What’s new in medical literature
What's new in the medical literature?
Updated 23 April 2025
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Coated versus standard peripherally inserted central catheters
Whether specialized materials or coatings reduce complications from peripherally inserted central catheters (PICC) has been uncertain. In a randomized trial including over 1000 patients, those assigned to receive a chlorhexidine PICC had a higher complication rate than those assigned to a hydrophobic or standard polyurethane PICC (approximately 39, 22, and 22 percent respectively) [2]. The device failure rate was not significantly different among the three groups and was defined as the cessation of PICC function or the need to remove the PICC before completion of the intended therapy. The results of this trial support our practice of using standard PICCs. (See "Central venous access: Device and site selection in adults", section on 'Antimicrobial-impregnated catheters'.).
Giant cell arteritis in patients initially diagnosed with polymyalgia rheumatica
Polymyalgia rheumatica (PMR) may be an isolated diagnosis or a feature of giant cell arteritis (GCA); however, the frequency with which patients with isolated PMR are eventually diagnosed as having GCA has been unclear. In a prospective cohort study of 62 patients with PMR, 3 percent of patients had radiologic evidence of subclinical GCA and another 3 percent developed late-onset GCA during the following year [16]. Although the risk is relatively low, GCA should be considered in all patients presenting with PMR. At presentation and at each follow-up visit, we assess for symptoms or physical findings referable to GCA (eg, new-onset headache, visual impairment, jaw pain with mastication) and pursue large-vessel imaging as indicated by symptoms. (See "Clinical manifestations and diagnosis of polymyalgia rheumatica", section on 'Association with GCA'.)
Inebilizumab for IgG4-related disease
Although rituximab (an anti-CD20 monoclonal antibody) is commonly used for the treatment of IgG4 related disease (IgG4 RD) refractory to glucocorticoids, this practice has not been well validated in clinical trials. Recently, the US Food and Drug Administration (FDA) granted approval for the use of inebilizumab, an anti-CD19 monoclonal antibody, for the treatment of IgG4 RD based on a trial of 135 patients with IgG4 RD randomized to receive inebilizumab (300 mg intravenous infusions on days 1 and 15 and week 26) or placebo [26]. At the end of 52 weeks of observation, patients treated with inebilizumab had fewer flares than patients treated with placebo (10 versus 62 percent). Patients assigned to inebilizumab were also more likely to have a flare-free, glucocorticoid-free, complete remission, than patients treated with placebo (odds ratio 5.0). Theoretically, antibodies directed against CD19 result in deeper depletion of the B-cell compartment than anti-CD20 antibodies; however, absent comparative data, the choice between these agents is based on payor preferences and the clinician’s experience with these agents. (See "Treatment and prognosis of IgG4-related disease", section on 'Rituximab or inebilizumab'.)
Intravenous iron supplementation in heart failure
In patients with heart failure (HF) with reduced ejection fraction (HFrEF), iron supplementation reduces the risk of readmissions, but whether sustained iron therapy has additional beneficial effects remains uncertain. In a trial in more than 1100 patients with HFrEF, New York Heart Association class II or III HF symptoms, and iron deficiency who were treated for up to three years with ferric carboxymaltose or placebo, there were similar rates of mortality and HF hospitalizations between the groups [16]. Subgroup analyses, including an analysis by transferrin saturation (ie, 20 percent cutoff), showed similar findings to the main trial results. Despite the results of this trial, patients with HF who have iron deficiency with or without anemia should receive iron and should be evaluated for the cause of the deficiency. (See "Evaluation and management of anemia and iron deficiency in adults with heart failure", section on 'Iron supplementation'.)
Outcomes associated with sepsis bundles
A "sepsis bundle" refers to a set of early interventions (eg, intravenous fluids, antibiotics, and laboratory tests) that improve the diagnosis, management, and survival of patients with sepsis; the time required to complete the "sepsis bundle" is widely used in hospitals as a pay-for-performance measure. A recent review analyzed 17 observational trials examining outcomes associated with compliance or implementation of a sepsis bundle [10]. Five studies demonstrated a mortality benefit from bundle compliance while seven did not. Only one study showed a mortality benefit from bundle implementation. High-quality data are needed to demonstrate a clear mortality benefit from sepsis bundles. (See "Evaluation and management of suspected sepsis and septic shock in adults", section on 'Early goal-directed therapy'.)
