Epilepsy is a common neurologic condition characterized by at least 1 unprovoked seizure and a high risk for recurrent seizures. Distinguishing epilepsy from conditions that can mimic seizures is important for accurate diagnosis and effective treatment. This article reviews the evaluation of patients suspected of having epilepsy and discusses behavioral strategies and pharmacologic and surgical therapies that can help reduce morbidity associated with recurrent seizures.

Osteoporosis is a skeletal condition characterized by low bone mass and fragility resulting in an increased risk for fracture. It affects all bones, but fractures most often occur in the hip and spine. Osteoporosis is common in postmenopausal women, with estrogen deficiency thought to be a major contributing factor. Screening for osteoporosis with bone densitometry is recommended in all women 65 years of age or older and in postmenopausal women younger than 65 who are at increased risk. In 2023, the American College of Physicians published updated guidance on the pharmacologic treatment of osteoporosis. Among the recommendations was for clinicians to take an individualized approach regarding whether to start treatment with a bisphosphonate in women older than 65 years with osteopenia (a lesser degree of bone loss) to reduce the risk for fractures. Here, 2 bone endocrinologists debate how to manage a patient with both osteopenia and osteoporosis on bone densitometry. They discuss how to interpret and address these findings.

What is the added risk for death from smoking? Logistic regression has become the most common statistical method to answer such questions in the biomedical literature. However, the typical analyses estimate odds ratios, a metric too often misunderstood and misinterpreted. Although estimates of risks, and their differences and ratios, offer transparent clinical interpretations, commonly used statistical models have known methodological shortcomings. "Standardization" through modeling, weighting, or matching offers a solution. The goals of this article are to review classical concepts of standardization and to link them to regression modeling for causal inference. The authors also describe approaches based on weighting and matching compared with regression-based standardization. Using an example of smoking from the ARIC (Atherosclerosis Risk in Communities) study, they explain the value of standardization, long used in medicine and public health, to estimate risks and their differences and ratios for binary outcomes. The authors demonstrate how standard statistical software using models that best fit the data and respect underlying biological or clinical processes can reexpress results in clinically meaningful metrics. The Supplement offers examples with common software packages.

Medicare Advantage (MA) plans report diagnoses more intensely than providers in the traditional Medicare (TM) program, and there is wide variation in coding intensity across MA plans.

Whether artificial intelligence (AI) assistance is associated with quality of care is uncertain.

Tirzepatide, a once-weekly glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist approved for the treatment of adults with type 2 diabetes or obesity, showed clinically meaningful reductions in hemoglobin A1c (HbA1c) and body weight in the SURPASS phase 3 clinical trial program.

The American College of Physicians' Population Health and Medical Science Committee (PHMSC) developed this best practice advice to inform clinicians about what is currently known about the benefits and harms of cannabis or cannabinoids in the management of chronic noncancer pain and to provide advice for clinicians counseling patients seeking this therapy.

GIM/FP/GP: [Formula: see text] Infectious Disease: [Formula: see text] Pulmonology: [Formula: see text] Public Health: [Formula: see text].

Rural communities throughout the United States experience disparities in health and access to health care. Low population densities, isolating terrain, and vast geographic distances to other population centers create barriers to attracting and retaining physicians and other health professionals. The characteristics of rural communities also pose barriers to facilitating robust economic activity conducive to the production of health and the presence of health care facilities. As such, rural communities have faced high levels of hospital closures and "diseases of despair," such as opioid misuse and suicide. The heterogeneity of rural geographies and population characteristics produces unique and differing challenges across communities that require tailored policy interventions. Interventions that are culturally appropriate for rural communities must be adopted that address diseases and health conditions that impact rural populations and the related social and economic conditions that create and perpetuate these diseases and health conditions. Policymakers must invest in the economies, social services, and infrastructure of rural communities, especially those programs that provide health coverage and services to them. Ensuring access to telehealth is a critical component of expanding health care access. Medical education institutions and the medical community at large have a responsibility to equip physicians and physicians-in-training to care for rural communities and provide opportunities for trainees to practice in rural settings. These institutions must be supported through public policy that incentivizes the recruitment and retainment of a qualified physician workforce in rural communities.

GIM/FP/GP: [Formula: see text] Infectious Disease: [Formula: see text] Public Health: [Formula: see text].

During 2024, there were many practice-changing innovations in the field of endocrinology, particularly related to the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs). From the substantial new evidence published in 2024, 10 studies are highlighted that offer critical information for clinicians who manage or comanage patients with endocrine disorders including prediabetes, diabetes, obesity, and hyperparathyroidism. Two of the 10 articles are focused on use of GLP-1RAs in multiple clinical settings not studied in the original GLP-1RA trials, including after bariatric surgery and before endoscopy. Two additional studies focused on GLP-1RA explore the risk for thyroid cancer in patients prescribed GLP-1RA and the effect of a GLP-1RA on chronic kidney disease in patients with type 2 diabetes. Three articles investigate opportunities for deintensification of insulin frequency or an alternate method of insulin delivery in patients with type 2 diabetes. One article explores the cardiometabolic effects of intermittent fasting in persons with prediabetes and type 2 diabetes. The last 2 articles explore the incidence of diabetes after SARS-CoV-2 infection and the skeletal effects of parathyroidectomy as a treatment of hyperparathyroidism. The results of each study have a direct effect on the delivery of care for patients with prediabetes, type 2 diabetes, and hyperparathyroidism.

There have been many recent advancements in cardiology research, with numerous studies published across the multiple subspecialties. Having screened more than 1200 articles published in 2024, we summarize 10 studies in this article that highlight key changes in this field. Starting with atrial fibrillation (AF), we note articles that examine which patients benefit most from catheter ablation, a procedure that is becoming increasingly common. We then examine new evidence regarding anticoagulation in device-detected AF and in patients with AF and coronary disease. In patients with severe aortic stenosis, the timing of valve intervention in relation to development of symptoms was a hot topic and is addressed here. There have also been developments in treatment of heart failure with preserved ejection fraction, including research into medications such as finerenone and tirzepatide. Certain studies attempt to challenge our current medical practices, including routine use of β-blockers after myocardial infarction (MI) and holding of renin-angiotensin system inhibitors before noncardiac surgery. Finally, the role of invasive treatment strategies for older adults with non-ST-segment elevation MI has also been addressed.

GIM/FP/GP: [Formula: see text] Infectious Disease: [Formula: see text] Critical Care: [Formula: see text].

GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text] Endocrinology: [Formula: see text].

Emergency Med: [Formula: see text] GIM/FP/GP: [Formula: see text] Critical Care: [Formula: see text].