What’s new in medical literature
What's new in the medical literature?
Updated 6 June 2025
______________________________________________________________________________
Anti-inflammatory reliever therapy in patients with mild asthma
As-needed inhaled glucocorticoids reduce asthma exacerbations in those with poor control despite multiple maintenance therapies, but whether this practice benefits patients with more mild disease has been unclear. In a trial that enrolled over 2400 patients with poor asthma control on albuterol alone (71 percent) or low-dose inhaled glucocorticoids, use of albuterol-budesonide as needed reduced the risk of exacerbations requiring systemic glucocorticoids compared with albuterol as-needed alone (5.3 versus 9.4 percent; hazard ratio 0.54) [1]. However, given their poor asthma control at baseline, all patients enrolled in this study would qualify for a step-up in asthma therapy, which was not initiated in the control group. These results support our recommendation for anti-inflammatory reliever therapy as a preferred initial controller option for patients with asthma who have moderately frequent symptoms. (See "Initiating asthma therapy and monitoring in adolescents and adults", section on 'As-needed low-dose ICS and SABA (step 1)'.)
Cervical length in twin pregnancy
Cervical length (CL) less than 25 mm is widely used in singleton pregnancies to assess the risk of spontaneous preterm birth (sPTB), but the prognostic value of CL in twin pregnancies is less well established. In a meta-analysis of individual participant data of twin pregnancies with available mid-trimester transvaginal ultrasound CL measurements, the mean CL at 16 to 26 weeks was 39 mm [1]. The prognostic value of CL for predicting sPTB was linear, risk of sPBT <34 weeks was reduced by 6.8 percent for every millimeter increase in cervical length, and there was no strong evidence for selecting one cut-off versus another for reliably predicting or excluding sPBT. These results support mid-trimester CL measurement in twin pregnancies and using the measurement to counsel patients about their relative risk of sPTB. (See "Twin pregnancy: Routine prenatal care", section on 'Screening for short cervical length'.)
Dexmedetomidine in mechanically ventilated patients
The Society of Critical Care Medicine (SCCM) has recently issued guidelines for managing pain, agitation, and delirium (PAD) in mechanically ventilated patients [12]. The SCCM analyzed 29 randomized trials comparing dexmedetomidine with propofol (which is commonly used in this setting). Dexmedetomidine reduced the prevalence (risk reduction [RR] 0.55) and duration of delirium (mean difference -25.6 hours) but increased the risk of bradycardia (RR 1.65). Dexmedetomidine had no impact on mortality (RR 0.98). We agree with the SCCM that dexmedetomidine is a reasonable first-line agent for managing PAD in mechanically ventilated patients especially when a decreased risk of delirium and a reduction in heart rate is desirable. (See "Sedative-analgesia in ventilated adults: Management strategies, agent selection, monitoring, and withdrawal", section on 'Dexmedetomidine'.)
Digital screen use and myopia risk
Studies suggest that near-vision activities (eg, reading at close range, digital screen use) increase risk for the development of myopia in children and adults, though the strength of this association is uncertain. In a meta-analysis of 34 observational studies from multiple countries including over 314,000 children and adults (mean age 9 years), myopia risk increased nonlinearly with duration of digital screen use (ie, smartphones, tablets, game consoles, computers, television) [4]. Odds of myopia ranged from 5 percent higher with one hour of daily exposure to 97 percent higher with four hours. These data suggest that limiting digital screen use could be a useful strategy to prevent or slow the progression of myopia. (See "Refractive errors in children", section on 'Natural history and risk factors' and "Visual impairment in adults: Refractive disorders and presbyopia", section on 'Risk factors'.)
Home- or center-based cardiac rehabilitation for patients with heart failure
In patients with heart failure (HF), exercise training is associated with a lower risk of hospital admission and improvement in quality of life, but it remains unclear whether home-based rehabilitation programs are as effective as center-based programs. In a recent trial in more than 100 patients with HF, patients randomly assigned to home-based or center-based cardiac rehabilitation had similar improvements in exercise capacity and quality of life [10]. This finding is consistent with prior studies and trials. For patients with HF who can be adequately supervised using remote or no monitoring, cardiac rehabilitation may be performed at a center or at home. (See "Cardiac rehabilitation in patients with heart failure", section on 'Exercise location'.)
