Hay AD, Abbs S, Ridd M
… +18 more, Granier S, Lane JA, Muir P, Taylor J, Young G, Eastwood K, Dash H, Bradshaw L, Clarke R, Lui M, Bridgeman E, Brierley RCM, Brown E, Thornton HV, Mitchell PM, Zhu L, Yardley L, Metcalfe C
JAMA Intern Med
· 2026 Jul · PMID 42149561
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IMPORTANCE: Most antibiotic prescribing takes place in primary care, driving antimicrobial resistance, a top-10 threat to global public health. There is considerable international interest in whether rapid multiplex micr...IMPORTANCE: Most antibiotic prescribing takes place in primary care, driving antimicrobial resistance, a top-10 threat to global public health. There is considerable international interest in whether rapid multiplex microbiological point-of-care testing (RM-POCT) can safely reduce antibiotic prescribing in primary care. OBJECTIVE: To investigate whether the use of a RM-POCT can safely reduce same-day antibiotic prescribing for children and adults presenting to primary care with respiratory infections. DESIGN, SETTING, AND PARTICIPANTS: This parallel-group randomized clinical trial was conducted at 16 general practices in Southwest England between December 2022 and April 2024. Patients were eligible if they were aged 12 months or older, presented with any clinician-diagnosed acute (≤21 days) respiratory tract infection, and the patient or clinician believed antibiotic treatment was, or might be, necessary. Participants were randomized (1:1) to RM-POCT or usual care. The research team, including those conducting statistical analyses, were unaware of group allocation. Data were analyzed from November 21, 2024, to March 13, 2025. INTERVENTION: Patients in the intervention group were tested with RM-POCT to indicate the presence or absence of 19 respiratory viral pathogens and 4 atypical bacteria in approximately 45 minutes. MAIN OUTCOMES AND MEASURES: The primary outcome was same-day antibiotic prescribing. The safety outcome was patient-reported symptom severity on days 2 to 4. RESULTS: Among 552 included patients (mean [SD] age, 40.0 [21.2] years; 349 [63%] female), 276 were randomized to the intervention group and 276 to usual care. Primary outcome data were available for all participants, and safety outcome data were available in 216 intervention participants (78%) and 203 usual care participants (74%). Same-day antibiotics were prescribed to 124 participants (45%) in each group (odds ratio [OR], 1.00 [95% CI, 0.71 to 1.41]; P > .99). Prespecified subgroup analyses showed evidence of differentially reduced antibiotic prescribing in participants from whom a virus was detected (OR, 0.35 [95% CI, 0.20 to 0.63]; P for interaction < .001) and those with chronic lung disease (OR, 0.55 [95% CI, 0.28 to 1.09]; P for interaction = .046) but not children younger than 16 years (OR, 1.75 [95% CI, 0.64 to 4.74]; P for interaction = .24), nor where patients and clinicians disagreed on antibiotic necessity (OR, 1.12 [95% CI, 0.63 to 1.98]; P for interaction = .53). There was no difference in symptom severity on days 2 to 4 between groups (difference in means, 0.09 [95% CI, -0.10 to 0.27]; P = .36). CONCLUSIONS AND RELEVANCE: In this randomized clinical trial among patients with respiratory tract infections being considered for antibiotic treatment in primary care, use of an RM-POCT did not reduce same-day antibiotic prescribing or worsen patient outcomes. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN16039192.
