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One-Minute Telegram

Last updated: March 10, 2026

Introductiontoggle arrow icon

The One-Minute Telegram is a biweekly digest of the latest medical research. It is designed for our colleagues who want to keep up with medical literature without having to comb through a flood of new research. Every paper has been carefully selected and summarized by our team of physician editors to bring you the most important developments as concisely as possible. Integration of AMBOSS tooltips and links to related content ensures you have all the context you need at your fingertips. Whether you're on your way home from a long shift or just taking a break on a busy day, you'll always find a minute to stay current. Subscribe by clicking on the image or via the link in “Tips and Links” below.

See "Journal club."

See also the One-Minute Telegram Archive 2025, One-Minute Telegram Archive 2024, One-Minute Telegram Archive 2023, One-Minute Telegram Archive 2022, One-Minute Telegram Archive 2021, and One-Minute Telegram Archive 2020.

Q1 2026toggle arrow icon

Edition 143 - March 14, 2026toggle arrow icon

Mind the gap: pharmacological prophylaxis for postoperative delirium in older adults

One-Minute Telegram 143-2026-1/3

10-second takeaway

Postoperative delirium is common in older adults and is associated with cognitive decline and increased health care costs, but there is a lack of evidence regarding the benefit of pharmacological therapy for postoperative delirium prophylaxis. This systematic review and network meta-analysis of 158 randomized controlled trials (RCTs) found that dexmedetomidine was effective in preventing postoperative delirium in adults aged ≥ 60 years across several settings, and that other pharmacological agents (e.g., corticosteroids, melatonin receptor agonists) were effective in specific settings. The quality of evidence for many of these findings was low, which emphasizes the need for high-quality studies to assess the effectiveness of perioperative pharmacological therapy for delirium prophylaxis in vulnerable older adults.

Study breakdown

  • Study population: 41,084 adults aged ≥ 60 years undergoing surgery requiring regional or general anesthesia
  • Study design: systematic review and network meta-analysis of 158 RCTs
    • Setting
      • Multinational
      • 135 studies were conducted at a single site; 23 studies were multicenter.
      • Studies were published between 1999 and 2024; 55% published after 2021.
    • Intervention: perioperative pharmacological agent for postoperative delirium prophylaxis (52 agents assessed) vs. placebo, alternative agent, or usual care
    • Primary outcome: incidence of postoperative delirium
    • Secondary outcomes included delirium severity, length of hospital stay, mortality, and postoperative complications.
  • Main results
  • Limitations include:
    • The high risk of bias in 17 trials and additional concerns in 48 others (e.g., regarding trial registration and reporting) reduced the quality of evidence for several analyses.
    • Methods for assessing secondary outcomes differed across studies, limiting the ability to analyze and interpret the data.
    • Results are not generalizable to individuals < 60 years of age.
    • Underrepresentation of adults > 80 years of age in the study population limits generalizability to this age group.
  • Study funding: National Institute for Health and Care Research Oxford Biomedical Research Centre
  • Original study: Effectiveness of drug interventions to prevent delirium after surgery for older adults: systematic review and network meta-analysis of randomised controlled trials [1]
  • Related AMBOSS articles: Delirium

Discussion points

Solriamfetol: a wake-up call for when shift (work) happens

One-Minute Telegram 143-2026-2/3

10-second takeaway

Shift workers are at risk of sleep disorders (i.e., shift-work disorder), impaired work performance, and accidents, and there are limited data on treatments for individuals with early morning shifts. In this randomized, placebo-controlled trial, solriamfetol significantly reduced objective and subjective sleepiness over 4 weeks in workers with early morning shifts. Wakefulness-promoting agents are a promising treatment for improving safety and work performance in this high-risk population.

Study breakdown

Vax-ing and waning: the rise and fall of newborn HBV vaccination

One-Minute Telegram 143-2026-3/3

10-second takeaway

Hepatitis B virus (HBV) vaccination at birth is highly effective at preventing HBV infection in infancy, which carries a high risk of chronic infection. However, this interrupted time series analysis of electronic health record (EHR) data for over 12.4 million US newborns born between 2017 and 2025 found that after peaking in early 2023, newborn HBV vaccination rates fell significantly below forecasted levels. With rising vaccine hesitancy and changing national recommendations around the childhood immunization schedule, monitoring rates of vaccine-preventable diseases in childhood is critical.

