Brit J Hosp Med
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The contribution of health care to environmental and climate crises is significant, under-addressed, and with consequences for human health. This editorial is a call to action. Focusing on pharmaceuticals as a major environmental threat, we examine pharmaceutical impacts across their lifecycle, summarising greenhouse gas emissions, pollution, and biodiversity loss, and outlining challenges and opportunities to reduce this impact. We urge health care decision-makers and providers to urgently consider environmental factors in their decision-making relating to both policy, and practice, promoting actions such as rational prescribing, non-pharmaceutical interventions, and research and advocacy for sustainable production, procurement, and use.
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Predictive algorithms have myriad potential clinical decision-making implications from prognostic counselling to improving clinical trial efficiency. Large observational (or "real world") cohorts are a common data source for the development and evaluation of such tools. There is significant optimism regarding the benefits and use cases for risk-based care, but there is a notable disparity between the volume of clinical prediction models published and implementation into healthcare systems that drive and realise patient benefit. Considering the perspective of a clinician or clinical researcher that may encounter clinical predictive algorithms in the near future as a user or developer, this editorial: (1) discusses the ways in which prediction models built using observational data could inform better clinical decisions; (2) summarises the main steps in producing a model with special focus on key appraisal factors; and (3) highlights recent work driving evolution in the ways that we should conceptualise, build and evaluate these tools.
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Editorial Review
Once-Weekly Insulin: A Breakthrough in Diabetes Management or an Unresolved Challenge?
The advent of once-weekly insulin icodec is a promising development in the care of individuals with diabetes. These once-weekly formulations aimed to improve patient adherence and quality of life for patients who find daily injection administration challenging. Insulin icodec has demonstrated comparable glycemic control to conventionally used daily basal insulins, such as insulin glargine and degludec, in the ONWARDS clinical trials. ⋯ Moreover, logistical hurdles, including production costs and supply chain complexities need to be addressed especially in low-resource settings. Future studies should evaluate the broader health impacts of weekly insulin, including cardiovascular outcomes, quality of life, and personalized dosing strategies. Making weekly insulin safe, affordable, and widely available is important to fully realize its potential in diabetes management.
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Editorial
Finerenone: Do We Really Need an Additional Therapy in Type 2 Diabetes Mellitus and Kidney Disease?
Patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) face considerable cardiorenal morbidity and mortality despite existing therapies. Recent clinical trials demonstrate the efficacy of finerenone, a novel non-steroidal mineralocorticoid receptor antagonist, in reducing adverse renal and cardiovascular outcomes. This editorial briefly reviews the evidence and its implications for clinical practice, advocating the use of finerenone in these high-risk patients in combination with currently established treatment agents.
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Editorial Review
Diversity in Cardiovascular Care: Advancing Health Equity.
Health inequities exist in cardiovascular care and outcomes, especially among women, older people, individuals from racial and ethnic minorities, lower income and rural communities often those most vulnerable to adverse health outcomes. Such diverse groups form most of the patient population but they are rarely reflected in the composition of the cardiovascular care workforce. ⋯ Such diversity also benefits student and staff development and strengthens organizational performance. A work environment and culture that embraces and celebrates diversity will likely advance health equity.