Pemivibart for prevention of COVID-19 in selected immunocompromised patients
For selected immunocompromised patients expected to have suboptimal immune response to vaccination (eg, those with active hematologic malignancy, recent stem cell transplantation, or history of solid organ transplantation), we suggest adjunctive pre-exposure prophylaxis with the monoclonal antibody pemivibart to reduce the risk of severe COVID-19 (Grade 2C). Monoclonal antibodies have been used as adjunctive pre-exposure prophylaxis to reduce the risk of COVID-19 in individuals expected to have suboptimal response to vaccination, although emergence of variants that escape neutralization limit their utility. In March 2024 in the United States, the novel monoclonal antibody pemivibart received emergency use authorization to prevent COVID-19 in individuals age 12 years or older (weighing at least 40 kg) who have moderate-to-severe immunocompromising conditions (table 8) [23]. Pemivibart is active against JN.1, the dominant SARS-CoV-2 variant. We suggest pemivibart in individuals at the highest risk for vaccine nonresponse (eg, those with hematologic malignancy or recent history of transplantation) as long as it remains active against the main circulating variants. (See "COVID-19: Epidemiology, virology, and prevention", section on 'Limited role for monoclonal antibodies in selected patients'.)
Procalcitonin and antibiotic duration in sepsis
While procalcitonin (PCT) has a clear role in determining antibiotic duration for patients with community-acquired pneumonia, its role in managing sepsis is less clear. A recent multicenter randomized trial of 2760 adults with sepsis, reported a reduction in antibiotic duration for patients in whom a daily PCT-guided protocol was implemented compared with standard care (9.8 versus 10.7 days) [11]. However, over half of study participants had lower respiratory tract infections which may have impacted the outcome. Based upon these and other cumulating data in patients with sepsis, we support measuring PCT to guide antibiotic duration. (See "Evaluation and management of suspected sepsis and septic shock in adults", section on 'Initial investigations'.)
Reduced-dose apixaban and rivaroxaban for indefinite venous thromboembolism treatment
The optimal anticoagulant dose for prevention of venous thromboembolism (VTE) among patients at high risk of recurrence is unknown. In a trial of over 2700 such patients who had completed 6 to 24 months of anticoagulation, patients who transitioned either to reduced-dose apixaban (2.5 mg twice daily) or rivaroxaban (10 mg once daily) had a higher five-year VTE recurrence rate, compared with patients who continued to take full-dose anticoagulants (2.2 versus 1.8 percent) [7]. However, low-dose anticoagulant therapy was associated with a lower risk of major and/or clinically relevant bleeding (9.9 versus 15.2 percent). Low-dose apixaban or rivaroxaban is appropriate for most patients at high risk of recurrent VTE who require indefinite anticoagulation. (See "Selecting adult patients with lower extremity deep venous thrombosis and pulmonary embolism for indefinite anticoagulation", section on 'Reduced-dose regimens for indefinite anticoagulation'.)
Risk of rheumatoid arthritis in patients with arthralgias
Patients presenting with arthralgias and seropositivity (ie, the presence of anti-citrullinated protein antibodies (ACPA) and/or rheumatoid factor (RF) are presumed to be at risk of progression to rheumatoid arthritis (RA), but the magnitude of risk has been unclear. In a prospective cohort of over 600 seropositive patients presenting with arthralgias, approximately one-third of patients were diagnosed with RA after a mean follow-up of approximately four years [7]. Risk factors for progression to RA included morning stiffness, high titer ACPA, double-positivity for ACPA and RF, and having a first-degree relative with RA. Patients with arthralgias who have these characteristics should be monitored closely for the development of RA. (See "Undifferentiated inflammatory arthritis in adults", section on 'Prognosis'.)
Small interfering RNA reduces lipoprotein(a)
An elevated serum concentration of lipoprotein(a), also known as Lp(a), is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD); however, available lipid-lowering agents have minimal efficacy in lowering Lp(a). In a phase 2 trial in over 300 patients with elevated Lp(a) who were randomly assigned to lepodisiran (subcutaneous injection of 16, 96, or 400 mg), an investigational small interfering RNA that targets hepatic Lp(a) synthesis, or placebo, lepodisiran lowered Lp(a) in a dose-dependent manner from 60 to 180 days after administration [22]. Mild injection-site reactions occurred in up to 12 percent of participants in the highest-dose group. Larger studies are needed to determine whether lepodisiran improves clinical outcomes. (See "Lipoprotein(a)", section on 'Investigational therapies'.)
Stepwise de-escalation of antiplatelet therapy after drug-coated balloon angioplasty
For patients at high risk of bleeding who undergo drug-eluting stent (DES) placement, a shorter course of dual antiplatelet therapy (DAPT) is sometimes used; whether this approach might be appropriate for patients undergoing drug-coated balloon (DCB) angioplasty is uncertain. In a trial in which over 1900 patients with acute coronary syndrome treated with paclitaxel DCBs were randomly assigned to stepwise de-escalation of antiplatelet therapy (ie, aspirin plus ticagrelor for one month, then five months of ticagrelor, then six months of aspirin) or standard DAPT (ie, aspirin plus ticagrelor for 12 months), rates of the primary composite endpoint (ie, death, stroke, myocardial infarction, revascularization, Bleeding Academic Research Consortium [BARC] type 3 or 5 bleeding) were similar between the groups. Patients in the de-escalation group experienced less bleeding. For patients undergoing DCB angioplasty, especially those at high bleeding risk, stepwise de-escalation of antiplatelet therapy may be a reasonable alternative to standard DAPT [32]. (See "Patients with high bleeding risk undergoing percutaneous coronary intervention", section on 'Drug-coated balloon angioplasty'.)