No benefit of mechanical thrombectomy for acute stroke due to medium vessel occlusion
For patients with acute ischemic stroke due to a medium vessel occlusion (MeVO; ie, middle cerebral artery beyond the proximal dominant M2 segment, anterior cerebral artery beyond the A1 segment, or posterior cerebral artery beyond the P1 segment), we recommend against routine treatment with mechanical thrombectomy (Grade 1B). Data from multiple randomized clinical trials have established the benefit of mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusion (LVO). However, there was no high-quality evidence to support the use of MT for patients with acute stroke due to medium vessel occlusion (MeVO), generally defined as the middle cerebral artery beyond the proximal dominant M2 segment, the anterior cerebral artery beyond the A1 segment, and the posterior cerebral artery beyond the P1 segment. This situation has changed with new data from the recent ESCAPE-MeVO and DISTAL trials [1,2]. Both trials failed to demonstrate the benefit of MT for patients with acute ischemic stroke due to MeVO, and the ESCAPE-MeVO trial found that MT increased mortality [1]. Given these data, we recommend against routine treatment with MT for patients with acute ischemic stroke due to a MeVO. Regardless of whether they are candidates for MT, eligible patients should still receive standard treatment with intravenous thrombolysis. (See "Mechanical thrombectomy for acute ischemic stroke", section on 'Medium and distal vessel occlusion'.)
Real-world effectiveness of nirsevimab for the prevention of RSV infections in infants
Nirsevimab, a monoclonal antibody, was introduced in the fall of 2023 for the prevention of respiratory syncytial virus (RSV) infections in infants. A meta-analysis of 27 studies including more than 230,000 infants from five countries was conducted to evaluate the real world effectiveness of nirsevimab for the prevention of RSV-related hospitalizations, intensive care unit (ICU) admissions, and lower respiratory tract infection (LRTI) in infants 0 to 12 months of age [2]. Receipt of nirsevimab was associated with fewer events for all three outcomes compared with no receipt of nirsevimab: RSV-related hospitalizations (1.9 versus 7.7 percent), ICU admissions (0.2 versus 1.3 percent), and LRTIs (0.8 versus 11 percent). Similarly, surveillance data from two large networks also found a significant decrease in RSV-associated infant hospitalization during the 2024 to 2025 RSV season compared with the 2018 to 2020 seasons; the decrease was most pronounced in infants 0 to 2 months of age [3]. These findings support our recommendation for nirsevimab prophylaxis (table 1). (See "Respiratory syncytial virus infection in infants and children: Prevention", section on 'Immunoprophylaxis'.)
Reduced-dose apixaban for extended anticoagulation in patients with cancer-associated thrombosis
Many patients with cancer-associated venous thromboembolism (VTE) are at high risk for VTE recurrence and receive extended anticoagulation despite an increased risk of bleeding. Whether a reduced-dose anticoagulation regimen might be as effective while decreasing the bleeding risk is unknown. In a trial of over 1700 patients with cancer-associated VTE who had completed six months of anticoagulant therapy, reduced-dose apixaban (ie, 2.5 mg twice daily) resulted in similar 12-month VTE recurrence rates compared with full-dose (ie, 5 mg twice daily) apixaban (2.1 versus 2.8 percent) [36]. However, fewer patients taking reduced-dose apixaban experienced clinically relevant bleeding, compared with patients taking full-dose apixaban (12.1 versus 15.6 percent). For most patients with active cancer on apixaban for extended anticoagulation, we suggest a reduced-dose regimen (2.5 mg twice daily). (See "Anticoagulation therapy for venous thromboembolism (lower extremity venous thrombosis and pulmonary embolism) in adult patients with malignancy".)
Tecovirimat not effective for mpox
For most immunocompetent patients with mpox, we suggest not using antiviral therapy (Grade 2B). In patients with severe disease (eg, encephalitis, pneumonitis) or highly immunocompromised patients at risk for severe disease, we suggest combination antiviral therapy with tecovirimat and either brincidofovir or cidofovir (Grade 2C). The antiviral tecovirimat has been used for patients with or at risk for severe mpox based on animal studies and observational studies in humans. However, in a randomized clinical trial of mostly immunocompetent people in Africa with clade 1 mpox infection, there were no differences in time to lesion healing (7 versus 8 days), mortality, or pregnancy outcomes with tecovirimat compared with placebo [3]. Preliminary data from a trial evaluating tecovirimat in patients with clade 2 disease demonstrated similar findings [4]. We now suggest not using antiviral therapy for most immunocompetent patients with mpox. For highly immunocompromised patients and those with severe disease (eg, encephalitis or pneumonitis), we suggest tecovirimat plus another antiviral; although monotherapy with tecovirimat does not appear effective for mpox, its role in combination antiviral therapy has not been evaluated. (See "Treatment and prevention of mpox (formerly monkeypox)", section on 'Tecovirimat'.)
