Introduction
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.
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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 2026
- One-Minute Telegram 141-2026
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One-Minute Telegram 140-2026
- Better off alone? Monotherapy vs. combination therapy for pediatric musculoskeletal pain
- Playing the long game: lipoprotein(a) predicts 30-year cardiovascular risk in women
- Revisiting D-dimers in old-timers
-
One-Minute Telegram 139-2026
- Time to rethink the pack-year? Smoking duration may improve lung cancer screening equity
- Protecting the bump: COVID-19 vaccination reduces maternal and perinatal risks
- Small steps for the Whipple: laparoscopic vs. open approach
Edition 141 - February 14, 2026
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)
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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)
- Lifespan based on all-cause mortality
- Healthspan: years lived free of cardiovascular disease, cancer, type 2 diabetes, COPD, and dementia
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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:
- Gains in lifespan and healthspan were primarily driven by MVPA
- A synergistic and dose-response effect was observed when all three behaviors were optimized.
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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 [1]
- 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
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Study design: cross-sectional study
- Setting: US (utilizing the National Vital Statistics System, Pregnancy Mortality Surveillance System, and Guttmacher Institute data)
- Exposure: continued pregnancy (leading to live birth or stillbirth) vs. induced abortion
- End point: ratio of pregnancy-related to abortion-related mortality
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Main results
- Overall mean ratio of pregnancy-related mortality to abortion-related mortality: 69.6 (range, 52.9–105.2)
- In sensitivity analyses:
- 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.
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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. [2]
- 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 [3]
- 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)
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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
- Agentic LLM response, including differences in triage urgency, over-the-counter (OTC) vs. prescription medication selection, follow-up timeframe, sick-leave approval and duration, response style, and appropriateness of request
- The strength of association between categorical variables was assessed using Cramer’s V from chi-square tests or Cohen's d from t-tests.
- 40 real-world patient e-messages were used to externally validate the results.
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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.
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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 [4]
Edition 140 - January 31, 2026
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
- Study population: 653 children aged 6–17 years (mean age, 11.5 years; 47.4% female) presenting to the ED with an acute nonoperative limb injury and moderate to severe pain
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Study design: pooled analysis of two simultaneous multicenter, randomized, double-blind, placebo-controlled trials
- Setting: 6 tertiary care pediatric EDs in Canada between April 2019 and March 2023
- Intervention: single oral dose of ibuprofen (10 mg/kg, max. 600 mg) combined with a single oral dose of either hydromorphone (0.05 mg/kg, max. 5 mg), acetaminophen (15 mg/kg, max. 1000 mg), and/or placebo
- Opioid trial intervention: randomized 1:1:1 (changed to 1:1:2 mid-trial) to ibuprofen alone (n = 65), ibuprofen + acetaminophen (n = 66), or ibuprofen + hydromorphone (n = 107)
- Nonopioid trial intervention: randomized 1:1 to ibuprofen alone (n = 209) or ibuprofen + acetaminophen (n = 206)
- Primary efficacy outcome: self-reported verbal numerical rating scale (vNRS) pain score (range 0–10) at 60 minutes
- Primary safety outcome: proportion of children with a study-drug–related adverse event
- Follow-up: up to 120 minutes in the ED, with digital surveys at 1–3 days and 1–2 weeks after discharge
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Main results
- Mean vNRS pain scores at 60 minutes were similar across the 3 groups (P = 0.78).
- Ibuprofen alone: 4.6 ± 2.3
- Ibuprofen + acetaminophen: 4.6 ± 2.4
- Ibuprofen + hydromorphone: 4.8 ± 2.6
- The proportion of children with drug-related adverse events was more than 4 times higher in the hydromorphone group compared to the other groups.
- Ibuprofen + hydromorphone: 28.2%
- Ibuprofen + acetaminophen: 6.1%
- Ibuprofen alone: 5.8%
- No serious adverse events were reported.
- Mean vNRS pain scores at 60 minutes were similar across the 3 groups (P = 0.78).
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Limitations include:
- The study only evaluated single doses of oral analgesics.
- Only children with nonoperative musculoskeletal injuries were included; results are not generalizable to other causes of pain.
- Lack of data on certain demographic variables (e.g., race, ethnicity) prevents subgroup analyses and limits generalizability.
- Pooling data from two trials may introduce bias.
- Study funding: Canadian Institutes of Health Research
- Original study: Acetaminophen (paracetamol) or opioid analgesia added to ibuprofen for children’s musculoskeletal injury: two randomized clinical trials [5]
- Related AMBOSS articles: Principles of pain management
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
- Study population: female health professionals (median age, 53 years) without cardiovascular disease, cancer, or other major chronic illness at baseline, and one or both of the following
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Study design: prospective cohort study
- Setting: data from the Women’s Health Study in the US from 1993 to 2023
- Exposure
- Baseline Lp(a) measurement (continuous values, clinical thresholds, and percentiles)
- LPA rs3798220 genotype known to be associated with elevated Lp(a) levels
- Primary outcome: incident major cardiovascular events (myocardial infarction, coronary revascularization, ischemic stroke, cardiovascular death)
- Secondary outcomes: coronary heart disease, ischemic stroke, cardiovascular death
- Median follow-up: 27.8 years (IQR, 22.8–29.4)
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Main results
- Incident major cardiovascular events occurred in 3707 women with baseline Lp(a) measurements; the risk was higher with increased Lp(a) levels.
- Lp(a) levels ≥ 30 mg/dL or > 75th percentile were associated with a stepwise increase in the incidence of major cardiovascular events.