Timing of balloon catheter removal during cervical ripening
Balloon catheters are placed intracervically for 6 or 12 hours to ripen the unfavorable cervix for labor induction. In a meta-analysis of six trials including over 1100 patients, the group assigned to planned removal at 6 hours had a shorter interval from balloon placement to delivery than that assigned to 12 hours (mean difference -3.7 hours) and a modest reduction in cesarean birth (30 versus 36 percent) [14]. Other maternal and neonatal outcomes were similar for both groups. A limitation of the analysis was that it was underpowered to reliably assess some outcomes. We believe planned catheter removal at either 6 or 12 hours is reasonable until more definitive data are available. (See "Induction of labor: Techniques for preinduction cervical ripening", section on 'Single-balloon catheter'.)
TNF inhibitors for temporomandibular joint arthritis in juvenile idiopathic arthritis
Temporomandibular joint (TMJ) arthritis is a frequent manifestation of juvenile idiopathic arthritis (JIA) that can cause significant pain and dysfunction; how to manage such patients, however, has been less clear. A recent prospective study of 18 patients with JIA-related TMJ arthritis evaluated the efficacy of combining either methotrexate or leflunomide with a tumor necrosis factor (TNF) inhibitor [6]. Over 24 months of follow-up, there were improvements in TMJ function and symptoms of pain and morning stiffness, and 17 patients (47 percent) had stable or improved deformity scores as determined by repeat clinical evaluation and magnetic resonance imaging (MRI). While randomized trials are needed, this suggests that combining a TNF inhibitor with methotrexate or leflunomide can be an effective treatment strategy for TMJ arthritis in JIA. (See "Juvenile idiopathic arthritis: Immunizations and complications", section on 'Treatment and prognosis'.)
Upadacitinib for giant cell arteritis
Tocilizumab, an anti-interleukin 6 antibody, is the only biologic agent currently used to treat giant cell arteritis. In a randomized trial of 209 patients with either newly diagnosed or relapsing giant cell arteritis, the Janus kinase (JAK) inhibitor upadacitinib (15 mg, administered orally, once daily) plus a 26-week glucocorticoid taper was superior to a 52-week glucocorticoid taper at achieving sustained remission (46.4 versus 29.0 percent) [15]. Upadacitinib also reduced flare rates and glucocorticoid exposure without increasing serious adverse events. JAK inhibitors have been associated with an increased risk of malignancy, venous thromboembolic events, and cardiovascular events in older adults. While an increased risk of these events was not seen in this study among patients assigned to upadacitinib, long-term follow-up studies are required. We consider upadacitinib as an option for patients who require a steroid-sparing agent but cannot use tocilizumab due to comorbidities such as diverticulitis. (See "Treatment of giant cell arteritis", section on 'Upadacitinib'.)
Vascular access for cardiac life support
Few studies have directly compared intraosseous (IO) and intravenous (IV) vascular access in adults with cardiac arrest. A systematic review and meta-analysis identified three randomized trials that enrolled over 9300 patients with out-of-hospital cardiac arrest treated by emergency medical services and compared a strategy of IO-first with IV-first vascular access [1]. While successful placement was more common for IO-first participants (92 to 94 percent, proximal tibia or humerus placement) than for IV-first participants (58 to 80 percent), the time to first drug administration did not vary, and there was no significant difference in 30-day survival. However, in two studies (7545 participants), the rate of sustained return of spontaneous circulation was higher in the IV-first group (25 versus 23 percent). While IV access is preferred, when it cannot be readily established, IO lines are safe and effective. (See "Advanced cardiac life support (ACLS) in adults", section on 'Vascular access for medication administration'.)
Withdrawal of adalimumab in patients with uveitis related to juvenile idiopathic arthritis
Chronic anterior uveitis (CAU) is a common comorbidity for patients with juvenile idiopathic arthritis (JIA); however, the optimal approach to tapering therapy after sustained remission is unclear. A trial of 87 patients with JIA-related uveitis in sustained remission on adalimumab randomly assigned patients to continue adalimumab or switch to placebo [5]. While treatment failure during the two-year trial was more common among patients switched to placebo (14 versus 68 percent), these patients were able to re-establish sustained disease control with re-initiation of adalimumab after a median of 105 days. This trial supports the approach to tapering therapy after a period of sustained remission in patients with CAU and JIA. (See "Juvenile idiopathic arthritis: Immunizations and complications", section on 'Subsequent monitoring and duration of therapy'.)
