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)
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.
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).
#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)
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)
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)
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)
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)
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)
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)
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)
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)
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)
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.
Another interesting list of commonly used low-value practices that should be questioned.
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)
When available, Factor Xa inhibitors seems to be a better choice for treating these patients.
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)
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.
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)
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”.
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)
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 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)
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)
“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”.
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.
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)
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)
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”.
Commentary: EHR Time Exceeds Patient Face Time in Family Practice Visits – Medscape (free registration required)
Related: Care-Centered Clinical Documentation in the Digital Environment: Solutions to Alleviate Burnout – National Academy of Medicine (free) AND Date Night with the EHR – NEJM Catalyst (free) AND Why Physician Burnout Is Endemic, and How Health Care Must Respond – NEJM Catalyst (free) AND Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians(free)
Association of Varicose Veins With Incident Venous Thromboembolism and Peripheral Artery Disease – JAMA (link to abstract – $ for full-text)
Commentaries: Patients with varicose veins at greater risk for thrombosis, other vascular diseases – Cardiovascular Business (free) AND Varicose Veins Linked to Greater Risk for VTE, PAD – NEJM Physician’s First Watch (free) AND Varicose Veins May Increase Likelihood of Blood Clots – Physician’s Weekly (free)
Sex Differences in the Association Between Measures of General and Central Adiposity and the Risk of Myocardial Infarction: Results From the UK Biobank – Journal of the American Heart Association (free for a limited period)
Related Systematic Review: Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis – BMC Medicine (free) AND Commentary: Age itself is not a risk factor for complications after surgery among older patients – OnMedica (free)
Related guideline: Social anxiety disorder: recognition, assessment and treatment – NICE (free) AND Summary: Recognition, assessment and treatment of social anxiety disorder: summary of NICE guidance – The BMJ (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)
Commentaries: Bariatric Surgery Associated With Reduced Need For Diabetes Medications at Six Years – MedicalResearch (free) AND Roughly Half of Obese Patients Who Have Bariatric Surgery Are Off Type 2 Diabetes Meds at 6 Years – TCTMD (free)
See related studies on the long-term effects of Bariatric Surgery in our January 17th issue (see #1, #2 and #3)
Original article: Interventions for paracetamol (acetaminophen) overdose – Cochrane Library (link to abstract – $ for full-text)
Richard Lehman reviews the latest research in the top medical journals.
Commentaries: FDA: Antibiotic Linked to Increased Risk of Death in Heart Disease Patients – MPR (free) AND FDA: Clarithromycin Risks Persist in Patients With CAD – TCTMD (free) FDA Alert: Clarithromycin Risky in Patients With Heart Disease – Medscape (free registration required)
Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Commentaries: Pulmonary Embolism Rule-out Criteria non-inferior to usual care for patients at low-risk for pulmonary embolism – 2 Minute Medicine (free) AND EM Nerd-The Case of the Diagnostic Absurdity (free) AND Using PERC & Sending Home Pulmonary Emboli For Fun and Profit – Emergency Literature of Note (free)
Publicar daqui a alguns dias e colocar link para revisões e guidelines recentes
Related articles: Stress cardiomyopathy of the critically ill: Spectrum of secondary, global, probable and subclinical forms – Indian Heart Journal (free) AND Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy – New England Journal of Medicine (free) AND The challenge of Takotsubo syndrome: heterogeneity of clinical features – Swiss Medical Weekly (free) AND Clinical Management of Takotsubo Cardiomyopathy – Circulation Journal (free)
Commentaries: Infective Endocarditis Vegetation Size vs. Embolic Risk – American College of Cardiology, Latest in Cardiology (free) AND Larger Endocarditis Vegetations More Likely to Embolize, Kill – MedPage Today (free registration required)
“Roughly 1 in 3 CVD hospitalizations resulted in 30‐day readmission; nearly 1 in 20 was followed by death within 30 days”.
