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Annals of Internal Medicine: Highlights From 2018

 

While I would love to think that readers scour every new article that Annals of Internal Medicine publishes, I know that our readers are busy people and many things—family, patient care, teaching, and your own research responsibilities—take priority to keeping up with the medical literature. The transition to a new year seems like a good time to share a few 2018 highlights from Annals that you may have missed. These articles will be freely accessible through February 28, 2019.

As in 2017, opioid misuse and its consequences and prevention of firearm injury are topics that unfortunately continue to be very much front and center for our U.S. readers, and Annals published many articles on these topics in 2018. These articles help us better understand how to decrease firearm injury and how to prevent and treat opioid misuse disorders.

Beyond public policy on firearms, we published several other important policy position papers. These include American College of Physicians position papers on social determinants of health and gender equity in the medical profession.

2018 was a year that saw tremendous expansion of the legal use of marijuana for both medical and recreational purposes in many U.S. states and in Canada. Annals published several papers that explored both perceptions of and evidence about the effectiveness and safety of marijuana, including 2 systematic reviews that summarized what we know about the adverse pulmonary and cardiovascular effects of marijuana use.

Clinical guidelines are important Annals’ content. A notable one published in 2018 is the American College of Physicians' recommendations on hemoglobin A1c targets for nonpregnant adults with type 2 diabetes. The ACP recommended targets that are higher than those recommended by the American Diabetes Association, creating quite a bit of healthy debate between endocrinologists and general internists. A number of commentaries presenting various sides of this debate also appeared in Annals during 2018.

Another notable diabetes article presented data that draws the current diagnostic criteria for type 2 diabetes into question.

Diabetes was not the only common internal medicine condition covered in research published in Annals this past year. To summarize a few of those articles…

The 2013 pooled cohort equations are central in prevention guidelines for cardiovascular disease. A 2018 Annals article showed that updating the 2013 pooled cohort equations with data from modern cohorts reduces the number of persons considered to be at high risk. Clinicians and patients should consider the potential benefits and harms of reducing the number of persons recommended aspirin, blood pressure, or statin therapy.

Continuing with the theme of research articles on common clinical conditions, we published 2 PCORI-funded analyses of the large PCORnet database relevant to obesity. These studies examined the comparative effectiveness of currently available bariatric surgery interventions in achieving weight loss and reducing microvascular complications of diabetes.

Dementia is another topic heavily covered in Annals during 2018, with 4 systematic reviews examining evidence regarding addressing the effectiveness of strategies to prevent cognitive decline, mild cognitive impairment, and Alzheimer dementia—physical activity, dietary supplements, pharmacologic therapy. Unfortunately, the evidence shows that we need other strategies as none of these appear very effective.

Stroke is another common condition covered in Annals during 2018. Two separate systematic reviews showed that, in patients with patent foramen ovale and cryptogenic stroke, closure of the defect decreases risk for recurrent stroke compared with medical therapy alone, but may increase risk for atrial fibrillation.

And in the area of hepatitis C virus infection, several articles explored the effectiveness and cost-effectiveness of different strategies for managing hepatitis C treatment in patients who need kidney transplant.

Other notable articles highlight innovations in diagnosis and treatment.

In the arena of diagnosis, machine learning and artificial intelligence is garnering substantial interest. A preliminary but very interesting article examined the use of computer-assisted colonoscopy to better characterize the malignant potential of polyps. While preliminary, this study suggests promise for real-time CAD to assist in identifying diminutive, nonneoplastic rectosigmoid polyps that can be managed with a diagnose-and-leave strategy.

Regarding therapeutic innovation—immunotherapy is clearly a major current advance and Annals published a number of articles related to both the effectiveness and safety of immunotherapy.

And the last articles I'll mention are On Being a Doctor essays that address the unfortunate but timely issues of suicide and sexual harassment.

—Christine Laine, MD, MPH, Editor in Chief, Annals of Internal Medicine


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