Atalla M, Gupta V, Khalid M
… +2 more, Kussmaul WG, Lacombe MA
Ann Intern Med
· 2026 May · PMID 41974015
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During 2025, new data emerged that are important to internal medicine specialists and subspecialists who frequently encounter and manage patients with common cardiovascular conditions. Among these conditions, the landsca...During 2025, new data emerged that are important to internal medicine specialists and subspecialists who frequently encounter and manage patients with common cardiovascular conditions. Among these conditions, the landscape of therapy is changing with regard to hypertension, heart failure, and anticoagulation in atrial fibrillation. Management of acute cardiovascular diseases often involves collaboration between specialists and generalists. The choice of initial imaging modality in patients with suspected coronary artery disease, whether β-blockers are routinely indicated after myocardial infarction, and the role of invasive versus conservative management in older patients after myocardial infarction are all addressed in this article. Also reviewed are articles highlighting groundbreaking therapies in more specialized areas, such as obstructive hypertrophic cardiomyopathy and advanced treatment of hyperlipidemia. As these newer therapies become more widely disseminated, generalists will need to know about them. Finally, regarding a topic of perennial interest to many physicians and patients, an article addresses coffee drinking in patients with atrial fibrillation and suggests that it might be safer than previously believed.
AlAwadhi HK, Hyesoo Chang N, Jogendran M
… +1 more, Bretthauer M
Ann Intern Med
· 2026 May · PMID 41974014
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During 2025, gastroenterology and hepatology experienced advances in treatment and surveillance of common diseases. Technological innovations have been reported that may positively affect patients worldwide. New drug opt...During 2025, gastroenterology and hepatology experienced advances in treatment and surveillance of common diseases. Technological innovations have been reported that may positively affect patients worldwide. New drug options for treatment of metabolic dysfunction-associated steatohepatitis are emerging, and old drugs have new indications and patterns of use for common gastroenterologic diseases. The 9 articles featured here were selected because they represent important information for clinicians who are not gastroenterologists but who often diagnose, treat, and follow patients with gastroenterologic conditions. Two randomized trials address potential overtreatment of patients with Barrett esophagus without high-grade dysplasia and patients with severe alcohol-associated hepatitis. For clinicians who care for patients with malignant gastric outlet obstruction, 2 new randomized trials now provide evidence that a new endoscopic approach is a good alternative to traditional surgical gastroenterostomy or duodenal stenting. Aspirin is emerging as promising adjuvant therapy for patients with colorectal cancer that is positive for PI3K pathway alterations, and fecal microbiota transplantation has been shown to be noninferior to standard vancomycin for patients with a first episode of infection. Finally, a randomized trial showed that structured exercise and training for patients with colon cancer after surgery and adjuvant oncologic treatment reduce recurrence and increase survival.
Ann Intern Med
· 2026 Apr · PMID 41974013
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Cirrhosis affects millions of U.S. adults and costs the U.S. health care system upward of $6 billion annually. Cirrhosis is underrecognized, and the only cure is transplantation. Complications, including bleeding, infect...Cirrhosis affects millions of U.S. adults and costs the U.S. health care system upward of $6 billion annually. Cirrhosis is underrecognized, and the only cure is transplantation. Complications, including bleeding, infection, ascites, and renal injury, contribute to high rates of hospitalization, readmission, and mortality in this population. Evidence-based practices and guidelines offer quality recommendations for clinicians, but many of these guidelines have changed recently. This article provides an update on the current guidelines for the inpatient management of cirrhosis.
Akbari S, Alharbi S, Al-Magooshi A
… +2 more, Jarrar F, Sehgal AR
Ann Intern Med
· 2026 May · PMID 41974012
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This article highlights some important nephrology studies published in 2025 that are relevant for many nonnephrologist physicians. Two studies examined aspects of acute kidney injury (AKI), including the use of sodium bi...This article highlights some important nephrology studies published in 2025 that are relevant for many nonnephrologist physicians. Two studies examined aspects of acute kidney injury (AKI), including the use of sodium bicarbonate infusion to treat severe metabolic acidemia and the use of artificial intelligence models to predict AKI onset, severity, and complications. Three studies examined factors that may influence kidney function, including high-intensity long-term physical exercise, pregnancy, and the combined use of finerenone and empagliflozin. Three studies examined interventions to address common problems among patients receiving maintenance dialysis, including cognitive behavioral therapy for chronic pain, factor Xa inhibitors for atrial fibrillation, and fish oil for cardiovascular events.
