This Week in General Medicine — Jul 13, 2026

Welcome to This Week in General Medicine. This week we are covering seven notable papers spanning venous thromboembolism management, wound care optimization, and the latest updates in clinical pharmacology and preventive health. Let's dive in.

Diagnosing pulmonary embolism in patients with active cancer is historically difficult because these patients have a baseline hypercoagulable state and frequently elevated D-dimer levels, meaning clinical guidelines have traditionally recommended bypassing clinical decision rules and proceeding directly to computed tomographic pulmonary angiography, or CTPA. However, a major randomized clinical trial published in JAMA, known as the Hydra study, challenges this default approach [1]. In this open-label, noninferiority trial conducted across twenty-one hospitals in Europe, researchers randomized 698 patients with active cancer and suspected acute pulmonary embolism into two groups. The first group underwent diagnostic management using the YEARS algorithm, which incorporates three clinical items—clinical signs of deep vein thrombosis, hemoptysis, and whether pulmonary embolism is the most likely diagnosis—paired with risk-adjusted D-dimer thresholds. The second group underwent immediate CTPA. The primary outcome was a ninety-day rate of centrally adjudicated symptomatic venous thromboembolism or possible pulmonary embolism-related death. Among patients in whom pulmonary embolism was initially excluded, only 1.8 percent of those in the YEARS group experienced a primary outcome event within ninety days, compared to 5.5 percent in the CTPA-only group. This represented an absolute risk difference of minus 3.7 percentage points, successfully demonstrating the noninferiority of the YEARS algorithm. Furthermore, utilizing this clinical algorithm allowed clinicians to completely avoid CTPA in 22 percent of the patients in the YEARS group, without any significant difference in the proportion of negative scans between the two arms. This is a critical finding for general internists, as it suggests we can safely spare nearly a quarter of our cancer patients from unnecessary radiation, contrast exposure, and healthcare costs by applying the structured YEARS algorithm rather than proceeding directly to imaging.

Remaining in the realm of thromboembolism prevention, we turn to the New England Journal of Medicine, which published the EPCAT III trial evaluating thromboprophylaxis after major joint surgery [2]. While guidelines support using aspirin after a brief initial course of a direct oral anticoagulant like rivaroxaban, there has been lingering uncertainty about whether aspirin alone is sufficient from day one. This multicenter, double-blind, randomized controlled trial enrolled 5429 patients undergoing total hip or total knee arthroplasty. Patients were randomized to receive either 81 milligrams of aspirin daily or 10 milligrams of oral rivaroxaban daily for the first five days post-surgery. Following this initial five-day period, all patients transitioned to 81 milligrams of aspirin daily for an additional nine days after knee replacement, or thirty additional days after hip replacement. Over a ninety-day follow-up period, symptomatic venous thromboembolism occurred in 0.48 percent of the aspirin-alone group compared to 0.45 percent of the rivaroxaban-then-aspirin group. This tiny risk difference of just 0.02 percentage points met the pre-specified noninferiority margin of 0.7 percentage points, establishing that aspirin alone is noninferior to the combination strategy. In terms of safety, major or clinically relevant non-major bleeding occurred in 1.66 percent of the aspirin-alone group and 2.04 percent of the rivaroxaban-aspirin group, showing no clinically relevant difference between the two strategies. For practicing physicians, these results simplify post-discharge care, demonstrating that starting aspirin immediately after total hip or knee arthroplasty is just as safe and effective as starting with a direct oral anticoagulant, while potentially reducing prescription costs and clinical complexity.

