Research ArticleResearchWorkflowQuality Improvement

YEARS was noninferior and avoided immediate CT angiography in 22% of cancer patients

JAMA (PubMed)Aug 25, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A multicenter randomized noninferiority trial found a YEARS-based diagnostic strategy was as safe as CT pulmonary angiography alone for suspected pulmonary embolism in active cancer and avoided immediate CT imaging in 22% of patients.

What NurseJet pulled from the source

The Hydra trial randomized 698 patients with active cancer and suspected pulmonary embolism at 21 hospitals. Among patients whose PE was ruled out initially, 90-day symptomatic venous thromboembolism or possible PE-related death met the prespecified noninferiority criterion for YEARS versus CTPA-only management. YEARS managed 77 of 352 patients without CTPA.

Why this matters for nurses

Oncology, emergency, and medical-unit nurses frequently initiate assessment and testing workflows for cancer patients with new dyspnea, chest pain, hypoxemia, or other possible PE features. The trial supports protocolized risk assessment while preserving prompt escalation for instability or changing symptoms.

Bedside takeaway

YEARS can reduce immediate CT imaging in eligible cancer patients when used within an approved diagnostic pathway.

How This Applies in Practice

Use this when: Caring for a patient with active cancer who is being evaluated for suspected acute pulmonary embolism.

On your shift

Escalate hemodynamic instability, hypoxemia, new chest symptoms, or other urgent findings through the PE response pathway.
Gather and document the clinical assessment elements and ordered D-dimer required by the organization's diagnostic algorithm.
Confirm that imaging or PE exclusion decisions are completed under the approved pathway and responsible clinician.

Keep in mind: YEARS should not be used independently or outside an approved cancer-specific pathway. Follow facility protocol and provider orders.

Key takeaways

The trial randomized 698 patients with active cancer and suspected acute pulmonary embolism.
A YEARS strategy using clinical items, D-dimer, and risk-dependent CTPA met the prespecified noninferiority criterion.
The YEARS pathway avoided immediate CTPA in 77 of 352 patients, or 22%.
The proportion of negative CTPA results did not differ significantly between groups.

Practice implications

Recognize and escalate possible PE promptly, collect the clinical information and ordered D-dimer needed for the approved pathway, and verify whether the organization permits YEARS in active cancer. Do not use the trial to independently rule out PE or defer imaging outside protocol.

Limitations & cautions

The study was open label, applied a prespecified noninferiority margin, and was conducted in 21 European hospitals. The result supports the tested pathway in eligible patients but does not validate unsupervised bedside use or every cancer population.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

Open source

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JAMA (PubMed)

JAMA (PubMed). YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism in Patients With Cancer: A Randomized Clinical Trial.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42437322/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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A single-center retrospective cohort found that approximately one quarter of laboratory-defined acute kidney injury cases on internal medicine wards were not documented, particularly when maximal creatinine was lower.

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Among 161 adult hospitalizations meeting serum-creatinine criteria for acute kidney injury, 39 cases (24.2%) were undocumented. Length of stay and in-hospital mortality did not differ significantly by documentation status.

Key takeaways

In the 149 hospitalizations with a demonstrable creatinine change, 33 cases (22.1%) were undocumented.
Higher maximal creatinine was associated with lower adjusted odds of underdocumentation.
The study did not test whether a detection or documentation intervention improves care or outcomes.

Why this matters on shift

A smaller creatinine rise may receive less attention even when it meets the study's laboratory definition of acute kidney injury, which can affect how renal risk is communicated across the inpatient team.

Bedside takeaway

Trend ordered renal-function results and communicate clinically important changes through local escalation and documentation workflows.

Nursing implications

Trend ordered renal-function results and communicate clinically important changes through the care team according to local escalation and documentation workflows.

Limitations & cautions

Abstract-only summary. This was a retrospective, single-center study of 161 hospitalizations; urine-output criteria and reliable preadmission creatinine values were unavailable, and the reference creatinine method may affect case classification.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Renal failure (PubMed). Underdocumentation of laboratory-defined acute kidney injury in internal medicine wards: a retrospective cohort study.

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AI-summarized from the linked source. Review the original article before applying to practice.

Pediatric emergency care (PubMed)Sep 7, 2026Research Article

A double-blind randomized trial found no reduction in vomiting or faster oral tolerance with intravenous pantoprazole versus placebo in children with acute gastroenteritis and persistent vomiting after ondansetron.

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The trial randomized 100 children. Vomiting episodes and oral tolerance at 6 and 12 hours did not differ significantly, while median hospital stay was 2 days with pantoprazole and 1 day with placebo.

Key takeaways

The median participant age was 14 months, and 67% of participants were male.
Oral tolerance at 12 hours was 86% in both groups.
The longer stay associated with pantoprazole requires cautious interpretation because this was a single-center trial.

Why this matters on shift

The trial does not support empiric intravenous proton-pump inhibition for persistent vomiting in pediatric acute gastroenteritis after ondansetron.

Bedside takeaway

Clarify the indication for empiric acid suppression and keep hydration and oral-tolerance assessment central to care.

Nursing implications

Prioritize the ordered hydration and oral-tolerance plan, document ongoing emesis, and clarify the indication before administering empiric acid suppression.

Limitations & cautions

Abstract-only summary. This was a single-center study of 100 children in Tehran, and the abstract does not describe adverse events or explain why hospitalization was longer in the pantoprazole group.
AI-summarized from the linked source. Review the original article before applying to practice.

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Pediatric emergency care (PubMed). Effect of Intravenous Pantoprazole on Clinical Outcomes in Pediatric Acute Gastroenteritis: A Placebo-Controlled RCT.

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European heart journal (PubMed)Sep 6, 2026Research Article

In the pragmatic TARGET-D randomized trial, vitamin D dosing titrated to a serum target did not significantly reduce the composite of death, recurrent myocardial infarction, heart-failure hospitalization, or stroke after myocardial infarction.

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Among 630 participants followed for an average of 4.2 years, major cardiovascular events occurred in 15.7% with targeted vitamin D management and 18.4% with usual care (hazard ratio 0.85, 95% CI 0.58 to 1.24; P=0.40).

Key takeaways

At baseline, 87% of participants had a 25-hydroxyvitamin D level of 40 ng/mL or lower.
The primary composite outcome and the individual outcomes of death, heart-failure hospitalization, and stroke were not significantly different.
A lower recurrent-MI rate was a secondary finding and should not override the nonsignificant primary result.

Why this matters on shift

The trial cautions against presenting targeted vitamin D supplementation as a proven strategy for reducing major cardiovascular events after myocardial infarction.

Bedside takeaway

Present vitamin D as prescribed supplementation, not as a replacement for established post-MI secondary prevention.

Nursing implications

Reinforce the prescribed secondary-prevention plan and avoid implying that vitamin D replaces therapies with established post-MI benefit.

Limitations & cautions

Abstract-only summary. The trial included 630 participants, 78.1% were men, the primary confidence interval included benefit and no benefit, and individual secondary outcomes were not the primary endpoint.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

European heart journal (PubMed). Targeted vitamin D supplementation and major adverse cardiovascular events after myocardial infarction: the TARGET-D trial.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

One in four laboratory-defined AKI cases went undocumented on medicine wards

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