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RCT: No difference in ICU length of stay or 90-day mortality between tight and liberal glucose control

2 Oct, 2023 | 11:25h | UTC

Study Design and Population: This randomized controlled trial assessed the effects of tight versus liberal glucose control on the length of ICU stay in critically ill patients. A total of 9,230 patients were included, with 4,622 in the liberal-control group (insulin initiation when blood glucose levels exceeded 215 mg/dL) and 4,608 in the tight-control group (blood glucose targeted between 80 and 110 mg/dL). In both groups, parenteral nutrition was withheld during the first week of ICU admission. The primary endpoint was the duration of ICU stay, and 90-day mortality served as a key safety outcome.

Main Findings: No significant differences were observed in the primary endpoint, the length of ICU stay, between the two groups (hazard ratio 1.00; 95% CI, 0.96 to 1.04; P=0.94). The 90-day mortality rates were also similar (10.1% in the liberal-control group vs. 10.5% in the tight-control group, P=0.51). Incidences of severe hypoglycemia were low and statistically similar in both groups (1.0% in the tight-control group vs. 0.7% in the liberal-control group). Secondary outcomes, including new infections and the duration of respiratory and hemodynamic support, showed no significant differences. However, lower incidences of severe acute kidney injury and cholestatic liver dysfunction were observed in the tight-control group.

Implications & Limitations: The study supports existing evidence that tight glucose control doesn’t provide substantial benefits in reducing ICU stay duration or mortality. This suggests that a more liberal approach to glucose control may be preferable in most ICU settings, especially to minimize hypoglycemia risk. Key limitations of the study include its narrow focus on the absence of early parenteral nutrition, which could limit generalizability, and the inability to blind caregivers to treatment assignments. Future research should investigate the impact of tight glucose control in various patient subgroups and under different nutritional conditions.

Article: Tight Blood-Glucose Control without Early Parenteral Nutrition in the ICU – New England Journal of Medicine


RCT: Propafenone leads to quicker sinus rhythm restoration than amiodarone in supraventricular arrhythmias related to septic shock

1 Oct, 2023 | 15:19h | UTC

Study Design & Population: The research was a two-center, prospective, controlled parallel-group, double-blind trial involving 209 septic shock patients who had new-onset supraventricular arrhythmia and a left ventricular ejection fraction above 35%. Patients were randomized to receive either intravenous propafenone (70 mg bolus followed by 400–840 mg/24 h) or amiodarone (300 mg bolus followed by 600–1800 mg/24 h).

Main Findings: The primary outcomes focused on the proportion of patients in sinus rhythm 24 hours post-infusion, time to the first sinus rhythm restoration, and arrhythmia recurrence rates. No significant difference was observed in 24-hour sinus rhythm rates between the propafenone (72.8%) and amiodarone (67.3%) groups (p=0.4). Time to the first rhythm restoration was significantly shorter for the propafenone group (median 3.7 hours) compared to the amiodarone group (median 7.3 hours, p=0.02). Recurrence of arrhythmia was notably lower in the propafenone group (52%) than in the amiodarone group (76%, p<0.001). In the subgroup of patients with a dilated left atrium, amiodarone appeared to be more effective.

Implications & Limitations: The study suggests that while propafenone doesn’t offer better rhythm control at 24 hours compared to amiodarone, it does provide faster cardioversion and fewer arrhythmia recurrences, especially in patients with a non-dilated left atrium. No significant differences were observed in clinical outcomes, such as ICU or long-term mortality, between propafenone and amiodarone in the trial. Limitations include potential underpowering of the study and the inability to fully account for the impact of multiple covariates involved in the complex therapy of septic shock.

Article: Balik, M., Maly, M., Brozek, T. et al. Propafenone versus amiodarone for supraventricular arrhythmias in septic shock: a randomised controlled trial. Intensive Care Med (2023)


Commentary on Twitter: operations paused for the foreseeable future.

23 Aug, 2023 | 12:44h | UTC

Dear LinksMedicus Subscribers,

I regret to inform you that will be pausing operations for the foreseeable future. After 12 years and over 30.000 curated articles in all specialties, I will now focus on my clinical practice.