Transcatheter edge-to-edge repair for acute mitral regurgitation
Patients with acute severe mitral regurgitation (MR) require prompt mitral valve intervention, but the risk of mitral valve surgery is high; transcatheter edge-to-edge repair (TEER) is a potential alternative to surgery in this setting. In a meta-analysis of 24 studies including over 5000 patients with severe MR, cardiogenic shock, and a high surgical risk score (mean 15.2) treated with TEER, device success (defined as MR reduction by at least 2 grades) was achieved in 86 percent [34]. Thirty-day mortality was higher among patients with acute myocardial infarction (MI) than in those without acute MI (20 versus 13 percent). These data demonstrate the feasibility of TEER in selected patients with acute severe MR, although data comparing outcomes with mitral surgery and TEER in this setting are lacking. (See "Acute mitral regurgitation: Management", section on 'Choice of intervention'.)
______________________________________________________________________________
Adjuvant epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) for the treatment of people with resected stage I to III non‐small‐cell lung cancer and EGFR mutation Cochrane Library 27 May 2025
Adjuvant EGFR TKIs may improve disease‐free survival compared to both placebo/BSC and chemotherapy. There is moderate‐certainty evidence that EGFR TKIs increase overall survival compared to placebo/BSC. However, they likely result in little to no difference in overall survival compared to chemotherapy. We could not rule out a potential survival benefit of adjuvant chemotherapy in people with EGFR‐mutant NSCLC. Approximately 50% of participants experienced relapse or death within one year of stopping TKI therapy, indicating that the disease‐free survival benefit may wane after withdrawal. This raises the possibility that prolonged adjuvant TKI therapy could be associated with improved long‐term outcomes, although further research is needed to clarify this.
Community care navigation intervention for people who are at risk of unplanned hospital presentations Cochrane Library 5 June 2025
Community care navigation for people at risk of unplanned hospital presentations is likely to reduce hospital admission rates within 12 months (365 days) and increase outpatient appointments within one month (30 days) compared to usual care, with moderate to high certainty of evidence. Results showed little to no effect on hospital admissions within one month (30 days) or on emergency department presentation rates compared to usual care. The evidence is very uncertain about the effect of community care navigation on health‐related quality of life and quality of care. More robust studies are required to produce greater evidence certainty. Study risk of bias can be improved if future studies use traditional RCT designs and implement strategies to reduce dropout rates and reduce missing follow‐up data.
Corticosteroids for treating sepsis in children and adults Cochrane Library 5 June 2025
Moderate‐certainty evidence indicates that corticosteroids probably reduce 28‐day, 90‐day and hospital mortality amongst patients with sepsis. Corticosteroids may shorten ICU and hospital length of stay (low‐certainty evidence). There may be little or no difference in the risk of superinfection. The risk of muscle weakness is uncertain. The effects of continuous versus intermittent bolus administration of corticosteroids are uncertain.
Cycle regimens for endometrial preparation prior to frozen embryo transfer Cochrane Library 3 June 2025
As the evidence was often of low certainty, and the confidence intervals were wide and therefore consistent with possible benefit and harm, we are uncertain whether one cycle regimen is more effective and safer than another in preparation for FET in subfertile women.
Effects of combinations of diagnostic and treatment strategies for postpartum haemorrhage: a network meta‐analysis Cochrane Library 4 June 2025
Both 3‐option trigger Postpartum haemorrhage (PPH) diagnosis plus MOTIVE (uterine Massage, Oxytocics, Tranexamic acid, IntraVenous fluids, and Examination and Escalation of care) bundle and 2‐option trigger PPH diagnosis plus MOTIVE bundle were more effective than visual estimation‐based diagnosis plus usual care (direct evidence). 3‐option trigger PPH diagnosis plus MOTIVE bundle was more effective than 2‐option trigger PPH diagnosis plus MOTIVE bundle (indirect evidence). As the treatment strategy (MOTIVE bundle) is the same in these combinations, the increased effectiveness is likely due to the 3‐option trigger PPH diagnosis, which adds blood loss of ≥ 300 mL to < 500 mL in the drape plus abnormal clinical observations as a PPH diagnostic trigger. None of the comparisons demonstrated differences in blood transfusion or maternal mortality outcomes.
Exercise for patellar tendinopathy Cochrane Library 27 May 2025
We are very uncertain whether strengthening exercise reduces pain compared to no treatment. Strengthening exercise may make little or no difference to function compared to no treatment and to function or pain compared to glucocorticoid injection. Compared to surgery, we are very uncertain whether strengthening exercise reduces pain or improves function, and it may make little or no difference to treatment success and the proportion of athletes returning to sport. No trials measured adverse events. All trials analyzed in this review included participants who were athletes, limiting the findings to athletes rather than the general public.
