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Vitamin D Deficiency Increases Mortality Risk in the UK Biobank. 英国生物库中的维生素 D 缺乏会增加死亡风险。
IF 19.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-29 DOI: 10.7326/ANNALS-24-02797
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引用次数: 0
VA/DoD Clinical Practice Guideline for the Management of Headache. 退伍军人事务部/国防部《头痛治疗临床实践指南》。
IF 19.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-29 DOI: 10.7326/ANNALS-24-00551-PS
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引用次数: 0
Comparative Effectiveness and Safety of Atorvastatin Versus Rosuvastatin : A Multi-database Cohort Study. 阿托伐他汀与瑞舒伐他汀的有效性和安全性比较:一项多数据库队列研究。
IF 19.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-29 DOI: 10.7326/M24-0178
Shiyu Zhou, Ruixuan Chen, Jiao Liu, Zhixin Guo, Licong Su, Yanqin Li, Xiaodong Zhang, Fan Luo, Qi Gao, Yuxin Lin, Mingzhen Pang, Lisha Cao, Xin Xu, Sheng Nie

Background: Rosuvastatin and atorvastatin are the most widely prescribed moderate- to high-intensity statins. However, evidence on their efficacy and safety during actual use is limited.

Objective: To compare the real-world effectiveness and safety of rosuvastatin and atorvastatin.

Design: Active comparator cohort study using target trial emulation.

Setting: The China Renal Data System (CRDS) and UK Biobank (UKB) databases.

Participants: Adults newly prescribed rosuvastatin or atorvastatin.

Measurements: The primary outcome was all-cause mortality. Cox proportional hazards regressions were used after 1:1 multilevel propensity score matching.

Results: Among the 285 680 eligible participants in both databases, 6-year all-cause mortality was lower for rosuvastatin than for atorvastatin (2.57 vs. 2.83 per 100 person-years in the CRDS database and 0.66 vs. 0.90 per 100 person-years in the UKB database), with differences in cumulative incidence of -1.03% (95% CI, -1.44% to -0.46%) in the CRDS database and -1.38% (CI, -2.50% to -0.21%) in the UKB database. For secondary outcomes in both databases, rosuvastatin conferred lower risks for major adverse cardiovascular events and major adverse liver outcomes. In the UKB database, the risk for development of type 2 diabetes mellitus was higher with rosuvastatin, and the 2 medications carried similar risks for development of chronic kidney disease and other statin-related adverse effects.

Limitation: Possible residual confounding.

Conclusion: This study found differences in risks for some important outcomes associated with rosuvastatin and atorvastatin. The differences were relatively small, and many did not meet traditional standards for statistical significance. Further research is needed to understand whether these findings can be used with confidence in clinical practice.

Primary funding source: National Key R&D Program of China and National Natural Science Foundation of China.

背景:瑞舒伐他汀和阿托伐他汀是处方量最大的中高强度他汀类药物。然而,有关它们在实际使用过程中的有效性和安全性的证据却很有限:比较罗伐他汀和阿托伐他汀在现实世界中的有效性和安全性:设计:采用目标试验模拟法进行主动比较队列研究:中国肾脏数据系统(CRDS)和英国生物库(UKB)数据库:新处方罗伐他汀或阿托伐他汀的成人:主要结果为全因死亡率。在进行1:1多层次倾向评分匹配后,采用Cox比例危险度回归:在两个数据库的285 680名合格参与者中,罗伐他汀的6年全因死亡率低于阿托伐他汀(在CRDS数据库中为每100人年2.57例 vs. 2.83例,在UKB数据库中为每100人年0.66例 vs. 0.90例),在CRDS数据库中累计发生率的差异为-1.03% (95% CI, -1.44% to -0.46%),在UKB数据库中累计发生率的差异为-1.38% (CI, -2.50% to -0.21%)。对于两个数据库中的次要结果,罗伐他汀可降低主要不良心血管事件和主要不良肝脏结果的风险。在UKB数据库中,罗伐他汀的2型糖尿病发病风险较高,两种药物的慢性肾脏病和其他他汀相关不良反应的发病风险相似:局限性:可能存在残余混杂因素:本研究发现,罗伐他汀和阿托伐他汀对某些重要结果的风险存在差异。这些差异相对较小,而且许多差异不符合传统的统计学意义标准。要想了解这些研究结果是否可以在临床实践中放心使用,还需要进一步的研究:国家重点研发计划和国家自然科学基金。
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引用次数: 0
2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline for the Management of Headache. 2023 美国退伍军人事务部和美国国防部头痛治疗临床实践指南。
IF 19.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-29 DOI: 10.7326/ANNALS-24-00551
Jason J Sico, Natasha M Antonovich, Jennifer Ballard-Hernandez, Andrew C Buelt, Amy S Grinberg, Franz J Macedo, Ian W Pace, James Reston, James Sall, Friedhelm Sandbrink, Karen M Skop, Thomas R Stark, Rebecca Vogsland, Lisa Wayman, Aven W Ford

