Abstract
Kidney stones and kidney cancer:
A systematic review and meta-analysis of 13 observational studies found that a history of kidney stones was associated with approximately twice the risk of developing kidney cancer, consistently across subgroups and study designs. Causality cannot be established, but for general practice, where kidney stone disease affects around 10% of adults, the findings add weight to careful consideration of renal cancer in relevant patients.
Bhojani N, Miller L, Bhattacharyya S, et al. (2025) Association between kidney stones and future risk of kidney cancer: A systematic review and meta-analysis. Canadian Urological Association Journal. DOI: 10.5489/cuaj.9394.
Semaglutide and sight loss
The Medicines and Healthcare Products Regulatory Agency (MHRA) has updated prescribing guidance for semaglutides (Ozempic®, Wegovy®, Rybelsus®), confirming that non-arteritic anterior ischaemic optic neuropathy (NAION), causing sudden, typically irreversible, painless monocular vision loss, is a very rare side effect affecting up to one in 10,000 users. Patients should attend urgently if they notice sudden visual change, and semaglutide should be discontinued if NAION is confirmed. As prescribing continues to expand in primary care, proactive patient education and Yellow Card reporting are essential.
Medicines and Healthcare products Regulatory Agency (2026) Semaglutide (Wegovy®, Ozempic® and Rybelsus®): Risk of Non-arteritic Anterior Ischemic Optic Neuropathy (NAION). Available at: www.gov.uk/drug-safety-update/semaglutide-wegovy-ozempic-and-rybelsus-risk-of-non-arteritic-anterior-ischemic-optic-neuropathy-naion (accessed 11 April 2026)
GLP-1 receptor agonists and substance use disorders
A large target trial emulation study of over 600,000 US veterans with type 2 diabetes found that GLP-1 (glucagon-like peptide) receptor agonists were associated with a significantly lower overall risk of developing a substance use disorder compared with SGLT-2 ( sodium-glucose cotransport) inhibitors, with reductions seen across alcohol, cannabis, cocaine, nicotine and opioid use. Among those with pre-existing substance use disorders, GLP-1 use was associated with fewer overdoses, emergency admissions and deaths. The observational design limits causal inference, but these addictive-behaviour benefits may be worth raising in shared decision-making conversations.
Cai M, Choi T, Xie Y, et al. (2026) Glucagon-like peptide-1 receptor agonists and risk of substance use disorders among US veterans with type 2 diabetes: Cohort study. BMJ 392. DOI: 10.1136/bmj-2025-086886.
HRT, fezolinetant and menopause
A Danish register-based cohort study of over 876,000 women found that menopausal hormone therapy (HRT) was not associated with increased all-cause, cardiovascular or cancer-specific mortality over 14 years of follow-up. Women who underwent bilateral oophorectomy aged 45–54 experienced a 27–34% mortality reduction with hormone therapy. Alongside this, National Institute for Care and Health Excellence (NICE) has recommended fezolinetant, a once-daily neurokinin-3 receptor antagonist, for moderate-to-severe vasomotor symptoms in the approximately 500,000 women in England for whom hormone therapy is unsuitable or unwanted. Together these developments offer both reassurance about hormone therapy safety and a meaningful new non-hormonal prescribing option.
Mikkelsen A, Bergholt T,Lidegaard Ø, et al. (2026) Menopausal hormone therapy and long term mortality: Nationwide, register based cohort study. BMJ 2026; 392 doi: https://doi.org/10.1136/bmj-2025-085998 (Published 18 February 2026)
NICE (2026) Fezolinetant for treating moderate to severe vasomotor symptoms associated with menopause. Available at: www.nice.org.uk/guidance/ta1143 (accessed 11 April 2026).
Apixaban or rivaroxaban
The COBRRA (comparison of bleeding risk between rivaroxaban and apixaban) trial randomised 2760 patients with acute venous thromboembolism to apixaban or rivaroxaban for 3 months. Clinically relevant bleeding occurred in 3.3% versus 7.1%, respectively, with no significant difference in mortality. This is a meaningful safety difference between these agents. When initiating or reviewing anticoagulation, these findings support a preference for apixaban where individual patient factors permit.
Castellucci L, Chen V, Kovacs M, et al. (2026) Bleeding risk with Apixaban vs. Rivaroxaban in acute venous thromboembolism. The New England Journal of Medicine 394(11): 1051–1060. DOI: 10.1056/NEJMoa2510703.
