Annals of Internal Medicine最新文献

{"title":"In patients with ESUS, the effects of OAC and antiplatelet therapy on recurrent ischemic stroke differ across subgroups at 1 to 5 y.","authors":"Eleni Korompoki, James D Douketis","doi":"10.7326/ANNALS-24-03608-JC","DOIUrl":"10.7326/ANNALS-24-03608-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":"JC18"},"PeriodicalIF":19.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143121852","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 rifampicin-resistant TB, bedaquiline-containing regimens reduced unfavorable status vs. a control regimen at 132 wk.","authors":"Alex Nachman, Zain Chagla","doi":"10.7326/ANNALS-24-03918-JC","DOIUrl":"10.7326/ANNALS-24-03918-JC","url":null,"abstract":"<p><strong>Clinical impact ratings: </strong>GIM/FP/GP: [Formula: see text] Infectious Disease: [Formula: see text] Pulmonology: [Formula: see text].</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"JC19"},"PeriodicalIF":19.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143121853","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":"Assessing the Risk for Falls in Older Adults After Initiating Gabapentin Versus Duloxetine.","authors":"Alexander Chaitoff, Rishi J Desai, Niteesh K Choudhry, Katharina T Jungo, Nancy Haff, Julie C Lauffenburger","doi":"10.7326/ANNALS-24-00636","DOIUrl":"https://doi.org/10.7326/ANNALS-24-00636","url":null,"abstract":"<p><strong>Background: </strong>The evidence informing the harms of gabapentin use are at risk of bias from comparing users with nonusers.</p><p><strong>Objective: </strong>To describe the risk for fall-related outcomes in older adults starting treatment with gabapentin versus duloxetine.</p><p><strong>Design: </strong>New user, active comparator study using a target trial emulation framework.</p><p><strong>Setting: </strong>MarketScan (IBM) commercial claims between January 2014 and December 2021.</p><p><strong>Participants: </strong>Adults aged 65 years or older with diabetic neuropathy, postherpetic neuralgia, or fibromyalgia and without depression, anxiety, seizures, or cancer in the 365 days before cohort entry.</p><p><strong>Intervention: </strong>New initiation of treatment with gabapentin or duloxetine (comparator).</p><p><strong>Measurements: </strong>The primary outcome was the hazard of experiencing any fall-related visit in the 6 months after initiating gabapentin or duloxetine until discontinuation of treatment. Secondary outcomes were hazard of severe fall-related events defined as a fall associated with hip fracture or emergency department visit or hospitalization associated with a fall. Stabilized inverse probability of treatment weighting was used to adjust for baseline characteristics.</p><p><strong>Results: </strong>Our analytic cohort included 57 086 older adults with a diagnosis of interest initiating treatment with gabapentin (<i>n</i> = 52 152) or duloxetine (<i>n</i> = 4934). Overall median follow-up duration was 30 days (IQR, 30 to 90 days). Weighted cumulative incidence of a fall-related visit per 1000 person-years at 30, 90, and 180 days was 103.60, 90.44, and 84.44 for gabapentin users and 203.43, 177.73, and 158.21 for duloxetine users, respectively. At 6-month follow-up, incident gabapentin users had lower hazard of falls (hazard ratio, 0.52 [95% CI, 0.43 to 0.64]), but there was no difference in the hazards of experiencing severe falls. Results were similar across sensitivity and subgroup analyses.</p><p><strong>Limitation: </strong>Claims may contain fewer frail adults and undercount falls.</p><p><strong>Conclusion: </strong>Compared with incident use of duloxetine, incident use of gabapentin was not associated with increased fall-related visits.</p><p><strong>Primary funding source: </strong>None.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":"178 2","pages":"187-198"},"PeriodicalIF":19.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439758","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":"Efficacy and Safety of Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss Among Adults Without Diabetes : A Systematic Review of Randomized Controlled Trials.","authors":"Areesha Moiz, Kristian B Filion, Helia Toutounchi, Michael A Tsoukas, Oriana H Y Yu, Tricia M Peters, Mark J Eisenberg","doi":"10.7326/ANNALS-24-01590","DOIUrl":"https://doi.org/10.7326/ANNALS-24-01590","url":null,"abstract":"<p><strong>Background: </strong>Recent randomized controlled trials (RCTs) have investigated glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual or triple co-agonists for weight loss among adults with overweight or obesity and without diabetes.