Scherger SJ, Kalil AC, ACP Journal Club Editorial Team at McMaster University
Ann Intern Med
· 2026 Apr · PMID 41941738
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GIM/FP/GP:[Formula: see text] Infectious Disease:[Formula: see text] Critical Care:[Formula: see text] Pulmonology:[Formula: see text].GIM/FP/GP:[Formula: see text] Infectious Disease:[Formula: see text] Critical Care:[Formula: see text] Pulmonology:[Formula: see text].
Bell C, Weitz JI, ACP Journal Club Editorial Team at McMaster University
Ann Intern Med
· 2026 Apr · PMID 41941736
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Emergency Med:[Formula: see text] GIM/FP/GP:[Formula: see text] Hematology:[Formula: see text].Emergency Med:[Formula: see text] GIM/FP/GP:[Formula: see text] Hematology:[Formula: see text].
Agarwal A, Goumeniouk N, Lang E
… +1 more, ACP Journal Club Editorial Team at McMaster University
Ann Intern Med
· 2026 Apr · PMID 41941735
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Emergency Med:[Formula: see text] GIM/FP/GP:[Formula: see text] Hematology:[Formula: see text].Emergency Med:[Formula: see text] GIM/FP/GP:[Formula: see text] Hematology:[Formula: see text].
Shaik H, Jillella D, ACP Journal Club Editorial Team at McMaster University
Ann Intern Med
· 2026 Apr · PMID 41941731
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GIM/FP/GP:[Formula: see text] Neurology:[Formula: see text] Hematology:[Formula: see text].GIM/FP/GP:[Formula: see text] Neurology:[Formula: see text] Hematology:[Formula: see text].
Ann Intern Med
· 2026 May · PMID 41911556
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Full text
BACKGROUND: The One Big Beautiful Bill Act (H.R.1) implemented Medicaid work requirements for beneficiaries in states participating in the Affordable Care Act, but congressional policymakers are considering extending wor...BACKGROUND: The One Big Beautiful Bill Act (H.R.1) implemented Medicaid work requirements for beneficiaries in states participating in the Affordable Care Act, but congressional policymakers are considering extending work requirements nationally to all Medicaid enrollees. However, little is known about Medicaid-enrolled adults at risk of disenrollment. OBJECTIVE: To assess the functional status and overall health of adults at risk of Medicaid disenrollment under national work requirements. DESIGN: Cross-sectional study. SETTING: Medical Expenditure Panel Survey, 2022-2023. PARTICIPANTS: Adults aged 19 to 64 years enrolled in Medicaid who did not meet common H.R.1 exemption criteria. Beneficiaries were classified as at risk of disenrollment if they worked less than 20 hours per week. MEASUREMENTS: Measures of functional impairment across physical, neuropsychological, and independent living domains and composite measures of physical and mental health. RESULTS: The annual weighted population of Medicaid beneficiaries aged 19 to 64 years was 16.5 million (mean age, 40.5 years; 54.4% female). Among these enrollees, 50.4% or 8.3 million (SE ±0.5 million) would be at risk of disenrollment by working too few hours. Compared with beneficiaries meeting work requirements, those at risk of disenrollment reported higher levels of functional impairment across physical, neuropsychological, and independent living domains. Proportions with poor self-reported health were also higher among beneficiaries at risk of disenrollment than those reporting better health (poor physical health: 32.7% vs. 10.9% and poor mental health: 28.2% vs. 19.5%, respectively). LIMITATION: Self-reported measures and inability to capture all exemption criteria. CONCLUSION: Under national Medicaid work requirements considered by Congress, half of all beneficiaries would be at risk of disenrollment even though they had greater functional impairment and poorer health than those who were not at risk. These impairments might not meet formal disability criteria but could compromise enrollees' ability to adhere to work requirements, thereby increasing their risk of coverage loss. PRIMARY FUNDING SOURCE: Patrick and Catherine Weldon Donaghue Medical Research Foundation.
