female

Patients with BRCA mutations should consider prophylactic ovariectomies prior to age 50 based upon this epidemiological simulation. James W. Mold, MD, MPH

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Importance Women with a BRCA1 or BRCA2 variant face a high lifetime risk of ovarian cancer and are often advised to undergo preventive surgery (bilateral salpingo-oophorectomy [BSO]) before cancer develops. The recommended age of BSO is 35 years for BRCA1 carriers and is 45 years for BRCA2 carriers, but some women choose to delay surgery until the age of menopause; there is no standard upper age at which surgery is no longer advised.

Objective To estimate the residual lifetime risk of ovarian cancer among BRCA carriers by current age and projected age at BSO.

Design, Setting, and Participants This was a prospective cohort study in an international cohort of BRCA carriers monitored for incident ovarian cancer. A life table analysis used age-specific ovarian cancer incidence rates and competing mortality rates to estimate lifetime risk of ovarian cancer among women with a BRCA1 or BRCA2 pathogenic variant with both ovaries intact and no prior ovarian cancer at baseline. Patients were recruited between 1995 and 2024 across 24 international centers, and the mean (SD) follow-up was 4.4 (3.9) years.

Exposure Timing of BSO, defined as immediate BSO, delayed BSO, or no BSO.

Main Outcome and Measures Residual lifetime risk of ovarian cancer.

Results The cohort consisted of 4286 BRCA1 and 1427 BRCA2 carriers between the ages of 30 and 74 years at baseline (mean [SD] age, 42.0 [10.8] years). There were 249 incident ovarian cancers in the follow-up period. The lifetime risk of ovarian cancer was 55.0% (95% CI, 48.8-61.9) for a BRCA1 carrier and 24.1% (95% CI, 15.1-36.6) for a BRCA2 carrier. A 30-year-old BRCA1 carrier with BSO delayed to age 50 years had a projected residual ovarian cancer risk of 23.9% (95% CI, 20.7-27.4). At age 75 years, the residual risk of ovarian cancer was estimated to be 8.4% (95% CI, 1.7-22.7) for a BRCA1 carrier and 3.7% (95% CI, 0.1-22.7) for a BRCA2 carrier.

Conclusions and Relevance The residual risk of ovarian cancer for older women in good health is sufficiently high to consider preventive surgery. BRCA1 carriers who defer BSO until age 50 years may face a substantial risk of developing ovarian cancer.

Author/s:

Vasily Giannakeas, PhD, Adriana I. Apostol, MD, Claudia Diella, et al.

Cervical Cancer Screening Updates—Focus on Self-Collected Primary Human Papillomavirus Testing

Mary Cervantes — Fri, 28 Aug 2026 01:36:17 +0000

Date Added:

August 27, 2026

Journal/Publication:

JAMA Internal Medicine: Clinical Insights

Publisher:

JAMA Internal Medicine

Publication Date:

August 24, 2026

URL:

Cervical Cancer Screening Updates—Focus on Self-Collected Primary Human Papillomavirus Testing

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2026.3980

Keywords

cervical cancer

Cervical Cancer Screening

Papillomavirus Testing

Screening Updates

Women's Health

MeSH

early detection of cancer

Early Detection of Cancer / standards

Early Detection of Cancer* / methods

American Cancer Society

Gynecologists

Papillomavirus Infections

uterine cervical neoplasms

Uterine Cervical Neoplasms* / diagnosis

primary health care

female

An update to the cervical cancer screening guidelines from the USPSTF. James W. Mold, MD, MPH

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The incidence and mortality of cervical cancer have fallen since the adoption of widespread screening, but it still disproportionately affects underserved populations in the US. Expanding access to screening, especially in primary care settings, may reduce these disparities and improve women’s health. This Clinical Insights article summarizes cervical cancer screening recommendations for patients with average and higher than average risk, including recommendations for self-collected human papillomavirus (HPV) testing. It highlights statements by the US National Cancer Institute–sponsored Enduring Guidelines Committee, which was established to continuously evaluate new technologies for cervical cancer screening, management, and surveillance.

Author/s:

Hunter K. Holt, MD, MAS, Yasaswi Kislovskiy, MSc, George F Sawaya

Diagnosis and Management of Resistant Hypertension: A Review

Megan George — Wed, 29 Apr 2026 21:23:10 +0000

Date Added:

April 29, 2026

Journal/Publication:

JAMA

Publication Date:

March 23, 2026

URL:

Diagnosis and Management of Resistant Hypertension: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2026.1221

Keywords

hypertension

drug therapy

Drug Resistance

Antihypertensive Agents

blood pressure

PMID (1):

41870448

MeSH

Antihypertensive Agents* / therapeutic use

blood pressure

Blood Pressure Monitoring

Ambulatory

drug resistance, bacterial

drug therapy

Combination

Hypertension* / complications

female

male

Humans

Hypertension* / drug therapy

Hypertension* / epidemiology

Hypertension* / therapy

Recommendations for the diagnosis and management of patients with resistant hypertension. James W. Mold, MD, MPH

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Importance: Hypertension, defined as office systolic blood pressure (SBP) 130 mm Hg or greater and/or diastolic blood pressure 80 mm Hg or greater, affects 43.9% of women and 49.5% of men in the US. Approximately 19.7% of patients treated for hypertension have apparent resistant hypertension (blood pressure ≥130/80 mm Hg) despite using 3 or more antihypertensive medications, preferably a renin-angiotensin system blocker, a calcium channel blocker, and a thiazide-type diuretic, at maximally tolerated doses.

