What’s new in medical literature
What's new in the medical literature?
Updated 4 July 2025
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Acute normovolemic hemodilution in cardiac surgery
Acute normovolemic hemodilution (ANH) is an intraoperative blood conservation technique used to potentially reduce allogenic blood transfusions; typically, two to three units of blood are removed and replaced with fluid, so that it is available for re-infusion during surgery. However, a randomized trial of ANH in over 2000 patients undergoing cardiac surgery noted no reduction in the number of patients receiving at least one allogeneic red blood cell (RBC) transfusion compared with those receiving usual care [3]. Limitations of this study included the low volume of blood withdrawn (median 650 mL), lack of a standardized transfusion protocol, and protocol violations. Additionally, previous meta-analyses of randomized trials in cardiac surgery found that ANH led to a 0.6 to 1.0 unit reduction in allogenic RBC transfusions. Because of these issues, we continue to use ANH in selected cardiac surgical patients. (See "Surgical blood conservation: Acute normovolemic hemodilution", section on 'Efficacy'.)
Bedtime versus morning antihypertensive dosing in frail older adults
Although some trials suggest that bedtime rather than morning dosing of antihypertensive therapy has cardiovascular benefits, the two largest trials found no difference, and we recommend taking antihypertensive drugs at a time of day that optimizes adherence for each individual patient. A new trial compared bedtime versus morning antihypertensive drug dosing in nearly 800 frail, older adults; there were no important differences in all-cause mortality, cardiovascular events, falls, or cognitive decline between the groups [19]. We continue to advise that the timing of antihypertensive therapy be individualized for convenience and maximal adherence. (See "Hypertension in adults: Initial drug therapy", section on 'Approaches with limited evidence of benefit'.)
Clinical features of acquired hemophilia A
Acquired hemophilia A (AHA), caused by autoantibodies to coagulation factor VIII, can cause life-threatening bleeding. The largest series to date, which included 1450 individuals hospitalized with AHA, described clinical bleeding during the admission in 30 percent, in-hospital mortality of 7 percent, and 30-day readmission rate of 27 percent [5]. Venous and arterial thrombotic events also occurred. Solid tumors were the most common underlying condition, followed by autoimmune diseases. This study emphasizes the severity of this condition and the need for prompt initiation of therapy by experts in managing bleeding disorders. (See "Acquired hemophilia A (and other acquired coagulation factor inhibitors)", section on 'Typical presentation and clinical findings'.)
Duration of observation for children treated with epinephrine for anaphylaxis
Consensus does not exist regarding the optimal observation period for a child successfully treated for anaphylaxis; concern for biphasic reactions results in significant practice variation and potentially unnecessary hospital observation. In a retrospective study of over 5600 children with acute allergic reactions that were treated with epinephrine before or shortly after presentation to the emergency department (ED), there was a minimal (<2 percent) hourly increase in receiving additional epinephrine after four hours, even in patients who presented with cardiovascular involvement [17]. These findings support our recommendation for discharging patients, including children, from the ED after an appropriate observation period following resolution of anaphylaxis signs and symptoms. (See "Anaphylaxis: Emergency treatment", section on 'Duration of observation'.)
Efficacy of varenicline for vaping cessation in teens and young adults
Varenicline is an accepted first-line therapy for smoking cessation in adults, but evidence in adolescents is limited. In a trial of 175 adolescents and young adults (ages 16 to 25 years) who were interested in nicotine vaping cessation, more patients assigned to varenicline plus weekly counseling were abstinent at 9 to 12 weeks compared with counseling alone (51 versus 14 percent) [3]. These results are promising but differ from two prior trials of varenicline for cessation of combustible nicotine (smoking) in adolescents that did not demonstrate benefit. We suggest varenicline as second line therapy (with a nicotine patch) for adolescent patients who have not had success with nicotine replacement therapy alone and are close to 18 years of age. (See "Management of smoking and vaping cessation in adolescents", section on 'Varenicline'.)
Intensive blood pressure lowering among those with isolated systolic hypertension and low diastolic pressures
Management of blood pressure (BP) in older adults with isolated systolic hypertension is somewhat controversial because, although intensive systolic BP lowering is beneficial in this age group, there is concern that a low attained diastolic BP as a result of treatment can have adverse cardiovascular consequences. In a meta-analysis of five large goal BP trials composed of nearly 17,000 patients, more intensive as compared with less intensive BP lowering reduced the risk of cardiovascular events and all-cause mortality, irrespective of baseline diastolic BP [20], including among those in the lowest quartile of baseline diastolic BP (mean 65 mmHg). When treating older patients with isolated systolic hypertension, we generally target the optimal systolic BP independent of the diastolic BP, provided the patient does not develop symptoms related to BP lowering. (See "Goal blood pressure in adults with hypertension", section on 'Older adults with isolated systolic hypertension'.)
