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What’s new in medical literature

What's new in the medical literature?

Updated 14 November 2025  

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UpToDate

Antidepressants and treatment-emergent insomnia
Insomnia, which is a symptom of pediatric major depression, may also be precipitated or exacerbated by antidepressants. In a meta-analysis of 20 randomized trials, the incidence of treatment-emergent insomnia was modestly greater in youth treated with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) than with placebo (6 percent versus 4 percent) [1]. Additional analyses found that the risk of insomnia with SSRIs or SNRIs was comparable, and that the risk was greatest with sertraline and least with duloxetine. Youth receiving antidepressants for depression should be assessed for insomnia at baseline and subsequently monitored for changes in insomnia, as well as other symptoms. (See "Pediatric unipolar depression and pharmacotherapy: General principles", section on 'Treatment-emergent insomnia'.) 

CHEST guidelines on platelet and plasma transfusions in the ICU
CHEST has released new guidelines on platelet and plasma transfusions in critically ill patients [5]. They suggest prophylactic platelet transfusion if the platelet count is <10,000/microL in stable patients who do not have a high risk of bleeding, and <30,000 to 50,000/microL for those at high risk of bleeding (concomitant coagulation abnormalities, disseminated intravascular coagulation [DIC], or comorbidities), acknowledging this is a subjective assessment. For many invasive procedures, they suggest not routinely transfusing platelets or plasma. Unlike red blood cell transfusions, for which multiple randomized trials have been performed, platelet and plasma transfusion decisions generally lack evidence from randomized trials comparing different thresholds. (See "Use of blood products in the critically ill", section on 'Plasma indications' and "Use of blood products in the critically ill", section on 'Platelet indications'.) 

Dexmedetomidine for palliative sedation
Evidence for various medications used for palliative sedation is limited. Benzodiazepines such as midazolam are often the first choice, although paradoxical agitation and delirium can be unwanted side effects with this drug class. In a trial involving 52 patients comparing dexmedetomidine, an alpha-2 agonist, with midazolam for palliative sedation, responsiveness was similar between the two groups at 72 hours, as was patient comfort and severity of delirium [2]. Dexmedetomidine appears to be an option that broadens the drug classes available for palliative sedation. (See "Palliative sedation", section on 'Sedative medications'.) 

High-dose influenza vaccine in older adults (September 2025, Modified November 2025) 
Among patients ≥65 years, most studies comparing high-dose (HD) with standard-dose (SD) inactivated influenza vaccine have observed reductions in hospitalization with the HD vaccine, but sometimes the number of events was small. In a randomized trial among more than 100,000 adults ≥65 years in Spain, HD vaccine reduced hospitalization for influenza or pneumonia compared with SD vaccine (relative vaccine effectiveness 24 percent) [20]. In a similar trial among more than 330,000 adults ≥65 years in Denmark, hospitalization rates were similar between the groups (relative vaccine effectiveness 6 percent) [21]. In a prespecified pooled analysis of data from these two trials, HD vaccine reduced hospitalization for influenza or pneumonia compared with SD vaccine (relative vaccine effectiveness 8.8 percent) [22]. We continue to favor HD over SD vaccine for this patient group. (See "Seasonal influenza vaccination in adults", section on 'Patients 65 years and older'.) 

Intensive versus conventional intraoperative blood pressure management
Optimum intraoperative blood pressure (BP) targets for individual patients are unclear. Strategies in three 2025 trials included:

  • Targeting mean arterial pressure (MAP) ≥80 mmHg compared with ≥60 mmHg (or at least 60 percent of the preoperative baseline BP) [9].
  • Targeting MAP based on risk of intraoperative hypotension (low risk 70 mmHg; intermediate risk 80 mmHg; high risk 90 mmHg) compared with avoiding MAP <65 mmHg [10]. 
  • Targeting MAP based on preoperative mean nighttime MAP compared with maintaining MAP ≥65 mmHg [11].

The incidence of postoperative composite outcomes (eg, acute kidney injury, myocardial injury, cardiac arrest, death) or functional disability was similar in study versus standard management groups in these trials. Notably, high-risk patients (eg, chronic hypertension with high baseline BP values) and high-risk procedures (eg, carotid endarterectomy, organ transplantation) were excluded. We aim to avoid prolonged or severe hypotension and target a MAP >65 mmHg. However, higher thresholds may be reasonable in high-risk patients. (See "Hemodynamic management during anesthetic care in adults", section on 'Establishing blood pressure targets'.)

