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Low-risk first follow-up needs no further checks
After the first follow-up colonoscopy, only patients with high-risk polyps again had higher colorectal cancer rates and likely needed a second follow-up.
*Retrospective cohort study; Level 2b (OCEBM).

Citation

Robbins EC, Wooldrage K, Rutter MD, Veitch AM, Cross AJ. Colorectal cancer incidence after the first surveillance colonoscopy and the need for ongoing surveillance: a retrospective, cohort analysis. Gut. 2025. doi:10.1136/gutjnl-2024-334242.

Background

Guidelines clearly define who should receive a first follow-up colonoscopy after polyp removal, but there is less evidence on whether more follow-up is needed after that first visit.

Patients

10,508 adults from 17 United Kingdom hospitals who had colonoscopy with polyp removal and at least one follow-up colonoscopy.

Intervention

Risk classification using polyp findings at baseline and at the first follow-up colonoscopy; assessment of need for additional follow-up colonoscopy.

Control

Colorectal cancer rates in the general population.

Outcome

New diagnosis of colorectal cancer after the first follow-up colonoscopy; and after a second follow-up colonoscopy when performed.

Follow-up Period

Median 8.0 years after the first follow-up colonoscopy (registry follow-up through 2017).

Results

Patient group (polyp risk) Time period Relative colorectal cancer incidence vs general population
Low risk at baseline and first follow-up After first follow-up (until second follow-up or end) 0.48 (95% confidence interval 0.34 to 0.67)
High risk at baseline and first follow-up After first follow-up (until second follow-up or end) 2.84 (95% confidence interval 1.30 to 5.39)
Low risk at baseline and first follow-up After second follow-up (when performed) 0.56 (95% confidence interval 0.36 to 0.82)
Analysis approach: observational time-to-event; not randomized (no intention-to-treat/per-protocol).
Non-inferiority trial: no.
Minimally important difference: not established for this outcome.
Was the control current treatment? Comparison was to general-population rates, not an active treatment.

Limitations

Retrospective data with missing quality details; possible selection bias; reasons for repeat colonoscopies not always verifiable; very small “low-risk then high-risk” subgroup limited conclusions.

Funding

National Institute for Health Research; Cancer Research UK; funders had no role.

Clinical Application

After polyp removal, consider stopping ongoing follow-up if the first follow-up colonoscopy shows low-risk findings; prioritize a second follow-up when high-risk findings persist.