Intravenous magnesium and risk of cisplatin-associated acute kidney injury
Acute kidney injury (AKI) is an important complication of cisplatin therapy in patients with cancer; while experimental studies suggest that prophylactic magnesium may reduce the risk of cisplatin-associated AKI (CP-AKI), large clinical trials in humans are lacking. In a recent multicenter cohort study of over 13,000 patients with cancer receiving cisplatin, patients who received prophylactic intravenous (IV) magnesium prior to their first dose of cisplatin had a lower odds of CP-AKI (defined as a twofold or greater rise in serum creatinine or receipt of kidney replacement therapy within 14 days after cisplatin) than those who did not receive magnesium (adjusted odds ratio 0.80, 95% CI 0.66-0.97) [1]. These findings suggest that IV magnesium prior to cisplatin therapy may help to prevent CP-AKI; for patients receiving cisplatin, we suggest administering IV isotonic saline supplemented with potassium chloride and magnesium sulfate before and after therapy. (See "Cisplatin nephrotoxicity", section on 'Magnesium supplementation' and "Cisplatin nephrotoxicity", section on 'Intravenous saline'.)
Labor and delivery outcomes among kidney transplant recipients
Prior studies have shown that kidney transplant recipients who become pregnant have a higher risk of cesarean birth compared with the general population, but the factors driving this increased risk are incompletely understood. In a recent analysis of data from the Australian and New Zealand Dialysis and Transplant Registry and perinatal datasets that compared births of female kidney transplant recipients with those of nontransplant patients, rates of cesarean birth were twofold higher among kidney transplant recipients (63 versus 26 percent) [25]. The main indications for cesarean birth before the onset of labor were breech presentation and hypertensive disorders of pregnancy. These findings may be useful for preconception counseling in kidney transplant recipients who wish to become pregnant. (See "Sexual and reproductive health after kidney transplantation", section on 'Maternal outcomes'.)
Maintaining peritoneal dialysis after cardiac surgery
Patients on peritoneal dialysis (PD) may be switched to hemodialysis (HD) before cardiac surgery because of historical concerns that PD confers a higher risk of postoperative complications compared with HD. In an observational study of over 30,000 patients on dialysis undergoing coronary artery bypass grafting and surgical valve procedures, patients on PD had lower multivariable-adjusted odds of in-hospital mortality and prolonged mechanical ventilation compared with those on HD [4]. These data support the practice of planning and preparing to maintain PD in the cardiac surgery perioperative period to avoid temporary HD and its associated complications. (See "Issues in patients on peritoneal dialysis undergoing surgery", section on 'Indications for preemptive hemodialysis'.)
Management of nondisplaced tibial spiral (toddler's) fractures in children
Toddler's fractures of the tibia (image 1) are common injuries in ambulatory infants and young children; the best approach to management is debated. In the largest randomized trial of 129 toddlers (mean age 2.2 years), the majority of whom had toddler's fractures of the distal two-thirds of the tibia on radiograph, more patients assigned to a pediatric walking boot (WB) had returned to baseline activities at three weeks compared with those assigned to a long- or short-leg cast (77 versus 41 percent) [24]. Caregivers in the WB group also reported fewer challenges with home care tasks than the cast group. There was a nonsignificant trend towards more pressure sores in the WB group, which appeared to be mitigated by placement of a stockinette prior to WB application. Based on this and other studies, we suggest a WB rather than a cast for children with these fractures on imaging. (See "Tibial and fibular shaft fractures in children", section on 'Tibial spiral (toddler's) fractures'.)
Meconium-related obstruction and prematurity
Meconium-related obstruction (MRO; eg, meconium ileus) is associated with cystic fibrosis (CF) and Hirschsprung disease, but studies suggest that it may be more commonly associated with prematurity or low birth weight (LBW). In an observational study including 1844 infants treated for MRO, 94.5 percent had neither CF nor Hirschsprung disease based on ICD-10 diagnoses [32]. On adjusted analysis, preterm (gestational age <32 weeks) and very LBW (<1500 g) infants were more likely to have MRO compared with term or normal weight infants. This data and findings from prior studies suggest that MRO is often unrelated to CF or Hirschsprung disease and is more likely to occur in premature or very LBW infants. Further studies are needed to determine the magnitude of this association and the clinical significance of MRO in neonates without CF or Hirschsprung disease. (See "Overview of short-term complications in preterm infants", section on 'Meconium-related obstruction'.)
Medium-term health outcomes of interventions for obesity during childhood
Long-term outcomes of treatment for obesity during childhood were evaluated in a prospective study of more than 6700 children and adolescents with obesity who participated in various health behavior and lifestyle interventions in Sweden (mean age at treatment initiation 12 years) [2]. By the end of treatment (mean duration three years), significant improvement or remission of obesity was more likely in children <12 years compared with those ≥12 years (38 versus 29 percent). In post-treatment follow-up in early adulthood, participants who had a good response were less likely to have type 2 diabetes, dyslipidemia, and mortality compared with those with a poor response. These observations suggest that younger children are more likely to respond to a lifestyle intervention for obesity, and that a good initial response is associated with better long-term health outcomes. (See "Overview of the health consequences of obesity in children and adolescents", section on 'Prevalence and association with obesity'.)