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Cochrane Library

Cognitive behavioural therapy for insomnia in people with cancer Cochrane Library 31 October 2025
This Cochrane review found very low‐certainty to moderate‐certainty evidence suggesting that CBT‐I may offer small to very small improvements in patient‐reported insomnia severity, sleep quality, and most subjective sleep diary parameters when compared with inactive controls. Against aerobic activities, low‐certainty evidence indicates that CBT‐I may also improve insomnia severity and sleep quality. The incidence of SAEs appeared similar between CBT‐I and comparator groups, and the certainty of this evidence is very low.

Colchicine for the secondary prevention of cardiovascular events Cochrane Library 13 November 2025
People with cardiovascular disease using low‐dose colchicine as secondary prevention for at least six months benefit from reduced rates of myocardial infarction and stroke, without an increase in serious adverse events. Moderate‐certainty evidence did not show a benefit from low‐dose colchicine for the risk of mortality (i.e. all‐cause and cardiovascular mortality) or coronary revascularisation rates. Colchicine use was associated with an increased risk of gastrointestinal adverse events, which were typically described as mild and transient in nature. Additional studies are warranted to investigate the benefits and harms of low‐dose colchicine in relevant subgroups and in specific indications, such as long‐term use in individuals with stable coronary artery disease versus limited‐time use following acute coronary syndrome.

High‐frequency oscillatory ventilation versus conventional ventilation for infants with severe pulmonary dysfunction born at or near term Cochrane Library 11 November 2025
Based on the available evidence, we are very uncertain about the effects of HFOV on failed therapy. HFOV may increase mortality. We are unable to support or refute the use of HFOV in near‐term or term infants with severe pulmonary dysfunction. Further randomized controlled trials are needed, stratified by disease and including long‐term neurodevelopmental outcomes. There is also a need for studies comparing newer forms of CV and HFOV.

Indications and timings for caffeine initiation in preterm infants Cochrane Library 11 November 2025
The evidence is very uncertain about the effect of C2H and C72 on CLD and DMV compared to caffeine initiated within 24 hours of life and after 72 hours of life in high‐risk preterm infants, respectively. The evidence is very uncertain about the effect of C72 on DHS. C72H likely reduces CLD and apnea. In high‐risk preterm infants, C72H compared to caffeine treatment of symptomatic infants only, may result in little to no difference in all‐cause mortality until hospital discharge, but likely reduces CLD. C72H of life may result in little to no difference in any adverse event leading to caffeine cessation. The evidence is very uncertain about the effect of C72H on DMV and DHS. The evidence is very uncertain about the effect on all‐cause mortality until hospital discharge of caffeine initiated while on mechanical ventilation compared to initiated at time of extubation. Caffeine initiated while on mechanical ventilation may reduce CLD and may result in a large reduction in DMV. No studies reported any adverse events, apnea, or DHS. The results of ongoing studies could change the outcomes of this review.

Thiazolidinediones for people with chronic kidney disease and diabetes Cochrane Library 13 November 2025
Thiazolidinediones may have little or no effect on the risk of cardiovascular death, whilst the effects of severe hypoglycaemia or other cardiovascular and kidney outcomes were uncertain in people with CKD and type 2 diabetes. The effects of thiazolidinediones in people with CKD and type 2 diabetes are insufficient to provide firm conclusions. Future studies will address the benefits and harms of thiazolidinediones in this setting, reporting the core outcomes as prioritised by stakeholders to better inform decision‐making.

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Guidelines

ANZ Concussion Guidelines The Acquired Brain Injury in Children Research Program 2 November 2025

  • Early recognition, removal from play, and patient education improves outcomes.
  • Strict rest is not beneficial, early graduated return to activity improves recovery times.
  • Age-appropriate standardised concussion symptom inventory tools are useful in concussion management, while neuroimaging should not be routinely used.
  • Physical, cognitive and psychological comorbidities may impede recovery and are important therapeutic targets where post-concussion symptoms persist.
  • People with persistent post-concussion symptoms require timely, stepped collaborative care involving a multidisciplinary team with expertise in concussion management.

