Latest Family Practice research

Top 10 this week

Week of 1 November 2026

1. 1

   Specialist Referral for Cardiovascular Risk in Patients With Prostate Cancer: A Randomized Clinical Trial

   JAMA internal medicine · Q1 journal · RCT · Evidence level 1 (High) · 30 August 2026

   In a trial of 2,487 men on androgen deprivation therapy, routine referral to a cardiology or internal-medicine specialist produced a win-ratio of 1.60, driven mainly by a 12 mg/dL greater reduction in total cholesterol from increased statin use. Blood pressure and hard cardiovascular events did not differ, leaving the impact on clinical outcomes uncertain.

2. 2

   Low-Voltage Ablation in Persistent Atrial Fibrillation: The IDEAL-AF Randomized Clinical Trial

   JAMA · Q1 journal · RCT · Evidence level 1 (High) · 30 August 2026

   In a Swedish trial of 209 patients with persistent atrial fibrillation and sizable low-voltage areas, adjunctive low-voltage zone ablation after pulmonary vein isolation achieved freedom from arrhythmia in 68% versus 37% with isolation alone, without more serious complications. The approach also improved quality-of-life scores, suggesting a targeted strategy for this high-risk subgroup, though broader validation is needed.

3. 3

   Menopausal hormone therapy and primary liver cancer: long-term follow-up of the women's health initiative randomized trials

   British journal of cancer · Q1 journal · RCT · Evidence level 1 (High) · 16 September 2026

   In two randomized trials followed for nearly 24 years, neither estrogen alone nor estrogen plus progestin significantly changed liver cancer incidence or deaths; just 74 cancers occurred. Estrogen plus progestin was linked to more cancers in some subgroups, including women aged 50 to 59 and prior oral contraceptive users, but these signals need further study.

4. 4

   Protocol-Based Implementation of Early Intensive Lipid Management After Acute Coronary Syndrome: The BRIDGE Trial

   Journal of the American College of Cardiology · Q1 journal · RCT · Evidence level 1 (High) · 31 August 2026

   In a cluster-randomized trial of 315 ACS patients, a prespecified algorithm for early high-intensity statin, ezetimibe, and PCSK9-inhibitor use raised the proportion reaching LDL-C < 70 mg/dL at six months from 74% to 86% (12-point absolute gain). The same approach more than doubled attainment of the stricter < 55 mg/dL target, suggesting that structured, hospital-based protocols can close the gap between guidelines and real-world lipid control.

5. 5

   Effectiveness and Cost-effectiveness of a Digital Mindfulness-Based Intervention for Psychological Distress Delivered by Trainee Instructors: A Randomized Controlled Trial

   Psychotherapy and psychosomatics · Q1 journal · RCT · Evidence level 1 (High) · 14 August 2026

   In a Chinese RCT of 1,281 adults with high psychological distress, an 8-week digital mindfulness program delivered by trainee instructors reduced distress by about half a standard deviation versus usual care and improved other mental-health scores. The intervention also lowered average costs by roughly $40 per participant, with high adherence and no serious adverse events, though long-term effects remain unknown.

6. 6

   Culturally adapted psychoeducation for bipolar disorder: a multicentre, assessor-masked, randomised controlled trial

   EClinicalMedicine · Q1 journal · RCT · Evidence level 1 (High) · 24 October 2026

   In a trial of 303 adults with bipolar disorder in remission, 12 weekly culturally adapted sessions plus routine care prolonged time to a mood episode recurrence over 48 weeks compared with routine care alone. Participants also showed gains in recovery, medication adherence, and depressive symptoms; whether the benefits extend to other settings remains to be seen.

7. 7

   Cost-utility analysis of integrated therapist and online CBT over and above usual care for patients with depression in primary care: an economic evaluation of the INTERACT randomised controlled trial

   BMJ mental health · Q1 journal · RCT · Evidence level 1 (High) · 22 October 2026

   Over 12 months, integrated online and therapist-led cognitive behavioral therapy cost GBP 30,576 per quality-adjusted life-year gained compared with usual care, from the UK health and social care perspective. Its estimated chance of being cost-effective ranged from 26% to 50% at commonly used thresholds, so the findings do not firmly support adoption as a standalone treatment without evidence of longer-term value.