Methotrexate as initial therapy for symptomatic, moderate-to-severe pulmonary sarcoidosis
For most symptomatic patients with pulmonary sarcoidosis who have severe lung involvement, worsening radiographic opacities, or increasing pulmonary function impairment, we suggest initial treatment with methotrexate rather than glucocorticoid therapy, observation alone, or other alternative therapies (Grade 2C). Pulmonary sarcoidosis is usually treated initially with oral glucocorticoids, which have numerous side effects. In a new open-label trial of 138 treatment-naïve patients with pulmonary sarcoidosis and moderate-to-severe symptoms, impaired lung function, or disease progression over the last 12 months, patients randomly assigned to weekly oral methotrexate monotherapy for 24 weeks had similar lung function improvement compared with patients assigned to prednisone (6.2 versus 5.7 percentage point improvement in predicted forced vital capacity) [2]. Methotrexate had a slower onset of action but was associated with less weight gain (1.1 versus 5.0 kg) and similar patient satisfaction by the end of the trial. Based in part on this evidence, we now suggest methotrexate as initial therapy for most patients with moderate-to-severe pulmonary sarcoidosis requiring treatment; concurrent oral glucocorticoids are appropriate for those with rapidly progressing disease. (See "Treatment of pulmonary sarcoidosis: Initial approach", section on 'Efficacy of methotrexate'.)
New AABB guidelines for platelet transfusion
The Association for the Advancement of Blood & Biotherapies (AABB) has released new guidelines for platelet transfusion [3]. These provide suggested platelet count thresholds for platelet transfusion with some common invasive procedures and to reduce the risk of spontaneous bleeding. Suggested thresholds include platelet count <10,000/microL in afebrile patients with bone marrow suppression from hematopoietic stem cell transplantation or chemotherapy, and <20,000 for lumbar puncture. The guidelines also emphasize the importance of considering individual patient factors in deciding whether to transfuse. (See "Platelet transfusion: Indications, ordering, and associated risks", section on 'Specific clinical scenarios'.)
New clinical practice statement on the diagnosis and management of interstitial lung abnormalities (ILAs)
Interstitial lung abnormalities (ILAs) are bilateral radiologic findings found incidentally in a small percentage of older adults, which may represent early or subclinical interstitial lung disease; however, the optimal approach for surveillance, monitoring, and management has not been clear. The American Thoracic Society has provided new guidance in a clinical practice statement [25]. These include a new formal radiologic definition, suggestions for surveillance imaging for ILAs in high-risk groups (eg, those with connective tissue disease or relatives of those with familial pulmonary fibrosis), and an approach to suspected interstitial lung disease (eg, evaluation of symptoms, pulmonary function testing, and signs of progression). The practice statement also recommends imaging follow-up in two to three years for patients newly diagnosed with ILAs. Our authors contributed to these guidelines and are in general agreement with their recommendations. (See "Interstitial lung abnormalities", section on 'Determining whether an ILD is present'.)
No benefit of sildenafil in preventing intrapartum fetal distress
Intrapartum fetal distress is a major contributor to emergency cesarean or operative vaginal birth. Limited data suggest that sildenafil, a potent vasodilator, may reduce the rate of intrapartum fetal distress by increasing uteroplacental and fetal blood flow. However, in a recent multicenter randomized trial including over 3200 patients with term singleton or dichorionic twin pregnancies attempting vaginal birth, those assigned to prophylactic sildenafil had similar rates of intrapartum events suggestive of hypoxia (eg, five-minute Apgar score of <4, umbilical artery pH <7.0, admission to the neonatal intensive care unit for >48 hours), emergency cesarean birth, and operative vaginal birth as those assigned to placebo [14]. Additional trials are needed before sildenafil can be routinely used for the prevention of intrapartum fetal distress. (See "Intrapartum fetal heart rate monitoring: Overview", section on 'Investigational preventive therapy'.)
Rheumatoid arthritis and heart failure
Patients with rheumatoid arthritis (RA) have an increased risk of heart failure (HF), but whether they also have an increased risk of poor outcomes from HF is less clear. In a study of over three million index hospitalizations for heart failure, RA was associated with a significantly increased risk of readmission and death during readmission in the 90 days following the index hospitalization (adjusted odds ratio 1.2 and 1.1, respectively) [8]. Older age, rural residence, and higher median household income were all associated with an increased risk of death during readmission. Patients with RA should be monitored carefully following hospitalization for heart failure; the association between mortality and high socioeconomic status among patients with RA and HF warrants further study. (See "Heart failure in rheumatoid arthritis", section on 'Prognosis'.)