The first Australian evidence‐based guidelines on male infertility MJA 3 November 2025
Introduction: Infertility affects about one in six couples and a male factor may contribute to 50% of cases. Until recently, no Australian‐based clinical guidelines for the management of male infertility had been published. A panel of experts was assembled to formulate the first Australian evidence‐based guidelines on male infertility. 
Main recommendations:

  • The initial evaluation of male fertility should include a reproductive and medical history, physical (including scrotal) examination and semen analysis, and simultaneous evaluation of the female partner.
  • Further evaluation of men with suspected infertility should be guided by an expert in male reproduction and include hormonal evaluation and an estimate of testicular volume. Extra tests according to clinical indication are sperm DNA testing, somatic genetic testing and imaging.
  • Varicocele treatment should be considered in men with infertility who have a clinical varicocele(s) and associated clinical indications.
  • Men with azoospermia should be evaluated to differentiate between obstructive and non‐obstructive azoospermia.
  • Micro testicular sperm extraction is the preferred method of sperm retrieval in men with non‐obstructive azoospermia and prior diagnostic biopsy or fine needle aspiration is not required.
  • The management of male infertility should include counselling men regarding potentially modifiable risk factors, associated health conditions, and implications for their future health and offspring.
  • Surgical management of infertility includes retrieval of sperm for use in assisted reproductive technology and treatment of varicocele, and non‐surgical management includes management of hormonal disorders.
  • Specific guidelines are included for men with cryptorchidism, varicoceles and Klinefelter syndrome and cancer and male infertility.
  • Changes in management as a result of the guidelines: These first Australian evidence‐based guidelines will serve as a long overdue clinical aid to the large number of practitioners who provide services to men with infertility. The broad and comprehensive nature of the guidelines will facilitate evidence‐based care for the most common areas of male infertility. The formulation of these guidelines by experts representing key stakeholder organisations should enhance the promotion of the guideline statements and help raise awareness of this common condition.

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MJA

Changes in patient management after preoperative MRI for newly diagnosed breast cancer: a multicentre prospective observational study MJA 10 November 2025
The known: Preoperative breast MRI has higher sensitivity than conventional imaging, but little evidence confirms which patient subgroups are likely to benefit.
The new: MRI was most frequently requested for women with dense breasts. There was an absolute increase in mastectomy of 13 percentage points following MRI, and increases were seen for all subgroups except women aged ≥ 70 years and those for whom neoadjuvant therapy was already planned. The majority of changes in surgery plans (85%) were potentially justified by the final pathology findings.
The implications: MRI for selected women where conventional imaging is suboptimal may improve surgical planning and thus afford better outcomes. MRI is less likely to change outcomes in older women.

Sharing custodianship of learning: development of an Indigenous Nation-led learning charter model centring self-determination and wellbeing MJA 2 November 2025
The known: Narrow forms of learner recognition limit definitions of educational success. This is exacerbated for First Nations learners, who have historically and systematically been excluded by education systems.
The new: Agreements between Indigenous Nations and schools that operate on their Country create a foundation of shared custodianship for learners that centres the wellness of the Indigenous learner as a whole being.
The implications: The Indigenous Nation-led learning charter model that we developed sets the aspirations for all Aboriginal and Torres Strait Islander learners learning on a specific Country. It provides guidance and leadership in partnership with schools that centres First Nations learners.

The early implementation phase of the Omega-3 Test-and-Treat Program for reducing the risk of preterm birth, South Australia, 2021–22: an implementation evaluation study MJA 11 November 2025
The known: Preterm birth is associated with high infant morbidity and mortality. Omega-3 fatty acid supplementation can reduce the risk of preterm birth for women with low omega-3 fatty acid levels, but systematic identification of and treatment of low omega-3 fatty acid status during pregnancy is not undertaken.
The new: The Omega-3 Test and Treat Program is a feasible approach for identifying pregnant women who could benefit from omega-3 fatty acid supplementation. The characteristics of the women who were tested were similar to those of women who were not, indicating the broad and equitable reach of the program.
The implications: The Omega-3 Test and Treat Program could be conveniently integrated into routine antenatal care to reduce the risk of preterm birth in Australia.