Observations: Approximately 10% of patients treated for hypertension have true resistant hypertension confirmed with home or 24-hour ambulatory blood pressure monitoring to exclude white-coat hypertension (approximately 37.5% of apparent resistant hypertension) and after excluding medication nonadherence (approximately 50%) and secondary hypertension such as primary aldosteronism (approximately 5%-25%). Conditions associated with resistant hypertension include obesity, diabetes, chronic kidney disease, and sleep apnea. Resistant hypertension is associated with increased risk of cardiovascular death vs controlled blood pressure at 5 years to 10 years (absolute risk increase, 10.3% [95% CI, 8.7%-12.1%]). Lifestyle modifications for resistant hypertension include a low-sodium diet (<1500 mg/d), reducing or avoiding alcohol, 150 min/wk or more of aerobic exercise, and weight loss. Illicit drugs (eg, cocaine) and medications that increase blood pressure (eg, nonsteroid anti-inflammatory drugs, serotonin-norepinephrine reuptake inhibitors) should be avoided. Sleep apnea should be treated when diagnosis is confirmed. Pharmacologic optimization includes use of combination tablets of antihypertensives; intensifying diuretic therapy by using chlorthalidone; and sequential addition of antihypertensive medications using evidence-based algorithms. In a meta-analysis of 20 studies (9 randomized clinical trials [RCTs] and 11 observational studies [331 participants]), use of antihypertensive therapies that combine 2 to 3 medications into a single formulation reduced SBP by -3.99 mm Hg (95% CI, -7.92 to -0.07) vs equivalent doses given separately. For patients with apparent or true resistant hypertension who have an estimated glomerular filtration rate of 45 mL/min/1.73 m2 or greater and a serum potassium level of 4.5 mmol/L or less, adding spironolactone (25-50 mg/d) compared with placebo lowers office SBP by -13.3 mm Hg (95% CI, -17.89 to -8.72 [4 RCTs]) and 24-hour ambulatory SBP by -8.46 mm Hg (95% CI, -12.54 to -4.38 [2 RCTs]) in a network meta-analysis of 24 RCTs (3485 patients with resistant hypertension). A meta-analysis of 10 RCTs (2478 participants) reported that compared with a sham procedure, catheter-based renal denervation, which disrupts the sympathetic nerves in the renal artery walls, decreased 24-hour ambulatory SBP by -4.4 mm Hg (95% CI, -6.1 to -2.7) and office SBP by -6.6 mm Hg (95% CI, -9.7 to -3.6).

Conclusions and relevance: True resistant hypertension affects 10% of patients treated for hypertension and is diagnosed after excluding white-coat hypertension, medication nonadherence, and secondary hypertension such as primary aldosteronism. First-line treatment includes lifestyle modifications, diuretic therapy with chlorthalidone, and combination tablets of antihypertensives. Spironolactone and renal denervation decrease blood pressure in patients with true resistant hypertension.

Author/s:

Michel Azizi, Wanpen Vongpatanasin, Naomi D. L. Fisher

Diagnosis and management of bronchiectasis

Megan George — Wed, 22 Apr 2026 20:03:10 +0000

Date Added:

April 22, 2026

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

June 19, 2017

URL:

Diagnosis and management of bronchiectasis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1503/cmaj.160830

Keywords

MeSH

A concise review of the diagnosis and management of patients with bronchiectasis. James W. Mold, MD, MPH

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Bronchiectasis is a chronic, debilitating respiratory condition that affects people of all ages. It is most prevalent in women and those older than 60 years, and prevalence is increasing. Patients have daily excessive sputum and associated symptoms, recurrent chest infections and impaired health-related quality of life. In North America, management guidelines are lacking. This review discusses best evidence to guide the long-term management of non–cystic fibrosis bronchiectasis in adults, focusing on the two most common single-entity types of bronchiectasis in adults: idiopathic and postinfectious bronchiectasis (Box 1). Table 1 lists all the types of bronchiectasis by cause.

Author/s:

Maeve P. Smith

2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Megan George — Tue, 31 Mar 2026 13:32:45 +0000

Date Added:

March 31, 2026

Journal/Publication:

JACC

Publication Date:

March 13, 2026

URL:

2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.jacc.2025.11.016

Keywords

Proliferating Cell Nuclear Antigen

PMID (1):

41824590

MeSH

Proliferating Cell Nuclear Antigen

Updated (2026) Guidelines for management of dyslipidemia. James W. Mold, MD, MPH

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Aim: The "2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia" retires and replaces the "2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol."

Methods: A comprehensive literature search was conducted from October 2024 to December 2024 to identify clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.

Structure: The focus of this clinical practice guideline is to address the evaluation, management, and monitoring of individuals with dyslipidemias, including high blood cholesterol, hypertriglyceridemia, and elevated lipoprotein(a).

Keywords: ACC/AHA clinical practice guideline; HDL; LDL; anticholesteremic agents; atherosclerosis; atherosclerotic disease; cardiovascular disease; cardiovascular diseases; cholesterol; drug interactions; dyslipidemia(s); hydroxymethylglutaryl-CoA reductase inhibitors; hypercholesterolemia; hyperlipid(a)emia/s; hyperlipoproteinemia type II; hypertriglyceridemia; hypolipidemic agents; lipids; lipoprotein(a); primary prevention; risk adjustment; risk assessment; risk factors; simvastatin; statin(s); triglycerides.

