Search Results for: "american academy"

Background: There is limited evidence of the strategies to mitigate burnout among all health care professionals (HCPs). Purpose: To evaluate the effectiveness of all interventions to mitigate burnout among HCPs. Data Sources: PubMed and Scopus (up to 14 May 2025). Study Selection: Independent study selection (2 people) of randomized controlled trials (RCTs) and cluster RCTs of interventions to mitigate burnout (vs. no active intervention) among HCPs. Data Extraction: Independent extraction with validation by second reviewer. Continuous data for burnout outcomes extracted for emotional exhaustion (EE), depersonalization, personal accomplishment (PA), and single-concept burnout measurement. Separate random-effects models were stratified by role. Data Synthesis: 93 RCTs and 6 cluster RCTs evaluating individual-level interventions were included (9330 participants). Among physicians, professional coaching was probably effective in reducing some aspects of burnout (EE standardized mean difference [SMD], −0.37 [95% CI, −0.62 to −0.13], low certainty; and depersonalization SMD, −0.30 [CI, −0.42 to −0.19], moderate certainty), but mindfulness-based interventions may not be effective (EE SMD, −0.46 [CI, −1.28 to 0.35], very low certainty; depersonalization SMD, −0.09 [CI, −0.30 to 0.12], moderate certainty). However, mindfulness-based interventions may reduce burnout among nurses and midwives (EE SMD, −0.90 [CI,−1.46 to −0.34], low certainty) and among a mixture of HCP roles (EE SMD, −0.40 [−0.65 to −0.16], low certainty; depersonalization SMD, −0.36 [CI, −0.58 to −0.14], low certainty; and PA SMD, 0.48 [CI, 0.29 to 0.67], moderate certainty). Mindfulness-based and professional coaching interventions were generally more than 4 weeks in duration. Limitations: Most trials were unblinded with subjective outcomes. There was substantial heterogeneity among interventions and populations despite stratifying by role. Conclusion: Although mindfulness-based interventions may reduce burnout in nurses and midwives and among a mixture of HCPs, professional coaching probably reduces burnout among physicians, particularly when sustained for more than 4 weeks. Primary Funding Source: Barts Charity. (PROSPERO: CRD42024552385)

Assessing the System-Instruction Vulnerabilities of Large Language Models to Malicious Conversion Into Health Disinformation Chatbots

Large language models (LLMs) offer substantial promise for improving health care; however, some risks warrant evaluation and discussion. This study assessed the effectiveness of safeguards in foundational LLMs against malicious instruction into health disinformation chatbots. Five foundational LLMs—OpenAI’s GPT-4o, Google’s Gemini 1.5 Pro, Anthropic’s Claude 3.5 Sonnet, Meta’s Llama 3.2-90B Vision, and xAI’s Grok Beta—were evaluated via their application programming interfaces (APIs). Each API received system-level instructions to produce incorrect responses to health queries, delivered in a formal, authoritative, convincing, and scientific tone. Ten health questions were posed to each customized chatbot in duplicate. Exploratory analyses assessed the feasibility of creating a customized generative pretrained transformer (GPT) within the OpenAI GPT Store and searched to identify if any publicly accessible GPTs in the store seemed to respond with disinformation. Of the 100 health queries posed across the 5 customized LLM API chatbots, 88 (88%) responses were health disinformation. Four of the 5 chatbots (GPT-4o, Gemini 1.5 Pro, Llama 3.2-90B Vision, and Grok Beta) generated disinformation in 100% (20 of 20) of their responses, whereas Claude 3.5 Sonnet responded with disinformation in 40% (8 of 20). The disinformation included claimed vaccine–autism links, HIV being airborne, cancer-curing diets, sunscreen risks, genetically modified organism conspiracies, attention deficit–hyperactivity disorder and depression myths, garlic replacing antibiotics, and 5G causing infertility. Exploratory analyses further showed that the OpenAI GPT Store could currently be instructed to generate similar disinformation. Overall, LLM APIs and the OpenAI GPT Store were shown to be vulnerable to malicious system-level instructions to covertly create health disinformation chatbots. These findings highlight the urgent need for robust output screening safeguards to ensure public health safety in an era of rapidly evolving technologies.

Annals On Call - Lifestyle Recommendations: Can They Really Improve Public Health?

From Disparities to Equity in Chronic Disease Burden: Progress Requires Persistence

Metabolic Dysfunction–Associated Steatotic Liver Disease

Metabolic dysfunction–associated steatotic liver disease (MASLD) is the most common chronic liver disease in the United States. It is characterized by steatosis in the liver and is potentially reversible. Risk factors include obesity, type 2 mellitus, and other metabolic disorders. Metabolic dysfunction–associated steatohepatitis (MASH), a more severe form of MASLD, puts patients at risk for cirrhosis, liver decompensation, and liver cancer. Diet, exercise, and weight loss are the cornerstones of management. Although only 1 medication has been approved for treatment of MASH, other pharmacotherapies and surgeries that aid weight loss and optimize metabolic risk factors can be used. Early diagnosis and intervention are important to prevent progression to cirrhosis and its complications, including cancer.