The number of cancer-related deaths that could be attributable to spatial disparities in survival in Australia, 2010–2019: a retrospective population-based cohort study MJA 6 November 2025
The known: Despite improvements, cancer survival varies across Australia.
The new: More than one in ten cancer-related deaths could be attributed to spatial disparities in survival in Australia. This was estimated using Bayesian spatial modelling, applied to cancer registry data from across Australia. Patterns in attributable cancer deaths were analysed spatially and by geographical factors. While disparities differed by cancer type, the highest percentages of cancer-related deaths that were attributable to survival disparities were in remote and socio-economically disadvantaged areas.
The implications: By quantifying the impact of these survival disparities, these findings highlight the need for evidence-based interventions to reduce spatial disparities in cancer survival across Australia.

The power of recognising more: a qualitative study of young people’s perspectives on broader recognition for learning and wellbeing MJA 2 November 2025
The known: Education is a social determinant of health, yet systems often prioritise academic outcomes over wellbeing, overlooking the diverse ways young people learn and succeed — especially those experiencing disadvantage.
The new: This youth-led co-research project found that broader recognition of learning, through non-formal learning, trusted relationships, supportive environments and learner agency, strengthens wellbeing across three dimensions: knowledge and skills, subjective wellbeing, and social connection. 
The implications: Young people must be well to learn well. Redefining success in education to include recognition of broader learning — shaped by learners and their contexts — can enhance engagement, improve outcomes, disrupt disadvantage, and support more equitable systems that promote wellbeing and lifelong learning. 

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MJA insight

Are we at the point where not using AI in medicine poses risk? MJA insight 3 November 2025
Artificial intelligence (AI) is moving rapidly from promise to practice in Australian health care. While the potential of AI in medicine has been recognised for a number of years now, technologies such as scribes have now become ubiquitous. This transformation into AI-augmented practice extends well beyond medicine, with nursing care and allied health applications emerging on the near horizon too.

As Australians struggle with healthcare costs, many support greater government investment MJA insight 11 November 2025
Access to healthcare in Australia isn’t equal for everyone. Young adults, people with chronic diseases, people from lower socio-economic areas and people without private health insurance report significant challenges in being able to access the care they need.

Climate change is a health crisis — world leaders must deliver solutions MJA insight 11 November 2025
The Australian Medical Association will be watching the outcomes of COP30 closely. The disastrous health impacts of climate change are well known, and we must address this crisis without delay. Heat-related deaths have surged since the 1990s, now claiming half-a-million lives each year, according to the latest Lancet Countdown on health and climate change report. That equates to about one heat-related death every minute. It is a terrifying thought — but it is the reality we face.

Complex trauma and trauma-informed care over 30 years MJA insight 3 November 2025
Over the last 30 years, there have been significant advances in our understanding of ‘complex trauma’ — repeated ongoing and often extreme interpersonal violence, abuse and neglect, occurring at any life stage or over multiple stages. People experiencing the impacts of complex trauma benefit from medical practice which is trauma-informed.

Doctors wary of bulk-billing changes to Medicare MJA insight 11 November 2025
Not all GPs are convinced the Bulk Billing Practice Incentive Scheme will benefit their practice

Educating and advocating for an environmentally sustainable and climate-resilient future MJA insight 11 November 2025
Australia’s current and future doctors must be educated and equipped to provide healthcare in the face of the escalating climate crisis, the health impacts of which have been starkly outlined in the recently released National Climate Risk Assessment.

Lifestyle interventions must become a core part of mental health care MJA insight 3 November 2025
Australians living with severe mental illness continue to die around 15 years earlier than the general population. The majority of this gap is driven not by suicide but by preventable physical health conditions such as heart disease and diabetes.

National Nutrition Survey reveals how much red meat Australians are consuming MJA insight 3 November 2025
The 2023 national nutrition survey from the Australian Bureau of Statistics, published in September 2025, shows women are eating substantially  less red meat than men, averaging 47.8g a day with men consuming on average 64.3g per day. The Australian Dietary Guidelines (ADGs) advise up to 65g per day (a maximum of 455g cooked lean red meat per week) to enhance dietary variety and reduce some of the health risks associated with consuming excess meat.

Polycystic ovary syndrome: beyond the myth, towards better care MJA insight 10 November 2025
Around one in eight Australian women live with PCOS. Clearer diagnosis and multidisciplinary care are key to supporting their reproductive, metabolic and psychological health across the lifespan.

