Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2021


      It can be challenging to identify new evidence that may shift clinical practice within internal medicine. Synthesis of relevant articles and guideline updates can facilitate staying informed of these changes. The titles and abstracts from the 7 general internal medicine outpatient journals with highest impact factors and relevance were reviewed by 8 internal medicine physicians. Coronavirus disease 2019 research was excluded. The New England Journal of Medicine (NEJM), The Lancet, Journal of the American Medical Association (JAMA), The British Medical Journal (BMJ), Annals of Internal Medicine, JAMA Internal Medicine, and Public Library of Science Medicine were reviewed. Additionally, article synopsis collections and databases were reviewed: American College of Physicians Journal Club, NEJM Journal Watch, BMJ Evidence-Based Medicine, McMaster/DynaMed Evidence Alerts, and Cochrane Reviews. A modified Delphi method was used to gain consensus based on clinical relevance to outpatient internal medicine, potential impact on practice, and strength of evidence. Article qualities and importance were debated until consensus was reached. Clusters of articles pertinent to the same topic were considered together. In total, 8 practice-changing articles were included.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Zhang W.
        • Zhang S.
        • Deng Y.
        • et al.
        Trial of intensive blood-pressure control in older patients with hypertension.
        N Engl J Med. 2021; 385: 1268-1279
        • Blood Pressure Lowering Treatment Trialists’ Collaboration
        Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis.
        Lancet. 2021; 398: 1053-1064
        • Lewis C.E.
        • Fine L.J.
        • et al.
        • SPRINT Research Group
        Final report of a trial of intensive versus standard blood-pressure control.
        N Engl J Med. 2021; 384: 1921-1930
        • Juraschek S.P.
        • Hu J.R.
        • Cluett J.L.
        • et al.
        Effects of intensive blood pressure treatment on orthostatic hypotension: a systematic review and individual participant-based meta-analysis.
        Ann Intern Med. 2021; 174: 58-68
        • Albasri A.
        • Hattle M.
        • Koshiaris C.
        • et al.
        Association between antihypertensive treatment and adverse events: systematic review and meta-analysis.
        BMJ. 2021; 372: n189
        • Hopewell S.
        • Keene D.J.
        • Marian I.R.
        • et al.
        Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 x 2 factorial, randomised controlled trial.
        Lancet. 2021; 398: 416-428
        • Page M.J.
        • Green S.
        • McBain B.
        • et al.
        Manual therapy and exercise for rotator cuff disease.
        Cochrane Database Syst Rev. 2016; 2016CD012224
        • Buchbinder R.
        • Green S.
        • Youd J.M.
        Corticosteroid injections for shoulder pain.
        Cochrane Database Syst Rev. 2003; 2003CD004016
        • Wilding J.P.H.
        • Batterham R.L.
        • Calanna S.
        • et al.
        Once-weekly semaglutide in adults with overweight or obesity.
        N Engl J Med. 2021; 384: 989
        • Anker S.D.
        • Butler J.
        • Filippatos G.
        • et al.
        Empagliflozin in heart failure with a preserved ejection fraction.
        N Engl J Med. 2021; 385: 1451-1461
        • McMurray J.J.V.
        • Solomon S.D.
        • Inzucchi S.E.
        • et al.
        Dapagliflozin in patients with heart failure and reduced ejection fraction.
        N Engl J Med. 2019; 381: 1995-2008
        • Packer M.
        • Anker S.D.
        • Butler J.
        • et al.
        Cardiovascular and renal outcomes with empagliflozin in heart failure.
        N Engl J Med. 2020; 383: 1413-1424
        • Nassif M.E.
        • Windsor S.L.
        • Borlaug B.A.
        • et al.
        The SGLT2 inhibitor dapagliflozin in heart failure with preserved ejection fraction: a multicenter randomized trial.
        Nat Med. 2021; 27: 1954-1960
        • Krist A.H.
        • Davidson K.W.
        • et al.
        • US Preventive Services Task Force
        Screening for lung cancer: US Preventive Services Task Force recommendation statement.
        JAMA. 2021; 325: 962-970
        • Jonas D.E.
        • Reuland D.S.
        • Reddy S.M.
        • et al.
        Screening for lung cancer with low-dose computed tomography: updated evidence report and systematic review for the US Preventive Services Task Force.
        JAMA. 2021; 325: 971-987
        • Aberle D.R.
        • Berg C.D.
        • et al.
        • National Lung Screening Trial Research Team
        The national lung screening trial: overview and study design.
        Radiology. 2011; 258: 243-253
        • de Koning H.J.
        • van der Aalst C.M.
        • de Jong P.A.
        • et al.
        Reduced lung-cancer mortality with volume CT screening in a randomized trial.
        N Engl J Med. 2020; 382: 503-513
        • Meza R.
        • Jeon J.
        • Toumazis I.
        • et al.
        Evaluation of the Benefits and Harms of Lung Cancer Screening With Low-Dose Computed Tomography: a collaborative modeling study for the US Preventive Services Task Force.
        Agency for Healthcare Research and Quality, Rockville, Md2021
        • Peery A.F.
        • Shaukat A.
        • Strate L.L.
        AGA clinical practice update on medical management of colonic diverticulitis: expert review.
        Gastroenterology. 2021; 160: 906-911.e1
        • Strate L.L.
        • Morris A.M.
        Epidemiology, pathophysiology, and treatment of diverticulitis.
        Gastroenterology. 2019; 156: 1282-1298.e1
        • Au S.
        • Aly E.H.
        Treatment of uncomplicated acute diverticulitis without antibiotics: a systematic review and meta-analysis.
        Dis Colon Rectum. 2019; 62: 1533-1547
        • Hall J.
        • Hardiman K.
        • Lee S.
        • et al.
        The American Society of colon and rectal surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis.
        Dis Colon Rectum. 2020; 63: 728-747
        • Sartelli M.
        • Weber D.G.
        • Kluger Y.
        • et al.
        2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting.
        World J Emerg Surg. 2020; 15: 32
        • Francis N.K.
        • Sylla P.
        • Abou-Khalil M.
        • et al.
        EAES and SAGES 2018 consensus conference on acute diverticulitis management: evidence-based recommendations for clinical practice.
        Surg Endosc. 2019; 33: 2726-2741
        • Gaber C.E.
        • Kinlaw A.C.
        • Edwards J.K.
        • et al.
        Comparative effectiveness and harms of antibiotics for outpatient diverticulitis: two nationwide cohort studies.
        Ann Intern Med. 2021; 174: 737-746
        • Inker L.A.
        • Eneanya N.D.
        • Coresh J.
        • et al.
        New creatinine- and cystatin C-based equations to estimate GFR without race.
        N Engl J Med. 2021; 385: 1737-1749
      1. National Kidney Foundation; American Society of Nephrology. Removing race from estimates of kidney function. March 9, 2021. Available at: Accessed February 19, 2022.

        • Davidson K.W.
        • Barry M.J.
        • et al.
        • US Preventive Services Task Force
        Screening for colorectal cancer: US Preventive Services Task Force recommendation statement.
        JAMA. 2021; 325: 1965-1977
        • Knudsen A.B.
        • Rutter C.M.
        • Peterse E.F.P.
        • et al.
        Colorectal cancer screening: an updated modeling study for the US Preventive Services Task Force.
        JAMA. 2021; 325: 1998-2011