Study breakdown

  • Study population: 12,404,779 newborns born in the US between January 2017 and August 2025
  • Study design: interrupted time series analysis
    • Setting: EHR data from over 1809 hospitals and 41,500 clinics in the US (using the Epic Cosmos database)
    • Interruption point in July 2023 due to:
      • Wide circulation of a podcast by US Department of Health and Human Services Secretary Robert F. Kennedy, Jr. about HBV vaccination
      • Overall increase in public discussions around childhood vaccination
    • Outcome: monthly newborn HBV vaccination rate (doses administered within 30 days of birth divided by number of live births)
  • Main results
    • Newborn HBV vaccination rates increased until February 2023, after which they declined by > 10% over 2 years.
      • 67.5% in January 2017
      • 83.5% in February 2023
      • 73.2% in August 2025
    • After July 2023, HBV vaccination rates were significantly lower than rates projected by a forecasting model.
  • Limitations include:
    • Data are from sites included in an EHR database and may not be nationally representative.
    • The lack of data on individual demographic factors (e.g., race, socioeconomic status) limits generalizability.
  • Study funding: none reported
  • Original study: US newborn hepatitis B virus vaccination rates [3]
  • Related AMBOSS articles: Hepatitis B; Immunization schedule

Edition 142 - February 28, 2026toggle arrow icon

Spilling the tea: coffee and tea linked to lower dementia risk

One-Minute Telegram 142-2026-1/3

10-second takeaway

Lifestyle factors play a significant role in cognitive health, yet the specific effects of tea and coffee are unclear. This large prospective cohort study followed over 130,000 participants for up to 43 years and found that moderate consumption of tea and caffeinated coffee (but not decaffeinated coffee) was associated with a significantly lower risk of incident dementia and subjective cognitive decline. These findings suggest that moderate consumption of tea (1–2 cups/day) and/or caffeinated coffee (2–3 cups/day) may align with brain-healthy dietary patterns, although causal relationships remain unestablished.

Study breakdown

  • Study population
    • 131,821 adults; predominantly health professionals
    • 65.7% female
    • Mean age at baseline: 46.2 years in the Nurses’ Health Study (NHS) and 53.8 years in the Health Professionals Follow-up Study (HPFS)
  • Study design: prospective cohort study (NHS 1980–2023 and HPFS 1986–2023)
    • Setting: United States
    • Exposure: intake of caffeinated coffee, decaffeinated coffee, and tea assessed via validated food frequency questionnaires every 2–4 years
    • Outcomes (adjusted for confounding)
      • Primary: incident dementia assessed via death records and self-reported physician diagnoses
      • Secondary: subjective cognitive decline and objective cognitive function assessed via validated questionnaires and a phone-based cognitive test
  • Main results
    • Median follow-up: 36.8 years
    • Incident dementia
      • Caffeinated coffee: Higher intake was associated with a lower risk (adjusted hazard ratio [aHR] 0.82; 95% CI, 0.76 to 0.89).
      • Tea: Higher intake was associated with a lower risk (aHR 0.86; 0.83 to 0.90).
      • Decaffeinated coffee: Intake was not associated with the risk of incident dementia (aHR 0.97; 0.93 to 1.01).
    • Subjective cognitive decline
      • Caffeinated coffee: Higher intake was associated with a lower risk (adjusted prevalence ratio [aPR] 0.85; 95% CI, 0.78 to 0.93).
      • Tea: Higher intake was associated with a lower risk (aPR 0.86; 0.80 to 0.93).
      • Decaffeinated coffee: Higher intake was associated with a higher risk (aPR 1.16; 1.08 to 1.24).
    • Objective cognitive function (NHS only)
      • Caffeinated coffee: Higher intake showed a trend toward slightly better performance (global score mean difference [MD] 0.02; 95% CI, -0.01 to 0.0).
      • Tea: Higher intake was associated with slightly better performance (MD 0.04; 0.02 to 0.06).
      • Decaffeinated coffee: Intake was not associated with cognitive performance (MD 0.0; -0.02 to 0.02).
    • Dose response: showed a nonlinear association; the lowest risk of dementia was observed at intake levels of approx. 2–3 cups/day of caffeinated coffee or 1–2 cups/day of tea.
  • Limitations include:
    • Observational design is susceptible to residual confounding.
    • Dietary intake was self-reported, introducing potential recall bias.
    • Dementia was ascertained via death records and self-reports, which are susceptible to misclassification and may not account for milder cases.
    • Objective cognitive function findings were characterized by very small effect sizes and inconsistent results across measures, suggesting limited clinical significance at the individual level.
    • Participants were health professionals, potentially limiting generalizability.
  • Study funding: National Institutes of Health
  • Original study: Coffee and tea intake, dementia risk, and cognitive function [4]
  • Related AMBOSS articles: Major neurocognitive disorder

Discussion points

  • Study design: Why is a prospective cohort design with repeated measures valuable for this research question?
  • Study methods: How did the researchers account for reverse causation bias, whereby early cognitive symptoms might influence beverage consumption and/or the accuracy of self-reported intake?
  • Clinical application: How should this study inform counseling for patients concerned about cognitive decline?