Author/s:

Roger S. Blumenthal, Pamela B. Morris, Mario Gaudino, Heather M. Johnson, Timothy S. Anderson, Vera A. Bittner, Ron Blankstein, LaPrincess C. Brewer, Leslie Cho, Sarah D. de Ferranti, Eugenia Gianos, Ty J. Gluckman, Kristen F. Gradney, Ijeoma Isiadinso, Donald M. Lloyd-Jones, Joel C. Marrs, Seth S. Martin, Kellie H. McLain, Laxmi S. Mehta, Samia Mora, Wudeneh M. Mulugeta, Pradeep Natarajan, Ann Marie Navar, Carl E. Orringer, Tamar S. Polonsky, Harmony R. Reynolds, Joseph J. Saseen, Michael D. Shapiro, Daniel E. Soffer, Sheila A. Tynes, Chloé D. Villavaso, Salim S. Virani, John T. Wilkins

Statin Therapy for Primary Prevention and Clinical Outcomes in Adults Aged 80 and Older: A Retrospective Comparative Cohort Study

Megan George — Tue, 10 Mar 2026 15:14:46 +0000

Date Added:

March 10, 2026

Journal/Publication:

Journal of the American Geriatric Society

Publication Date:

March 7, 2026

URL:

Statin Therapy for Primary Prevention and Clinical Outcomes in Adults Aged 80 and Older: A Retrospective Comparative Cohort Study

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1111/jgs.70375

Keywords

prevention

cardiovascular disease

statins

PMID (1):

41793188

MeSH

female

Humans

cardiovascular diseases

Electronic Health Records

Hydroxymethylglutaryl-CoA Reductase Inhibitors

Proportional Hazards Models

retrospective studies

aged

Statins taken for primary prevention in adults over 80 were associated with a reduction in 4-year mortality rates of 31%. James W. Mold, MD, MPH

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Background: Evidence supporting the use of statins for primary prevention of cardiovascular disease (CVD) in individuals aged ≥ 80 years remains limited. This study aimed to evaluate the long-term clinical benefits and safety of statins for primary prevention in patients aged 80 years and older.

Methods: We conducted a population-based retrospective cohort study using electronic medical records and pharmacy dispensing data from Clalit Health Services in Israel, covering the period from January 2015 to December 2020. Patients aged ≥ 80 years without prior CVD who were persistent statin users were compared with similar patients not receiving statins. Exclusions included prior CVD, dialysis, or death within 1 year of follow-up. Outcomes included all-cause mortality, new coronary events, myopathy, dementia, and diabetes mellitus. Cox proportional hazards models, adjusted for potential confounders, were used to assess the association between statin use and clinical outcomes.

Results: Among 15,745 patients (mean age 84.5 years; 66% female), 8413 were statin users. Over a 4-year mean follow-up, statin use was associated with a 31% reduction in mortality (HR 0.69; 95% CI: 0.34-0.74; p < 0.001) and a 20% reduction in new coronary events (HR 0.80; 95% CI: 0.68-0.94; p = 0.008). No significant differences were observed in the incidence of myopathy, diabetes, or dementia. Benefits were not observed in patients who discontinued statins before age 80.

Conclusions: In patients aged ≥ 80 years, statin therapy for primary prevention was associated with reduced all-cause mortality and coronary morbidity, without increased risk of adverse events. Early discontinuation diminished these benefits.

Author/s:

Ophir Lavon, Wafaa Hamodi, Sameer Kassem

Secondary Prevention after Ischemic Stroke

Megan George — Wed, 04 Mar 2026 18:17:01 +0000

Date Added:

March 4, 2026

Journal/Publication:

New England Journal of Medicine

Publication Date:

February 18, 2026

URL:

Secondary Prevention after Ischemic Stroke

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1056/NEJMcp2415601

Keywords

Acute Ischemic Stroke

prevention

Strokes

PMID (1):

41707139

MeSH

A review of the causes of ischemic stroke and the risk reduction strategies available to prevent recurrences. James W. Mold, MD, MPH

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The risk of recurrent ischemic stroke can be reduced by managing modifiable risk factors and instituting a regimen of mechanism-specific secondary stroke prevention. Strategies for secondary prevention should be instituted as early as possible. Poststroke monitoring of risk metrics, lifestyle behaviors, and medication recommendations is of key importance.

Author/s:

Karen L. Furie, Peter J. Kelly

Risk Factors for the Development of Food Allergy in Infants and Children: A Systematic Review and Meta-Analysis

Megan George — Tue, 10 Feb 2026 17:08:03 +0000

Date Added:

February 10, 2026

Journal/Publication:

JAMA

Publication Date:

February 9, 2026

URL:

Risk Factors for the Development of Food Allergy in Infants and Children: A Systematic Review and Meta-Analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamapediatrics.2025.6105

Keywords

Food Hypersensitivity

PMID (1):

41661638

Major modifiable risk factors for childhood food allergies include delayed introduction of solid foods and early treatment with antibiotics. James W. Mold, MD, MPH

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Importance: The incidence and risk (predictive) factors for early life food allergy development remain uncertain.

Objective: To estimate the incidence and quantify risk factors for food allergy development.