Fenestrated endovascular repair for abdominal aortic aneurysms Cochrane Library 28 May 2025
We did not identify eligible RCTs or quasi‐RCTs that compared treatment of complex AAAs with FEVAR versus open surgical repair or conservative management. This is a difficult area in which to conduct research due to low incidence rates and aneurysm heterogeneity. Future studies could consider commissioning agreements mandating patient inclusion in studies to make the generation of high‐quality evidence in this area feasible.
Post‐incident debriefing for people with schizophrenia after coercive measures Cochrane Library 27 May 2025
Considering the available evidence, it is not possible to arrive at definitive conclusions that post‐incident debriefing after coercive measures is effective for people with schizophrenia or schizophrenia‐type psychosis. Further high‐quality studies are warranted to evaluate the effects of post‐incident debriefing in psychiatric inpatient care.
Regional analgesia techniques for postoperative pain after breast cancer surgery: a network meta‐analysis Cochrane Library 4 June 2025
Overall, the regional analgesia techniques included in our network meta‐analyses (NMAs) seem comparable in reducing postoperative pain and rates of complications.
Selected laboratory‐based biomarkers for assessing vitamin A deficiency in at‐risk individuals Cochrane Library 28 May 2025
Available data indicate that methods to determine vitamin A deficiency had generally low sensitivity, when estimable (0% to 54%), and generally high specificity (74% to 94%) in individuals at risk for vitamin A deficiency. Estimates should be interpreted with caution because no included studies were designed or conducted as DTA studies. Data assessing the accuracy of the breast milk vitamin A, RDR, and MRDR compared to reference standards, particularly in patients with vitamin A deficiency, are limited.
The use of telemedicine services for medical abortion Cochrane Library 4 June 2025
Pre‐ to post‐abortion telemedicine models probably result in little to no difference in successful abortion, continuing pregnancy, and adherence to the medical abortion regimen, with moderate‐certainty evidence. We found low‐certainty evidence that this intervention may result in little to no difference in rates of blood transfusions, emergency visits, and satisfaction, but we are uncertain about the effect on hospitalisation. Post‐abortion telemedicine models likely result in higher rates of adherence to follow‐up procedures, with moderate‐certainty evidence. We downgraded studies mainly due to serious risk of bias or imprecision, with some outcomes being rare events. Altogether, the findings indicate that telemedicine models for medical abortion in early pregnancy may result in similar outcomes in terms of safety, effectiveness, and acceptability when compared to in‐clinic provision.
Ultrasound guidance versus anatomical landmarks for neuraxial anaesthesia in adults Cochrane Library 27 May 2025
Compared to anatomical landmarks, ultrasound guidance for neuraxial anaesthesia in adults reduces the number of attempts required for success and reduces procedure (needling) time. It likely increases the rate of first‐attempt success. Low‐certainty evidence suggests that ultrasound guidance may result in little to no difference in participant satisfaction or technical failure. The evidence is very uncertain about the effect of ultrasound guidance on pain and adverse events. Although ultrasound guidance can be beneficial for neuraxial anaesthesia without increased risk, these results should be interpreted with caution due to some uncertainties in the evidence.
Yoga for fatigue in people with cancer Cochrane Library 27 May 2025
Our review provides uncertain evidence of the beneficial effects of yoga initiated during or after anticancer therapy compared to no yoga for people with cancer. Although there are indications supporting the use of yoga to address CRF, the uncertainty of the evidence underscores the need for caution in its implementation. Future RCTs should employ rigorous methodologies, enrol sufficient participants, and use appropriate controls.
________________________________________________________________________________
Evaluating the impact of COVID-19 vaccination strategies on infections and hospitalisations in Victoria with non-seasonal epidemic wave patterns: a modelling study MJA 1 June 2025
The known: Despite COVID-19 leading to 62 000 hospitalisations and 6500 deaths in Australia during 2023, only 11% of people aged 16 years or older had been vaccinated in the preceding twelve months. As COVID-19 epidemics do not follow a regular seasonal pattern in Australia, it is unclear how annual vaccination programs should be organised.
The new: Our modelling study found that annual vaccination campaigns could reduce the annual number of SARS-CoV-2 infections by 1–13% and COVID-19 hospitalisations by 3–14%.
The implications: Annual vaccination campaigns alongside those for influenza vaccination could reduce the number of COVID-19 infections and the burden on hospitals.
No silver lining with health misinformation: argyria caused by intentional silver consumption MJA 26 May 2025
Lessons from practice
- Argyria is a rare but permanent condition caused by prolonged silver exposure, often linked to consumption of colloidal silver products.
- Early recognition of argyria and cessation of exposure is important to prevent further skin pigmentation or other complications.