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Abdominal drainage to prevent intraperitoneal abscess after appendectomy for complicated appendicitis Cochrane Library 11 April 2025The evidence is very uncertain whether abdominal drainage prevents intraperitoneal abscess, wound infection, or morbidity in paediatric and adult participants undergoing open or laparoscopic appendectomy for complicated appendicitis. Abdominal drainage may increase hospital stay in paediatric and adult participants undergoing open or laparoscopic appendectomy for complicated appendicitis, but the evidence is very uncertain. Consequently, there is no evidence for any clinical improvement with the use of abdominal drainage in people undergoing open or laparoscopic appendectomy for complicated appendicitis. The increased risk of mortality with drainage comes from eight deaths observed in paediatric and adult participants undergoing open appendectomy for complicated appendicitis. Larger studies are needed to more reliably determine the effects of drainage on mortality outcomes.
Acupuncture for procedural pain in newborn infants Cochrane Library 22 April 2025
Acupuncture may reduce pain assessed with different scales during the procedure, with little to no difference in any harms, when compared to no intervention. The evidence is very uncertain about the effect of acupuncture on pain assessed with different scales during the procedure when compared to any non‐pharmacological treatment; acupuncture may result in little to no difference in any harms. The evidence is very uncertain about the effect of acupressure on pain assessed during the procedure when compared to foot massage or reflexology.
Clinical rating scales for assessing pain in newborn infants Cochrane Library 14 April 2025
Clinical staff should be vigilant when applying the currently available neonatal rating scales. Further development of rating scale content and testing for structural validity are necessary and should be prioritised. Together, they determine the content and structure of rating scales, underpin further testing, including reliability, and their prioritisation will make the greatest contribution to the evidence base for rating scales to assess neonatal pain. Collaborative efforts between clinicians and methodology experts will prevent methodological pitfalls and contribute to improving the validity and reliability of pain‐rating scales in neonatology.
Delayed initiation or reduced initial dose of calcineurin‐inhibitors for kidney transplant recipients at high risk of delayed graft function Cochrane Library 8 April 2025
There may be little or no difference in delayed graft function (DGF) or acute rejection when delaying the start of calcineurin inhibitors (CNI) or when starting it at a lower dose in kidney transplant recipients at high risk of DGF. The available data are of low certainty.
Delivery of intravenous anti‐cancer therapy at home versus in hospital or community settings for adults with cancer Cochrane Library 22 April 2025
Evidence on the safety and cost‐effectiveness of IV anti‐cancer therapy at home is scarce and outdated. IV anti‐cancer regimens have evolved; the findings of studies performed more than a decade ago may lack applicability to current practice. However, key considerations when considering suitability for home treatment remain unchanged: safety, duration of treatment and geographic catchment area. The finding that patients may prefer future treatments at home after receiving treatment in this setting, albeit based upon low‐certainty evidence, is consistent with the widespread current practice of delivering IV anti‐cancer therapy, including immunotherapies, at home when judged safe and preferred by the patient. Appropriate selection of patients and regimens is a key consideration for ensuring the safety of delivering IV anti‐cancer therapy at home.
Drug treatment for myotonia Cochrane Library 8 April 2025
More‐recent trials are more robust, and well‐conducted RCTs demonstrate moderate‐certainty evidence for the efficacy of symptomatic treatments in non‐dystrophic myotonias. Additionally, the data suggest that not all patients respond to therapy and research into aetiology and treatment options for non‐responders is needed. Other agents that have not been tested in RCTs, such as acetazolamide, flecainide, ranolazine, and lacosamide, will need to be considered when planning future clinical trials. Moreover, the RCTs, in particular the small numbers of most trials, highlight the challenges in recruitment and design of robust trials in rare diseases, and research into trial design to improve recruitment in rare diseases will be important for future trials.
Entecavir for children and adults with chronic hepatitis B Cochrane Library 22 April 2025
Given the issues of risk of bias and insufficient power of the included trials and the very low certainty of the available evidence, we could not determine the effect of entecavir versus no treatment or placebo on critical outcomes such as all‐cause mortality and serious adverse events. There is a lack of data on health‐related quality of life. Given the first‐line recommendation and wide usage of entecavir in people with chronic hepatitis B, further evidence on clinically important outcomes, analysed in this review, is needed.
Factors that influence caregivers’ and adolescents’ views and practices regarding human papillomavirus (HPV) vaccination for adolescents: a qualitative evidence synthesis Cochrane Library 15 April 2025
Our review reveals that caregivers’ and adolescents’ HPV vaccination views and practices are not only influenced by issues related to individual knowledge and perceptions of the vaccine, but also an array of more complex, contextual factors and meanings: social, political, economic, structural, and moral. Successful development of interventions to promote the acceptance and uptake of HPV vaccination for adolescents requires an understanding of the context‐specific factors that influence HPV vaccination views and practices in the target setting. Through this, more tailored and in turn more relevant, acceptable, and effective responses could be developed. The eight overarching themes that emerged from our review could serve as a basis for gaining this understanding.
