2018 ESC Guidelines for the diagnosis and management of syncope – European Heart Journal (free for a limited period)
Related guideline: 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society (free)
#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)
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)
Invited commentary, by Kofi Annan: Data can help to end malnutrition across Africa (free)
Other commentaries: Africa ‘very, very far away’ from meeting global target to end child malnutrition – The Guardian (free) Local Burden of Disease – Child Growth Failure – IHME (free) AND Zooming in on advances and opportunities – IHME (free)
#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.
Grader Variability and the Importance of Reference Standards for Evaluating Machine Learning Models for Diabetic Retinopathy – Ophthalmology (link to abstract – $ for full-text)
Aromatherapy Versus Oral Ondansetron for Antiemetic Therapy Among Adult Emergency Department Patients: A Randomized Controlled Trial – Annals of Emergency Medicine (link to abstract – $ for full-text)
Commentaries: Practice Changing: Inhaled Isopropyl Alcohol Superior to Oral Ondansetron as an Antiemetic – NEJM Journal Watch (free) AND Wake Up And Smell the Isopropyl – Emergency Medicine Literature of Note (free)
Richard Lehman reviews the latest research in the top medical journals.
Plasma 25-hydroxyvitamin D concentration and subsequent risk of total and site specific cancers in Japanese population: large case-cohort study within Japan Public Health Center-based Prospective Study cohort – The BMJ (free)
“Wake me up when there is a positive randomized trial of vitamin D pills for anything” (from Richard Lehman’s review).
Commentaries: Survival benefit seen for some patients when cardiologists are away at academic conferences – Harvard Medical School, via ScienceDaily (free) AND TCT paradox: Patients more likely to survive MI during interventional cardiology conference – Cardiovascular Business (free)
“The study’s release date is particularly timely considering another major conference—the American College of Cardiology’s Scientific Session—kicks off this weekend”. (from Cardiovascular Business)
#ACC18 – Effect of Loading Dose of Atorvastatin Prior to Planned Percutaneous Coronary Intervention on Major Adverse Cardiovascular Events in Acute Coronary Syndrome: The SECURE-PCI Randomized Clinical Trial – JAMA (free for a limited period)
Editorial: Lipid Lowering in Acute Coronary Syndrome: Is Treatment Early Enough? (free for a limited period)
Commentaries: Statins Evaluation in Coronary Procedures and Revascularization – SECURE-PCI – American College of Cardiology (free) AND No Benefits Likely with Very Early Statins in ACS Patients – MedPage Today (free registration required) AND SECURE-PCI Comes Up Short for Statin Preloading in ACS Patients – TCTMD (free)
#ACC18 – Hospital Readmission After Perioperative Acute Myocardial Infarction Associated With Noncardiac Surgery – Circulation (free PDF for a limited period)
Commentaries: Hospital Readmissions After Perioperative AMI – American College of Cardiology, Latest in Cardiology (free) AND Perioperative MIs Bring Too Many Patients Back to the Hospital After Noncardiac Surgery – TCTMD (free)
#ACC18 – Inflammatory Bowel Disease Increases Likelihood of a Heart Attack – American College of Cardiology (free) AND Inflammatory bowel disease may raise heart attack risk – Medical News Today (free) AND Those with IBD twice as likely to have heart attack – Cardiovascular Business (free) AND Inflammatory Bowel Disease Makes Heart Attack Twice as Likely – Cardiosmart (free)
#ACC18 – Getting flu shot halves death risk for heart failure patients – Cardiovascular Business (free) AND Flu Vaccine Reduces Mortality, Hospitalization in HF Patients: Meta-analysis – TCTMD (free) AND Flu Shot Cuts Risk for Death by Half in Heart Failure – Medscape (free registration required) AND Getting Flu Vaccine Cuts Risk of Death by Half in People with Heart Failure – American College of Cardiology (free)
This meta-analysis of observational studies suggests a possible benefit.