Description: Headache medicine and therapeutics evidence have been rapidly expanding and evolving since the 2020 U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) clinical practice guideline (CPG) for the management of headache. Therefore, the CPG was revised in 2023, earlier than the standard 5-year cycle. This article reviews the 2023 CPG recommendations relevant to primary care clinicians for treatment and prevention of migraine and tension-type headache (TTH).

Methods: Subject experts from the VA and the DoD developed 12 key questions, which guided a systematic search using predefined inclusion and exclusion criteria. After reviewing evidence from 5 databases published between 6 March 2019 and 16 August 2022, the work group considered the strength and quality of the evidence, patient preferences, and benefits versus harms on critical outcomes before making consensus recommendations.

Recommendations: The revised CPG includes 52 recommendations on evaluation, pharmacotherapy, invasive interventions, and nonpharmacologic interventions for selected primary and secondary headache disorders. In addition to triptans and aspirin-acetaminophen-caffeine, newer calcitonin gene-related peptide (CGRP) inhibitors (gepants) are options for treatment of acute migraine. Medications to prevent episodic migraine (EM) include angiotensin-receptor blockers, lisinopril, magnesium, topiramate, valproate, memantine, the newer CGRP monoclonal antibodies, and atogepant. AbobotulinumtoxinA can be used for prevention of chronic migraine but not EM. Gabapentin is not recommended for prevention of EM. Ibuprofen (400 mg) and acetaminophen (1000 mg) can be used for treatment of TTH, and amitriptyline for prevention of chronic TTH. Physical therapy or aerobic exercise can be used in management of TTH and migraines.

内容简介自 2020 年美国退伍军人事务部(VA)和美国国防部(DoD)发布头痛管理临床实践指南(CPG)以来,头痛医学和治疗学证据一直在迅速扩展和发展。因此,2023 年对 CPG 进行了修订,早于标准的 5 年周期。本文回顾了 2023 年 CPG 中与初级保健临床医生治疗和预防偏头痛和紧张型头痛 (TTH) 相关的建议:来自退伍军人事务部和国防部的主题专家提出了 12 个关键问题,并以此为指导,采用预定义的纳入和排除标准进行了系统检索。在审查了 5 个数据库中 2019 年 3 月 6 日至 2022 年 8 月 16 日期间发表的证据后,工作组考虑了证据的强度和质量、患者偏好以及关键结果的利弊,然后提出了一致建议:修订后的 CPG 包括 52 项建议,涉及选定的原发性和继发性头痛疾病的评估、药物治疗、侵入性干预和非药物干预。除了曲坦类药物和阿司匹林-乙酰氨基酚-咖啡因外,较新的降钙素基因相关肽(CGRP)抑制剂(gepants)也是治疗急性偏头痛的选择。预防发作性偏头痛(EM)的药物包括血管紧张素受体阻滞剂、利辛普利、镁、托吡酯、丙戊酸钠、美金刚、较新的CGRP单克隆抗体和阿托格潘。AbobotulinumtoxinA 可用于预防慢性偏头痛,但不能用于 EM。不建议将加巴喷丁用于预防EM。布洛芬(400 毫克)和对乙酰氨基酚(1000 毫克)可用于治疗 TTH,阿米替林可用于预防慢性 TTH。物理疗法或有氧运动可用于治疗 TTH 和偏头痛。
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引用次数: 0
Risk for Financial Precarity From Hospitalization: Implications for Targeting Financial Assistance in Medicare. 住院的经济风险:对确定医疗保险财政援助目标的影响。
IF 19.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-29 DOI: 10.7326/ANNALS-24-00787
Paula Chatterjee, Eliza Macneal, Syama R Patel, Eric T Roberts