Libman H, Smetana GW, Hovaguimian AE
… +1 more, Smith CC
Ann Intern Med
· 2026 Apr · PMID 41974011
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Migraine headaches are highly prevalent and, for women below the age of 50, the leading cause of years lived with disability. Migraines disproportionately affect persons of lower socioeconomic status and those who are un...Migraine headaches are highly prevalent and, for women below the age of 50, the leading cause of years lived with disability. Migraines disproportionately affect persons of lower socioeconomic status and those who are uninsured, and they result in millions of office and emergency department visits annually. Migraines are also responsible for billions of dollars in lost productivity and health care expenses each year. Medication classes traditionally used for migraine headache treatment have included nonsteroidal anti-inflammatory drugs, acetaminophen, antihypertensive drugs, antiseizure drugs, antidepressant drugs, and botulinum toxin. In recent years, triptans have come into widespread use for acute treatment, and calcitonin gene-related peptide antagonists, including gepants and monoclonal antibodies, have been used for both acute treatment and prevention. In 2025, the International Headache Society and the American College of Physicians published guidelines on pharmacotherapy for migraine headaches covering both acute and preventive treatments. Here, 2 experts in this field, a primary care physician and a neurologist and headache specialist, debate how to manage the case of a patient with frequent migraine headaches. They discuss the diagnostic considerations and the acute and preventive treatment challenges in the care of this population.
Adeolu M, Ehiwario J, Emamian MA
… +1 more, Dotan E
Ann Intern Med
· 2026 May · PMID 41974010
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Oncology care increasingly necessitates collaboration with physicians in other specialties. This article highlights 10 studies published in 2025 that we believe are important for nononcologists who participate in the car...Oncology care increasingly necessitates collaboration with physicians in other specialties. This article highlights 10 studies published in 2025 that we believe are important for nononcologists who participate in the care of patients with cancer. The articles selected provide updates on advancements that influence the full spectrum of oncology care. Several studies present therapeutic developments for lung, colorectal, and breast cancer. A major theme of the 2025 literature is evidence-based de-escalation, including reducing mammographic surveillance in older breast cancer survivors and omitting autologous stem cell transplant in patients with multiple myeloma who achieve measurable residual disease negativity. Another study addresses reduced-dose apixaban for extended cancer-associated thrombosis management and the validation of elinzanetant for nonhormonal management of vasomotor symptoms. These studies collectively move the field toward highly personalized, biomarker-driven interventions that require integrated care models to optimize patient outcomes.
Albaloul H, Nemer A, Saini N
… +1 more, Schuster MG
Ann Intern Med
· 2026 May · PMID 41974008
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This article highlights clinical trials on infectious diseases published in 2025 that we believe are highly relevant to internal medicine physicians who are not infectious diseases specialists. Selected studies address p...This article highlights clinical trials on infectious diseases published in 2025 that we believe are highly relevant to internal medicine physicians who are not infectious diseases specialists. Selected studies address prevention and treatment strategies across infectious diseases. We highlight 2 studies of sexually transmitted infections (STIs): one examining the effectiveness of treating male partners to reduce recurrence of bacterial vaginosis and another study of doxycycline as postexposure prophylaxis against bacterial STI. A strategy for using methanamine hippurate to prevent recurrent urinary tract infections (UTIs) in older women is included in our review. We review the updated evidence supporting the effectiveness of COVID-19, respiratory syncytial virus, and influenza vaccines for the 2025-2026 season, and a modified messenger RNA influenza vaccine, which showed superior efficacy with an acceptable safety profile. In HIV care, a study of dual antiretroviral maintenance therapy showed that dolutegravir and lamivudine was noninferior to triple therapy at 48 weeks. A meta-analysis supporting shorter antibiotic courses for pyelonephritis and complicated UTIs provides important information for antibiotic stewardship strategies. In serious infections, dalbavancin was noninferior to standard therapy for bacteremia, whereas cefiderocol expanded treatment options for gram-negative bloodstream infections without clear superiority, particularly in carbapenem-resistant pathogens. Finally, a study found that elevated C-reactive protein identifies patients most likely to benefit from adjunctive corticosteroids in community-acquired pneumonia.
