New legislation now allows doctors to prescribe and mail abortion medications anonymously. This California (USA) law is intended to protect both patients and health professionals from legal threats and disciplinary action, particularly in the wake of U.S. states seeking to restrict abortion access.

The measure also ensures continued availability of abortion drugs such as mifepristone, even if the U.S. Food and Drug Administration (FDA) revokes its federal approval. This approach mirrors ongoing European discussions about safeguarding access to reproductive health services when political or regulatory environments become restrictive.

"California stands for a woman's right to choose," said Newsom. "I'm proud to sign these bills to protect access to essential health care and shield patients and health care providers in the face of amplified attacks on the fundamental right to reproductive freedom."

The law was enacted following the overturning of Roe v. Wade, which ended the federal guarantee of abortion rights in the United States. In Europe, debates over abortion vary widely: while access is broadly protected in countries such as France and Sweden, others - including Poland and Malta - maintain strict legal barriers. California's move can thus be seen as part of a larger international conversation about safeguarding reproductive autonomy in the face of rising political opposition.

Under the law, pharmacists in California may dispense abortion medications without patient-identifying information on packaging. Records of prescriptions are kept internally, accessible only by law enforcement through subpoena, and are specifically shielded from access by out-of-state authorities.  The legislation also mandates that health plans cover abortion drugs and adds protections for clinicians who prescribe, dispense, or transport them, shielding them from lawsuits or professional sanctions. 

California's action was prompted partly by a lawsuit filed in Texas against a California doctor who had mailed abortion medication across state lines. To further reinforce protections, Newsom also signed additional bills, including measures to prevent disciplinary action against lawyers advising on abortion cases and to strengthen privacy around patient data near reproductive health clinics.

How do you feel about politics and policy increasingly shaping what doctors can and cannot do in medicine?

Medical research drives progress in healthcare, but it is also one of the greatest sources of frustration for clinicians. Every day, new studies claim to revolutionize practice, and yet many of them collapse within a few years-or worse, are quietly abandoned. For doctors, the constant churn breeds skepticism: if "the latest evidence" so often turns out to be wrong, why should we trust it in the first place?

The scale of the problem was laid bare by John Ioannidis in 2005, when he published Why Most Published Research Findings Are False in PLoS Medicine. Using a Bayesian framework, he demonstrated that in fields with small sample sizes, low prior probabilities, and high flexibility in design and reporting, the majority of positive findings are likely false positives. Two decades later, his thesis has only grown more relevant.

Evidence bears this out. A landmark JAMA study of highly cited clinical research found that one-third of trials were later contradicted or had much smaller effects when retested in larger, better studies. A Mayo Clinic Proceedings review identified 146 cases of "medical reversals"-treatments once thought effective but later proven ineffective or harmful-within just ten years. In oncology, replication efforts have been especially sobering: a Nature Cancer perspective reported that only 11% of landmark cancer biology experiments could be reproduced under rigorous testing.

The crisis extends to the supposed "gold standard" of evidence-systematic reviews and meta-analyses. A 2025 JAMA Internal Medicine analysis found that 35% of meta-analyses changed their conclusions by at least 10% once retracted studies were removed. A parallel BMJ study showed how retracted trials contaminated guidelines, leading to flawed clinical recommendations. This isn't just noise in the literature-it directly affects what doctors are told is "best practice."

The research community itself acknowledges the depth of the problem. A 2024 international survey of over 1,600 biomedical scientists reported that 72% believe there is a reproducibility crisis, and 62% blame pressure to publish as a key driver. The Brazilian Reproducibility Initiative, one of the largest of its kind, confirmed the same reality on the ground: fewer than half of regional biomedical experiments reproduced successfully, showing this is not just a Western problem but a global one.

This leaves doctors caught in the middle-bombarded with claims, expected to update practice instantly, and later blamed when those claims unravel. The constant cycle erodes trust not just in individual studies, but in the research enterprise itself. It fosters a culture of cynicism where many clinicians quietly roll their eyes at the next "breakthrough" headline, even as academic medicine insists they should celebrate it.

And perhaps here lies the most ironic twist. This very essay, critiquing the biases and weaknesses of research, is itself built entirely on published studies.

