The Daily Med

THE DAILY EDITIONWEDNESDAY, 4 NOVEMBER 2026

Case of the Day · Clinical Reasoning

High clinical probability: image directly.

A 46-year-old has acute pleuritic pain, tachycardia and dyspnoea. She is haemodynamically stable; clinical probability is high and renal function permits contrast.

What is the next diagnostic test?

Drug Corner

Pharmacology in practice

BIGUANIDE

Metformin (oral)

Indication: Type 2 diabetes.
Mechanism: Reduces hepatic glucose production and improves insulin sensitivity without stimulating insulin secretion.
Interactions: Renal impairment and acute hypoxic illness increase accumulation/lactic-acidosis risk; monitor renal function.
Important adverse effect: GI upset is common during initiation; lactic acidosis is rare but serious.
Dosing: Start 500–850 mg two or three times daily with meals and titrate; contraindicated GFR <30 mL/min.
Sources: Metformin SmPC: https://www.medicines.org.uk/emc/product/15731/smpc

Paper of the Day

Research, without the noise

Cardiology · Trial design

The Emerging Role of Treatment Policy Implementation Trials in Acute Coronary Syndrome

This NEJM item is an editorial, not a clinical trial. It discusses the role of treatment-policy implementation trials in acute coronary syndrome and how intention-to-treat estimates address adoption of a strategy despite treatment changes. It reports no new patient cohort or effect estimate; consult the primary trial reports for clinical decisions.

Authors: R.A. Byrne

Published: 29 August 2026 · New England Journal of Medicine

DOI: 10.1056/NEJMe2610678

Read the original paper →

Journal Watch

What's new in medicine?

Endocrinology · Diabetes and dialysis

Real-Time Continuous Glucose Monitoring Among People With Type 2 Diabetes and End-Stage Kidney Failure Undergoing Maintenance Hemodialysis: A Randomized Clinical Trial

A randomized crossover brief report compared continuous glucose monitoring with capillary testing in adults with diabetes receiving hemodialysis; the primary time-below-range comparison was not significantly different.

Cardiology · Heart failure

Undiagnosed Chronic Kidney Disease, Outcomes, and Finerenone in Heart Failure: The FINEARTS-HF Randomized Clinical Trial

A secondary FINEARTS-HF analysis investigated unrecognized CKD and outcomes; it highlights kidney assessment but is not a separate randomized estimate of finerenone efficacy.

Diabetes · Kidney outcomes

Serum ketone body levels and risk of incident kidney and cardiovascular events among patients with type 2 diabetes: a prospective cohort study

This prospective cohort examined serum ketone-body levels against incident kidney and cardiovascular outcomes in type 2 diabetes; the verified record available here did not provide results, so no direction or effect estimate is asserted.

Today's Topic

Build your clinical knowledge

Geriatrics · Cognitive assessment

Cognitive testing in older adults: interpret the score in context

Diagnosis / Testing

Take a history of cognitive and functional change from the patient and, when possible, an informant. Examine and assess reversible contributors; use a validated brief cognitive tool if concern persists.

Treatment / Care Decisions

A brief score is not a diagnosis. If impairment remains suspected, refer for specialist assessment and subtype diagnosis after reversible causes are considered.

Risk Assessment / Prognosis / Epidemiology

Education, language, sensory impairment, mood and delirium influence test performance; account for these before interpretation.

Pathophysiology / Basic Science

Cognitive impairment may arise from neurodegenerative, vascular, psychiatric, medication-related or systemic disease; brief instruments sample domains and have imperfect sensitivity.

Further reading: NICE NG97: Dementia—assessment, management and support.