- Complementary and alternative health remedies are widespread in Australia although patients may not immediately disclose their use.
- Health misinformation can have harmful consequences thus clinicians should engage patients in open communication about alternative medicines and advise them appropriately on the potential dangers.
Remote patient monitoring for managing acute COVID-19, and mortality and hospital use in Sydney, New South Wales, 2021–22: a retrospective observational cohort study MJA 26 May 2025
The known: The COVID-19 pandemic increased the burden on health care systems. The effect of community remote patient monitoring for managing acute COVID-19 on hospital use and patient outcomes has not been examined in Australia.
The new: Remote monitoring of people with COVID-19, based on a smartphone application, clinical portal, and phone calls from clinicians, was associated with increased numbers of hospitalisations, but also with shorter mean length of stay and lower risk of death within 28 days of clinical onset.
The implications: Community remote monitoring of people with acute COVID-19 is feasible and safe, and could also be used for managing other medical conditions.
Respiratory syncytial virus preventives for children in Australia: current landscape and future directions MJA 23 May 2025
Summary
- Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory tract infections, and a leading cause of hospitalisation in children under 6 months of age.
- Previously, palivizumab, a costly, short-acting monoclonal antibody, was the primary preventive option. The recent introductions of nirsevimab (Beyfortus), a long-acting monoclonal antibody, and Abrysvo, a maternal RSV vaccine, have brought about significant advances in RSV prevention for children.
- Western Australia, Queensland and New South Wales launched state-managed nirsevimab programs targeting infants and high risk groups for the 2024 RSV season.
- International data support nirsevimab's effectiveness in reducing RSV-related hospitalisations and severity of disease in real-world settings.
- In 2025, Australia's national RSV prevention program includes free maternal vaccination with Abrysvo and targeted infant protection with nirsevimab for high risk or newborns whose mothers did not receive Abrysvo at least 2 weeks before delivery, funded by individual jurisdictions.
- Real-world efficacy data derived from Australian states and territories and the national prevention program will be pivotal in evaluating and refining the integration of maternal immunisation with Abrysvo and infant passive immunisation with nirsevimab.
- Key logistical considerations include ensuring timely access and equitable distribution, particularly for First Nations populations who face increased risk from RSV infection. Coordinated efforts are essential to overcome health care disparities and deliver effective prevention strategies to these prioritised groups.
The first live term birth following uterus transplantation in Australia MJA 23 May 2025
The known: In Australia, the options for women with uterine factor infertility who wish to have children are adoption and surrogacy. Both options are limited by legal, availability, and ethical barriers.
The new: The first live birth after uterus transplantation in Australia confirms that it could be a solution for women with uterine factor infertility who wish to have children with whom they are biologically related.
The implications: Uterus transplantation is a new reproduction alternative for women with uterine factor infertility. Further research and regulation are important for refining surgical procedures and assessing surgical risks, immunosuppression effects, obstetric complications, costs, and benefits, as well as the long term medical and psychological effects. _________________________________________________________________________________
High-riding patella found in ACL-reconstructed knees MJA insight 26 May 2025
New research shows a high-riding patella may contribute to patellofemoral osteoarthritis by shifting pressure onto areas of cartilage that do not normally bear load.
How vaccine campaigns could reduce COVID-19 infections MJA Insight 2 June 2025
New research examines how COVID-19 infections and hospitalisations could be reduced through national vaccine campaigns.
Human metapneumovirus joins the gang of winter respiratory viral infections MJA insight 26 May 2025
As we head into the winter months, respiratory viral infections begin to rise. This year, human metapneumovirus is poised to make an impact. Winter is coming ‒ together with an expected wave of respiratory viral infections. Influenza viruses, SARS-CoV-2, and respiratory syncytial virus (RSV) will again predominate, but a recent outbreak in China highlighted the lesser known but important human metapneumovirus (hMPV), which is related to RSV, and completes the gang of four. hMPV will also play a significant role this winter in Australia.
Medical journals of the world unite to demand action on nuclear weapons MJA insight 26 May 2025
The Medical Journal of Australia joins with medical journals around the world to call for the re-establishment of the World Health Organization’s mandate on addressing the health consequences of nuclear weapons and war.
More people are trying medicinal cannabis for chronic pain. But does it work? MJA insight 26 May 2025
In Australia, chronic pain affects around one in five Australians aged 45 and over, with an enormous impact on people’s lives. So what does the current evidence tell us about the effectiveness of medicinal cannabis for chronic pain?
New global treatment guidelines for schizophrenia MJA Insight 2 June 2025
The INTEGRATE project offers a concise, algorithmic guideline for schizophrenia pharmacotherapy, co-designed by global experts and those with lived experience.
