General Interest
RCT: Lack of significant effect of Paxlovid (nirmatrelvir–ritonavir) on symptom alleviation in Covid-19
26 Apr, 2024 | 11:49h | UTCStudy Design and Population:
This phase 2–3 randomized clinical trial investigated the efficacy of nirmatrelvir in combination with ritonavir for treating mild-to-moderate Covid-19 in adults. Participants, both vaccinated and unvaccinated, were enrolled based on their risk factors for severe Covid-19. The study included 1296 adults who had confirmed Covid-19 with symptom onset within the past 5 days. They were randomly assigned to receive either nirmatrelvir–ritonavir or placebo every 12 hours for 5 days.
Main Findings:
The primary endpoint was the time to sustained alleviation of all targeted Covid-19 signs and symptoms. Results showed that the median time to alleviation was 12 days for the treatment group and 13 days for the placebo group, a difference that was not statistically significant (P=0.60). Hospitalizations and deaths were slightly lower in the treatment group (0.8%) compared to the placebo group (1.6%), but this difference was also not statistically significant. Adverse events were similar across both groups, with dysgeusia and diarrhea being the most common in the treatment group.
Implications for Practice:
The findings indicate that nirmatrelvir–ritonavir treatment does not significantly reduce the time to symptom alleviation for Covid-19 compared to placebo among vaccinated or unvaccinated adults. These results suggest that further research is needed to explore the potential benefits of this treatment in specific subpopulations or in combination with other interventions.
Reference (free full-text):
Systematic Analysis: Global Burden and Trends of Nervous System Disorders, 1990–2021
21 Mar, 2024 | 11:10h | UTCStudy Design and Population
This study, a systematic analysis conducted by the Global Burden of Disease Study 2021, aimed to estimate the global, regional, and national health loss attributable to 37 unique nervous system conditions from 1990 to 2021. The researchers estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) across 204 countries. The analysis included morbidity and deaths directly resulting from damage to the central or peripheral nervous system, as well as neurological health loss from conditions where nervous system morbidity is a secondary outcome.
Main Findings
The collective global burden of these nervous system conditions emerged as the leading cause of DALYs in 2021, affecting approximately 3.40 billion individuals (43.1% of the global population) and resulting in 443 million DALYs. Although global DALY counts for these conditions increased by 18.2% from 1990 to 2021, there was a notable decrease in the age-standardised rates of deaths and DALYs by 33.6% and 27.0%, respectively. The conditions contributing most significantly to the age-standardised DALYs were stroke, neonatal encephalopathy, migraine, and Alzheimer’s disease among others.
Implications for Practice
This analysis underscores the critical need for effective prevention, treatment, and rehabilitation strategies for nervous system disorders, which now lead the global disease burden. Highlighting an 18.2% increase in DALY counts over the study period, it calls for heightened public health attention and resource allocation towards these conditions. The findings support the prioritization of nervous system health on the global health agenda and stress the importance of further research into modifiable risk factors and equitable access to care.
Reference
GBD 2021 Nervous System Disorders Collaborators (2024). Systematic Analysis: Global Burden and Trends of Nervous System Disorders, 1990–2021. The Lancet Neurology, Volume(issue), Pages. DOI: https://doi.org/10.1016/S1474-4422(24)00038-3. Access the study here: Link
Meta-Analysis: Efficacy of exercise modalities in major depressive disorder treatment
20 Mar, 2024 | 17:54h | UTCStudy Design and Population: This article presents a systematic review and network meta-analysis of randomized controlled trials to assess the optimal dose and modality of exercise for treating major depressive disorder, comparing its effects to psychotherapy, antidepressants, and control conditions such as usual care or placebo. The review included 218 unique studies encompassing 495 arms with a total of 14,170 participants who met the clinical cutoffs for major depression.
Main Findings: The findings revealed moderate reductions in depression symptoms for several exercise modalities when compared to active controls. Notably, walking or jogging, yoga, and strength training demonstrated the most significant effects. The effectiveness of exercise was found to be proportional to the intensity of the activity prescribed. Among these, yoga and strength training were identified as the most acceptable modalities for participants. However, the overall confidence in these results is low due to the high risk of bias in the included studies, with only one study meeting the criteria for a low risk of bias.
Implications for Practice: The study concludes that exercise, particularly walking or jogging, yoga, and strength training at sufficient intensities, can be an effective treatment for major depressive disorder. These modalities could be recommended alongside traditional treatments such as psychotherapy and antidepressants. Future research should focus on blinding participants and staff to mitigate expectancy effects and improve the reliability of findings. The inclusivity of exercise as a core treatment for depression could significantly impact treatment strategies and patient outcomes.