Background: High out-of-pocket costs in Medicare may leave many beneficiaries in financial precarity. Beneficiaries with modest incomes are often ineligible for Medicaid (which covers most out-of-pocket Medicare costs) and may have insufficient resources to pay an unexpected health care bill. This has prompted calls to improve financial protections, but the target population remains uncharacterized.

Objective: To identify beneficiaries who would face financial precarity if exposed to the Medicare Part A hospital deductible ($1600).

Design: Cross-sectional study of the 2018 wave of the Health and Retirement Study.

Setting: United States.

Participants: Community-dwelling Medicare beneficiaries with incomes greater than 100% to 400% or less of the federal poverty level.

Measurements: Nationally representative estimates of financial precarity, defined as having insufficient funds to pay the deductible, examined across 4 scenarios that considered checking and savings account balances, total liquid assets (with a reserve for future living costs), and supplemental insurance.

Results: Among 4881 beneficiaries (population weighted n = 26 619 823), 45.0% had insufficient funds in checking and savings accounts to pay the Medicare hospital deductible. Financial precarity was more prevalent among Black and Hispanic versus White beneficiaries (73.5% and 76.2% vs. 36.2%), those with less versus more than high school education (70.0% vs. 37.1%), and those with 3 or more versus 2 or fewer chronic conditions (49.2% vs. 39.1%). In defining financial precarity to include beneficiaries with insufficient liquid assets to pay the deductible while maintaining a $5000 reserve for future living expenses, 50.7% were financially precarious. Building off this definition to assume supplemental insurance covered the deductible, 39.0% remained financially precarious.

Limitation: Cost-sharing exposure is limited to hospitalization.

Conclusion: Many Medicare beneficiaries with modest incomes are at risk for financial hardship from costs of a single hospital stay.

Primary funding source: National Institute on Aging.

背景:医疗保险的高额自付费用可能会使许多受益人陷入经济困境。收入不高的受益人通常没有资格享受医疗补助计划(该计划涵盖了大部分医疗保险的自付费用),并且可能没有足够的资源来支付意外的医疗账单。这促使人们呼吁改善财务保护,但目标人群仍未定性:确定哪些受益人在面临医疗保险 A 部分医院免赔额(1600 美元)时将面临财务不稳定:设计:2018 年健康与退休研究的横断面研究:环境:美国:居住在社区的医疗保险受益人,其收入高于联邦贫困线的100%至400%或以下:具有全国代表性的财务不稳定性估计值(定义为没有足够资金支付免赔额),在考虑支票和储蓄账户余额、流动资产总额(未来生活费用储备)和补充保险的 4 种情况下进行检查:在 4881 名受益人(人口加权 n = 26 619 823)中,45.0% 的支票和储蓄账户资金不足以支付医疗保险住院自付额。在黑人和西班牙裔受益人与白人受益人(73.5% 和 76.2% 与 36.2%)、高中以下教育程度与高中以上教育程度受益人(70.0% 与 37.1%)以及患有三种或三种以上慢性病与患有两种或两种以下慢性病的受益人(49.2% 与 39.1%)中,财务不稳定的情况更为普遍。财务不稳定的定义包括受益人的流动资产不足以支付免赔额,同时又要维持 5000 美元的未来生活费用储备,50.7% 的受益人财务不稳定。根据这一定义,假定补充保险涵盖了自付额,39.0% 的受益人仍处于财务不稳定状态:费用分担风险仅限于住院治疗:许多收入不高的医疗保险受益人有可能因一次住院费用而陷入经济困境:主要资金来源:美国国家老龄化研究所。
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引用次数: 0
Projected Impact and Cost-Effectiveness of Novel Molecular Blood-Based or Stool-Based Screening Tests for Colorectal Cancer. 基于血液或粪便的新型结直肠癌分子筛查检验的预期影响和成本效益。
IF 19.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-29 DOI: 10.7326/ANNALS-24-00910
Uri Ladabaum, Ajitha Mannalithara, Robert E Schoen, Jason A Dominitz, David Lieberman