Data sources: MEDLINE and Embase were systematically searched to January 1, 2025. Data were analyzed from June 1, 2025, to November 25, 2025.

Study selection: Incidence estimates included studies confirming food allergy via food challenge. Risk factor analyses included cohort, case-control, and cross-sectional studies in any language assessing children younger than 6 years using multivariable analyses.

Data extraction and synthesis: Paired reviewers independently extracted data. Random-effects meta-analyses pooled incidence and adjusted odds ratios (ORs). Risk of bias was assessed using the QUIPS tool, and certainty of evidence assessed using GRADE.

Main outcome and measure: The primary outcome was food allergy to age 6 years.

Results: A total of 190 studies involving 2.8 million participants across 40 countries were analyzed. Among studies using food challenge, overall food allergy incidence was likely 4.7% (moderate certainty). Among 176 studies identifying 342 risk factors with varying certainty, the strongest and most certain factors included prior allergic conditions (eg, atopic dermatitis [eczema] within the first year of life [OR, 3.88; risk difference [RD], 12.0%; 95% CI, 8.8%-15.7%], allergic rhinitis [OR, 3.39; RD, 10.1%; 95% CI, 6.7%-14.4%], and wheeze [OR, 2.11; RD, 5.0%; 95% CI, 2.1%-8.8%]), severity of atopic dermatitis (OR, 1.22; RD, 1.0%; 95% CI, 0.6%-1.6%), increased skin transepidermal water loss (OR, 3.36; RD, 10.0%; 95% CI, 6.3%-14.8%), filaggrin gene sequence variations (OR, 1.93; RD, 4.2%; 95% CI, 2.4%-6.4%), delayed solid food introduction (eg, peanut after age 12 months [OR, 2.55; RD, 6.8%; 95% CI, 1.9%-14.6%]), infant antibiotic use (first month [OR, 4.11; RD, 12.8%; 95% CI, 0.4%-40%], first year [OR, 1.39; RD, 1.8%; 95% CI, 0.8%-3.1%], during pregnancy [OR, 1.32; RD, 1.5%; 95% CI, 0.6%-2.5%]), male sex (OR, 1.24; RD, 1.1%; 95% CI, 0.7%-1.6%), firstborn child (OR, 1.13; RD, 0.6%; 95% CI, 0.3%-1.0%), family history of food allergy (eg, mother [OR, 1.98; RD, 4.4%; 95% CI, 2.5%-6.8%], father [OR, 1.69; RD, 3.2%; 95% CI, 1.3%-5.5%], both parents [OR, 2.07; RD, 4.8%; 95% CI, 1.3%-5.5%], siblings [OR, 2.36; RD, 6.0%; 95% CI, 4.4%-8.0%]), parental migration (OR, 3.28; RD, 9.7%; 95% CI, 4.9%-16.3%), self-identification as Black (vs White [OR, 3.93; RD, 12.1%; 95% CI, 5.2%-22.5%], vs non-Hispanic White [OR, 2.23; RD, 5.5%; 95% CI, 3.0%-8.7%]), and cesarean delivery (OR, 1.16; RD, 1.0%; 95% CI, 0.3%-1.2%). Factors like low birth weight, postterm birth, maternal diet, and stress during pregnancy showed no significant risk difference.

Conclusions and relevance: In this meta-analysis, the most credible risk factors associated with development of childhood food allergy are a combination of major and minor risk factors, including early allergic conditions (atopic march/diathesis), delayed allergen introduction, genetics, antibiotic exposure, demographic factors, and birth-related variables.

Author/s:

Nazmul Islam, Alexandro W L Chu, Falana Sheriff, Farid Foroutan, Gordon H Guyatt, Romina Brignardello-Petersen, Paul Oykhman, Alfonso Iorio, Ariel Izcovich, Katherine M Morrison, Yetiani Roldan Benitez

Management of Premenstrual Disorders

Megan George — Mon, 09 Feb 2026 14:12:26 +0000

Date Added:

February 9, 2026

Journal/Publication:

JAMA

Publication Date:

February 4, 2026

URL:

Management of Premenstrual Disorders

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.26054

Keywords

Premenstrual Dysphoric Disorder

Luteal Phase

menstruation

Affective Symptoms

PMID (1):

41637081

MeSH

Premenstrual Dysphoric Disorder

A review of what we know and think about how to help women with premenstrual disorders. James W. Mold, MD, MPH

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Premenstrual disorders encompass a spectrum of cyclic affective and physical symptoms that interfere with daily functioning, occurring during the luteal phase and resolving with or immediately following menstruation. Premenstrual disorders may be caused by fluctuations of estrogen in the luteal phase, leading to dysregulation of serotonin, increased sensitivity to changes in the progesterone metabolite allopregnanolone, or both. Diagnosis can be made based on symptom assessment with daily ratings for at least 2 consecutive menstrual cycles, such as the Daily Record of Severity of Problems.1,2 Affective symptoms include lability (mood swings, sudden sadness or tearfulness, sensitivity to rejection), irritability or anger, depressed mood, and anxiety or tension. Physical symptoms include difficulty concentrating, lethargy or fatigue, appetite changes, sleep disturbances, breast tenderness, joint pain, and abdominal bloating.

