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NEWS - Family Medicine

#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.


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)


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)


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)


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.


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”.


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”.


Richard Lehman’s journal review, 26 February 2018 – The BMJ Opinion (free)

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


Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a multicentre, randomised controlled trial – The Lancet (link to abstract – $ for full-text)

The mean number of hypoglycemic events per 28 days was reduced from 10.8 to 3.5 among patients in the continuous glucose monitoring group and from 14.4 to 13.7 among control group participants.


Opinion: Stories about tragic flu deaths wrongly portray Tamiflu as a panacea – HealthNewsReview (free)

Related: Tamiflu and Relenza: getting the full evidence picture – Cochrane Library (free)

“The review confirms small benefits on symptom relief, namely shortening duration of symptoms by half a day on average. However, there is little evidence to support any belief that use of NIs reduces hospital admission or the risk of developing confirmed pneumonia”. (from Cochrane)


Risk of Recurrent Disease and Surgery Following an Admission for Acute Diverticulitis – Diseases of the Colon and Rectum (link to abstract – $ for full-text)

Commentary: Which Patients with Diverticulitis Require Surgery? – Diseases of the Colon & Rectum, via NewsWise (free)

In this large cohort of 65,162 patients identified with a first episode of acute diverticulitis, younger patients, women, smokers, obese individuals, and those who had diverticulitis with perforation and/or abscess were more likely to develop recurrent diverticulitis.


Richard Lehman’s journal reviews, 19 February 2018 – The BMJ Opinion (free)

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


Systolic Blood Pressure and Outcomes in Patients With Heart Failure With Preserved Ejection Fraction – JAMA Cardiology (link to abstract – $ for full-text)

Commentaries: Aggressive Systolic Blood Pressure Control In Older Patients With HFpEF Should Be Avoided – MedicalResearch.com (free) AND Low blood pressure linked to worse outcomes in HFpEF patients – Cardiovascular Business (free)

“A systolic blood pressure level of less than 120 mm Hg identifies patients with heart failure with preserved ejection fraction at higher risk for short- and long-term mortality and emphasizes the need for future prospective studies to evaluate optimal systolic blood pressure treatment goals in this patient population”.


New Cochrane Systematic Reviews – Vaccines for Preventing Influenza and Its Complications

In Healthy Children (free) / Summary (free)

In The Elderly (free) / Summary (free)

In Immunosuppressed Adults With Cancer (free) / Summary (free)

In Healthy Adults (free) / Summary (free)


Screening for Ovarian Cancer: US Preventive Services Task Force Recommendation Statement – JAMA (free)

Editorials: Screening for Ovarian Cancer in Asymptomatic Women (free) AND The Yet Unrealized Promise of Ovarian Cancer Screening (free) AND Is There a Future for Ovarian Cancer Screening? (free)

Author interview: USPSTF Recommendation: Screening for Ovarian Cancer (free audio)

“The USPSTF recommends against screening for ovarian cancer in asymptomatic women. (D recommendation) This recommendation applies to asymptomatic women who are not known to have a high-risk hereditary cancer syndrome”.


Medical News & Perspectives: Do All Patients Need β-Blockers After a Heart Attack? – JAMA (free for a limited period)


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

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


Trimethoprim use for urinary tract infection and risk of adverse outcomes in older patients: cohort study – The BMJ (free)

“Trimethoprim is associated with a greater risk of acute kidney injury and hyperkalaemia compared with other antibiotics used to treat UTIs, but not a greater risk of death”


Extrafine inhaled triple therapy versus dual bronchodilator therapy in chronic obstructive pulmonary disease (TRIBUTE): a double-blind, parallel group, randomised controlled trial – The Lancet (link to abstract – $ for full-text)

“Steroid-containing fine-mist triple inhaler comp with dry powder double inhaler resulting in 0.09 fewer exacerbations per year. Yup.” (via @RichardLehman1 see Tweet) See Richard Lehman’s point of view


Atypical antipsychotics, insulin resistance and weight; a meta-analysis of healthy volunteer studies – Progress in Neuro-Psychopharmacology and Biological Psychiatry (link to abstract – $ for full-text) (via @psychopharmacol see Tweet)

“These findings provide preliminary evidence that atypical antipsychotics cause insulin resistance and weight gain directly, independent of psychiatric disease and may be associated with length of treatment”.


