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Grand RoundsWeekly Evidence Brief

Internal Medicine

Edition

30-Second Takeaway

  • ICM-triggered, nurse-led diuretic protocols were safe but did not improve a 5-component HF composite.
  • Stepwise CDS plus reflex urine-culture stewardship substantially reduced unnecessary antibiotics.

Week ending May 30, 2026

Five recent trials and analyses with direct clinic implications across heart failure, oncology survivorship education, SLE trial diversity, iAMD trial design, and urine-culture stewardship

ICM-based alerts plus nurse-led diuretic protocol safe but no primary outcome benefit in HF

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGYMay 27, 2026

In 711 HF patients randomized to ICM alert–triggered, centrally managed nurse diuretic protocols versus observation, the primary 5-component composite did not improve (win ratio 0.79; P = 0.06). Mean follow-up was 17.3 months, and intervention-related serious adverse events were rare (0.32%). Cumulative cardiovascular death and HF events were numerically higher in the intervention arm (HR 1.43; P = 0.091). An exploratory adjustment for baseline quality-of-life imbalance neutralized the primary signal, implying implementation factors influenced results.

Protocol: randomized trial of AI-driven personalized education after head and neck cancer surgery in older adults

BMC GERIATRICSMay 30, 2026

This single-center RCT will randomize 100 postoperative head and neck cancer patients aged ≥60 to 12 months of AI-personalized education versus standard SMS education. Primary outcomes include stress, sleep, pain, loneliness, nutrition, and multiple quality-of-life scales assessed at five timepoints to 12 months. The design uses intention-to-treat analysis with linear mixed models to handle missing data. Generalisability is limited by single-center conduct and self-reported outcomes.

SLE RCTs under-represent racial minorities despite high disease burden

AUTOIMMUNITY REVIEWSMay 27, 2026

Systematic review of 63 SLE RCTs (2014–2024) found pooled participant composition of 61% White, 14% Black, 14% Asian, and 8% Indigenous. Women comprised 91% of trial participants. Under-representation of Black and Indigenous groups risks limiting external validity for these populations. Hispanic/Latino reporting was inconsistent, complicating ethnicity-based interpretation.

References

Numbered in order of appearance. Click any reference to view details.

Additional Reads

Optional additional studies from this edition.

Edition context

Clinical signal

  • Monitor for possible increased HF events with alert-driven interventions until replicated.
  • Consider CDS plus reflex testing to reduce urine-culture overuse and antibiotic exposure.
  • Interpret SLE trial results cautiously given under-representation of Black and Indigenous patients.