- Adjusted hazard ratio (aHR) for Lp(a) ≥ 120 mg/dL vs. < 10 mg/dL: 1.54 (95% CI, 1.24–1.92)
- aHR for Lp(a) > 99th percentile vs. ≤ 50th percentile: 1.74 (1.35–2.25)
- Very high Lp(a) levels (≥ 120 mg/dL) vs. < 10 mg/dL were also associated with an increased risk of:
- Coronary heart disease: aHR, 1.80 (1.36–2.37)
- Cardiovascular death: aHR, 1.63 (1.16–2.28)
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Lp(a) levels ≥ 99th percentile vs. ≤ 50th percentile were also associated with an increased risk of:
- Coronary heart disease: aHR, 2.06 (1.49–2.84)
- Ischemic stroke: aHR, 1.85 (1.17–2.93)
- Cardiovascular death: aHR, 1.86 (1.26–2.75)
- Major cardiovascular events occurred in 3165 women with genotype data, and carriers of the LPA rs3798220 minor allele had an increased risk (aHR, 1.27; 1.07–1.51).
- Incident major cardiovascular events occurred in 3707 women with baseline Lp(a) measurements; the risk was higher with increased Lp(a) levels.
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Limitations include:
- The study cohort consisted of female health professionals, primarily of European descent, which limits generalizability.
- Lp(a) was only measured at baseline; while generally stable, it is unknown whether levels changed over time.
- Potential for bias due to apparent violation of the proportional hazards assumption in the analysis of the association between Lp(a) as a categorical variable and major cardiovascular events
- Study funding: National Institutes of Health and the Independent Research Fund Denmark
- Original study: Thirty-year risk of cardiovascular disease among healthy women according to clinical thresholds of lipoprotein(a) [6]
- Related AMBOSS articles: Atherosclerotic cardiovascular disease; Coronary artery disease; Ischemic stroke
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)
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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
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Main results
- Among 2169 participants with a non-high or unlikely pretest probability of DVT:
- 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
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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 [7]
- Related AMBOSS articles: Deep vein thrombosis
Edition 139 - January 17, 2026
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
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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
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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 [8]
- 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 [9]
- 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)
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Main results
- Screening eligibility gaps decreased with duration-based criteria compared to 2021 USPSTF criteria, especially for:
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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.
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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 [10]
- 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? [11]
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
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Study population: 19,899 pregnant individuals with SARS-CoV-2 infection
- COVID-19 vaccination status before diagnosis: 72.2% vaccinated (of which 80% were vaccinated before pregnancy), 27.8% unvaccinated
- COVID-19 variant period: 69.2% Omicron, 30.8% Delta
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Study design: population-level surveillance study
- Setting: 8 Canadian provinces and 1 territory between April 5, 2021, and December 31, 2022
- Exposure: vaccination against COVID-19 vs. no vaccination
- Primary outcomes: COVID-19–associated hospitalization, ICU admission, and preterm birth (< 37 weeks' gestation)
- Secondary outcomes included mode of delivery, stillbirth, and neonatal ICU admission.
- Follow-up: All individuals were followed until pregnancy conclusion.
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Main results
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Vaccination was associated with a significantly lower risk of maternal hospitalization.
- Delta variant period: RR, 0.38 (95% CI, 0.30–0.48)
- Omicron variant period: RR, 0.38 (0.27–0.53)
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Vaccination was associated with a significant reduction in maternal ICU admission.
- Delta: RR, 0.10 (0.04–0.26)
- Omicron: RR, 0.10 (0.03–0.29)
- Vaccinated individuals had a lower risk of preterm birth.
- Delta: RR, 0.80 (0.66–0.98)
- Omicron: RR, 0.64 (0.52–0.77)
- In a multivariable analysis adjusting for comorbidities, unvaccinated individuals remained at higher risk for hospitalization compared to vaccinated individuals.
- Omicron: adjusted RR, 2.43 (1.72–3.43)
- Delta: adjusted RR, 3.82 (2.38–6.14)
- Cesarean delivery rates were similar, while neonatal ICU admissions were lower in vaccinated individuals.
- Vaccination during pregnancy was associated with lower observed rates of preterm birth and stillbirth compared with vaccination before pregnancy (post hoc analysis).
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Vaccination was associated with a significantly lower risk of maternal hospitalization.
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Limitations include:
- The observational study design precludes causal conclusions.
- The potential incomplete capture of mild cases, especially during the less virulent and less rigorously tracked Omicron period, may have skewed the sample toward more severe disease.
- Vaccination was analyzed primarily as a binary exposure; dose-response effects and booster doses were not evaluated.
- Variant classification was based on dominant time periods rather than laboratory confirmation.
- Analyses comparing vaccination before and during pregnancy were post hoc, unadjusted, and limited to selected perinatal outcomes.
- Study funding: Public Health Agency of Canada, Canadian Institutes of Health Research, BC Women’s Health Foundation
- Original study: The role of vaccination in maternal and perinatal outcomes associated with COVID-19 in pregnancy [12]
- Related AMBOSS articles: COVID-19 (coronavirus disease 2019); Prenatal care
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)
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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
- Primary end point: Comprehensive Complication Index (CCI) score at 90 days
- Secondary end points included TTFR, length of hospital stay, and mortality.
- Follow-up: 90 days
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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)
- MIPD was noninferior to OPD for 90-day complications.
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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 [13]
- Related AMBOSS articles: Pancreatic and hepatic surgery; Pancreatic cancer