Today’s understanding is that “pimping” on rounds and similar tactics tend to inhibit rather than promote learning. Yet residents and fellows, and to a lesser extent medical students, continue to complain of demeaning interactions in medical learning environments. Icahn School of Medicine instituted a system to take in reports of such behavior in an attempt to improve the educational environment there. In their model, the instructor is informed that an individual perceived a degrading interaction. The purpose is to allow the instructor to be aware and make changes as needed. But institutions who want to follow the example of the school need to be prepared to allocate the needed resources to do this follow up if the system is to have any benefit.

Given the global shortage of nirmatrelvir–ritonavir for COVID, alternative antivirals are in demand. This phase 3 randomized trial compared VV116 to nirmatrelvir–ritonavir for adults with mild-to-moderate COVID-19 at risk for progression. The trial was conducted during Omicron strain prevalence (B.1.1.529). Time to clinical recovery was 4 days with VV116 versus 5 days with nirmatrelvir–ritonavir. AEs were seen in 67.4% and 77.3% of the VV116 nirmatrelvir–ritonavir groups, respectively.

Commotio cordis — cardiac arrest after a blunt force trauma to the chest — is thought to occur because a hard object strikes the chest in a vulnerable moment in the cardiac cycle, setting off ventricular fibrillation. The rare condition has been described with a ball strike to the chest, but primarily in young men whose chests haven’t fully developed, making them more susceptible to the blunt force of a ball.

This neurology news roundup from MedPage Today includes four highlights of note: First, a JAMA Internal Medicine article pointing out that gabapentin will not solve the opioid crisis in the US. Second, ublituximab, approved for relapsing MS at the end of December, has been included in the Institute for Clinical and Economic Review’s report on comparative effectiveness. Third, the same organization says that the newly approved Alzheimer’s drug lecanemab will need to be priced below $21,000 per year to be cost effective. And finally, a link to Neurology‘s crystal ball view into neurology education in the coming decade.

Fast-tracked tirzepatide is looking to join the diabetes-turned-obesity drug market. Additional options in the class could be a boon to patients, given the persisting semiglutide shortage.

High functioning depression is an oversimplified label for someone who effectively hides their persistent depression and seems to be managing their life well. The proper diagnosis is probably dysthymia. Dysthymia is difficult to detect until it intensifies into a major depressive episode. Asking questions about mood, sleep, medication and duration of depressive symptoms can help the clinician achieve a proper diagnosis.