Bhatt SP, Sun Y, Wang Y
… +16 more, Balte PP, Schwartz JE, Cassano P, Chaves PH, Couper D, Jacobs DR, Kalhan R, Kaplan RC, Lloyd-Jones D, Newman AB, O'Connor GT, Sadatsafavi M, Umans JG, White WB, Yende S, Oelsner EC
JAMA Intern Med
· 2026 Jul · PMID 42143630
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IMPORTANCE: Chronic obstructive pulmonary disease (COPD) is a leading cause of death and age-standardized COPD mortality has increased substantially over the past few decades. Robust estimates of life expectancy and year...IMPORTANCE: Chronic obstructive pulmonary disease (COPD) is a leading cause of death and age-standardized COPD mortality has increased substantially over the past few decades. Robust estimates of life expectancy and years of life lost (YLL) from COPD, which are important to patient care and policy decisions, are lacking. OBJECTIVE: To determine whether COPD is associated with lower life expectancy and whether the YLL are associated with disease severity. DESIGN, SETTING, AND PARTICIPANTS: The National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study harmonized and pooled data from 8 US general population cohorts. Participants aged 17 to 98 years were enrolled from 1983 to 2011 and followed up longitudinally through 2020. Data analysis was conducted from January 1, 2025, to January 15, 2026. EXPOSURES: Presence of COPD, which was defined by a prebronchodilator forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio of less than 0.70 and disease stages per the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations. MAIN OUTCOMES AND MEASURES: This study used a parametric proportional hazards model with a Gompertz baseline hazard function to estimate survival by GOLD stage from the time of initial spirometry. The multivariable hazards function was used to estimate life expectancy, adjusting for demographics, educational attainment, body mass index, smoking status, pack-years of smoking, diabetes, hypertension, and hypercholesterolemia. YLL was calculated in comparison with individuals with no airflow obstruction. RESULTS: Of 45 886 participants (mean [SD] age, 52.4 [15.8] years; 25 827 [56.3%] females), 13 869 (30.2%) died over a median follow-up of 15.2 (IQR, 9.7-27.1) years. COPD was present in 8058 participants (17.6%). In age-adjusted models, mean life expectancy for an individual aged 65 years was 21.5 (95% CI, 21.3-21.6) years without COPD, decreasing to 20.0 (95% CI, 19.7-20.4) years for GOLD stage 1, 16.4 (95% CI, 16.1-16.8) years for GOLD stage 2, 13.1 (95% CI, 12.5-13.8) years for GOLD stage 3, and 10.7 (95% CI, 8.9-12.6) years for GOLD stage 4. YLL were 0.71 (95% CI, 0.34-1.08) for GOLD stage 1, 2.58 (95% CI, 2.21-2.95) for GOLD stage 2, 5.07 (95% CI, 4.39-5.74) for GOLD stage 3, and 7.12 (95% CI, 5.21-9.04) for GOLD stage 4. Comparable decreases were noted for COPD in those who never smoked vs ever smoked. YLL for GOLD stages 2 to 4 were similar or greater than the YLL for hypertension (2.7; 95% CI, 2.4-3.0), diabetes (4.1; 95% CI, 3.7-4.4), obesity (0.5; 95% CI, 0.1-0.9), and cigarette smoking (5.5; 95% CI, 5.1-5.9). CONCLUSIONS AND RELEVANCE: In this cohort study, COPD was associated with lower life expectancy, including in adults who never smoked.
Bhasin S, Burnett AL, Gagliano-Jucá T
… +10 more, Storer TW, Reid KF, Shang YV, Privat F, Chandra MS, Weiss M, Memish-Beleva Y, Lam H, Kibel AS, Pencina KM
JAMA Intern Med
· 2026 Jul · PMID 42113507
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IMPORTANCE: A majority of men with prostate cancer have low-grade cancer and an excellent prognosis after radical prostatectomy. Hypogonadism and associated symptoms impair quality of life in prostate cancer survivors. M...IMPORTANCE: A majority of men with prostate cancer have low-grade cancer and an excellent prognosis after radical prostatectomy. Hypogonadism and associated symptoms impair quality of life in prostate cancer survivors. Many guidelines, citing a lack of randomized clinical trials showing safety and efficacy of testosterone replacement therapy (TRT), consider a history of prostate cancer a contraindication for TRT. OBJECTIVE: To evaluate the short-term safety and efficacy of TRT in prostate cancer survivors with symptomatic hypogonadism. DESIGN, SETTING, AND PARTICIPANTS: This randomized, placebo-controlled, double-blind, parallel-group, phase 2 trial was conducted at 2 academic medical centers in men 40 years and older with organ-confined, low-grade prostate cancer (Gleason score of 6 [3 + 3] or 7 [3 + 4]). Participants had undetectable prostate-specific antigen (PSA) for at least 2 years after radical prostatectomy, a mean of 2 testosterone levels less than 275 ng/dL, and low libido, erectile dysfunction, or fatigue. Patients were allocated using concealed, block randomization, with stratification for age (40-60 years or >60 years) and phosphodiesterase-5 inhibitor (PDE5I) use. The first participant was randomized on May 13, 2019, and the last study visit was completed on May 16, 2025. INTERVENTION: Testosterone