This Week in Family Medicine — Oct 25, 2026
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The week's practice-changing Family Medicine research, summarized for clinicians.
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Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease: The VIDEO-KD Randomized Clinical Trial.
A video decision aid plus patient-recorded preferences raised advance care planning documentation from 40 to about 57 percent among older adults with advanced kidney disease.
JAMA Internal Medicine · 2026 · PubMed
This week’s papers
- 01
Obesity in Children Aged 2 to 12 Years: A Review.
Intensive family-based lifestyle treatment remains the evidence base for obesity in children aged 2 to 12, while drug options are limited and long-term pediatric safety data remain thin.
Fox CK et al. · JAMA · 2026
From the briefingIn JAMA, Fox, Armstrong and Kelly review obesity in children aged 2 to 12, a group in which about one in five school-age children in the United States now meets the definition [1]. Their review restates that body mass index screening is recommended from age 2, that obesity is defined as a body mass index at or above the 95th percentile, and that the backbone of treatment remains intensive health behavior and lifestyle treatment, meaning at least 26 contact hours with the child and family over three to twelve months. The authors are candid that this treatment produces only a modest drop in body mass index. On the drug side, setmelanotide is the only agent approved by the Food and Drug Administration under age 12, and only for rare genetic and hypothalamic forms of obesity, while a randomized trial of liraglutide in children aged 6 to 11 cut body mass index by about 7 percent against placebo. The review frames pharmacotherapy as potentially additive but notes that short and long term safety data in young children remain thin.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 02
Retatrutide Once Weekly for Treatment of Obstructive Sleep Apnea.
Weekly retatrutide significantly reduced sleep apnea severity versus placebo over 80 weeks in adults with obesity, with a larger effect in those without type 2 diabetes.
Grunstein RR et al. · New England Journal of Medicine · 2026
From the briefingAt the adult end of the spectrum, the New England Journal of Medicine reports two phase 3 trials from Grunstein and colleagues testing retatrutide, a weekly triple agonist of the GIP, GLP-1 and glucagon receptors, in adults with moderate to severe obstructive sleep apnea and overweight or obesity [2]. Patients started with severe disease, close to 60 breathing events per hour. At 80 weeks, in the trial without diabetes, the 9 milligram dose reduced the apnea-hypopnea index by roughly 24 more events per hour than placebo; in the trial with type 2 diabetes the advantage was smaller, about 14 to 15 events per hour. Weight loss reached about a fifth of body weight at the top dose, and gastrointestinal effects were most common. This is industry-funded and the drug is investigational, but it adds to growing evidence that incretin-based weight loss substantially treats sleep apnea, with a somewhat weaker effect in people with diabetes.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 03
Sodium-Glucose Cotransporter 2 Inhibitor Use and Levels of Hemoglobin, Markers of Iron Metabolism, and Erythropoiesis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.
Across 85 randomized trials, SGLT2 inhibitors raised hemoglobin by about 0.6 g/dL and increased erythropoietin, a small, consistent effect whose clinical significance remains unclear.
Yang Y et al. · JAMA · 2026
From the briefingRounding out the theme, a JAMA meta-analysis from Yang and colleagues pooled 85 randomized trials and about 70,000 participants to quantify the familiar rise in hemoglobin with SGLT2 inhibitors [3]. Compared with control, hemoglobin rose by about 0.6 grams per decilitre and hematocrit by just over two points, accompanied by higher erythropoietin and a slight fall in transferrin saturation. The authors stress that the clinical significance is unclear, but for clinicians it offers a quantified explanation when a patient's hemoglobin creeps up after starting one of these drugs.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 04
Prevalence of ECG-detected and previously unrecognized atrial fibrillation among older adults attending a family health center: a single-center cross-sectional screening study.
A single screening ECG found atrial fibrillation in about 12 percent of primary care patients aged 65 and over, roughly half previously unrecognized, though outcome benefit was not assessed.
