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What’s new in medical literature

What's new in the medical literature?

Updated 28 February 2025

Articles from:

UpToDate (click on article title for abstract)

Cochrane Library (click on article title to go to article)

MJA (click on article title for abstract)

MJA insight (click on article title for abstract)

BMJ (click on article title for abstract)

JAMA (click on article title for abstract)

Other journals (click on article title for abstract)

UpToDate

American College of Chest Physicians guidelines on management of central airway obstruction
The guideline recommends airway dilation in patients undergoing therapeutic bronchoscopy who have stenotic, nonmalignant central airway obstruction, and stent placement for patients with symptomatic malignant or nonmalignant central airway obstruction, after other modalities have failed. The guideline also recommends curative surgical resection, when feasible. We agree with these recommendations. (See "Management of non-life-threatening, nonmalignant subglottic and tracheal stenosis in adults" and "Clinical presentation, diagnostic evaluation, and management of malignant central airway obstruction in adults", section on 'Introduction'.)

Combination pharmacotherapy for posttraumatic stress disorder
Novel treatment options are needed for posttraumatic stress disorder (PTSD), which is often only partially responsive to treatment and frequently leads to persistent psychosocial dysfunction. In a randomized trial of 416 participants with PTSD, the combination of brexpiprazole, a second-generation antipsychotic agent, plus sertraline, a selective serotonin reuptake inhibitor, reduced measures of symptoms severity after ten weeks compared with sertraline plus placebo [15]. Measures of anxiety, depression, and psychosocial functioning, and discontinuation due to adverse effects also favored treatment with brexpiprazole plus sertraline. Further studies investigating the utility of this combination in the treatment of PTSD are warranted. (See "Posttraumatic stress disorder in adults: Treatment overview", section on 'Treatments with limited supporting evidence'.)

European Respiratory Society guidelines on benign pleural effusion
The European Respiratory Society has published its first consensus guideline on the management of nonmalignant pleural effusion [32].  (See "Management of nonmalignant pleural effusions in adults", section on 'Introduction' and "Pleural fluid analysis in adults with a pleural effusion".)

Extended-interval dosing for zoledronic acid in postmenopausal women with low bone mass
In postmenopausal women with low bone mass, zoledronic acid administered every one to two years increases bone mineral density. The clinical efficacy of a longer dosing interval was evaluated in a 10-year trial of zoledronic acid (5 mg IV once at baseline only or once at baseline and again at five years) versus placebo in 1054 early postmenopausal women (mean age 56 years) with T-scores >-2.5 and <0.0 [11]. Participants who received one or two doses of zoledronic acid had a lower incidence of morphometric vertebral fracture compared with those who received placebo. Both zoledronic acid regimens also reduced risk of major osteoporotic fracture. Extended dosing intervals for zoledronic acid may help reduce treatment burden for postmenopausal women who opt for pharmacotherapy to prevent osteoporosis. (See "Overview of the management of low bone mass and osteoporosis in postmenopausal women", section on 'Options for pharmacotherapy'.)

Lack of benefit from perioperative intravenous lidocaine infusion
Although intravenous lidocaine has been used to treat acute and chronic pain, its benefit in the perioperative setting is unknown. In a randomized trial of over 500 patients undergoing elective minimally invasive colorectal surgery, perioperative intravenous administration of lidocaine (1.5 mg/kg bolus at induction of anesthesia followed by 1.5 mg/kg/hour for 6 or 12 hours) did not improve return of gut function at 72 hours or postoperative pain control compared with placebo [3]. Given its potential toxicity, intravenous lidocaine should be used judiciously, rather than routinely in the perioperative setting. (See "Measures to prevent prolonged postoperative ileus", section on 'Local anesthetics'.)

New classifications for patients with obesity
Body mass index (BMI) is increasingly recognized as an inadequate tool to fully capture an individual’s obesity-related health status. A global commission of obesity experts has proposed new strategies to better identify those with increased adiposity and further classify patients based on obesity-related health consequences [10]. One important change is the proposal of new diagnostic categories for "preclinical" and "clinical" obesity. Those with clinical obesity have objectively altered organ function or symptoms related to obesity, whereas those with preclinical obesity have no identifiable health effects from extra weight. These new classifications may help identify those who would benefit most from intensive treatment. We continue to individualize obesity interventions based on overall health status and risk factors for obesity-related morbidity. (See "Obesity in adults: Prevalence, screening, and evaluation", section on 'Preclinical versus clinical obesity'.)