#ACC18 – Aspirin Lowers Risk of Death for Patients with Diabetes, Heart Failure – American College of Cardiology (free) AND Aspirin Linked to Lower Mortality in Diabetes With Heart Failure – Medscape (free registration required) AND ACC 2018: Aspirin Lowers Risk of Death in Patients With Diabetes and Heart Failure – PracticeUpdate (free registration required)
Commentaries: Lead and the heart: an ancient metal’s contribution to modern disease – The Lancet Public Health (free) AND Lead exposure may be linked to 412,000 premature US deaths yearly, study says – The Guardian (free) AND Lead and CDV deaths in US adults – Science Media Centre (free) AND Expert reaction to lead and CVD deaths in the US – Science Media Centre (free)
The 2017 ESC Guidelines on PADs: what’s new? – European Heart Journal (free) AND The ‘Ten Commandments’ of 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases – European Heart Journal (free)
Health Care Spending in the United States and Other High-Income Countries – JAMA (free article, editorials, author interview and video summary)
Commentaries: Why Is U.S. Health Care So Expensive? Some of the Reasons You’ve Heard Turn Out to Be Myths – The New York Times (10 articles per month are free) AND Huge cost of US healthcare driven by drug prices and salaries – The Guardian (free) AND Healthcare: It’s The Prices, Stupid. Isn’t It? – Forbes (free) AND Physician Salaries, Drug Prices Drive High US Health Costs – Medscape (free registration required)
Related commentary: PD or HD: Which Road Do We Take? – AJKD Blog (free)
Original article: Comparison of Patient Survival Between Hemodialysis and Peritoneal Dialysis Among Patients Eligible for Both Modalities – American Journal of Kidney Diseases (link to abstract – $ for full-text)
Very interesting resource: A Visual introduction to the basic concepts of probability theory – Seeing Theory (free) (via @CochraneUK see Tweet)
State of The Art Review: Pulmonary arterial hypertension: pathogenesis and clinical management – The BMJ (free for a limited period)
Related Guidelines: Pharmacologic Therapy for Pulmonary Arterial Hypertension in Adults – CHEST Guideline and Expert Panel Report (free) AND 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension (free)
#ACC18 – 6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): a randomised, open-label, non-inferiority trial – The Lancet (link to abstract – $ for full-text)
Commentaries: SMART-DATE: Myocardial Infarction Risk Higher with Six-Month Versus Twelve-Month DAPT – American College of Cardiology (free) AND Too Soon for 6-Month DAPT, Say SMART-DATE Investigators, Despite Positive Trial – TCTMD (free)
Related Guidelines: 2018 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Focused Update of the Guidelines for the Use of Antiplatelet Therapy (free) AND 2017 European Society of Cardiology focused update on dual antiplatelet therapy in coronary artery disease (free) AND 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease (free)
Key Points: Evaluation and Treatment of Hirsutism in Premenopausal Women – JAMA Clinical Guidelines Synopsis (free for a limited period)
Effects of stress on the development and progression of cardiovascular disease – Nature Reviews Cardiology (free PDF for a limited period) (via @Abraham_RMI)
Commentaries: New analysis recommends against using digital rectal exam in primary care – American Academy of Family Physicians, vie EurekAlert (free) AND Little Evidence Supports Use of Digital Rectal Exam – Medscape (free registration required) AND Digital Rectal Exams for Routine Prostate Screening Discouraged – NEJM Physician’s First Watch (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”.
Colonoscopy and Colorectal Cancer Mortality in the Veterans Affairs Health Care System: A Case–Control Study – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentaries: Colonoscopy significantly reduces mortality from colorectal cancer in Veterans Affairs study – 2 Minute Medicine (free) AND Colonoscopy Significantly Reduces CRC Deaths – Medscape (free registration required)
N-Terminal Pro–B-Type Natriuretic Peptide in the Emergency Department – Journal of the Americana College of Cardiology (link to abstract – $ for full-text)
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”.