Reference: Noetel, M., et al. (2024). Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ, 384, e075847. DOI: https://doi.org/10.1136/bmj-2023-075847. Access the study here: [Link]
Perspective | Clinicians debate the usefulness of NAFLD name change
11 Aug, 2023 | 15:39h | UTCClinicians debate the usefulness of NAFLD name change – MDedge
Original article: From NAFLD to MASLD | New consensus changes fatty liver disease terminology to avoid stigmatization
Study | The high financial and human cost of quality metric reporting in hospitals
11 Aug, 2023 | 15:36h | UTCThe Volume and Cost of Quality Metric Reporting – JAMA (link to abstract – $ for full-text)
Author Interview: The Costs of Quality Reporting – JAMA
Commentaries:
The Cost of “Quality” – Emergency Medicine Literature of Note
How John Hopkins spent $5m and 108,478 hours on quality reporting in one year – HealthLeaders
The cost of quality metric reporting – Becker’s Hospital Review
[News Release] RCT | Semaglutide 2.4 mg reduces cardiovascular risk by 20% in adults with CVD & obesity
9 Aug, 2023 | 15:40h | UTCCommentaries:
SELECT: Semaglutide Cuts CV Events in Adults With Overweight or Obesity – TCTMD
Perspective | Creation and adoption of large language models in medicine
9 Aug, 2023 | 15:38h | UTCCreation and Adoption of Large Language Models in Medicine – JAMA (free for a limited period)
Commentary: Rethinking large language models in medicine – Stanford Medicine
Perspective | An AI-enhanced electronic health record could boost primary care productivity
9 Aug, 2023 | 15:36h | UTCAn AI-Enhanced Electronic Health Record Could Boost Primary Care Productivity – JAMA (free for a limited period)
Perspective | Large language models answer medical questions accurately, but can’t match clinicians’ knowledge
9 Aug, 2023 | 15:35h | UTCLarge Language Models Answer Medical Questions Accurately, but Can’t Match Clinicians’ Knowledge – JAMA (free for a limited period)
Perspective | Artificial-intelligence search engines wrangle academic literature
9 Aug, 2023 | 15:33h | UTCArtificial-intelligence search engines wrangle academic literature – Nature
Research Letter | GPT-3.5 and GPT-4 show low accuracy in citing journal articles
9 Aug, 2023 | 15:31h | UTCAccuracy of Chatbots in Citing Journal Articles – JAMA Network Open
Commentary on Twitter
21% of medical journal articles cited by GPT-4 were found to be fake; GPT-3.5 cited an estimated 98% fake articles. Narrower topics had more fake articles than broader topics. Despite its promise, ChatGPT is currently not a reliable source of medical data. https://t.co/DCTIkT1OkZ
— JAMA Network Open (@JAMANetworkOpen) August 9, 2023
Survey | The manifold costs of being a non-native English speaker in science
7 Aug, 2023 | 15:00h | UTCThe manifold costs of being a non-native English speaker in science – PLOS Biology
Commentary from the author: Non-native English speaking scientists work much harder just to keep up, global research reveals – The Conversation
News Releases:
The cost of being a non-native English speaker in science – PLOS
Science language barrier could cost countless careers – University of Queensland
Commentary on Twitter
Some potential solutions to reducing disadvantages for non-native English speakers in publishing & conferences
By @tatsuya_amano & colleagues from their seminal @PLOSBiology paperhttps://t.co/luBndai3FQ @PLOS pic.twitter.com/68x6rZBMW4
— Madhu Pai, MD, PhD (@paimadhu) August 5, 2023
RCT | Mammography screening with AI reduces workload by 44.3% without loss in detection efficacy
4 Aug, 2023 | 12:13h | UTCArtificial intelligence-supported screen reading versus standard double reading in the Mammography Screening with Artificial Intelligence trial (MASAI): a clinical safety analysis of a randomised, controlled, non-inferiority, single-blinded, screening accuracy study – The Lancet Oncology (link to abstract – $ for full-text)
News Release: First randomized trial finds AI-supported mammography screening is safe and almost halves radiologist workload – Lancet
Commentaries:
Large Mammography Study Shows Significant Benefits with AI-Aided Screening – Diagnostic Imaging
Evidence Review | AA and other 12-step programs outperform CBT for alcohol use disorder
2 Aug, 2023 | 14:05h | UTCAlcohol dependence: evidence and experience on 12 steps to recovery – Evidently Cochrane
Original study: Alcoholics Anonymous and other 12‐step programs for alcohol use disorder – Cochrane Library
UNESCO calls for global ban on smartphones in schools
28 Jul, 2023 | 14:26h | UTCReport: Technology in education – UNESCO
News Releases:
UNESCO calls for global ban on smartphones in schools – UN News
Smartphones in school? Only when they clearly support learning – UNESCO
Commentary: ‘Put learners first’: Unesco calls for global ban on smartphones in schools – The Guardian
Study | Only 11% of sports supplements listing botanical ingredients accurately declare contents, 12% contain FDA-prohibited stimulants
28 Jul, 2023 | 14:21h | UTCCommentaries:
Ensuring the Safety and Value of Supplements – JAMA Network Open
BMJ Investigation | Medical royal colleges receive millions from drug and medical devices companies
28 Jul, 2023 | 14:19h | UTCMedical royal colleges receive millions from drug and medical devices companies – The BMJ
News Release: Medical royal colleges receive millions from drug/medical device companies – BMJ Newsroom
Commentary on Twitter
Drug and medical device companies have given £9m to UK royal colleges in recent years.
