121. Multicancer Detection Tests for Screening : A Systematic Review.
作者: Leila C Kahwati.;Matthew Avenarius.;Leslie Brouwer.;Norah L Crossnohere.;Chyke A Doubeni.;Cecelia Miller.;Mariam Siddiqui.;Christiane Voisin.;Roberta C Wines.;Daniel E Jonas.
来源: Ann Intern Med. 2025年178卷11期1591-1604页
Screening for multiple types of cancer with a single blood test is potentially transformative.
122. Identifying Core Clinical Topics and Recommending Core Performance Measures for Internal Medicine Physicians: A Position Paper From the American College of Physicians.
作者: Amir Qaseem.;Nick Fitterman.;Samantha Tierney.;Rhea E Powell.;Karen Campos.;Elisa I Choi.;Carolyn J Crandall.;J Thomas Cross.;Linda L Humphrey.;Adam J Obley.;Timothy J Wilt.;Rebecca A Andrews.; .;Peter Basch.;Roger S Khetan.;Scott T MacDonald.;Nancy L Miller.;Cristin A Mount.;Brook Watts.;Ethan M Balk.;Thomas G Cooney.;Johanna Lewis.;Michael Maroto.;Matthew C Miller.;Douglas K Owens.;Jeffrey A Tice.;Curtis S Harrod.;Hector Pardo-Hernández.;Tatyana Shamliyan.
来源: Ann Intern Med. 2025年178卷11期1616-1623页
Internal medicine physicians are specialists who promote health, emphasize disease prevention, manage complex acute and chronic conditions in adults, and receive extensive training in the diagnosis and treatment of diseases affecting all systems of the human body. As a result, internal medicine performance measures (PMs) target several topics. Many PMs are not based on high-certainty evidence of at least moderate net benefit and are burdensome, with low or no value to patient care. The American College of Physicians (ACP) wants to provide a national focus to improve the quality of health care in the United States. The ACP is a leader in the evidence-based world, being the only physician organization designated as a GRADE (Grading of Recommendations Assessment, Development and Evaluation) Center, an Appraisal of Guidelines for Research and Evaluation (AGREE) Center, and a member of the Cochrane U.S. Network. Using a structured, stepwise, evidence-based approach, ACP identified the most important clinical topics evaluated and treated by internal medicine physicians. The ACP is also actively working toward recommending essential PMs for each core clinical topic that can be used to evaluate and improve patient care. This position paper describes ACP's method and results of identifying core clinical topics. It also offers a blueprint for defining core PMs and illustrating the principals through application to 2 core clinical topics. The ACP plans to apply this method on PMs for other core clinical topics.
124. Exposure to Computed Tomography Before Pregnancy and Risk for Pregnancy Loss and Congenital Anomalies : A Population-Based Cohort Study.
作者: Camille Simard.;Longdi Fu.;Tomi Odugbemi.;Andrea N Simpson.;Jun Guan.;Vicky Tagalakis.;Aurélien Delluc.;Joel G Ray.
来源: Ann Intern Med. 2025年178卷11期1539-1548页
Animal studies show ovarian follicle damage and mutagenesis after ionizing radiation exposure. Computed tomography (CT) imaging is commonly done outside pregnancy, but risks to future pregnancy are unknown.
125. Addressing Missingness in Predictive Models That Use Electronic Health Record Data.
作者: Shanshan Lin.;Rolf H H Groenwold.;Hemalkumar B Mehta.;Ji Soo Kim.;Jodi B Segal.
来源: Ann Intern Med. 2025年178卷10期1451-1463页
Electronic health record (EHR) data are increasingly used to develop prediction models that guide clinical decision making at the point of care. These include algorithms that use high-frequency data, like in sepsis prediction, as well as simpler equations, such as the Pooled Cohort Equations for cardiovascular outcome prediction. Although EHR data used in prediction models are often highly granular and more current than other data, there is systematic and nonsystematic missingness in EHR data as there is with most data. Despite growing use for clinical decisions, algorithms implemented in EHRs are mostly unregulated and are often opaque to the user. Guidelines about the development, validation, implementation, and reporting on clinical prediction models are sparse in their recommendations regarding missing data. This article characterizes missingness in EHR data, summarizes methods for attending to missing data when developing prediction models, makes recommendations about validation and implementation of models in practice when data are missing, and identifies research needs in this field.
126. Chronic Kidney Disease.
Nearly 14% of Americans have chronic kidney disease (CKD), which includes persistent decrements in glomerular filtration rate or the presence of albuminuria. Although CKD is commonly attributed to diabetes or hypertension, there is growing awareness of the interplay among cardiovascular, kidney, and metabolic health. Progression of CKD can result in metabolic abnormalities and end-stage kidney disease, but cardiovascular events are even more common. The main goals of CKD treatment include slowing the decline in kidney function, preventing cardiovascular disease, and treating metabolic complications. Recent pharmacologic advancements have yielded effective therapeutic agents capable of concurrently addressing all of these objectives.
127. The Potential Impact of Ending the Ryan White HIV/AIDS Program on HIV Incidence: A Simulation Study in 31 U.S. Cities.
作者: Ryan Forster.;Melissa Schnure.;Joyce Jones.;Catherine Lesko.;D Scott Batey.;Isolde Butler.;Dafina Ward.;Karen Musgrove.;Keri N Althoff.;Mamta K Jain.;Kelly A Gebo.;David W Dowdy.;Maunank Shah.;Parastu Kasaie.;Anthony T Fojo.
来源: Ann Intern Med. 2025年178卷11期1580-1590页
With antiretroviral therapy, people with HIV can live a normal lifespan and not transmit HIV. The Ryan White HIV/AIDS Program provides care for over half of people with HIV in the United States.
130. In MASH with moderate or advanced liver fibrosis, weekly semaglutide improved histologic steatohepatitis and fibrosis at 72 wk.
GIM/FP/GP: [Formula: see text] Gastroenterology: [Formula: see text].
132. Effect of Personalized Risk Messages on Uptake of Colorectal Cancer Screening : A Randomized Controlled Trial.
作者: Peter H Schwartz.;Susan M Perkins.;Susan M Rawl.;Karen K Schmidt.;Sandra Althouse.;Thomas F Imperiale.
来源: Ann Intern Med. 2025年178卷10期1390-1399页
Providing personalized risk information to patients and their providers could improve colorectal cancer (CRC) screening.
133. In resistant hypertension, amiloride was noninferior to spironolactone for reducing home SBP at 12 wk.
GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text].
138. In carotid stenosis with low or intermediate risk for stroke, adding revascularization to OMT did not improve outcomes at 2 y.
GIM/FP/GP: [Formula: see text] Neurology: [Formula: see text].
139. In acute ischemic stroke with large core infarct, EVT improves mRS scores but increases symptomatic intracranial hemorrhage at 90 d.
Emergency Med: [Formula: see text] GIM/FP/GP: [Formula: see text] Neurology: [Formula: see text].
140. In ischemic stroke prevention, apixaban and aspirin do not differ for intracranial hemorrhage events.
GIM/FP/GP: [Formula: see text] Hematology: [Formula: see text] Neurology: [Formula: see text].
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