High Frequency of Chronic Urticaria Following an Investigational HIV-1 BG505 MD39.3 Trimer mRNA Vaccine in a Phase 1, Randomized, Open-Label Clinical Trial (HVTN 302)

Background: The mRNA platform is under investigation for many vaccines, including HIV-1 vaccines. Objective: To evaluate the safety and tolerability of 3 investigational HIV-1 trimer mRNA vaccines. Design: Safety analysis of mRNA vaccination in a phase 1, randomized, open-label trial. (ClinicalTrials.gov: NCT05217641) Setting: Ten research sites in the United States. Participants: 108 volunteers aged 18 to 55 years without HIV-1. Intervention: Investigational HIV-1 BG505 MD39.3 trimer mRNA vaccines (gp140 soluble trimer, gp151 membrane-bound trimer, and gp151 CD4KO membrane-bound trimer) at doses of 100 and 250 mcg at 0, 2, and 6 months. Measurements: Solicited and unsolicited adverse reactions and events reported during the 12 months after the first vaccination. Results: Participants (n = 108) were randomly assigned to 6 vaccine groups. Mild to moderate local and systemic solicited events were common. Eighty participants reported 190 unsolicited adverse events (AEs); 30 were considered to be related to a study product. Most (73%) related AEs were mild, and the rest were moderate. Among related AEs, urticaria was reported by 7 of 108 participants (7% [95% CI, 3% to 13%]), 4 of whom had unresolved, intermittent urticaria at 12 months. In post hoc analyses, demographic characteristics, history of allergy or medication use, and COVID-19 were not associated with urticaria. In a comparison of participants with versus without urticaria, 100% (7 of 7; CI, 65% to 100%) versus 37% (37 of 101; CI, 28% to 46%) reported previous Moderna COVID-19 vaccination, 29% (2 of 7; CI, 8% to 64%) versus 76% (77 of 101; CI, 67% to 84%) reported previous Pfizer–BioNTech COVID-19 vaccination, and 0% (0 of 7; CI, 0% to 35%) versus 5% (5 of 101; CI, 2% to 11%) reported no previous mRNA COVID-19 vaccination. Limitations: Lack of a placebo group, open-label study, and post hoc evaluation of urticarial risk. Conclusion: Urticarial reactions associated with experimental HIV-1 mRNA vaccines were observed in this trial. Studies to investigate the mechanism and approaches to mitigate these reactions are underway to further advance HIV-1 vaccine research. Primary Funding Source: National Institutes of Health, National Institute of Allergy and Infectious Diseases.

In ischemic stroke treated within 4.5 h, reteplase vs. alteplase increased excellent functional outcome at 90 d

Source Citation Li S, Gu HQ, Li H, et al; RAISE Investigators. Reteplase versus alteplase for acute ischemic stroke. N Engl J Med. 2024;390:2264-2273. 38884332

Dementia

Dementia, or major neurocognitive disorder, is defined as a decline in 1 or more cognitive domains that causes impairment in everyday function. Alzheimer disease is the most common type of dementia in the United States, with an estimated 6.9 million adults who have Alzheimer disease and are 65 years or older. This article discusses the latest findings in preventing cognitive decline. It also discusses dementia screening, diagnosis, treatment, and the quality of life for persons with dementia and their caregivers.

Assessment and Management of Patients at Risk for Suicide: Synopsis of the 2024 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines

Description: The U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DOD) updated the 2019 joint clinical practice guideline (CPG) for assessing and managing patients who are at risk for suicide. This synopsis provides primary care physicians with a summary of the updated 2024 recommendations regarding evaluation and management of military members and veterans at risk for suicide. Methods: In 2023, the VA/DOD Evidence-Based Practice Work Group convened to develop a joint VA/DOD guideline, including clinical stakeholders, which conformed to the National Academy of Medicine's tenets for trustworthy CPGs. The Work Group drafted 12 key questions, reviewed systematically identified literature (1 April 2018 to 15 March 2023), evaluated the evidence, created algorithms, and advanced 24 recommendations in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Recommendations: Despite insufficient evidence to recommend for or against suicide risk screening programs as a means for reducing suicide attempts or deaths, the VA/DOD Work Group identified validated tools that could be used to identify populations at higher risk for suicide-related behaviors. Cognitive behavioral therapy was also recommended for reducing the risk for suicide attempts and decreasing suicidal ideation among those with a history of suicidal behavior or a history of self-directed violence. Periodic communications after previous suicide attempts were also recommended as a prevention strategy. Pharmacologic treatments, such as clozapine or ketamine infusion, also have a role in the management of suicide risk among those with schizophrenia or major depressive disorder, respectively.

The Past, Present, and Future of Restrictive Covenants in Medicine in the United States: A Narrative Review: Annals of Internal Medicine: Vol 178, No 1

Restrictive covenants (RCs) are clauses placed into employment agreements across various industries, and they are frequently used in health care—specifically within physician contracts. Given the most recent guidance and rule determined by the Federal Trade Commission in April 2024, the relevancy of RCs in health care has come under even more scrutiny in the latter half of 2024. This review will focus on the history of RC law and review the value of these clauses from the perspectives of the employer, practicing physician, and patient. We also provide the stakeholder responses to both the ban and the subsequent blockage of enforcement by a Texas federal court in August of 2024.

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