Best regards to all.


Euclides Cavalcanti

São Paulo, Brazil


Crossover RCT | Using one-size cuff results in major inaccuracy in BP readings across varying arm sizes

11 Aug, 2023 | 15:41h | UTC

Effects of Cuff Size on the Accuracy of Blood Pressure Readings: The Cuff(SZ) Randomized Crossover Trial – JAMA Internal Medicine (free for a limited period)


When it comes to blood pressure cuffs, size matters –

One-size-fits-all blood pressure cuffs ‘strikingly inaccurate,’ study says – CNN


Brief Review | Why is cuff size so important and other factors that affect accurate blood pressure measurement

[News release – not published yet] Study finds blood pressure cuff size matters, affects blood pressure readings


Commentary on Twitter


Perspective | Clinicians debate the usefulness of NAFLD name change

11 Aug, 2023 | 15:39h | UTC

Clinicians debate the usefulness of NAFLD name change – MDedge

Original article: From NAFLD to MASLD | New consensus changes fatty liver disease terminology to avoid stigmatization


Presented at ASRS Meeting | Studies link GLP-1 agonists to progression of diabetic retinopathy

11 Aug, 2023 | 15:38h | UTC

Studies link GLP-1 agonists to progression of diabetic retinopathy – MDedge


Study | The high financial and human cost of quality metric reporting in hospitals

11 Aug, 2023 | 15:36h | UTC

The Volume and Cost of Quality Metric Reporting – JAMA (link to abstract – $ for full-text)

Author Interview: The Costs of Quality Reporting – JAMA


The Cost of “Quality” – Emergency Medicine Literature of Note

How John Hopkins spent $5m and 108,478 hours on quality reporting in one year – HealthLeaders

The cost of quality metric reporting – Becker’s Hospital Review


Study | Uncovering the potential overuse of laboratory tests by combining cost, abnormal result proportion, and physician variation

11 Aug, 2023 | 15:34h | UTC

Data-driven approach to identifying potential laboratory overuse in general internal medicine (GIM) inpatients – BMJ Open Quality


Guideline | Closure of laparotomy in emergency settings

11 Aug, 2023 | 15:33h | UTC

ECLAPTE: Effective Closure of LAParoTomy in Emergency—2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings – World Journal of Emergency Surgery


ERS statement on protracted bacterial bronchitis in children

11 Aug, 2023 | 15:32h | UTC

ERS statement on protracted bacterial bronchitis in children – European Respiratory Journal


Perspective | AI predicted to play major role in cardiac CT and CV care in the coming decade

11 Aug, 2023 | 15:30h | UTC

AI Predicted to Play Major Role in Cardiac CT and CV Care in the Coming Decade – TCTMD


M-A | Pharmacist-led home BP telemonitoring enhances control over usual care

11 Aug, 2023 | 15:29h | UTC

Adding Pharmacist-Led Home Blood Pressure Telemonitoring to Usual Care for Blood Pressure Control: A Systematic Review and Meta-Analysis – American Journal of Cardiology


RCT | Superior PFS with avelumab vs. chemotherapy in second-line treatment for mCRC with microsatellite instability

11 Aug, 2023 | 15:25h | UTC

Avelumab vs Standard Second-Line Chemotherapy in Patients With Metastatic Colorectal Cancer and Microsatellite Instability: A Randomized Clinical Trial – JAMA Oncology

See also: Visual Abstract

Commentary: Avelumab Outperforms Standard Second-Line Therapy in dMMR/MSI Metastatic CRC – Cancer Therapy Advisor


Review | An approach to non-left main bifurcation lesions

11 Aug, 2023 | 15:22h | UTC

An Approach to Non-left Main Bifurcation Lesions: A Contemporary Review – US Cardiology Review


Commentary on Twitter


Cohort Study | Mortality risk in anti-MDA5 dermatomyositis linked to rapid ILD progression and anti-Ro52 antibody levels