And yet, there is a strange kind of hope in this chaos. The fact that medicine overturns itself so often is not just evidence of failure-it is evidence that science is self-correcting. Every reversal is painful, but it is also progress: a sign that medicine is willing to admit its mistakes and move closer to the truth. The problem is not that doctors are too skeptical; the problem is that skepticism is not celebrated as part of good clinical practice.

Perhaps the silver lining is this: doctors, by necessity, are becoming the best skeptics in science. We are the ones forced to weigh weak data against lived patient outcomes, to recognize when a study's "significant" finding is clinically meaningless, and to resist the seduction of novelty. If researchers embraced that same pragmatism-valuing replication as highly as discovery-perhaps the literature would become as trustworthy as the doctors who must rely on it. Until then, maybe the most provocative thought is this: the cynicism of clinicians is not the problem in medicine. It might be the solution.

References

• Ioannidis JPA. Why Most Published Research Findings Are False. PLoS Med. 2005;2(8):e124. 

• Prasad V, et al. A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices. Mayo Clin Proc. 2013;88(8):790-798.

• Grimes DR, et al. Towards replicability and sustainability in cancer research. Nat Cancer. 2024;5:609–616.

• Possamai A, et al. Inclusion of Retracted Studies in Systematic Reviews and Meta-analyses. JAMA Intern Med. 2025.

• Xu S, et al. Investigating the impact of trial retractions on evidence synthesis. BMJ. 2025;389:e082068. 

• Cobey KD, et al. Biomedical researchers' perspectives on reproducibility. J Clin Epidemiol. 2024;163:58-68.

The landscape of modern medicine has always evolved with science, technology, and social change. But in 2025, the most aggressive force reshaping healthcare delivery has been political. This year, physicians worldwide have felt a tightening grip of political authority around their clinical autonomy. From reproductive care to mental health access, from Vaccine distribution to gender-related treatment policies, medicine is increasingly at the mercy of lawmakers. These aren't peripheral issues-they're core matters of patient care, ethics, and scientific integrity. The medical community is now reckoning with a difficult truth: politics is no longer outside the clinic; it's in the room with the patient.

In the United States, legislative battles around abortion have reached new levels of complexity. Since the fall of Roe v. Wade, over a dozen states have passed or expanded laws that criminalize doctors for performing or even recommending certain reproductive procedures, even in medically urgent situations. In 2025, several high-profile cases have shown physicians facing prosecution for providing standard miscarriage management or ectopic pregnancy care. The legal environment is now so precarious that hospitals in restrictive states often delay critical care while waiting for legal teams to weigh in. This creates moral distress for physicians, many of whom now practice in constant fear of lawsuits or even arrest-just for doing what they were trained to do.

Outside the U.S., similar trends are unfolding. In parts of Latin America and Eastern Europe, governments have tightened control over what is considered "acceptable" reproductive care, often under the guise of protecting national values or traditional family structures. Physicians in countries like Hungary and El Salvador report mounting pressure to withhold information or restrict access to contraception and abortion, even when it goes against clinical guidelines. Meanwhile, international NGOs trying to provide comprehensive reproductive health services are being blocked or defunded. These constraints have created a two-tiered healthcare system-one for those with means to travel and another for those left behind.

One of the most heated and politically charged areas in 2025 has been gender-affirming care. Several countries have enacted legislation banning or severely limiting this type of care for minors, while others are placing restrictions on adult services as well. As doctors, we're taught to respect patients and evidence-but this issue has become increasingly fraught. Some physicians, myself included, have genuine concerns about the long-term impacts of hormone therapy and surgical interventions in adolescents. We've seen cases where patients later regret transitioning or feel they were rushed into decisions without adequate psychological assessment. These concerns are not rooted in hatred, but in caution, ethics, and a responsibility to "do no harm." Yet raising such concerns today often leads to accusations of bias or professional misconduct. Political and institutional forces seem determined to silence even respectful debate within the medical field, leaving many physicians to navigate these dilemmas quietly, without guidance or support.

The politicization of public health has also disrupted our ability to respond effectively to infectious disease outbreaks. In several countries, Vaccine programs have stalled due to partisan interference. In India, for instance, regional governments have delayed the rollout of a new dengue Vaccine due to internal power struggles, despite surging infection rates. In the U.S., routine childhood vaccination rates continue to decline, fueled by political figures who cast doubt on their safety or necessity. Physicians are once again in the position of defending settled science in the face of misinformation, while battling mistrust from patients who view every public health recommendation as a political statement.

