episodic migraine headache (defined as 1 to 14 headache days per month) managed in outpatient settings.</p><p><strong>Recommendation 1: </strong>ACP recommends that clinicians add a triptan to a nonsteroidal anti-inflammatory drug to treat moderate to severe acute episodic migraine headache in outpatient settings for nonpregnant adults who do not respond adequately to a nonsteroidal anti-inflammatory drug (strong recommendation; moderate-certainty evidence).</p><p><strong>Recommendation 2: </strong>ACP suggests that clinicians add a triptan to acetaminophen to treat moderate to severe acute episodic migraine headache in outpatient settings for nonpregnant adults who do not respond adequately to acetaminophen (conditional recommendation; low-certainty evidence).</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647152","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 of Acute Episodic Migraine Headache in Outpatient Settings: A Visual Clinical Guideline From the American College of Physicians.","authors":"","doi":"10.7326/ANNALS-24-03095-VG","DOIUrl":"10.7326/ANNALS-24-03095-VG","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"e2403095VG"},"PeriodicalIF":19.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647173","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":"Racing to Nowhere-Primary Care Productivity Benchmarks and the Red Queen's Race.","authors":"Mark Earnest","doi":"10.7326/ANNALS-24-03544","DOIUrl":"https://doi.org/10.7326/ANNALS-24-03544","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647156","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":"Low Prevalence of Coronary Artery Disease Among Ugandans With and Without HIV: Local Anomaly or Regional Reality?","authors":"Mpiko Ntsekhe","doi":"10.7326/ANNALS-24-03940","DOIUrl":"https://doi.org/10.7326/ANNALS-24-03940","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612927","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":"Epidemiology of Coronary Atherosclerosis Among People Living With HIV in Uganda : A Cross-Sectional Study.","authors":"Mark J Siedner, Brian Ghoshhajra, Geoffrey Erem, Rita Nassanga, Mangun Randhawa, Andrew Ochieng, Moses Acan, Michael T Lu, Vikas Thondapu, Angelo Takigami, Zahra Reynolds, Flavia Atwiine, Edna Tindimwebwa, Rebecca F Gilbert, Eliza Passell, Shruti Sagar, Yao Tong, Ntobeko A B Ntusi, Alexander C Tsai, Prossy Bibangambah, Thomas Gaziano, Susanne S Hoeppner, Christopher T Longenecker, Samson Okello, Stephen Asiimwe","doi":"10.7326/ANNALS-24-02233","DOIUrl":"10.7326/ANNALS-24-02233","url":null,"abstract":"<p><strong>Background: </strong>Data on the prevalence of coronary atherosclerotic disease (CAD) in the African region among people with and without HIV are lacking.</p><p><strong>Objective: </strong>To estimate the prevalence of CAD in Uganda and determine whether well-controlled HIV infection is associated with increased presence or severity of CAD.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Southwestern Uganda.</p><p><strong>Participants: </strong>Ambulatory people living with HIV (PWH), aged older than 40 years, taking antiretroviral therapy for 3 or more years, and population-based, age- and sex-similar people without HIV (PWoH).</p><p><strong>Measurements: </strong>Participants had cardiovascular (CV) disease (CVD) risk profiling and computed tomography scanning for detection of CAD, defined as the presence of calcified or noncalcified plaque.</p><p><strong>Results: </strong>Of 630 screened, 586 (93%) met criteria and had evaluable images. Of these, 287 (49.0%) were PWH and nearly all (272 of 287 [95%]) were virologically suppressed. Mean age (57.9 vs. 57.4 years), proportion female (49%), and median CVD risk score (4.1 vs. 3.4) did not differ by HIV serostatus. The prevalence of CAD was low overall (45 of 586 [7.7%]) and among both PWH (26 of 287 [9.1%]) and PWoH (19 of 299 [6.4%]; absolute prevalence difference, 2.7% [95% CI, -1.6% to 7.0%]). Results were similar after adjustment for CVD risk factors.</p><p><strong>Limitations: </strong>Our findings may not generalize to symptomatic populations or those with greater predicted CVD risk. The study was not powered to detect small differences in CAD prevalence between HIV subgroups. Both PWH and PWoH had similar CV risk factor profiles, but residual confounding between HIV and CAD cannot be excluded.</p><p><strong>Conclusion: </strong>The prevalence of CAD in Uganda was low compared with population-based cohorts from the Global North with similar CVD risk profiles and was similar between HIV serostatus subgroups. Our results suggest that CAD may not be a major cause of morbidity in Uganda.</p><p><strong>Primary funding source: </strong>National Institutes of Health.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612852","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":"Evaluation and Management of Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2024 Clinical Practice Guideline.","authors":"Magdalena Madero, Adeera Levin, Sofia B Ahmed, Juan Jesus Carrero, Bethany Foster, Anna Francis, Rasheeda K Hall, William G Herrington, Guy Hill, Lesley A Inker, Rümeyza Kazancıoğlu, Edmund Lamb, Peter Lin, Natasha McIntyre, Kelly Morrow, Glenda Roberts, Dharshana Sabanayagam, Michael Shlipak, Rukshana Shroff, Navdeep Tangri, Teerawat Thanachayanont, Ifeoma Ulasi, Germaine Wong, Chih-Wei Yang, Luxia Zhang, Karen A Robinson, Lisa M Wilson, Renee F Wilson, Bertram L Kasiske, Michael Cheung, Amy Earley, Paul E Stevens, Elke Schaeffner","doi":"10.7326/ANNALS-24-01926","DOIUrl":"https://doi.org/10.7326/ANNALS-24-01926","url":null,"abstract":"<p><strong>Description: </strong>The Kidney Disease: Improving Global Outcomes (KDIGO) organization updated its existing clinical practice guideline in 2024 to provide guidance on the evaluation, management, and treatment of chronic kidney disease (CKD) in adults and children who are not receiving kidney replacement therapy.</p><p><strong>Methods: </strong>The KDIGO CKD Guideline Work Group defined the scope of the guideline and determined topics for systematic review. An independent Evidence Review Team systematically reviewed the evidence and graded the certainty of evidence for each of the review topics. Latest searches of the English-language literature were done in July 2023. Final modification of the guideline was informed by a public review process during summer of 2023 involving registered stakeholders.</p><p><strong>Recommendations: </strong>The full guideline included 28 recommendations and 141 practice points. This synopsis focuses on the recommendations that have the greatest evidence. Practice points reflect the expert opinion of the group where evidence is not that strong. Recommendations include greater emphasis on cystatin C for assessment of glomerular filtration rate, point-of-care testing in remote areas, a shift to an individualized risk-based approach to predict kidney failure, sodium-glucose cotransporter-2 inhibitors for some patients with CKD with and without diabetes, and statin use for adults older than 50 years and CKD. Together the recommendations and practice points provide guidance for how to evaluate and manage persons with CKD.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596060","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":"An Urgent Need to Improve Accessibility of Preventive Services for People With Disabilities.","authors":"Emily Hotez, Susan Duan, Janet Ma, Sahana Shankar","doi":"10.7326/ANNALS-25-00374","DOIUrl":"https://doi.org/10.7326/ANNALS-25-00374","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596099","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":"Web Exclusive. Annals Video Summary - Health Care Delivery of Clinical Preventive Services for People With Disabilities: A Systematic Review.","authors":"","doi":"10.7326/ANNALS-25-00443-VS","DOIUrl":"10.7326/ANNALS-25-00443-VS","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"e2500443VS"},"PeriodicalIF":19.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596103","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}