Open access

NEWS - Internal Medicine / Hospital 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.


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”.


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)


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)


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”.


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.


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”.


Patterns and Predictors of Short-Term Peripherally Inserted Central Catheter Use: A Multicenter Prospective Cohort Study – Journal of Hospital Medicine (free PDF)

Commentary: Short-term use of IV devices is common — and risky — study shows – University of Michigan, via ScienceDaily (free)

“Intravenous devices known as PICCs should be reserved for long-term use, but a new study shows 1 in 4 are used for 5 days or less” (from ScienceDaily)


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

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


Best supportive care for idiopathic pulmonary fibrosis: current gaps and future directions – European Respiratory Review (free)

Publicar daqui a alguns dias e colocar link para revisões e guidelines recentes


Readmissions Following a Hospitalization for Cardiovascular Events in Dialysis Patients: A Retrospective Cohort Study – Journal of the American Heart Association (free for a limited period)

“Roughly 1 in 3 CVD hospitalizations resulted in 30‐day readmission; nearly 1 in 20 was followed by death within 30 days”.


Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty – New England Journal of Medicine (link to abstract – $ for full-text)

Quick Take Video Summary: Preventing VTE after Hip or Knee Arthroplasty (free)

“Among patients who received 5 days of rivaroxaban prophylaxis after total hip or total knee arthroplasty, extended prophylaxis with aspirin was not significantly different from rivaroxaban in the prevention of symptomatic venous thromboembolism”.


Effect of Haloperidol on Survival Among Critically Ill Adults With a High Risk of Delirium: The REDUCE Randomized Clinical Trial – JAMA (free)

Prophylactic haloperidol in this population with elevated risk of delirium did not reduce mortality or any of the 15 prespecified secondary outcomes, including delirium incidence, 28-day delirium-free and coma-free days, duration of mechanical ventilation, and ICU and hospital length of stay.


Outcomes of non-invasive diagnostic modalities for the detection of coronary artery disease: network meta-analysis of diagnostic randomised controlled trials – The BMJ (free)

Among patients with low risk acute coronary syndrome, stress echocardiography, cardiovascular magnetic resonance, and exercise electrocardiograms resulted in fewer invasive referrals for coronary angiography than coronary computed tomographic angiography, without apparent impact on the future risk of myocardial infarction. Similarly, for outpatients with suspected stable angina, an initial strategy based on functional testing might be preferable, resulting in fewer referrals for invasive coronary angiography and revascularization, without a statistically significant difference in the future risk of MI.


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.


Short-Term Versus Long-Term Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Elderly Patients: A Meta-Analysis of Individual Participant Data From 6 Randomized Trials – JACC: Cardiovascular Interventions (link to abstract – $ for full-text)

Commentary: Dual Antiplatelet Therapy Duration in Elderly Patients – American College of Cardiology, Latest in Cardiology (free)

Short-term Dual Antiplatelet Therapy was not associated with increased risk of ischemic events in elderly patients and was associated with a significant reduction in major bleeding.


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.


Incidence, Etiology, and Outcomes of Community-Acquired Pneumonia: A Population-Based Study – Open Forum Infectious Diseases (free)

“Aside from the rare extra-pulmonary manifestations of mycoplasma (e.g., rashes, hemolysis, neurologic complications), do any of the many causes of pneumonia have distinctive clinical presentations? Probably not”. (via @PaulSaxMD see Tweet)


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”.


Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine – New England Journal of Medicine (link to abstract – $ for full-text)

Commentaries: No benefit of sodium bicarbonate or acetylcysteine for prevention of complications after angiography: The PRESERVE trial – 2 Minute Medicine (free) AND Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine – NEJM Resident 360 (free)

“Among patients at high risk for renal complications who were undergoing angiography, there was no benefit of intravenous sodium bicarbonate over intravenous sodium chloride or of oral acetylcysteine over placebo for the prevention of death, need for dialysis, or persistent decline in kidney function at 90 days or for the prevention of contrast-associated acute kidney injury”.


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)


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