Role of insulin therapy for pre-diabetes stages of cystic fibrosis-related diabetes
Insulin therapy has established benefits for people with cystic fibrosis-related diabetes (CFRD), but its utility in pre-diabetic stages has been unclear. In a new randomized trial in 104 children and adolescents with elevated postprandial blood glucose but without CFRD, once-daily basal insulin treatment did not improve body weight or pulmonary function compared with a control group managed without insulin therapy [48]. These findings suggest that insulin treatment is not beneficial for people who do not meet diagnostic criteria for CFRD. (See "Cystic fibrosis-related diabetes mellitus", section on 'Indications'.)
Treatment of persistent mixed urinary incontinence in women
The treatment of female patients with mixed urinary incontinence (MUI; ie, symptoms of both stress and urgency urinary incontinence) includes lifestyle modifications, medication, and procedures for persistent symptoms; however, data to guide procedure selection are lacking. In a randomized trial of 137 patients with persistent, moderate-to-severe MUI, both mid-urethral sling surgery and intradetrusor injections of onabotulinumtoxinA resulted in similar improvement in MUI symptoms at six months [24]. These results further support our approach to the treatment of persistent MUI, including the selection of a procedure based on patient preference and predominant symptom. (See "Female urinary incontinence: Treatment", section on 'Mixed urinary incontinence (MUI) treatment'.)
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Brexanolone, zuranolone and related neurosteroid GABAA receptor positive allosteric modulators for postnatal depression Cochrane Library 25 June 2025
This review provides moderate‐certainty evidence that zuranolone probably improves depression response and remission but also increases maternal adverse events compared to placebo. There may be little or no difference in depression response and remission and probably little or no difference in maternal adverse events with intravenous neurosteroid GABAA positive allosteric modulators such as brexanolone, compared to placebo. Evidence from this review, alongside current clinical guidelines and reference to evidence from the general adult population, could be used to inform an individualised risk‐benefit discussion with women seeking treatment for postnatal depression. However, it is difficult to make recommendations about the use of neurosteroid GABAA receptor positive allosteric modulators for the treatment of postnatal depression as no studies have compared them to active treatment.
Early treatment versus expectant management of hemodynamically significant patent ductus arteriosus for preterm infants Cochrane Library 23 June 2025
Early or very early pharmacotherapeutic treatment of an hemodynamically significant patent ductus arteriosus (hs‐PDA) probably results in little to no difference in mortality in preterm infants (moderate‐certainty evidence). However, very early use of ibuprofen may lead to a moderate increase in mortality in extremely preterm infants. Conversely, very early treatment of an hs‐PDA leads to a trivial reduction in the need for invasive PDA closure (high‐certainty evidence). Early or very early hs‐PDA treatment may result in little to no difference in chronic lung disease (CLD), severe intraventricular hemorrhage (IVH), or necrotizing enterocolitis (NEC) (low‐ to moderate‐certainty evidence). Very early treatment of an hs‐PDA also probably results in little to no difference in moderate to severe neurodevelopmental impairment (moderate‐certainty evidence). Given the potential adverse effects of medical therapy, future research should focus on identifying the appropriate patient population for clinical trials to maximize the chances of detecting a clinically meaningful effect while avoiding potential harm.
Peripheral venous blood gas analysis for the diagnosis of respiratory failure, hypercarbia and metabolic disturbance in adults Cochrane Library 25 June 2025
Very limited data suggest peripheral venous blood gas analysis (PVBGA) performs poorly as a diagnostic test for respiratory failure compared to the reference standard of Arterial blood gas analysis (ABGA). The index test PVBGA was highly sensitive for the diagnosis of respiratory failure and isolated hypercarbia, but its specificity was poor for these two primary target conditions. The high sensitivity means PVBGA may have a useful role as a "rule out test" for respiratory failure and isolated hypercarbia; however, the high false‐positive rates make the clinical interpretation of a positive test difficult. Moreover, we are uncertain regarding these estimates because we have only low to very low certainty about the evidence. Further studies that use (ABGA) established thresholds for the diagnosis of each target condition are needed.
Peritoneal drainage versus laparotomy as initial treatment for surgical necrotising enterocolitis or spontaneous intestinal perforation in preterm very low birth weight infants Cochrane Library 24 June 2025
Peritoneal drainage, when compared to laparotomy, likely results in little to no difference in mortality or overall neurodevelopmental outcomes at 18 to 24 months of age, and mortality before initial hospital discharge in preterm very low birth weight infants with surgical necrotising enterocolitis (NEC) or spontaneous intestinal perforation (SIP). However, peritoneal drainage likely results in an increase in the risk of moderate to severe cerebral palsy. In addition, infants in the peritoneal drainage group are more likely to need subsequent laparotomy during the first hospital stay. In the absence of any substantial ongoing RCTs, clinicians may have to use the existing evidence to make management decisions.