Moving from systemic vascular issues to localized venous disease, managing venous leg ulcers is a common and often frustrating task in primary care and community medicine. Strong compression therapy is the cornerstone of treatment, but clinical trials comparing different compression modalities have been limited. A pragmatic, three-arm randomized controlled trial published in PLoS Medicine, the VenUS 6 study, investigated the clinical effectiveness of different compression systems on the time to ulcer healing [3]. The trial randomized 637 adults across thirty-three sites in the United Kingdom to receive either compression wraps, a two-layer compression bandage, or evidence-based compression, which consisted of either a four-layer bandage or two-layer compression hosiery. In the primary modified intention-to-treat analysis, the two-layer compression bandage was shown to be noninferior to standard evidence-based compression, with a hazard ratio of 1.01. However, when comparing compression wraps to evidence-based compression, the researchers observed that healing was significantly slower in the compression wrap group, with a hazard ratio of 0.78. A similar trend of slower healing was noted when comparing compression wraps to the two-layer bandage group, which yielded a hazard ratio of 0.79. Although the trial faced limitations, including frequent departures from the allocated treatment, slight under-recruitment, and lower-than-expected healing rates, the findings suggest that compression wraps are unlikely to accelerate healing and may actually prolong the time to recovery compared to traditional multi-layer bandages or compression hosiery. When treating venous leg ulcers, clinicians should continue to favor established multi-layer bandaging or compression hosiery over compression wraps to optimize healing times.

Next, let's look at preventive health and lifestyle medicine. The BMJ reported on updated physical activity guidance from top United Kingdom medical officers, who are emphasizing the profound impact of incorporating small, regular boosts of movement into daily routines [6]. Notably, the updated guidance includes dedicated recommendations for patients taking glucagon-like peptide-one, or GLP-one, receptor agonists. For these patients, regular physical activity, particularly resistance training, is highlighted as a vital countermeasure to preserve lean muscle mass and support healthy, long-term metabolic adaptations. As GLP-one prescriptions continue to rise exponentially, general practitioners should actively counsel patients on combining these medications with structured exercise to ensure that weight loss consists of adipose tissue rather than muscle.

We conclude with three key clinical updates from JAMA covering pharmacology, men's health, and obstetric safety. First, the Food and Drug Administration has approved the first oral carbapenem for the treatment of complicated urinary tract infections [4]. This approval represents a major milestone in outpatient infectious disease management, potentially allowing clinicians to treat resistant, complicated urinary infections orally and avoid the need for intravenous catheter placement and home infusion services. Second, a clinical review in JAMA addresses the ongoing debate surrounding testosterone therapy, questioning whether recent evidence warrants broader prescribing [5]. The discussion centers on balancing the potential quality-of-life benefits of testosterone with long-term cardiovascular safety, reminding general internists to maintain a cautious, evidence-based approach to hormone replacement, reserved primarily for patients with clearly documented hypogonadism. Finally, a new study in JAMA reaffirms that acetaminophen use during pregnancy is unlikely to cause autism or attention-deficit/hyperactivity disorder, or ADHD, in children [7]. This large-scale reassurance is valuable for family physicians and obstetricians, providing robust data to counsel pregnant patients that acetaminophen remains a safe and appropriate choice for managing pain and fever during pregnancy.

If you only have time for one paper this week, make it the Hydra study on the YEARS algorithm in patients with active cancer, published in JAMA [1]. This trial provides practice-changing evidence that we can safely use a structured clinical algorithm to rule out pulmonary embolism in cancer patients, sparing nearly a quarter of these vulnerable individuals from unnecessary imaging without compromising clinical safety.

Here are the key takeaways from this week in General Medicine. First, the YEARS algorithm is a safe and efficient strategy to rule out acute pulmonary embolism in patients with active cancer, reducing the need for computed tomographic pulmonary angiography by twenty-two percent. Second, following total hip or knee arthroplasty, daily aspirin alone is noninferior to a five-day course of rivaroxaban followed by aspirin for preventing venous thromboembolism, with comparable bleeding risks. Third, when managing venous leg ulcers, traditional multi-layer compression bandages or compression hosiery should remain the preferred first-line therapy, as compression wraps may lead to slower healing times. Fourth, when prescribing GLP-one receptor agonists, clinicians should emphasize regular physical activity and resistance training to help patients preserve critical muscle mass during weight loss. Finally, reassure pregnant patients that acetaminophen remains a safe option for pain and fever, as recent data reaffirm it is unlikely to increase the risk of autism or ADHD in children.

That's your roundup for This Week in General Medicine. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

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This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.