Annals of Internal Medicine最新文献

{"title":"Cost-Effectiveness of Extending Human Papillomavirus Vaccination to Population Subgroups Older Than 26 Years Who Are at Higher Risk for Human Papillomavirus Infection in the United States.","authors":"Jean-François Laprise, Harrell W Chesson, Lauri E Markowitz, Mélanie Drolet, Marc Brisson","doi":"10.7326/M24-0421","DOIUrl":"https://doi.org/10.7326/M24-0421","url":null,"abstract":"<p><strong>Background: </strong>In June 2019, the U.S. Advisory Committee on Immunization Practices recommended shared clinical decision making regarding potential human papillomavirus (HPV) vaccination of men and women aged 27 to 45 years (\"mid-adults\").</p><p><strong>Objective: </strong>To examine the incremental cost-effectiveness ratios (ICERs) and number needed to vaccinate (NNV) to prevent 1 HPV-related cancer case of expanding HPV vaccination to subgroups of mid-adults at increased risk for HPV-related diseases in the United States.</p><p><strong>Design: </strong>Individual-based transmission dynamic modeling of HPV transmission and associated diseases using HPV-ADVISE (Agent-based Dynamic model for VaccInation and Screening Evaluation).</p><p><strong>Data sources: </strong>Published data.</p><p><strong>Target population: </strong>All U.S. mid-adults and higher-risk subgroups within this population.</p><p><strong>Time horizon: </strong>100 years.</p><p><strong>Perspective: </strong>Health care sector.</p><p><strong>Intervention: </strong>Expanding 9-valent HPV vaccination to mid-adults and higher-risk subgroups.</p><p><strong>Outcome measures: </strong>ICERs and NNVs.</p><p><strong>Results of base-case analysis: </strong>Expanding 9-valent HPV vaccination to all mid-adults, those with more lifetime partners, and those who have just separated was projected to cost an additional $2 005 000, $763 000, and $1 164 000 per quality-adjusted life-year (QALY) gained, respectively. The NNVs to prevent 1 additional HPV-related cancer case were 7670, 3190, and 5150, respectively, compared with 223 for vaccination of persons aged 9 to 26 years (vs. no vaccination).</p><p><strong>Results of sensitivity analysis: </strong>The mid-adult strategy with the lowest ICER and NNV was vaccinating infrequently screened mid-adult women who have just separated and have a higher number of lifetime sex partners (ICER, $86 000 per QALY gained; NNV, 470).</p><p><strong>Limitation: </strong>Uncertainty about rate of new sex partners and natural history of HPV among mid-adults.</p><p><strong>Conclusion: </strong>Vaccination of mid-adults against HPV is substantially less cost-effective and produces higher NNVs than vaccination of persons younger than 26 years under all scenarios investigated. However, cost-effectiveness and NNV are projected to improve when higher-risk mid-adult subgroups are vaccinated, such as mid-adults with more sex partners and who have recently separated, and women who are underscreened.</p><p><strong>Primary funding source: </strong>Centers for Disease Control and Prevention.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715293","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":"Ethical Approaches to Limiting Overall Costs for Glucagon-Like Peptide-1 Receptor Agonists for Weight Management.","authors":"Johan Dellgren, Ezekiel Emanuel, Govind Persad","doi":"10.7326/ANNALS-24-01317","DOIUrl":"https://doi.org/10.7326/ANNALS-24-01317","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715296","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":"Association of Work Control With Burnout and Career Intentions Among U.S. Physicians : A Multi-Institution Study.","authors":"Christine A Sinsky, Roger L Brown, Lisa Rotenstein, Lindsey E Carlasare, Purva Shah, Tait D Shanafelt","doi":"10.7326/ANNALS-24-00884","DOIUrl":"https://doi.org/10.7326/ANNALS-24-00884","url":null,"abstract":"<p><strong>Background: </strong>Physician control over their clinical work is hypothesized to be associated with both burnout and career intentions.</p><p><strong>Objective: </strong>To assess the association of perceived work control with burnout and career intentions.</p><p><strong>Design: </strong>A multi-institution study.</p><p><strong>Setting: </strong>Cross-sectional survey.</p><p><strong>Participants: </strong>A sample of U.S. physicians between November 2022 and December 2023.</p><p><strong>Measurements: </strong>A novel multicomponent measure of work control, Mini-Z single-item burnout measure, intent to reduce clinical hours (ITR), and intent to leave the current practice.</p><p><strong>Results: </strong>Among respondents, 61.4% (1318 of 2144) reported adequate control over patient load, 60.6% (1301 of 2144) adequate control over membership of their clinical team, and 61.3% (1434 of 2339) adequate control over workload. Adequate control over hiring of staff and clinical schedule were reported by 49.0% (772 of 1574) and 74.6% (1175 of 1574), respectively. Most respondents (58.3% [692 of 1186]) reported that they had sufficient authority/autonomy over that for which they are accountable. On multivariable analyses adjusting for personal and professional characteristics, poor control over patient load, team composition, clinical schedule, domains for which the physician is accountable, and workload were independently associated with burnout. Poor control over patient load and workload were each independently associated with ITR.