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Neurology

First Dementia Global Monitoring System Launched: Global Dementia Observatory (free resources)

News release: Dementia: number of people affected to triple in next 30 years – World Health Organization (free)

 


Clinical Management of Insomnia Disorder – JAMA (free)

“Cognitive Behavior Therapy for insomnia is recommended as 1st-line Tx; pharmacotherapy, if used, should be on a short-term basis” (RT @JAMAInternalMed see Tweet)

 


Increasing prevalence of vascular risk factors in patients with stroke – Neurology (link to abstract – $ for full-text)

Commentary: Health Conditions That Increase Stroke Risk Rise Across All Ages, Races – NPR (free)

“An estimated 80% of all 1st strokes are due to risk factors that can be changed,” says new study (RT @ACCmediacenter see Tweet)

 


Relationship of Sleep Duration With All‐Cause Mortality and Cardiovascular Events: A Systematic Review and Dose‐Response Meta‐Analysis of Prospective Cohort Studies – Journal of The American Heart Association (free)

“Our findings indicate that both short and long sleep duration is associated with an increased risk of all‐cause mortality and cardiovascular events”.

 


Antipsychotic Use With and Without Comorbid Psychiatric Diagnosis Among Adults with Intellectual and Developmental Disabilities – The Canadian Journal of Psychiatry (link to abstract – $ for full-text)

Commentaries: Antipsychotics common for adults with intellectual and developmental disabilities – Centre for Addiction and Mental Health (free) AND Antipsychotics Overused in Intellectually Disabled Adults – Medscape (free registration required)

“Antipsychotics are used inappropriately particularly in vulnerable groups: Poor children; Intellectually challenged; Autistic; Nursing homes. (RT @AllenFrancesMD see Tweet)

 


Individualised prediction model of seizure recurrence and long-term outcomes after withdrawal of antiepileptic drugs in seizure-free patients: a systematic review and individual participant data meta-analysis – The Lancet Neurology (link to abstract – $ for full-text)

Commentary: Model Predicts Outcomes After AED Withdrawal – Neurology Reviews (free registration required)

Source: Journal Watch ($ resource to find articles of interest)

“A meta-analysis allows researchers to identify predictors of seizure recurrence and long-term seizure outcomes” (from Neurology Reviews).

 


Headache and migraine: interventions for preventing or treating headache and migraine – Cochrane Library (free) (RT @CochraneUK see Tweet)

Migraine awareness week (3-9 September). Latest Cochrane Evidence on interventions for preventing or treating headache and migraine.

 


Physical Activity Frequency and the Risk of Stroke: A Nationwide Cohort Study in Korea – Journal of The American Heart Association (free)

“Even 1 to 2 times a week of moderate‐ to vigorous‐intensity physical activity might be beneficial to prevent a first‐ever stroke in the general population… from a public health perspective, we need to encourage inactive people to start exercising with more‐achievable goals”.

 


Head injuries in sport must be taken more seriously – Nature News (free)

“Sports organizations are only starting to understand the harm that can be inflicted by high-contact activities. Science must play its part in highlighting the problem and in aiding diagnosis”.

 


Association of Sleep-Disordered Breathing With Cognitive Function and Risk of Cognitive Impairment: A Systematic Review Meta-analysis – JAMA Neurology (link to abstract – $ for full-text)

Commentaries: Breathing Disorders During Sleep Tied to Cognitive Issues – MedPage Today (free registration required) AND Sleep-Disordered Breathing Raises Risk for Cognitive Decline – Medscape (free registration required)

This meta-analysis of observational studies suggests a possible association. Further studies are needed to examine whether the treatment of this condition can help in the prevention of dementia and in improvement of cognition.

 


Long-Term Effects of Repeated Injections of Local Anesthetic With or Without Corticosteroid for Lumbar Spinal Stenosis: A Randomized Trial – Archives of Physical Medicine and Rehabilitation (free)

Source: ACP Journal Wise ($)

“Epidural injections of corticosteroid plus lidocaine offered no benefits from 6 weeks to 12 months beyond that of injections of lidocaine alone”

 



Risk of Stroke With Various Types of Menopausal Hormone Therapies: A National Cohort Study – Stroke (link to abstract – $ for full-text)

Source: EvidenceAlerts

This large cohort confirms an increased stroke risk with oral hormone therapies, but suggests no increased risk of stroke with transdermal or vaginal estrogen application.