When the slow lane isn’t safer: sodium correction and the cost of caution

One-Minute Telegram 142-2026-2/3

10-second takeaway

Current guidelines prioritize slow correction of hyponatremia to prevent osmotic demyelination syndrome, but this strategy may inadvertently increase the risk of mortality. In this large retrospective cohort study, medium (8–12 mEq/L) and fast (> 12 mEq/L) sodium correction rates per 24 hours were associated with significantly lower risks of 90-day mortality and neurological events compared to slow correction (< 8 mEq/L). These findings challenge "slow and steady" approaches to hyponatremia management, suggesting that the optimal correction rate may be higher than currently recommended. Randomized controlled trials are needed to establish definitive correction targets.

Study breakdown

  • Study population: 13,988 adults hospitalized with severe hyponatremia (serum sodium ≤ 120 mEq/L; median age, 74 years; 63% female)
  • Study design: retrospective cohort study
  • Main results
    • The primary composite outcome occurred in 21% of patients; faster correction rates were associated with a lower risk:
      • Medium vs. slow: risk difference (RD) -5.6%; 95% CI, -7.1% to -4.0%
      • Fast vs. slow: RD -9.0%; -11.1% to -6.9%
      • Fast vs. medium: RD -3.4%; -5.6% to -1.3%
    • 90-day mortality occurred in 18% of patients; faster correction rates were associated with a lower risk:
      • Medium vs. slow: RD -5.2%; -6.7% to -3.7%
      • Fast vs. slow: RD -8.1%; -10.0% to -6.2%
      • Fast vs. medium: RD -2.9%; -5.0% to -0.8%
    • Delayed neurological events occurred in 4% of patients; faster correction rates were associated with a lower or near-equivalent risk:
      • Medium vs. slow: RD -0.9%; -1.8% to -0.0%
      • Fast vs. slow: RD -1.7%; -2.6% to -0.7%)
      • Fast vs. medium: RD -0.8%; -1.8% to -0.2%
    • Exploratory analyses suggested a U-shaped relationship between correction speed and patient risk, with the lowest risk observed at 24-hour correction rates of approx. 20 mEq/L.
  • Limitations include:
    • Retrospective design is susceptible to residual confounding.
    • Potential survival bias: Time-dependent exposure may bias early deaths toward the slow-correction group, inflating the apparent harm of slower correction.
    • Reliance on ICD diagnostic codes for neurological events may have led to misclassification or undercounting of subtle neurological sequelae.
    • The absence of preadmission sodium values precludes differentiation between acute and chronic hyponatremia.
    • The insured, integrated-system cohort may limit generalizability to uninsured populations or less well-integrated care settings.
  • Study funding: The Permanente Medical Group Rapid Analytics Unit Program
  • Original study: Sodium correction rates and associated outcomes among patients with severe hyponatremia: a retrospective cohort study [5]
  • Related AMBOSS articles: Hyponatremia

Outpatient COVID-19 antivirals: final ACP practice points

One-Minute Telegram 142-2026-3/3

10-second takeaway

Managing outpatient COVID-19 requires up-to-date knowledge of antiviral efficacy against current variants such as Omicron. The 2026 American College of Physicians (ACP) version 3 practice points for confirmed COVID-19 in symptomatic adults reaffirm the use of nirmatrelvir/ritonavir and molnupiravir for high-risk patients in the outpatient setting while advising against ivermectin and sotrovimab. These guidelines clarify effective therapies for the Omicron variant and retire this topic from "living" status, as further practice-changing evidence is unlikely to emerge and ongoing updates are no longer anticipated.