</p><p><strong>Limitation: </strong>This is a cross-sectional study, so causation cannot be determined, and it is a convenience sample of practices with more than 100 physicians, so it may not be representative of all U.S. physicians.</p><p><strong>Conclusion: </strong>In this large, cross-sectional study, poor control over specific aspects of work was associated with burnout and intentions to reduce clinical effort or leave one's organization. Efforts to reduce burnout and improve retention should consider how to provide physician control over appropriate aspects of their clinical work environment.</p><p><strong>Primary funding source: </strong>American Medical Association.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715290","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":"Firearms Are Not Motor Vehicles.","authors":"Michelle Degli Esposti, Rebeccah L Sokol, Douglas J Wiebe","doi":"10.7326/ANNALS-24-02305","DOIUrl":"https://doi.org/10.7326/ANNALS-24-02305","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715301","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 Effect of Denosumab on Risk for Emergently Treated Hypocalcemia by Stage of Chronic Kidney Disease : A Target Trial Emulation.","authors":"Steven T Bird, Kate Gelperin, Elizabeth R Smith, Tae Hyun Jung, Hai Lyu, Aliza Thompson, Olivia Easley, Kushal B Naik, Yueqin Zhao, Rekha Kambhampati, Michael Wernecke, Ali Niak, Marina Zemskova, Yoganand Chillarige, Jeffrey A Kelman, David J Graham","doi":"10.7326/M24-0013","DOIUrl":"10.7326/M24-0013","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of data on treatment of osteoporosis in patients with advanced chronic kidney disease (CKD).</p><p><strong>Objective: </strong>To assess the risk for emergently treated hypocalcemia with denosumab by stage of CKD and presence of CKD-mineral and bone disorder (CKD-MBD).</p><p><strong>Design: </strong>Target trial emulation.</p><p><strong>Setting: </strong>Medicare fee-for-service data with prescription drug coverage, 2012 to 2020.</p><p><strong>Participants: </strong>Female patients aged 65 years or older initiating denosumab, oral bisphosphonates, or intravenous (IV) bisphosphonates for osteoporosis.</p><p><strong>Measurements: </strong>Hospital and emergency department admissions (that is, emergent care) for hypocalcemia were assessed in the first 12 treatment weeks. Inverse probability of treatment weighted cumulative incidence and weighted risk differences (RDs) were calculated.</p><p><strong>Results: </strong>A total of 361 453 patients treated with denosumab, 829 044 treated with oral bisphosphonates, and 160 413 treated with IV bisphosphonates were identified. Risk for emergently treated hypocalcemia with denosumab versus oral bisphosphonates increased with worsening CKD stage (<i>P</i> < 0.001), with greatest risk among dialysis-dependent (DD) patients (3.01% vs. 0.00%; RD, 3.01% [95% CI, 2.27% to 3.77%]) and non-dialysis-dependent (NDD) patients with CKD stages 4 and 5 (0.57% vs. 0.03%; RD, 0.54% [CI, 0.41% to 0.68%]). Among patients with stages 4 and 5 CKD (NDD + DD), denosumab had a greater risk for emergently treated hypocalcemia versus oral bisphosphonates in those with CKD-MBD (1.53% vs. 0.02%; RD, 1.51% [CI, 1.21% to 1.78%]) than in those without CKD-MBD (0.22% vs. 0.03%; RD, 0.19% [CI, 0.08% to 0.31%]). Denosumab also showed increased risk compared with IV bisphosphonates.</p><p><strong>Limitation: </strong>Generalizability to men and non-Medicare populations.</p><p><strong>Conclusion: </strong>Risk for emergently treated hypocalcemia with denosumab increased with worsening CKD stage and was highest in DD patients and those with CKD-MBD.</p><p><strong>Primary funding source: </strong>U.S. Food and Drug Administration.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666926","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":"Increasing Incidence and Stable Mortality of Pancreatic Cancer in Young Americans.","authors":"Vishal R Patel, Adewole S Adamson, Jason B Liu, H Gilbert Welch","doi":"10.7326/ANNALS-24-00635","DOIUrl":"10.7326/ANNALS-24-00635","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666922","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":"Peer Review: Insights Gleaned From Observing the Editorial Process at <i>Annals of Internal Medicine</i>.","authors":"Yuri Matusov, Taylor Brooks, Desiree Burroughs-Ray, Maniraj Neupane","doi":"10.7326/ANNALS-24-01737","DOIUrl":"10.7326/ANNALS-24-01737","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666925","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":"Oropouche Virus: A Rising Threat in the Western Hemisphere.","authors":"Kevin O'Laughlin, Ralph Huits, Michael Libman, Phyllis Kozarsky, Davidson H Hamer","doi":"10.7326/ANNALS-24-03049","DOIUrl":"10.7326/ANNALS-24-03049","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666924","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":"From Risk to Recovery: Looking Ahead to the Next 50 Years of Preoperative Cardiovascular Assessment.","authors":"Lauren E Gibson, Jeanine P Wiener-Kronish, Lee A Fleisher","doi":"10.7326/ANNALS-24-02405","DOIUrl":"https://doi.org/10.7326/ANNALS-24-02405","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612043","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":"Misuse of Race in the Interpretation of HbA_1c.","authors":"Elizabeth Selvin","doi":"10.7326/ANNALS-24-01661","DOIUrl":"https://doi.org/10.7326/ANNALS-24-01661","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612152","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}