Reis G, Dos Santos Moreira Silva EA, Medeiros Silva DC
… +26 more, Thabane L, Ferreira TS, Reis LLF, Figueiredo Guimaraes Almeida AP, Menezes Amaral M, Savassi LCM, de Souza Campos VH, Campos Simplicio MI, Barra Ribeiro L, de Souza Medeiros T, Campos Siqueira T, Vieira TS, Drumond Rausse N, Garofolo TC, Fagundes Silva EC, Harari O, D'Urso G, Forrest JI, Park J, Nachega JB, Lindsell C, Glenn JS, Thorlund K, Dybul M, Mills EJ, REVIVE Investigators
Ann Intern Med
· 2026 May · PMID 41911553
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BACKGROUND: Postacute sequelae of SARS-CoV-2, or long COVID, presents a major therapeutic challenge, with fatigue being a prevalent and debilitating symptom. OBJECTIVE: To assess the efficacy of fluvoxamine and metformin...BACKGROUND: Postacute sequelae of SARS-CoV-2, or long COVID, presents a major therapeutic challenge, with fatigue being a prevalent and debilitating symptom. OBJECTIVE: To assess the efficacy of fluvoxamine and metformin for long COVID fatigue. DESIGN: Randomized, placebo-controlled, adaptive trial. (ClinicalTrials.gov: NCT06128967). SETTING: Outpatient sites in Brazil. PARTICIPANTS: 399 adults with fatigue persisting 90 or more days after confirmed SARS-CoV-2 infection. INTERVENTION: Participants were randomly assigned to fluvoxamine (100 mg twice daily), metformin (750 mg twice daily), or matching placebo for 60 days. MEASUREMENTS: The primary outcome was change in Fatigue Severity Scale (FSS) score. RESULTS: Fluvoxamine showed a significant reduction in fatigue compared with placebo at day 60 (mean difference, -0.43 [95% credible interval {CrI}, -0.80 to -0.07]), with a sustained effect at day 90 (mean difference, -0.58 [CrI, -0.98 to -0.16]). Fluvoxamine also improved quality-of-life scores with high posterior probability. Metformin showed no significant benefit. Adverse events were less frequent with fluvoxamine (20.0%) than with metformin (28.8%) or placebo (29.7%). Grade 3 and higher adverse events were rare across all groups. LIMITATIONS: The 90-day follow-up period limits conclusions about the durability of treatment effects, and the exclusive focus on fatigue as the primary outcome does not address other prevalent long COVID symptoms, leaving fluvoxamine's broader therapeutic utility uncertain. CONCLUSION: Fluvoxamine, but not metformin, may be an effective treatment for reducing fatigue and improving quality of life in patients with long COVID. PRIMARY FUNDING SOURCE: The Latona Foundation.
Ann Intern Med
· 2026 May · PMID 41871357
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BACKGROUND: Recurrent kidney stones are unpleasant and may lead to kidney damage, sepsis, or invasive procedures. PURPOSE: To assess benefits and harms of diet, pharmacologic therapy, and surveillance imaging to prevent...BACKGROUND: Recurrent kidney stones are unpleasant and may lead to kidney damage, sepsis, or invasive procedures. PURPOSE: To assess benefits and harms of diet, pharmacologic therapy, and surveillance imaging to prevent recurrent nephrolithiasis. DATA SOURCES: PubMed, Cochrane Library, and trial registries through December 2025. STUDY SELECTION: Randomized controlled trials (RCTs) or nonrandomized studies of interventions (NRSIs) in nonpregnant adults or children. DATA EXTRACTION: One reviewer extracted data, and a second reviewer checked for accuracy. Dual independent assessments of risk of bias and strength of evidence (SOE) were done. DATA SYNTHESIS: Among 31 studies (26 RCTs and 5 NRSIs), none evaluated imaging strategies. All but 3 included adults only. For adults with calcium oxalate or phosphate stones, increased water intake; a diet with normal to high calcium, low protein, and low sodium; thiazides; alkali treatment; and allopurinol may reduce stone recurrence (low SOE). There may be no difference between selective and empirical pharmacotherapy (low SOE). Acetohydroxamic acid may reduce stone growth in adults with infection-related stones (low SOE) but had insufficient evidence on prevention of recurrent stones and probably increased adverse events (moderate SOE). There may be increased minor adverse events with lemon juice but no increased harm due to serious adverse events with thiazides and allopurinol (low SOE). LIMITATION: Studies not published in English or with fewer than 30 participants per group were excluded. CONCLUSION: Increased fluid intake; a diet with normal to high calcium, low protein, and low sodium; thiazides; alkali therapy; and allopurinol may prevent stone recurrence in adults with calcium oxalate or calcium phosphate stones. Evidence is limited on other interventions, including imaging strategies, in children and on harms and other outcomes. PRIMARY FUNDING SOURCE: Patient-Centered Outcomes Research Institute and Agency for Healthcare Research and Quality (contract no. 75Q80120D00007/75Q80124F32010). (PROSPERO: CRD42024617257).