</p><p><strong>Purpose: </strong>To assess the efficacy and safety of GLP-1 RAs and co-agonists for the treatment of obesity among adults without diabetes.</p><p><strong>Data sources: </strong>MEDLINE, Embase, and Cochrane CENTRAL from inception to 4 October 2024.</p><p><strong>Study selection: </strong>Placebo-controlled RCTs in otherwise healthy participants with overweight or obesity.</p><p><strong>Data extraction: </strong>The primary outcome was change in relative or absolute body weight from baseline to maximum on-treatment follow-up. Safety outcomes included death, serious adverse events (SAEs), any adverse events (AEs), and gastrointestinal AEs.</p><p><strong>Data synthesis: </strong>A total of 26 RCTs comprising 15 491 participants (72% female; mean body mass index, 30 to 41 kg/m²; mean age, 34 to 57 years) and 12 agents (3 commercially available agents [liraglutide, semaglutide, and tirzepatide] and 9 premarket agents for long-term weight management) were included. Treatment ranged from 16 to 104 weeks (median, 43 weeks). Compared with placebo, tirzepatide (15 mg once weekly) resulted in weight loss of up to 17.8% (95% CI, 16.3% to 19.3%) after 72 weeks of therapy; semaglutide (2.4 mg once weekly), up to 13.9% (CI, 11.0% to 16.7%) after 68 weeks; and liraglutide (3.0 mg once daily), up to 5.8% (CI, 3.6% to 8.0%) after 26 weeks. Retatrutide (12 mg once weekly) produced greater weight loss of up to 22.1% (CI, 19.3% to 24.9%) after 48 weeks; other novel single and combination GLP-1 agents were also efficacious to varying degrees. Although AEs were frequent (GLP-1 RA vs. placebo: 80% to 97% vs. 63% to 100%), the majority were gastrointestinal-related (47% to 84% vs. 13% to 63%, respectively), most commonly nausea, vomiting, diarrhea, and constipation. AEs requiring treatment discontinuation (0% to 26% vs. 0% to 9%, respectively) and SAEs (0% to 10% vs. 0% to 12%, respectively) were rare.</p><p><strong>Limitations: </strong>No head-to-head RCTs were available. Heterogeneity prevented meta-analysis.</p><p><strong>Conclusion: </strong>GLP-1 RAs and co-agonists are efficacious for weight loss, with reported safety concerns predominantly gastrointestinal in nature, when used among adults with overweight or obesity and without diabetes.</p><p><strong>Primary funding source: </strong>None. (PROSPERO: CRD42024505558).</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":"178 2","pages":"199-217"},"PeriodicalIF":19.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439763","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":"Health Expenditures of Patients With Diabetes After Bariatric Surgery: Comparing Gastric Bypass and Sleeve Gastrectomy.","authors":"Matthew L Maciejewski, Lindsay Zepel, Valerie A Smith, David E Arterburn, Mary K Theis, Aileen Baecker, Caroline Sloan, Amy G Clark, Ryan M Kane, Christopher R Daigle, Karen J Coleman, Aniket A Kawatkar","doi":"10.7326/ANNALS-24-00480","DOIUrl":"https://doi.org/10.7326/ANNALS-24-00480","url":null,"abstract":"<p><strong>Background: </strong>Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) differ in their effects on body weight and risk for reoperation. However, it is unclear whether long-term health expenditures differ by procedure type in patients with diabetes.</p><p><strong>Objective: </strong>To compare health expenditures 3 years before and 5.5 years after bariatric surgery between patients with diabetes undergoing RYGB versus SG.</p><p><strong>Design: </strong>Retrospective cohort study using target trial emulation principles.</p><p><strong>Setting: </strong>Integrated health system.</p><p><strong>Patients: </strong>Patients with diabetes undergoing RYGB (<i>n</i> = 3147) or SG (<i>n</i> = 3510) from 2012 to 2019.</p><p><strong>Measurements: </strong>Total, inpatient, outpatient, and medication expenditures.</p><p><strong>Results: </strong>Characteristics of patients undergoing RYGB and SG were well balanced after weighting; 73% were female, average body mass index was 43.8 kg/m², and average age was 50 years. Expenditures per 6-month period decreased by about 30% for both groups, from $4039.06 (95% CI, $3770.88 to $4326.31) 3 years before to $2441.13 (CI, $2151.07 to $2770.30) 5.5 years after RYGB and from $3918.37 (CI, $3658.75 to $4196.40) 3 years before to $2658.15 (CI, $2279.17 to $3100.16) 5.5 years after SG. Total expenditures after surgery did not differ between groups through 5.5 years (difference at 5.5 years, -$217.02 [CI, -$671.29 to $201.96]) except for the first 6 months, when expenditures were transiently higher in the RYGB group (difference, $564.32 [CI, $232.60 to $895.20]), driven by a higher inpatient admission rate. Otherwise, postsurgical outpatient and medication expenditures did not appear to differ between RYGB and SG.