Pharmacological interventions for the prevention of pain during endotracheal suctioning in ventilated neonates Cochrane Library 20 June 2025
Morphine may have little to no effect on Premature Infant Pain Profile (PIPP) or duration of ventilation (evidence very uncertain). Morphine may not increase the risk of hypotension and probably does not reduce the incidence of severe intraventricular haemorrhage (IVH). Alfentanil may reduce CHEOPS and heart rate change from baseline (evidence very uncertain). Meperidine may reduce behavioural pain score (BPS).
Phosphate binders for preventing and treating chronic kidney disease‐mineral and bone disorder (CKD‐MBD) Cochrane Library 27 June 2025
Sevelamer may lower death from any cause and incur less hypercalcaemia compared to calcium‐based binders in people on dialysis. Lanthanum may also result in less hypercalcaemia compared to calcium. Sevelamer may increase the risk of constipation, while lanthanum may increase both the risk of nausea and constipation, but may slightly reduce serum phosphate in people with CKD compared to placebo/usual care. No clinically important benefits of phosphate binders were identified for cardiovascular death or coronary artery calcium score compared to placebo/usual care. The evidence for the effects of other phosphate binders on key clinical outcomes in head‐to‐head comparisons was uncertain.
Virtual reality for stroke rehabilitation Cochrane Library 20 June 2025
We found moderate‐ to low‐certainty evidence that the use of virtual reality and interactive video gaming is slightly more beneficial than alternative therapy approaches in improving upper limb function, balance, and activity limitation. Furthermore, greater benefits were seen for upper limb function when virtual reality was used in addition to usual care (to increase overall therapy time). There was mixed evidence on the effects on mobility outcomes including gait speed, and insufficient evidence to reach any conclusions about the effect of virtual reality and interactive video gaming on participation restriction and quality of life. _________________________________________________________________________________
Australasian Diabetes in Pregnancy Society (ADIPS) 2025 consensus recommendations for the screening, diagnosis and classification of gestational diabetes MJA 23 June 2025
Introduction: In the context of a global obesity and diabetes epidemic, gestational diabetes mellitus and other forms of hyperglycaemia in pregnancy are increasingly common. Hyperglycaemia in pregnancy is associated with short and long term complications for both the woman and her baby. These 2025 consensus recommendations from the Australasian Diabetes in Pregnancy Society (ADIPS) update the guidance for the screening, diagnosis and classification of hyperglycaemia in pregnancy based on available evidence and stakeholder consultation.
Main recommendations:
- Overt diabetes in pregnancy (overt DIP) should be diagnosed at any time in pregnancy if one or more of the following criteria are met: (i) fasting plasma glucose (FPG) ≥ 7.0 mmol/L; (ii) two‐hour plasma glucose (2hPG) ≥ 11.1 mmol/L following a 75 g two‐hour pregnancy oral glucose tolerance test (POGTT); and/or (iii) glycated haemoglobin (HbA1c) ≥ 6.5% (≥ 48 mmol/mol).
- Irrespective of gestation, gestational diabetes mellitus should be diagnosed using one or more of the following criteria during a 75 g two‐hour POGTT: (i) FPG ≥ 5.3–6.9 mmol/L; (ii) one‐hour plasma glucose (1hPG) ≥ 10.6 mmol/L; (iii) 2hPG ≥ 9.0–11.0 mmol/L.
- Women with risk factors for hyperglycaemia in pregnancy should be advised to have the HbA1c measured in the first trimester. Women with HbA1c ≥ 6.5% (≥ 48 mmol/mol) should be diagnosed and managed as having overt DIP.
- Before 20 weeks’ gestation, and ideally between ten and 14 weeks’ gestation, if tolerated, women with a previous history of gestational diabetes mellitus or early pregnancy HbA1c ≥ 6.0‐6.4% (≥ 42–47 mmol/mol), but without diagnosed diabetes, should be advised to undergo a 75 g two‐hour POGTT.
- All women (without diabetes already detected in the current pregnancy) should be advised to undergo a 75 g two‐hour POGTT at 24–28 weeks’ gestation.
Changes in management as a result from this consensus statement: These updated recommendations raise the diagnostic glucose thresholds for gestational diabetes mellitus and clarify approaches to early pregnancy screening for women with risk factors for hyperglycaemia in pregnancy.
Development and calibration of the 2023 Australian cardiovascular disease risk prediction equations: a model updating study MJA 2 July 2025
The known: Until 2023, the risk of a primary cardiovascular disease (CVD) event was assessed in Australia using clinical criteria and an outdated United States-based equation that generally overestimated risk, but underestimated it in Aboriginal and Torres Strait Islander people.
The new: New Zealand equations for estimating CVD risk have been adapted and calibrated for use in Australia. The internal validity of both the general and diabetes-specific equations is good, and they have been incorporated into the 2023 guideline-recommended Australian CVD risk equation.
The implications: The new CVD risk calculator should substantially improve the accuracy of risk assessment, and consequently facilitate more targeted preventive pharmacotherapy and primary care.