Commentaries: Gout Drug Febuxostat Linked to More CV Deaths Without Uptick in CV Events: CARES Trial – TCTMD (free) AND CARES: Increased Risk of Death With Febuxostat in Patients With Gout and CV Disease – American College of Cardiology (free) AND
Related (just published) systematic review: Perioperative beta-blockers for preventing surgery-related mortality and morbidity – Cochrane Library (free)
Commentary: Combo Tx Offers New Hope for Cryptococcal Meningitis – MedPage Today (free registration required)
Editorial: Recognizing the Global Impact of Zika Virus Infection during Pregnancy (free)
Quick Take Video Summary: Pregnancy Outcomes after Zika (free)
Calcium and vitamin D supplementation and increased risk of serrated polyps: results from a randomised clinical trial – Gut (link to abstract – $ for full-text)
Commentaries: Calcium and vitamin D supplements may raise risk of polyps – MedicalNewsToday (free) AND Calcium Supplements Up Risk for Precancerous Serrated Polyps – Medscape (free registration required)
See original guideline and commentary: ACP Guideline: Hemoglobin A1c Targets for Glycemic Control in Type 2 Diabetes
Related: Get Ready For A Tsunami Of ECGs – Cardiobrief (free) AND: Thoughts on the Apple Watch and Mobile ECG, by Dr John Mandrola (free) AND Overdiagnosis Only a Matter of Time With ECG Watches – Medscape (free registration required)
“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)
Commentaries: High Cardiovascular Fitness in Midlife Tied to Lower Dementia Risk Later – NEJM Physician’s First Watch (free) AND Physically fit women nearly 90 percent less likely to develop dementia – American Academy of Neurology, via ScienceDaily (free)
Elder Abuse: Sometimes It’s Self-Inflicted – The New York Times (10 articles per month are free)
Related guidelines: Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults – United European Gastroenterology (free) Management Guidelines of Eosinophilic Esophagitis in Childhood – Journal of Pediatric Gastroenterology and Nutrition (free) AND ACG Clinical Guideline: Evidenced Based Approach to the Diagnosis and Management of Esophageal Eosinophilia and Eosinophilic Esophagitis (EoE) (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.
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)
Low-Calorie Vegetarian Versus Mediterranean Diets for Reducing Body Weight and Improving Cardiovascular Risk Profile: CARDIVEG Study (Cardiovascular Prevention With Vegetarian Diet) – Circulation (free PDF for a limited period)
Commentaries: Low-Calorie Vegetarian vs. Mediterranean Diets – American College of Cardiology, Latest in Cardiology (free) AND Vegetarian and Mediterranean diet may be equally effective in preventing heart disease – American Heart Association, via ScienceDaily (free)
Related: Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) (free)
Effectiveness of Early Psychosis Intervention: Comparison of Service Users and Nonusers in Population-Based Health Administrative Data – American Journal of Psychiatry (link to abstract – $ for full-text)
Commentaries: Early Psychosis Intervention Program Found to Increase Patient Contact With Psychiatrists, Reduce Mortality – Psychiatry News Alert (free) AND Early Psychosis Interventions May Reduce Patient Mortality – PsychCentral (free)
Crispr gene editing ready for testing in humans – Financial Times (free for a limited period)
Source: Medical Futurist Newsletter
Commentaries: Vegan Diet Rapidly Improves Type 2 Diabetes Markers in Adults – Medscape (free registration required) AND Going vegan could prevent type 2 diabetes – MedicalNewsToday (free) AND New study shows vegan diet improves diabetes markers in overweight adults – EurekAlert (free)
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)
Commentary: Major Medical Associations Feud Over Diabetes Guidelines – NPR (free)
“Clinicians should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes”
A free, online resource on the principles and interventions needed to reduce healthcare associated infections, with suggested control measures across different resource levels.
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.