Background: Cell-free DNA blood tests (cf-bDNA) and next-generation stool tests could change colorectal cancer (CRC) screening.

Objective: To estimate the clinical and economic impacts of novel CRC screening tests.

Design: Cost-effectiveness analysis using MOSAIC (Model of Screening and Surveillance for Colorectal Cancer).

Data sources: Published data.

Target population: Average-risk persons.

Time horizon: Ages 45 to 100 years.

Perspective: Health sector.

Intervention: Novel versus established CRC screening tests.

Outcome measures: Incidence and mortality of CRC, quality-adjusted life-years (QALYs), costs.

Results of base-case analysis: For colonoscopy every 10 years, annual fecal immunochemical test (FIT), and triennial next-generation multitarget stool DNA, FIT-RNA, cf-bDNA (Guardant Shield), or cf-bDNA (Freenome), the relative rates (RRs) and 95% uncertainty intervals (UIs) versus no screening for CRC incidence were 0.21 (0.19 to 0.22), 0.29 (0.27 to 0.31), 0.33 (0.32 to 0.36), 0.32 (0.30 to 0.34), 0.58 (0.55 to 0.61) and 0.58 (0.55 to 0.60), respectively; the RRs for CRC death were 0.19 (0.17 to 0.20), 0.25 (0.23 to 0.27), 0.28 (0.27 to 0.30), 0.28 (0.26 to 0.30), 0.44 (0.42 to 0.47), and 0.46 (0.44 to 0.49), respectively. The cf-bDNA test (Shield; list price $1495) cost $89 600 ($74 800 to $102 300) per QALY gained versus no screening; alternatives were less costly and more effective.

Results of sensitivity analysis: Incremental costs exceeded incremental benefits when novel test intervals were shortened to 2 or 1 years. The cf-bDNA test matched FIT's impact on CRC mortality at 1.35 (1.30 to 1.40)-fold FIT's uptake rate, assuming equal colonoscopy follow-up. If persons who accept colonoscopy or stool tests shifted to cf-bDNA, CRC deaths increased. This adverse effect was overcome if every 3 such substitutions were counterbalanced by cf-bDNA uptake by 2 or more persons refusing alternatives, assuming equal colonoscopy follow-up.

Limitation: Longitudinal test-specific participation patterns are unknown.

Conclusion: First-generation cf-bDNA tests may deliver net benefit or harm, depending on the balance between achieving screening in persons who decline alternatives versus substituting cf-bDNA for more effective alternatives.

Primary funding source: The Gorrindo Family Fund.