Recommendations breakdown

  • Applicable population: symptomatic adults with confirmed mild to moderate COVID-19 in the outpatient setting (regardless of vaccination status)
  • Recommendations
    • Consider nirmatrelvir/ritonavir combination therapy within 5 days of symptom onset for patients who are at high risk of progression to severe disease.
    • Consider molnupiravir within 5 days of symptom onset for patients who are at high risk of progression to severe disease.
    • Do not use ivermectin to treat patients with confirmed mild to moderate COVID-19.
    • Do not use sotrovimab to treat patients with confirmed mild to moderate COVID-19.
    • No advice was offered for ensitrelvir, favipiravir, or simnotrelvir/ritonavir due to lack of benefit or insufficient evidence.
  • Implementation
  • Rationale and additional information
    • Omicron focus: This version of the practice points reaffirms previous recommendations on the management of infections with the SARS-CoV-2 Omicron variant.
    • Evidence basis
      • Nirmatrelvir/ritonavir: probably reduces all-cause mortality and hospital admissions (moderate-certainty evidence); may increase overall adverse events (moderate-certainty)
      • Molnupiravir: probably improves recovery time and reduces persistent symptoms (moderate-certainty); probably does not reduce hospital admissions (moderate-certainty)
    • Status change: The ACP is retiring this topic from "living" status because this update did not yield major changes, and new high-quality randomized controlled trials are unlikely to emerge.
  • Limitations include:
    • Evidence for mortality and hospitalization was generally of lower certainty than for recovery outcomes.
    • Adequate data on older adults with frailty and those living in congregate situations were lacking.
    • There were insufficient data to determine if treatment effects vary by age, gender, comorbidities, vaccination status, or prior infection.
  • Funding: American College of Physicians (operating budget)
  • Original study: Outpatient treatment of confirmed COVID-19 in symptomatic adults: living, rapid practice points from the American College of Physicians (version 3) [6]
  • Related AMBOSS articles: COVID-19 (coronavirus disease 2019)

Edition 141 - February 14, 2026toggle arrow icon

Small changes in behavior, big gains in lifespan!

One-Minute Telegram 141-2026-1/3

10-second takeaway

Sleep, physical activity, and nutrition (SPAN) affect health and longevity, but the minimum combined "dose" needed for meaningful improvement in years lived disease-free (healthspan) and life expectancy (lifespan) is unknown. This prospective cohort study analyzed wearable-derived sleep and activity data and retrospective diet information from ∼ 60,000 UK Biobank participants to estimate gains in lifespan and healthspan associated with SPAN. Investigators found that modest improvements made concurrently (e.g., five more minutes of sleep PLUS two additional minutes of exercise PLUS half an extra serving of vegetables daily) could result in one year of lifespan gained, while larger changes were required to improve healthspan. Maintaining a healthy lifestyle doesn't have to be all or nothing: advising small changes to multiple health-promoting behaviors may be an effective way of counseling on nutrition and regular exercise and counseling on sleep hygiene.

Study breakdown

  • Study population: 59,078 adults from the UK Biobank (median age, 64 years; 55% female)
  • Study design: prospective cohort study
    • Setting: United Kingdom
    • Exposure: SPAN score derived from combined SPAN behaviors
      • Sleep duration: hours/day measured by wrist accelerometer
      • Moderate to vigorous physical activity (MVPA): minutes/day measured by wrist accelerometer
      • Diet quality: 0–100 on a validated diet quality score (DQS)
    • Outcomes (adjusted for confounding)
  • Main results
    • Median follow-up: 8.1 years
    • Optimal SPAN levels (highest tertiles)
      • Sleep duration: 7.2–8.0 hours
      • MVPA: > 42 minutes/day
      • DQS: 57.5–72.5
    • Optimal SPAN levels compared to the least favorable tertiles were associated with:
      • 9.35 additional years of lifespan (95% CI, 6.67–11.63)
      • 9.45 additional years of healthspan (5.45–13.61)
    • Minimum "dose" of SPAN was associated with:
      • + 1 year (95% CI, 0.69–1.15) of lifespan: + 5 minutes/day sleep, + 1.9 minutes/day MVPA, and a 5-point DQS increase (e.g., adding half a serving of vegetables/day)
      • + 4 years (0.50–8.61) of healthspan: + 24 minutes/day sleep, + 3.7 minutes/day MVPA, and a 23-point DQS increase
    • Gains in lifespan and healthspan were primarily driven by MVPA
    • A synergistic and dose-response effect was observed when all three behaviors were optimized.
  • Limitations include:
    • Dietary data were self-reported, retrospective, and gathered at recruitment for the previous 12 months, and therefore prone to recall bias.
    • Physical activity and sleep data were gathered 5.5 years after dietary data, and only for 7 days.
    • SPAN data were collected at a single point in time and do not account for changes in participant behavior.
    • The UK Biobank cohort is generally healthier and less diverse than the general population, limiting the generalizability of findings.
  • Study funding: Australian National Health and Medical Research Council
  • Original article: Minimum combined sleep, physical activity, and nutrition variations associated with lifeSPAN and healthSPAN improvements: a population cohort study [7]
  • Related AMBOSS articles: Patient communication and counseling

Discussion points:

  • Study design: What is the main methodological reason this study was designed as a prospective cohort rather than a randomized controlled trial?
  • Study methods: How does the use of accelerometry (wearables) improve the validity of this study compared to traditional lifestyle research?
  • Clinical application: How can the "minimum dose" findings be used to improve patient adherence to lifestyle modifications?