Premenstrual syndrome (PMS) is characterized by the cyclic occurrence of any of these affective or physical findings during the premenstrual period and affects approximately one-quarter of menstruating individuals. Premenstrual dysphoric disorder (PMDD) is more severe than PMS and less common (affecting 2%-5% of females). Based on the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5), the diagnosis of PMDD requires at least 5 symptoms, including at least 1 affective symptom and 1 physical symptom, the week before menses. Symptoms of PMDD substantially decrease or resolve the week after menses.1,2 Treatment choices are based on the timing and severity of symptoms and patient goals such as desire for contraception.

Author/s:

Rebeca Ortiz Worthington, Lindsey M Eastman, Jason T Alexander

Exacerbation risk in patients with bronchiectasis receiving DPP-1 inhibitors vs placebo: A meta-analysis of RCTs

Megan George — Tue, 03 Feb 2026 14:17:01 +0000

Date Added:

February 3, 2026

Journal/Publication:

Respiratory Medicine

Publication Date:

January 31, 2026

URL:

Exacerbation risk in patients with bronchiectasis receiving DPP-1 inhibitors vs placebo: A meta-analysis of RCTs

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.rmed.2025.108607

Keywords

Bronchiectasis

DPP-1 inhibitor

Dipeptidyl-peptidases and tripeptidyl-peptidases

meta-analysis

PMID (1):

41443427

MeSH

Bronchiectasis* / drug therapy

Bronchiectasis* / physiopathology

Dipeptidyl-Peptidase IV Inhibitors* / therapeutic use

Disease Progression

Forced Expiratory Volume / drug effects

Randomized Controlled Trials as Topic

GLP-1 inhibitors appear to benefit patients with bronchiectasis apart from their weight reduction effect. James W. Mold, MD, MPH

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Background: No therapies have been approved to alter bronchiectasis progression. Dipeptidyl peptidase-1 (DPP-1) inhibitors, which target neutrophil serine protease activation, are under investigation as potential disease-modifying agents.

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing DPP-1 inhibitors versus placebo in patients with non-cystic fibrosis bronchiectasis. PubMed, Cochrane, EMBASE, Web of Science, Scopus, ClinicalTrials.gov, and ICTRP were searched from inception until April 26, 2025. Primary outcomes included time to first exacerbation and proportion of patients remaining exacerbation-free. Secondary outcomes included post-bronchodilator % Forced Expiratory Volume in 1 s (FEV1), Quality of Life-Bronchiectasis (QoL-B) questionnaire scores, and rate of adverse events. Time-to-event outcome was analyzed using Kaplan-Meier (KM)-estimated individual patient data (IPD), whereas random-effects meta-analyses were performed for remaining outcomes.

Results: 2523 patients from four RCTs were included, of whom 1689 (66.9 %) received DPP-1 inhibitors. Compared with placebo, DPP-1 inhibitors prolonged the time to first exacerbation (HR 0.79; 95 % CI: 0.71 to 0.88) and increased the proportion of patients remaining exacerbation-free (RR 1.33; 95 % CI 1.12 to 1.58). A slower decline in post-bronchodilator % FEV1 was observed (MD 1.1 %; 95 % CI 0.05 to 2.15), but no difference in QoL-B scores (MD 1.35; 95 % CI -0.72 to 3.42). The safety profile of DPP-1 inhibitors was acceptable and comparable to placebo. Moderate certainty was found across endpoints.

Conclusions: DPP-1 inhibitors prolong time to first exacerbation and reduce exacerbation rates in patients with bronchiectasis, with an acceptable safety profile. These findings support their potential as a disease-modifying strategy.

Registration: PROSPERO (CRD420251042542).

Keywords: Bronchiectasis; DPP-1 inhibitor; Dipeptidyl-peptidases and tripeptidyl-peptidases; Meta-analysis; Randomized controlled trials; Systematic review.

Author/s:

Giulia Carvalhal, Júlia Moreira Diniz, Larissa Calixto Hespanhol, David Curi Barbosa Izoton Cabral, Jafar Aljazeeri

Ann Arbor Guide to Triaging Adults With Suspected Urinary Tract Infection for In-Person and Telehealth Settings

Megan George — Mon, 02 Feb 2026 15:48:55 +0000

Date Added:

February 2, 2026

Journal/Publication:

Consensus Statement Infectious Diseases

Publication Date:

January 29, 2026

URL:

Ann Arbor Guide to Triaging Adults With Suspected Urinary Tract Infection for In-Person and Telehealth Settings

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2025.56135

Keywords

urinary tract infections

Triage

Urinalysis

telemedicine

PMID (1):

41609831

MeSH

Anti-Bacterial Agents* / therapeutic use

practice guidelines as topic

Urinary Tract Infections* / diagnosis

Urinary Tract Infections* / drug therapy

Guidance regarding how to triage adults with symptoms of urinary tract infection. I'm not sure it applies well to older women who may have UTI-like symptoms related to atrophic changes in the urethra. James W. Mold, MD, MPH

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Importance: Urinary tract infection (UTI) is common in ambulatory care settings and the primary reason for antibiotic prescribing. Despite several guidelines focused on the type and duration of antibiotics prescribed for treating UTI, there is limited outpatient guidance on how to best triage patients with presumed UTI.

Objective: To assess the appropriateness of different triage and management recommendations involving empiric antibiotics, urine testing strategies, and visit types and how these recommendations vary by patient sex, age, presenting symptoms, and clinical history.