背景:无细胞DNA血液检验(cf-bDNA)和下一代粪便检验可改变结直肠癌(CRC)筛查:估算新型 CRC 筛查试验的临床和经济影响:设计:使用 MOSAIC(结直肠癌筛查和监测模型)进行成本效益分析:目标人群目标人群:平均风险人群:角度:卫生部门:干预措施:新型与成熟的 CRC 筛查试验:结果测量:CRC 发病率和死亡率、质量调整生命年(QALYs)、成本:对于每 10 年进行一次结肠镜检查、每年进行一次粪便免疫化学检验 (FIT)、每三年进行一次下一代多靶点粪便 DNA、FIT-RNA、cf-bDNA (Guardant Shield) 或 cf-bDNA (Freenome),与不进行筛查相比,CRC 发病率的相对率 (RR) 和 95% 不确定区间 (UI) 分别为 0.21(0.19至0.22)、0.29(0.27至0.31)、0.33(0.32至0.36)、0.32(0.30至0.34)、0.58(0.55至0.61)和0.58(0.55至0.60);CRC死亡的RR分别为0.19(0.17~0.20)、0.25(0.23~0.27)、0.28(0.27~0.30)、0.28(0.26~0.30)、0.44(0.42~0.47)和0.46(0.44~0.49)。与不进行筛查相比,cf-bDNA 检测(Shield;上市价格为 1495 美元)的每 QALY 收益成本为 89 600 美元(74 800 美元至 102 300 美元);替代品的成本更低,效果更好:敏感性分析结果:当新型检测间隔缩短为 2 年或 1 年时,增量成本超过了增量收益。假定结肠镜检查的随访率相同,cf-DNA 检测对 CRC 死亡率的影响与 FIT 的 1.35 倍(1.30-1.40)相匹配。如果接受结肠镜检查或粪便检测的人转向 cf-DNA,则 CRC 死亡率会增加。假定结肠镜检查随访率相同,如果每 3 个这样的替代者中就有 2 个或更多人拒绝接受 cf-bDNA 检查,则可以抵消这种不利影响:局限性:纵向特定检测参与模式尚不清楚:第一代 cf-bDNA 检测可能会带来净收益,也可能会带来损害,这取决于在拒绝接受其他检测方法的人群中实现筛查与用 cf-bDNA 替代更有效的其他检测方法之间的平衡:主要资金来源:戈林多家族基金。
{"title":"Projected Impact and Cost-Effectiveness of Novel Molecular Blood-Based or Stool-Based Screening Tests for Colorectal Cancer.","authors":"Uri Ladabaum, Ajitha Mannalithara, Robert E Schoen, Jason A Dominitz, David Lieberman","doi":"10.7326/ANNALS-24-00910","DOIUrl":"https://doi.org/10.7326/ANNALS-24-00910","url":null,"abstract":"<p><strong>Background: </strong>Cell-free DNA blood tests (cf-bDNA) and next-generation stool tests could change colorectal cancer (CRC) screening.</p><p><strong>Objective: </strong>To estimate the clinical and economic impacts of novel CRC screening tests.</p><p><strong>Design: </strong>Cost-effectiveness analysis using MOSAIC (Model of Screening and Surveillance for Colorectal Cancer).</p><p><strong>Data sources: </strong>Published data.</p><p><strong>Target population: </strong>Average-risk persons.</p><p><strong>Time horizon: </strong>Ages 45 to 100 years.</p><p><strong>Perspective: </strong>Health sector.</p><p><strong>Intervention: </strong>Novel versus established CRC screening tests.</p><p><strong>Outcome measures: </strong>Incidence and mortality of CRC, quality-adjusted life-years (QALYs), costs.</p><p><strong>Results of base-case analysis: </strong>For colonoscopy every 10 years, annual fecal immunochemical test (FIT), and triennial next-generation multitarget stool DNA, FIT-RNA, cf-bDNA (Guardant Shield), or cf-bDNA (Freenome), the relative rates (RRs) and 95% uncertainty intervals (UIs) versus no screening for CRC incidence were 0.21 (0.19 to 0.22), 0.29 (0.27 to 0.31), 0.33 (0.32 to 0.36), 0.32 (0.30 to 0.34), 0.58 (0.55 to 0.61) and 0.58 (0.55 to 0.60), respectively; the RRs for CRC death were 0.19 (0.17 to 0.20), 0.25 (0.23 to 0.27), 0.28 (0.27 to 0.30), 0.28 (0.26 to 0.30), 0.44 (0.42 to 0.47), and 0.46 (0.44 to 0.49), respectively. The cf-bDNA test (Shield; list price $1495) cost $89 600 ($74 800 to $102 300) per QALY gained versus no screening; alternatives were less costly and more effective.</p><p><strong>Results of sensitivity analysis: </strong>Incremental costs exceeded incremental benefits when novel test intervals were shortened to 2 or 1 years. The cf-bDNA test matched FIT's impact on CRC mortality at 1.35 (1.30 to 1.40)-fold FIT's uptake rate, assuming equal colonoscopy follow-up. If persons who accept colonoscopy or stool tests shifted to cf-bDNA, CRC deaths increased. This adverse effect was overcome if every 3 such substitutions were counterbalanced by cf-bDNA uptake by 2 or more persons refusing alternatives, assuming equal colonoscopy follow-up.</p><p><strong>Limitation: </strong>Longitudinal test-specific participation patterns are unknown.</p><p><strong>Conclusion: </strong>First-generation cf-bDNA tests may deliver net benefit or harm, depending on the balance between achieving screening in persons who decline alternatives versus substituting cf-bDNA for more effective alternatives.</p><p><strong>Primary funding source: </strong>The Gorrindo Family Fund.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520769","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}
引用次数: 0
Artificial Intelligence-Assisted Colonoscopy for Polyp Detection : A Systematic Review and Meta-analysis. 用于息肉检测的人工智能辅助结肠镜检查:系统综述与 Meta 分析。
IF 19.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-22 DOI: 10.7326/ANNALS-24-00981
Saeed Soleymanjahi, Jack Huebner, Lina Elmansy, Niroop Rajashekar, Nando Lüdtke, Rumzah Paracha, Rachel Thompson, Alyssa A Grimshaw, Farid Foroutan, Shahnaz Sultan, Dennis L Shung