Reproductive risks: comparative health risks of pregnancy and abortion

One-Minute Telegram 141-2026-2/3

10-second takeaway

Discussions regarding access to induced abortion in the US often include the statistic that pregnancy-related mortality is 14 times higher than abortion-related mortality, based on data from the early 2000s. This cross-sectional study analyzed national US birth and abortion data from 2018 to 2021 to compare pregnancy-related and abortion-related mortality. Investigators found that the risk of death from continued pregnancy is 44–70 times higher than that of abortion. This updated statistic highlights that the mortality risk associated with pregnancy is substantially more than 14 times higher than that of abortion. Laws restricting abortion access may force individuals to accept the significantly higher health risks associated with pregnancy.

Study breakdown

  • Study population: 14,902,571 births and 3,662,580 abortions in the US between 2018 and 2021
  • Study design: cross-sectional study
  • Main results
    • Overall mean ratio of pregnancy-related mortality to abortion-related mortality: 69.6 (range, 52.9–105.2)
    • In sensitivity analyses:
      • Excluding nonspecific or commonly misclassified causes of maternal death decreased the ratio to 52.9 (38.2–74.2).
      • Also excluding COVID-19–related deaths decreased the ratio to 44.3 (34.5–74.2).
    • These updated ratios are at least three times higher than the widely cited historical estimate of 14.7 (based on 1998–2005 data).
    • Abortion-related mortality remained extremely rare, with only 17 deaths recorded among the 3.6 million abortions performed during the study period.
  • Limitations include:
    • Due to limitations in US data sources, the denominator for pregnancy-related mortality is the annual number of births instead of the annual number of pregnancies.
    • Abortion-related mortality is a very rare event; the low annual number of deaths (2–6 per year) causes high annual variance in the calculated ratios.
    • Although the pregnancy checkbox on death certificates improves detection of maternal deaths, misclassification or erroneous completion can lead to overcounting and information bias. [8]
    • The data are limited to 2018–2021 and do not capture the specific impact on mortality of the 2022 Dobbs decision.
    • Aggregate data lack individual-level clinical details regarding comorbidities and socioeconomic factors.
  • Study funding: none reported
  • Original article: Pregnancy- and abortion-related mortality in the US, 2018-2021 [9]
  • Related AMBOSS articles: Induced abortion

Check your tone: how patient communication style biases medical AI

One-Minute Telegram 141-2026-3/3

10-second takeaway

With the rapid adoption of large language models (LLMs) for clinical message triage, understanding their susceptibility to nonclinical factors has become critical. This experimental study analyzed 120,000 runs of five agentic LLMs responding to 1000 synthetic primary care e-visits presented in varying tones (e.g., neutral, urgent, threatening). Findings show that demanding, urgent, threatening, or emotional tones increased same-day or urgent care assessment recommendations and shifted medication recommendations toward prescription use compared to neutral tone. This shows that LLMs treat tone as clinical information, escalating care or altering prescribing based on forceful language rather than medical need, which may introduce hidden biases into e-medicine workflows.

Study breakdown

  • Study sample: 1000 clinician-validated, synthetic primary care e-visits (500 clinical, 500 sick-leave)
  • Study design: experimental comparative trial
    • Setting: US-based synthetic primary care environment
    • Intervention
      • 8 communication styles (e.g., neutral tone compared to 7 tone variations) applied to otherwise identical synthetic e-visits
      • Each of the 5 agentic LLMs was tested on all 8 communication styles.
      • For each agent and per framing condition, vignettes were run 3 times to capture variability (i.e., 120,000 total runs).
    • Outcomes
    • 40 real-world patient e-messages were used to externally validate the results.
  • Main results
    • Input tone led to reproducible changes in LLM output.
    • Compared to neutral framing:
      • Demanding, urgent, threatening, or emotional tones increased same-day or urgent care assessment recommendations from 14% to 37–63% (P < 0.001 for all).
      • Threatening tone increased emergency referrals from 0% to 17%.
      • Demanding, urgent, threatening, or emotional tones shifted medication recommendations toward prescription use (5% to 7–9%) instead of OTC suggestions (P < 0.001 for all).
      • Threatening tone reduced sick leave approval rates (58% to 50% ).
      • Threatening tone reduced granted duration of sick leave (2.60 to 2.36 days ).
      • Emotional, threatening, and urgent framing significantly increased the frequency of empathy-based model responses.
    • LLMs performed differently: e.g., GPT-4.1 and Gemini 2.0 had the most outcomes affected by framing.
    • External validation with real-world e-messages confirmed that tone alters model outputs.
  • Limitations include:
    • No comparison was made between the LLM output and real-world health care provider responses.
    • Synthetic vignettes, while clinically validated, cannot capture the longitudinal relationships or full nuance of real-world physician–patient narratives.
    • The study only evaluated English-language and closed-source models (e.g., GPT, Gemini).
    • Predefined framing categories may not reflect the full range of patient tones encountered in practice.
    • The real-world validation set was small and limited to a single Israeli health system.
  • Study funding: National Institutes of Health, Clinical and Translational Science Awards, Icahn School of Medicine at Mount Sinai
  • Original article: Impact of patient communication style on agentic AI-generated clinical advice in e-medicine [10]