Evidence review: Using the RAND/UCLA Appropriateness Method, a 13-member multidisciplinary panel (physicians, advanced practice providers, and nurses) performed a scoping review of the literature publications from 2009 to June 2024 and rated the appropriateness of 136 clinical scenarios (48 for women, 49 for men, and 39 scenarios not specific to sex) with up to 9 management strategies per scenario for a total of 1094 scenarios. For each scenario, experts rated the appropriateness of empiric treatment, types of urine testing, and triage to visit type (in-person, virtual, or none) as appropriate (ie, benefits outweigh risks), inappropriate, or of uncertain appropriateness. Appropriateness ratings were summarized into 2 groups: nonpregnant adult women and adult men.

Findings: Major recommendations based on symptoms included (1) same-day in-person evaluation if symptoms were concerning for pyelonephritis, complicated cystitis, or urinary obstruction; (2) a visit if additional nonurinary symptoms were present (ie, diarrhea, genital discharge, or cough); (3) neither urine testing nor empiric treatment solely due to a change in urine color or appearance without other bladder (cystitis) symptoms; (4) empiric treatment without testing or a visit, for women, if there were new classic cystitis symptoms of dysuria, urinary frequency, urgency, or suprapubic pain without risks for antibiotic resistance; (5) urinalysis with culture (ideally reflexed to culture) before taking first antibiotic dose for women at risk of antibiotic resistance (eg, recent antibiotic treatment for UTI or recurrent UTIs) and all men; and (6) empiric treatment considered for patients with barriers to obtaining timely urine testing or visits.

Conclusions and relevance: The appropriateness of empiric antibiotics, urine testing, and different clinical evaluation options were defined for adults presenting with concerns for UTI in common ambulatory triage settings, including telehealth. These criteria for ambulatory triage of suspected UTI symptoms in adults are anticipated to help standardize and improve the appropriateness of empiric antibiotic prescribing, urine testing, and visit type triage.

Author/s:

Jennifer Meddings, Kristin Chrouser, Karen E. Fowler

Restless Legs Syndrome: A Review

Megan George — Wed, 28 Jan 2026 18:57:15 +0000

Date Added:

January 28, 2026

Journal/Publication:

JAMA

Publication Date:

January 21, 2026

URL:

Restless Legs Syndrome: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.23247

Keywords

Restless Legs Syndrome

sleep

quality of life

methadone

MeSH

Restless Legs Syndrome

A review of what we think we know about restless legs syndrome. James W. Mold, MD, MPH

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Importance Restless legs syndrome (RLS) is a sleep-related movement disorder that affects approximately 3% of US adults to a clinically significant extent and can cause substantial sleep disturbance.

Observations Restless legs syndrome is characterized by an overwhelming urge to move the limbs, typically the legs, often accompanied by unpleasant limb sensations (eg, achiness, tingling). Symptoms, provoked by immobility, are relieved while moving and are typically present or most severe in the evening or at night. Restless legs syndrome symptoms may lead to difficulty falling asleep, staying asleep, or returning to sleep. According to population-based studies, approximately 8% of US adults experience RLS symptoms of any frequency annually and 3% experience moderately or severely distressing symptoms at least twice weekly. Patients with RLS have impaired quality of life and elevated rates of cardiovascular disease (29.6% with coronary artery disease, stroke, or heart failure), depression (30.4%), and suicidal ideation or self-harm (0.35 cases/1000 person-years). Restless legs syndrome is common among patients with multiple sclerosis (27.5%), end-stage kidney disease (24%), and iron deficiency anemia (23.9%); during pregnancy and especially in the third trimester (22%); with peripheral neuropathy (eg, diabetic, idiopathic; 21.5%); and with Parkinson disease (20%). Other risk factors include family history of RLS, northern European descent, female sex (2:1 vs male sex), and older age (RLS prevalence of 10% in adults ≥65 years). Restless legs syndrome is diagnosed based on clinical history; polysomnography is not recommended for diagnosis. Iron supplementation with ferrous sulfate (325-650 mg daily or every other day) or intravenous iron (1000 mg) should be initiated for serum ferritin level less than or equal to 100 ng/mL or transferrin saturation less than 20%. If possible, medications associated with RLS, including serotonergic antidepressants, dopamine antagonists, and centrally acting H1 antihistamines (eg, diphenhydramine), should be discontinued. Gabapentinoids (eg, gabapentin, gabapentin enacarbil, pregabalin) are first-line pharmacologic therapy. In randomized clinical trials, approximately 70% of patients treated with gabapentinoids had much or very much improved RLS symptoms vs approximately 40% with placebo (P < .001). Dopamine agonists (eg, ropinirole, pramipexole, rotigotine) are no longer recommended as first-line medications due to the risk of augmentation, an iatrogenic worsening of RLS symptoms, which has an annual incidence of 7% to 10% with these medications. Patients who do not improve with first-line treatment or have augmented RLS often benefit from low-dose opioids (eg, methadone 5-10 mg daily).

Conclusions and Relevance Restless legs syndrome affects approximately 3% of adults and can have negative effects on sleep and quality of life. Initial management includes cessation of exacerbating medications, as well as iron supplementation for patients with low-normal iron indices. If medication therapy is indicated, gabapentinoids are first-line treatment.