Interventions for smokeless tobacco use cessation Cochrane Library 15 April 2025
Cessation counselling, brief advice, and varenicline each probably help more people to quit smokeless tobacco use than minimal or no support, or placebo. NRT may help more people to quit smokeless tobacco use than placebo or no medication. Low‐certainty evidence does not currently support bupropion as a smokeless tobacco cessation intervention. Despite the majority of smokeless tobacco users living in South and Southeast Asia, only a minority of trials are conducted in those regions. Future trials should address this imbalance.
Prevention of infection in aortic or aortoiliac peripheral arterial reconstruction Cochrane Library 22 April 2025
Very low‐certainty evidence suggests that the use of prophylactic antibiotics may prevent SSIs in aortic or aortoiliac peripheral arterial reconstruction. We found no superiority amongst specific antibiotics or differences in extended antibiotic use (over 24 hours) compared with shorter use (up to 24 hours), with low‐certainty evidence. For other interventions, very low‐ to moderate‐certainty evidence showed little or no difference across various outcomes. We advise interpreting these conclusions with caution due to the limited number of events in all groups and comparisons.
Prophylactic antibiotics for uterine evacuation procedures to manage miscarriage Cochrane Library 15 April 2025
When all studies were considered, the evidence suggested that routine antibiotic prophylaxis may reduce uterine infection amongst women undergoing uterine evacuation procedures to manage early pregnancy loss (EPL), but the evidence is of low certainty. It is important to note that the quality of the evidence included was seriously affected by poor follow‐up and high non‐compliance with antibiotic prophylaxis. A sensitivity analysis based on three trials assessed to have low risk of bias (85% of the total participants), demonstrated a larger effect size with high certainty, resulting in a 43% reduction in the risk of uterine infection rates with antibiotic prophylaxis. Prophylactic antibiotics may reduce hospitalisation for treatment of infection, and may reduce the need for a course of antibiotics to treat infection after uterine evacuation procedures to treat EPL, but this evidence is very uncertain. Data were limited and uncertain with regard to potential adverse effects, such as vomiting, diarrhoea, allergy, and anaphylaxis.
Psychological interventions for treatment of inflammatory bowel disease Cochrane Library 17 April 2025
Psychological interventions in adults are likely to improve the quality of life, depression and anxiety slightly. Psychotherapy is probably also effective for improving the quality of life in children and adolescents. The evidence suggests that psychological interventions may have little to no effect on disease activity. The interpretation of these results presents a challenge due to the clinical heterogeneity of the included trials, particularly concerning the type and various components of the common multimodular interventions. This complexity underscores the need for further research and exploration in this area.
Surgical interventions for presbyopia Cochrane Library 14 April 2025
The available data were limited to short‐term (three months) and mid‐term (six months) outcomes and provided low‐ or very low‐certainty evidence. Little information was reported regarding QoL, binocular CS, or ocular AEs; no study addressed economic aspects of interventions.
Switching antipsychotics versus continued current treatment in people with non‐responsive schizophrenia Cochrane Library 11 April 2025
This review synthesises currently available RCT evidence on switching antipsychotics versus continuing the same antipsychotic in individuals with schizophrenia who did not respond to their initial treatment. Overall, the evidence remains highly uncertain regarding the effects of either strategy on efficacy and safety outcomes, and no definitive recommendations can currently be made. There is an urgent need for larger, well‐designed trials to identify the optimal treatment strategy for these cases.
Uterotonic agents for preventing postpartum haemorrhage: a network meta‐analysis Cochrane Library 16 April 2025
Most agents are effective for preventing PPH when compared with placebo or no treatment. Ergometrine plus oxytocin, and misoprostol plus oxytocin may be more effective than the current standard oxytocin. All agents, except for carbetocin, are associated with an increased risk of some side effects compared with oxytocin.
Vaccines for preventing infections in adults with solid tumours Cochrane Library 16 April 2025
In adults with solid tumours, herpes zoster vaccines reduced the incidence of herpes zoster (high‐certainty evidence), although localised events at the injection site were more likely to occur (high‐certainty evidence). The evidence is very uncertain about the effects of influenza vaccines on all‐cause mortality, any‐grade AEs, and SAEs (very low‐certainty evidence); the incidence of influenza was not measured in the studies. COVID‐19 vaccines probably decrease the incidence of COVID‐19 in those without prior infection (moderate‐certainty evidence) but probably increase any‐grade AEs (moderate‐certainty evidence). We found no RCTs or NRSIs investigating vaccines for preventing pneumococcal disease, Haemophilus influenzae type b disease, meningococcal disease, pertussis, hepatitis B, tetanus, polio, diphtheria compared to placebo or no vaccine, in adults with solid tumours. Additional research, preferably of RCT design, is necessary to resolve uncertainties.
