Internal Medicine

Day-4 de-escalation of broad-spectrum sepsis antibiotics appears safe and shortens stay

In this target trial emulation of 36,924 adults with community-onset sepsis at 67 hospitals, empiric broad-spectrum therapy was often narrowed on day 4. Among patients without multidrug-resistant infection, anti-MRSA or anti-Pseudomonas de-escalation produced similar 90-day mortality to continued broad-spectrum therapy (ORs about 1.0). De-escalation reduced antibiotic days to day 14 (risk ratio 0.91 for both anti-MRSA and anti-Pseudomonas coverage). It also shortened hospital length of stay (risk ratio 0.88 for anti-MRSA, 0.91 for anti-Pseudomonas), without worsening other mortality outcomes. 1

Four-year US data reveal high risk of burdensome health costs and foregone care

This cohort study used 4-year longitudinal MEPS data (2018-2022) to examine out-of-pocket cost burden, catastrophic burden, and foregone care. Over four years, 17.4% of adults experienced cost burdens at least once, and 9.9% experienced catastrophic burdens, exceeding year-1 prevalence. Family-level burdens were common, with about one-quarter of individuals in families experiencing cost burdens and over one-tenth facing catastrophic burdens. Overall, 26.7% of adults had either foregone care due to cost or cost burden, especially with low income, uninsurance, hospitalization, or chronic disease. More than half of decedents experienced cost burdens before death, underscoring end-of-life financial toxicity relevant to serious illness planning. 2

Semaglutide reduces total hospitalizations and hospital days in obesity with ASCVD

This prespecified SELECT trial analysis included 17,604 adults with BMI ≥27, established cardiovascular disease, and no diabetes, followed for about 3.5 years. Once-weekly semaglutide 2.4 mg lowered all-cause hospitalizations compared with placebo (18.3 vs 20.4 admissions per 100 patient-years; mean ratio 0.90). Serious-adverse-event hospitalizations were similarly reduced (15.2 vs 17.1 per 100 patient-years; mean ratio 0.89). Semaglutide also reduced total days in hospital for any cause and serious adverse events (rate ratio 0.89 for both). Benefits were consistent across BMI, age, and sex subgroups, supporting broad applicability within this high-risk population. 3

EHR-integrated MyLungHealth tool modestly improves lung cancer screening workflows

This pragmatic randomized trial at two health systems enrolled 31,303 adults aged 50-79 years with smoking history and active patient portals. All clinicians received a Decision Precision+ reminder and shared decision-making tool; intervention patients additionally completed the MyLungHealth portal tool. Among those with uncertain eligibility, MyLungHealth roughly doubled new identification of screening eligibility (4.7% vs 2.3%; adjusted OR 2.19). Among already-eligible patients, the tool modestly increased low-dose CT ordering (20.5% vs 19.2%; adjusted OR 1.16). Absolute gains were small, indicating that EHR tools alone are insufficient to achieve high lung cancer screening uptake. 4