Author/s:

John W. Winkelman, Benjamin Wipper

The Role of Vaccination in Maternal and Perinatal Outcomes Associated With COVID-19 in Pregnancy

Megan George — Tue, 20 Jan 2026 15:44:12 +0000

Date Added:

January 20, 2026

Journal/Publication:

JAMA

Publication Date:

December 15, 2025

URL:

The Role of Vaccination in Maternal and Perinatal Outcomes Associated With COVID-19 in Pregnancy

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jama.2025.21001

Keywords

PMID (1):

41396589

MeSH

COVID immunization benefits pregnant mothers and their babies. James W. Mold, MD, MPH

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Importance: Gaps in knowledge exist about the impact of COVID-19 and vaccination on pregnancy outcomes.

Objective: To investigate the impact of vaccination on maternal and perinatal outcomes associated with SARS-CoV-2 infection in pregnancy.

Design, setting, and population: Population-level surveillance of pregnant individuals infected with SARS-CoV-2 and their infants using the CANCOVID-Preg database between April 5, 2021 (beginning of the Delta variant time period and initiation of recommendations for vaccination in pregnancy in Canada), and December 31, 2022. Cases were identified based on COVID-19 diagnoses in pregnancy in 9 of 13 Canadian provinces/territories. Cases occurring through 2022 were followed up into 2023 for pregnancy conclusion and infant outcomes.

Exposure: SARS-CoV-2 infection in pregnancy, with or without prior vaccination.

Main outcomes and measures: COVID-19-associated hospitalization, critical care unit admission, and preterm birth.

Results: Of 26 584 cases identified, 19 899 cases were eligible for analysis. Among these, most infections occurred among those aged 30 to 35 years (46.3%) and among those of White race (55.9%). A total of 72% (n = 14 367) of cases were vaccinated and 28% (n = 5532) were unvaccinated prior to their COVID-19 diagnosis. Among those vaccinated prior to COVID-19 diagnosis, 80% (n = 11 425) were vaccinated prior to pregnancy and 20% (n = 2942) were vaccinated during pregnancy. Cases occurred during both Delta (n = 6120) and Omicron (n = 13 799) variant time periods. Vaccination was associated with lower risk of hospitalization (Delta: relative risk [RR], 0.38 [95% CI, 0.30-0.48]; absolute risk difference [ARD], 8.7% [95% CI, 7.3%-10.2%]; Omicron: RR, 0.38 [95% CI, 0.27-0.53]; ARD, 3.8% [95% CI, 2.4%-5.2%]), critical care unit admission (Delta: RR, 0.10 [95% CI, 0.04-0.26]; ARD, 2.4% [95% CI, 1.8%-2.9%]; Omicron: RR, 0.10 [95% CI, 0.03-0.29]; ARD, 0.85% [95% CI, 0.27%-1.44%]), and preterm birth (Delta: RR, 0.80 [95% CI, 0.66-0.98]; ARD, 1.8% [95% CI, 0.3%-3.4%]; Omicron: RR, 0.64 [95% CI, 0.52-0.77]; ARD, 4.1% [95% CI, 2.0%-6.2%]). In multivariable analyses, vaccination was still associated with lower hospitalization risk in both variant time periods after controlling for comorbid conditions. In Omicron, compared with the vaccinated group, those unvaccinated had an adjusted RR of hospitalization of 2.43 (95% CI, 1.72-3.43). In Delta, those unvaccinated had an adjusted RR of hospitalization of 3.82 (95% CI, 2.38-6.14).

Conclusions and relevance: Vaccination against SARS-CoV-2 prior to and during pregnancy, before COVID-19 diagnosis, was associated with a lower risk of severe maternal disease and preterm birth regardless of variant time period.

Author/s:

Sandra Blitz, Elisabeth McClymont, Lucia Forward

Online Unsupervised Tai Chi Intervention for Knee Pain and Function in People With Knee Osteoarthritis: The RETREAT Randomized Clinical Trial

Megan George — Tue, 06 Jan 2026 14:16:13 +0000

Date Added:

January 6, 2026

Journal/Publication:

JAMA Internal Medicine

Publication Date:

October 27, 2025

URL:

Online Unsupervised Tai Chi Intervention for Knee Pain and Function in People With Knee Osteoarthritis: The RETREAT Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamainternmed.2025.5723

Keywords

PMID (1):

41143827

MeSH

aged

Arthralgia* / etiology

Arthralgia* / therapy

Knee* / physiopathology

Middle Aged

Knee* / therapy

Pain Management* / methods

Tai Ji* / methods

A free online Tai Chi app improved comfort and function in patients with OA of the knees. James W. Mold, MD, MPH

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Importance Tai chi is a type of exercise recommended for knee osteoarthritis, but access to in-person tai chi can be limited.

Objective To evaluate the effects of an unsupervised multimodal online tai chi intervention on knee pain and function for people with knee osteoarthritis.

Design, Setting, and Participants The RETREAT study was a 2-group superiority randomized clinical trial enrolling participants who met clinical criteria for knee osteoarthritis in Australian communities from August 2023 and November 2024.

Interventions Participants in the control group received access to a purpose-built website containing information about osteoarthritis and exercise benefits. Participants in the intervention group received the My Joint Tai Chi intervention comprising access to the same website plus tai chi information, a 12-week unsupervised video-based Yang-style tai chi program, and encouragement to use an app to facilitate program adherence.

Main Outcomes and Measures Changes in knee pain during walking (Numeric Rating Scale; range 0-10 with higher scores indicating greater pain) and difficulty with physical function (Western Ontario and McMaster Universities Osteoarthritis Index; range 0-68 with higher scores indicating greater dysfunction) during 12 weeks. Secondary outcomes included another knee pain measure, sport and recreation function, quality of life, physical and mental well-being, fear of movement, self-efficacy, balance confidence, positive activated affect, sleep quality, global improvement, and oral medication use.