 


Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis in Stroke Patients: A Meta-Analysis – Stroke (link to abstract – $ for full-text)

Commentary: Better outcomes seen in patients who received IV thrombolysis before thrombectomy – ACP Hospitalist (free)

“The results support current guideline recommendations to give intravenous thrombolysis to eligible patients even if they are being considered for mechanical thrombectomy, according to the meta-analysis authors” (from ACP)

 


What do hypnotics cost hospitals and healthcare? – F1000 Research (free)

Source: Hospital Medicine Virtual Journal Club

“A best estimate is that U.S. costs of hypnotic harms to healthcare systems are on the order of $55 billion, but conceivably might be as low as $10 billion or as high as $100 billion”.

 


Have Smartphones Destroyed a Generation? – The Atlantic (free)

Long read… very interesting.

 


Mechanical clot removal for stroke reduces disability at two years – NIHR Signal (free)

“Mechanical thrombectomy within six hours of stroke onset provides a sustained reduction of disability for patients” (RT @NIHR_DC see Tweet)

 


Prescribing regular drugs to prevent febrile convulsions risks more harm than benefit – NIHR Signal (free)

Original article: Prophylactic drug management for febrile seizures in children – Cochrane Library (link to summary – $ for full-text)

“Benefits of anti-epileptic medication for children who’ve had a convulsion while feverish, do not outweigh harms” (RT @NIHR_DC see Tweet)

 


Association of History of Dizziness and Long-term Adverse Outcomes With Early vs Later Orthostatic Hypotension Assessment Times in Middle-aged Adults – JAMA Internal Medicine (free)

Invited commentary: Early Orthostatic Hypotension and Orthostatic Intolerance—More Than an Observation or Annoyance (free)

Practice Changing – Orthostatic hypotension within 1 min of standing (rather than at 3 minutes) has greater relation to falls, fracture, syncope, motor vehicle crash, and mortality.

 


Association of History of Dizziness and Long-term Adverse Outcomes With Early vs Later Orthostatic Hypotension Assessment Times in Middle-aged Adults – JAMA Internal Medicine (free)

Invited commentary: Early Orthostatic Hypotension and Orthostatic Intolerance—More Than an Observation or Annoyance (free)

Practice Changing – Orthostatic hypotension within 1 min of standing (rather than at 3 minutes) has greater relation to falls, fracture, syncope, motor vehicle crash, and mortality.

 


Is cyclobenzaprine useful for pain? – Therapeutics Initiative (free)

“…cyclobenzaprine is a long-acting sedative, not a muscle relaxant, and questioning whether any potential benefits are worth the side effects”. (from TI Newsletter). “If prescribed, a dose of 5 mg at bedtime should be tried first.  Evidence suggests titration based on response and tolerability to a maximum dose of 15 mg/day, for no longer than one week”.

 


Amyloid PET a ‘Game Changer’ for MCI Diagnosis – Medscape (free registration required)

Coverage from the Alzheimer’s Association International Conference (AAIC) 2017

 


Effectiveness of Lateral Decubitus Position for Preventing Post-Dural Puncture Headache: A Meta-Analysis – Pain Physician (free PDF)

Source: Hospital Medicine Virtual Journal Club (free resource to find articles of interest)

Evidence suggests lateral decubitus position is associated with reduced incidence of post-dural puncture headache.

 


Viewpoint: The Evolving Story of Overlapping Surgery – JAMA (free) (RT @pash22 see Tweet)

Commentary: 3 steps to restore patient trust in overlapping surgeries – FierceHealthcare (free)

This interesting viewpoint discusses the practice of scheduling overlapping surgeries, in which a qualified practitioner finishes noncritical parts of the first operation while the primary surgeon moves to the next surgery.