8. 8

   Integrated care management and comprehensive geriatric assessment using a mHealth-based approach in older multimorbid patients with atrial fibrillation: the AFFIRMO cluster-randomised trial

   The Lancet regional health. Europe · Q1 journal · RCT · Evidence level 1 (High) · 30 August 2026

   In a cluster-randomized trial of 1,260 older adults with atrial fibrillation and multiple conditions, unplanned hospitalizations affected 17.1% receiving mobile integrated care and 18.2% receiving usual care. The intervention showed no added benefit in a population already receiving high levels of guideline-recommended care, and limited app use leaves its value in less-optimized settings unknown.

9. 9

   Sarcopenia Is Associated With Severe Treatment Toxicity and Mortality in Older Adults With Advanced Cancer: A Secondary Analysis

   Journal of cachexia, sarcopenia and muscle · Q1 journal · RCT · Evidence level 1 (High) · 1 October 2026

   Sarcopenia predicts toxicity in older cancer patients

10. 10

    Efficacy and safety of oral orforglipron in Japanese participants with obesity disease (ATTAIN-J): a double-blind, randomised, placebo-controlled, parallel-group, phase 3 trial

    The lancet. Diabetes & endocrinology · Q1 journal · RCT · Evidence level 1 (High) · 30 October 2026

    In this phase 3 trial, Japanese adults taking daily orforglipron lost an average of 5.9% to 8.7% of their bodyweight over 72 weeks, compared with 0.6% with placebo; about 46% to 61% lost at least 5%. Gastrointestinal symptoms were common, and nausea or vomiting sometimes led people to stop treatment; longer-term safety and results beyond this population remain open questions.

Paper of the day, last two weeks

• Digital Health Intervention to Optimize Heart Failure Management After Hospital Discharge in Brazil (OPT-HF): A Randomized Clinical Trial

  Circulation. Heart failure · Q1 journal · RCT · Evidence level 1 (High) · 6 November 2026

  In a 154-patient Brazilian trial, a digital program pairing remote monitoring, teleconsultations and education improved medication optimization scores by 3 points more than usual care at 90 days. Hospitalizations were also less frequent, while deaths did not differ significantly; the small trial and short follow-up leave the longer-term effects uncertain.

• Preparing for responsive management versus renal dialysis in older people living with kidney failure and frailty or multimorbidity in the UK (Prepare for Kidney Care): a two-arm, superiority, parallel-group, open-label, pragmatic, phase 3, individually randomised controlled trial

  Lancet (London, England) · Q1 journal · RCT · Evidence level 1 (High) · 4 November 2026

  Conservative vs dialysis management in frail older CKD

• Statin Intolerance, Treatment Gaps, and Cardiovascular Outcomes: A 24-Year Health System Analysis

  Journal of the American Heart Association · Q1 journal · Unclassified · Evidence level 5 (Expert Opinion) · 2 November 2026

  Highlights lipid-treatment gaps and risks after statin intolerance

• Clinical practice guideline recommendations for subthreshold depression in adults: A systematic review

  Journal of affective disorders · Q1 journal · Guideline · Evidence level 1 (High) · 3 November 2026

  A review of 13 clinical guidelines found that those offering specific recommendations generally put low-intensity psychological or psychosocial support, or supportive care, first for subthreshold depression. None recommended routine antidepressant use or made it the initial treatment. The condition was rarely addressed on its own, leaving clinicians to navigate recommendations often grouped with mild depression.

• Molecular bacterial detection in nasopharyngeal swabs does not predict the clinical course of lower respiratory tract infections in primary care: an ancillary study of a randomized controlled trial

  The British journal of general practice : the journal of the Royal College of General Practitioners · Q1 journal · RCT · Evidence level 1 (High) · 2 November 2026

  In this analysis of 345 primary care patients with lower respiratory infections, 41% had bacteria detected in nasopharyngeal swabs, but median recovery time was 7 days in both groups. Bacterial detection also did not predict recovery time or symptom duration, regardless of antibiotic prescription, raising questions about the value of these tests for guiding care.

