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Editorial | Top-down and bottom-up approaches to low-value care

15 Feb, 2023 | 16:08h | UTC

Top-down and bottom-up approaches to low-value care = BMJ Quality & Safety

Original Study: Evaluation of the NHS England evidence-based interventions programme: a difference-in-difference analysis – BMJ Quality & Safety

 

Commentary on Twitter

 

Worsening heart failure: nomenclature, epidemiology, and future directions

15 Feb, 2023 | 16:06h | UTC

Worsening Heart Failure: Nomenclature, Epidemiology, and Future Directions: JACC Review Topic of the Week – Journal of the American College of Cardiology

 

Cohort Study | Incidence of acute cardiac events during COVID-19-associated hospitalizations

15 Feb, 2023 | 16:05h | UTC

Acute Cardiac Events During COVID-19-Associated Hospitalizations – Journal of the American College of Cardiology

Editorial: Acute Cardiovascular Complications of COVID-19: The High Risk of Underlying Heart Disease – Journal of the American College of Cardiology

 

Consensus Paper | ED management of patients with alcohol intoxication, alcohol withdrawal, and alcohol use disorder

14 Feb, 2023 | 11:05h | UTC

Emergency Department Management of Patients with Alcohol Intoxication, Alcohol Withdrawal, and Alcohol Use Disorder: A White Paper Prepared for the American Academy of Emergency Medicine – The Journal of Emergency Medicine

 

Diagnostic Study | Level of attention to motherese speech as an early marker of autism spectrum disorder

14 Feb, 2023 | 11:04h | UTC

Summary: A study was conducted to determine if levels of attention to motherese speech can be used as a diagnostic marker for autism spectrum disorder (ASD) and if they are associated with social and language abilities. The study involved 653 toddlers aged 12 to 48 months and used gaze-contingent eye tracking to measure attention to motherese speech. The results showed that toddlers without ASD had high levels of fixation on motherese speech, while those with ASD had significantly reduced levels. If a toddler fixated on motherese speech at or below 30%, the probability of them being accurately diagnosed with ASD was 94%, and it was also associated with reduced social and language abilities. The findings suggest that attention to motherese speech may be a diagnostic and prognostic marker of ASD.

(By ChatGPT, reviewed and edited)

 

Article: Level of Attention to Motherese Speech as an Early Marker of Autism Spectrum Disorder – JAMA Network Open

Commentaries:

Attention to motherese speech is a promising early diagnostic marker for autism spectrum disorder – News Medical

Toddlers’ Attention to ‘Motherese’ Could Give Clues to Autism – HealthDay

 

Developments under assisted dying legislation: the experience in Belgium and other countries

14 Feb, 2023 | 11:02h | UTC

Summary: The legalization of assisted dying (including euthanasia and physician-assisted suicide) remains a controversial issue as more countries consider such laws. A selective literature review was conducted to examine the developments globally, and the experience in Belgium was found to be instructive. Since legalization, the practice of assisted dying has increased gradually, accompanied by a growing acceptance among the public and physicians. Although fears have been largely alleviated, ongoing monitoring and research are necessary to address important concerns. Research in Belgium has not found evidence of harmful effects, but the implementation of assisted dying laws should always consider integration into the healthcare system, physician training, conscientious objection, availability of palliative care, public education, and monitoring systems. To ensure the quality of end-of-life care, it is advisable to set up monitoring and evaluation systems and carry out impartial studies. It is important to have high levels of openness and involvement with healthcare providers and the general public.

(By ChatGPT, reviewed and edited)

 

Article: Developments Under Assisted Dying Legislation: The Experience in Belgium and other countries – Deutsches Ärzteblatt international

 

Performance of ChatGPT on USMLE: potential for AI-assisted medical education using large language models

14 Feb, 2023 | 11:00h | UTC

Summary: The researchers evaluated the performance of ChatGPT, a large language-based AI, on the United States Medical Licensing Exam (USMLE). The USMLE is a set of three standardized tests required for medical licensure in the US. The results showed that ChatGPT performed at or near the passing threshold (60%) on all three exams without specialized training or reinforcement. The AI also demonstrated a high level of concordance and insight in its explanations, suggesting that it may have potential to assist with medical education and potentially, clinical decision-making in the future. This marks a notable milestone in AI maturation and increased confidence in its trust and explainability.