11 Aug, 2023 | 15:21h | UTC

Mortality risk in patients with anti-MDA5 dermatomyositis is related to rapidly progressive interstitial lung disease and anti-Ro52 antibody – Arthritis Research & Therapy


Commentary on Twitter


Systematic Review | Poor handling of continuous predictors in clinical prediction models using logistic regression

11 Aug, 2023 | 15:19h | UTC

Poor handling of continuous predictors in clinical prediction models using logistic regression: a systematic review – Journal of Clinical Epidemiology


RCT – 2ry analysis | Aerobic exercise intervention shows potential to reduce chemotherapy-induced peripheral neuropathy

11 Aug, 2023 | 15:17h | UTC

Effect of Exercise on Chemotherapy-Induced Peripheral Neuropathy Among Patients Treated for Ovarian Cancer: A Secondary Analysis of a Randomized Clinical Trial – JAMA Network Open

See also: Visual Abstract

Commentary: Aerobic Exercise Cuts Chemotherapy-Induced Peripheral Neuropathy Symptoms – HealthDay


Commentary on Twitter


Cohort Study | Younger age at hypertrophic cardiomyopathy diagnosis, male sex among predictors of developing LV systolic dysfunction

11 Aug, 2023 | 15:16h | UTC

Left Ventricular Systolic Dysfunction in Patients Diagnosed With Hypertrophic Cardiomyopathy During Childhood: Insights From the SHaRe Registry – Circulation


Commentary on Twitter


RCT | Field sobriety tests display insufficient accuracy for detecting THC-specific driving impairment

11 Aug, 2023 | 15:14h | UTC

Evaluation of Field Sobriety Tests for Identifying Drivers Under the Influence of Cannabis: A Randomized Clinical Trial – JAMA Psychiatry

See also: Visual Abstract

News Release: Can field sobriety tests identify drivers under the influence of cannabis? – University of California – San Diego

Commentary: Trained Officers Using Current Field Sobriety Tests May Misclassify Cannabis-Impaired Drivers – Psychiatric News Alert


Commentary on Twitter


Cohort Study | U-shaped relationship between BMI and mortality in heart failure patients

11 Aug, 2023 | 15:12h | UTC

Body mass index and survival in people with heart failure – Heart


Commentary on Twitter


Survival ≠ Recovery | A narrative review of post-intensive care syndrome

11 Aug, 2023 | 15:11h | UTC

Survival ≠ Recovery: A Narrative Review of Post-Intensive Care Syndrome – CHEST Critical Care


Review | Primary ciliary dyskinesia

11 Aug, 2023 | 15:10h | UTC

Primary Ciliary Dyskinesia – CHEST Pulmonary


RCT | Restrictive vs. liberal red blood cell transfusion strategy for critically injured patients

11 Aug, 2023 | 15:08h | UTC

The Restrictive Red Blood Cell Transfusion Strategy for Critically Injured Patients (RESTRIC) trial: a cluster-randomized, crossover, non-inferiority multicenter trial of restrictive transfusion in trauma – Journal of Intensive Care


[News Release] RCT | Semaglutide 2.4 mg reduces cardiovascular risk by 20% in adults with CVD & obesity

9 Aug, 2023 | 15:40h | UTC

Novo Nordisk A/S: Semaglutide 2.4 mg reduces the risk of major adverse cardiovascular events by 20% in adults with overweight or obesity in the SELECT trial – Novo Nordisk


SELECT: Semaglutide Cuts CV Events in Adults With Overweight or Obesity – TCTMD

Expert reaction to Novo Nordisk press release announcing the headline results from their SELECT cardiovascular outcomes semaglutide trial – Science Media Centre

Related: Role of Glucagon‐Like Peptide‐1 Receptor Agonists in Achieving Weight Loss and Improving Cardiovascular Outcomes in People With Overweight and Obesity – Journal of the American Heart Association


Perspective | Creation and adoption of large language models in medicine

9 Aug, 2023 | 15:38h | UTC

Creation and Adoption of Large Language Models in Medicine – JAMA (free for a limited period)

Commentary: Rethinking large language models in medicine – Stanford Medicine


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