Estimated carbon emissions for PBS-subsidised prescription respiratory inhalers, Australia, 2019–2023: a descriptive analysis MJA 26 June 2025
In the first comprehensive estimate of carbon emissions for PBS-subsidised inhalers in Australia, we found differences in dispensing according to the demographic characteristics of inhaler users. To better support efforts to reduce respiratory inhaler emissions as part of Australian health care decarbonisation plans, we recommend routine collecting and reporting of over-the-counter inhaler sales data, and that these data are made freely available to complement PBS-subsidised dispensing data. Our findings could inform targeted interventions for reducing the use of high emission inhalers in Australia and updates to clinical practice guidelines.
Factors that affect the provision of medical abortion services in Australian primary care: a mixed methods systematic review MJA 30 June 2025
A range of individual, service level, and system factors exacerbate the effects of geographic location and financial considerations on the provision of medical abortion in Australian primary care. Our findings indicate that financial and structural support is needed for the geographic decentralisation of medical abortion training and services, the establishment of nurse‐led models of care, and the integration of abortion care into primary care.
Prescription opioid supply-restricting policies and hospital use by people prescribed opioid medications, Victoria, 2018–22: a controlled interrupted time series analysis MJA 26 June 2025
The known: Pharmaceutical opioids contribute to considerable harm in Australia. Many policies have been implemented in recent years to reduce high rates of opioid prescribing and related harm.
The new: Two opioid medication control policies implemented in mid-2020 were associated with a decline in the opioid-related emergency department presentation rate, but also with a sharp but temporary increase non-opioid substance-related presentations.
The implications: Policies that restrict opioid medication supply can reduce opioid-related harm, but this outcome is accompanied by unintended consequences, including a short term increase in non-opioid substance-related harm.
Promoting resilience to weather-related and seasonal provocations to health in people with multimorbid heart disease: a prospective pragmatic, randomised trial MJA 24 June 2024
The known: Threats to cardiovascular health posed by climate change are recognised, but few disease management programs aim to modulate exposure to challenging weather conditions.
The new: Our novel intervention aimed to establish greater resilience to external provocations to health for people hospitalised with multimorbid heart disease. It did not increase their time alive and not in hospital after their discharge home.
The implications: Our program was ineffective in achieving its primary aim, but our trial provided proof of concept evidence that a modified program could achieve better health outcomes for people after hospitalisation with multimorbid heart disease.
The prevalence of and variation in indicators of the quality and safety of long term aged care in Australia, 2019: a cross-sectional population-based study MJA 24 June 2024
The marked national variations by residential or home aged care provider in antibiotic use, ED presentations, high sedative load, longer waiting times for home care services, home medicines reviews, and chronic disease management plans suggest these areas could benefit from targeted quality improvement strategies.
When may an adult woman with cognitive impairment still have capacity to consent to an abortion? MJA 2 July 2025
For adult women, an analysis of the limited number of recent cases reinforces that:
- capacity is always presumed;
- women can still have capacity to consent to an abortion, despite being found to lack capacity for other decisions; and
- a general understanding of the nature and effect of the procedure is sufficient to fulfil the functional test of capacity.
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Beyond crazy socks: a doctor’s mental health journey MJA insight 30 June 2025
In medicine, we’re good at showing up. No matter what’s happening in our personal lives — relationship breakdowns, exam failures, exhaustion — we turn up, we do the work, we tick the boxes. But we’re far less skilled at saying, “I’m not okay.”
Gay and bisexual men will soon be able to donate blood and plasma MJA insight 23 June 2025
Many gay and bisexual men have been excluded from donating blood and plasma (the liquid portion of blood) for decades because of rules developed during the HIV crisis in the 1980s. The Australian Red Cross’ blood donation arm, Lifeblood, has announced these restrictions will be lifted. This opens donation pathways for many gay and bisexual men, and other men who have sex with men.
Inaccurate and misogynistic: why we need to make the term ‘hysterectomy’ history MJA insight 30 June 2025
Hysteria was a psychiatric condition first formally defined in the 5th century BCE. It had many symptoms, including excessive emotion, irritability, anxiety, breathlessness and fainting. But hysteria was only diagnosed in women. Male physicians at the time claimed these symptoms were caused by a “wandering womb”. They believed the womb (uterus) moved around the body looking for sperm and disrupted other organs. Because the uterus was blamed for hysteria, the treatment was to remove it. This procedure was called a hysterectomy. Sadly, many women had their healthy uterus unnecessarily removed and most died.
Keeping adolescents healthy assures our future – but how do we ensure their wellbeing? MJA insight 23 June 2025
The second Lancet Commission on Adolescent Health and Wellbeing aims to understand and advance adolescent health and wellbeing at a global, regional, country and local level.
New cosmetic guidelines demand higher standards and accountability MJA insight 23 June 2025
Ahpra’s new guidelines for non-surgical cosmetic procedures explicitly reaffirm that practitioners are required to work within the limits of their skills, training and experience.