Oral antihyperglycemics are less effective than insulin in pregnancy
Insulin is the preferred antihyperglycemic medication for pharmacotherapy of gestational diabetes mellitus (GDM) because of its well-established safety and efficacy. In a recent randomized trial comparing a sequential strategy of beginning metformin therapy and adding glyburide if glucose targets were not met versus a strategy of insulin alone, the oral antihyperglycemic strategy resulted in higher rates of large-for-gestational-age infants and maternal hypoglycemia [1]. (See "Gestational diabetes mellitus: Glucose management, maternal prognosis, and follow-up", section on 'Choice of pharmacotherapy'.)

Prophylactic tranexamic acid did not reduce postpartum hemorrhage after vaginal birth
Tranexamic acid (TXA) is commonly used for managing postpartum hemorrhage (PPH), whereas its role for preventing PPH is unclear. In a meta-analysis of randomized trials, prophylactic use of oxytocin plus TXA after vaginal birth resulted in little or no reductions in PPH ≥500 mL and 1000 mL, blood transfusion, surgical intervention to control hemorrhage, and severe maternal morbidity or death compared with oxytocin plus placebo [19]. The use of additional uterotonics in patients without anemia was modestly reduced. (See "Management of the third stage of labor: Prophylactic pharmacotherapy to minimize hemorrhage", section on 'After vaginal birth'.)

Suicide in preteens
Although suicide deaths in preteens are rare, they remain a leading cause of death and the incidence appears to be increasing over time. A recent study in children ages 8 to 12 years found that the rate of suicide between the periods 2009 to 2015 and 2016 to 2023 increased by 40 percent [1]. Among preteens with risk factors for suicide, such as psychiatric disorders, we suggest monitoring for suicidal ideation and behavior. Patients with suicidality should be treated for any underlying disorder and provided with a safety plan. (See "Suicidal behavior in children and adolescents: Epidemiology and risk factors", section on 'Age'.)

MJA

Management challenges and prognostic uncertainties in heat-induced acute liver failure Lessons from practice

  • Heatstroke is a life-threatening condition that occurs when the body temperature rises above 40°C due to failed thermal regulation.
  • Heatstroke can lead to extreme and life-threatening complications, such as acute liver failure, which requires comprehensive management, including liver transplant in severe cases.
  • The King's College criteria for severe cases may not apply to heatstroke-induced acute liver failure due to multiorgan involvement, highlighting the need for better risk stratification.
  • Climate change may increase the incidence of these cases, necessitating a better understanding of the condition, prompt management and improved public health strategies.

MJA 14 February 2025

Management of Mycobacterium ulcerans infection (Buruli ulcer) in Australia: consensus statement
Main recommendations and changes in management as a result of this consensus statement:

  • Buruli ulcer is a notifiable disease in Victoria, the Northern Territory and Queensland. Cases identified in other states or territories should be discussed with relevant health authorities. We call for Buruli ulcer to be made nationally notifiable to monitor for its potential emergence in non-endemic regions.
  • Diagnosis using polymerase chain reaction is sensitive and specific if performed correctly; a dry swab under the undermined edge of ulcers or a tissue sample via punch biopsy if the lesion is not ulcerated is recommended. If swabs are incorrectly performed or performed on non-ulcerated skin, they can give a false negative result.
  • There is high quality evidence to support treatment of eight weeks’ duration using rifampicin-based dual oral antibiotic therapy, in combination with clarithromycin or a fluoroquinolone; relapse is very rare but can occur in people with risk factors. There is emerging evidence for shorter durations of treatment (six weeks) in individuals with small lesions who are at low risk of relapse and in those who have undergone surgical excision of the lesion (four weeks).
  • Patients should be warned that ulcers typically enlarge with antibiotic treatment, will not have healed by completion of antibiotics, and take a median of four to five months to heal.
  • Surgical management is usually not required, but may be beneficial to reduce healing times, avoid or reduce the duration of antibiotics, and manage paradoxical reactions.
  • Early identification and treatment of paradoxical reactions is important, as they are associated with increased tissue necrosis and delayed wound healing.
  • Good wound care is critical in successful treatment of Buruli ulcer, as it enhances healing and prevents secondary bacterial infection.
  • Compared with adults, children have a higher proportion of non-ulcerative and severe lesions, are less likely to experience adverse antibiotic effects, but have higher rates of paradoxical reactions; specialist referral is recommended.