Another major impact of politics this year has been on mental health funding and policy. In the wake of post-COVID burnout, economic strain, and social polarization, demand for mental health services has skyrocketed. Yet several governments-particularly in the UK, Italy, and Australia-have cut funding for public mental health programs as part of broader austerity agendas. In practice, this has left general practitioners, emergency room physicians, and pediatricians scrambling to manage complex psychiatric cases without adequate support. Waiting lists have ballooned. Suicide rates have risen in several countries. And physicians are increasingly asked to take on roles they are not fully trained for, simply because the systems meant to support them are collapsing under political pressure.

Even international medical collaboration has suffered. Geopolitical tensions, especially among NATO, BRICS, and non-aligned states, have made global health data harder to access. Projects on infectious disease surveillance, antibiotic resistance, and climate-related health threats have stalled due to nationalism and protectionism. Several governments are now blocking cross-border data sharing unless certain political conditions are met. This slows response time during outbreaks, stifles innovation, and undermines trust among health professionals who once relied on international cooperation to advance their work.

Ultimately, what 2025 has taught us is that medicine cannot remain insulated from politics. Whether we like it or not, our clinical decisions, patient relationships, and professional obligations are now being shaped by external forces-sometimes subtly, sometimes overtly. Physicians must adapt to this new reality. We must stay informed, protect our ethical ground, and advocate where needed. And we must find ways to voice dissent, even within a system that increasingly prefers compliance. The health of our patients-and the integrity of our profession-depends on it.

The limits of learning in medicine often reveal themselves in the contrast between the boundless expansion of knowledge and the finite capacity of individual doctors. Medical science evolves at a pace that no human being can realistically match, with journals, studies, and clinical guidelines updating daily. Even the most diligent physician cannot hope to internalize everything, and so choices must be made about what is worth mastering and what must remain peripheral. Specialization becomes not just a preference but a necessity, carving medicine into fragments that no single mind can fully hold.

Time places another boundary on learning. Doctors work within a rhythm dictated by patients, emergencies, and administrative demands, leaving limited space for continuous study. Medical education does not end with graduation, yet professional life rarely allows for the same immersion as those years of training. Learning becomes a process of triage, where the urgent and the directly applicable take precedence, while broader knowledge can only be skimmed.

Memory and attention, fallible by nature, impose further restrictions. Clinical reasoning relies on patterns and heuristics precisely because no one can recall every possible detail. These shortcuts are efficient but imperfect, leading to oversights and diagnostic errors. The tension between the ideal of total knowledge and the reality of cognitive limits underscores the value of decision support systems, guidelines, and teamwork. Learning cannot be limitless when the human brain itself has boundaries.

Finally, there is the irreducible limit of uncertainty. Medicine will always involve questions without answers, conditions without cures, and patients who do not respond as expected. No amount of study or experience can eliminate this. Learning in medicine ultimately runs into the edge of what science itself can explain, and the practice becomes as much about navigating ambiguity as it is about applying knowledge.

What emerges from these limits is not defeat but perspective. The physician's task is not to master every fact, but to cultivate wisdom in choosing what matters most, to lean on collaboration where personal knowledge falls short, and to recognize that uncertainty is not a failure but an inherent part of care. In this way, the boundaries of learning do not diminish the role of the doctor-they define it. The value of medicine rests not in the illusion of limitless knowledge, but in the humility to act within its limits while still striving for progress.

Do you have a personal system (alerts, journals, colleagues, podcasts, etc.) for staying updated - and do you actually remember and apply the new things you learn?

MONDAY, May 6, 2024 (HealthDay News) -- Among outpatients, 7.0 percent have at least one adverse event (AE), with adverse drug events being the most common, according to a study published online May 7 in the Annals of Internal Medicine.

Noting that knowledge of outpatient AEs remains limited, David M. Levine, M.D., M.P.H., from Harvard Medical School in Boston, and colleagues describe the frequency and types of harm that occurred at 11 outpatient sites during one year. Data were reviewed for 3,103 patients who received outpatient care. Possible AEs were identified by nurse reviewers and adjudicated by physicians.