(By ChatGPT, reviewed and edited)

 

Article: Performance of ChatGPT on USMLE: Potential for AI-assisted medical education using large language models – PLOS Digital Health

News Release: ChatGPT can (almost) pass the US Medical Licensing Exam – PLOS

Commentaries:

Expert reaction to study on ChatGPT almost passing the US Medical Licensing Exam – Science Media Centre

New and surprising evidence that ChatGPT can perform several intricate tasks relevant to handling complex medical and clinical information – News Medical

 

Commentary from one of the authors on Twitter (thread – click for more)

 

Perspective | ChatGPT-assisted diagnosis: is the future suddenly here?

14 Feb, 2023 | 10:59h | UTC

Summary: The article discusses the potential of ChatGPT, a new AI chatbot, to revolutionize medical diagnosis. It compares ChatGPT’s performance with that of symptom checkers and physicians, finding that it performs better than symptom checkers and is approaching the accuracy of physicians. The article highlights the limitations of the study, including the small sample size and sensitivity of results to the way information is presented. It also acknowledges potential challenges with the use of AI in medical diagnosis, including the need for more rigorous testing, the issue of feeding patient information into an algorithm, and the possibility of AI algorithms being biased. Despite these challenges, the article suggests that the future of computer-assisted diagnosis is here and the healthcare system will need to address these challenges.

(By ChatGPT, reviewed and edited)

 

Source: ChatGPT-assisted diagnosis: Is the future suddenly here? – STAT

 

Opinion | The “evidence pyramid” should be dismantled, brick by ill-conceived brick

14 Feb, 2023 | 10:57h | UTC

Summary: The text criticizes the use of the so-called “evidence pyramid” in medicine, which suggests that systematic reviews and meta-analyses (SRMAs) are the highest level of evidence in medicine. The author argues that SRMAs are not evidence themselves, but a lens through which actual evidence from randomized controlled trials (RCTs) and observational studies is viewed. They depend on the quality of the review process and the evidence appraised, which are often low quality and small studies with various methodologies. The author suggests that a better framework would place RCTs at the top of the pyramid and relegates SRMAs to the role of a lens. The author also points out that good observational studies may be better than bad RCTs, and that each paper should be read and judged on its individual merits, not by its strata on a pyramid.

(By ChatGPT, reviewed and edited)

 

Source: The “evidence pyramid” should be dismantled, brick by ill-conceived brick – Sensible Medicine

 

Perspective | Generating scholarly content with ChatGPT: ethical challenges for medical publishing

14 Feb, 2023 | 10:58h | UTC

Summary: The article discusses the ethical challenges posed by the use of ChatGPT, an AI chatbot, in medical publishing. The authors note that the impact of generative AI on medical publishing is currently unknown, but it could have substantial ethical implications, including copyright, attribution, plagiarism, and authorship issues. The authors argue that there is a growing need for robust AI author guidelines in scholarly publishing, and that the International Association of Scientific, Technical, and Medical Publishers has produced a white paper on AI ethics. They also raise concerns about the potential for ChatGPT to widen existing disparities in knowledge dissemination and scholarly publishing, as well as the potential for the chatbot to produce misleading or inaccurate content. The authors call on The Lancet Digital Health and the Lancet family to initiate discussions around the implications of AI-generated content within scholarly publishing and to create comprehensive guidance.