Nursing interventions for smoking cessation – Cochrane Library (free)

Summary: Does support and intervention from nurses help people to stop smoking? – Cochrane Library (free)

“There’s moderate quality evidence that behavioural support to motivate & sustain smoking cessation delivered by nurses can lead to a modest increase in the number of people who achieve prolonged abstinence” (via @CochraneUK see Tweet)


Direct Oral Anticoagulants in Addition to Antiplatelet Therapy for Secondary Prevention After Acute Coronary Syndromes: A Systematic Review and Meta-analysis – JAMA Cardiology (link to abstract – $ for full-text)

Commentaries: Could NOACs Have a Role for Secondary Prevention After STEMI? – TCTMD (free) AND Meta-Analysis: ACS Type Matters for DOAC Use in Secondary Prevention – MedPage Today (free registration required) AND Adding DOACs Beneficial for STEMI — Not Non-STEMI — But with Bleeding Risk – Physician’s First Watch (free)

“63 STEMI patients would need to receive a DOAC to prevent one cardiovascular event, while 96 would need to be treated to cause one major bleeding event”. (from Physician’s First Watch)


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

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


Risk of pre-eclampsia in women taking metformin: a systematic review and meta-analysis – Diabetic Medicine (free)

Source: ACP Journal Wise ($)

“Metformin was associated with lower gestational weight gain and a lower risk of pre-eclampsia compared with insulin”


Catheter Ablation for Atrial Fibrillation with Heart Failure – New England Journal of Medicine (link to abstract – $ for full-text)

Commentary: Catheter ablation better than pharmacological atrial fibrillation therapies – University of Utah Health, via EurekAlert (free)

“In patients w/heart failure & atrial fibrillation, catheter ablation lowers rate of death and hospitalization for worsening HF vs. medical therapy”. (via @NEJM see Tweet)


One Day Your Mind May Fade. At Least You’ll Have a Plan – The New York Times (10 articles per month are free)

Free download: Health Directive for Dementia (free PDF) from Advanced Directive for Dementia

Source: New document allows advance planning for dementia – Univadis (free registration required)

“A Simple Way to Document the Medical Care You Would Want If You Had Dementia”


Associations of Omega-3 Fatty Acid Supplement Use With Cardiovascular Disease Risks: Meta-analysis of 10 Trials Involving 77 917 Individuals – JAMA Cardiology (free)

Commentary: Omega-3 Supplements Don’t Protect Against Heart Disease – The New York Times (10 articles per month are free)

Omega-3 fatty acids did not prevent fatal or nonfatal coronary heart disease or any major vascular events.


Traumatic brain injury and the risk of dementia diagnosis: A nationwide cohort study – PLOS One (free)

Commentaries: TBI is associated with increased dementia risk for decades after injury – PLOS, via ScienceDaily (free) AND More evidence traumatic brain injuries raise later dementia risk – Reuters (free)

“Using longitudinal, case-control, and sibling-matched analyses of nationwide data from Sweden, Peter Nordström & Anna Nordström describe the association between TBI and dementia, its time course, and the influence of familial factors”. (via @PLOSMedicine see Tweet)


Safety of hydroxyanthracene derivatives for use in food – EFSA Journal (free)

Press release: EFSA confirms health concerns for hydroxyanthracene derivatives in food – European Food Safety Agency (free)

Commentary: Europe’s safety watchdog says laxatives may increase cancer risk – Reuters (free)

“This group of substances naturally occurs in plants such as aloe or senna species. Extracts containing them are used in food supplements for their laxative effect”. (from Press Release)


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