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NEWS - Internal Medicine / Hospital Medicine

Antibiotics for acute rhinosinusitis in adults – Cochrane Library (free for a limited period)

Summary: Antibiotics for sinus infection of short duration in adults – Cochrane Library (free)

“Considering antibiotic resistance, and the very low incidence of serious complications, we conclude there is no place for antibiotics for people with uncomplicated acute rhinosinusitis.”

 


Screening: How overdiagnosis and other harms can undermine the benefits – Health News Review (free)

“All screening programs do harm, some do good as well.”

 


Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study – The Lancet (link to abstract – $ for full-text)

Commentaries: The Lancet: Dairy consumption linked to lower rates of cardiovascular disease and mortality – EurekAlert (free) AND Dairy food in moderation ‘may protect the heart’ – The Guardian (free) AND Is Whole-Fat Dairy Good for the Heart? – New York Times (free)

Related: Meta-Analysis: Cheese consumption and risk of cardiovascular disease (link to abstract and commentaries) AND Milk and dairy consumption and risk of cardiovascular diseases and all-cause mortality (free study and commentaries)

“It is not the ultimate seal of approval for recommending whole-fat dairy over its low-fat or skimmed counterparts. Readers should be cautious, and treat this study only as yet another piece of the evidence (albeit a large one) in the literature.”

 


Statins for primary prevention of cardiovascular events and mortality in old and very old adults with and without type 2 diabetes: retrospective cohort study – The BMJ (free)

Editorial: Primary prevention with statins for older adults (free)

Commentaries: Expert reaction to study on use of statins in older people – Science Media Centre (free) AND Widespread use of statins in healthy older people to prevent heart disease not recommended in new study – BMJ, via ScienceDaily (free)

“New research does not support widespread use of statins in healthy older people to prevent heart disease and stroke. Results found that any protective effect was limited to those with type 2 diabetes aged between 75 and 84” (via @bmj_latest see Tweet)

 


Antidepressants for treating depression in dementia – Cochrane Library (free for a limited period)

Summary: Antidepressants for treating depression in dementia – Cochrane Library (free)

“On the only measure of efficacy for which we had high-quality evidence (depression rating scale scores), antidepressants showed little or no effect.”

 


Abraar Karan: Changing the way we communicate about patients – The BMJ Opinion (free) (via @NUNESDOC)

“Father of 2, retired car salesman and keen on football NOT the colon cancer in Bed 4 – social history brings humanity back to the bedside” (via @hospicedoctor see Tweet)

 


Type 2 Poliovirus Detection after Global Withdrawal of Trivalent Oral Vaccine – New England Journal of Medicine (free)

“Wild-type transmission of poliovirus is nearly halted. To eradicate poliomyelitis, cessation of vaccine-derived poliovirus transmission must also be addressed. Strategies to accomplish this are analyzed.” (via @NEJM see Tweet)

 


High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial – The Lancet (free)

Commentaries: Diagnosing myocardial infarction: a highly sensitive issue – The Lancet (free) AND Hs-TnI in Suspected ACS: High-STEACS Trial – American College of Cardiology (free) AND Is High Sensitivity Troponin Too Sensitive? – NEJM Journal Watch (free)

“Introduction of a high-sensitivity cardiac troponin I assay reclassified 1 in 6 patients with previously undetected myocardial necrosis, but did not lead to improved clinical outcomes in this large randomised trial” (via @chapdoc1 see Tweet)

“Very important study. What’s weird is that the “better” (more sensitive) troponin assays get, the less helpful the test becomes at the bedside. Look for a coming tsunami of iatrogenesis from overzealous evaluation of troponin bumps.” (via @drjohnm see Tweet)

 


ESC Council on hypertension position document on the management of hypertensive emergencies – European Heart Journal – Cardiovascular Pharmacotherapy (free) (@Abraham_RMI)

“Patients that lack acute hypertension-mediated end organ damage to the heart, retina, brain, kidneys, or large arteries do not have a hypertensive emergency and can be treated with oral BP-lowering agents and usually discharged after a brief period of observation.”

 


Optimal Blood Pressure Target in Diabetic and Nondiabetic Hypertensive Patients – Circulation Research (free)

See counterpoint suggesting lower BP targets: Sprinting Toward the Optimal Blood Pressure Target for Hypertensive Patients – Circulation Research (free)

“We have reviewed the randomized trial evidence in favor of a target blood pressure (BP) around 130/80 mm Hg in hypertensive patients with and without diabetes mellitus”

 


Guideline for the management of hip and knee osteoarthritis – Royal Australian College of General Practitioners (free PDF)

News Release: Updated osteoarthritis guideline designed to reduce unnecessary imaging and surgery (free)

Commentary: Australia hopes to reduce unnecessary imaging, surgery with updated osteoarthritis guidelines – Health Imaging (free)

““The Guideline for the management of knee and hip osteoarthritis,” offer up exercise and weight loss as a first line defense, and warn against costly treatments using glucosamine, opioids and arthroscopic surgery, said David Hunter, co-chair of the RACGP group responsible for the update.” (from Health Imaging)

 


CLARIFY: No Survival Benefit With Beta-Blockers Beyond 1 Year Post-MI in Stable CAD – TCTMD (free)

Related Study: B-Blockers and Mortality After Acute Myocardial Infarction in Patients Without Heart Failure or Ventricular Dysfunction (free study and commentary)

“The problem, said Sorbets, is that there have never been large randomized trials to test the prognostic effects of beta-blockers in this patient group and instead, recommendations have been drawn from meta-analyses using data extracted from the acute MI setting or from observational studies.”