cypionate, 100 mg, or placebo intramuscularly weekly for 12 weeks. MAIN OUTCOMES AND MEASURES: The primary efficacy outcome was sexual activity. Secondary outcomes included sexual desire, erectile function, well-being, body composition, aerobic capacity, and physical function. The safety outcome was biochemical recurrence (PSA ≥ 0.2 ng/mL). RESULTS: A total of 136 men were randomized, 68 to receive testosterone cypionate, 100 mg, and 68 to receive placebo, and 125 men completed the study. Groups were similar at baseline (mean [SD] age, 68.6 [6.5] years; 52 [38%] had a Gleason score of 6; and 84 [62%] had a Gleason score of 7). No participant in either group experienced biochemical recurrence. TRT significantly increased sexual activity more than placebo, adjusted for PDE5I use and age (between-group difference, 0.91 daily events [95% CI, 0.56-1.26]; P < .001). TRT increased sexual desire and prostate cancer quality-of-life sexual domain score, and decreased negative affect more than placebo. Erectile function did not change. TRT significantly improved body composition, loaded stair-climbing power, and peak aerobic performance (VO2 peak) compared with placebo. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, TRT for 12 weeks in men treated with radical prostatectomy for low-grade prostate cancer significantly improved sexual activity, sexual desire, well-being, body composition, physical function, and aerobic performance compared to placebo without biochemical recurrence. The trial was neither long enough nor large enough to evaluate clinical recurrence or long-term safety; this proof-of-concept trial was essential for rationalizing a larger, long-term study. These findings do not apply to men with high-grade prostate cancer or those treated with androgen deprivation therapy or radiation therapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03716739.
Zhang L, Morgan KM, Cohen J
… +2 more, McConnell M, Ganguli I
JAMA Intern Med
· 2026 Jul · PMID 42113503
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IMPORTANCE: Primary care physicians face increasing pressure to deliver complex care within fixed, short visit durations. Prior evidence links higher time pressure to lower-quality care, but the effects of reduced time p...IMPORTANCE: Primary care physicians face increasing pressure to deliver complex care within fixed, short visit durations. Prior evidence links higher time pressure to lower-quality care, but the effects of reduced time pressure on care delivery are not well understood. OBJECTIVE: To evaluate whether reduced visit-level time pressure is associated with measures related to greater comprehensiveness and preventive care delivery in primary care visits, overall and by patient chronic condition burden and continuity with one's usual physician. DESIGN, SETTING, AND PARTICIPANTS: This quasi-experimental cross-sectional study used electronic health record data from 2021 to 2024. The study included visits to primary care physicians at primary care practices within a large integrated health system in the Northeastern US who routinely offered same-day visit slots for adult patients in their schedules. Visits preceding an unfilled same-day visit (reduced time pressure) were compared with visits preceding a filled same-day visit (regular time pressure) using linear regression models that included physician and temporal fixed effects. EXPOSURE: Reduced time pressure, defined as an unfilled same-day visit slot immediately following the index visit. MAIN OUTCOMES AND MEASURES: Indicators for comprehensiveness of care (total and new diagnoses addressed, total and new prescriptions, diagnostic testing, and referrals) and ordering of preventive care (immunizations and health maintenance items). RESULTS: Among 191 269 visits across 311 physicians (170 526 regular time pressure; 20 743, reduced time pressure), mean (SD) patient age was 57.7 (18.1) years, and 59.7% of visits were with female patients. Under reduced time pressure, physicians recorded 0.11 (95% CI, 0.08-0.15) more total diagnoses, 0.09 (95% CI, 0.07-0.11) more new diagnoses, and 0.02 (95% CI, 0.01-0.03) more new prescriptions, and ordered 0.08 (95% CI, 0.03-0.13) more diagnostic tests, with no differences in referrals or preventive care. The estimated effects of reduced time pressure on total and new diagnoses were largest among patients with 3 or more chronic conditions (total diagnoses: 0.16 [95% CI, 0.10-0.21]; new diagnoses: 0.10 [95% CI, 0.07-0.14]). Visits with a patient's usual physician included more orders for diagnostic testing and preventive care, although time pressure effects were similar when seeing one's usual physician vs another physician. CONCLUSIONS AND RELEVANCE: In this study, reduced time pressure visits had care patterns aligned with more comprehensive care, particularly for patients with multimorbidity. These modest results highlight the potential trade-offs between visit length and the scope of care delivered, underscoring the importance of addressing time constraints in primary care.