Randomized double-blind controlled study of bedtime low dose amitriptyline in chronic neck pain – European Journal of Pain (link to abstract – $ for full-text)
Commentary: Low-dose amitriptyline reduces idiopathic chronic neck pain – Univadis (free registration required)
Clinical Guidelines Synopsis: Management of ARDS in Adults – JAMA (free)
Related Review: Acute Respiratory Distress Syndrome: Advances in Diagnosis and Treatment – JAMA (free)
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 Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial – JAMA (free)
Commentaries: Low-Carb And Low-Fat Diets Battle To A Draw – Cardiobrief (free) AND Matching DNA to a diet doesn’t work: ‘We didn’t even come close,’ researcher says – STAT (free) AND Counting Calories Is Not the Key to Weight Loss, New Study Finds – The New York Times (10 articles per month are free) AND Debating low-fat vs low-carb diets? New study found a draw – Scope (free)
Commentaries: Alcohol and dementia: a complex relationship with potential for dementia prevention – The Lancet Public Health (free) AND Expert reaction to study looking at alcohol use disorders and dementia risk – Science Media Centre (free) AND Heavy Drinking Tied to Early-Onset Dementia in French Study – MedPage Today (free registration required)
“Of 57,000 people diagnosed before age 65 with early-onset dementia, 39% had alcohol-related dementia by definition, and 18% had an additional diagnosis of alcohol use disorders” (via @medpagetoday see Tweet)
Related AHA Scientific Statement: Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science (free)
Commentaries: Women Who Clean at Home or Work Face Increased Lung Function Decline – American Thoracic Society, via NewsWise (free) AND Cleaning Chemicals ‘Likely Cause Substantial Damage To Women’s Lungs’, Study Finds – Huffpost (free) AND Cleaning at home or work linked to faster lung function decline in women – Univadis (free registration required)
Perspective: Our Other Prescription Drug Problem – New England Journal of Medicine (free)
Related opinion: Benzodiazepines: our other prescription drug epidemic – STAT (free)
Ischaemic stroke, haemorrhage, and mortality in older patients with chronic kidney disease newly started on anticoagulation for atrial fibrillation: a population based study from UK primary care – The BMJ (free)
Commentaries: Anticoagulants Tied With Stroke, Hemorrhage in CKD – Renal & Urology News (free) AND Could a Blood Thinner Actually Raise Stroke Risk for Some? – HealthDay (free) AND Anticoagulants for Patients with Afib and Kidney Disease? Study Yields Mixed Findings – Physician’s First Watch (free) AND Blood-thinning drugs designed to cut stroke risk may actually increase it – The Guardian (free)
“Given the lack of guidelines, the decision to start anticoagulant treatment in patients with chronic kidney disease and new onset atrial fibrillation should be made on an individual basis, concludes research” (via @bmj_latest see Tweet)
Association of Cigarette, Cigar, and Pipe Use With Mortality Risk in the US Population – JAMA Internal Medicine (free for a limited period)
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.
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.
Hydroxychloroquine Effectiveness in Reducing Symptoms of Hand Osteoarthritis: A Randomized Trial – Annals of Internal Medicine (link to abstract – $ for full-text)
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)
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.
“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)
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 reviews the latest research in the top medical journals.
“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”.
Commentaries: Breast MRIs may lead to more biopsies that catch fewer cancers – Reuters (free) AND MRI-Based Breast Screening Leads to More Biopsies, Lower Cancer Yields – Physician’s First Watch (free)
Draft Recommendation Statement: Weight Loss to Prevent Obesity-Related Morbidity and Mortality in Adults: Behavioral Interventions – U.S. Preventive Services Task Force (free)
Commentaries: USPSTF Again Recommends Offering Behavioral Interventions to Obese Adults – Physician’s First Watch (free) AND USPSTF Posts Draft Recs for Treatment of Adults With Obesity – Medscape (free registration required) AND USPSTF: ‘Yes’ To Behavioral Obesity Therapy – MedPage Today (free)
Related position statement: Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association – Circulation (free PDF)
Beta-blocker Therapy and Clinical Outcomes in Patients with Moderate COPD and Heightened Cardiovascular Risk: An Observational Sub-study of SUMMIT – Annals of the American Thoracic Society (link to abstract – $ for full-text)
Related review and meta-analysis: Beta-blockers in patients with chronic obstructive disease and coexistent cardiac illnesses – COPD Research and Practice (free) AND Beta-blocker use and COPD mortality: a systematic review and meta-analysis – BMC Pulmonary Medicine (free)
Related observational studies: β-Blockers in COPD: A Cohort Study From the TONADO Research Program – CHEST (free) AND Effect of β blockers in treatment of chronic obstructive pulmonary disease: a retrospective cohort study – The BMJ (free)
Commentary: Beta-blockers may not change COPD lung function – Univadis (free registration required)
Regular Yogurt Intake and Risk of Cardiovascular Disease Among Hypertensive Adults – American Journal of Hypertension (link to abstract – $ for full-text)
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”.
Source: Antiarrhythmics: multinational consensus recommendations – Univadis (free registration required)
Related: The Fake Hypertension War: Medical politics and mud fights – MedPage Today (free registration required)
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”.
Commentary: New Guidelines for Treating Checkpoint Inhibitor Toxicities – Medscape (free registration required)
Relate guideline: Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group (free) AND Review: New drugs, new toxicities: severe side effects of modern targeted and immunotherapy of cancer and their management – Critical Care (free)
Review: Physical Activity in the Prevention and Treatment of Coronary Artery Disease – Journal of the American Heart Association (free for a limited period)
Medical News & Perspectives: Do All Patients Need β-Blockers After a Heart Attack? – JAMA (free for a limited period)
Opioid Analgesic Use and Risk for Invasive Pneumococcal Diseases: A Nested Case–Control Study – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentaries: Opioids may be associated with increased risk for serious invasive pneumococcal infections – ACP Internist (free) AND Opioids For Pain Can Exacerbate Pneumococcal Infections – MedicalResearch.com (free) AND Prescription Opioid Use Tied to Higher Pneumonia Risk – MedPage Today (free registration required)
Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism – New England Journal of Medicine (link to abstract – $ for full-text)
Quick Take Video Summary: Edoxaban for Cancer-Associated Venous Thromboembolism (free)
Commentaries: Edoxaban Noninferior to Dalteparin for Cancer-Associated VTE – Physician’s First Watch (free) AND Oral Edoxaban Noninferior to Dalteparin for Cancer-Related Venous Thromboembolism – Cardiology Advisor (free)
Opinion: Heart Stents Are Useless for Most Stable Patients. They’re Still Widely Used – The New York Times (10 articles per month are free)