Brief Amici Curiae - Massachusetts ingredient disclosure requirement, Mass. Ann. Laws

Health Care Needs of the Adolescent

Tobacco Control and Prevention

Assuring Universal Access to Health Coverage and Primary Care

Joint Comment Letter on Public Charge Ground of Inadmissibility Proposed Rule

ACP Comment Letter to CMS Regarding the MACRA Request for Information

Low-Volume Polyethylene Glycol for Bowel Preparation in Hospitalized Adults: A Multicenter Randomized Trial: Annals of Internal Medicine: Vol 179, No 6

Background: Adequate bowel preparation is essential for high-quality colonoscopy but remains challenging in hospitalized patients, and comparative data on preparation volume are limited. Objective: To compare the efficacy, tolerability, and safety of very low-volume (1-liter [1L]), low-volume (2-liter [2L]), and high-volume (4-liter [4L]) polyethylene glycol (PEG) regimens for inpatient colonoscopy preparation. Design: Multicenter, randomized controlled, endoscopist-blinded trial. (EudraCT: 2019–002799–15; ClinicalTrials.gov: NCT04708366) Setting: Community and academic hospitals in Italy. Patients: Hospitalized adults undergoing elective colonoscopy. Intervention: Patients were randomly assigned (1:1:1) to split-dose 1L PEG-ascorbate, 2L PEG-ascorbate, or 4L PEG. Measurements: Primary end point was adequate bowel cleansing (Boston Bowel Preparation Scale [BBPS] score ≥6 with all segments ≥2). Secondary end points included high-quality cleansing (BBPS score, 8 to 9), high-quality right-colon cleansing (BBPS score, 3), and willingness to repeat. Results: Among 665 randomly assigned patients (1L, n = 228; 2L, n = 218; 4L, n = 219), adequate overall cleansing occurred in 82.0%, 78.0%, and 78.5% (absolute difference between the 1L and 2L groups [Δ1L–2L], 4.0 percentage points [95% CI, −3.4 to 11.4 percentage points]; absolute difference between the 1L and 4L groups [Δ1L–4L], 3.5 percentage points [CI, −3.9 to 10.9 percentage points]). High-quality overall cleansing occurred in 46.9%, 35.3%, and 37.4% (Δ1L–2L, 11.6 percentage points [CI, 2.5 to 20.5 percentage points]; Δ1L–4L, 9.5 percentage points [CI, 0.3 to 18.5 percentage points]). High-quality right-colon cleansing occurred in 40.6%, 29.5%, and 31.6% (Δ1L–2L, 11.2 percentage points [CI, 2.1 to 20.0 percentage points]; Δ1L–4L, 9.0 percentage points [CI, 0.0 to 17.9 percentage points]). Tolerability was good across regimens, with the highest willingness to repeat in the 1L group (84.2%), despite more frequent vomiting and thirst. Limitation: Patients requiring urgent colonoscopy for active gastrointestinal bleeding and those with severe/unstable comorbid conditions were excluded. Conclusion: In hospitalized adults undergoing elective colonoscopy, 1L PEG-ascorbate yielded higher rates of high-quality cleansing, including right colon, than 2L PEG-ascorbate and 4L PEG, with similar rates of adequate cleansing and high willingness to repeat. Primary Funding Source: Norgine Srl.

Neither Metformin nor Ursodeoxycholic Acid Effectively Treats Postacute Sequelae of COVID-19: A Randomized Clinical Trial: Annals of Internal Medicine: Vol 179, No 4

Background: There is no proven treatment to alleviate symptoms of postacute sequelae of SARS-CoV-2 infection (PASC), despite its substantial public health burden. Objective: To evaluate the efficacy of metformin and ursodeoxycholic acid (UDCA) in improving PASC symptoms in adults. Design: Double-blind, placebo-controlled, randomized clinical trial. (Clinical Research Information Service: KCT0009342) Setting: Two tertiary hospitals in South Korea, July 2024 to April 2025. Participants: Of 666 adults screened, 396 with a PASC index score of 12 or greater were randomly assigned. Intervention: Oral metformin (uptitrated to 1500 mg/d), UDCA (900 mg once daily), or double placebo for 14 days (1:1:1). Measurements: Proportion of participants achieving PASC recovery (index score <12) at 8 weeks. Results: Among 396 randomized participants (median age, 36 years [IQR, 28 to 49 years]; 72% women), 132 received metformin, 132 received UDCA, and 132 received placebo. The mean interval from SARS-CoV-2 infection was 9.8 months (SD, 7.5). The mean baseline PASC score was 19.3 (SD, 5.7). Recovery occurred in 63.6% (84 of 132) with metformin, 68.2% (90 of 132) with UDCA, and 68.2% (90 of 132) with placebo. Mean changes in PASC scores from baseline to week 8 were −10.05 (95% CI, −11.35 to −8.76) with metformin and −10.62 (CI, −11.79 to −9.45) with UDCA, compared with −10.43 (CI, −11.69 to −9.18) with placebo. Limitation: Findings may not be generalizable to patients with more severe or persistent long COVID. Conclusion: A 2-week course of metformin or UDCA did not significantly improve recovery from PASC. Primary Funding Source: National Institute of Infectious Diseases, National Institute of Health, South Korea

Iron Deficiency Anemia

Iron deficiency anemia (IDA) is caused by iron deficiency, a common yet underrecognized clinical entity. Populations at greatest risk include children, menstruating and pregnant persons, and people of low socioeconomic status. Timely diagnosis and management of iron deficiency are key to preventing IDA and require thorough assessment of the underlying cause and appropriate iron repletion through either oral or parenteral therapy. Blood transfusion does not provide adequate elemental iron but is sometimes indicated along with iron therapy in patients with cardiovascular compromise, active bleeding, or severe anemia where more rapid correction is warranted. Alternative causes of anemia can be differentiated by red blood cell morphology and reticulocyte count and should be considered if anemia persists despite adequate repletion of iron stores.