Unaccompanied child homelessness in Australia: How health care practitioners can respond MJA insight 11 November 2025
Health care practitioners are a key voice in championing the rights of unaccompanied children to survive, to receive health care, and to experience wellbeing, writes Associate Professor Catherine Robinson.

Why is Trump using autism as a political football? MJA insight 3 November 2025
The Trump administration and US Health Secretary RFK Jr have made several unscientific announcements about autism recently. After RFK Jr announced in April he would ‘find’ the cause of Autism by September, he then linked autism to the use of acetaminophen (Tylenol) by pregnant people, to vaccines, and even the cultural practice of circumcision. Why is autism receiving so much negative attention?

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BMJ

Advances in the management of acute decompensated heart failure BMJ 5 November 2025
Heart failure is a common condition that affects millions of people worldwide and is associated with substantial morbidity and mortality. Acute decompensated heart failure refers to the worsening of symptoms that requires changes in drugs or the start of new treatments such as non-invasive positive pressure ventilation. This review summarizes the current data and provides an evidence based approach to the diagnosis and management of acute decompensated heart failure. The review discusses common nomenclature and classifications of the condition, followed by the diagnostic accuracy of medical history, physical examination, electrocardiography, radiographs of the chest, point-of-care ultrasound, and laboratory testing. Current and emerging medical treatments are also discussed.

Cause specific mortality risks associated with tropical cyclones in multiple countries and territories: two stage, time series study BMJ 5 November 2025
After tropical cyclones, mortality risk increased variably for different causes, populations, and regions. Integrating epidemiological evidence into the development of management systems for climate extremes is urgently needed, particularly in regions with higher levels of deprivation and in those with historically fewer tropical cyclones. These measures are necessary to improve the adaptive capacity in responding to the growing risks and shifting activity of tropical cyclones in a warming climate. 

Continued versus discontinued oral anticoagulant treatment for unprovoked venous thromboembolism: target trial emulation BMJ 12 November 2025
Based on two US nationally representative routine care databases, continuing versus discontinuing oral anticoagulants (OACs) after initial anticoagulation of ≥90 days was associated with lower risk of recurrent venous thromboembolism (VTE) higher risk of major bleeding, and a net clinical benefit. This observation persisted among those using OACs for at least three years after VTE.

Diagnosis and management of metabolic dysfunction associated steatotic liver disease BMJ 13 November 2025
What you need to know

  • Metabolic dysfunction associated steatotic liver disease (MASLD) is the most common type of steatotic liver disease and affects one third of the adult population
  • MASLD is defined by steatosis plus at least one cardiometabolic risk factor, and patients with the condition are at increased risk of adverse cardiovascular and liver related events
  • Patients at risk of liver related adverse events can be identified by performing a blood test (FIB-4) and a measurement of liver stiffness using vibration controlled transient elastography
  • Treatment requires a multidisciplinary approach, including advice on lifestyle changes, management of risk factors associated with comorbidities, and, in those eligible, drug therapies

Greenness and hospital admissions for cause specific mental disorders: multicountry time series study BMJ 5 November 2025
Greenness was statistically associated with lower risks of hospital admissions for mental disorders in several countries, particularly in urban settings. Some adverse associations were, however, observed, and findings were heterogeneous across contexts.

Help me cope with new motherhood in the heat BMJ 5 November 2025
What you need to know

  • Effects of climate change can impact the physical and mental health of pregnant and postpartum women and their babies
  • Managing the effects of climate change, such as extreme heat, may help protect the mental wellbeing of new mothers
  • Engaging women in community climate action harnesses local knowledge and innovative capacities for sustainable solutions

Interpreting abnormal liver blood test results BMJ 13 November 2025
What you need to know

  • Core liver blood tests have low sensitivity and specificity for diagnosing liver disease, so consider an abnormal result a prompt to use a more specific test
  • Repeat a liver blood test only if you know the cause of the abnormality, and if you are not sure, establish the most likely cause first
  • Abnormal liver blood test results rarely return to normal within one month
  • Liver blood tests should not be interpreted in isolation, but used as part of a diagnostic pathway in conjunction with other investigations
  • Risk and prognosis in liver disease are determined by cause, more than degree of liver blood test abnormality 

Maternal paracetamol (acetaminophen) use during pregnancy and risk of autism spectrum disorder and attention deficit/hyperactivity disorder in offspring: umbrella review of systematic reviews BMJ 10 November 2025
Existing evidence does not clearly link maternal paracetamol use during pregnancy with autism or ADHD in offspring.

