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#ACC18 – Carvedilol for Prevention of Chemotherapy Related Cardiotoxicity – Journal of the American College of Cardiology (link to abstract – $ for full-text)

Commentaries: Beta Blocker Shows Mixed Results in Protecting Against Chemo-Induced Heart Damage – American College of Cardiology (free) AND Carvedilol Effect in Preventing Chemotherapy Induced CardiotoxicitY – CECCY – American College of Cardiology (free)

Related study from #ACC18: Heart Drugs Prevented Cardiotoxicity in Breast Cancer Treated With Anthracycline and Trastuzumab – American College of Cardiology (free)

“According to the CECCY trial, carvedilol had no effect on left ventricular function in breast cancer patients treated w/ doxorubicin, but did result in a reduction in troponin I levels & diastolic dysfunction”. (via @ACCinTouch see Tweet)


#ACC18 – Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops – New England Journal of Medicine (free for a limited period)

Commentaries: Barbershop-Based Intervention Leads to Blood Pressure Reductions in African-American Men – American College of Cardiology (free) AND Mixing Haircuts and Hypertension Rx a ‘Home Run’ for Blood Pressure Control – TCTMD (free)

“Among black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in larger blood-pressure reduction when coupled with medication management in barbershops by specialty-trained pharmacists”.


Do Antidepressants Work? – The New York Times (10 articles per month are free)

“The most comprehensive study on them has recently been published, showing mostly modest effects”.

See related meta-analysis and commentaries in our February 23rd issue (see #3)


#ACC18 – The ODYSSEY Trial Ends Well— But Will It Be Enough? – Cardiobrief (free) AND Ten Quick Thoughts on ODYSSEY – John Mandrola, via Medscape (free registration required)

“An absolute risk reduction of 1.6% in the primary endpoint translates to a number needed to treat of 64. Using the current price of $14,500 per year, Kaul calculated that preventing one event over the trial period of almost 3 years would cost about $2.6 million” (via John Mandrola). This study was presented at #ACC18 and has not been published yet. Among the many commentaries, these two were selected for a balanced point of view.


Richard Lehman’s journal reviews, 12 March 2018 – The BMJ Opinion (free)

Richard Lehman reviews the latest research in the top medical journals.


Endovascular treatment for acute ischaemic stroke in routine clinical practice: prospective, observational cohort study (MR CLEAN Registry) – The BMJ (free)

Related guideline: 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association / American Stroke Association (free PDF) AND Summary for ED-relevant care: 2018 AHA/ASA Ischemic Stroke Updates – emDocs (free)

“In routine clinical practice, endovascular treatment for patients with acute ischemic stroke is at least as effective and safe as in the setting of a randomized controlled trial”.


N-Terminal Pro–B-Type Natriuretic Peptide in the Emergency Department – Journal of the Americana College of Cardiology (link to abstract – $ for full-text)

Commentary: NT-proBNP cutpoints validated for diagnosing and ruling out heart failure in the ED – ACP Hospitalist (free)

Related review: BNP in the emergency department: The evidence – First10EM (free)

“In acutely dyspneic patients seen in the ED setting, age-stratified NT-proBNP cutpoints may aid in the diagnosis of acute HF. An NT-proBNP <300 pg/ml strongly excludes the presence of acute HF”.


Like It Or Not, Personal Health Technology Is Getting Smarter – NPR (free)

“Nice article about wearables related issues, such as medicalization of the healthy, privacy loss, low adherence, uncertain reliability of measurements and uncertain health benefits”. (via @RasoiniR see Tweet)


Elder Abuse: Sometimes It’s Self-Inflicted – The New York Times (10 articles per month are free)

“The house is filthy. The elderly resident is struggling. But who has the right to intervene?” (via @NYTHealth see Tweet)


Socioeconomic disparities in first stroke incidence, quality of care, and survival: a nationwide registry-based cohort study of 44 million adults in England – The Lancet Public Health (free)

Invited commentary: Preventing stroke on the street where you live, work, and play (free)

Patients from the lowest socioeconomic groups had first stroke a median of 7 years earlier than those from the highest and a 26% higher adjusted risk of 1-year mortality.


Efficacy of a single-dose regimen of inactivated whole-cell oral cholera vaccine: results from 2 years of follow-up of a randomised trial – The Lancet Infectious Diseases (free)

Invited commentary: Cholera control: one dose at a time (free)

“Our results indicate that when such emergencies occur in populations with endemic cholera, the challenges of successfully completing a two-dose regimen should not deter deployment of OCV, because older children and adults will be protected for at least 2 years by a single dose”. (via @Onisillos see Tweet)


Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: a systematic review and meta-analysis – Diabetes Research and Clinical Practice (link to abstract – $ for full-text)

“Carbohydrate-restricted diets, associated with reductions in HbA1c of around 0.4% in short term” (via @kamleshkhunti see Tweet)


New Guide to Infection Control in The Hospital – International Society for Infectious Diseases (free)

A free, online resource on the principles and interventions needed to reduce healthcare associated infections, with suggested control measures across different resource levels.