(By ChatGPT, reviewed and edited)

 

Article: Generating scholarly content with ChatGPT: ethical challenges for medical publishing – The Lancet Digital Health

 

Podcast | “Things we do for no reason” pearls

14 Feb, 2023 | 10:56h | UTC

#381 LIVE! Patient Centered Things We Do For No Reason – The Curbsiders

 

Cohort Study | In utero exposure to ADHD medication does not seem to result in worse offspring neurodevelopmental outcomes

14 Feb, 2023 | 10:54h | UTC

Summary: The authors conducted a study to investigate the long-term effects of in utero exposure to ADHD medication (methylphenidate, amphetamine, dexamphetamine, lisdexamphetamine, modafinil, atomoxetine, clonidine) on offspring. The study followed 1,068,073 liveborn singletons from 1998 to 2018 and compared the outcomes of children whose mothers continued or discontinued ADHD medication during pregnancy. The main outcomes were neurodevelopmental psychiatric disorders, impairments in vision or hearing, epilepsy, seizures, or growth impairment during childhood or adolescence. After adjustment for demographic and psychiatric characteristics of the mother, no increased risk of any developmental disorders was found in offspring exposed to ADHD medication compared to those not exposed. The results provide reassurance for women with ADHD who depend on medication and consider continuing it during pregnancy.

(By ChatGPT, reviewed and edited)

 

Article: In utero exposure to ADHD medication and long-term offspring outcomes – Molecular Psychiatry (link to abstract – $ for full-text)

News Release: Study: Pregnant women on ADHD medications shouldn’t worry about pediatric neurodevelopmental disorders – The Mount Sinai Hospital

 

Commentary from the author on Twitter (thread – click for more)

 

Study suggests long-term caloric restriction could slow biological aging in healthy adults

14 Feb, 2023 | 10:52h | UTC

Summary: The article reports the results of a study that analyzed the impact of caloric restriction (CR), defined as reducing caloric intake without depriving essential nutrients, on DNA methylation, a measure of aging, in blood samples from the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) trial. The results showed that the CALERIE intervention slowed the pace of aging, as measured by the DunedinPACE DNAm algorithm, but did not lead to significant changes in biological age estimates measured by various DNAm clocks. The authors note that while treatment effect sizes were small, a modest slowing of the pace of aging can have a significant impact on population health. They also highlight the need for further trials with long-term follow-up to establish the effects of interventions on primary healthy-aging endpoints, including the incidence of chronic disease and mortality.

(By ChatGPT, reviewed and edited)

 

Article: Effect of long-term caloric restriction on DNA methylation measures of biological aging in healthy adults from the CALERIE trial – Nature Aging

Commentaries:

Long-term caloric restriction has a small effect on the DNA methylation measure of the pace of aging – News Medical

Expert reaction to study looking at long-term caloric restriction on DNA methylation measures of biological aging in healthy adults – Science Media Centre

Restrict calories to live longer, study says, but critics say more proof is needed – CNN

 

Recommended adult immunization schedule, United States, 2023

13 Feb, 2023 | 13:06h | UTC

Recommended Adult Immunization Schedule, United States, 2023 – Annals of Internal Medicine

Commentary: Recommended 2023 Adult Immunization Schedule Published – HealthDay

 

Commentary on Twitter

 

RCT | Azithromycin reduces the risk of maternal sepsis or death in women planning a vaginal birth

13 Feb, 2023 | 13:02h | UTC

Azithromycin to Prevent Sepsis or Death in Women Planning a Vaginal Birth – New England Journal of Medicine (link to abstract – $ for full-text)

News Release: Single-dose antibiotic prevents maternal sepsis and death – NIH News

Commentaries:

In large study, a single antibiotic dose slashed rate of sepsis in childbirth – STAT

Dose of azithromycin found to cut risk of maternal death, sepsis in childbirth – CIDRAP

Single dose of the antibiotic azithromycin decreases sepsis and death risk during childbirth – News Medical/ University of Virginia Health System

 

RCT | Tenecteplase noninferior to alteplase in acute ischemic cerebrovascular events

13 Feb, 2023 | 12:59h | UTC

Tenecteplase versus alteplase in acute ischaemic cerebrovascular events (TRACE-2): a phase 3, multicentre, open-label, randomised controlled, non-inferiority trial – The Lancet (link to abstract – $ for full-text)

