Annals On Call - Metabolic Dysfunction–Associated Steatotic Liver Disease

Unifying Efforts to Empower Equitable Obesity Care: Synopsis of an American College of Physicians and Council of Subspecialty Societies Summit

Obesity is a leading cause of morbidity and mortality with health consequences that crosscut most medical specialties. Despite the emergence of effective and promising new therapies, many impediments to comprehensive obesity care remain. As part of their commitment to improving obesity care, the American College of Physicians (ACP) and its Council of Subspecialty Societies (CSS) held a summit on 24 October 2023 to identify barriers to and opportunities for collaborative action in the domains of physician education, health care policy and care delivery, and addressing weight bias. This report summarizes the summit proceedings and provides a postsummit synthesis from ACP and CSS. Key themes were centered on knowledge, advocacy, action, and compassion, including the need for culture change, paradigm shifts, and stakeholder engagement and collaboration; a focus on empowerment of both clinicians and patients; the importance of knowing patients as people to help address social determinants of health; the need to address learned helplessness; and the importance of embracing artificial intelligence and technology as disruptive innovations. Recommendations for next steps for collaborative action include leveraging and improving already available educational and clinical resources, developing obesity education and care standards that incorporate patients’ perspectives and address social determinants of health, developing community and public–private partnerships to improve access and public awareness, and coordinating messaging and policy advocacy efforts that align with mitigating the longstanding obesity epidemic.

Extracorporeal Shock-Wave Lithotripsy and Endoscopy for the Treatment of Pain in Chronic Pancreatitis

Extracorporeal Shock-Wave Lithotripsy and Endoscopy for the Treatment of Pain in Chronic Pancreatitis

Associations of Testosterone and Related Hormones With All-Cause and Cardiovascular Mortality and Incident Cardiovascular Disease in Men

Medications and Risk for Microscopic Colitis: A Nationwide Study of Older Adults in Sweden

Background: Several medications have been identified as potential risk factors for microscopic colitis (MC), but evidence so far is hampered by methodological limitations. Objective: To examine the potential causal effects of previously implicated medications on risk for MC. Design: Emulation of 6 target trials. Setting: Sweden. Participants: All residents in Sweden aged 65 years or older between 2006 and 2017 who met eligibility criteria (n = 191 482 to 2 634 777). Measurements: The primary outcome was biopsy-verified MC. The date of diagnosis was obtained from the nationwide histopathology cohort ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden). Twelve- and 24-month cumulative incidences and absolute risk differences for MC were estimated via inverse probability weighing. Results: The 12- and 24-month cumulative incidences of MC were less than 0.5% under all treatment strategies. Estimated 12-month risk differences were close to null under angiotensin-converting enzyme versus calcium-channel blocker (CCB) initiation, angiotensin-receptor blocker versus CCB initiation, nonsteroidal anti-inflammatory drug initiation versus noninitiation, proton-pump inhibitor initiation versus noninitiation, and statin initiation versus noninitiation. The estimated 12-month risk difference was 0.04% (95% CI, 0.03% to 0.05%) for selective serotonin receptor inhibitors (SSRIs) versus mirtazapine. Results were similar for 24-month risk differences. Several medications were also associated with increased risk for receiving a colonoscopy with a normal colorectal mucosa biopsy result. Limitations: There is possible residual bias due to differential health care utilization or surveillance. Lack of primary care data limited measurement of, and adjustment for, symptoms and medical diagnoses that increase risk for receiving a colonoscopy. Conclusion: No evidence of a causal relationship between most previously suspected pharmacologic triggers and risk for MC was found. Previously reported associations and persistent associations with SSRI initiation may be due to surveillance bias. Primary Funding Source: The National Institutes of Health and the Swedish Research Council.

Antibiotic, Glucocorticoid, and Opioid Prescribing in Urgent Cares: An Opportunity for Reducing Medication Overuse

Annals for Educators - December 2024

Hemochromatosis

Hemochromatosis is an inheritable condition that mainly affects White populations of European descent. Most patients remain asymptomatic, but others develop advanced organ damage that reduces quality of life and long-term survival. Arthropathy, diabetes mellitus, cirrhosis, hypogonadotropic hypogonadism, and cardiomyopathy are key clinical manifestations. Primary care and hospital medicine physicians play an essential role in early identification of this disease, which can be accomplished via standard hematologic testing. Early diagnosis and therapeutic phlebotomy improve clinical outcomes.

A 30-Year Analysis of National Institutes of Health F32 Grants to Internal Medicine Trainees