- Tom Nolan, clinical editor; sessional GP, Surrey
- The BMJ, London
A sure bet
Most football-obsessed children in the UK could probably name you half a dozen gambling websites, thanks to various sponsorship deals and the constant deluge of adverts that accompany any live football on television. In the US, sportsbooks—as sports gambling bookies are known—were banned in most states until 2018. This created a natural experiment for researchers to explore the impact of the ban being lifted on demand for gambling addiction services. A study of Google search trends in JAMA Internal Medicine found that searches for gambling addiction help have increased by an estimated 23% since the ban was overturned. In 2023, $121 billion was wagered, 93% of it online. The authors call for a range of measures, including easier access to help for addiction and restrictions on advertising.
JAMA Intern Med doi:10.1001/jamainternmed.2024.8193
AI tool effective for treatment of AF
In theory, tailoring ablation for atrial fibrillation (AF) to the specific electrical patterns that cause it should lead to higher success rates in people with persistent AF. A new multicentre trial aimed to do just that, using an AI-driven software, developed in 2020 before large language models were a thing. The tailored approach shows a lot of promise. Fewer of the 374 patients enrolled who underwent the tailored ablation procedure had AF a year later, compared with those who underwent a conventional pulmonary vein isolation (PVI) ablation (88% v 70% free from AF respectively).
Nat Med doi:10.1038/s41591-025-03517-w
Calorie restriction for gestational diabetes
Weekly food boxes were the intervention in a double-blind randomised controlled trial of 425 women with gestational diabetes. On the menu were scrambled tofu with potato rosti for breakfast and salmon with lemon puy lentils for dinner. Participants received either a standard energy control diet of 2000 kcal/day or a reduced energy diet of 1200 kcal/day from 29 weeks gestation until delivery. The reduced energy diet was found to be safe and reduced insulin requirements, but it did not lead to any improvement in maternal weight or birth weight compared with the standard energy diet.
Nat Med doi:10.1038/s41591-024-03356-1
Evidence for SEP-1 sepsis bundles
The debate over sepsis bundles rumbles on in the US, where the Severe Sepsis and Septic Shock Management Bundle (SEP-1) is part of Medicare and Medicaid. Criticism of SEP-1 includes concern over driving antimicrobial resistance from requiring all patients to receive antibiotics within three hours. Others argue that removing SEP-1 would lead to fewer patients receiving timely, lifesaving sepsis care. A new systematic review found 17 observational studies of SEP-1 bundles and concluded there was “no moderate or high-level evidence to support that compliance with or implementation of SEP-1 was associated with sepsis mortality.”
Ann Intern Med doi:10.7326/ANNALS-24-02426
Skin tone and pulse oximetry in children
Pulse oximeters are still overestimating oxygen saturation in people with darker skin. A prospective study tested two pulse oximeters in 320 children undergoing cardiac catheterisation in the US. They used spectrophotometers to measure skin pigmentation, and categorised skin tone according to the individual typology angle (ITA). In those with brown and dark skin tones (ITA 5 and 6) the devices overestimated arterial oxygenation by 2.43% for one device and 3.67% for the other, compared with 0.86% and 1.37% in those with very light and light skin tone (ITA 1 and 2).
N Engl J Med doi:10.1056/NEJMc2414937