Related: Tenecteplase vs. alteplase for treatment of acute ischemic stroke: A systematic review and meta-analysis of randomized trials – Frontiers in Neurology

 

Updated child and adolescent immunization schedule, United States, 2023

13 Feb, 2023 | 13:05h | UTC

Child and Adolescent Immunization Schedule by Age – Centers for Diseases Control and Prevention

See also: Recommended Childhood and Adolescent Immunization Schedule: United States, 2023 – Pediatrics

Commentary: Immunization Schedule for Children, Teens Updated for 2023 – HealthDay

 

RCTs | Endovascular therapy improves functional outcomes in large ischemic strokes, but increases bleeding and vascular complications

13 Feb, 2023 | 13:00h | UTC

Study 1: Trial of Endovascular Thrombectomy for Large Ischemic Strokes – New England Journal of Medicine (link to abstract – $ for full-text)

Commentary: Major international study finds thrombectomy highly effective treatment for large strokes – University Hospitals Cleveland Medical Center

Study 2: Trial of Endovascular Therapy for Acute Ischemic Stroke with Large Infarct – New England Journal of Medicine (link to abstract – $ for full-text)

 

M-A | Tenecteplase vs. alteplase for treatment of acute ischemic stroke

13 Feb, 2023 | 12:57h | UTC

Tenecteplase vs. alteplase for treatment of acute ischemic stroke: A systematic review and meta-analysis of randomized trials – Frontiers in Neurology

Related: Tenecteplase versus alteplase in acute ischaemic cerebrovascular events (TRACE-2): a phase 3, multicentre, open-label, randomised controlled, non-inferiority trial – The Lancet (link to abstract – $ for full-text)

 

Perspective | Five new realities in critical care for patients with cancer

13 Feb, 2023 | 12:53h | UTC

Five new realities in critical care for patients with cancer – Intensive Care Medicine

Related:

Consensus Conference: Critically ill cancer patient’s resuscitation.

Raising awareness for time-limited trial discussion upon ICU triage and admission.

Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study

 

Commentary on Twitter

 

Video | ChatGPT: will it transform the world of health care?

13 Feb, 2023 | 12:55h | UTC

ChatGPT: Will It Transform the World of Health Care? – UCSF Department of Medicine

Related:

ChatGPT and the future of medical writing (ChatGPT itself wrote this paper)

ChatGPT: five priorities for research – Nature

The path forward for ChatGPT in academia – Lumo’s Newsletter

Nonhuman “Authors” and Implications for the Integrity of Scientific Publication and Medical Knowledge – JAMA

ChatGPT is fun, but not an author – Science

Tools such as ChatGPT threaten transparent science; here are our ground rules for their use – Nature

ChatGPT listed as author on research papers: many scientists disapprove – Nature

Abstracts written by ChatGPT fool scientists

 

RCT | A deprescribing intervention reduced medication burden among older adults in post-acute care

13 Feb, 2023 | 12:50h | UTC

Deprescribing Medications Among Older Adults From End of Hospitalization Through Postacute Care: A Shed-MEDS Randomized Clinical Trial – JAMA Internal Medicine (free for a limited period)

Related:

Achieving sustainable healthcare through deprescribing of unnecessary medications: making sense of the evidence – Cochrane Library

Deprescribing medicines in older people living with multimorbidity and polypharmacy: the TAILOR evidence synthesis – Health Technology Assessment

Barriers and facilitators to deprescribing of cardiovascular medications: a systematic review – BMJ Open

A National Modified Delphi Consensus Process to Prioritize Experiences and Interventions for Antipsychotic Medication Deprescribing Among Adult Patients With Critical Illness – Critical Care Explorations

Deprescribing proton pump inhibitors – Australian Journal of General Practice

Medication reviews and deprescribing as a single intervention in falls prevention: a systematic review and meta-analysis – Age and Ageing