Aktura N et al. · BMC Primary Care · 2026
From the briefingIn BMC Primary Care, Aktura and colleagues ran a single 12-lead ECG on 357 consecutive adults aged 65 and over at a family health center in Istanbul [4]. Atrial fibrillation turned up in about 12 percent of participants, rising to about a quarter of those aged 80 and older, and roughly half of the cases were previously unrecognized. Heart failure was linked to nearly six-fold higher odds of atrial fibrillation in an exploratory model. Most patients with atrial fibrillation met the anticoagulation threshold, yet 18 patients with newly found arrhythmia were not on anticoagulation. This is a small, single-center, cross-sectional study, and the authors explicitly say it does not establish that screening improves outcomes, but it gives a concrete sense of opportunistic yield in an older primary care population.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 05
Diagnosis and Treatment of Cardiovascular Conditions in Medicare Advantage In-Home Health Risk Assessments.
A growing share of Medicare Advantage cardiovascular diagnoses come from insurer in-home assessments, yet treatment after those diagnoses is consistently lower than after clinic-based diagnoses.
Oseran AS et al. · Annals of Internal Medicine · 2026
From the briefingA very different picture of detection comes from Annals of Internal Medicine, where Oseran and colleagues used complete Medicare claims covering more than 21 million Medicare Advantage beneficiaries [5]. Between 2018 and 2022, an increasing share of cardiovascular diagnoses were made during insurer-run in-home health risk assessments rather than in clinics, reaching about two thirds of hyperlipidemia diagnoses and nearly three quarters of peripheral vascular disease diagnoses. Treatment rates were consistently and substantially lower after a diagnosis made at home than after one made in a facility, and minority beneficiaries and those in lower-rated plans were more likely to be diagnosed this way. The data are observational, severity could not be assessed, and prescription fills were a proxy for treatment, but the pattern supports the critique that these visits generate diagnoses and risk-adjusted payments without reliably connecting patients to care. Read together, the Turkish screening study and the Medicare analysis make the same point from opposite directions: finding a condition matters only if someone acts on it.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 06
Cost-Effectiveness of HCV Screening in Emergency Departments Using DETECT Hep C Trial Results.
Modelling based on trial data found nontargeted emergency department hepatitis C screening cost-effective at about 12,800 dollars per quality-adjusted life year, outperforming targeted or no screening.
Czoty LMW et al. · JAMA Internal Medicine · 2026
From the briefingOn hepatitis C, JAMA Internal Medicine publishes a cost-effectiveness analysis by Czoty and colleagues built on the DETECT Hep C trial in three emergency departments [6]. Nontargeted screening of all emergency department patients beat both targeted screening and no screening, at roughly 12,800 dollars per quality-adjusted life year, well under the conventional threshold. Absolute population gains were narrow because more than 90 percent of patients screened did not have the virus, but benefits were clear among those who did. It is a modelling study, yet it strengthens the economic argument for universal approaches over risk-based ones.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 07
Overuse and False Restraint in Large Language Model Recommendations for Choosing Wisely Scenarios.
Commercial language models rarely withheld appropriate care but recommended low-value care in about 5 percent of responses, concentrated in thyroid nodule ultrasound and routine low-risk ECGs.
Ariel D et al. · Annals of Internal Medicine · 2026
From the briefingFinally, Annals of Internal Medicine also carries a benchmark study from Ariel and colleagues testing six commercial large language models on 225 scenarios drawn from Choosing Wisely recommendations [7]. Overall the models endorsed low-value care in about 5 percent of responses and wrongly withheld appropriate care in under 1 percent. But the overuse clustered in two areas familiar to family physicians: the models recommended thyroid ultrasound for an incidental subcentimetre nodule in about 43 percent of responses and routine ECGs in low-risk adults in about 28 percent. This was a single-prompt benchmark rather than real-world use, so it signals where these tools drift toward overtesting rather than proving harm.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 08
Helicobacter pylori Infection - Advances, Challenges, and the Road Ahead.