Ann Intern Med
· 2026 May · PMID 41974007
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Internal medicine physicians are often the first physicians from whom patients with rheumatic conditions seek guidance, and they collaborate with rheumatologists when caring for these patients. Here, we summarize 6 studi...Internal medicine physicians are often the first physicians from whom patients with rheumatic conditions seek guidance, and they collaborate with rheumatologists when caring for these patients. Here, we summarize 6 studies published in the rheumatology literature in 2025 of relevance to internal medicine specialists and subspecialists who are not rheumatologists. The first study concerns the treat-to-target urate strategy for gout. The second study compared the benefits of a very-low-calorie diet and exercise compared with exercise alone in patients with hip osteoarthritis. The investigators of the third study examined the step counts of purposeful walking and incidence of symptomatic knee osteoarthritis. The fourth study explored the burden of nonarticular pain on quality of life in patients with early rheumatoid arthritis. The fifth study suggested that metformin showed promise in improving knee pain, stiffness, and function in patients with knee osteoarthritis. The last study compared nonsteroidal anti-inflammatory drugs with colchicine in preventing gout exacerbation when initiating urate-lowering therapy. These articles offer new insights for the management of rheumatic conditions that internal medicine physicians often manage.
Ann Intern Med
· 2026 May · PMID 41974006
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Research in pulmonology generated several landmark publications over the past year. We screened more than 900 studies published in 2025 and selected 8 articles that highlight novel treatments and possible practice-changi...Research in pulmonology generated several landmark publications over the past year. We screened more than 900 studies published in 2025 and selected 8 articles that highlight novel treatments and possible practice-changing evidence in several respiratory conditions. Two articles studied therapeutic options in interstitial lung disease, including a novel antifibrotic agent for pulmonary fibrosis and first-line methotrexate use in sarcoidosis. Two articles outlined the role of corticosteroids in community-acquired pneumonia and selecting patients who may benefit most. One article described evidence for an alternate agent for smoking cessation in patients with or without chronic obstructive pulmonary disease (COPD), while another article studied the use of mepolizumab in patients with eosinophilic COPD. We also reviewed the first head-to-head trial comparing biologic medications in asthma and chronic rhinosinusitis with nasal polyps. Finally, we summarized the latest evidence of a first-in-class therapeutic agent that reduced exacerbations in patients with bronchiectasis.
Doumat G, Ratz D, Horowitz JK
… +8 more, Gandhi TN, Petty LA, Malani AN, Osterholzer D, Misra P, Gupta AB, Flanders SA, Vaughn VM
Ann Intern Med
· 2026 May · PMID 41974005
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BACKGROUND: Shorter antibiotic courses for community-acquired pneumonia (CAP) may reduce adverse effects and resistance. However, real-world data supporting very short durations remain limited. OBJECTIVE: To evaluate the...BACKGROUND: Shorter antibiotic courses for community-acquired pneumonia (CAP) may reduce adverse effects and resistance. However, real-world data supporting very short durations remain limited. OBJECTIVE: To evaluate the safety and effectiveness of 3- to 4-day versus 5-day or more antibiotic durations in hospitalized patients with CAP who achieve clinical stability by day 3 (afebrile, no new oxygen, and stable vital signs). DESIGN: Observational emulation of a target trial. SETTING: 67 Michigan hospitals between 2017 and 2024. PATIENTS: Adults hospitalized (non-intensive care unit) with CAP who received 3 days of antibiotics, were clinically stable by antibiotic day 3, and met the strict eligibility criteria of the Pneumonia Short Treatment trial. INTERVENTION: 0 to 1 additional days of antibiotic treatment versus 2 or more days of additional antibiotic treatment (that is, shorter [3 to 4 days] vs. longer [≥5 days] total antibiotic duration). MEASUREMENTS: The main outcome was 30-day all-cause mortality. Other outcomes included 30-day hospital readmission, urgent health care visits, and infection. RESULTS: Among 55 517 hospitalized patients with CAP, 5620 (10.1%) ultimately met eligibility criteria for short-course therapy after comorbidity, clinical stability, and treatment duration criteria were applied. Median age of eligible patients was 68.2 years, and 54.3% were men. Median antibiotic duration was 7 days, with only 7.9% (444 of 5620) receiving 3 to 4 days. Thirty-day adjusted risk ratios for short- versus long-course antibiotic therapy were 0.89 for mortality (95% CI, 0.01 to 2.25), 1.07 for readmission (CI, 0.81 to 1.42), 0.94 for urgent visit (CI, 0.70 to 1.28), and 1.01 for infection (CI, 0.18 to 5.68). LIMITATION: Few short-duration patients and potential residual confounding. CONCLUSION: Only 10.1% of inpatients with CAP met the strict eligibility criteria for short-course therapy. The short- and longer-course antibiotic treatment groups had similar mortality rates, and there was little difference in benefits and harms. PRIMARY FUNDING SOURCE: Blue Cross Blue Shield of Michigan and Blue Care Network.
