Inhaler-Related Greenhouse Gas Emissions in the USA Serial Cross-Sectional Analysis
From 2014 to 2024 in the U.S., inhaler usage for asthma and COPD accounted for approximately 24.9 million metric tons of CO₂ equivalent emissions, with 98 % of those emissions coming from metered-dose inhalers. The annual emission rate rose by 24 % over the decade, from ~1.9 million mtCO₂e to about 2.3 million mtCO₂e. Clinical Implications: This underscores the environmental footprint of respiratory care and suggests that prescribers should consider switching (when medically appropriate) to lower-emission alternatives such as dry powder or soft mist inhalers. Full Access: JAMA
Agreement Between Apps and Physicians in Interpreting 12-Lead EKGs For STEMI in The Correctional Setting: An Analysis
The study compared the diagnostic accuracy of correctional setting advanced practice clinicians (APCs) with that of physicians in interpreting 12-lead ECGs for ST-elevation myocardial infarction (STEMI). In a sample of 37 completed submissions, no statistically significant difference was found between APCs and physicians in overall ECG-STEMI diagnostic accuracy. Clinical implications: In a correctional-care context (or similar resource-limited settings), empowering APCs may be a viable strategy to expand capacity and maintain diagnostic quality, but further studies with larger samples and controlled assessments are needed. Full Access: PubMed
Diphenhydramine, Sodium Bicarbonate, or Combination for Acute Peripheral Vertigo- A Randomized Clinical Trial
In this randomized clinical trial of 222 adults with acute peripheral vertigo, treatment with intravenous Diphenhydramine alone, Sodium Bicarbonate alone, or the combination of both was compared. The combination therapy produced a greater reduction in vertigo severity at 60 minutes. Rescue medication use was also lower with the combination (17.8 %) versus diphenhydramine alone (46.7 %; P < .001). Diphenhydramine was more likely to cause lethargy (≈70 % of patients), while sodium bicarbonate had more injection-site discomfort. Clinical Implications: The findings suggest that for acute care settings with acute peripheral vertigo, combining diphenhydramine and sodium bicarbonate may deliver more rapid symptom relief and reduce need for additional treatment, with the caveat of balancing sedation risk and injection-related discomfort. Full Access: JAMA
Watchful Waiting for Children with Acute Otitis Media: Frequency of Use and Outcomes in Clinical Practice
This article evaluates how often watchful waiting (WW) is used for children with acute otitis media (AOM) and examines associated outcomes. Despite guideline support for WW in select low-risk cases, the study found relatively low adoption, with many clinicians still prescribing antibiotics initially. Children managed with WW generally had favorable outcomes, low rates of treatment failure, and fewer antibiotic-related adverse events. The study also highlights variability across practices, suggesting inconsistent implementation of AOM guidelines. Clinical implications: Increasing appropriate use of WW could reduce unnecessary antibiotic exposure, lower adverse events, and support antimicrobial stewardship. Clearer workflows, parent education, and clinician support tools may improve adoption in eligible children. Full Access: Journal of the Pediatric Infectious Diseases Society