Remote FNQ hospital celebrates one year of birthing local babies MJA insight 30 June 2025
The Palm Cockatoo Midwifery Group Practice (MGP) at Weipa Hospital, Cape York Peninsula, has assisted local women to give birth locally rather than travelling 800 km to Cairns. The group wants to make a culturally safe space so that more Aboriginal and Torres Strait Islander women can give birth in the Western Cape.
Update to the Australian guideline for diagnosing and managing acute coronary syndromes MJA insight 30 June 2025
The goal of the updated guideline is to ensure that clinicians are supported by the best evidence-based recommendations available, to provide the best possible outcomes for people with acute coronary syndromes.
When a parent is worried that their child is getting worse, listen! MJA insight 30 June 2025
A new study from Monash University demonstrates that parental concern that their child is deteriorating is a stronger, and sometimes earlier, predictor of ICU admission than abnormal vital signs.
Why climate change is a heart attack, and what we can do about it MJA insight 23 June 2025
Climate change and cardiovascular disease are intrinsically linked, and more needs to be done to combat this existential threat to human health.
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Beyond body mass index: rethinking doctors’ advice for weight loss BMJ 25 June 2025
Doctors should provide high quality, evidence based care reflecting individual preferences and needs, regardless of weight.
Cancer related lymphedema BMJ 3 July 2025
Cancer related lymphedema (CRL) is a prevalent, chronic condition that can lessen quality of life among people living with and beyond cancer. Early detection and a growing collection of evidence based treatments, particularly resistive exercise, prevent and temporize CRL. Surgical approaches that spare lymphatics for CRL prevention have become standard care, although approaches used to restore lymphatic function are a focus of intense investigative and clinical interest. Manual and behavioral therapies, delivered by an interdisciplinary team, remain the cornerstone of reductive CRL treatment.
Effects of intravaginal conjugated oestrogen on pessary continuation for pelvic organ prolapse: multicentre, randomised, double blind, placebo controlled trial BMJ 27 June 2025
Oestrogen cream did not improve the continuation rate of ring pessary use with satisfaction. Use of oestrogen cream might be associated with a lower risk of common adverse events. The clinical decision to use vaginal oestrogen should take into account its benefits and risks and the patient’s personal preferences.
Global, regional, and national characteristics of the main causes of increased disease burden due to the covid-19 pandemic: time-series modelling analysis of global burden of disease study 2021 BMJ 2 July 2025
The covid-19 pandemic significantly increased the burden of several non-covid conditions, particularly mental health disorders, malaria in young children in the African region, and stroke and ischaemic heart disease in older adults, with notable disparities across age and sex. These findings underscore the urgent need to strengthen health system resilience, enhance integrated surveillance, and adopt syndemic-informed strategies to support equitable preparedness for future public health emergencies.
Maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years—summary of new NICE guidance BMJ 26 June 2025
What you need to know
- All healthcare practitioners have a role in improving uptake of vitamin supplements before and during pregnancy, during breastfeeding, and early childhood; supporting breastfeeding and/or safe and appropriate formula feeding; and timely and appropriate introduction of solids
- Exclusive breastfeeding for six months and continued breastfeeding thereafter is recommended, and advice on infant feeding should be evidence based and non-commercial
- Optimal weight gain in pregnancy is uncertain and routine monitoring of weight in pregnancy is not recommended, unless there is a clinical indication such as gestational diabetes or hyperemesis gravidarum, and the focus should be on starting or maintaining healthy eating and physical activity
Practical Prescribing: Aspirin BMJ 2 July 2025
What you need to know
- Aspirin has multiple indications, including prevention of coronary, cerebrovascular, and peripheral vascular disease; treatment of acute coronary syndromes and ischaemic stroke; prevention of pre-eclampsia; and colorectal cancer in Lynch syndrome, as well as pain, migraine, and pyrexia
- Consider starting aspirin for a clinical diagnosis of stable angina while awaiting a formal cardiology assessment
- Before prescribing aspirin, screen for gastrointestinal symptoms, assess risk of gastrointestinal bleeding, and consider co-prescribing a proton pump inhibitor
- Enteric coated aspirin does not reduce the risk of gastrointestinal side effects and is therefore not recommended
Right C7 neurotomy at the intervertebral foramen plus intensive speech and language therapy versus intensive speech and language therapy alone for chronic post-stroke aphasia: multicentre, randomised controlled trial BMJ 25 June 2025
Seventh cervical nerve (C7) neurotomy plus three weeks of intensive SLT was associated with a greater improvement in language function compared with three weeks of intensive SLT alone over a period of six months. No severe adverse events or long term troublesome symptoms or functional loss were reported.
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Climate conditions, weather changes, and air pollutants and atopic dermatitis: A meta-analysis JAMA 25 June 2025
The study results suggest that there is a need for solutions to reduce pollution and factors associated with extreme weather due to their harmful health effects and the global burden of atopic dermatitis.
COVID-19 and cognitive change in a community-based cohort JAMA 30 June 2025
This cohort study of older participants found accelerated decreases in cognition among individuals hospitalized for SARS-CoV-2 infection, but not nonhospitalized infection, in comparison with individuals not yet infected.