• A multidomain, nurse-led, mobile health-supported intervention for dementia risk reduction in primary care (HAPPI MIND): a pragmatic, single-blind, two-arm, cluster randomised controlled trial

  The Lancet regional health. Western Pacific · Q1 journal · RCT · Evidence level 1 (High) · 20 October 2026

  In 403 adults aged 45 to 65 with at least two dementia risk factors, five nurse-led sessions plus an app produced a statistically significant improvement in estimated risk profiles compared with education and usual care. The trial measured risk factors, not dementia diagnoses; further implementation and cost studies are needed before wider use can be recommended.

• Implementation of the National Asthma Guidelines in New Zealand: a retrospective patient-level study of the change to anti-inflammatory reliever therapy in 324,972 patients

  The Lancet regional health. Western Pacific · Q1 journal · Retrospective cohort · Evidence level 3 (Low) · 22 October 2026

  After New Zealand's 2020 asthma guideline change, the share of patients dispensed inhaled corticosteroid-formoterol without a separate short-acting reliever rose from 10.9% to 23.8%; any short-acting reliever dispensing fell from 74.1% to 60.8%. But 57.1% of patients on reliever-only treatment before the change remained on it, pointing to a gap that guideline publication alone did not close.

• Effect of the CP@clinic program (Community Paramedicine at Clinic program) on health care utilization from administrative data during and after the intervention: a cluster-randomized controlled trial

  Frontiers in health services · Q1 journal · RCT · Evidence level 1 (High) · 15 October 2026

  Across 30 Ontario apartment buildings housing low-income older adults, hospital admission rates were 25% lower during the 12-month program and 18% lower in the following year than with usual care. Emergency visits and days hospitalized did not differ; primary care visits dipped during the trial, then rose slightly afterward, leaving the reasons for the sustained reduction unclear.

• Specialist-led community-based cardio-kidney-metabolic-pulmonary care in high-risk individuals: multi-centre pragmatic prospective randomized open-label blinded endpoint trial

  European heart journal open · Q1 journal · RCT · Evidence level 1 (High) · 7 October 2026

  At 6 months, 62% of adults offered two community visits with a cardiology specialist had a medication started or increased for cardiovascular, kidney, metabolic, or pulmonary risk, versus 23% with usual care. The trial shows specialist review can close treatment gaps, but it measured prescribing changes, not whether these changes prevent heart attacks or other clinical events.

• Instrumental Support Calls vs. Caring Contacts Texts to Prevent Suicide in Adolescents and Adults: The SPARC Randomized Clinical Trial

  The American journal of psychiatry · Q1 journal · RCT · Evidence level 1 (High) · 28 October 2026

  Adults receiving instrumental support calls had lower suicidal ideation

• E-Cigarettes with and without Behavioral Support for Smoking Cessation

  NEJM evidence · Q1 journal · RCT · Evidence level 1 (High) · 27 October 2026

  E-cigarettes alone more effective than supportive messages for smoking cessation

• Intravenous iron supplementation in heart failure and iron deficiency: an umbrella review of systematic reviews and meta-analyses

  Frontiers in cardiovascular medicine · Q1 journal · SR/MA of RCTs · Evidence level 1 (High) · 8 October 2026

  Intravenous iron evidence informs heart-failure referral and ongoing care

• Effects of an e-health enhanced multicomponent outpatient intervention for children and adolescents with overweight or obesity in routine primary care (STARKIDS): a cluster-randomized controlled trial

  The Lancet regional health. Europe · Q1 journal · RCT · Evidence level 1 (High) · 14 October 2026

  At 12 months, 33% of children and adolescents receiving STARKIDS had a BMI z-score reduction of at least 0.2, compared with 22% receiving one-time counseling. The groups no longer differed at 18 months, and adolescents' quality of life did not improve significantly; the early weight benefit may need more ongoing support to last.

• Effects of an internet-delivered behavioral self-monitoring intervention on depressive symptoms in older widowed adults: A randomized controlled trial

  Journal of consulting and clinical psychology · Q1 journal · RCT · Evidence level 1 (High) · 1 September 2026

  Internet self‑monitoring RCT reducing depression in widowed elders

Evidence summaries in Family Practice

• Clinical Decision Support Systems
• Tobacco Cessation Interventions
• Value-Based Care Models