Results Of 2106 patients screened, 178 met inclusion criteria and were randomized, 89 (mean [SD] age, 61.0 [8.7] years; 66 female [74%] and 23 [26%] male participants) to the control group and 89 (mean [SD] age, 62.1 [7.3] years; 59 [66%] female and 30 male [34%] participants) to the tai chi intervention. Of the total, 170 (96%) completed both of the primary outcomes at 12 weeks. The tai chi group reported greater improvements in knee pain (control, −1.3; tai chi, −2.7; mean difference, −1.4 [95% CI, −2.1 to −0.7] units; P < .001) and function (control, −6.9; tai chi, −12.0; mean difference, −5.6 [95% CI, −9.0 to −2.3] units; P < .001) compared to the control group. More participants in the tai chi than in the control group achieved a minimal clinically important difference in pain (73% vs 47%; risk difference, 0.3; 95% CI, 0.1 to 0.4; P < .001) and function (72% vs 52%; risk difference, 0.2; 95% CI, 0.1 to 0.3; P = .007). Between-group differences for most secondary outcomes favored tai chi, including another knee pain measure, sport and recreation function, quality of life, physical and mental well-being, global improvement, pain self-efficacy, and balance confidence. No associated serious adverse events were reported.

Conclusions and Relevance This randomized clinical trial found that this unsupervised multimodal online tai chi intervention improved knee pain and function compared with the control at 12 weeks. This free-to-access web-based intervention offers an effective, safe, accessible, and scalable option for guideline-recommended osteoarthritis exercise.

Author/s:

Shiyi Julia Zhu, Rana S. Hinman, Rachel K. Nelligan

Therapeutic Use of Cannabis and Cannabinoids: A Review

Megan George — Tue, 02 Dec 2025 16:11:48 +0000

Date Added:

December 2, 2025

Journal/Publication:

JAMA

Publication Date:

November 26, 2025

URL:

Therapeutic Use of Cannabis and Cannabinoids: A Review

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1001/jama.2025.19433

Keywords

medical marijuana

cannabis

PMID (1):

41296368

MeSH

acquired immunodeficiency syndrome

Central Nervous System Depressants

united states food and drug administration

sleep initiation and maintenance disorders

myocardial infarction

anxiety disorders

A review of the therapeutic uses for cannabinoids. James W. Mold, MD, MPH

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Importance: Approximately 27% of adults in the US and Canada report having ever used cannabis for medical purposes. An estimated 10.5% of the US population reports using cannabidiol (CBD), a chemical compound extracted from cannabis that does not have psychoactive effects, for therapeutic purposes.

Observations: Conditions for which cannabinoids have approval from the US Food and Drug Administration include HIV/AIDS-related anorexia, chemotherapy-induced nausea and vomiting, and certain pediatric seizure disorders. A meta-analysis of randomized clinical trials reported a small but significant reduction in nausea and vomiting from various causes (eg, chemotherapy, cancer) when comparing prescribed cannabinoids (eg, dronabinol, nabilone) with placebo or active comparators (eg, alizapride, chlorpromazine; standardized mean difference [SMD], -0.29 [95% CI, -0.39 to -0.18]). A meta-analysis of randomized clinical trials among patients with HIV/AIDS reported that cannabinoids had a moderate effect on increasing body weight compared with placebo (SMD, 0.57 [95% CI, 0.22 to 0.92]). Evidence-based guidelines do not recommend the use of inhaled or high-potency cannabis (≥10% or 10 mg Δ9-tetrahydrocannabinol [Δ9-THC]) for medical purposes. High-potency cannabis compared with low-potency cannabis use is associated with increased risk of psychotic symptoms (12.4% vs 7.1%) and generalized anxiety disorder (19.1% vs 11.6%). A meta-analysis of observational studies reported that 29% of individuals who used cannabis for medical purposes met criteria for cannabis use disorder. Daily inhaled cannabis use compared with nondaily use was associated with an increased risk of coronary heart disease (2.0% vs 0.9%), myocardial infarction (1.7% vs 1.3%), and stroke (2.6% vs 1.0%). Evidence from randomized clinical trials does not support the use of cannabis or cannabinoids for most conditions for which it is promoted, such as acute pain and insomnia. Before considering cannabis or cannabinoids for medical use, clinicians should consult applicable institutional, state, and national regulations; evaluate for drug-drug interactions; and assess for contraindications (eg, pregnancy) or conditions in which risks likely outweigh benefits (eg, schizophrenia or ischemic heart disease). For patients using cannabis or cannabinoids for treatment of medical conditions, clinicians should discuss harm reduction strategies, including avoiding concurrent use with alcohol or other central nervous system depressants such as benzodiazepines, using the lowest effective dose, and avoiding use when driving or operating machinery.

Conclusions and relevance: Evidence is insufficient for the use of cannabis or cannabinoids for most medical indications. Clear guidance from clinicians is essential to support safe, evidence-based decision-making. Clinicians should weigh benefits against risks when engaging patients in informed discussions about cannabis or cannabinoid use.

Author/s:

Michael Hsu, Arya Shah, Ayana Jordan, Mark S Gold, Kevin P Hill