</p><p><strong>Limitation: </strong>Unobserved confounding.</p><p><strong>Conclusion: </strong>Overall expenditures decreased substantially in the postsurgical period, primarily due to reductions in pharmacy expenditures, with no differences between RYGB and SG except in the first 6 months after surgery.</p><p><strong>Primary funding source: </strong>National Institute of Diabetes and Digestive and Kidney Diseases.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051392","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":"Guidelines International Network: Principles for Use of Artificial Intelligence in the Health Guideline Enterprise.","authors":"Bernardo Sousa-Pinto, Manuel Marques-Cruz, Ignacio Neumann, Yuan Chi, Artur J Nowak, Marge Reinap, Mariette Awad, Monika Nothacker, Milana Trucl, Jan Brozek, Pablo Alonso-Coello, Wojtek Wiercioch, Amir Qaseem, Elie A Akl, Holger J Schünemann","doi":"10.7326/ANNALS-24-02338","DOIUrl":"10.7326/ANNALS-24-02338","url":null,"abstract":"<p><strong>Description: </strong>Artificial intelligence (AI) has been defined by the High-Level Expert Group on AI of the European Commission as \"systems that display intelligent behaviour by analysing their environment and taking actions-with some degree of autonomy-to achieve specific goals.\" Artificial intelligence has the potential to support guideline planning, development and adaptation, reporting, implementation, impact evaluation, certification, and appraisal of recommendations, which we will refer to as \"guideline enterprise.\" Considering this potential, as well as the lack of guidance for the use of AI in guidelines, the Guidelines International Network (GIN) proposes a set of principles for the development and use of AI tools or processes to support the health guideline enterprise.</p><p><strong>Methods: </strong>A GIN working group on AI developed these principles, informed by the results of a scoping review and practical examples, through iterative discussion.</p><p><strong>Recommendations: </strong>Eight principles were identified to adhere to when using AI in the guideline context: transparency, preplanning, additionality, credibility, ethics, accountability, compliance, and evaluation. These complementary principles are described in a comprehensive way, but they do not provide detailed instructions on how to use specific AI tools. Although these principles are expected to apply across different contexts and stages of the guideline enterprise, details on their implementation have some degree of flexibility. Guideline development groups choosing to use AI will be able to adequately implement the principles if they ensure aspects such as structured reporting on the use of AI tools, involvement of experts in AI, and allocation of funding for the adequate use of AI tools. The GIN principles may support guideline developers in the responsible and transparent use of AI to ensure trustworthy guidelines.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051391","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 Updates Family and Medical Leave Policy.","authors":"Renee Butkus","doi":"10.7326/ANNALS-24-03993","DOIUrl":"https://doi.org/10.7326/ANNALS-24-03993","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051387","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 Updates Family and Medical Leave Policy.","authors":"Renee Butkus","doi":"10.7326/ANNALS-24-03994","DOIUrl":"https://doi.org/10.7326/ANNALS-24-03994","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051388","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 Graphic Medicine - 2 Face Comics Presents: Art Is the Best Medicine.","authors":"Raphel Awa","doi":"10.7326/G24-0016","DOIUrl":"10.7326/G24-0016","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"eG240016"},"PeriodicalIF":19.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977193","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 asymptomatic severe AS, early surgery vs. conservative therapy reduced a composite of death, MI, stroke, or HF hospitalization at 63 mo.","authors":"Raúl Moreno","doi":"10.7326/ANNALS-24-03367-JC","DOIUrl":"10.7326/ANNALS-24-03367-JC","url":null,"abstract":"<p><strong>Clinical impact ratings: </strong>GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text].</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":"178 1","pages":"JC6"},"PeriodicalIF":19.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998468","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}