The impact of noise pollution on health BMJ 3 November 2025
What you need to know:

  • Noise pollution affects over 100 million people in Europe and is estimated to contribute to around 12 000 premature deaths and the loss of over one million healthy life years annually
  • Long term exposure to environmental noise is associated with a wide range of adverse health outcomes, including sleep disturbance and cardiovascular diseases
  • Effective management requires a multidisciplinary approach at the patient, provider, and policy levels to restore health, restrict exposure, reduce noise at its source, or, as a last resort, remodel the receiver’s environment

Vernakalant versus procainamide for rapid cardioversion of patients with acute atrial fibrillation (RAFF4): randomised clinical trial BMJ 11 November 2025
In this head-to-head comparison, vernakalant was superior to procainamide for patients with higher conversion rates and faster times to conversion. Therefore, vernakalant is a safe and highly effective intravenous alternative for the rapid cardioversion and discharge home of patients with acute atrial fibrillation.

Why health misinformation spreads—and honesty about uncertainty is the answer BMJ 13 November 2025
England’s chief medical officer said in a recent lecture that misinformation has always accompanied medical progress—and that the battle is winnable if we can talk honestly about uncertainty 

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JAMA

Caffeinated coffee consumption or abstinence to reduce Atrial Fibrillation: The DECAF randomized clinical trial JAMA 9 November 2025
In this clinical trial of coffee drinkers after successful cardioversion, allocation to consumption of caffeinated coffee averaging 1 cup a day was associated with less recurrence of AF or atrial flutter compared with abstinence from coffee and caffeinated products.

Evaluation of interventions for cognitive symptoms in Long COVID: A randomized clinical trial JAMA 10 November 2025
The trial failed to demonstrate differential benefits from online cognitive training, a structured cognitive rehabilitation program, or transcranial direct current stimulation in participants with cognitive long COVID.

Filtration rate and Albuminuria; A meta-analysis JAMA 7 November 2025
In this meta-analysis, SGLT2 inhibitors were found to lower the risk of CKD progression regardless of baseline eGFR or albuminuria, including in patients with stage 4 CKD or minimal albuminuria, supporting their routine use to improve kidney outcomes across the full spectrum of kidney function among patients with type 2 diabetes, CKD, or heart failure.

Functional Somatic Disorders in individuals with a history of sexual assault JAMA 12 November 2025
These findings suggest that sexual assault is associated with the risk of FSD, with a high prevalence of symptoms across organ systems, emphasizing the need for clinical awareness and preventive interventions.

Ketogenic diets and Depression and Anxiety: A systematic review and meta-analysis JAMA 5 November 2025
This systematic review and meta-analysis assesses the associations between ketogenic diets and mental health outcomes in adults, with a focus on depressive and anxiety symptoms.

Liberal or restrictive postoperative transfusion in patients at high cardiac risk: The TOP randomized clinical trial JAMA 8 November 2025
A liberal transfusion strategy compared with a restrictive strategy did not significantly reduce 90-day postoperative death or major ischemic event rates.

Metformin to improve walking performance in lower extremity Peripheral Artery Disease: The PERMET randomized clinical trial JAMA 8 November 2025
These results do not support metformin for improving walking performance in people with PAD.

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NEJM

Antithrombotic therapy after successful catheter ablation for Atrial Fibrillation NEJM 8 November 2025
Among patients who had had successful catheter ablation for atrial fibrillation at least 1 year earlier and had risk factors for stroke, treatment with rivaroxaban did not result in a significantly lower incidence of a composite of stroke, systemic embolism, or new covert embolic stroke than treatment with aspirin.

A phase 2 trial of Tobevibart plus Elebsiran in Hepatitis D NEJM 9 November 2025
In this phase 2 trial, tobevibart plus elebsiran as well as tobevibart monotherapy decreased hepatitis D virus (HDV) RNA and ALT levels through week 48. Treatment with tobevibart plus elebsiran was associated with a high incidence of undetectable HDV RNA and of a decrease in the HBsAg level.