Optimizing Medication Use in Older Adults With Rheumatic Musculoskeletal Diseases: Deprescribing as an Approach When Less May Be More – ACP Open Rheumatology

Facing the challenge of polypharmacy when prescribing for older people with cardiovascular disease. A review by the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy – European Heart Journal – Cardiovascular Pharmacotherapy

Deprescribing in Older Adults with Cardiovascular Disease – Journal of the American College of Cardiology

Multimorbidity in Older Adults with Cardiovascular Disease – American College of Cardiology, Latest in Cardiology

Antihypertensive Deprescribing in Older Adults: a Practical Guide – Current Hypertension Reports

How-to guide for medication reviews in older adults with cancer: A Young International Society of Geriatric Oncology and Nursing & Allied Health Interest Group initiative – Journal of Geriatric Oncology

Deprescribing in Palliative Cancer Care – Life

Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review – Kidney360

Process evaluation of implementation strategies to reduce potentially inappropriate medication prescribing in older population: A scoping review – Research in Social and Administrative Pharmacy

AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review – Gastroenterology

Development of a Metric to Detect and Decrease Low-Value Prescribing in Older Adults – JAMA Network Open

The MedSafer Study—Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial – JAMA Internal Medicine

Quantifying Anticholinergic Burden and Sedative Load in Older Adults with Polypharmacy: A Systematic Review of Risk Scales and Models – Drugs & Aging

Deprescribing in palliative patients with cancer: a concise review of tools and guidelines – Supportive Care in Cancer

Prescribing practices, patterns, and potential harms in patients receiving palliative care: A systematic scoping review – Exploratory Research in Clinical and Social Pharmacy

A narrative review of evidence to guide deprescribing among older adults – Journal of General and Family Medicine

Polypharmacy, inappropriate prescribing, and deprescribing in older people: through a sex and gender lens – The Lancet Health Longevity

Polypharmacy Management in Older Patients – Mayo Clinic Proceedings

Psychopharmacological Treatment in Older People: Avoiding Drug Interactions and Polypharmacy – Deutsches Ärzteblatt international

Eliminating Medication Overload: A National Action Plan – Lown Institute

International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP): Position Statement and 10 Recommendations for Action – Drugs & Aging

Common ED Medication Errors: Polypharmacy – emDocs

Current and future perspectives on the management of polypharmacy – BMC Family Practice

Routine deprescribing of chronic medications to combat polypharmacy – Therapeutic Advances in Drug Safety

Polypharmacy—an Upward Trend with Unpredictable Effects – Deutsches Ärzteblatt international

Clinical Consequences of Polypharmacy in Elderly – Expert Opinion on Drug Safety

 

Commentary on Twitter

 

The Lancet Series | Breastfeeding 2023

13 Feb, 2023 | 12:52h | UTC

Homepage: Breastfeeding 2023 – The Lancet

Editorial: Unveiling the predatory tactics of the formula milk industry

Breastfeeding: crucially important, but increasingly challenged in a market-driven world

Marketing of commercial milk formula: a system to capture parents, communities, science, and policy

The political economy of infant and young child feeding: confronting corporate power, overcoming structural barriers, and accelerating progress

Stemming commercial milk formula marketing: now is the time for radical transformation to build resilience for breastfeeding

Commentaries:

Expert reaction to review of formula baby milk – Science Media Centre

Lancet Series outlines baby formula companies’ exploitative marketing playbook to sell products – University of the Witwatersrand/News Medical

 

Consensus Statement | Development of an Enhanced Recovery After Surgery (ERAS) surgical safety checklist

10 Feb, 2023 | 14:03h | UTC

Development of an Enhanced Recovery After Surgery Surgical Safety Checklist Through a Modified Delphi Process – JAMA Network Open

 

Commentary from the author on Twitter (thread – click for more)

 

Guideline for management of septic arthritis in native joints

10 Feb, 2023 | 14:00h | UTC

Guideline for management of septic arthritis in native joints (SANJO) – Journal of Bone and Joint Infection

 

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