Daily Archives: February 24, 2023
Cluster RCT | Effect of an antibiotic stewardship intervention to improve antibiotic prescribing for suspected UTI in older adults
24 Feb, 2023 | 13:58h | UTCSummary: The study evaluated the effectiveness of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections (UTI) in frail older adults. The study was a pragmatic, parallel, cluster-randomized controlled trial conducted in four European countries and included 1041 frail older adults aged 70 or older. The intervention involved a decision tool for appropriate antibiotic use, supported by a toolbox with educational materials. The control group provided care as usual. The primary outcome was the number of antibiotic prescriptions for suspected UTI per person year, and secondary outcomes included incidence of complications, hospital referrals, admissions, and mortality. The results showed that the intervention group had a lower rate of receiving an antibiotic prescription for a suspected UTI (0.27 per person year) compared to the control group (0.58 per person year), with no increase in complications or adverse events.
Commentary: Trial: Stewardship intervention cuts antibiotic prescribing for suspected urinary infections – CIDRAP
Related:
Case-Control Study | Current pyuria cut-offs may promote inappropriate UTI diagnosis in older women
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
[Not published yet] M-A | Too little sodium can be harmful to heart failure patients
24 Feb, 2023 | 13:59h | UTCSummary: New research presented at the American College of Cardiology’s annual scientific session suggests that heart failure patients restricting their dietary sodium intake to levels below the standard recommended maximum of 2.3 grams per day do not have additional benefits and may be at increased risk of death. The study analyzed nine randomized controlled trials that assessed different levels of sodium restriction and found that patients following a diet with a sodium intake target below 2.5 grams per day were 80% more likely to die than those following a diet with a target of 2.5 grams per day or more. The researchers recommend establishing a safe level of sodium consumption instead of overly restricting sodium.
News release: Too Little Sodium Can be Harmful to Heart Failure Patients – American College of Cardiology
Review | Glioblastoma and other primary brain malignancies in adults
24 Feb, 2023 | 13:54h | UTCArticle: Glioblastoma and Other Primary Brain Malignancies in Adults: A Review – JAMA (free for a limited period)
Audio clinical review: Glioblastoma and Other Primary Brain Malignancies in Adults – JAMA
Commentary on Twitter
Review summarizes current evidence regarding diagnosis and treatment of primary malignant brain tumors in adults. https://t.co/pNKio61bN5
— JAMA (@JAMA_current) February 21, 2023
RCT | Aspirin discontinuation at 24 to 28 weeks’ gestation in pregnancies at high risk of preterm preeclampsia
24 Feb, 2023 | 13:56h | UTCArticle: Aspirin Discontinuation at 24 to 28 Weeks’ Gestation in Pregnancies at High Risk of Preterm Preeclampsia: A Randomized Clinical Trial – JAMA (free for a limited period)
Editorial: Biomarkers and the Risk of Preeclampsia – JAMA (free for a limited period)
Commentary on Twitter
Aspirin discontinuation at 24 to 28 weeks of gestation was noninferior to aspirin continuation for preventing preterm preeclampsia in pregnant individuals at high risk of preeclampsia and a normal sFlt-1:PlGF ratio. https://t.co/6yIBsfxwU5 pic.twitter.com/RGqQLvb20l
— JAMA (@JAMA_current) February 21, 2023
Guideline | Diagnosis and treatment of Helicobacter pylori
24 Feb, 2023 | 13:53h | UTCRelated:
Consensus Statement | Standardized imaging and reporting for thyroid ultrasound
24 Feb, 2023 | 13:52h | UTCRelated: ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee
Consensus Paper | Early management of isolated severe traumatic brain injury in a hospital without neurosurgical capabilities
24 Feb, 2023 | 13:49h | UTC
Commentary from the author on Twitter
Great to see our consensus published. Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES).https://t.co/k9hwI82dOW pic.twitter.com/pIp5gFRnPa
— Deepak Sharma (@deepak_neuro) January 14, 2023
M-A | Efficacy of elimination diets in eosinophilic esophagitis
24 Feb, 2023 | 13:47h | UTCSummary: This systematic review and meta-analysis evaluated the effectiveness of various dietary treatment regimens for eosinophilic esophagitis (EoE). After analyzing 34 studies with 1762 patients, it was concluded that dietary therapy is a viable and efficacious option for individuals with EoE of all ages, with an overall histological remission rate of 53.8% and a clinical response rate of 80.8%. The study also found that highly restrictive dietary regimes, such as a six-food elimination diet, may not be superior to less restrictive dietary regimens, such as a four-food elimination diet or one-food elimination diet, in achieving histological remission, supporting less restrictive dietary regimens as a treatment option. The study has several limitations, such as the observational nature of most studies included.