 


Coronary CT Angiography and 5-Year Risk of Myocardial Infarction – New England Journal of Medicine (free for a limited period)

Commentary: Five Reasons I Don’t Believe an Imaging Test Improves Outcomes – by Dr. John Mandrola, in Medscape (free registration required)

See also an interesting Tweetorial by @AnilMakam, also suggesting caution before adopting this study results in clinical practice.

 


Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 – The Lancet (free)

Commentaries: No level of alcohol consumption improves health – The Lancet (free) AND No amount of alcohol is good for your overall health, global study says – CNN (free) AND New scientific study: no safe level of alcohol – Institute for Health Metrics and Evaluation (free)

“Alcohol was responsible for nearly 3 million deaths in 2016, the study says. It was the leading risk factor for disease and premature death in men and women between the ages of 15 and 49 worldwide in 2016, accounting for nearly one in 10 deaths.” (from @cnni see Tweet)

 


Extended antibiotic infusions could save lives: Here’s how to do it – PulmCCM (free)

Related Research: Mortality lower with prolonged vs. short-term IV infusion of antipseudomonal beta-lactams (free)

“The simplest (and cheapest) technique is simply to reduce the time between doses.”

 


Seven days of antibiotics were as good as 14 for gram-negative bacteremia – PulmCCM (free)

Related Commentary: Seven-day antibiotic course delivers similar outcomes to 14-days for Gram-negative bacteraemia – European Society of Clinical Microbiology and Infectious Diseases, via EurekAlert (free)

“It’s important to note that source control was believed to be achieved in all enrolled patients. If source control cannot be achieved (e.g., an abscess, or an infected heart valve or indwelling catheter that cannot safely be removed), prolonged antibiotic courses are often advisable.”

 


Association Between Electronic Cigarette Use and Myocardial Infarction – American Journal of Preventive Medicine (free for a limited period)

Commentary: Risk of heart attacks is double for daily e-cigarette users – University of California – San Francisco, via ScienceDaily (free)

“New analysis shows five-fold risk for people who use both cigarettes and e-cigarettes daily” (from ScienceDaily)

 


Screening for Atrial Fibrillation With Electrocardiography: US Preventive Services Task Force Recommendation Statement – JAMA (free)

Editorials: Screening for Atrial Fibrillation Comes With Many Snags (free for a limited period) AND Electrocardiography Screening for Atrial Fibrillation: We Can Do Better (free for a limited period)

Author Interview: USPSTF Recommendation: Screening for Atrial Fibrillation With Electrocardiography (free audio)

“The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for atrial fibrillation with ECG. (I statement)”

 


The Illness Is Bad Enough. The Hospital May Be Even Worse – The New York Times (10 articles per month are free)

Related: Post-Hospital Syndrome — An Acquired, Transient Condition of Generalized Risk – New England Journal of Medicine (free) AND Is Posthospital Syndrome a Result of Hospitalization-Induced Allostatic Overload? – Journal of Hospital Medicine (free) (via @hmkyale)

“The elderly are particularly vulnerable to “post-hospital syndrome,” some experts believe, and that may be why so many patients return.”

 


Colloids versus crystalloids for fluid resuscitation in critically ill people – Cochrane Library (link to abstract – $ for full-text)

Summary: Colloids or crystalloids for fluid replacement in critically people – Cochrane Library (free)

“Using starches, dextrans, albumin or FFP (moderate-certainty evidence), or gelatins (low-certainty evidence), versus crystalloids probably makes little or no difference to mortality. Starches probably slightly increase the need for blood transfusion and RRT (moderate-certainty evidence), and albumin or FFP may make little or no difference to the need for renal replacement therapy (low-certainty evidence)”.

 


Aspirin Plus Clopidogrel vs Aspirin Alone for Preventing Cardiovascular Events Among Patients at High Risk for Cardiovascular Events – JAMA (free for a limited period)

“Clopidogrel+ASA: Reduced risk for MI and ischemic stroke – Increased risk for major bleeding compared with aspirin alone. Combined therapy is NOT associated with lower mortality.” (via @ehlJAMA see Tweet)

 


Richard Lehman’s journal reviews, 30 July 2018 – The BMJ Opinion (free)

Richard Lehman’s final review of the latest research in the top medical journals.

 


Antidepressant Withdrawal Syndrome – Therapeutics Initiative (free)

Related Perspective: Many People Taking Antidepressants Discover They Cannot Quit – The New York Times (10 articles per month are free)

“Antidepressants should be added to the list of drugs associated with tolerance, dependence and a withdrawal syndrome.”

“Withdrawal symptoms occur in at least one-third of patients who stop.”

 


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