The researchers found that 7.0 percent of patients had at least one AE (8.6 events per 100 patients per year). The most common AEs were adverse drug events, health care-associated infections, and surgical or procedural events (63.8, 14.8, and 14.2 percent, respectively). AEs were never fatal; 17.4 and 2.1 percent were serious and life-threatening, respectively. Of the AEs, 23.2 percent were preventable. Having at least one AE occurred less often at ages 18 to 44 years versus ages 65 to 84 years (standardized risk difference, −0.05) and occurred more often with Black versus Asian race (standardized risk difference, 0.09). Overall, 1.8 to 23.6 percent of patients had at least one AE across study sites; there was considerable variation observed in the clinical category of AEs.

"We believe these data serve as an urgent call for patient safety research and innovation in the outpatient setting," the authors write.

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WEDNESDAY, May 29, 2024 (HealthDay News) -- From 2007 to 2019, there was an increase in inflation-adjusted health care spending, largely due to increasing contributions to premiums, according to a research letter published online May 28 in JAMA Internal Medicine.

Sukruth A. Shashikumar, M.D., from the Beth Israel Deaconess Medical Center in Boston, and colleagues conducted a cross-sectional study using 2007 to 2019 Medicare Expenditure Panel Survey data for respondents and family members younger than 65 years with private insurance to understand changes in the financial burden of health care. Families' total health care spending was calculated as a contribution of premiums plus out-of-pocket medical and prescription drug spending; annual financial medical burden was assessed by dividing their total health care spending by postsubsistence income.

The unweighted sample included 96,075 families and the mean annual weighed population included 83,523,039 families. The researchers observed an increase in inflation-adjusted mean total health care spending from $3,920 to $4,907, mainly due to an increase in contributions to premiums. The financial medical burden was 8.4 and 9.8 percent of postsubsistence income in 2007 and 2019, respectively. Mean total health care spending was $3,163 and $3,247 in 2007 and 2019, respectively, for low-income families, and their medical burden was 23.5 and 26.4 percent, respectively. Among higher-income families, the corresponding mean total health care spending was $4,071 and $5,239 and medical burden was 5.4 and 6.5 percent in 2007 and 2019.

"Our findings highlight the need to strengthen financial safeguards for low-income families," the authors write.

One author disclosed ties to a health insurance company; a second author disclosed ties to the pharmaceutical industry.

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COVID-19 was associated with more severe disease outcomes than influenza or respiratory syncytial virus (RSV) during the 2022 to 2023 season, according to a study published online Jan. 27 in JAMA Internal Medicine.

Kristina L. Bajema, M.D., from Veterans Affairs Portland Health Care System in Oregon, and colleagues compared disease severity of COVID-19, influenza, and RSV among U.S. veterans in a retrospective cohort study. The cumulative incidence and risk differences were calculated for the primary outcomes of 30-day hospitalization, intensive care unit admission, and death.

The researchers found that the 30-day risk for hospitalization was similar for COVID-19 and influenza (16.2 versus 16.3 percent) and was lower for RSV (14.3 percent) during the 2023 to 2024 season. The 30-day risk for death was slightly higher for COVID-19 compared with influenza or RSV during the 2022 to 2023 season (1.0 percent versus 0.7 and 0.7 percent), but was similar during the 2023 to 2024 season. At 180 days, mortality risk was higher for COVID-19 during both seasons. In both seasons, higher mortality was seen for veterans without COVID-19 vaccination in the previous year compared with those without seasonal influenza vaccination. In contrast, no mortality differences were seen at any time point between COVID-19 and influenza among those vaccinated against their respective infections.

"Severe acute respiratory syndrome coronavirus 2 was far more common than influenza or RSV and resulted in more severe disease outcomes, including short-term hospitalization and mortality through six months," the authors write. "This was most apparent among older adults and attenuated by updated COVID-19 vaccination."

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WEDNESDAY, April 17, 2024 (HealthDay News) -- There was a 67.4 percent increase in head and neck computed tomography angiography (CTA) ordering for emergency department patients presenting for headache or dizziness from 2017 through 2021, according to a study published online March 21 in Internal and Emergency Medicine.