Commentary: Elimination diets effective for patients with eosinophilic esophagitis – ACP Gastroenterology
Commentary on Twitter
Efficacy of dietary therapy in eosinophilic esophagitis for (1) histologic remission & (2) clinical response
6⃣-food elimination diet: 61%, 93%
4⃣-food elimination diet: 49%, 74%
1⃣-food elimination diet: 51%, 87%
Targeted elimination diet: 46%, 69%#EoEhttps://t.co/VKXgCQO9O6 pic.twitter.com/KfpSburuwN— John Damianos, M.D. (@john_damianosMD) February 1, 2023
Article under a Creative Commons Attribution (CC BY 4.0) license
RCT | Electroacupuncture may improve opioid-induced constipation in patients with cancer
24 Feb, 2023 | 13:46h | UTCSummary: The study was a randomized clinical trial that evaluated the efficacy and safety of electroacupuncture (EA) for opioid-induced constipation (OIC) in adult patients with cancer pain. The trial included 100 patients with cancer and OIC who were randomly assigned to receive either EA or sham electroacupuncture (SA) for 24 sessions over 8 weeks. The study found that the proportion of overall responders was greater with EA (40,1%) than with SA (9,0%) at week 8, suggesting that EA treatment could be a safe and effective alternative for managing OIC in adult cancer patients. However, the trial’s limitations, such as the wide heterogeneity of cancer patients, the self-reported diary measurements, and the inability to blind acupuncturists, should be considered. Additionally, it’s worth noting that more patients in the EA group guessed that they received actual EA treatment compared to those who received SA (46 vs 22 patients).
Commentary on Twitter
RCT: Electroacupuncture (EA) could alleviate opioid-induced constipation in adult cancer patients with a good safety profile. EA may be considered as an alternative treatment for opioid-induced constipation. https://t.co/zywl2A14ij pic.twitter.com/9RhSVaZVSJ
— JAMA Network Open (@JAMANetworkOpen) February 22, 2023
SR | Antenatal dietary supplementation with myo‐inositol for preventing gestational diabetes
24 Feb, 2023 | 13:45h | UTCSummary: The article discusses the effectiveness of myo-inositol, a naturally occurring sugar, as a dietary supplement for preventing gestational diabetes in pregnant women. The review included seven randomized controlled trials, with a total of 1319 women who were 10 to 24 weeks pregnant at the start of the studies. The results showed that myo-inositol may reduce the incidence of gestational diabetes, hypertensive disorders of pregnancy, and preterm birth, but there was limited data on other outcomes, such as perinatal mortality and serious infant morbidity. The certainty of the evidence was low to very low due to small sample sizes, inconsistency in doses and timing of administration, and lack of data from diverse populations. The authors suggest that further well-designed studies are needed to assess the effectiveness of myo-inositol in preventing gestational diabetes and improving other health outcomes for mothers and their babies.
Cohort Study | Association of large-for-gestational age birth and prediabetes/diabetes 10-14 years’ postpartum
24 Feb, 2023 | 13:43h | UTCSummary: Several studies show that women who develop diabetes during pregnancy are at increased risk of developing diabetes later in life. This study investigated whether giving birth to a larger-than-normal baby is associated with an increased risk of prediabetes or diabetes 10-14 years after pregnancy in individuals without gestational diabetes. The study used data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Follow-up Study, including pregnant individuals without gestational diabetes. After adjusting for various baseline maternal characteristics, the researchers found that individuals who gave birth to a large-for-gestational age (LGA) infant had a 21% higher risk of being diagnosed with prediabetes or diabetes 10-14 years after delivery compared to those who had an appropriate-for-gestational age (AGA) infant. The study concluded that having a previous LGA infant is a marker of increased risk of developing prediabetes or diabetes in individuals without gestational diabetes.