Top Journal Rankings - February 2026

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303 abstracts scored across 7 criteria. Click any article to expand criterion scores.
1. 8.7
Online Unsupervised Tai Chi Intervention for Knee Pain and Function in People With Knee Osteoarthritis: The RETREAT Randomized Clinical Trial.
Overall: A well-conducted community RCT shows a scalable online tai chi program meaningfully improves knee OA pain and function with no serious safety signals, making it highly applicable and potentially practice-influencing in primary care.
View 6 Criterion Scores
Primary-Care Relevance & Applicability 9.0
Knee osteoarthritis is a common primary-care condition, and the intervention (home/online exercise) aligns with typical outpatient management decisions.
Validity, Bias Control & Precision 8.0
Randomized superiority trial with high completion of primary outcomes (96%) and clear effect estimates with 95% CIs, though the sample is modest and outcomes are self-reported with likely limited blinding.
Patient-Oriented Outcomes 9.0
Primary outcomes (pain during walking and physical function) are directly patient-important, with supportive secondary outcomes including quality of life and global improvement.
Magnitude of Net Benefit 8.5
Clinically meaningful improvements are reported, including higher rates achieving MCID for pain (73% vs 47%) and function (72% vs 52%), with no serious adverse events and relatively low burden.
Implementability & Practicality 9.0
A free-to-access, unsupervised 12-week video-based program is scalable and feasible for many patients without requiring in-person visits or specialized equipment.
Practice-Changing Potential 8.5
Provides actionable evidence for an accessible, guideline-consistent nonpharmacologic option that could expand exercise therapy uptake where in-person tai chi is unavailable.
2. 8.4
Effects of Sodium Glucose Cotransporter 2 Inhibitors by Diabetes Status and Level of Albuminuria: A Meta-Analysis.
Overall: This large RCT-based meta-analysis reports consistent, clinically important reductions in kidney progression, hospitalizations, and some mortality outcomes across diabetes and albuminuria strata, with strong precision, making it highly credible and likely to influence outpatient CKD prescribing decisions.
View 6 Criterion Scores
Primary-Care Relevance & Applicability 8.5
Chronic kidney disease management and deciding on SGLT2 inhibitors (including in patients without diabetes and with varying albuminuria) is a common outpatient decision that often involves primary care, even if some patients are co-managed with nephrology.
Validity, Bias Control & Precision 9.5
Meta-analysis of 8 randomized clinical trials with a very large sample (n=58,816) and consistently favorable hazard ratios with fairly tight confidence intervals supports strong internal validity and precision.
Patient-Oriented Outcomes 9.0
Outcomes include kidney disease progression, acute kidney injury, hospitalization, and death, which are clearly patient-important rather than purely surrogate laboratory measures.
Magnitude of Net Benefit 8.0
Absolute event-rate reductions are clinically meaningful for kidney progression and hospitalizations across diabetes strata; mortality benefit is clearer in diabetes and less precise without diabetes (CI crosses 1.0), and the abstract provides limited detail on other potential adverse effects beyond serious outcomes like AKI.
Implementability & Practicality 7.0
SGLT2 inhibitors are practical oral therapies, but real-world use can involve prescribing/coverage friction and monitoring considerations; the abstract does not address these implementation barriers or discontinuation burden.
Practice-Changing Potential 8.5
By quantifying absolute benefits irrespective of diabetes status and across albuminuria levels, this evidence could strengthen clinician confidence and guideline uptake for broader CKD use, particularly in groups where recommendations have differed.
3. 8.3
An mHealth (Mobile Health) Intervention for Smoking Cessation in People With Tuberculosis: A Cluster Randomized Clinical Trial.
Overall: A large multicenter cluster RCT shows a substantial improvement in biochemically verified smoking cessation (and lower reported mortality) using a low-burden text-message program, supporting real-world adoption in TB care while generalizability beyond similar settings remains somewhat limited.
View 6 Criterion Scores
Primary-Care Relevance & Applicability 7.0
Smoking cessation is broadly relevant, but the intervention was delivered in TB clinics and limited to people with newly diagnosed drug-sensitive pulmonary TB who smoked and had phone access, which narrows generalizability to typical primary-care populations/settings.
Validity, Bias Control & Precision 8.5