Edition 140 - January 31, 2026toggle arrow icon

Better off alone? Monotherapy vs. combination therapy for pediatric musculoskeletal pain

One-Minute Telegram 140-2026-1/3

10-second takeaway

While ibuprofen is the preferred treatment for acute musculoskeletal pain, it often provides inadequate relief in children. This pooled analysis of two multicenter randomized clinical trials showed that in children with moderate to severe pain from acute nonoperative limb injuries presenting to the emergency department (ED), adding a single oral dose of hydromorphone or acetaminophen to ibuprofen did not improve 60-minute pain scores compared with ibuprofen alone, and hydromorphone increased drug-related adverse events. These results support ibuprofen monotherapy over combination therapy for pain management in children with acute nonoperative musculoskeletal injuries.

Study breakdown

Discussion points

  • Study design: What is a preference-informed complementary trial design, and what is the advantage of this approach?
  • Study methods: Why was 60 minutes postmedication chosen as the primary time point for assessment?
  • Clinical application: How do these findings influence the choice of pain management in children with an acute nonoperative musculoskeletal injury?

Playing the long game: lipoprotein(a) predicts 30-year cardiovascular risk in women

One-Minute Telegram 140-2026-2/3

10-second takeaway

Elevated lipoprotein(a) [Lp(a)] levels are a significant and largely genetically determined risk factor for atherosclerotic cardiovascular disease, but they are not widely used for risk assessment in the general population. In this prospective cohort study in female health professionals, a baseline Lp(a) level of ≥ 30 mg/dL was associated with an increased 30-year risk of major adverse cardiovascular events and coronary heart disease, and very high levels (≥ 120 mg/dL or > 99th percentile) were also associated with an increased risk of ischemic stroke and cardiovascular death. These results suggest that population-based strategies incorporating Lp(a) screening can help identify patients at high risk for atherosclerotic cardiovascular disease and guide future tailored primary prevention strategies.

Study breakdown

Revisiting D-dimers in old-timers

One-Minute Telegram 140-2026-3/3

10-second takeaway

D-dimer testing is central to ruling out suspected deep vein thrombosis (DVT) in patients with a low or intermediate pretest probability, but its specificity declines with age and can lead to unnecessary imaging in older adults. This multinational prospective clinical study in patients with suspected DVT in the emergency department (ED) validated the use of an age-adjusted D-dimer cutoff to rule out DVT in patients at low or intermediate risk. No venous thromboembolism (VTE) occurred in participants in whom DVT was ruled out by the age-adjusted cutoff, suggesting that this strategy can reduce unnecessary imaging in older adults without compromising safety.