Commentaries: 5 Classifications of Diabetes Proposed – Physician’s First Watch (free) AND Should diabetes be divided into 5 categories to improve treatment? – Cardiovascular Business (free) AND Diabetes Consists of Five Types, Not Two, Say Researchers – Medscape (free registration required)
The Challenge of Doctor-Patient Relations in the Internet Age – The New York Times (10 articles per month are free)
Summary for ED-relevant care: 2018 AHA/ASA Ischemic Stroke Updates – emDocs (free)
Original 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)
The Tobacco Atlas, Sixth Edition (free PDF)
See companion website: TobaccoAtlas.org
Related: Explore the GBD tool to compare tobacco risks globally – IHME (free interactive tool)
Commentary with key points to remember: European Position Paper on Spontaneous Coronary Artery Dissection – American College of Cardiology, Latest in Cardiology (free)
Related: Aortic Dissection and Aortic Aneurysms Associated with Fluoroquinolones: A Systematic Review and Meta-Analysis – American Journal of Medicine (free) AND Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study – BMJ Open (free) AND Risk of Aortic Dissection and Aortic Aneurysm in Patients Taking Oral Fluoroquinolone – JAMA Internal Medicine (free)
Maintenance proton pump inhibition therapy and risk of oesophageal cancer – Cancer Epidemiology (link to abstract – $ for full-text)
Commentary: Long-term PPI Use and Increased Esophageal CA Risk – Medscape (free registration required)
Related studies suggesting a link with gastric cancer: Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population-based study – Gut (link to abstract – $ for full-text) AND Maintenance therapy with proton pump inhibitors and risk of gastric cancer: a nationwide population-based cohort study in Sweden – BMJ Open (free)
This observational study suggests a possible link.
Metformin use in PCOS pregnancies increases the risk of offspring overweight at 4 years of age; follow-up of two RCTs – The Journal of Clinical Endocrinology & Metabolism (link to abstract – $ for full-text)
Commentaries: Diabetes drug use during pregnancy linked to child’s weight – The Endocrine Society, via ScienceDaily (free) AND Diabetes drug use during pregnancy affects child’s weight – OnMedica (free) AND Metformin in Pregnancy May Increase Childhood Obesity Risk – Medscape (free registration required)
Another interesting list of commonly used low-value practices that should be questioned.
Commentary: Probiotics and fish oil in pregnancy may reduce allergies in children – NHS Choices (free) AND Diet During Pregnancy May Cut Offspring Allergy Risk – MedPage Today (free registration required) AND Probiotics and Fish Oil During Pregnancy May Curb Allergies in Kids – The New York Times (10 articles per month are 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)
Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Commentaries: Opioids Don’t Beat Other Medications For Chronic Pain – NPR (free) AND More Data Opioids No Better for Chronic Back, Arthritis Pain – Medscape (free registration required) AND Opioids no better than NSAIDs for chronic back or arthritis pain – Reuters (free)
When available, Factor Xa inhibitors seems to be a better choice for treating these patients.
Frequency and level of evidence used in recommendations by the National Comprehensive Cancer Network guidelines beyond approvals of the US Food and Drug Administration: retrospective observational study – The BMJ (free)
Commentaries: Vinay Prasad on the NCCN’s cancer treatment guidelines: The US system needs an audit – The BMJ Opinion (free) AND US cancer network recommending expensive drugs based on weak evidence, study finds – The Guardian (free) AND New Study Questions Evidence for NCCN Recommendations – Medscape (free registration required)
Association Between Estimated Cumulative Vaccine Antigen Exposure Through the First 23 Months of Life and Non–Vaccine-Targeted Infections From 24 Through 47 Months of Age – JAMA (link to abstract – $ for full-text)
