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We agree with Guglieri and colleagues that specific recommendations for how low-income countries can improve the quality of care for heart failure are needed. Indeed the REPORT-HF data strongly support the call for a focus on low-income regions in showing that (1) mortality following hospitalization for heart failure was 58% higher in patients from lower-income (vs. higher-income) countries1; (2) attainment of established quality indicators (QIs) was significantly lower in lower-income countries than in higher-income countries.

Objectives
To estimate the proportion and correlates of self-reported financial difficulty among patients with multiple myeloma (MM) or chronic lymphocytic leukaemia (CLL).

Setting
Sixty-six US community and minority oncology practices affiliated with the National Cancer Institute Community Oncology Research Programme (NCORP).

Participants
A total of 521 patients (≥18 years) with MM or CLL consented and 416 responded to a survey (completion rate=79.8%). Respondents had a MM diagnosis (74.0%), an associate degree or higher (53.4%), were White (89.2%), insured (100%) and treated with clinician-administered drugs (68.0%).

Study design
Observational, theoretical model and protocol-based patient survey administered between May 2019 and June 2020.

Primary and secondary outcome measures
Financial difficulty was assessed using a single-item measure, the EORTC QLQC30: ‘Has your physical condition or medical treatment caused you financial difficulties in the past year?’ and using an ‘any-or-none’ composite measure of 22 items assessing financial difficulty, worries and the use of cost-coping strategies. Multivariable logistic regression models assessed the association of financial difficulty with diagnosis, socioeconomic and treatment characteristics.

Results
About 16.8% reported experiencing financial difficulty using the single-item measure and 60.3% using the composite measure. Most frequently endorsed items in the composite measure were financial worry about having to pay large medical bills related to cancer and difficulty paying medical bills. Financial difficulty using the single-item measure was associated with having MM vs CLL (adjusted OR (aOR), 0.34; 95% CI, 0.13 to 0.84; p=0.02), having insurance other than Medicare (aOR, 2.53; 95% CI, 1.37 to 4.66; p=0.003), being non-White (aOR, 2.21; 95% CI, 1.04 to 4.72; p=0.04) and having a high school education or below (aOR, 0.36; 95% CI, 0.21 to 0.64; p=0.001). Financial difficulty using the composite measure was associated with having a high school education or below (aOR, 0.62; 95% CI, 0.41 to 0.94; p=0.03).

Conclusions
US patients with MM and CLL report financial difficulty, especially those with low socio-economic status. Interventions are needed to mitigate patients’ financial difficulty.

Trial registration number
NCT03870633.

Annals of Internal Medicine, Ahead of Print.

Uptake of nirsevimab varied substantially between the countries that have implemented infant RSV immunisation programmes. Despite the limited number of studies and the lack of more accurate data at national level the low uptake estimates for RSV maternal vaccine and RSV vaccines for older adults are concerning. National, clinical, and public health initiatives are needed to increase uptake of RSV immunisation products and ensure maximum benefit to people currently at risk of severe RSV outcomes.

Our findings suggest that monthly IPTp-SP has superior effect on GWG compared to weekly chloroquine or IPTp-DHA + PPQ in malaria-endemic areas. The result provides further evidence indicating that IPTp-SP improves maternal weight gain, an important determinant of fetal growth beyond its antimalarial effects. Due to the limited number of trials with weight and height measures available for the IPD meta-analysis we were likely underpowered to detect any significant difference between 2-dose SP and monthly IPTp-SP.

The REPORT-HF registry evaluated the quality of care (QoC) in acute heart failure and its association with outcomes across 44 countries.1 The authors conclude that improving QoC could reduce mortality in acute heart failure. While this is a reasonable assertion, specific recommendations for how low-income countries can achieve this improvement are needed.2,3 Among targeted strategies for quality improvement that may increase the practical impact, it is suggested that NYHA classification (despite its limitations) and its routine assessment in HF with minimal cost should be promoted.

Snow fell overnight, a deep slush like the red sludge my uterus sheds after tumor removal. In a year they will grow back.

This Perspective examines the rapid adoption of DeepSeek, a large language model, across Chinese hospitals and the regulatory and governance concerns surrounding the use of artificial intelligence–enabled models in health care.

In Reply In response to the Letter by Ms Chen and colleagues about our recent study, we concur that severe maternal morbidity conditions can arise from both preexisting maternal conditions (eg, cardiac complications) and pregnancy-induced conditions (eg, severe sepsis). Addressing preexisting conditions through targeted preconception and antenatal care, such as prescribing low-dose aspirin to reduce severe preeclampsia, is essential. Early identification of high-risk individuals (eg, women with a history of psychiatric disorders) could potentially improve maternal outcomes. Furthermore, as Chen and colleagues highlight, the effect of interpregnancy interval warrants attention, given that long-term clinical follow-up and reproductive counseling may alleviate the risk of severe maternal morbidity in subsequent pregnancies.

In a rabbit endocarditis model, low-dose daptomycin plus cloxacillin or ceftaroline resulted in valve sterilization in ≥90% of animals without development of daptomycin nonsusceptibility.

In Reply We thank Mermel for his thoughtful and careful review of our Teachable Moment article, “The Harm of Inappropriate Central Line Blood Cultures in Clinical Practice.” We agree that whether a positive central line culture reflects a bloodstream infection, colonization, or a false-positive result requires accounting for the outcome of each blood culture obtained. In our case, we reported that the initial central line blood culture grew coagulase-negative Staphylococcus, yet the initial and repeated peripheral cultures had negative results. As only 1 of the 2 initial blood cultures revealed infection, the positive result was limited to the central line culture, and subsequent cultures revealed negative results. This suggests colonization of the catheter hub or lumen or a false-positive result due to a skin contaminant. Coupled with an alternative explanation for the patient’s fever (ie, community-acquired pneumonia), the infectious diseases consultant did not disregard the possibility of a catheter-related bloodstream infection; rather, as stated in our initial report, they determined the risk to be low. Last, we agree that alcohol end caps are an important strategy to reduce false-positive results drawn from central lines, along with careful skin and catheter disinfection. Unfortunately, such strategies do not eliminate the risk of a false-positive result, supporting our conclusion to limit central line blood culture specimens in clinical practice to specific indications: inability to obtain peripheral blood cultures, suspected catheter-related bloodstream infection in the absence of another recognized source of infection, and neutropenic fever.

This double-blind, placebo-controlled randomized clinical trial determines the safety and efficacy of repeated low doses of lysergic acid diethylamide (LSD) in reducing attention-deficit/hyperactivity disorder (ADHD) symptoms compared with placebo.

To the Editor Saal et al classified the progressive diseases (PDs) of patients receiving immune checkpoint inhibitor (ICI) treatment, taking into account lesion growth or new lesions, and classified PD after ICI treatment into 3 categories: low risk, intermediate risk, and high risk. Classification performance was demonstrated in multiple cohorts, which is expected to guide clinical decision-making for patients with solid tumors undergoing ICI treatment after PD. Although the author’s modified classification demonstrated good potential for guiding treatment, we found some problems that need to be addressed.

The Patient Page titled “I Need Supplemental Oxygen—What Should I Know?” published online April 7, 2025, contained an error in the section How Do I Get Started on Supplemental Oxygen? The correct threshold for low blood level of oxygen is 88% or less. This article has been corrected online.