Study breakdown

  • Study population: 3205 adults presenting to the ED with suspected lower extremity DVT (median age, 59 years; 54% female)
  • Study design: multinational prospective clinical study (management outcome study)
    • Setting: 27 EDs in Belgium, Canada, France, and Switzerland between January 2015 and October 2022
    • Intervention: D-dimer was performed in patients with a Wells score suggestive of non-high or unlikely pretest probability of DVT.
      • Conventional D-dimer cut-off (< 500 mcg/L): ruled out DVT in participants aged < 50 years
      • Age-adjusted D-dimer cut-off (< age × 10 mcg/L): ruled out DVT in participants aged ≥ 50 years
      • All participants with a high or likely pretest probability of DVT or in whom D-dimer did not rule out DVT had an ultrasound and received anticoagulation if positive.
    • Primary outcome: failure rate, defined as the rate of symptomatic VTE (DVT and/or pulmonary embolism) in participants with D-dimer between 500 mcg/L and the age-adjusted cutoff
    • Secondary outcome: proportion of participants with non-high or unlikely pretest probability with D-dimer between 500 mcg/L and the age-adjusted cutoff, stratified by age group
    • Follow-up: 3 months
  • Main results
    • Among 2169 participants with a non-high or unlikely pretest probability of DVT:
      • 24.5% (95% CI, 22.7%–26.4%) had D-dimer < 500 mcg/L
      • 7.4% (6.4%–8.6%) had D-dimer between 500 mcg/L and the age-adjusted cutoff
      • 68.1% had D-dimer above the age-adjusted cutoff or D-dimer was not performed
    • No VTEs occurred among participants with D-dimer between 500 mcg/L and the age-adjusted cutoff: failure rate, 0% (95% CI, 0%–2.3%).
    • Using age-adjusted D-dimer cutoffs increased the proportion of participants with negative D-dimer results across all age groups.
      • 50–64 years: 6.1% absolute increase
      • 65–74 years: 14.8% absolute increase
      • ≥ 75 years: 17.4% absolute increase
  • Limitations include:
    • Outcomes could not be compared with a control group because the study was not a randomized controlled trial.
    • A variety of D-dimer assays were used (although all were highly sensitive).
    • Protocol deviations resulted in some participants having ultrasounds when not indicated based on D-dimer results.
    • Only patients with suspected lower extremity DVT were included; results are not generalizable to other thrombosis sites.
  • Study funding: Swiss National Research Foundation, Heart and Stroke Foundation of Canada, and various French and Belgian institutional grants
  • Original study: Age-adjusted D-dimer cutoff levels to rule out deep vein thrombosis [13]
  • Related AMBOSS articles: Deep vein thrombosis

Edition 139 - January 17, 2026toggle arrow icon

Time to rethink the pack-year? Smoking duration may improve lung cancer screening equity

One-Minute Telegram 139-2026-1/3

10-second takeaway

Individuals from minority racial and ethnic groups develop lung cancer at a lower smoking intensity and longer smoking duration than White individuals. Despite the 2021 USPSTF reduction of the lung cancer screening eligibility threshold from 30 to 20 pack-years, screening disparities persist. In this prospective cohort study, replacing pack-years with a ≥ 30-year smoking duration criterion narrowed eligibility gaps for African American and Latino individuals and increased the overall sensitivity of cancer detection. More real-world data and implementation studies are needed to assess the impact of smoking duration-based lung cancer screening on eligibility, overdiagnosis, and mortality across different racial and ethnic groups and geographical regions.

Study breakdown

  • Study population: 105,261 adults aged 45–75 years with a smoking history
    • Mean age, 59.8 years; 57.0% men
    • 18.3% African American, 25.9% Japanese American, 20.3% Latino, 7.9% Native Hawaiian, 27.6% White
  • Study design: prospective, population-based cohort study
    • Setting: Multiethnic Cohort linked to registries in California and Hawai‘i, recruited between 1993 and 1996
    • Comparison: hypothetical implementation of different lung cancer screening criteria
      • 2021 USPSTF screening criteria: i.e., ≥ 20 pack-years [14]
      • Smoking duration-based screening: i.e., ≥ 30 years
      • Risk-based screening criteria using the recalibrated Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial 2012 model [15]
    • Outcome: screening eligibility and prognostic performance (sensitivity and specificity) in identifying 6-year lung cancer incidence
      • Primary outcome: 2021 USPSTF criteria vs. smoking duration-based criteria
      • Secondary outcome: smoking duration-based criteria vs. risk-based criteria
    • Follow-up: cancer ascertainment over > 22 years (through 2018)
  • Main results
    • Screening eligibility gaps decreased with duration-based criteria compared to 2021 USPSTF criteria, especially for:
      • African American vs. White individuals: 30.4% vs. 28.8% with duration-based criteria; 21.4% vs. 30.2% with 2021 USPSTF criteria
      • Latino vs. White individuals: 25.1% vs. 28.8% with duration-based criteria; 15.7% vs. 30.2% with 2021 USPSTF criteria
    • Lung cancer detection prognostic sensitivity increased and specificity decreased with duration-based criteria compared to 2021 USPSTF criteria.
      • Overall sensitivity: 66.1% vs. 57.7%
      • Overall specificity: 73.0% vs. 76.5%
      • The greatest change was seen in African American and Latino individuals; values remained relatively stable in other groups.
    • Risk-based screening criteria (1.1% threshold) yielded the highest overall sensitivity but widened eligibility gaps, particularly between Latino and White individuals, and showed lower sensitivity in Latino individuals compared with duration-based criteria.
  • Limitations include:
    • This was a hypothetical, prospective, registry data-based study; no actual screening was performed.
    • Analysis was based on eligibility at the time of cohort enrollment (1993–1996) and may not reflect current smoking trends or risk factors.
    • Data from California and Hawai‘i may not be generalizable to other populations.
    • The potential for overdiagnosis could not be assessed given the hypothetical nature of the study.
    • Smoking data was self-reported, which is subject to recall bias.
  • Study funding: National Institutes of Health
  • Original study: Eligibility and prognostic performance of smoking duration-based versus pack-year-based U.S. national lung cancer screening criteria across racial and ethnic groups [16]
  • Related AMBOSS articles: Lung cancer; Tobacco product use and smoking cessation

