Daily Archives: March 13, 2023
CDC recommends HBV screening at least once in a lifetime for all adults aged ≥18 years
13 Mar, 2023 | 15:14h | UTCSummary: The Centers for Disease Control and Prevention (CDC) has issued new recommendations for screening and testing for hepatitis B virus (HBV) infection in the US.
The recommendations include screening for HBV infection at least once in a lifetime for adults aged ≥18 years and more frequent testing for persons at increased risk for HBV infection. The risk groups include:
- Persons incarcerated or formerly incarcerated in jail, prison, or other detention settings.
- Persons with a history of sexually transmitted infections or multiple sex partners.
- Persons with a history of hepatitis C virus infection.
The CDC recommends using the triple panel (HBsAg, anti-HBs, and total anti-HBc) for initial screening to help identify persons who have an active HBV infection, have resolved infection and might be susceptible to reactivation, are susceptible and need vaccination, or are vaccinated.
Commentaries:
Universal Adult Hepatitis B Screening and Vaccination as the Path to Elimination – JAMA
CDC recommends hepatitis B screening for all adults – CIDRAP
CDC Recommends Universal Screening for Hepatitis B Virus – HCP Live
Commentary on Twitter
CDC recommends that all adults get tested for #HepatitisB at least once in their life. Ask your doctor if you’ve been tested. Learn more: https://t.co/kLBZyQYZtQ @CDCMMWR pic.twitter.com/EBkQ9s4MsQ
— CDC (@CDCgov) March 9, 2023
RCT | Localized prostate cancer treatment options have similar 15-year survival outcomes
13 Mar, 2023 | 15:12h | UTCSummary: The study followed 1643 men diagnosed with localized prostate cancer (diagnosed by screening with PSA) in the United Kingdom between 1999 and 2009 who were randomly assigned to receive active monitoring, prostatectomy, or radiotherapy.
After a median follow-up of 15 years, the study found that while prostatectomy and radiotherapy decreased metastasis, local progression, and the need for long-term androgen deprivation therapy, death from prostate cancer was low regardless of the treatment assigned, with 17 deaths (3.1%) in the active-monitoring group, 12 deaths (2.2%) in the prostatectomy group, and 16 (2.9%) deaths in the radiotherapy group (P=0.53). Additionally, the study found that overall deaths were similar between the groups.
The authors suggest that the choice of therapy for localized prostate cancer involves weighing the benefits and harms associated with each treatment option.
Article: Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer – New England Journal of Medicine (link to abstract – $ for full-text)
News Release: Delaying treatment for localised prostate cancer does not increase mortality risk, trial shows – University of Bristol
Commentary on Twitter
Presented at #EAU23: In men with prostate cancer on PSA screening, radical treatments led to half the incidence of metastasis and local progression as active monitoring without affecting disease-specific or overall survival (ProtecT trial) https://t.co/G2ABkMkyJg #oncology pic.twitter.com/s2Va08Fpxj
— NEJM (@NEJM) March 11, 2023
RCT | Immediate complete revascularization non-inferior to staged approach in ACS patients with multivessel disease
13 Mar, 2023 | 15:10h | UTCSummary: Patients with an acute coronary syndrome and multivessel disease not presenting with cardiogenic shock usually benefit from complete revascularization by percutaneous coronary intervention (PCI). Complete revascularization involves treating all significant blockages in the coronary arteries, including those not causing symptoms (non-culprit lesions).
The BIOVASC randomized non-inferiority trial investigated whether patients with acute coronary syndrome and multivessel coronary disease should undergo immediate complete revascularization during the index procedure or undergo a staged approach with PCI of the culprit lesion only during the index procedure followed by another procedure within 6 weeks of all non-culprit lesions deemed to be clinically significant. The exclusion criteria were:
- Previous coronary artery bypass surgery.
- Cardiogenic shock.
- Single-vessel coronary disease.
- The presence of a chronic coronary total occlusion.
A total of 1525 patients with acute coronary syndrome and multivessel coronary disease were randomly assigned to either an immediate complete revascularization group (764 patients) or a staged complete revascularization group (761 patients). The primary outcome was a composite of all-cause mortality, myocardial infarction, unplanned ischemia-driven revascularization, or cerebrovascular events at 1 year after the index procedure. The study found that immediate complete revascularization was non-inferior to staged complete revascularization for the primary outcome.