How Would You Manage This Diabetic Patient With a Foot Infection? Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Foot infections are the most common cause of hospitalization in patients with diabetes. They may be superficial, involving only the skin, or deep, involving the soft tissues or bone. Superficial infections are generally caused by aerobic gram-positive cocci, whereas deep infections, including osteomyelitis, tend to be polymicrobial in origin. Clinical manifestations of skin and soft tissue infections include local evidence of inflammation, but peripheral neuropathy and peripheral artery disease may mask these findings. Management is determined by the extent of infection and often includes oral or parenteral antibiotic therapy in combination with surgical debridement. In 2023, the International Working Group on the Diabetic Foot and the Infectious Diseases Society of America updated their guideline on the diagnosis and management of diabetic foot infection. The guideline includes specific recommendations regarding the use of inflammatory markers, tissue and bone culture, and imaging studies in the diagnosis of diabetic foot infection, as well as the indications for surgical debridement and hospitalization. Here, 2 experts in this field, an infectious diseases physician and a podiatrist, debate how to manage the case of a diabetic patient with foot infection. They discuss diagnostic and treatment challenges in the care of this population.

Protecting the Integrity and Quality of the Medicare Advantage Program: A Position Paper From the American College of Physicians

Medicare Advantage (MA), the private plan option within Medicare, now enrolls more than half of all beneficiaries and is projected to keep expanding. The American College of Physicians (ACP) assesses the ethical and policy dimensions of this growth and its implications for the delivery of fair, high-quality, and fiscally responsible care to older adults and persons with disabilities. Payment and risk adjustment policies have created vulnerabilities to overpayment and favorable risk selection, whereas quality measurement remains fragmented and overly complex. Beneficiaries often face challenges in navigating plan choice, marketing practices, prior authorization, and access to clinicians and postacute services, with these barriers disproportionately affecting persons with low income, persons with several chronic conditions, or persons who live in rural communities. Limited transparency about ownership structures and relationships between insurers, “provider” networks, and investors complicates accountability and public oversight. ACP calls for reforms to ensure accurate payment, streamline and strengthen quality metrics, and protect enrollees from inappropriate utilization controls while supporting innovations that promote coordinated, patient-centered care. Collaborative engagement among policymakers, clinicians, health systems, insurers, and beneficiaries is essential to align MA with its original purpose and ensure that it complements traditional Medicare while providing accessible, affordable, and high-quality coverage for all who depend on it.

My Nights Eat My Days: How My Eating Disorder Overshadowed the Autism No One Saw

Generations at Risk: Unveiling the Global Increase in Cancer at Both Ends of Adulthood

When Would You Screen This 39-Year-Old Woman for Breast Cancer? Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Breast cancer is the second leading cause of cancer death among women in the United States. Screening mammography, which aims to detect asymptomatic breast cancers at earlier and more intervenable stages, has reduced breast cancer mortality, but not overall mortality, in randomized trials. As of 2024, the U.S. Preventive Services Task Force now recommends biennial screening mammography for women aged 40 to 74 years (grade B recommendation). In these rounds, 2 experts, the first a primary care physician and member of the Task Force and the second an epidemiologist and family practitioner, debate this recommendation in the context of Ms. R, a 39-year-old woman. They discuss the benefits and harms of breast cancer screening, the ideal age and frequency at which to conduct screening, and the key points to include when having a conversation with a patient about breast cancer screening.

Principles of Managed Care: A Position Paper From the American College of Physicians

Most U.S. health plans use managed care strategies, including health care use management and clinician networks. Most Medicare, Medicaid, and commercial insurance enrollees are covered by managed care plans. Managed care is ostensibly used to steer patients toward high-quality clinicians and facilities and contain costs; however, prior authorization, narrow clinician networks, and other managed care strategies often restrict access to necessary care, causing frustration among patients and physicians. In this position paper, the American College of Physicians offers policy recommendations to protect patients from onerous managed care processes, reduce administrative burdens associated with managed care, and ensure that patients can promptly access high-value, medically necessary care.

How Would You Treat Tricuspid Valve Infective Endocarditis in a Patient Who Uses Injection Drugs? Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Infective endocarditis is a common and morbid condition involving prolonged hospital stays, significant disability, and a high mortality rate. The current crises of injection drug use and opioid use disorder have contributed to high rates of infective endocarditis in the United States. Endocarditis in patients who inject drugs involves additional management complexity for multiple reasons. Several infective endocarditis management guidelines exist, including from the American Heart Association and the European Society of Cardiology. In light of the unique challenges of caring for this particular population, in 2022 the American Heart Association published a scientific statement specifically focusing on infective endocarditis in people who inject drugs. In these rounds, 2 experts in their respective fields, an infectious diseases specialist and a cardiac surgeon, discuss medical management, interventional approaches, and the value of multidisciplinary care for tricuspid valve endocarditis in a person who uses injection drugs, both in general and in relation to Mr. Y, a 30-year-old man with a history of substance use disorder, methicillin-sensitive Staphylococcus aureus bacteremia, and right-sided endocarditis.