Grant H. Rigney, from Harvard Medical School in Boston, and colleagues examined trends in head and neck CTA ordering in patients with emergent concerns for nonfocal neurological complaints and determined whether a correlation exists between imaging utilization and positivity rates. The analysis included data from 24,892 patients presenting with headache and/or dizziness to the emergency department of a single quaternary referral center (January 2017 through December 2021).

The researchers found that 9.1 percent of patients underwent head and neck CTA imaging, with an increase in the percentage of patients who received a scan from 7.89 percent in 2017 to 13.24 percent in 2021. This increase represents a 67.4 percent increase from baseline (odds ratio, 1.14). Over time, the positivity rate (the percentage of scans ordered that revealed attributable acute pathology) declined from 16.8 percent in 2017 to 10.4 percent in 2021 (odds ratio, 0.86), a 38 percent reduction in positive examinations.

"This finding suggests the increasing trend does not reflect increasing need, and that hospitals should take steps to ensure that imaging is appropriately used," co-senior author Marc Succi, M.D., also from Harvard Medical School, said in a statement.

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STAT

An article in JAMA Internal Medicine, “Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum,” generated a great deal of discussion — much of it horrified. In particular, people are focusing on the study’s conclusions: that “chatbot responses were longer than physician responses, and the study’s health care professional evaluators preferred chatbot-generated responses over physician responses 4 to 1. Additionally, chatbot responses were rated significantly higher for both quality and empathy, even when compared with the longest physician-authored responses.”

While this study is thought-provoking and has generated much interesting discussion, that conversation isn’t focusing on the real root of the problem in physician-patient communication: time.When I read the article, I found myself thinking about a recent conversation with my extended family of nonphysicians. I explained why doctors have hours of work after we’re finished seeing patients. “What is it that you have left to do when all the patients have gone home?” they asked. It has to do with electronic medical records, I told them — more specifically, something called the EMR in-basket. Unfortunately, most of us have no dedicated time in the day to respond to them.

All of this provides important context to the recent uproar over the “empathetic chatbot” research. Before we rush to accept that generative AI is more empathetic than human physicians, let’s take a moment to dive into the details and methods of the study. It is important to note that this was not a comparative study of “chatbot versus human” in real-world conditions, i.e., the EMR. The real heart of the matter isn’t whether generative AI truly has the human capacity of empathy (it doesn’t), but how the shortage of physician time and corresponding high rates of burnout affect physician empathy...Read more

How can an AI chatbot truly compare to a human physician?

Interprofessional addiction consultation services significantly increase postdischarge medication for opioid use disorder (MOUD) initiation and engagement among patients with opioid use disorder, according to a study published online July 29 in JAMA Internal Medicine.

Jennifer McNeely, M.D., from New York University Grossman School of Medicine in New York City, and colleagues assessed whether interprofessional hospital addiction consultation services increase initiation and engagement in MOUD treatment after discharge. The analysis included 2,315 adults with hospitalizations identified through Medicaid claims (October 2017 to January 2021) at one of six public hospitals randomly assigned to addiction consultation teams (composed of a medical clinician, social worker or addiction counselor, and peer counselor) or usual care.

The researchers found that initiation of MOUD was 11.0 percent in the Consult for Addiction Treatment and Care in Hospitals (CATCH) program versus 6.7 percent with treatment as usual. Further, engagement in MOUD was 7.4 versus 5.3 percent, and continuation for six months was 3.2 versus 2.4 percent. Odds of initiating MOUD were 7.96 times higher (log-odds ratio, 2.07) and odds of 30-day MOUD engagement were 6.90 times higher (log-odds ratio, 1.93) for patients hospitalized during the CATCH program.

"The observed rates of MOUD initiation and engagement were still low; further efforts are still needed to improve hospital-based and community-based services for MOUD treatment," the authors write.

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As more countries and states legalize medical aid in dying (MAiD), discussions around ethics, legality, and access have taken center stage. However, one critical question remains underexplored: Do we fully understand the safety, efficacy, and potential complications of the drugs used in assisted dying? While these medications are meant to provide a peaceful, dignified passing, research suggests that complications, prolonged deaths, and inconsistent protocols may pose significant concerns.