Helicobacter pylori eradication and screening offer major gastric cancer prevention potential, but rising global antibiotic resistance and the lack of a vaccine remain central obstacles.
Li H et al. · New England Journal of Medicine · 2026
From the briefingIn the New England Journal of Medicine, Li, Megraud and Marshall review four decades of Helicobacter pylori research, emphasizing its role in peptic ulcer disease and gastric cancer, the expanding case for screening as primary prevention of gastric cancer, and the twin obstacles of rising antibiotic resistance worldwide and the absence of a vaccine [8]. As a narrative review it offers context rather than new data.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 09
How do we monitor doxy-PEP impact and when should we consider revisiting guidelines?
Doxycycline post-exposure prophylaxis is expected to select for antimicrobial resistance, and its benefit per dose shrinks as infections fall, arguing for adaptive, periodically reviewed guidelines.
Grad YH et al. · PLOS Medicine · 2026
From the briefingResistance is also the core concern of a policy piece in PLOS Medicine from Grad and colleagues on doxycycline post-exposure prophylaxis for bacterial sexually transmitted infections, now recommended in 2026 World Health Organization guidelines [9]. The authors argue doxy-PEP should be governed as an adaptive intervention with transparent periodic review, because it is expected to select for resistance in gonorrhoea, Staphylococcus aureus and the microbiome, and because as infection rates fall the benefit per dose shrinks while the resistance cost per dose grows. They also note that attributing changes in prevalence or resistance to doxy-PEP will be methodologically hard. This is an expert perspective rather than new evidence, but it frames the questions prescribers will face.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 10
Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease: The VIDEO-KD Randomized Clinical Trial.
A video decision aid plus patient-recorded preferences raised advance care planning documentation from 40 to about 57 percent among older adults with advanced kidney disease.
Volandes AE et al. · JAMA Internal Medicine · 2026
From the briefingTurning to decisions in serious illness, JAMA Internal Medicine reports the VIDEO-KD randomized trial from Volandes and colleagues, involving 453 adults aged 65 and over with advanced chronic kidney disease across 12 ambulatory clinics [10]. Patients in the intervention arm watched a certified video decision aid covering hemodialysis, peritoneal dialysis and conservative kidney management, then recorded their own statement of goals and preferences, which was sent to their clinician. At 12 months, advance care planning documentation rose about 17 percentage points, to just under 57 percent compared with 40 percent under usual care. After the video, only about one in eight intervention patients remained undecided about treatment, compared with about four in ten controls, and about half of intervention patients preferred conservative management. The outcome is documentation rather than goal-concordant care or quality of life, and the trial population was predominantly White, but it is randomized evidence that a low-cost, scalable tool shifts conversations that are notoriously under-documented in outpatient practice.
If you only have time for one paper this week, make it the VIDEO-KD trial in JAMA Internal Medicine [10]. It provides randomized evidence that a simple video decision aid meaningfully changes advance care planning for older adults facing dialysis decisions, a conversation that often falls to primary care and is rarely recorded, and it reopens the question of how often conservative kidney management is chosen once patients understand it.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
The full briefing
This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.
Welcome to This Week in Family Medicine. This week we're covering 10 notable papers spanning obesity and cardiometabolic therapeutics, screening and what happens after a diagnosis is made, and stewardship and shared decision-making in infection and serious illness. Let's dive in.