Drug treatment effects on outcomes in heart failure with preserved ejection fraction: a systematic review and meta-analysis – Heart (free)

Editorial: Pharmacological strategies in heart failure with preserved ejection fraction: time for an individualised treatment strategy? (free)

Commentary: Heartbeat: Is there any effective therapy for heart failure with preserved ejection fraction? (free)

In this meta-analysis of RCT testing treatments for patients with heart failure with preserved ejection fraction, only beta-blockers demonstrated reductions in all-cause and cardiovascular mortality.


Effectiveness of brief alcohol interventions in primary care populations – Cochrane Library (free)

In general practice or emergency care settings, brief alcohol interventions can reduce alcohol consumption and related harm.


Effect of a Low-Intensity PSA-Based Screening Intervention on Prostate Cancer Mortality: The CAP Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)

Commentary: One-off PSA screening for prostate cancer does not save lives – eCancer News (free)

“Largest ever prostate cancer trial – CAP – published in the JAMA. No effect from low intensity PSA screening on prostate cancer mortality at 10 years”. (via @KariTikkinen see Tweet)


Authors of premier medical textbook didn’t disclose $11 million in industry payments – STAT (free)

“’The most recognized book in all of medicine’ is also rife with hidden financial conflicts. Should Harrison’s authors be disclosing $11 million in payments from drug and device makers?” (via @caseymross see Tweet)


Richard Lehman’s journal review, 5 March 2018 – The BMJ (free)

Richard Lehman reviews the latest research in the top medical journals.


Outcomes, experiences and palliative care in major stroke: a multicentre, mixed-method, longitudinal study – Canadian Medical Association Journal (free)

““Palliative care” had connotations of treatment withdrawal and imminent death… practicing the principles of palliative care is needed, but the term “palliative care” should be avoided or reframed”.

See related articles on this subject: Palliative care: renaming as supportive care and integration into comprehensive cancer care – CMAJ (free) AND Perceptions of palliative care among patients with advanced cancer and their caregivers (free)


Opioid Wisely – Choosing Wisely Canada (free)

Related Guideline: Guideline for opioid therapy and chronic noncancer pain – Canadian Medical Association Journal (free)

See complete lists from Choosing Wisely U.S. / Choosing Wisely UKChoosing Wisely Australia AND Choosing Wisely Canada

This campaign encourages thoughtful conversation between clinicians and patients to reduce harms associated with opioid prescribing, with recommendations relevant to different specialties.


Balanced Crystalloids versus Saline in Critically Ill Adults – New England Journal of Medicine (free)

Related article: Balanced Crystalloids versus Saline in Noncritically Ill Adults – New England Journal of Medicine (free)

Commentary: Balanced Crystalloids May Be Better Than Saline for Critically Ill Patients – NEJM Physician’s First Watch (free)

“Balanced crystalloids may be superior to saline in critically ill patients — but not in patients hospitalized outside an ICU” (from Physician’s First Watch)


Opinion: Doctors, Revolt! – The New York Times (free)

“Healing is replaced with treating, caring is supplanted by managing, and the art of listening is taken over by technological procedures. Bernard Lown” (via @lucadf see Tweet)


Guidelines for Adolescent Depression in Primary Care – American Academy of Pediatrics

Part I. Practice Preparation, Identification, Assessment, and Initial Management (free)

Part II. Treatment and Ongoing Management (free)

Commentary: Pediatricians Call For Universal Depression Screening For Teens – NPR (free)


Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial – The Lancet (free)

Commentaries: Hypertension: time for doctors to switch the driver’s seat? (free) AND Should home-based blood pressure monitoring be commonplace in NHS? – University of Oxford News & Events (free)

“Self-monitoring, with or without telemonitoring, when used by general practitioners to titrate antihypertensive medication in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings”.


Meta-analysis: Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting – Journal of the American College of Cardiology (link to abstract – $ for full-text)

Commentary: Long-Term Outcomes of On- vs. Off-Pump CABG – American College of Cardiology, Latest in Cardiology (free)

“Off pump CABG. probably best used in a limited set of patients…” (via @keaglemd see Tweet)


Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data – The Lancet (free)

This meta-analysis of randomized trials showed CABG had a mortality benefit over PCI in patients with multivessel disease, particularly those with diabetes and higher coronary complexity. There was no mortality benefit in patients with left main disease.


Are Hospitals Becoming Obsolete? – The New York Times (10 articles per month are free)


Robot-assisted laparoscopic surgery versus conventional laparoscopic surgery in randomized controlled trials: A systematic review and meta-analysis – PLOS One (free)

“Despite higher operative cost, robot-assisted laparoscopic surgery does not result in statistically better treatment outcomes, with the exception of lower estimated blood loss. Operative time and total complication rate are significantly more favorable with conventional laparoscopic surgery”.


Comparative Effectiveness and Safety of Cognitive Enhancers for Treating Alzheimer’s Disease: Systematic Review and Network Meta-analysis – Journal of the American Geriatrics Society (free)

Source: Medscape (free registration required)

“Cognitive enhancers in general have minimal effects on cognition according to minimal clinically important difference and global ratings. The drugs appear safe, but this must be interpreted cautiously because trial participants may have less comorbidity and fewer adverse effects than those treated with these drugs in clinical practice”.


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