What Mattered Most in 2025

Managing asymptomatic carotid artery stenosis — In a landmark randomized trial in patients with asymptomatic carotid artery stenosis (≥70%), surgical endarterectomy offered no advantage over medical therapy alone after 4 years of follow-up. Stenting was associated with a significant decrease in nondisabling strokes but also with periprocedural disabling strokes and mortality. We agree with the editorialists: Medical management should be favored over revascularization.

Steroid dosing for acute alcohol-associated hepatitis — New RCT data show that a patient with acute alcohol-associated hepatitis who responds to an initial trial of corticosteroids can be treated with a 4-week, tapered-dose steroid strategy rather than a 4-week moderate-dose strategy.

A bright idea for depression — A meta-analysis of bright light therapy showed that this cheap and easy-to-use treatment option for patients with depression improved depression symptoms more than placebo.

Earlier repair of hip fracture when troponins are elevated — Among patients with new hip fractures who also have elevated troponin levels on admission, those undergoing rapid hip fracture repair (within ≈6 hours) — compared with standard repair (≈24 hours) — were significantly less likely to have died at 90 days (10% vs. 23%).

Management of asthma exacerbations — More data emerged in 2025 that support using a combination of an inhaled corticosteroids plus fast-acting ꞵ-agonists (e.g., formoterol, albuterol) to manage asthma exacerbations rather than albuterol alone.

Earlier termination of futile resuscitation in inpatient cardiac arrest — Using large cohorts, investigators determined that patients who developed inpatient cardiac arrest have a very low likelihood of survival beyond 10 minutes of resuscitation, if they meet three additional criteria: unmonitored status (i.e., not on telemetry), unwitnessed arrest, and initial asystole rhythm (0.5% survival at 30 days). Clinicians can reasonably terminate resuscitation efforts early when these other prognostic traits are present.

More reasons to get the shingles vaccine — Two large studies that showed the shingles vaccine might lower risk for dementia and cardiovascular disease, strengthen the case for vaccination.

Urea tablets for SIADH — In a meta-analysis of ≈500 patients with syndrome of inappropriate antidiuretic hormone (SIADH), oral urea tablets effectively raised serum sodium levels by ≈9 mEq/L. They essentially were as effective as fluid restriction or vaptans.

Should weight be a barrier to joint replacement? — No. Weight loss prior to knee or hip arthroplasty was not associated with better surgical outcomes, calling into question whether a “hard” body–mass index cutoff even exists.

Metformin in the hospital — Hospitalized adults with type 2 diabetes who continued metformin during hospitalization had fewer episodes of hypoglycemia, readmission, and death by 90 days following hospital discharge. Continuing metformin in hospitalized and non–critically ill patients is reasonable.

Guidance on microscopic hematuria — The American Urological Association published an updated guideline on the managing microscopic hematuria, including a practical, risk-stratified approach to evaluation.

Managing shock without invasive vascular access — Clinicians can safely begin vasopressor infusion via a peripheral IV, rather than a central line, in an intensive care unit patient with sepsis-induced hypotension. Separately, deferring arterial line placement early in septic shock is OK.