MJA 23 February 2025

Methylphenidate and (lis)dexamfetamine toxicity-related deaths of adults, Australia, 2000–24: analysis of NCIS data
The stimulants methylphenidate, dextroamfetamine, and lisdexamfetamine are prescribed for the treatment of attention deficit hyperactivity disorder (ADHD) in adults. The prescribing of ADHD medications has increased notably since 2000, and, while they are considered to have good safety profiles, the number of poisonings in Australia has also increased. Few reports on fatal poisonings with these drugs in adults have been published. The authors identified 64 deaths of adults in which the ingestion of methylphenidate, dextroamfetamine, or lisdexamfetamine was deemed to be a contributory factor; in 20% of cases, the death was judged to be intentional. In 78% of cases, people had ingested more than one drug, and 70% of people had known substance use problems. MJA 18 February 2025

The impact of pay-for-performance incentives for stroke unit access on public hospital costs and use, Queensland, 2012–17: interrupted time series analysis
The known: Pay-for-performance financial stimuli are widely used to improve quality of care, but little is known about their impact on value for health care expenditure. A pay-for-performance incentive program for increasing stroke unit access in Queensland public hospitals was associated with markedly improved access and lower 6-month mortality.
The new: The pay-for-performance program was not associated with increased hospital costs, hospital length of stay, or re-admission rates for people admitted with stroke.
The implications: By stimulating improved quality of care without increasing costs or hospital demand, the Queensland pay-for-performance program increased value for health care spending. MJA 25 February 2025

MJA Insight

Australia’s booming cosmetic industry: closing regulatory gaps to protect patients
The rapid expansion of Australia’s cosmetic industry underscores the urgent need for stronger regulation, better oversight and stricter enforcement of safety standards. MJA insight 24 February 2025

Cannabis poisonings among children increasing
As access to medicinal cannabis in Australia increases, so too does the risk of poisoning, especially in adolescents and small children. MJA insight 17 February 2025

It’s authoritarianism. Does the scientific and medical community have a duty of care?
The global scientific and medical community finds itself witnessing authoritarian acts in the United States. In the last few weeks, the Trump administration has ordered the United States Centre for Disease Control and Prevention (CDC) to pause publications, recall research, and has moved to censor words including “LGBT” from government publications and research grant applications. MJA insight 17 February 2025

Leaders urged to push back on Trump Administration’s attack on evidence, health and rights
The new Trump Administration has wasted no time in implementing its destructive agenda on matters that are of importance to human health – including climate policies, mining expansion, and tariffs on many health items including pharmaceuticals. MJA insight 24 February 2025

Linking antibiotic use with socio-economic status: insights to combat antimicrobial resistance
New research uncovers how socio-economic disparities influence antibiotic use in Australia, providing critical tools to address AMR. MJA insight 17 February 2025

Long-awaited funding for women’s reproductive health
With a federal budget and election looming, the federal government has pledged half a billion dollars towards women’s reproductive health. MJA insight 17 February 2025

The growing national burden of arthritis demands urgent attention and investment
New projections for the future burden of arthritis in Australia provide an important impetus for greater investment in arthritis to ensure Australia’s health system can capably meet future health care demand and deliver high value care. MJA insight 17 February 2025

BMJ

Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomised trials
This network meta-analysis (NMA) of randomised trials provides low to moderate certainty evidence that, compared with sham procedures, commonly performed interventional procedures for axial or radicular chronic non-cancer spine pain may provide little to no pain relief. BMJ 19 February 2025

Commonly used interventional procedures for non-cancer chronic spine pain: a clinical practice guideline
These recommendations apply to people living with chronic spine pain (≥3 months duration) that is not associated with cancer or inflammatory arthropathy and do not apply to the management of acute spine pain. Further research is warranted and may alter recommendations in the future: in particular, whether there are differences in treatment effects based on subtypes of chronic spine pain, establishing the effectiveness of interventional procedures currently supported by low or very low certainty evidence, and effects on poorly reported patient-important outcomes (such as opioid use, return to work, and sleep quality). BMJ 19 February 2025