Background: Randomized clinical trials (RCTs) of computer-aided detection (CADe) system-enhanced colonoscopy compared with conventional colonoscopy suggest increased adenoma detection rate (ADR) and decreased adenoma miss rate (AMR), but the effect on detection of advanced colorectal neoplasia (ACN) is unclear.

Purpose: To conduct a systematic review to compare performance of CADe-enhanced and conventional colonoscopy.

Data sources: Cochrane Library, Google Scholar, Ovid EMBASE, Ovid MEDLINE, PubMed, Scopus, and Web of Science Core Collection databases were searched through February 2024.

Study selection: Published RCTs comparing CADe-enhanced and conventional colonoscopy.

Data extraction: Average adenoma per colonoscopy (APC) and ACN per colonoscopy were primary outcomes. Adenoma detection rate, AMR, and ACN detection rate (ACN DR) were secondary outcomes. Balancing outcomes included withdrawal time and resection of nonneoplastic polyps (NNPs). Subgroup analyses were done by neural network architecture.

Data synthesis: Forty-four RCTs with 36 201 cases were included. Computer-aided detection-enhanced colonoscopies have higher average APC (12 090 of 12 279 [0.98] vs. 9690 of 12 292 [0.78], incidence rate difference [IRD] = 0.22 [95% CI, 0.16 to 0.28]) and higher ADR (7098 of 16 253 [44.7%] vs. 5825 of 15 855 [36.7%], rate ratio [RR] = 1.21 [CI, 1.15 to 1.28]). Average ACN per colonoscopy was similar (1512 of 9296 [0.16] vs. 1392 of 9121 [0.15], IRD = 0.01 [CI, -0.01 to 0.02]), but ACN DR was higher with CADe system use (1260 of 9899 [12.7%] vs. 1119 of 9746 [11.5%], RR = 1.16 [CI, 1.02 to 1.32]). Using CADe systems resulted in resection of almost 2 extra NNPs per 10 colonoscopies and longer total withdrawal time (0.53 minutes [CI, 0.30 to 0.77]).

Limitation: Statistically significant heterogeneity in quality and sample size and inability to blind endoscopists to the intervention in included studies may affect the performance estimates.

Conclusion: Computer-aided detection-enhanced colonoscopies have increased APC and detection rate but no difference in ACN per colonoscopy and a small increase in ACN DR. There is minimal increase in procedure time and no difference in performance across neural network architectures.

