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81. 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.
82. 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].
83. 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
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.
84. 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].
85. 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].
89. 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].
90. 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].
92. 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].
99. Association Between Body Composition and Cardiometabolic Outcomes : A Prospective Cohort Study.
作者: Matthias Jung.;Marco Reisert.;Hanna Rieder.;Susanne Rospleszcz.;Michael T Lu.;Fabian Bamberg.;Vineet K Raghu.;Jakob Weiss.
来源: Ann Intern Med. 2025年178卷11期1561-1570页
Current measures of adiposity have limitations. Artificial intelligence (AI) models may accurately and efficiently estimate body composition (BC) from routine imaging.
100. Palliative Care Educational App for Family Caregivers of Homebound Patients With Incurable Cancer : A Single-Center Randomized Trial.
作者: Ying Yu.;Hao Xue.;Chen Suo.;Hui Wang.;Yanyu Pang.;Chunhui Ji.;Wanwan Hou.;Yuting Lu.;Dantong Lu.;Leqing Sang.;Jia Xu.;Chenbiao Li.;Li Jin.;Leming Shi.;Jiayun Zhang.;Ji Liang.;Weiwei Zhao.;Xingdong Chen.
来源: Ann Intern Med. 2025年
Home-based palliative care relies on empowered family caregivers to overcome the limited availability of palliative care professional resources in managing incurable cancer.
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