Glucagon-like peptide-1 receptor agonists and risk of suicidality among patients with type 2 diabetes: active comparator, new user cohort study
In this large cohort study, the use of GLP-1 receptor agonists was not associated with an increased risk of suicidality compared with the use of DPP-4 inhibitors or SGLT-2 inhibitors in patients with type 2 diabetes. BMJ 27 February 2025

Intensive care unit acquired weakness and physical rehabilitation in the ICU
This review summarizes the latest evidence on the definition, diagnosis, epidemiology, pathophysiology, risks factors, implications, and management of intensive care unit acquired weakness (ICUAW). It specifically highlights research gaps and challenges, with considerations for future research for physical rehabilitation interventions. BMJ 27 February 2025

Plain versus drug balloon and stenting in severe ischaemia of the leg (BASIL-3): open label, three arm, randomised, multicentre, phase 3 trial
Neither drug coated balloon angioplasty with or without bare metal stenting (DCBA±BMS) nor drug eluting stenting (DES) conferred significant clinical benefit over plain balloon angioplasty with or without bare metal stenting (PBA±BMS)in the femoro-popliteal segment in patients with chronic limb threatening ischaemia undergoing endovascular femoro-popliteal, with or without infra-popliteal, revascularisation. BMJ 24 January 2025

The role of masks and respirators in preventing respiratory infections in healthcare and community settings
extensive evidence generated during the covid-19 pandemic confirms the superiority of respirators and supports the use of masks and respirators in the community during periods of high epidemic activity. Some gaps in research remain, including economic analyses, research in special population groups for whom masking is challenging, and research on countering disinformation. BMJ 27 February 2025

JAMA

Endocrine therapy interruption, resumption, and outcomes associated with pregnancy after breast cancer
The authors studied outcomes for women with breast cancer in 2 well-resourced health care systems over 2 decades and found low resumption of clinically indicated endocrine therapy (ET) and imaging after a pause for pregnancy. JAMA 13 February 2025

Semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy
These findings provide further evidence of an association between semaglutide and nonarteritic anterior ischemic optic neuropathy (NAION) but show a smaller risk than that previously reported; additional studies are necessary to identify potential mechanisms and causality. JAMA 20 February 2025

Whole-body hypothermia for Neonatal Encephalopathy in preterm infants 33 to 35 weeks’ gestation: A randomized clinical trial
Among infants 33 to 35 weeks’ gestation with hypoxic-ischemic encephalopathy, hypothermia at less than 6 hours’ age did not reduce death or disability at 18 to 22 months’ corrected age. JAMA 24 February 2025

Other journals

Assessing the impact of telehealth on blood glucose management among patients with diabetes: a systematic review and meta-analysis of randomized controlled trials
This study demonstrates that telehealth interventions significantly enhance blood glucose management among patients with diabetes. The findings highlight the need for healthcare systems to prioritize telehealth integration into diabetes management protocols while developing tailored interventions to meet the diverse needs of various patient populations. BMC health services research 20 February 2025

A systematic review of psychological distress reduction programs among nurses in emergency departments
Three types of interventions have provided pathways to alleviate the psychological stress of ED nurses at various levels. Future efforts should refine interventions for ED nurses’ psychological distress, evaluate their long-term benefits, and explore organizational strategies to promote healthier workplaces. Policymakers and administrators must support these initiatives, focusing on prevention and empowerment. BMC nursing 19 February 2025

Comparing the post-operative complications following surgery for hip fracture of patients who were on warfarin versus patients who were on novel oral anticoagulants: a meta-analysis
The post-operative complications following surgery for hip fracture of patients who were on warfarin versus patients who were on novel oral anticoagulants (NOACs) were similar. However, those patients who were on warfarin had a significantly longer length of hospital stay. Perioperative medicine 17 February 2025

COVID-19 infection is a significant risk factor for death in patients presenting with acute cholecystitis: a secondary analysis of the ChoCO-W cohort study
Key Findings:

  • COVID-19 infection increased mortality risk by five times in patients with acute cholecystitis.
  • Postoperative complications elevated the odds of death sixfold.
  • Early laparoscopic cholecystectomy significantly reduced mortality by 86%.
  • Surgical Impact: Survivors were more likely to have undergone urgent laparoscopic surgery, suggesting it as a safer intervention during the pandemic.
  • Clinical Relevance: COVID-19 was confirmed as an independent predictor of death, highlighting the need for urgent intervention in stable patients with acute cholecystitis.

