Family Medicine

Nurse-led family support pathway in adult ICUs did not improve 12-month family mental health

A 16-ICU cluster RCT of a multicomponent, nurse-led family care pathway enrolled 885 family members; follow-up rates were 67–83% through 12 months. The intervention did not significantly change family functioning, distress, anxiety, depression, PTSD, or quality-of-life versus usual care over one year. Intervention units had higher patient mechanical ventilation and ICU death, and relationship type and prior ICU experience associated with some outcomes. Authors caution results are hypothesis-generating and limited by study constraints. 1

‘Personalized’ RCTs are heterogeneous, non-genomic, and have low transparency

A survey of 262 RCTs (2020–2022) using 'personalized'/'individualized'/'precision' labels found most interventions were behavioral, digital, or medication-based rather than genomic. Most trials compared personalized to non-personalized care and reported favorable conclusions in 70.6% of abstracts. Transparency was poor (data sharing 5.0%, code sharing 0.4%) and 68.6% of trials had high overall risk of bias. Interpret labels cautiously when applying trial claims of personalization to clinical decision-making. 2

CHW-led, tablet-assisted diabetes care improved glycemic control and engagement in rural Lesotho

In a cluster-randomized trial nested in the ComBaCaL cohort, 103 adults with uncontrolled type 2 diabetes were randomized to CHW-led versus facility care. At 12 months, mean HbA1c was 6.5% in the CHW arm versus 7.1% in controls (adjusted mean difference -0.46%, 95% CI -1.14 to 0.22). Engagement in care was higher with CHW-led, decision-support assisted management; no safety differences were reported. Authors recommend larger trials to confirm effectiveness and generalizability. 3