Beta-Blockers after Myocardial Infarction with Normal Ejection Fraction NEJM 9 November 2025
In this meta-analysis including individual-patient data from five randomized trials, beta-blocker therapy did not reduce the incidence of death from any cause, myocardial infarction, or heart failure in patients with an LVEF of at least 50% after myocardial infarction without other indications for beta-blockers.

Digital nudges to increase influenza vaccination in patients with chronic diseases NEJM 10 November 2025
Electronically delivered, letter-based nudges significantly increased influenza vaccination among 18-to-64-year-old individuals with chronic diseases compared with usual care, when delivered during a second consecutive season. The largest effect size was with a strategy where a letter focused on the potential cardiovascular benefits of influenza vaccination was sent twice.

Fish-oil supplementation and Cardiovascular events in patients receiving Hemodialysis NEJM 7 November 2025
The rate of serious cardiovascular events among participants receiving maintenance hemodialysis was lower with daily supplementation with n−3 fatty acids than with placebo.

Opioid deprescribing in patients with non-cancer pain NEJM 5 November 2025
Key points

  • Opioids are commonly used to treat noncancer pain but have limited effectiveness, as compared with placebo or nonopioid analgesics, and are associated with an increased risk of harm.
  • Opioid deprescribing is recommended when the potential harms of opioid therapy outweigh the potential benefits and ideally involves the patient in shared decision making to tailor the plan to the patient’s circumstances, goals, and preferences.
  • Inflexible application of opioid deprescribing without considering the individual patient can worsen outcomes and lead to serious harm.
  • Key strategies for opioid deprescribing include forming an agreed-on and individualized deprescribing plan with the patient that includes tailored and gradual dose reduction with pauses if required, frequent monitoring to assess patient response and progress, and offering treatments to minimize withdrawal symptoms and other negative effects (e.g., provision of naloxone to mitigate the risk of overdose).
  • Maximizing the use of nonpharmacologic and noninterventional pain management strategies and providing psychosocial support and multidisciplinary care are also recommended, although trial evidence on their effectiveness is often limited.

Oral Icotrokinra for Plaque Psoriasis in adults and adolescents NEJM 5 November 2025
Selective blockade of the interleukin-23 receptor with the targeted oral peptide icotrokinra resulted in a significantly higher incidence of skin clearance at week 16 than placebo among adults and adolescents with moderate-to-severe plaque psoriasis. Longer-term data will provide a more complete understanding of the benefit–risk profile of icotrokinra.

Strategies to reinvigorate the bedside clinical encounter NEJM 12 November 2025
Key points:

  • Medical learners in the 21st century spend less time with patients during training than their counterparts did in the 20th century, which decreases the knowledge and practice of bedside clinical skills.
  • Decreased bedside clinical skills lead to diagnostic error, poor clinical outcomes, increased health care costs, and physician burnout.
  • Taking learners to the bedside facilitates clinical observation skills, creates opportunities to practice skills, and allows for evidence-based demonstrations of examination skills.
  • Integration of point-of-care technology and artificial intelligence in the clinical encounter complements human observation, human clinical decision making, and human communication.
  • Seeking opportunities to provide feedback on clinical skills in a context-specific way improves the technique at the bedside, as well as the interpretation of information obtained from the encounter.
  • Beyond the diagnostic data obtained in the bedside clinical encounter, the physical examination helps learners navigate clinical uncertainty, helps teachers model interactions with patients, improves physician–patient communication, increases professional fulfillment, and helps address health care disparities.

Ten-year survival after Postmastectomy Chest-Wall Irradiation in Breast Cancer NEJM 5 November 2025
In this trial, chest-wall irradiation did not result in higher overall survival than no chest-wall irradiation among patients with intermediate-risk, early breast cancer treated with mastectomy and contemporary adjuvant systemic therapy.

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Other journals

Acupuncture improves migraine and quality of life in patients with migraine: a systematic review with meta-analysis Systematic reviews 11 November 2025
Acupuncture was significantly associated with reduced migraine duration, number of migraine attacks, number of migraine days, and improved quality of life. However, due to language restrictions and potential bias, further rigorous trials are needed to identify its efficacy and relevant exploratory trials are also warranted.

A randomized control trial comparing Falls Reduction for Elderly Emergency Department (FREED) interventions and usual care BMC emergency medicine 6 November 2025
This study evaluated the effectiveness of a Falls Reduction for Elderly Emergency Department (FREED) intervention in reducing recurrent falls among older adults presenting to the emergency department (ED) after a fall at 6 months.