World journal of emergency surgery 25 February 2025

Effective strategies for reducing patient length of stay in the emergency department: a systematic review and meta-analysis
The presence of a physician in the triage team demonstrated a reduction in patient Emergency Department Length of Stay(EDLOS), although with high heterogeneity among the analyzed studies. Similarly, the use of fast-track strategies is also significantly useful in reducing EDLOS, while point-of-care testing (POCT) reduces EDLOS but not significantly. BMC emergency medicine 20 February 2025

Guideline recommendations on the assessment and management of awake airway intubation: a systematic review
Through the AGREE II tool and the GRADE system, the strengths and weaknesses of each clinical practice guidelines (CPGs) were comprehensively analyzed on the basis of its scientific validity and practicability. Moreover, the limitations of the current CPGs in terms of indications, airway local anesthesia and complex clinical situations are presented, and clinicians are encouraged to apply the guidelines more scientifically and to update and improve the guidelines. BMC Anesthesiology 18 February 2025

Repetitive transcranial magnetic stimulation for motor function in stroke: a systematic review and meta-analysis of randomized controlled studies
This study aimed to systematically evaluate the safety and effectiveness of repetitive transcranial magnetic stimulation (rTMS) in treating motor dysfunction in stroke patients. Systematic reviews 24 February 2025

Risk factors for developing irritable bowel syndrome: systematic umbrella review of reviews
This review aims to consolidate the evidence regarding IBS risk factors by examining existing systematic reviews and meta-analyses, covering potential genetic, immunological, psychological, and dietary causes. BMC medicine 21 February 2025

Role of wound protectors in preventing surgical site infection in patients undergoing abdominal surgery: a meta-analysis of randomized controlled trials
The results indicated that the wound protectors (WPs) should not be used indiscriminately in all abdominal but gastrointestinal surgery. For patients with contaminated or dirty incisions, WPs should be considered. More studies are needed to determine the effect of WPs in laparoscopic surgery. BMC surgery 18 February 2025

Safety and effectiveness of inhaled sedation in critically ill patients: a systematic review and meta-analysis
Inhaled sedation has advantages over intravenous sedation in terms of awakening time, extubation time, and ICU LOS (non-cardiac ICU); however, there is no significant difference in the incidence of PONV. Inhaled sedation may be safe and effective for critically ill patients. Systematic reviews 19 February 2025

Safety of human-AI cooperative decision-making within intensive care: A physical simulation study
study emphasises the importance of human oversight in safety-critical AI and the value of evaluating human-AI systems in high-fidelity settings that more closely resemble real world practice. Plos digital health 24 February 2025

Summary of the best evidence for the management of kinesiophobia in patients after cardiac surgery
The comprehensive evidence summarised in this study for managing kinesiophobia in patients after cardiac surgery can provide resources for clinical translation. These insights can inform the development of kinesiophobia management plans to support the rapid recovery of patients after major surgery. BMC cardiovascular disorders 24 February 2025

Tranexamic acid in spontaneous intracerebral hemorrhage: a meta-analysis
Tranexamic acid (TA) does not significantly reduce hematoma growth or improve clinical outcomes in patients with Spontaneous intracerebral hemorrhage (sICH). Despite its affordability and availability, the routine use of TA in sICH is not supported by current evidence. European journal of medical research 25 February 2025

Tubal Ectopic Pregnancy

  • Tubal ectopic pregnancy is a time-sensitive medical condition that can be life-threatening.
  • Risk factors include previous ectopic pregnancy, a history of pelvic inflammatory disease, tubal surgery, and cigarette smoking.
  • The diagnosis is most commonly made by means of transvaginal ultrasonography showing the absence of an intrauterine pregnancy and the presence of adnexal mass.
  • Management strategies include surgical treatment (salpingectomy or salpingostomy), medical treatment (methotrexate), or, in selected cases, expectant management.
  • Post-treatment care should include attention to family planning and mental health.

NEJM 19 February 2025