 


Antiplatelet Regimen for Patients With Breakthrough Strokes While on Aspirin: A Systematic Review and Meta-Analysis – Stroke (link to abstract – $ for full-text)

Commentary: Adjusting Antiplatelet Regimen Could Decrease Risk For Stroke Patients on Aspirin Monotherapy – American College of Cardiology, Latest in Cardiology (free)

Meta-analysis of cohort studies: in patients who experienced an ischemic stroke or transient ischemic attack while on aspirin monotherapy, the addition of or a switch to another antiplatelet agent, versus aspirin monotherapy, was associated with a 32 percent reduction in the risk of major adverse cardiovascular events (HR 0.68; 0.54–0.85) and 30 percent reduction in recurrent strokes (HR, 0.70; 0.54–0.92). Additional randomized trials would better clarify the best antiplatet regimen for these patients.

 


Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke – European Heart Journal (link to abstract – $ for full-text)

Commentary: Blood Pressure and Outcomes After Ischemic Stroke – American College of Cardiology, Latest in Cardiology (free)

Related article: Editorial: Blood Pressure in Acute Stroke Still No Answer for Management – Stroke (free PDF)

Observational analysis of over 300.000 patients suggests a J-shaped, or U-shaped relationships between BP and outcomes (both lower and higher BP levels detrimental). Among patients submitted to thrombolytic therapy, there were fewer complications with lower blood pressure.

 


Effect of Antidepressant Switching vs Augmentation on Remission Among Patients With Major Depressive Disorder Unresponsive to Antidepressant Treatment: The VAST-D Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)

Commentaries: Study Compares Switching Meds vs an Additional Med for Patients Unresponsive to an Antidepressant – The Jama Network (free) AND For Treatment-Resistant Depression, Add an Antipsychotic or Switch Antidepressants? – Physician’s First Watch (free)

Augmentation with aripiprazole led to a modestly increased likelihood of remission, but with more adverse effects. “Given the small effect size and adverse effects associated with aripiprazole, further analysis including cost-effectiveness is needed to understand the net utility of this approach”.

 


Association of Positive Airway Pressure With Cardiovascular Events and Death in Adults With Sleep Apnea: A Systematic Review and Meta-analysis – JAMA (link to abstract – $ for full-text)

Commentaries: More Doubt Cast on CPAP for Reducing CVD Risk in Sleep Apnea Patients – MedPage Today (free registration required) AND Positive airway pressure doesn’t reduce heart risk with sleep apnea – Reuters (free)

“PAP for obstructive sleep apnea improves quality of life but not CV events or BP with up to 5 years of follow up” (RT @AnilMakam see Tweet)

 


Cochrane Review: Gabapentin for chronic neuropathic pain in adults – Cochrane Library (link to abstract – $ for full-text)

Commentary: Analgesic Effects of Gabapentin Assessed in Chronic Neuropathic Pain – MPR (free)

“Gabapentin at doses of 1800 mg to 3600 mg daily (1200 mg to 3600 mg gabapentin encarbil) can provide good levels of pain relief to some people with postherpetic neuralgia and peripheral diabetic neuropathy”.

 


Rivastigmine reviewed: doubts about dementia drug – Evidently Cochrane (free)

Related review: Rivastigmine for people with Alzheimer’s disease – Cochrane Library (link to abstract – $ for full-text)

“”Sadly, “small” and “of uncertain clinical importance” are the words chosen by the Cochrane reviewers to describe…” (RT @CochraneUK see Tweet)

 


Quality of Life in Dementia – The AMA Journal of Ethics (free)

“What can clinicians do to normalize the experience of dementia? Our new issue explores the ethics of dementia care” (RT @JournalofEthics see Tweet)

 



Brain-Invading Tapeworm That Eluded Doctors Spotted by New DNA Test – Scientific American (free)

“Genetic sequencing of spinal fluid hailed as an advance over standard procedures for diagnosing brain infections”

 


Spasticity Drug Cuts Alcohol Consumption in High-Risk Drinkers – Medscape (free registration required)

Unpublished results, presented at the 13th World Congress of Biological Psychiatry, suggesting baclofen is an effective alternative for high-risk alcohol consumption.

 


Performance Improvement: Phenytoin Toxicity – JAMA (free)

Interesting case of medication error and prevention of subsequent adverse events (RT @JAMA_current see Tweet)

 


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