Preventive Medicine

Real-world cohort: candesartan and amitriptyline reduced moderate–severe headache days.

In a prospective cohort of 254 adults starting oral migraine preventives, candesartan and amitriptyline each reduced moderate–severe headache days by 2.4 days at weeks 9–12 versus baseline. Metoprolol and topiramate did not show a significant reduction in the primary endpoint, though some secondary outcomes improved. Adverse drug reactions were common (77.1% experienced ≥1), and discontinuation before 12 weeks ranged from 22.3% to 46.8%, varying by drug. These findings apply to real-world clinic populations but derive from an observational design without randomized comparators. 1

Prognostic model predicts 1‑year postdischarge diabetic foot complications with modest discrimination.

Across 107,830 General Internal Medicine discharges, 2.7% developed a foot complication within one year. A Fine–Gray competing‑risk model showed pooled AUROC ~0.71 and better calibration than a random survival forest in held-out hospitals. Model performance and calibration varied substantially across hospitals, and high‑risk predictions ranged up to 14.0% for individuals. A pilot implementation reached patients after discharge; 41% of reachable patients accepted community foot‑care referral. 2

Network meta‑analysis: dexmedetomidine reduces postoperative delirium in elderly spinal surgery.

A network meta‑analysis of 32 RCTs (n=3454) evaluated 19 preventive interventions for postoperative delirium in elderly spinal surgery patients. Dexmedetomidine monotherapy reduced POD incidence with moderate‑certainty evidence (OR 0.35 versus control). Temperature protection combined with dexmedetomidine, melatonin, and goal‑directed fluid therapy also reduced POD but with low‑certainty evidence. All included trials were conducted in China, limiting direct generalizability to other settings. 3