Diagnosis and treatment of Type 2 Diabetes in adults: A review JAMA 24 June 2025
Type 2 diabetes affects up to 14% of the global population and is associated with preventable long-term complications, such as cardiovascular disease, kidney failure, vision loss, and increased mortality. In addition to lifestyle modifications including diet, exercise, and weight management, metformin is generally first-line therapy for attainment of hemoglobin A1C targets. For individuals with type 2 diabetes and cardiovascular or kidney disease or at high cardiovascular risk, guidelines recommend early treatment with SGLT2i and/or GLP-1RA medications.
Early invasive or conservative strategies for older patients with acute coronary syndromes: A meta-analysis JAMA 23 June 2025
he results of this systematic review and meta-analysis suggest that, in older patients with ACS, an early invasive strategy was not associated with reduced all-cause death compared with conservative management. An early invasive strategy was associated with reduced recurrent MI and repeated coronary revascularization during follow-up but increased risk of major bleeding. Competing risks associated with an early invasive strategy should be weighed in shared therapeutic decision-making for older patients with ACS.
Increased prescribing of Attention-Deficit/Hyperactivity Disorder medication and real-world outcomes over time JAMA 25 June 2025
In this study, ADHD medication remained associated with reduced risks of several serious real-world outcomes. However, the magnitude of these associations appears to have decreased alongside rising prescription rates over time. Thus, it is important to regularly evaluate medication use in different patient populations.
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Measles 2025 NEJM 25 June 2025
Key points
- Measles causes a range of serious health issues, including immune amnesia that may last up to 1 year in fully recovered patients and increased susceptibility to sometimes severe secondary infections. Research on restoring immunity more rapidly is needed.
- Measles vaccine has a long safety history and is highly effective against all circulating measles genotypes.
- Measles is highly contagious; therefore, a high coverage level (>95%) of both recommended doses of measles vaccine is necessary to prevent community transmission.
- Vitamin A supplementation is recommended for all persons who have measles to reduce complications and the risk of death, particularly in persons who have deficient levels of vitamin A, such as persons living in low- and middle-income countries. Vitamin A does not prevent measles infection. More data are needed regarding the benefits of vitamin A in persons living in developed countries who have measles.
- Waning levels of maternal measles antibodies at 3 to 4 months of age has increased measles risk in young infants. Further research on the effectiveness of early measles vaccination is needed.
- Additional randomized, controlled trials are needed to evaluate the clinical efficacy of vaccine microneedle patches, which may help to increase vaccination coverage.
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Association of sleep problems with suicidal behaviors and healthcare utilization in adults with chronic diseases: the role of mental illness Annals of general psychiatry 21 June 2025
Both extreme sleep durations and insomnia were independently associated with higher odds of suicidal behaviors and increased healthcare utilization in adults with chronic diseases, with mental illness playing a partial mediating role in these relationships.
Hemoglobin in cardiogenic shock: the lower, the poorer survival Journal of intensive care 3 June 2025
Anemia is a common condition frequently intertwined with cardiogenic shock (CS)worsening both short- and long-term mortality. Further randomized studies are warranted to understand its mechanisms and adapt the transfusion strategy.
Improving written handoff on inpatient medicine resident services: a resident-led safety initiative BMJ open quality 20 June 2025
This intervention improved the rates of written handoff completion based on the I-PASS handoff tool. It helped all members of the team feel more confident that they had the necessary information to care for patients and had the effect of reducing handoff time and improving satisfaction.
Post-COVID-19 dizziness associated with a patulous eustachian tube BMJ case reports 24 June 2025
A frequently occurring symptom following COVID-19 is dizziness. Yet, the causes of post-COVID-19 dizziness are still largely unclear. This paper presents a case of a patient in his 40s who developed persistent dizziness after a SARS-CoV-2 infection. Dizziness only occurred during nasal respiration. Inspection of the tympanic membrane on respiration indicated a patulous eustachian tube (PET). Video-oculography showed a slight nystagmus during nasal respiration. Placement of a tympanostomy tube 6 months after the start of symptoms immediately resolved the dizziness, and nystagmus during nasal respiration was reduced. A few days after treatment, the patient developed ocular fatigue and pain associated with eye movement, which was diagnosed as vestibular asthenopia. These symptoms were largely resolved by subsequent treatment with vestibulo-visual rehabilitation. This case report indicates that post-COVID-19 dizziness can be associated with a PET, and in that case, it can be successfully treated by placement of a ventilation tube.
Sepsis in patients with severe TBI: a retrospective CT scoring study International journal of emergency medicine 23 June 2025
Elevated computed tomography (CT) score is a well indicator of high incidence and mortality for sepsis after severe traumatic brain injury (sTBI) in the ICU, which suggests that this very current and practical event is involved to a global health care problem. But it could still need further verification in future investigation.
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