We start with obesity and the drugs that increasingly sit alongside it in primary care. In JAMA, Fox, Armstrong and Kelly review obesity in children aged 2 to 12, a group in which about one in five school-age children in the United States now meets the definition [1]. Their review restates that body mass index screening is recommended from age 2, that obesity is defined as a body mass index at or above the 95th percentile, and that the backbone of treatment remains intensive health behavior and lifestyle treatment, meaning at least 26 contact hours with the child and family over three to twelve months. The authors are candid that this treatment produces only a modest drop in body mass index. On the drug side, setmelanotide is the only agent approved by the Food and Drug Administration under age 12, and only for rare genetic and hypothalamic forms of obesity, while a randomized trial of liraglutide in children aged 6 to 11 cut body mass index by about 7 percent against placebo. The review frames pharmacotherapy as potentially additive but notes that short and long term safety data in young children remain thin. At the adult end of the spectrum, the New England Journal of Medicine reports two phase 3 trials from Grunstein and colleagues testing retatrutide, a weekly triple agonist of the GIP, GLP-1 and glucagon receptors, in adults with moderate to severe obstructive sleep apnea and overweight or obesity [2]. Patients started with severe disease, close to 60 breathing events per hour. At 80 weeks, in the trial without diabetes, the 9 milligram dose reduced the apnea-hypopnea index by roughly 24 more events per hour than placebo; in the trial with type 2 diabetes the advantage was smaller, about 14 to 15 events per hour. Weight loss reached about a fifth of body weight at the top dose, and gastrointestinal effects were most common. This is industry-funded and the drug is investigational, but it adds to growing evidence that incretin-based weight loss substantially treats sleep apnea, with a somewhat weaker effect in people with diabetes. Rounding out the theme, a JAMA meta-analysis from Yang and colleagues pooled 85 randomized trials and about 70,000 participants to quantify the familiar rise in hemoglobin with SGLT2 inhibitors [3]. Compared with control, hemoglobin rose by about 0.6 grams per decilitre and hematocrit by just over two points, accompanied by higher erythropoietin and a slight fall in transferrin saturation. The authors stress that the clinical significance is unclear, but for clinicians it offers a quantified explanation when a patient's hemoglobin creeps up after starting one of these drugs.
Our second theme is screening, and the harder question of whether detection actually leads to care. In BMC Primary Care, Aktura and colleagues ran a single 12-lead ECG on 357 consecutive adults aged 65 and over at a family health center in Istanbul [4]. Atrial fibrillation turned up in about 12 percent of participants, rising to about a quarter of those aged 80 and older, and roughly half of the cases were previously unrecognized. Heart failure was linked to nearly six-fold higher odds of atrial fibrillation in an exploratory model. Most patients with atrial fibrillation met the anticoagulation threshold, yet 18 patients with newly found arrhythmia were not on anticoagulation. This is a small, single-center, cross-sectional study, and the authors explicitly say it does not establish that screening improves outcomes, but it gives a concrete sense of opportunistic yield in an older primary care population. A very different picture of detection comes from Annals of Internal Medicine, where Oseran and colleagues used complete Medicare claims covering more than 21 million Medicare Advantage beneficiaries [5]. Between 2018 and 2022, an increasing share of cardiovascular diagnoses were made during insurer-run in-home health risk assessments rather than in clinics, reaching about two thirds of hyperlipidemia diagnoses and nearly three quarters of peripheral vascular disease diagnoses. Treatment rates were consistently and substantially lower after a diagnosis made at home than after one made in a facility, and minority beneficiaries and those in lower-rated plans were more likely to be diagnosed this way. The data are observational, severity could not be assessed, and prescription fills were a proxy for treatment, but the pattern supports the critique that these visits generate diagnoses and risk-adjusted payments without reliably connecting patients to care. Read together, the Turkish screening study and the Medicare analysis make the same point from opposite directions: finding a condition matters only if someone acts on it. On hepatitis C, JAMA Internal Medicine publishes a cost-effectiveness analysis by Czoty and colleagues built on the DETECT Hep C trial in three emergency departments [6]. Nontargeted screening of all emergency department patients beat both targeted screening and no screening, at roughly 12,800 dollars per quality-adjusted life year, well under the conventional threshold. Absolute population gains were narrow because more than 90 percent of patients screened did not have the virus, but benefits were clear among those who did. It is a modelling study, yet it strengthens the economic argument for universal approaches over risk-based ones. Finally, Annals of Internal Medicine also carries a benchmark study from Ariel and colleagues testing six commercial large language models on 225 scenarios drawn from Choosing Wisely recommendations [7]. Overall the models endorsed low-value care in about 5 percent of responses and wrongly withheld appropriate care in under 1 percent. But the overuse clustered in two areas familiar to family physicians: the models recommended thyroid ultrasound for an incidental subcentimetre nodule in about 43 percent of responses and routine ECGs in low-risk adults in about 28 percent. This was a single-prompt benchmark rather than real-world use, so it signals where these tools drift toward overtesting rather than proving harm.