Unlike most medical treatments, there is no single standardized drug regimen for assisted dying. Different countries, and even states within the U.S., use varying combinations of medications to induce death. These protocols typically involve a combination of barbiturates, benzodiazepines, opioids, muscle relaxants, or cardiac-affecting drugs, yet research on their effectiveness and potential complications remains limited. For example, in Oregon, over 70% of cases in 2022 used a combination of diazepam, digoxin, morphine sulfate, amitriptyline, and phenobarbital (DDMAPh), while 28% used a slightly modified version without phenobarbital (DDMA). Meanwhile, Canada has adopted a protocol using midazolam, propofol, and rocuronium, whereas the Netherlands primarily relies on high-dose barbiturates. These inconsistencies raise concerns about whether some regimens may be more effective or humane than others.

Despite the assumption that assisted dying is quick and painless, medical reports suggest that complications do occur. A 2024 study published in JAMA Internal Medicine found that while most cases followed expected trajectories, some patients experienced prolonged deaths, vomiting, or muscle spasms (myoclonus). In some cases, death took as long as 47 hours—raising ethical concerns about patient suffering. Other reported issues include:

• Delayed absorption of drugs, leading to extended or unpredictable time of death.
• Difficulty in maintaining IV access, requiring multiple attempts or additional interventions.
• Incomplete sedation, leading to distress before full unconsciousness.

These challenges highlight the need for more research into the pharmacokinetics and optimal drug combinations to ensure predictable, painless outcomes.

Most of the medications used in assisted dying were not originally designed for this purpose—many were repurposed from anesthesia or palliative care. Physicians administering MAiD often rely on trial-and-error adjustments to protocols based on patient response, yet there is no universally accepted "gold standard" for ensuring rapid, painless, and complication-free death. What happens when drugs do not work as expected? How often do patients experience unanticipated suffering? These are difficult but necessary questions that require more research and transparency.

Moreover, reporting on assisted dying outcomes is inconsistent. In some jurisdictions, data collection is minimal, making it difficult to assess how frequently complications occur or which protocols are most effective. A 2023 study found that in some cases, complications were significantly underreported, making it hard to develop evidence-based improvements in drug administration. As more jurisdictions legalize assisted dying, there is a growing need for clinical research into the most effective, humane, and reliable drug regimens. However, due to ethical concerns and regulatory barriers, controlled trials on assisted dying drugs remain a gray area in medical research. What are your thoughts?

FRIDAY, March 3, 2023 (HealthDay News) -- Breast cancer risk estimates for individual women vary substantially depending on which risk assessment model is used, according to a study published online Feb. 7 in the Journal of General Internal Medicine.

Jeremy S. Paige, M.D., Ph.D., from the University of California in Los Angeles, and colleagues assessed the accuracy and disagreement between three commonly used risk models (Breast Cancer Risk Assessment Tool [BCRAT], Breast Cancer Surveillance Consortium [BCSC] model, and International Breast Intervention Study [IBIS] model) in categorizing individual women as average versus high risk for developing invasive breast cancer. The analysis included 31,115 women (40 to 74 years) presenting for screening mammography at a multisite health system between 2011 and 2015 with five-year follow-up.

The researchers found that when using the ≥1.67 percent threshold, more than 21 percent of women were classified as high risk for developing breast cancer in the next five years by one model but were classified as average risk by another model. When using the ≥3.0 percent threshold, more than 5 percent of women had disagreements in risk severity between models. For the threshold of ≥1.67 percent, almost half of the women (46.6 percent) were classified as high risk by at least one of the three models versus 11.1 percent when using the ≥3.0 percent threshold. At the population level, all three models had similar accuracy.

"Women are likely receiving vastly different recommendations depending on which breast cancer risk model is used and which cutoff is used to define 'high risk,'" the authors write.

One author receives royalty payments from licenses for commercial use of the IBIS algorithm, through Cancer Research U.K.

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Inappropriate antibiotic prescribing is common with or without a plausible antibiotic indication, and inappropriate prescribing is also common in U.S. emergency department visits, according to a study published online April 26 in the Journal of General Internal Medicine and a second study published May 14 in Antimicrobial Stewardship and Healthcare Epidemiology.