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Geographic remoteness-based differences in in-hospital mortality among people admitted to NSW public hospitals with heart failure, 2002–21: a retrospective observational cohort study MJA 20 April 2025
The known: Each year, more than 180 000 people are admitted to Australian hospitals with heart failure. It is not known whether treatment advances over the past two decades have improved in-hospital survival for people living outside major cities.
The new: During 2002–21, in-hospital survival for people admitted with heart failure to New South Wales public hospitals improved, but the likelihood of dying in hospital was 12% higher for people from inner regional areas than for people from major cities, and 35% higher for people from outer regional or remote NSW.
The implications: Determining the reasons for these differences would enable targeted programs for improving outcomes for people in regional and remote Australia with heart failure.
Preparing Australia for future pandemics: strengthening trust, social capital and resilience MJA 15 April 2025
The Australian COVID-19 Inquiry report has found that the government can no longer rely on people willingly adhering to public health restrictions similar to those implemented during the COVID-19 pandemic in a future public health emergency.1 The Inquiry found that aspects of the pandemic response diminished trust and eroded public confidence.1 National planning for future pandemics must be centred on a rebuilding of trust, social cohesion and the social contract between government and the people, to be adequately prepared for public health emergencies. As the future Australian Centre for Disease Control is being established to prepare and respond to future public health emergencies, we believe that social scientists should be embedded within the organisation to examine and quantify factors such as trust, social capital and resilience. The integration of social sciences with natural (empirical) sciences and epidemiology is essential to better understand the roles these factors have in mitigating the negative effects of future pandemics and related measures on priority populations.
Severe hypoglycaemia secondary to chronic opioid-induced hypothalamic–pituitary–adrenal axis suppression: an under-recognised phenomenon MJA 15 April 2025
Lessons from practice
- Consider opioid-induced adrenal insufficiency (OIAI) as a potential cause of severe hypoglycaemia in patients on chronic opioid therapy.
- Standard guidelines for diagnosing adrenal insufficiency, including morning cortisol measurements and adrenocorticotropic hormone stimulation tests, may be applied but have not been prospectively validated in opioid-treated patients.
- Hydrocortisone is recommended for the management of OIAI, and tapering opioid use is advised when aiming for the restoration of hypothalamic–pituitary–adrenal (HPA) axis function.
- A significant knowledge gap exists regarding the mechanisms underlying opioid-induced HPA axis suppression and the timeline for its recovery.
Should self‐administered voluntary assisted dying be supervised? A Queensland case MJA 14 April 2025
All Australian states and the Australian Capital Territory have voluntary assisted dying (VAD) laws. Medication management will be topical in these laws’ mandatory reviews following a Queensland coronial inquest into the death of a person who consumed a VAD substance prescribed for their spouse. In a decision issued on 11 September 2024, the coroner found “operational flaws” in Queensland's VAD law, declaring current self‐administration procedures “inadequate to provide for medication safety and to prevent deliberate misuse”. These findings have nationwide relevance as all Australian VAD laws permit eligible persons to self‐administer without a health practitioner present
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A new diagnosis and definition of clinical obesity: what does it mean for clinical practice? MJA insight 22 April 2025
New definitions of obesity aim to overcome current limitations that exclude some people from receiving the health care they need, while pushing others towards unnecessary treatments.
Major update to antibiotic guidelines released MJA insight 22 April 2025
After six years, the Therapeutic Guidelines have released an “unprecedented” update to the antibiotic guidelines, covering several infections commonly treated in primary care.
MyMedicare promises better health care. But only 1 in 10 patients has signed up MJA insight 22 April 2025
MyMedicare is a scheme that encourages patients to register with a regular GP practice to improve their health. But few patients have enrolled.
New applications for 3D printing in plastic and reconstructive surgery MJA insight 22 April 2025
Advances in 3D printing technology could have profound implications for tissue engineering in plastic and reconstructive surgery.
Psychiatric specialist services in Australia: alarming increase in wait times and regional disparities MJA insight 14 April 2025
One significant challenge within Australia’s health care system is the rising wait times to see medical specialists. Our research reveals a significant increase in wait times for psychiatric specialist services across Australia, with regional and remote areas facing the greatest challenges.
Raising awareness of frailty after heart disease MJA insight 22 April 2025
When we think of heart disease, the primary concern for most people is about survival. But it is also important to know what happens after someone survives. New research reveals that a significant number of older people who survive a cardiovascular disease (CVD) event become frail.
Social media is media: a crucial reminder for doctors MJA insight 14 April 2025
Social media is a public publication platform. Doctors who confuse familiarity with privacy, do so at their peril.
The PBS targeted in Trump’s trade war: experts fear long term fall out for drug prices and access MJA insight 14 April 2025
As the Trump administration continues its program of “reciprocal tariffs” and the pharmaceutical industry calls out the Pharmaceutical Benefits Scheme (PBS) and generic drugs, Australian health experts say that Australia must preserve the current system.
