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561. A 30-Year Analysis of National Institutes of Health F32 Grants to Internal Medicine Trainees.
作者: Taylor M Horgan.;Anirudha S Chandrabhatla.;Emily D Fronk.;Simon W White.;Shreya Mandava.;Hannah Jacobs-El.;Patrick E H Jackson.;Adishesh K Narahari.;Neeral L Shah.
来源: Ann Intern Med. 2025年178卷11期1667-1670页 562. Maternal Influenza-Like Illness and Neonatal Health During the 1918 Influenza Pandemic in a Swiss City.
作者: Mathilde Le Vu.;Katarina L Matthes.;Eric B Schneider.;Aline Moerlen.;Irene Hösli.;David Baud.;Kaspar Staub.
来源: Ann Intern Med. 2025年178卷11期1632-1641页
Exposure to the 1918 influenza pandemic may have been associated with preterm birth (<37 weeks). Other outcomes, such as infant size or weight, have rarely been explored. Using 2177 historical birth records from University Maternity Hospital of Lausanne, it was estimated whether in utero exposure to maternal influenza-like illness (ILI) during the 1918 pandemic was associated with pregnancy outcomes and whether associations varied depending on the trimester of ILI during pregnancy or on fetal sex. Generalized linear models and robust linear models were used to analyze the association between ILI and gestational age, stillbirth, and anthropometric measurements, adjusting on covariates. Analyses were stratified by fetal sex. A total of 282 (13%) women developed ILI during pregnancy. Exposure to ILI was associated with lower anthropometric measurements: low birthweight (LBW; <2500 g) (marginally adjusted percentage was 13.3% compared with 6.9% in the unexposed group; difference, 6.4 percentage points [95% CI, 5.5 to 7.2 percentage points]). There was strong evidence that third trimester exposure was associated with worse adverse pregnancy outcomes, including with LBW (difference, 12.8 percentage points [CI, 11.8 to 13.7 percentage points]) and preterm birth rates (difference, 9.4 percentage points [CI, 8.2 to 10.6 percentage points]). Maternal ILI may have triggered premature birth. The magnitude of the declines in anthropometric parameters was higher among male fetuses, and they had a higher stillbirth rate. For instance, males exposed during the third trimester had their birthweight lowered by 228.4 g (CI, -391.0 to -65.8 g) compared with 126.3 g among females [CI, -256.6 to 4.0 g]. Only 41% of infants exposed to first-trimester ILI were males, suggesting a selection against male fetuses through miscarriage. Our findings may not generalize to the entire population of Lausanne, as 34% of births were home births at the time.
564. GRADE Guidance: Using Thresholds for Judgments on Health Benefits and Harms in Decision Making (GRADE Guidance 42).
作者: Wojtek Wiercioch.;Gian Paolo Morgano.;Thomas Piggott.;Robby Nieuwlaat.;Ignacio Neumann.;Bernardo Sousa-Pinto.;Pablo Alonso-Coello.;Elie A Akl.;Lawrence Mbuagbaw.;Fuad Mirzayev.;Lorenzo Moja.;Reem Mustafa.;Daniele Piovani.;Elena Parmelli.;Zuleika Saz-Parkinson.;Samuel G Schumacher.;Ilse Verstijnen.;Stefanos Bonovas.;Holger J Schünemann.
来源: Ann Intern Med. 2025年178卷11期1644-1652页
Users of GRADE (Grading of Recommendations Assessment, Development and Evaluation) make judgments about the size of intervention effects on desirable and undesirable people-important health outcomes or on benefits and harms. Benchmarking effect sizes by using decision thresholds (DTs) can help to facilitate these judgments and the process. This article provides GRADE guidance for use of DTs for judgments about the magnitude of desirable and undesirable health effects, such as in a health guideline or health technology assessment. Through iterative discussions and refinement in in-person and online meetings of a GRADE project group and through e-mail communication, the authors developed guidance for using DTs in Evidence-to-Decision (EtD) frameworks. The authors applied the approach and used these examples from guidelines and the results of a randomized methodological study to develop official GRADE guidance. Several alternatives for determining and using DTs are presented. In the first main approach, outcome-specific DTs for trivial, small, moderate, and large effects are determined through a calculation using empirically derived generic coefficients and the outcome's utility value and are compared with the effect estimate obtained from an evidence synthesis. In the second main approach, outcome-specific DTs are also determined, but through direct surveying of decision makers to explicitly assign thresholds for the prioritized health outcomes. The article also describes how these approaches can be combined. The suggested approaches provide transparency for judgments in EtD frameworks that are based on findings from evidence syntheses.
565. In nontraumatic acute headache in the ED, the Ottawa and Emerald rules have high sensitivity but low specificity for SAH.
Emergency Med: [Formula: see text] GIM/FP/GP: [Formula: see text] Neurology: [Formula: see text].
566. Trends in and Predictors of Physician Attrition From Clinical Practice Across Specialties : A Nationwide, Longitudinal Analysis.
作者: Lisa S Rotenstein.;Zili He.;James Dziura.;Yusuke Tsugawa.;Arjun K Venkatesh.;Edward R Melnick.;Cameron J Gettel.
来源: Ann Intern Med. 2025年178卷12期1698-1708页
The United States faces a predicted shortage of 36 500 physicians by 2036, with an increasing proportion of physicians leaving clinical practice or expressing an intent to do so. Evidence is limited about the extent to which stated intent to leave clinical practice translates to actual attrition from clinical practice and which factors are associated with this outcome.
567. In primary CDI, fecal microbiota transplantation was noninferior to vancomycin for clinical cure at 14 d without recurrence at 60 d.
GIM/FP/GP: [Formula: see text] Gastroenterology: [Formula: see text] Infectious Disease: [Formula: see text].
568. In older patients with ACS, early invasive and conservative management do not differ for all-cause mortality.
Emergency Med: [Formula: see text] GIM/FP/GP: [Formula: see text].
572. In adults with overweight or obesity and ≥5% weight loss, a patient-delivered intervention reduced weight regain at 18 mo.
GIM/FP/GP: [Formula: see text] Public Health: [Formula: see text].
573. In mechanically ventilated, critically ill adults, conservative vs. usual supplemental oxygen did not reduce mortality at 90 d.
GIM/FP/GP: [Formula: see text] Critical Care: [Formula: see text] Pulmonology: [Formula: see text].
575. In T2D and hypertension, the lower-sodium DASH4D diet reduced SBP more than a higher-sodium comparison diet at 5 wk.
GIM/FP/GP: [Formula: see text] Endocrinology: [Formula: see text].
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