Commentaries: Vaccines won’t overload your child’s immune system—or increase their risk of other infections – Science (free) AND Too Many Too Soon? No! – Science-Based Medicine (free) AND Study finds no immune overload for US kids’ vaccine schedule – CIDRAP (free)
Digoxin and Mortality in Patients With Atrial Fibrillation – Journal of the American College of Cardiology (link to abstract – $ for full-text)
Commentaries: Digoxin and Mortality in Patients With Atrial Fibrillation – American College of Cardiology, Latest in Cardiology (free) AND Digoxin Associated with Higher Mortality in Patients with Atrial Fibrillation – NEJM Physician’s First Watch (free)
Fluid therapy in neurointensive care patients: ESICM consensus and clinical practice recommendations – Intensive Care Medicine (free for a limited period) (via @luiscamacho02)
See also other recent CHEST guidelines on the management of cough in specific populations: Classification of Cough as a Symptom in Adults and Management Algorithms (free) AND Pharmacologic and Nonpharmacologic Treatment for Acute Cough Associated With the Common Cold (free) AND Chronic Cough Due to Gastroesophageal Reflux in Adults (free) AND Symptomatic Treatment of Cough Among Adult Patients With Lung Cancer (free) AND Cough in the athlete (free) AND Occupational and Environmental Contributions to Chronic Cough in Adults (free) AND Treatment of Unexplained Chronic Cough (free) AND Use of Management Pathways or Algorithms in Children With Chronic Cough (free) AND Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis (free)
Effect of Offering Same-Day ART vs Usual Health Facility Referral During Home-Based HIV Testing on Linkage to Care and Viral Suppression Among Adults With HIV in Lesotho: The CASCADE Randomized Clinical Trial – JAMA (free)
Editorial: The Global HIV Epidemic: What Will It Take to Get to the Finish Line? (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)
Relation of Dietary Sodium (Salt) to Blood Pressure and Its Possible Modulation by Other Dietary Factors: The INTERMAP Study – Hypertension (link to abstract – $ for full-text)
Richard Lehman reviews the latest research in the top medical journals.
““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)
Related Guideline: Guideline for opioid therapy and chronic noncancer pain – Canadian Medical Association Journal (free)
This campaign encourages thoughtful conversation between clinicians and patients to reduce harms associated with opioid prescribing, with recommendations relevant to different specialties.
Related: Global nursing movement launches – Devex (free) AND Nursing Now campaign: raising the status of nurses – The Lancet (free registration required)
See also: Nursing Now Website
Editorial: Escalating Inhaled Glucocorticoids to Prevent Asthma Exacerbations (free for a limited period)
Trial 1: Quintupling Inhaled Glucocorticoids to Prevent Childhood Asthma Exacerbations – The New England Journal of Medicine (free for a limited period)
Trial 2: Quadrupling Inhaled Glucocorticoid Dose to Abort Asthma Exacerbations – The New England Journal of Medicine (free for a limited period)
Comparative cardiovascular safety of non-steroidal anti-inflammatory drugs in patients with hypertension: a population-based cohort study – British Journal of Clinical Pharmacology (link to abstract – $ for full-text)
Reducing Overtreatment of Cancer With Precision Medicine: Just What the Doctor Ordered – JAMA (free for a limited period)
Research Methods & Reporting: Key design considerations for adaptive clinical trials: a primer for clinicians – The BMJ (free)
Colistin alone versus colistin plus meropenem for treatment of severe infections caused by carbapenem-resistant Gram-negative bacteria: an open-label, randomised controlled trial – The Lancet (link to abstract – $ for full-text)
“Combination therapy was not superior to monotherapy”.