New vaccines herald “era-defining advancements” in RSV prevention MJA insight 26 May 2025
The landscape of respiratory syncytial virus (RSV) in Australia has rapidly evolved, thanks to new vaccines and a rollout of state and national immunisation programs.
Running on fumes for years: junior doctors say system is unsafe, not just underfunded MJA insight 2 June 2025
Junior doctors in New South Wales have long decried what they describe as unsafe working conditions and unequal pay. In February, junior doctors went on strike after a leaked email referred to the group as “marshmallows” for questioning working hours. Recently, the NSW government released its report from the Special Commission of Inquiry into Healthcare Funding, which calls for further efficiencies and funding. InSight+ spoke to advocates to ask about working conditions, and what the report might change.
Social media for doctors: popularity is not respect MJA insight 2 June 2025
Social media algorithms reward engagement, but chasing likes can cost doctors dearly, writes Dr Maria Li. In 2025, more doctors than ever are using social media. While most of us start with the right intentions, many unknowingly fall under the influence of the algorithm — sometimes in ways that subtly erode our professionalism.
The TGA has approved donanemab for Alzheimer’s disease. How does this drug work and who will be able to access it? MJA insight 2 June 2025
This week, Australia’s Therapeutic Goods Administration (TGA) approved a drug called donanemab for people in the early stages of Alzheimer’s disease.
World Medical Association Statement on Physicians’ Wellbeing MJA insight 26 May 2025
The World Medical Association is taking steps to put doctors’ wellbeing front and centre with a review of their Statement on Physicians’ Wellbeing.
________________________________________________________________________________
Advances in the management of hepatitis B BMJ 3 June 2025.
This review summarizes the current landscape of hepatitis B, including its epidemiology and the clinical spectrum of acute and chronic infection.
Current management of hypertrophic cardiomyopathy BMJ 27 May 2025
Early identification is key to improving outcomes with advanced therapies including cardiac transplantation. The management of hypertrophic cardiomyopathy is rapidly evolving toward a more personalized approach, based on genotype and phenotype, to alter disease progression and improve patients’ outcomes.
Drug treatments for mild or moderate covid-19: systematic review and network meta-analysis BMJ 29 May 2025
Nirmatrelvir-ritonavir and remdesivir probably reduce admission to hospital, and systemic corticosteroids and molnupiravir may reduce admission to hospital. Several medications including systemic corticosteroids and molnupiravir probably reduce time to symptom resolution.
Effect of dapagliflozin on metabolic dysfunction-associated steatohepatitis: multicentre, double blind, randomised, placebo controlled trial BMJ 4 June 2025
Treatment with dapagliflozin resulted in a higher proportion of participants with metabolic dysfunction-associated steatohepatitis (MASH) improvement without worsening of fibrosis, as well as MASH resolution without worsening of fibrosis and fibrosis improvement without worsening of MASH, than with placebo.
P2Y12 inhibitor or aspirin after percutaneous coronary intervention: individual patient data meta-analysis of randomised clinical trials BMJ 4 June 2025
In patients who had undergone percutaneous coronary intervention (PCI) and discontinued dual antiplatelet therapy (DAPT), at a follow-up of about 5.5 years, P2Y12 inhibitor monotherapy with ticagrelor or clopidogrel was associated with lower major adverse cardiac and cerebrovascular events (MACCE), owing to reduced rates of myocardial infarction and stroke compared with aspirin monotherapy, without a concurrent increased risk of major bleeding.
Sacituzumab tirumotecan versus docetaxel for previously treated EGFR-mutated advanced non-small cell lung cancer: multicentre, open label, randomised controlled trial BMJ 5 June 2025
Sacituzumab tirumotecan (sac-TMT)showed statistically significant and clinically meaningful improvements in objective response rate, progression-free survival, and overall survival compared with docetaxel, with a manageable safety profile in patients with epidermal growth factor receptor (EGFR)-mutated locally advanced or metastatic non-small cell lung cancer (NSCLC).
_________________________________________________________________________________
Acceptance and commitment therapy–based parenting program in children with co-occurring Asthma and ADHD: A randomized clinical trial JAMA 2 June 2025
Integrating acceptance and commitment therapy–based parenting program (ACT-PAM) into asthma management may enhance both respiratory and behavioral outcomes in children with asthma and comorbid ADHD, highlighting its potential as a targeted intervention for this population.
Characterizing Long COVID symptoms during early childhood JAMA 27 May 2025
Results of this cohort study suggest that symptom patterns were distinguishable across infants/toddlers and preschool-aged children, and from previously studied older children and adults.