Joseph B. Ladines-Lim, M.D., Ph.D., from the University of Michigan in Ann Arbor, and colleagues examined the differences in inappropriate prescribing with or without a plausible indication between safety-net and non-safety-net populations. The analyses included 67,065,108 and 122,731,809 weighted visits for children and adults, respectively. The researchers found that the prevalence of inappropriate antibiotic prescribing was 11.7 and 22.0 percent, respectively, with a plausible indication among children in the safety-net and non-safety-net populations and 11.8 and 8.6 percent, respectively, without a plausible indication. For adults, the corresponding prevalence was 12.1 and 14.3 percent and 48.2 and 32.3 percent.

In a second study, Ladines-Lim and colleagues used national emergency department visit data from 2016 to 2021 to estimate the proportion of visits with inappropriate antibiotic prescribing. There were 819,395,799 weighted emergency department visits; 18.6 percent of these visits had one or more antibiotic prescription. The researchers found that 27.6 percent of the visits with antibiotic prescriptions had inappropriate prescribing, with 14.9 and 12.7 percent, respectively, with and without a plausible antibiotic indication. Of visits with inappropriate antibiotic prescribing, 54.0 and 46.0 percent had and did not have a plausible antibiotic indication, respectively.

"Emergency department antibiotic stewardship initiatives should focus both on reducing antibiotic prescribing for infectious, antibiotic-inappropriate conditions and on improving coding quality for antibiotic prescriptions," write the authors of the second study.

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WEDNESDAY, Feb. 1, 2023 (HealthDay News) -- A 12-month vigorous or moderate aerobic exercise program can produce long-term beneficial effects on diabetes prevention in individuals with central obesity, according to a research letter published online Jan. 30 in JAMA Internal Medicine.

Ying Chen, M.D., Ph.D., from Fudan University in Shanghai, and colleagues assessed the long-term effect of a 12-month vigorous or moderate exercise intervention (coached and supervised) on incident diabetes during 10 years of follow-up. The analysis included participants with central obesity and nonalcoholic fatty liver disease who were randomly assigned to vigorous aerobic exercise (73 individuals), moderate aerobic exercise (73 individuals), or a nonexercise control group (74 individuals). Participants were asked not to change their diet.

The researchers observed no significant differences between the groups at 10-year follow-up, although there was a trend of higher levels of leisure-time physical activity in the exercise groups versus the control group. The risk for diabetes was lower in the vigorous aerobic exercise group (relative risk, 0.51) and in the moderate aerobic exercise group (relative risk, 0.47) versus the nonexercise group. Similarly, hemoglobin A1c and waist circumference were significantly reduced in the vigorous and moderate exercise groups versus the nonexercise group. Fasting plasma glucose level and weight regain trended lower in the exercise groups than the nonexercise group, although not significantly.

“Our results are supportive of physical exercise as an effective scheme for obesity management to delay the progression of type 2 diabetes," the authors write.

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MONDAY, July 24, 2023 (HealthDay News) -- For patients with gout and type 2 diabetes, sodium-glucose cotransporter-2 inhibitors (SGLT2is) are associated with a reduced risk for recurrent gout flares and gout-primary emergency department visits and hospitalizations, and they confer cardiovascular benefits, according to a study published online July 25 in the Annals of Internal Medicine.

Natalie McCormick, Ph.D., from Massachusetts General Hospital in Boston, and colleagues compared gout flares and cardiovascular events among patients with gout and type 2 diabetes initiating SGLT2is versus dipeptidyl peptidase 4 inhibitors (DPP-4is) in a propensity score-matched cohort study.

The researchers found that the flare rate was lower among SGLT2i initiators than DPP-4i initiators after propensity score matching (52.4 versus 79.7 events per 1,000 person-years, respectively; rate ratio [RR], 0.66; rate difference [RD], −27.4 per 1,000 person-years). For gout-primary emergency department visits and hospitalizations, the corresponding RR and RD were 0.52 and −3.4 per 1,000 person-years. For myocardial infarction, the corresponding hazard ratio and RD were 0.69 and −7.6 per 1,000 person-years. The hazard ratio for stroke was not significantly lower. A higher risk for genital infection was seen for those who initiated SGLT2is (hazard ratio, 2.15); the risk for osteoarthritis encounter was not altered.

"Given the pleiotropic cardiometabolic benefits associated with SGLT2is among patients with type 2 diabetes, this class of medications may be a particularly attractive addition to our current urate-lowering therapies to simultaneously address the high burden of gout and cardiometabolic sequelae," the authors write.