Escudero C, Havranek K, Martinez Cruz M
… +1 more, Batch B
Ann Intern Med
· 2026 May · PMID 41974004
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During 2025, endocrinology witnessed the expansion of pharmacotherapeutic options for type 2 diabetes (T2DM), obesity, and metabolic dysfunction-associated steatohepatitis (MASH); increasing complexity of treatment algor...During 2025, endocrinology witnessed the expansion of pharmacotherapeutic options for type 2 diabetes (T2DM), obesity, and metabolic dysfunction-associated steatohepatitis (MASH); increasing complexity of treatment algorithms, including choices for intensification of therapy; and heightened concern about emerging side effects of commonly used medications. From the wealth of studies published in 2025, this article notes 9 studies that offer critical information for clinicians who manage or comanage patients with endocrine and metabolic disorders, including T2DM, obesity, and MASH. One of the 9 articles reviews the effectiveness of diabetes self-management education and support interventions, an important component of diabetes care, in improving hemoglobin A (HbA). Another is focused on comparing HbA lowering when escalating the dose of dulaglutide versus switching to tirzepatide in people with T2DM. Two of the 9 articles are focused on potential side effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs), including gastrointestinal side effects and nonarteritic anterior ischemic optic neuropathy. One article summarizes the risk for life-threatening pituitary immune-related adverse events caused by immune checkpoint inhibitors; another explores the use of GLP-1RAs in MASH. One additional study explores the risk for urogenital infections in patients with diabetes receiving sodium-glucose cotransporter-2 inhibitors (SGLT-2is) versus GLP-1RAs. Another study explores cardiovascular, kidney, and safety outcomes with canagliflozin (an SGLT-2i). The last article explores the efficacy and safety of finerenone in T2DM. The results of each study have a direct effect on clinical care for patients who often present to physicians who are not endocrinologists.
Goldstick JE, Carter PM, Delgado MK
… +2 more, Whiteside L, Cunningham RM
Ann Intern Med
· 2026 May · PMID 41941742
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BACKGROUND: Screening tools for interpersonal firearm violence (FV) are needed to facilitate prevention. OBJECTIVE: To validate the 4-item, 10-point SaFETy (Serious fighting, Friend weapon carrying, community Environment...BACKGROUND: Screening tools for interpersonal firearm violence (FV) are needed to facilitate prevention. OBJECTIVE: To validate the 4-item, 10-point SaFETy (Serious fighting, Friend weapon carrying, community Environment, and firearm Threats) score. DESIGN: Prospective longitudinal study. SETTING: 4 level 1 emergency departments (EDs) in 3 cities. PARTICIPANTS: Adults aged 18 to 24 years seen in an ED for any reason. MEASUREMENTS: FV (shooting someone or being shot) 12 months after baseline from self-report and medical record review, SaFETy score, and self-reported baseline covariates (demographic characteristics; baseline assault injury; violence-related ED use in the past 6 months; drug misuse; anxiety, depression, and posttraumatic stress screening; and FV in the past 6 months). RESULTS: Among 1506 participants (61.4% female; mean age, 21.3 years; 3.8% with assault injury at baseline), 12-month FV could be ascertained in 1122 (74.5%); of those, 73 (6.5%) had 12-month FV. For baseline SaFETy scores of 0, 1 to 5, and 6 or greater, 12-month FV rates were 1.8% (12 of 654), 12.1% (49 of 406), and 25.0% (10 of 40), respectively. The area under the receiver-operating characteristic (ROC) curve (AUC) for the score was 0.78 (95% CI, 0.72 to 0.83). The optimal ROC cut point was a SaFETy score greater than 0, with a sensitivity of 83.1% and specificity of 62.4%; a SaFETy score greater than 4 optimized positive predictive value (31.6%). Logistic regression of 12-month FV, including the full covariate set, examined estimated risks for patients grouped by SaFETy score and found that model-based predictions underestimated risk among those with SaFETy scores of 0 and overestimated risk among those with SaFETy scores of 1 to 5 or 6 or greater. Adding the SaFETy score to the full covariate set improved the predictions' AUC (0.84 vs. 0.81; = 0.025). The added contribution of the SaFETy score to predictions based only on variables typically available at triage (demographic data, ED visit reason, and recent ED use) was larger. LIMITATION: Outcomes were primarily self-reported, and the highest-risk subsamples were more likely to have missing data. CONCLUSION: The SaFETy score predicts FV risk in general samples of young adults in the ED. A comprehensive covariate set, involving factors that are difficult or intrusive to measure, did not reproduce the SaFETy score's risk gradient or explain its discriminatory power, suggesting that the score provides distinct predictive information. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention.