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Vertebral Fractures: Why Radiologists See Them, But Clinicians Miss Them

Vertebral fragility fractures are frequently visible on routine imaging but often go unrecognised by clinicians, leading to delayed diagnosis and treatment.

Why a first fracture often leads to another: The FLS gap in secondary prevention

Despite the known risk, many patients who experience a fragility fracture do not receive adequate secondary prevention, leaving a critical care gap.

Cemented fixation in hip fracture: Is the cardiopulmonary risk real?

Cemented fixation in hip fracture arthroplasty does not increase cardiopulmonary complications, a secondary analysis of the HIP ATTACK trial showed.

Why spinal stenosis imaging often fails to explain patient symptoms

Imaging findings in spinal stenosis frequently do not align with patient-reported symptoms, creating diagnostic and therapeutic challenges for clinicians.

Lumbar spinal stenosis: Why symptoms, not imaging, should guide surgery

Clinical symptoms, not radiographic findings, dictate surgical candidacy and outcomes in lumbar spinal stenosis, a review confirms. Imaging severity often poorly correlates with patient-reported disability.

Why 12-month biochemical response is the critical pivot in endocrine disease

Assessing biochemical response at 12 months is a key decision point across several endocrine conditions, setting the long-term prognostic trajectory for patients.

Fusion for Degenerative Spondylolisthesis: More Harm Than Help?

Lumbar decompression with fusion significantly increases mortality and morbidity compared to decompression alone in older adults with degenerative lumbar disease.

Why adults with severe hearing loss often miss out on cochlear implants

Cochlear implantation remains heavily underused in adults with severe-to-profound hearing loss, despite established benefits and guideline recommendations.

OTC hearing aids: When convenience isn't enough for hearing loss

Over-the-counter hearing aids offer accessibility but fall short for complex hearing loss, requiring careful patient counselling on their limitations.

Seladelpar and elafibranor: second-line options for PBC

For patients with primary biliary cholangitis (PBC) who do not respond adequately to ursodeoxycholic acid, seladelpar and elafibranor offer new therapeutic avenues.

Does treating hearing loss actually slow cognitive decline?

Addressing hearing loss with hearing aids or cochlear implants may reduce cognitive decline in older adults at higher risk.

Otitis media: Can shorter antibiotic courses truly deliver?

Shorter antibiotic courses for acute otitis media aim to reduce resistance, but their efficacy often falls short in specific patient populations, raising questions about optimal treatment duration.

Tympanostomy tube referrals: Why thresholds vary more than the evidence does

Referral criteria for tympanostomy tube insertion in children with recurrent acute otitis media or otitis media with effusion show significant variability across guidelines, despite a largely consistent evidence base. This disparity can lead to inconsistent patient care and unnecessary procedures.

Borderline personality disorder: where medication helps and where it does not

Off-label prescribing for psychiatric inpatients with intellectual disability is common, with psychotropics frequently used for unlicensed indications.

Watchful Waiting in AOM: Which Children Can Safely Wait?

Watchful waiting is a safe strategy for acute otitis media in specific pediatric populations, reducing antibiotic exposure without increasing complications.

Why benign paroxysmal positional vertigo remains undertreated despite quick fixes

Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness, yet its effective, rapid treatments are frequently underutilised in clinical practice.

Why HINTS examination outperforms imaging for acute vertigo

The HINTS examination accurately differentiates central from peripheral vertigo, reducing unnecessary neuroimaging in emergency department patients.

Vestibular rehabilitation: Which protocols deliver lasting relief?

Vestibular rehabilitation protocols vary widely, but specific approaches focusing on adaptation, habituation, and substitution are critical for durable patient benefit.

Hypoglossal Nerve Stimulation: Beyond AHI for OSA Patient Selection

Patient selection for hypoglossal nerve stimulation in obstructive sleep apnea must extend beyond the apnea-hypopnea index, considering anatomical factors and broader health impacts.

Tirzepatide in OSA: What SURMOUNT-OSA means for management

Tirzepatide demonstrated a reduction in the apnea-hypopnea index in patients with obstructive sleep apnea, offering a new therapeutic avenue for a condition often linked to metabolic dysfunction.

Navigating SMA Treatment: What Parents Prioritise in Newborn Screening Decisions

Parents choosing spinal muscular atrophy treatments for infants diagnosed via newborn screening weigh efficacy, administration, and long-term impact.

Newborn screening: How much function can presymptomatic treatment truly preserve?

Presymptomatic treatment after newborn screening aims to mitigate disease progression, but the extent of preserved function varies significantly across conditions.

Esketamine vs. Quetiapine: Which Augmentation Strategy for TRD?

A head-to-head trial compared esketamine and quetiapine as augmentation strategies for treatment-resistant depression, offering insights into their relative efficacy and tolerability.

Fabry Disease: Why Women Were Left Behind in Diagnosis and Treatment

Women with Fabry disease have historically faced significant diagnostic delays and undertreatment, stemming from outdated genetic assumptions and a lack of recognition of their diverse clinical presentations.

Fabry Disease: Why Early Recognition in Cardiology and Nephrology Clinics Remains Elusive

Fabry disease often presents with non-specific cardiac and renal symptoms, leading to significant diagnostic delays. Increased awareness and targeted screening in high-risk populations are essential for timely intervention.

Migalastat vs. ERT: How Fabry Chaperone Therapy Stacks Up

Migalastat, an oral chaperone, demonstrated non-inferiority to enzyme replacement therapy (ERT) in Fabry disease patients with amenable GLA mutations, offering a potential oral alternative.

Givinostat: Targeting the Downstream Disease in Duchenne Muscular Dystrophy

Givinostat, a histone deacetylase inhibitor, offers a non-genetic approach to Duchenne muscular dystrophy by addressing downstream disease mechanisms.

Duchenne Muscular Dystrophy: The Cardiac and Respiratory Surveillance That Changes Survival

Regular, proactive cardiac and respiratory monitoring is critical for Duchenne muscular dystrophy patients, directly impacting survival and quality of life.

Delandistrogene Moxeparvovec: Are Functional Endpoints Meeting Duchenne Expectations?

Delandistrogene moxeparvovec, an AAV micro-dystrophin gene therapy, has US FDA approval for Duchenne muscular dystrophy, but clinical benefit remains a point of contention.

Deep TMS for OCD: How durable is the response in treatment-resistant patients?

Deep transcranial magnetic stimulation offers a non-invasive option for treatment-resistant OCD, but questions remain about the long-term durability of its effects.

Why the heart team model is non-negotiable as structural options multiply

The escalating complexity of structural heart disease management demands a robust, multidisciplinary heart team approach to optimise patient outcomes and navigate expanding therapeutic options.

RET-altered thyroid cancer: how selective inhibitors changed advanced disease

The advent of selective RET inhibitors has significantly improved outcomes for patients with advanced RET-altered thyroid cancer. These targeted therapies address a critical unmet need in a previously challenging disease landscape.

Radioactive iodine: Which low-risk thyroid cancer patients can safely skip it?

For low-risk differentiated thyroid cancer, selective use of radioactive iodine ablation is a viable strategy, sparing many patients unnecessary treatment.

Tricuspid regurgitation: Navigating the least settled valve decision

Selecting patients for tricuspid valve intervention remains a complex clinical challenge, with evolving understanding of disease progression and optimal timing.

Active Surveillance for Papillary Thyroid Microcarcinoma: A Decade of Data

Active surveillance for low-risk papillary thyroid microcarcinoma shows comparable long-term oncological outcomes to immediate surgery, with significantly fewer interventions.

TAVI in low-risk patients: How long will the valves actually last?

Transcatheter aortic valve implantation (TAVI) has expanded to younger, low-risk patients, but long-term durability data remains a critical question. Accumulating evidence suggests favorable outcomes, but ongoing monitoring is essential.

Endocarditis: Why a multidisciplinary team referral is a matter of life and death

A multidisciplinary team approach to infective endocarditis management is consistently associated with improved patient outcomes, particularly reduced mortality. Early referral to an 'endocarditis team' is a critical intervention.

PD-L1 as a compass for immunotherapy in head and neck cancer

PD-L1 expression levels guide selection for immunotherapy in recurrent and metastatic head and neck squamous cell carcinoma, impacting treatment efficacy.

Duke-ISCVID 2023: What changed for endocarditis diagnosis at the bedside?

The 2023 Duke-ISCVID criteria update refined diagnostic pathways for infective endocarditis, integrating advanced imaging and microbiological techniques to improve accuracy.

Managing the lasting damage of head and neck cancer treatment

Chemoradiation for head and neck cancers often leaves patients with chronic dysphagia and osteoradionecrosis, requiring complex, multidisciplinary management strategies.

Partial oral antibiotics for endocarditis: What POET proved, and what it did not

The POET trial established noninferiority for partial oral antibiotic therapy in stable left-sided endocarditis, but it did not compare outpatient strategies.

De-escalation in HPV-positive oropharyngeal cancer: What trials have settled

Treatment de-escalation strategies for HPV-positive oropharyngeal cancer aim to reduce toxicity while maintaining efficacy, with ongoing trials exploring various approaches.

Why patient-reported outcomes rarely make it onto drug labels

Despite their clinical relevance, patient-reported outcomes (PROs) face significant hurdles in gaining regulatory approval for inclusion on drug labels.

Why ovarian cancer is still diagnosed late, despite decades of screening research

Despite extensive research into screening methods, ovarian cancer continues to be diagnosed at advanced stages, limiting treatment efficacy.

Folate Receptor Alpha Testing: Why Timing Matters in Platinum-Resistant Ovarian Cancer

Folate receptor alpha expression in ovarian cancer can change over time, complicating treatment decisions for mirvetuximab soravtansine in platinum-resistant disease.

PARP Inhibitors in Ovarian Cancer: HRD Status Dictates Maintenance Benefit

PARP inhibitors have transformed ovarian cancer treatment, but homologous recombination deficiency status critically determines their long-term efficacy.

Do patient-reported outcomes actually improve survival?

Routine symptom monitoring with patient-reported outcomes does not improve survival, despite its perceived benefits in quality of life.

How regulatory guidance on real-world evidence changed drug submissions

Regulatory bodies have refined their expectations for real-world evidence, pushing sponsors to integrate these data earlier and more strategically into drug development programs.