Travelling overseas? You could be at risk of measles. Here’s how to ensure you’re protected MJA insight 14 April 2025
On March 26 NSW Health issued an alert advising people to be vigilant for signs of measles after an infectious person visited Sydney Airport and two locations in western New South Wales. The NSW alert follows a string of similar alerts issued around Australia in recent days and weeks.
Urgent care clinics: are they worth the money? MJA insight 22 April 2025
An interim report into Medicare urgent care clinics (UCCs) shows that they are five times more expensive than a GP consult according to the Royal Australian College of General Practitioners (RACGP).
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Ask the consultant: Stroke BMJ 17 April 2025
What you need to know
- Long term anticoagulation is indicated for most patients with a new diagnosis of atrial fibrillation
- Offer thrombolysis with alteplase or tenecteplase in patients with acute ischaemic stroke within 4.5 hours of symptom onset, and those with unknown onset of events with confirmatory advanced imaging
- Obtain early intracranial imaging, ideally MRI, for patients who present with an atypical history but features potentially consistent with stroke
- Anticoagulate people with ischaemic stroke and atrial fibrillation or flutter within five days of onset for mild stroke and five to 14 days for moderate to severe stroke
Four cycles of docetaxel plus cisplatin as neoadjuvant chemotherapy followed by concurrent chemoradiotherapy in stage N2-3 nasopharyngeal carcinoma: phase 3 multicentre randomised controlled trial BMJ 15 April 2025
Four cycles of docetaxel plus cisplatin neoadjuvant chemotherapy with concurrent chemoradiotherapy can effectively reduce distant metastasis and improve survival for patients with stage N2-3 nasopharyngeal carcinoma with manageable toxicities.
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Acute blood pressure lowering and risk of ischemic lesions on MRI after intracerebral hemorrhage JAMA 21 April 2025
Study findings support the safety of systolic BP reduction to a target of less than 140 mm Hg in patients with acute ICH.
Artificial Intelligence–enabled prediction of heart failure risk from Single-Lead Electrocardiograms JAMA 16 April 2025
Across multinational cohorts, a noise-adapted AI-ECG model estimated HF risk using lead I ECGs, suggesting a potential HF risk-stratification strategy requiring prospective study using wearable and portable ECG devices.
Cytokine storms in COVID-19, Hemophagocytic Lymphohistiocytosis, and CAR-T Therapy JAMA 7 April 2025
This study of CS syndromes found distinct immune responses within each cohort. The distinct clinical patterns and outcomes associated with different CS etiologies emphasize the importance of early diagnosis and timely intervention.
Improving empiric antibiotic selection for patients hospitalized with abdominal infection: The INSPIRE 4 Cluster Randomized Clinical Trial JAMA 10 April 2025
Computerized provider order entry (CPOE) prompts recommending empiric standard-spectrum antibiotics (coupled with education and feedback) for patients admitted with abdominal infection who have low risk for MDRO infection significantly reduced extended-spectrum antibiotics without increasing ICU transfers or length of stay.
Kidney function following COVID-19 in children and adolescents JAMA 11 April 2025
These findings underscore the need for vigilant monitoring and management of kidney health in pediatric patients following SARS-CoV-2 infection.
Operative vs nonoperative treatment of Acute Cholecystitis in older adults with multimorbidity JAMA 16 April 2025
These findings suggest that in older patients with multimorbidity for whom the management decision is in clinical equipoise, operative treatment should be considered.
Oral vs extended-release injectable Naltrexone for hospitalized patients with alcohol use disorder: A randomized clinical trial JAMA 21 April 2025
Hospitalization represents an opportunity to start AUD pharmacotherapy; given their similar effectiveness, choice of oral vs extended-release injectable naltrexone should be directed by practical factors, such as patient preference and affordability.
Plastic waste and COVID-19 incidence among hospital staff after deescalation in PPE use JAMA 15 April 2025
This quality improvement study of hospital PPE usage observed that the national PPE deescalation guidelines corresponded with the reductions in protective gown use, associated costs, carbon footprint, and plastic waste generation with no apparent compromise to staff safety and health.
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Enteral Nutrition in hospitalized adults NEJM 16 April 2025
Key points:
- Malnutrition is prevalent among hospitalized patients, many of whom may be able to meet nutritional needs through oral intake.
- Standardized nutrition care pathways aid in the detection of malnutrition and the identification of patients who may benefit from enteral nutrition.
- Patients with inadequate caloric intake may need enteral nutrition.
- Recent evidence suggests that underfeeding (providing 70% of energy and protein requirements) is not harmful during the acute phase of critical illness in patients in the intensive care unit.
- An area requiring further investigation in enteral nutrition is the dosing of nutrition during recovery and rehabilitation.