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FRIDAY, Jan. 26, 2024 (HealthDay News) -- Coronary artery disease (CAD) testing within 90 days of hospitalization for heart failure is associated with a lower risk for heart failure readmission or all-cause mortality, according to a study published online Jan. 18 in the Journal of General Internal Medicine.

Cheng‑Wei Huang, M.D., from Kaiser Permanente Los Angeles Medical Center, and colleagues assessed whether widespread CAD testing in patients with new-onset heart failure leads to improved outcomes. The analysis included 2,729 adults with new-onset heart failure with reduced ejection fraction hospitalized within one of 15 Kaiser Permanente Southern California medical centers between 2016 and 2021.

The researchers found that 54.5 percent of patients received CAD testing, and after a median of 1.8 years, the testing group had a reduced risk for heart failure readmission or all-cause mortality (adjusted hazard ratio, 0.71; 95 percent confidence interval, 0.63 to 0.79). These results persisted across subgroups with a history of atrial fibrillation, diabetes, renal disease, myocardial infarction, or elevated troponin during hospitalization. Regardless of timing of CAD testing, findings were similar (early testing, or received testing before discharge, versus late testing, or up to 90 days after discharge: adjusted hazard ratio, 0.97; 95 percent confidence interval, 0.81 to 1.16).

"Further studies are necessary to examine factors associated with testing as well as testing completion to identify areas that may be more suitable for intervention to improve testing rates," the authors write.

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WEDNESDAY, Feb. 21, 2024 (HealthDay News) -- Measles cases around the globe have climbed 79%, with over 300,000 cases reported last year, World Health Organization officials said Tuesday.

The U.N. health agency said it did not yet have a tally for measles deaths in 2023, but it expects that number will also rise.

"In 2022, the number of deaths increased by 43%, according to our models, to more than 130,000 deaths occurring from measles," Natasha Crowcroft, WHO's technical adviser on measles and rubella, said during a news conference.

"We would anticipate an increase in deaths in 2023 as well," Crowcroft added.

The WHO announcement came as a south Florida school district reported several cases of the measles. On Friday, Broward County Public Schools announced one confirmed case at Manatee Bay Elementary School, but that number jumped to four overnight, CBS News reported.

Health experts say outbreaks like that could soon become more common. Despite the fact that measles was declared eradicated in the United States more than two decades ago, declining vaccination rates are fueling new outbreaks and jeopardizing herd immunity in this country, CBS News reported.

"The way this viral illness spreads, we foresee that the number of unvaccinated children, the immune-compromised, we will start to see an increase in those numbers definitely," Dr. Pallavi Aneja, program director of Internal Medicine Residency at HCA FL Northwest and Westside Hospitals, told CBS News.

Looking ahead, 2024 is going to be "very challenging," Crowcroft added. 

"One of the ways we predict what's going to happen in terms of outbreaks and cases is looking at the distribution of unimmunized children," she said during the Tuesday media briefing. "We can see from data that's produced with WHO data by the U.S. CDC that more than half of all the countries in the world will be at high or very high risk of outbreaks by the end of this year."

More information

The U.S. Centers for Disease Control and Prevention has more on the measles.

SOURCE: CBS News

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MONDAY, June 26, 2023 (HealthDay News) -- Time-restricted eating (TRE) is more effective for weight loss than control, but is no more effective than calorie restriction (CR), according to a study published online June 27 in the Annals of Internal Medicine.

Shuhao Lin, a registered dietician from the University of Illinois Chicago, and colleagues conducted a 12-month randomized controlled trial involving 90 adults with obesity who were randomly assigned to eight-hour TRE (eating between noon and 8.00 p.m. only, without calorie counting), CR (25 percent energy restriction daily), or control (eating over a period of 10 or more hours per day). The study was completed by 77 adults (mean age, 40 years; 33 percent Black and 46 percent Hispanic).

The researchers found that the mean reduction in energy intake was −425 and −405 kcal/day for TRE and CR, respectively. Compared with the control group, weight loss by month 12 was −4.61 and −5.42 kg for the TRE and CR groups, respectively, with no statistically significant differences observed between the groups.

"Patient preference and other individual-specific considerations regarding ease of implementation can guide clinical choice of dietary weight loss intervention," write the authors of an accompanying editorial. "Further research is needed to understand who may do better with TRE versus CR."

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