Multicenter cluster randomized clinical trial with a large sample (n=1080), good retention (91%), and biochemical verification of the primary outcome; effect estimates include confidence intervals, though blinding and cluster-level analytic details are not described in the abstract.
Patient-Oriented Outcomes 8.0
Primary endpoint is sustained tobacco abstinence (clinically meaningful) with biochemical confirmation, and secondary outcomes include mortality and TB treatment outcomes, which are patient-important.
Magnitude of Net Benefit 9.5
Very large absolute increase in verified abstinence at 6 months (41.7% vs 15.3%) and a reported lower mortality (3.5% vs 7.5%; HR 0.4); intervention burden appears low (text messages), and no major harms are reported in the abstract.
Implementability & Practicality 9.0
Text messaging over a defined schedule is straightforward and scalable where mobile phone access exists, with minimal staffing/equipment needs beyond program setup and messaging infrastructure.
Practice-Changing Potential 8.0
The size of effect on verified cessation and the low-friction delivery make it compelling for TB programs, though applicability may be more limited outside TB treatment settings and the abstract provides limited detail on implementation logistics beyond messaging frequency.
4. 8.3
Assessment of adverse effects attributed to statin therapy in product labels: a meta-analysis of double-blind randomised controlled trials.
Overall: A large IPD meta-analysis of blinded RCTs provides strong, practice-relevant evidence that most statin-labeled adverse effects are not causally supported, with only small excesses for a few outcomes, enabling more accurate primary-care counseling and monitoring.
View 6 Criterion Scores
Primary-Care Relevance & Applicability 9.0
Statins are commonly prescribed and discussed in primary care, and clarifying true adverse effects directly informs counseling, monitoring, and adherence decisions.
Validity, Bias Control & Precision 9.5
Individual participant-level meta-analysis of large double-blind RCTs (≥1000 participants, ≥2 years; 123,940 participants) with effect estimates, 95% CIs, and false discovery rate control supports high credibility and precision.
Patient-Oriented Outcomes 7.5
Many outcomes are clinically meaningful symptoms/diagnoses (e.g., oedema; cognitive and mood conditions assessed), but key significant findings include laboratory abnormalities (liver tests) that are more intermediate than patient-centered endpoints.
Magnitude of Net Benefit 6.5
The main actionable signal is that most labeled adverse effects are not supported, while detected excess risks (e.g., liver test abnormalities and oedema) appear small in absolute terms (e.g., combined liver test abnormality annual excess 0.13%).
Implementability & Practicality 9.0
Results are readily implementable as updated risk communication and more targeted monitoring, without requiring new equipment, workflows, or specialist resources.
Practice-Changing Potential 8.5
By undermining many commonly cited statin side effects in official labels, the study could materially change clinician counseling and patient decisions about continuation, though changes may depend on label/guideline updates.
5. 8.2
Therapy for Atrial Fibrillation in Patients with Drug-Eluting Stents.
Overall: This multicenter randomized trial reports fewer net adverse clinical events and markedly less bleeding with NOAC monotherapy versus NOAC plus clopidogrel in AF patients ≥1 year after DES, with effect sizes and precision that make the findings potentially practice-influential and relatively easy to implement.
View 6 Criterion Scores
Primary-Care Relevance & Applicability 7.0
Long-term antithrombotic management for atrial fibrillation after drug-eluting stents is common, but decisions are often cardiology-co-managed and tied to prior PCI details.
Validity, Bias Control & Precision 8.5
Multicenter randomized noninferiority trial with a substantial sample (n=960) and reported hazard ratios and confidence intervals; open-label design and a composite endpoint introduce some bias risk.
Patient-Oriented Outcomes 8.5
Outcomes include death, myocardial infarction, stent thrombosis, stroke/systemic embolism, and bleeding—clinically meaningful events rather than purely surrogate markers.
Magnitude of Net Benefit 9.0
Monotherapy reduced the primary composite by 7.6% absolute (9.6% vs 17.2%) and substantially reduced bleeding (5.2% vs 13.2%), suggesting a clearly favorable benefit–harm balance over 12 months.
Implementability & Practicality 8.5
Switching from NOAC plus clopidogrel to NOAC alone is straightforward and likely reduces medication burden and bleeding-monitoring concerns without requiring special resources.
Practice-Changing Potential 8.0
Provides randomized evidence supporting NOAC monotherapy beyond 1 year post-DES with better clinical outcomes, which could meaningfully simplify practice, though generalizability beyond the studied setting remains uncertain.
6. 8.2
Age-Adjusted D-Dimer Cutoff Levels to Rule Out Deep Vein Thrombosis.
