Alcohol withdrawal on the ward: phenobarbital and diazepam performed alike in 24,600 admissions

The edition in brief

In a target-trial emulation of 24,643 US inpatients admitted with alcohol withdrawal, starting phenobarbital or diazepam on the day of admission gave similar length of stay (4.1 vs 4.3 days) and invasive ventilation rates (3.1% vs 2.7%). Self-directed discharge was less common after phenobarbital (9.5% vs 12.6%). Choice can follow local familiarity and safety monitoring rather than a belief that one drug is superior. A benchmark of six commercial large language models across 225 Choosing Wisely scenarios found overuse recommendations were uncommon overall (5.4%) but concentrated: thyroid ultrasound for incidental subcentimetre nodules (42.8% of responses) and routine ECGs in low-risk adults (28.3%). An interrupted time series of 3,246 US older adults with dementia found that after the 2016 CDC opioid guideline tramadol prescribing fell, while gabapentinoid prescribing rose from 9.5% to 11.5% across the study period without a guideline-linked change. A systematic review of five observational studies linked herpes zoster with a transient rise in stroke risk, peaking about three to four weeks after onset and greater after ophthalmic zoster. The pearl covers why gabapentinoids need renal dosing in older adults.