Primary funding source: None. (PROSPERO: CRD42023422835).

背景:计算机辅助检测(CADe)系统增强型结肠镜检查与传统结肠镜检查相比,随机临床试验(RCT)表明腺瘤检出率(ADR)提高,腺瘤漏检率(AMR)降低,但对晚期结直肠肿瘤(ACN)检出的影响尚不清楚。目的:进行一项系统综述,比较CADe增强型结肠镜检查与传统结肠镜检查的性能:数据来源:检索了 Cochrane Library、Google Scholar、Ovid EMBASE、Ovid MEDLINE、PubMed、Scopus 和 Web of Science Core Collection 数据库,检索期至 2024 年 2 月:已发表的比较 CADe 增强型结肠镜检查和传统结肠镜检查的 RCT:数据提取:每次结肠镜检查的平均腺瘤数(APC)和ACN是主要结果。腺瘤检出率、AMR和ACN检出率(ACN DR)是次要结果。平衡结果包括退出时间和非肿瘤性息肉(NNPs)切除率。通过神经网络架构进行亚组分析:数据综述:共纳入 44 项 RCT,36 201 个病例。计算机辅助检测增强型结肠镜检查的平均 APC 较高(12 279 例中的 12 090 例 [0.98] 对 12 292 例中的 9690 例 [0.78],发病率差异 [IRD] = 0.22 [95% CI, 0.16 to 0.28]),ADR 较高(16 253 例中的 7098 例 [44.7%] 对 15 855 例中的 5825 例 [36.7%],比率比 [RR] = 1.21 [CI, 1.15 to 1.28])。每次结肠镜检查的平均 ACN 相似(9296 例中的 1512 例 [0.16] 与 9121 例中的 1392 例 [0.15],IRD = 0.01 [CI, -0.01 to 0.02]),但使用 CADe 系统的 ACN DR 较高(9899 例中的 1260 例 [12.7%] 与 9746 例中的 1119 例 [11.5%],RR = 1.16 [CI, 1.02 to 1.32])。使用 CADe 系统会导致每 10 次结肠镜检查多切除近 2 个 NNPs,总退出时间延长(0.53 分钟 [CI, 0.30 至 0.77]):局限性:在质量和样本量方面存在统计学意义上的明显异质性,且所纳入的研究无法使内镜医师对干预措施视而不见,这些因素都可能会影响性能估计值:结论:计算机辅助检测增强型结肠镜检查提高了APC和检出率,但每次结肠镜检查的ACN没有差异,ACN DR略有增加。手术时间的增加极少,不同神经网络架构的性能也无差异:主要资金来源:无。(PROCEMO:CRD42023422835)。
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引用次数: 0
Utilizing Care Transitions for Diagnostic Error Detection in Hospital Medicine Patients. 利用护理转换检测医院内科病人的诊断错误。
IF 19.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-22 DOI: 10.7326/ANNALS-24-00563
Gopi J Astik, Andrew P J Olson, Danielle Steker, Katherine Welter, Michelle Fletcher, Ashish Gupta, Jane Kim, Luke Favia, Kevin J O'Leary
{"title":"Utilizing Care Transitions for Diagnostic Error Detection in Hospital Medicine Patients.","authors":"Gopi J Astik, Andrew P J Olson, Danielle Steker, Katherine Welter, Michelle Fletcher, Ashish Gupta, Jane Kim, Luke Favia, Kevin J O'Leary","doi":"10.7326/ANNALS-24-00563","DOIUrl":"https://doi.org/10.7326/ANNALS-24-00563","url":null,"abstract":"","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612214","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}
引用次数: 0
The Effect of the "Safety in Dementia" Online Tool to Assist Decision Making for Caregivers of Persons With Dementia and Access to Firearms : A Randomized Trial. 痴呆症安全 "在线工具在协助痴呆症患者护理人员决策和获得枪支方面的效果 :随机试验
IF 19.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-22 DOI: 10.7326/ANNALS-24-00763
Marian E Betz, Jennifer Portz, Christopher Knoepke, Megan L Ranney, Stacy M Fischer, Ryan A Peterson, Rachel L Johnson, Faris Omeragic, Mirella Castaneda, Emily Greenway, Daniel Matlock

Background: Caregivers face challenges (including competing desires to prevent injury, respect autonomy, and avoid conflict) when addressing firearm access by community-dwelling persons with Alzheimer disease and related dementias (ADRD).