Low-dose Methotrexate for the treatment of inflammatory knee Osteoarthritis: A randomized clinical trial JAMA 2 June 2025
The results of this randomized clinical trial show that, compared to placebo, low-dose methotrexate did not reduce pain or effusion-synovitis over 52 weeks in patients with knee OA and effusion-synovitis.
Meningeal embolization for preventing chronic subdural hematoma recurrence after surgery: The EMPROTECT randomized clinical trial JAMA 5 June 2025
Among patients who underwent surgery for chronic subdural hematoma (CSDH) recurrence or a first CSDH episode who are at high risk of recurrence, middle meningeal artery (MMA) embolization did not lead to a significantly lower rate of recurrence at 6 months compared with standard medical care alone.
Projected outcomes of removing fluoride from US public water systems JAMA May 30 2025
Cessation of fluoridation of US public water systems is projected to worsen oral health in children and to significantly increase national health care costs.
Robotic vs laparoscopic surgery for middle and low rectal cancer: The REAL randomized clinical trial JAMA 2 June 2025
The use of robotic surgery demonstrated superior oncological and functional outcomes compared with the use of laparoscopic surgery in patients with middle or low rectal cancer.
Transfusion strategy effect on quality of life in patients with Myocardial Infarction and Anemia: A secondary analysis of the MINT randomized clinical trial JAMA 3 June 2025
Higher hemoglobin levels maintained with red blood cell (RBC) transfusion may not offer significant benefits to quality of life (QOL) overall in patients with MI and anemia.
_________________________________________________________________________________
A 3-year structured exercise program initiated soon after adjuvant chemotherapy for colon cancer resulted in significantly longer disease-free survival and findings consistent with longer overall survival. NEJM 1 June 2025
A 3-year structured exercise program initiated soon after adjuvant chemotherapy for colon cancer resulted in significantly longer disease-free survival and findings consistent with longer overall survival.
Cancer of unknown primary site NEJM 28 May 2025
- Cancer of unknown primary site is a heterogeneous group of histologically confirmed metastatic cancers, with the primary anatomical site of origin remaining unidentified after a standard diagnostic workup.
- Baseline evaluation involves a detailed history; physical, laboratory, and imaging assessments (ideally, a contrast-enhanced computed tomographic scan of the chest, abdomen, and pelvis); and a thorough pathological workup of adequate tumor tissue.
- Although immunophenotyping is the mainstay of diagnosis, recent advances have led to the integration of molecular profiling in predicting the tissue of origin and identifying targetable alterations in the management of cancer of unknown primary site.
- Both site-specific therapy (treatment of a putative primary site) and empirical chemotherapy (with a platinum-based cytotoxic regimen) are acceptable options for treatment.
- The overall prognosis for patients with cancer of unknown primary site remains poor. Participation in clinical trials should be encouraged.
Omitting regional Nodal Irradiation after response to Neoadjuvant Chemotherapy NEJM 4 June 2025
The addition of adjuvant regional nodal irradiation did not decrease the risk of invasive breast cancer recurrence or death from breast cancer in patients who had negative axillary nodes after neoadjuvant chemotherapy.
_________________________________________________________________________________
AI-Powered early warning systems for clinical deterioration significantly improve patient outcomes: a meta-analysis BMC medical informatics and decision making 2 June 2025
The findings suggest that AI-based early warning models positively impact patient outcomes in real-world clinical settings. Despite the potential benefits, the effectiveness and real-world applicability of these models require further research. Challenges such as clinician adherence to AI warnings remain to be addressed.
Comparison of Glasgow coma scale, motor component, eye component, and simplified motor scale for predicting trauma outcomes: a 13-year multicenter retrospective cohort study BMC emergency medicine 30 May 2025
Although the full Glasgow Coma Scale (GCS) assessment exhibited higher accuracy in predicting 3-day mortality, 7-day mortality, in-hospital mortality, ICU length of stay (LOS) of ≥ 14 days, and hospital LOS of ≥ 30 days compared with the Glasgow Coma Scale Eye (GCSE), Glasgow Coma Scale Movement (GCSM), and Simplified Motor scale (sMS), the marginally higher accuracy of the full GCS may be negligible given its time-consuming nature. Furthermore, use of the GCSM provides no substantial advantage over use of the simpler sMS, which has comparable predictive accuracy.
Efficacy of high-flow nasal oxygen in preventing hypoxia during Gastrointestinal endoscopy: a retrospective cohort study BMC Anesthesiology 3 June 2025
High-flow nasal oxygen (HFNO) emerges as a promising approach for preventing hypoxia during gastrointestinal endoscopy, offering a simple, effective, and non-invasive means of respiratory support.