Our final theme covers stewardship and shared decisions, starting with infection. In the New England Journal of Medicine, Li, Megraud and Marshall review four decades of Helicobacter pylori research, emphasizing its role in peptic ulcer disease and gastric cancer, the expanding case for screening as primary prevention of gastric cancer, and the twin obstacles of rising antibiotic resistance worldwide and the absence of a vaccine [8]. As a narrative review it offers context rather than new data. Resistance is also the core concern of a policy piece in PLOS Medicine from Grad and colleagues on doxycycline post-exposure prophylaxis for bacterial sexually transmitted infections, now recommended in 2026 World Health Organization guidelines [9]. The authors argue doxy-PEP should be governed as an adaptive intervention with transparent periodic review, because it is expected to select for resistance in gonorrhoea, Staphylococcus aureus and the microbiome, and because as infection rates fall the benefit per dose shrinks while the resistance cost per dose grows. They also note that attributing changes in prevalence or resistance to doxy-PEP will be methodologically hard. This is an expert perspective rather than new evidence, but it frames the questions prescribers will face. Turning to decisions in serious illness, JAMA Internal Medicine reports the VIDEO-KD randomized trial from Volandes and colleagues, involving 453 adults aged 65 and over with advanced chronic kidney disease across 12 ambulatory clinics [10]. Patients in the intervention arm watched a certified video decision aid covering hemodialysis, peritoneal dialysis and conservative kidney management, then recorded their own statement of goals and preferences, which was sent to their clinician. At 12 months, advance care planning documentation rose about 17 percentage points, to just under 57 percent compared with 40 percent under usual care. After the video, only about one in eight intervention patients remained undecided about treatment, compared with about four in ten controls, and about half of intervention patients preferred conservative management. The outcome is documentation rather than goal-concordant care or quality of life, and the trial population was predominantly White, but it is randomized evidence that a low-cost, scalable tool shifts conversations that are notoriously under-documented in outpatient practice.
If you only have time for one paper this week, make it the VIDEO-KD trial in JAMA Internal Medicine [10]. It provides randomized evidence that a simple video decision aid meaningfully changes advance care planning for older adults facing dialysis decisions, a conversation that often falls to primary care and is rarely recorded, and it reopens the question of how often conservative kidney management is chosen once patients understand it.
Here is what this week's evidence adds up to in Family Medicine. First, incretin-based therapy keeps extending into obesity-related conditions, with retatrutide substantially reducing sleep apnea severity in phase 3 trials, while in young children lifestyle treatment remains the evidence base and drug safety data are still limited. Second, detection alone is not care: opportunistic ECGs find untreated atrial fibrillation in older patients, and in-home Medicare Advantage assessments generate diagnoses that are less often treated, though both studies are observational and neither shows outcome benefit. Third, modelling supports universal emergency department hepatitis C screening as good value over targeted approaches. Fourth, commercial language models rarely withhold appropriate care but lean toward overtesting for thyroid nodules and low-risk ECGs, based on benchmark data only. And fifth, a video decision aid increases documented advance care planning in advanced kidney disease, while whether that translates into care that matches patients' goals remains unsettled.
That's your roundup for This Week in Family Medicine. The full transcript and references are available on the episode page. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.
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