Overall: A large, prospective, multicenter management study suggests age-adjusted D-dimer can safely increase DVT rule-out in lower-probability outpatients with patient-important follow-up outcomes, offering a practical and potentially practice-shifting refinement to common diagnostic algorithms.
View 6 Criterion Scores
Primary-Care Relevance & Applicability 8.0
Addresses a very common front-line diagnostic problem (suspected DVT) in outpatients, using tools (Wells score, D-dimer, compression ultrasound) that map well to urgent care/ED and many primary-care referral pathways, though the study population is explicitly ED-based rather than primary-care clinics.
Validity, Bias Control & Precision 8.5
Large, multicenter, prospective management outcome design with a prespecified diagnostic strategy, 3-month follow-up, and adjudicated symptomatic events; estimates are fairly precise (e.g., 0% failures with an upper 95% CI of 2.3%), though it is not a randomized comparison and relies on an algorithmic workup.
Patient-Oriented Outcomes 8.5
Primary outcome is clinically meaningful (symptomatic venous thromboembolic events during follow-up after DVT was ruled out), rather than only test characteristics or biomarker changes.
Magnitude of Net Benefit 7.5
Using age-adjusted cutoffs increased the proportion of patients in whom DVT could be ruled out (notably in those ≥75 years) with no observed false negatives in the key subgroup, implying fewer ultrasounds and less downstream testing; however, residual uncertainty remains given the confidence interval around the failure rate.
Implementability & Practicality 8.5
Age-adjusted D-dimer is simple to apply (age × 10 µg/L for ≥50) and uses widely available testing alongside standard clinical probability assessment; implementation mainly requires protocolization and clinician uptake rather than new infrastructure.
Practice-Changing Potential 8.0
Provides prospective validation in suspected DVT (a key gap versus PE) and demonstrates increased rule-out efficiency without detected safety failures, which could reasonably shift diagnostic pathways—especially for older adults—though adoption may still depend on local protocols and guideline updates.
7. 8.1
Intensive Blood Pressure Control and Cardiovascular Outcomes Across Cardiovascular-Kidney-Metabolic Syndrome Stages: A Post Hoc Analysis of the China Rural Hypertension Control Project.
Overall: Large cluster-trial-derived evidence suggests intensive BP control improves major cardiovascular outcomes across CKM stages with manageable safety tradeoffs, offering a pragmatic, scalable primary-care strategy despite post hoc analytic limitations and limited absolute-effect reporting.
View 6 Criterion Scores
Primary-Care Relevance & Applicability 9.0
Addresses hypertension management in a large, community-based rural population aged ≥40 years, using a care model (trained nonphysician practitioners) that maps well to primary-care workflows.
Validity, Bias Control & Precision 7.5
Leverages a large cluster randomized trial dataset with ~3 years follow-up and relatively tight CIs, but this is a post hoc secondary analysis (greater risk of multiplicity and non-prespecified subgroup effects).
Patient-Oriented Outcomes 9.0
Reports major clinical outcomes (MACE components and cardiovascular death) and all-cause mortality, along with clinically important safety outcomes (hypotension, syncope, falls, kidney adverse events).
Magnitude of Net Benefit 7.0
Shows consistent relative reductions in cardiovascular events (HRs ~0.61–0.71) with mortality benefit in stages 2–3, but increased hypotension risk and lack of absolute event rates limits clarity on real-world net absolute benefit.
Implementability & Practicality 8.5
A BP target-based strategy (<130/80) delivered by trained nonphysician practitioners appears scalable and practical, though it likely requires ongoing medication titration and monitoring for hypotension.
Practice-Changing Potential 7.5
Provides large trial-based, stage-stratified evidence supporting intensive BP control across CKM stages, but being post hoc and conducted in a specific rural China setting may temper immediate universal practice change.
8. 8.1
RSV Prefusion F Vaccine for Prevention of Hospitalization in Older Adults.
Overall: A very large pragmatic randomized trial in older adults shows fewer RSV-related hospitalizations with RSVpreF and similar serious adverse events, though the absolute number of RSV hospitalizations was small and estimates are imprecise.
View 6 Criterion Scores
Primary-Care Relevance & Applicability 9.0
Targets adults ≥60 years and evaluates a common preventive decision (vaccination) that is routinely addressed in outpatient/primary-care settings.
Validity, Bias Control & Precision 8.0
Very large individually randomized pragmatic trial with intention-to-treat analysis and registry-based outcomes, but it is open-label and RSV-hospitalization events were rare, yielding wide confidence intervals.