Article: Immediate versus staged complete revascularisation in patients presenting with acute coronary syndrome and multivessel coronary disease (BIOVASC): a prospective, open-label, non-inferiority, randomised trial – The Lancet (free registration required)
Commentaries:
Revascularisation in acute coronary syndromes: change in practice? – The Lancet (free registration required)
No Downside to Immediate Complete Revascularization in ACS: BIOVASC – TCTMD
Immediate Complete Revascularization Non-Inferior to Staged Procedure in BIOVASC Trial – HCP Live
Related:
One-Year Outcomes after PCI Strategies in Cardiogenic Shock – New England Journal of Medicine
Review | Commonly missed findings on chest radiographs: causes and consequences
13 Mar, 2023 | 15:07h | UTCCommonly Missed Findings on Chest Radiographs: Causes and Consequences – CHEST (free for a limited period)
See also: Reducing Errors Resulting From Commonly Missed Chest Radiography Findings – CHEST (free for a limited period)
Review | Reducing errors resulting from commonly missed chest radiography findings
13 Mar, 2023 | 15:06h | UTCReducing Errors Resulting From Commonly Missed Chest Radiography Findings – CHEST (free for a limited period)
See also: Commonly Missed Findings on Chest Radiographs: Causes and Consequences – CHEST (free for a limited period)
M-A | Routine anaerobic coverage for aspiration pneumonia: limited evidence of benefit
13 Mar, 2023 | 15:03h | UTCSummary: Treating aspiration pneumonia with antibiotics that cover anaerobic bacteria has become common practice in many services, but recent studies suggest that this may not necessarily improve prognosis.
Out of 2523 publications, this systematic review and meta-analysis only included one randomized control trial and two observational studies. The study found no clear benefit of anaerobic coverage and concluded that there is not enough data to evaluate the necessity of anaerobic coverage in the antibiotic treatment of aspiration pneumonia.
The authors suggest that covering anaerobic bacteria with antibiotics may not be needed as an initial treatment for aspiration pneumonia if there is no formation of abscess or empyema and the patient has good oral hygiene.
Related: BTS clinical statement on aspiration pneumonia – Thorax
Brief Review | How we escalate vasopressor and corticosteroid therapy in patients with septic shock
13 Mar, 2023 | 15:04h | UTCHow We Escalate Vasopressor and Corticosteroid Therapy in Patients With Septic Shock – CHEST (free for a limited period)
M-A | Strength of association between comorbidities and asthma
13 Mar, 2023 | 15:01h | UTCSummary: The study investigated the strength of association between comorbidities and asthma, as the presence of comorbidities is related to poor asthma outcomes. A comprehensive literature search was conducted for observational studies reporting data on comorbidities in asthma and nonasthma populations.
A total of 5,493,776 subjects were analyzed, and several comorbidities were found to be strongly or very strongly associated with asthma and severe asthma, including allergic conjunctivitis, allergic rhinitis, bronchiectasis, hypertensive cardiomyopathy, nasal congestion, COPD, and other chronic respiratory diseases.
The study supports the relevance of individualized strategies for disease management that look beyond asthma and suggests a comprehensive approach should be used to assess whether poor symptom control is related to uncontrolled asthma or other underlying comorbidities.
M-A | Age, tracheal intubation time, tracheostomy, and APACHE II score are risk factors for post-extubation dysphagia in ICU patients
13 Mar, 2023 | 14:59h | UTCSummary: Post-extubation dysphagia is a common complication in ICU patients who have undergone intubation and mechanical ventilation, leading to a risk of aspiration and pneumonia.
The review included 15 studies involving 50,669 patients and found that: 1 – age; 2 – duration of tracheal intubation; 3 – tracheostomy; and 4 – APACHE II score were significant risk factors for post-extubation dysphagia.
By identifying these risk factors, clinicians can better identify patients at risk of developing dysphagia after extubation and take measures to prevent and manage the condition.
Article: Risk factors for post-extubation dysphagia in ICU: A systematic review and meta-analysis – Medicine
ISCCM Guidelines | Hemodynamic monitoring in the critically ill
13 Mar, 2023 | 14:58h | UTC
ISCCM Guidelines for the use of procalcitonin for rational use of antibiotics
13 Mar, 2023 | 14:57h | UTC
ISCCM Guidelines on acute kidney injury and renal replacement therapy
13 Mar, 2023 | 14:55h | UTC
ISCCM Consensus Statement | Prevention of venous thromboembolism in the critical care unit
13 Mar, 2023 | 14:53h | UTC
ISCCM Consensus Recommendations | Competencies for point-of-care ultrasonography in ICU
13 Mar, 2023 | 14:51h | UTC
ISCCM Position Statement | Recommendations for evaluation and selection of deceased organ donor
13 Mar, 2023 | 14:50h | UTC
RCT | Induction therapy with olamkicept vs. placebo in patients with active ulcerative colitis
13 Mar, 2023 | 14:48h | UTCEffect of Induction Therapy With Olamkicept vs Placebo on Clinical Response in Patients With Active Ulcerative Colitis: A Randomized Clinical Trial – JAMA (free for a limited period)
Commentary on Twitter
Among patients with active ulcerative colitis, biweekly infusion of olamkicept 600 mg, but not 300 mg, resulted in a greater likelihood of clinical response at 12 weeks compared with placebo. https://t.co/I9h3jTZxlL pic.twitter.com/hgMvFhdzDa
— JAMA (@JAMA_current) March 8, 2023
Decrease in hospitalizations and liver failure after FDA mandate limiting paracetamol dosage in prescription opioid combinations.