Modern hip replacements – likely last a lifetime
A systematic review and meta-analysis of about 1.9 million hip arthroplasties from eight national joint registries found an estimated survivorship of 93.6% at 20 years, extrapolating to 92.1% at 30 years, substantially higher than older implant designs. For primary care, these results provide a robust evidence base to reassure patients, including younger people hesitant about surgery, that a modern hip replacement is likely to outlast them.
Pentland V, Thompson Z, Dayimu A, et al. (2026) Survivorship of modern total hip replacement to 30 years: Systematic review, meta-analysis, and extrapolation of global joint registry data. Lancet 407(10531): 855–866. DOI: 10.1016/S0140-6736(25)02305-0.
Most rotator cuff MRI findings are incidental
A large Finnish cohort study found that most rotator cuff abnormalities detected on shoulder magnetic resonance imaging (MRI) were incidental, with structural findings common in asymptomatic shoulders and imaging unable to reliably distinguish symptomatic from asymptomatic cases. As MRI referrals for shoulder pain increase, this study reinforces the importance of a symptoms-first approach – incidental imaging findings should not automatically drive management.
Ibounig T, Järvinen T, Raatikainen S, et al. (2026) Incidental rotator cuff abnormalities on magnetic resonance imaging. Journal of the American Medical Association Internal Medicine e257903. DOI: 10.1001/jamainternmed.2025.7903.
AI in clinical medicine
An AI-assisted (artificial intelligence) systematic review identified 4609 peer-reviewed clinical evaluations of large language models published between 2022 and September 2025, yet only 1048 used real-world patient data and just 19 were prospective randomised trials. Most studies assessed simulated scenarios or examination tasks rather than clinical practice. For primary care clinicians encountering AI tools, critical appraisal of the quality of underlying evidence, not just volume of publication, should guide adoption.
Chen SF, Alyakin A, Seas A, et al. (2026) LLM-assisted systematic review of large language models in clinical medicine. Nature Medicine 32(3): 1152–1159. DOI: 10.1038/s41591-026-04229-5.
CV of failures
As I come towards the end of my career, I am able to look at many positive things I have achieved in 40 years, and to reflect on some of the paths I did not take or were blocked to me. Years ago my children were delighted to find out that I scraped a grade C in Chemistry – it seemed to help them deal with ‘unbeatable’ parents. An American professor, educator and winner of many awards, Adam Cifu, has recently shared his ‘CV of failures’ (curriculum vitae) on Sensible Medicine. Despite his awesome achievements he has a long list of medical schools that did not accept him, international journals that have turned down his articles, uncited articles and unpublished books. At the start of my time in medicine I wish I had known that ultimately a portfolio career would emerge despite all the failed applications. I admire him for sharing. I hope knowing that professors and ordinary GPs have failed in many things along the way helps you go on believing in yourselves and applying for projects and roles. You are all the leaders of the future.
Cifu A (2026) The CV of failures and the unplanned career path Available at: open.substack.com/pub/sensiblemed/p/the-cv-of-failures-and-the-unplanned?utm_campaign=post&utm_medium=email (accessed 7 March 2026).
Women in medicine
I am not sure why I have never seen the support given to Women’s History Month by the Royal College of Physicians. This year they have highlighted research on books owned by women – with Catherine James’ art installation Making Visible showing the books wrapped in blue paper.
Pragmatic prescribing
The British Geriatric Society has produced a simple document giving recommendations to simplify prescribing for common conditions in people with varying levels of frailty.
British Geriatrics Society (2025) Pragmatic prescribing to reduce harm for older people with moderate to severe frailty. Available at: www.bgs.org.uk/new-guidance-to-enable-pragmatic-prescribing-for-older-people-with-moderate-to-severe-frailty (accessed 7 March 2026).
Critical evaluation
At a recent educator meeting there was a powerful discussion about how we as clinicians could and should be influencing the type of AI (artificial intelligence) scribes and assistants. All of us are probably using some form of large language model in our everyday lives and most of us are currently or will soon be using AI in our clinical work. We wondered about the ways in which our trainees and we could work together pooling our clinical- and technology-based knowledge to think about how we critically evaluate the outputs from the tools we use. I wonder what teaching and training you are getting and how you might contribute to the development of the tools that will be key during your future practice.
Pre-exposure prophylaxis
Cabotegravir has been approved in England for adults and young people in England at high risk of human immunodeficiency virus (HIV) who cannot take the daily prophylaxis tablets. Current availability is via local sexual health clinics.