Patient-Oriented Outcomes 9.0
Primary and key secondary outcomes are hospitalizations (including RSV-related lower respiratory tract disease), which are clearly patient-important endpoints.
Magnitude of Net Benefit 6.0
Relative reduction in RSV-related hospitalization was large (83% effectiveness), but absolute event rates were very low (3 vs 18 events), while all-cause respiratory hospitalization benefit was modest (15%); serious adverse events were similar.
Implementability & Practicality 9.0
A vaccine intervention is generally straightforward to deliver in routine outpatient practice without specialized equipment or intensive monitoring.
Practice-Changing Potential 7.5
Provides randomized evidence on hospitalization reduction that could increase confidence and uptake, though it may be more confirmatory than transformative depending on existing vaccination practices.
9. 8.0
SGLT2 Inhibitors and Kidney Outcomes by Glomerular Filtration Rate and Albuminuria: A Meta-Analysis.
Overall: This large, high-quality RCT meta-analysis shows consistent reductions in clinically important kidney outcomes across eGFR and albuminuria strata, supporting broader SGLT2 inhibitor use, though harms and practical barriers are not detailed in the abstract.
View 6 Criterion Scores
Primary-Care Relevance & Applicability 8.0
Addresses CKD progression prevention across common primary-care populations (type 2 diabetes, CKD, heart failure) and informs prescribing decisions generalists often share, including in low eGFR/low albuminuria subgroups.
Validity, Bias Control & Precision 9.5
Large meta-analysis of 10 randomized, double-blind, placebo-controlled trials (70,361 participants) with clear effect estimates and tight confidence intervals, supporting robust and precise findings.
Patient-Oriented Outcomes 8.0
Includes kidney failure and kidney-related death within the primary composite and reports kidney failure alone; however, the composite also includes a major eGFR decline component, which is partly surrogate.
Magnitude of Net Benefit 7.5
Shows a substantial relative reduction in CKD progression (HR 0.62) with meaningful absolute event-rate differences, but the abstract does not report adverse events, discontinuation, or treatment burden needed to fully judge net benefit.
Implementability & Practicality 7.0
SGLT2 inhibitors are commonly used medications, but real-world use can involve cost/access issues and monitoring considerations (especially at low eGFR), which are not addressed in the abstract.
Practice-Changing Potential 8.0
Provides strong pooled evidence that benefits extend to stage 4 CKD and minimal albuminuria, which could broaden routine use and reduce reluctance to prescribe in these subgroups.
10. 7.8
Oral Corticosteroid Use During Pregnancy and the Risk of Gestational Diabetes.
Overall: A very large nationwide weighted cohort study suggests oral corticosteroids in pregnancy are not meaningfully associated with gestational diabetes overall, providing precise and clinically useful reassurance for outpatient prescribing, with only a small early-gestation risk signal that tempers practice impact.
View 6 Criterion Scores
Primary-Care Relevance & Applicability 8.5
Addresses a common primary-care counseling/prescribing issue (systemic steroid use in pregnancy) using a nationwide real-world pregnancy cohort, making the results broadly applicable to outpatient care.
Validity, Bias Control & Precision 8.0
Large population-based cohort with sequential landmark analysis and propensity-score overlap weighting; estimates are precise with narrow CIs. However, it remains observational with potential residual confounding and outcome/exposure misclassification risk despite a validated algorithm.
Patient-Oriented Outcomes 8.0
Gestational diabetes is a patient-important clinical outcome (not just a surrogate biomarker) and is clearly defined with a specified assessment window.
Magnitude of Net Benefit 6.5
Overall pooled association is essentially null (weighted RR 1.01, 95% CI 0.99–1.03), which is reassuring but not strongly beneficial; the only signal is a modest increased risk in weeks 4–6 (RR 1.10) without large absolute-impact information for that subgroup.
Implementability & Practicality 9.0
Findings are straightforward to apply in counseling—no new tests, workflows, or equipment—supporting continued use of oral corticosteroids when clinically indicated, with awareness of timing considerations.
Practice-Changing Potential 7.0
Likely to influence reassurance and shared decision-making (especially given the large dataset and mostly null effect), but the observational design and small early-gestation signal may limit immediate changes beyond nuanced counseling.
Score Guide: 9-10 Exceptional 7-8 Strong 5-6 Moderate 3-4 Weak 1-2 Poor
Showing top 10 of 303

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