13 Mar, 2023 | 14:45h | UTCAssociation of FDA Mandate Limiting Acetaminophen (Paracetamol) in Prescription Combination Opioid Products and Subsequent Hospitalizations and Acute Liver Failure – JAMA (free for a limited period)
Editorial: Moving the Needle to Reduce Acetaminophen (Paracetamol) Hepatotoxicity – JAMA (free for a limited period)
Author Interview: Limiting Acetaminophen in Prescription Combination Opioid Products – JAMA
Video Summary: Acetaminophen (Paracetamol) and Acute Liver Failure – JAMA
Commentary on Twitter
The @US_FDA mandate to limit acetaminophen to 325 mg/tablet in prescription combination acetaminophen and opioid medications was associated with a decline in hospitalizations involving acetaminophen and opioid toxicity. https://t.co/6tdqFAI4hG
— JAMA (@JAMA_current) March 7, 2023
DNA sequencing may identify an increased risk of relapse in adults with AML prior to hematopoietic cell transplantation
13 Mar, 2023 | 14:47h | UTCDNA Sequencing to Detect Residual Disease in Adults With Acute Myeloid Leukemia Prior to Hematopoietic Cell Transplant – JAMA (free for a limited period)
Commentary on Twitter
Among patients w AML in first remission prior to allogeneic hematopoietic cell transplant, the persistence of residual variants in the blood at an allele fraction ≥0.01% was assoc'd w increased relapse & worse survival vs those w/o these variants. https://t.co/KCnaQ1NRXJ
— JAMA (@JAMA_current) March 11, 2023
RCT | Sulfadoxine-pyrimethamine vs. dihydroartemisinin-piperaquine for preventive treatment of malaria in pregnant women in Africa
13 Mar, 2023 | 14:43h | UTC
Brief Review | Mechanical power: meaning, uses and limitations
13 Mar, 2023 | 14:44h | UTCMechanical power: meaning, uses and limitations – Intensive Care Medicine
Commentary on Twitter
Mechanical power, meaning, uses & limitations:
➡️ derivation of mechanical power
➡️ components of mechanical power and risk of VILI
➡️ association between MP and outcome
➡️ mechanical power normalisation
Open access #FOAMcc on @ICM
?️ https://t.co/nuhPh0qIXn pic.twitter.com/kBSTBdj54o— Intensive Care Medicine (@yourICM) March 8, 2023
Study shows potential for autonomous reporting of normal chest radiographs using artificial intelligence
13 Mar, 2023 | 14:41h | UTCAutonomous Chest Radiograph Reporting Using AI: Estimation of Clinical Impact – Radiology
News Release: AI accurately identifies normal and abnormal chest x-rays – Radiological Society of North America
Commentary: AI Has High Sensitivity for Abnormal Chest Radiographs – HealthDay
Commentary on Twitter
In a multicenter retrospective study of 1529 consecutive radiographs from adult patients, depending on referral setting, between 6% and 12% of all radiographs could potentially be autonomously reported, with the highest rates in outpatients. https://t.co/SEumLlqJMA pic.twitter.com/r2yTgoUb4H
— Radiology (@radiology_rsna) March 9, 2023
Brief Review | Enhanced recovery after emergency laparotomy
13 Mar, 2023 | 14:37h | UTCEnhanced recovery after emergency laparotomy – British Journal of Surgery
The global burden of metabolic disease: data from 2000 to 2019
13 Mar, 2023 | 14:39h | UTCThe global burden of metabolic disease: Data from 2000 to 2019 – Cell Metabolism (free for a limited period)
Minimum platelet count threshold before invasive procedures in cirrhosis: evolution of the guidelines
13 Mar, 2023 | 14:36h | UTC
Hospitalist comanagement reduces patients’ length of stay and improves oncologist experience, preliminary evidence suggests
13 Mar, 2023 | 14:33h | UTCOutcomes on an inpatient oncology service after the introduction of hospitalist comanagement – Journal of Hospital Medicine (link to abstract – $ for full-text)
News Release: Involving hospitalists in inpatient cancer care reduces patient stays, oncologist stress – Yale School of Medicine