Lorundrostat efficacy and safety in patients with uncontrolled Hypertension NEJM 23 April 2025
Lorundrostat was associated with greater reductions in 24-hour average blood pressure than placebo in participants with uncontrolled and treatment-resistant hypertension.
Phase 3 Trial of the DPP-1 Inhibitor Brensocatib in Bronchiectasis NEJM 23 April 2025
Among patients with bronchiectasis, once-daily treatment with brensocatib (10 mg or 25 mg) led to a lower annualized rate of pulmonary exacerbations than placebo, and the decline in FEV1 was less with the 25-mg dose of brensocatib than with placebo.
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Comparative efficacy and acceptability of resilience-focused interventions for nurses: a systematic review and network meta-analysis of randomized controlled trials BMC nursing 14 April 2025
Anger Management Psychoeducation, Mindfulness-Based Stress Reduction, and Emotional Intelligence training are the most effective interventions for enhancing nurses’ resilience.
Comparative evaluation of artificial intelligence models GPT-4 and GPT-3.5 in clinical decision-making in sports surgery and physiotherapy: a cross-sectional study BMC medical informatics and decision making 14 April 2025
GPT-4 demonstrates superior performance compared to GPT-3.5 in clinical decision-making for sports surgery and physiotherapy. These findings suggest that advanced AI models can aid in diagnostic accuracy, treatment planning, and rehabilitation strategies. However, AI should function as a decision-support tool rather than a substitute for expert clinical judgment. Future studies should explore the integration of AI into real-world clinical workflows, validate findings using larger datasets, and compare additional AI models beyond the GPT series.
Comparison of video laryngoscopy with direct laryngoscopy in critically ill patients: a systematic review and meta-analysis of randomized controlled trials European journal of medical research 5 April 2025
Video laryngoscope (VL) does not increase the first intubation rate. However, VL increases the first-attempt intubation success rate for in-hospital intubation and operators with similar proficiency in VL and direct laryngoscopy (DL).
Critical care nurses’ knowledge, confidence, and clinical reasoning in sepsis management: a systematic review BMC nursing 5 April 2025
This review provides a global perspective on sepsis management among critical care nurses, strengthened by diverse study designs. However, limitations include variability in measurement tools, self-reporting bias, small sample sizes, and language-based selection bias. Continuous education, targeted training, and the integration of AI-driven decision tools are essential to improving sepsis outcomes. Addressing gaps in sepsis knowledge and promoting better clinical reasoning will enhance the overall quality of care in critical settings.
Efficacy and safety of misoprostol versus oxytocin for labor induction in women with prelabor rupture of membranes: a meta-analysis BMC pregnancy and childbirth 21 April 2025
Misoprostol is a viable alternative to oxytocin for labor induction in Prelabor rupture of membranes (PROM), offering shorter labor durations and reduced postpartum hemorrhage (PPH), risk without compromising maternal and neonatal outcomes. Further researches are needed to optimize dosing, administration routes, and assess maternal satisfaction.
Enhancing patient safety: identifying fall risks during patient transfers in operating rooms BMC health services research 16 April 2025
This study provides valuable insights into the risk factors and potential prevention strategies regarding falls during patient transfers in operating rooms. Future research should incorporate multidisciplinary observational studies involving human factors to provide deeper insights. It is recommended to create systems for anonymous incident reporting and implement comprehensive training programs.
Factors associated with overall and high-risk return visits to the emergency department: a vital sign trajectory approach BMC emergency medicine 12 April 2025
In addition to older age and having a chronic major disease, a low and fluctuating oxygen saturation trajectory during the index ED stay may signal subsequent high-risk revisits. Thus, discharge decisions should be carefully re-evaluated in these high-risk populations.
Non-invasive brain stimulation for borderline personality disorder: a systematic review and network meta-analysis Annals of general psychiatry 16 April 2025
Preliminary evidence suggests potential efficacy of non-invasive brain stimulation for BPD, with well-tolerated side effects with well-tolerated side effects. Although there are noticeable statistically significant differences between the interventions and control groups, the results are inconclusive due to the small sample.
Technology-based challenges of informal clinical communication in an Australian tertiary referral hospital: a survey-based assessment of user perspectives BMJ open quality 17 April 2025
These findings provide a call for governance standards for informal clinical communication (ICC). The authors highlight the need for rationalisation of multimodal communication technologies to reduce communication complexity and identify some key functional requirements for new technologies.
The association of early antibiotic exposure with subsequent development of late-onset sepsis in preterm infants: a systematic review and meta-analysis studies International journal of emergency medicine 18 April 2025
Our findings indicate that prolonged early antibiotic exposure in preterm infants with sterile cultures does not significantly increase the risk of late-onset sepsis (LOS) compared to no antibiotic exposure. Interestingly, a shorter duration of antibiotic exposure might be associated with a slightly lower risk of LOS.
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