Objective: To test the effect of the online Safety in Dementia (SiD) decision aid on caregivers' decision making about firearm access for people with ADRD.

Design: Prospective 2-group randomized trial with longitudinal follow-up. (ClinicalTrials.gov: NCT05173922).

Setting: United States.

Participants: English- or Spanish-speaking caregivers (aged ≥18 years) of community-dwelling adults with ADRD and firearm access.

Intervention: SiD versus a web-based information control.

Measurements: The primary outcome was preparation for decision making about firearm access. The secondary outcome at follow-up was self-reported action to reduce access.

Results: Among 500 participants enrolled between June 2022 and February 2024, the mean age was 47 years, 69% identified as female, half were the adult child or stepchild of the person with ADRD, and 99% chose study participation in English. Participant characteristics were similar by study group. For the primary outcome, SiD significantly increased preparation for decision making versus the control (69.8 vs. 64.8 out of 100; mean difference, 4.80 [95% CI, 0.53 to 9.07]; P = 0.024). There was no significant effect on actions to reduce firearm access at 2 weeks or 2 months.

Limitation: The results may not be generalizable to non-English-speaking populations.

Conclusion: The online SiD decision aid increased preparation for decision making about firearm access in this sample of ADRD caregivers in the United States. Use of such resources in clinical or community settings may support caregivers and people with ADRD in avoiding firearm injury or death.

Primary funding source: National Institute on Aging, National Institutes of Health.

背景:护理人员在处理居住在社区的阿尔茨海默病及相关痴呆症(ADRD)患者使用枪支的问题时面临挑战(包括防止伤害、尊重自主权和避免冲突等相互竞争的愿望):测试在线痴呆症安全(SiD)决策辅助工具对照护者为阿尔茨海默病及相关痴呆症(ADRD)患者使用枪支做出决策的影响:设计:前瞻性两组随机试验,纵向跟踪。(ClinicalTrials.gov:NCT05173922).地点:美国:地点:美国:干预措施:SiD 与基于网络的信息对照:干预措施:SiD 与网络信息对照:主要结果是为使用枪支的决策做好准备。随访的次要结果是自我报告的减少使用枪支的行动:在 2022 年 6 月至 2024 年 2 月期间注册的 500 名参与者中,平均年龄为 47 岁,69% 为女性,半数为 ADRD 患者的成年子女或继子,99% 的人选择用英语参与研究。各研究组的参与者特征相似。在主要结果方面,与对照组相比,SiD 显著提高了决策准备度(69.8 vs. 64.8,满分 100 分;平均差异为 4.80 [95% CI, 0.53 to 9.07];P = 0.024)。2周或2个月后,对减少枪支接触的行动没有明显影响:局限性:研究结果可能不适用于非英语国家人群:在线 SiD 决策辅助工具提高了美国 ADRD 护理人员对枪支使用决策的准备程度。在临床或社区环境中使用此类资源可帮助护理人员和 ADRD 患者避免枪支伤害或死亡:主要资金来源:美国国立卫生研究院国家老龄化研究所。
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引用次数: 0
Prescription for Change: Health Care Professionals and Advocacy for Farm Bill Reform. 改革处方:医疗保健专业人员与农场法案改革宣传。
IF 19.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-22 DOI: 10.7326/ANNALS-24-02145
Christina Badaracco, Farshad F Marvasti, Jaclyn Albin, Olivia Thomas
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引用次数: 0
期刊
Annals of Internal Medicine
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