Effectiveness and safety of low-dose intraoperative tranexamic acid in cardiac surgery: a retrospective before-and-after study BMC Anesthesiology 7 November 2025
The routine implementation of low-dose intraoperative TXA in cardiac surgery was associated with a significant reduction in bleeding after cardiac surgery, without an increased risk of thrombotic complications or seizures.

‘I just didn’t find time to exercise’: Co-designed physical activity resources for young Australian shiftworkers Health promotion international 4 November 2025
Shiftworkers are vital to essential industries yet often experience adverse health impacts, including barriers to regular physical activity. Young shiftworkers face additional challenges due to the transitional life stage and the increase of unhealthy behaviours. This study aimed to co-design tailored, evidence-based physical activity resources to support the health and wellbeing of young shiftworkers.

Incidence and risk factors for unplanned intensive care unit transfer from the postanesthesia care unit: a case-control study BMC Anesthesiology 10 November 2025
In adult patients who underwent general anesthesia surgery, the incidence of UIAP was 0.115%. UIAP was significantly associated with an increased risk of ICU readmission. We identified emergency surgery, a higher ASA classification, ≥ 2 comorbidities, increased intraoperative blood loss and longer operative time as potential risk factors for unplanned transfer from the PACU to the ICU after general anesthesia. Additionally, increased preoperative hemoglobin level was a protective factor for UIAP patients.

Long-term cardiovascular events in individuals hospitalised with COVID-19: a retrospective cohort BMC infectious diseases 7 November 2025
These findings suggest a substantial burden of cardiovascular complications post-COVID-19, underscoring the need for health services to be prepared and commence screening and preventive measures for individuals at higher risk.

Risk factors of pressure injury in elderly inpatients: a systematic review and meta-analysis BMC geriatrics 10 November 2025
Pressure injury remains a serious and preventable complication among elderly inpatients. This study provided a comprehensive evaluation of the risk factors of pressure injury development among elderly inpatients, identifying eight major contributors. These findings may promote valuable evidence to inform clinical assessment, risk stratification, and the development of targeted prevention strategies.

Safety and efficacy of subcutaneous injection with HMI-115 versus placebo in endometriosis-associated pain in premenopausal women: a multicentre, double-blind, randomised, proof-of-concept phase 2 trial The Lancet Obstectrics, gynaecology and Women’s health 6 November 2025
In this proof-of-concept phase 2 trial, blocking the prolactin receptor with HMI-115 showed an acceptable tolerability profile and promising efficacy in alleviating endometriosis-associated pain. These findings support further investigation of HMI-115 in a phase 3 trial with a longer treatment duration to confirm clinical benefits and assess risk of harm.

The effects of short- and long-duration Kangaroo Mother Care and conventional care on improving weight gain in low birth weight infants: a systematic review and meta-analysis BMC pediatrics 10 November 2025
This study demonstrates that both short- and long-duration KMC effectively improve growth and breastfeeding outcomes in LBW infants, albeit with differential advantages across endpoints. Short-duration KMC was more effective for optimizing length gain and exclusive breastfeeding, while long-duration KMC provided greater benefits for weight and head growth. The findings suggest that KMC duration should be tailored based on specific clinical needs.

The impact of virtual reality (VR) on pain management in the emergency department: a systematic review and meta-analysis BMC emergency medicine 10 November 2025
Overall, VR offers effective pain management in adults and pediatric patients with non-procedural acute pain and those undergoing painful procedures in the ED.

Vascular and inflammatory diseases after COVID-19 infection and vaccination in children and young people in England: a retrospective, population-based cohort study using linked electronic health records The Lancet child and adolescent health 5 November 2025
Children and young people have higher risks of rare vascular and inflammatory diseases up to 12 months after a first COVID-19 diagnosis and higher risk of rare myocarditis or pericarditis up to 4 weeks after a first BNT162b2 vaccine, although the risk following vaccination is substantially lower than the risk following infection. These findings are of great importance for national policy makers and caregivers considering vaccination consent for children, and support the public health strategy of COVID-19 vaccination in children and young people to mitigate the more frequent and persistent risks associated with SARS-CoV-2 infection.

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