Enhancing emergency department triage for older patients: a prospective study on the integration of the identification of seniors at risk BMC emergency medicine 3 June 2025
Integrating the Identification of Seniors at Risk (ISAR) tool into ED triage modestly enhanced the identification of older patients at risk for short-term adverse outcomes, particularly among those aged ≥ 65 years. These findings support the value of incorporating geriatric screening into routine triage to enable more tailored risk stratification. Further studies are needed to evaluate implementation feasibility across different healthcare settings and to inform integration into routine practice.
Long-term alcohol consumption and incident health risk conditions related to cardiometabolic risk markers: A 20-year prospective cohort study Addiction 21 May 2025
Long-term light (within guideline limits), medium or heavy alcohol consumption appears to be positively and linearly associated with incident health risk conditions related to cardiometabolic risk markers. The threshold dose of alcohol for developing hyperglycemia and high blood pressure appears to be lower in women.
Molnupiravir or nirmatrelvir–ritonavir plus usual care versus usual care alone in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial The Lancet infectious diseases 15 May 2025
Adding molnupiravir or nirmatrelvir–ritonavir to usual care was not associated with improvements in clinical outcomes. However, low recruitment meant a clinically meaningful benefit of treatment could not be ruled out, particularly for nirmatrelvir–ritonavir.
Primary closure and prophylactic antibiotics for treatment of traumatic wounds caused by mammals, a systematic review and meta-analysis World journal of emergency surgery 4 June 2025
Regardless of whether prophylactic antibiotics are used or not, compared to delayed closure, primary closure should be given priority in treating traumatic wounds caused by mammals which can decrease the incidence of wound infection or poor wound healing and obtain the better wound cosmesis, but it does not show the superiority compared to no closure, unless under some specific clinical conditions. Prophylactic use of antibiotics may not benefit in prevention of wound infection unless under specific clinical conditions, such as wounds caused by mammals other than dogs or wounds located in face/head.
Prioritizing circulation over airway to improve survival in trauma patients with exsanguinating injuries: a world society of emergency surgery-panamerican trauma consensus statement World journal of emergency surgery 2 June 2025
Prioritizing circulation over airway management in trauma patients with exsanguinating injuries significantly reduces mortality compared to the traditional Airway-Breathing-Circulation (ABC) approach. The present consensus paper, conducted according to the WSES methodology, aims to provide a review of the literature comparing the Circulation-Airway-Breathing (CAB) approach to the traditional ABC sequence in trauma patients with exsanguinating hemorrhage, to develop a shared consensus statement based on the currently available evidence
Safety evaluation of remdesivir administration in patients with severe renal impairment and coronavirus disease: a systematic review and meta-analysis BMC infectious diseases 2 June 2025
Our meta-analysis demonstrated that remdesivir (RDV) administration in severe renal impairment (SRI) patients with COVID-19 was safe compared to non-SRI or SRI patient treated without RDV. We suggest that the use of RDV should be actively considered for SRI patients.
Suicide risk in persons with polycystic ovarian syndrome: a systematic review Annals of general psychiatry 2 June 2025
PCOS is associated with an increased risk of suicidal ideation and behaviour and associated psychiatric comorbidities. Persons with PCOS should be routinely evaluated for the presence of clinically significant suicidality. Whether increased suicidality in PCOS populations is a direct effect of the disease state and/or is largely moderated by psychiatric comorbidity is a future research vista.
Suitability of just-in-time adaptive intervention in post-COVID-19-related symptoms: A systematic scoping review Plos digital health 29 May 2025
Patients with post-COVID-19 syndrome (PCS) experience a lot of various, continuously fluctuating symptoms. Certain mobile health technologies, such as just-in-time adaptive intervention (JITAI), may help in dealing with these symptoms, and have been utilised in other health conditions. In this study, we investigate to what extent it would be possible to develop a JITAI for post-COVID-19 and what that would look like based on 11 existing JITAI-related articles. We found evidence for JITAI being helpful to deal with psychological problems (such as depression) and to a lesser extent with aspects of fatigue, using sensing technologies or user-reported variables. Our findings suggest that JITAI have potential to help PCS patients. However, more research is necessary to develop a JITAI to help patients deal with other symptoms (such as cognitive problems and breathing difficulties), as well as on how to predict when interventions can occur at the right time for fatigue. These findings may also be helpful to develop interventions in other disorders, such as chronic fatigue syndrome
Treatment of agitation in dementia - a systematic review International journal of emergency medicine 26 May 2025
This systematic review evaluates pharmacological and non-pharmacological interventions for managing agitation in dementia.
________________________________________________________________________________________________