Epilepsy

Epilepsy is a common neurologic condition characterized by at least 1 unprovoked seizure and a high risk for recurrent seizures. Distinguishing epilepsy from conditions that can mimic seizures is important for accurate diagnosis and effective treatment. This article reviews the evaluation of patients suspected of having epilepsy and discusses behavioral strategies and pharmacologic and surgical therapies that can help reduce morbidity associated with recurrent seizures.

Efficacy of Individual-Level Interventions to Mitigate the Risk for Burnout Among Health Care Professionals: A Systematic Review and Meta-analysis of Randomized Controlled Trials: Annals of Internal Medicine: Vol 179, No 1

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)

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

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

CBT and rehabilitation improved long COVID symptoms

Clinical Impact Ratings GIM/FP/GP: 5 out of 7 Infectious Disease: 6 out of 7 Phys Med & Rehab: 6 out of 7

Correction: Severe Maternal and Neonatal Morbidity Among Gestational Carriers

Implementation of Social Needs Screening and Intervention in Primary Care: A Systematic Review of Program-Level Determinants: Annals of Internal Medicine: Vol 179, No 1

Background: Health care systems are investing significant resources in social needs screening and intervention programs. Purpose: To understand characteristics contributing to implementation of social needs screening and intervention programs in primary care. Data Sources: CINAHL, Cochrane, Ovid, PubMed, and Scopus (January 2015 to April 2025). Study Selection: U.S.-based programs using structured tools to screen adult patients for at least 1 Healthcare Effectiveness Data and Information Set measure (food insecurity, transportation, and housing insecurity) and addressing social needs in primary care settings. Data Extraction: Program characteristics; screening and intervention implementation processes; and patient screening, intervention, clinical, and health care use outcomes. Data Synthesis: The review included 23 studies. Seventeen reported on screening outcomes, 11 in populations characterized by a particular condition or health care use and 6 in the general population. Programs with the highest percentage of patients screened focused on fewer than 500 patients with a particular condition or health care use and received support from additional staff or volunteers (4 of 17 studies). Of patients screened, 10.1% to 100% reported a social need. Eleven studies reported on receipt of assistance or resources, with a higher percentage of patients receiving assistance or resources among programs that targeted a smaller population. Few studies reported clinical and health care use outcomes, with mixed findings. Limitations: Few studies had complete reporting of screening and intervention rates and outcomes. Program characteristics and other screening and intervention processes varied across and within studies. Conclusion: Social needs programs focused on smaller, targeted populations were more likely to screen and assist a higher percentage of patients. Programs with adequate staffing may also screen a higher proportion of patients. However, evidence is mixed, particularly for clinical and health care use outcomes. Considerable differences among screening and intervention programs preclude simple suggestions for universal implementation. Primary Funding Source: Live Well Intramural Pilot Grant Program. (PROSPERO: CRD42023431151)

Efficacy of a Very-Low-Calorie Weight Loss Diet Plus Exercise Compared With Exercise Alone on Hip Osteoarthritis Pain: A Randomized Controlled Trial: Annals of Internal Medicine: Vol 178, No 9

Background: Exercise is recommended to manage hip osteoarthritis, but weight loss recommendations are conflicting. Objective: To evaluate the efficacy of a weight loss diet added to exercise on change in hip pain. Design: 2-group superiority randomized trial. (ClinicalTrials.gov: NCT04825483) Setting: Community. Participants: 101 adults with hip osteoarthritis and overweight or obesity. Intervention: Both the exercise only group and very-low-calorie diet (VLCD) plus exercise group were provided with a 6-month home exercise program via 5 telehealth consultations. The VLCD plus exercise group also received a VLCD via 6 telehealth consultations. Measurements: The primary outcome was 6-month change in hip pain severity (11-point scale; range 0 to 10, with higher scores indicating worse pain; minimum clinically important difference of 1.8). Secondary end points included other measures of hip pain, physical function, quality of life, body weight, body composition, and adverse events. Results: 99 (98%) and 95 (94%) participants provided 6- and 12-month primary outcomes, respectively. Although VLCD plus exercise lost 8.5% more weight than exercise only, VLCD plus exercise was not more effective for change in hip pain severity (mean difference, −0.6 units [95% CI, −1.5 to 0.3]) at 6 months. Between-group differences for other secondary outcomes at 6 months favored VLCD plus exercise except Hip Disability and Osteoarthritis Outcome Score (HOOS) pain and function. At 12 months, weight, body mass index, HOOS pain and function, and overall hip improvement, but not quality of life and physical activity, favored VLCD plus exercise. There were no serious related adverse events. Limitation: Participants were unblinded. Conclusion: Adding a weight loss diet to exercise did not change hip pain but improved most secondary outcomes. Primary Funding Source: National Health and Medical Research Council.

Long-Term Mpox Sequelae 11 to 18 Months After Acute Illness: A Cohort Study in Two U.S. Cities: Annals of Internal Medicine: Vol 179, No 3

Background: Little was known about persistent sequelae of mpox before the 2022 multinational clade II mpox virus outbreak. Objective: To characterize post-mpox sequelae 11 to 18 months after acute mpox diagnosis and compare outbreak-associated psychosocial and behavioral impact between at-risk persons who had or did not have mpox. Design: Cohort study. Setting: New York City, New York, and Houston, Texas. Participants: Adults attending HIV, pre-exposure prophylaxis, or sexually transmitted infection clinics diagnosed with mpox during May 2022 to January 2023 (post-mpox) or at risk for but never diagnosed with mpox (no-mpox). Measurements: All participants completed psychosocial and behavioral self-assessments. A clinician also assessed post-mpox participants by clinical history and physical examination; persisting mpox physical sequelae were classified by tissue affected and effect on appearance or function. Associations between post-mpox physical sequelae and medical history, acute mpox severity, and sociodemographic characteristics were assessed using marginally adjusted probabilities (presented as risk ratios with 95% CIs). Results: A total of 154 post-mpox and 201 no-mpox participants were enrolled. The proportion of participants reporting increased psychobehavioral symptoms was generally similar between groups. Fifty-eight percent (89 of 154) of post-mpox participants had at least 1 persistent sequela; 56% (86 of 154) were appearance related, of which 51% (44 of 86) occurred at 2 or fewer sites. Thirteen percent (20 of 154) of post-mpox participants had functional sequelae, of whom 50% (10 of 20) and 35% (7 of 20) had ongoing anorectal and urinary dysfunction, respectively. Limitations: Participants may not be representative of mpox-affected and susceptible populations. Findings may over- or underestimate frequency or severity of severe mpox sequelae. Conclusion: Post-mpox sequelae frequently persisted 11 to 18 months after acute mpox, with limited body distribution or physical morbidity but with continued social and sexual effects. Primary Funding Source: Centers for Disease Control and Prevention.