Abstract: Association of large-for-gestational age birth and prediabetes/diabetes 10-14 years’ postpartum in the HAPO follow-up study – American Journal of Obstetrics & Gynecology (link to abstract, presented at the Society for Maternal-Fetal Medicine’s annual meeting)
Commentaries:
Delivering a Plus-Sized Baby Could Be Sign of Diabetes Risk – HealthDay
Large for Gestational Age Births Could Increase Diabetes Risk in Women – HCP Live
Cohort Study | Heavy coffee intake is associated with kidney disfunction in genetically predisposed individuals
24 Feb, 2023 | 13:42h | UTCSummary: The study investigated whether a person’s genetic variation in the enzyme that metabolizes caffeine, called CYP1A2, modifies the association between coffee intake and kidney dysfunction. The study was conducted on 1180 participants with stage 1 hypertension. Data were collected from April 1, 1990, to June 30, 2006, with a follow-up of approximately 10 years. The study found that consuming more than three cups of coffee per day was associated with increased risks of albuminuria, hyperfiltration, and hypertension only among slow metabolizers of caffeine. The findings suggest that caffeine may play a role in the development of kidney disease in genetically susceptible individuals, but further studies are required to confirm these findings.
Article: CYP1A2 Genetic Variation, Coffee Intake, and Kidney Dysfunction – JAMA Network Open
Commentaries:
Drinking 3 or more cups of coffee daily may increase kidney dysfunction risk – Medical News Today
SR | Tranexamic acid for the reduction of bleeding during functional endoscopic sinus surgery
24 Feb, 2023 | 13:39h | UTC
M-A | Pregnancy outcomes in Takayasu arteritis patients
24 Feb, 2023 | 13:40h | UTCSummary: The systematic review and meta-analysis examined the data from 27 studies with 825 pregnancies and found that pregnant women with Takayasu arteritis (TA) are at higher risk for adverse pregnancy outcomes; 37% developed hypertension, 14% developed pre-eclampsia, and the occurrence of miscarriage was 16%. High disease activity during pregnancy, renal artery involvement, and history of hypertension were identified as risk factors, while maternal age or prolonged disease duration did not pose a risk. The most common treatments were corticosteroids, anti-hypertensive agents, low-dose aspirin, and azathioprine. The study was limited by the heterogeneity of the included studies and the lack of large-scale prospective case-control studies, indicating the need for further research.
Review | Young-onset dementia diagnosis, management and care
24 Feb, 2023 | 13:37h | UTC
Review | Management of gastrointestinal foreign bodies with brief review of the guidelines
24 Feb, 2023 | 13:36h | UTC
Review | Contact lens–associated keratitis — An often underestimated risk
24 Feb, 2023 | 13:33h | UTCContact Lens–Associated Keratitis— an Often Underestimated Risk – Deutsches Ärzteblatt international
M-A | Association of brain metastases with survival in patients with limited or stable extracranial disease
24 Feb, 2023 | 13:34h | UTC
Injurious falls before, during and after dementia diagnosis: a population-based study
24 Feb, 2023 | 13:31h | UTC
Living health technology assessments: how close to living reality
24 Feb, 2023 | 13:32h | UTCLiving health technology assessments: how close to living reality – BMJ Evidence-Based Medicine
M-A | Adjuvant chemotherapy for resected triple negative breast cancer patients
24 Feb, 2023 | 13:30h | UTC
Registry of the international society of uterus transplantation: first report
24 Feb, 2023 | 13:29h | UTCRegistry of the International Society of Uterus Transplantation: First Report – Transplantation
SR | The impact of Antimicrobial Stewardship Programs in pediatric emergency departments and primary care
24 Feb, 2023 | 13:20h | UTC
Review | When and how to use MIC in clinical practice?
24 Feb, 2023 | 13:28h | UTCWhen and How to Use MIC in Clinical Practice? – Antibiotics
Commentary on Twitter
https://twitter.com/ABsteward/status/1616852667124400129