Clinical bacteriology in low-resource settings: today’s solutions – The Lancet Infectious Diseases (free registration required)
Source: Critical Care Reviews Newsletter
“Balanced crystalloids may be superior to saline in critically ill patients — but not in patients hospitalized outside an ICU” (from Physician’s First Watch)
Hydrocortisone plus Fludrocortisone for Adults with Septic Shock – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Hydrocortisone-fludrocortisone cuts deaths in septic shock – The Hospitalist (free)
News release: Responding to inflight medical emergencies can be stressful for doctors – CMAJ News (free)
Impact of treatment delay on mortality in ST-segment elevation myocardial infarction (STEMI) patients presenting with and without haemodynamic instability: results from the German prospective, multicentre FITT-STEMI trial – European Heart Journal (free)
Commentaries: 3% rise in deaths for every 10 min delay in restoring blood flow after heart attack – OnMedica (free) AND Treatment Delay and Mortality in STEMI With Shock – American College of Cardiology, Latest in Cardiology (free)
Commentary and summary: New Guideline for Management of Alcoholic Liver Disease – NEJM Journal Watch (free for a limited period)
Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline Update – Journal of Clinical Oncology (free)
Related guidelines: Diagnosis and empirical treatment of fever of unknown origin (FUO) in adult neutropenic patients: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) (free) AND Management of febrile neutropaenia: ESMO Clinical Practice Guidelines (free) AND Guideline for the Management of Fever and Neutropenia in Children With Cancer and Hematopoietic Stem-Cell Transplantation Recipients: 2017 Update (free)
Public Health: Tackling multiple unhealthy risk factors: Emerging lessons from practice – The King’s Fund (free PDF)
Related: The Future of Peer Review – Scientific American (free) AND Peer review is a black box. Let’s open it up – STAT News (free) AND Exposing peer review – Research Information (free) AND Researchers debate whether journals should publish signed peer reviews – Science (free) AND The peer-review system for academic papers is badly in need of repair – The Conversation (free)
Policy Statement: Pediatric Medication Safety in the Emergency Department – American Academy of Pediatrics (free)
Commentaries: Recommendations Issued on Reducing Pediatric Medication Errors in the ED – NEJM Physician’s First Watch (free) AND Policy statement outlines ways to improve pediatric medication safety – 2 Minute Medicine (free)
Related guidelines: 2017 European Society of Cardiology focused update on dual antiplatelet therapy in coronary artery disease (free) AND 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease (free)
Guidelines for Adolescent Depression in Primary Care – American Academy of Pediatrics
Part II. Treatment and Ongoing Management (free)
Commentary: Pediatricians Call For Universal Depression Screening For Teens – NPR (free)
2018 consensus of the Taiwan Society of Cardiology and the Diabetes Association of Republic of China (Taiwan) on the pharmacological management of patients with type 2 diabetes and cardiovascular diseases – Journal of the Chinese Medical Association (free)
“For a typical lunch with an intake of 600 calories, such as a slice of pizza and a soft drink, labelling may reduce the energy content of food purchased by about 8% (48 calories)”
“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”.
Editorial: Treatment or surveillance for CIN2? (free)
Commentaries: Treatment or surveillance for CIN2: when less is more – The BMJ Opinion (free) AND Some irregular cervical lesions could be monitored rather that treated immediately – OnMedica (free) AND Regular monitoring rather than immediate treatment justified for some cervical lesions – EurekAlert (free)
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)
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.
Related: Updated WHO Recommendation on Tranexamic Acid for the Treatment of Postpartum Haemorrhage (free PDF) AND Early use of tranexamic acid reduces bleeding more effectively – NIHR Signal (free) AND Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients – The Lancet (free)
Commentaries: Maternal vaccination during pregnancy not associated with infant hospitalization, mortality – 2 Minute Medicine (free) AND Getting Recommended Vaccines During Pregnancy Doesn’t Lead to Harm in Infants – Physician’s First Watch (free)
Nut Consumption and Survival in Patients With Stage III Colon Cancer: Results From CALGB 89803 (Alliance) – Journal of Clinical Oncology (link to abstract – $ for full-text)
Commentaries: Nut Consumption May Aid Colon Cancer Survival – Yale Cancer Center, via NewsWise (free) AND Nuts, Especially Tree Nuts, and Improved CRC Survival – Medscape (free registration required
A survival benefit was suggested by this observational trial.
Commentarires: Aerobic exercise may mildly delay, slightly improve Alzheimer’s symptoms – American Geriatrics Society, via EurekAlert (free) AND Aerobic exercise slows cognitive decline in Alzheimer’s disease – Reuters (free)
Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) – Journal of Pediatric Gastroenterology and Nutrition (free)
Related Guidelines and Reviews: Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline (free) AND 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines (free) AND Canadian Cardiovascular Society Guidelines for Evaluation and Management of Cardiovascular Complications of Cancer Therapy (free) AND Cardiotoxicity of anticancer treatments: Epidemiology, detection, and management – CA: A Cancer Journal for Clinicians (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”.
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”.