Discussion points

  • Study design: Why is a prospective cohort linked to a cancer registry an effective way to study screening criteria?
  • Study methods: Why might smoking duration be a more equitable metric than pack-years for African American and Latino populations?
  • Clinical application: Should clinicians consider smoking duration when assessing lung cancer screening eligibility for minority patients who fall just short of the 20 pack-year threshold? [17]

Protecting the bump: COVID-19 vaccination reduces maternal and perinatal risks

One-Minute Telegram 139-2026-2/3

10-second takeaway

COVID-19 infection during pregnancy increases the risk of severe maternal morbidity and adverse birth outcomes. This population-level surveillance study analyzed nearly 20,000 pregnant individuals in Canada and found that vaccination before or during pregnancy was associated with a reduction in hospitalization, ICU admission, and preterm birth across both Delta and Omicron periods. These findings support existing evidence that COVID-19 vaccination in pregnancy is associated with a reduced risk of severe maternal disease and preterm birth.

Study breakdown

Small steps for the Whipple: laparoscopic vs. open approach

One-Minute Telegram 139-2026-3/3

10-second takeaway

Pancreatoduodenectomy (Whipple procedure) is a complex operation associated with substantial postoperative morbidity. This multicenter, patient-blinded randomized trial (DIPLOMA-2) found that minimally invasive pancreatoduodenectomy (MIPD), primarily using robotic assistance, was noninferior to open pancreatoduodenectomy (OPD) for 90-day complications and resulted in a modestly shorter time to functional recovery (TTFR) in centers experienced in MIPD. These findings suggest that, in centers with substantial experience, a minimally invasive approach may have comparable complication rates and limited recovery benefits for patients with resectable neoplasms; however, additional studies are needed to clarify mortality risk and long-term oncological outcomes.

Study breakdown

  • Study population: 288 adults with resectable pancreatic or periampullary neoplasms without vascular contact and BMI ≤ 35 kg/m2 (median age, 70 years in MIPD and 68 years in OPD; 58% men)
  • Study design: international, multicenter, patient-blinded randomized noninferiority trial
    • Setting: 14 high-volume surgical centers across 6 European countries
    • Intervention: MIPD (170 robotic, 20 laparoscopic) vs. OPD
    • End points
    • Secondary end points included TTFR, length of hospital stay, and mortality.
    • Follow-up: 90 days
  • Main results (modified intention-to-treat analysis)
    • MIPD was noninferior to OPD for 90-day complications.
      • Mean CCI score: 33.4 ± 27.5 (MIPD) vs. 35.3 ± 25.5 (OPD)
      • Mean difference: -1.9 (95% CI, -8.5 to 4.7); P = 0.002 for noninferiority
    • The MIPD group had a shorter median TTFR compared to the OPD group.
      • MIPD: 7 days (IQR, 6–14)
      • OPD: 8 days (IQR, 5–11)
      • P = 0.024
    • The MIPD group had a shorter median initial hospital stay compared to the OPD group.
      • MIPD: 9 days (IQR, 6–15)
      • OPD: 11 days (IQR, 7–20)
      • Median difference: -2.0 days (95% CI, -4.7 to 0.7)
    • 90-day mortality was higher in the MIPD group, but the difference did not reach statistical significance.
      • MIPD: 9/190 (4.7%)
      • OPD: 2/98 (2.0%)
      • RR, 2.40 (95% CI, 0.51 to 11.30)
  • Limitations include:
    • Results are limited to high-volume centers with surgeons experienced in MIPD.
    • The trial lacked power to assess mortality, resulting in wide confidence intervals and unresolved uncertainty regarding the higher 90-day mortality observed after MIPD.
    • Almost 90% of MIPDs were robotic; results may not be generalizable to centers performing nonrobotic laparoscopic surgery.
    • Multiple secondary end points were evaluated without adjustment for multiplicity.
    • The 90-day follow-up period is too short to evaluate long-term oncological outcomes.
  • Study funding: Intuitive Surgical (Switzerland), Fondazione Poliambulanza Istituto Ospedaliero
  • Original study: Minimally invasive versus open pancreatoduodenectomy for resectable neoplasms [19]
  • Related AMBOSS articles: Pancreatic and hepatic surgery; Pancreatic cancer

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