Scroll through our series of #BMJInfographics to see how much individual companies have paid each college ? https://t.co/s03xSl18BP pic.twitter.com/PX1Lzmtb4N
— The BMJ (@bmj_latest) July 27, 2023
Study | New deep learning model effectively detects type 2 diabetes from chest X-rays
28 Jul, 2023 | 14:15h | UTC
Commentary on Twitter
"Your Chest-ray indicates you may have diabetes"https://t.co/1TEHWvG33D
The latest unexpected outgrowth of deep learning #AI @NatureComms @AyisPyrros and colleagues pic.twitter.com/wZcTT2GCy2— Eric Topol (@EricTopol) July 11, 2023
Cohort Study | BMI of 25.0–29.9 not linked with higher mortality in 21st century U.S. adults
25 Jul, 2023 | 13:58h | UTCNews Release: No increase in mortality for most overweight people, study finds – PLOS
Commentary: Expert reaction to study looking at BMI and all-cause mortality – Science Media Centre
Perspective | Digital health for aging populations
24 Jul, 2023 | 13:13h | UTCDigital health for aging populations – Nature Medicine (if the link is paywalled, try this one)
Perspective | Medicine is plagued by untrustworthy clinical trials. How many studies are faked or flawed?
24 Jul, 2023 | 13:12h | UTCMedicine is plagued by untrustworthy clinical trials. How many studies are faked or flawed? – Nature
Related: Dozens of recent clinical trials may contain wrong or falsified data (free study by John Carlisle)
Commentary on Twitter
.@Nature reports on the investigations that suggest that, in some fields, at least one-quarter of clinical trials might be problematic or even entirely made up. The researchers behind these investigations are calling for stronger scrutiny. https://t.co/uztDC6JwbH
— Nature Portfolio (@NaturePortfolio) July 22, 2023
Correspondence | Potential “healthy vaccinee bias” in a study of BNT162b2 vaccine against Covid-19
21 Jul, 2023 | 13:43h | UTC
Commentary from the author on Twitter (thread – click for more)
Our correspondence is out in @njem written w @VPrasadMDMPH & Ram Duriseti
We show v strong evidence of healthy vaccinee bias in an Israeli study of Pfizer booster vs covid death, which wasn't disclosed
Could explain ALL reported benefit of the booster?https://t.co/F3WeafvUnw pic.twitter.com/b29YQ0lblh
— Tracy Høeg, MD, PhD (@TracyBethHoeg) July 20, 2023
Study | Large language models show potential for medical question answering capabilities
20 Jul, 2023 | 11:12h | UTCLarge language models encode clinical knowledge – Nature
News Release: Benchmarking AI’s ability to answer medical questions – Nature Publishing Group
Changes to breast structure and function across a woman’s lifespan: implications for managing and modeling female breast injuries
19 Jul, 2023 | 14:29h | UTC
Survey Study | ChatGPT’s performance in simulated patient-provider interactions
19 Jul, 2023 | 14:28h | UTCPutting ChatGPT’s Medical Advice to the (Turing) Test: Survey Study – JMIR Medical Education
Related: ChatGPT’s responses to patient questions rated higher for quality and empathy than physicians