Daily Archives: March 23, 2023
Study reveals high rates of nonadherence to antimicrobial prophylaxis guidelines, often due to unnecessary vancomycin use
23 Mar, 2023 | 13:13h | UTCSummary: The study evaluated adherence to surgical antimicrobial prophylaxis guidelines in 825 US hospitals for elective surgeries from 2019-2020. The study found that 41% of surgical prophylaxis regimens were nonadherent to the American Society of Health-System Pharmacists guidelines.
Unnecessary vancomycin use was the most common reason for nonadherence to surgical antimicrobial prophylaxis guidelines, accounting for 77% of nonadherent regimens and occurring in 31% of all surgeries. It’s noteworthy that when vancomycin was used, it was often unnecessarily combined with cefazolin, and patients who received this combination had a 19% higher risk of acute kidney injury compared to those who received cefazolin alone.
The authors suggest that quality-improvement efforts aimed at reducing unnecessary vancomycin use and potential guideline revisions may offer impactful strategies for improving the risk-benefit profile of antimicrobial prophylaxis.
Study reveals overuse of surveillance colonoscopy in older adults with limited life expectancy
23 Mar, 2023 | 13:11h | UTCSummary: This study investigated the association between estimated life expectancy, surveillance colonoscopy findings, and follow-up recommendations among older adults. The study utilized data from the New Hampshire Colonoscopy Registry and included adults over 65 who underwent colonoscopy for surveillance after prior polyps.
Life expectancy was estimated using a validated prediction model and categorized into three groups: less than 5 years, 5 to less than 10 years, and 10 or more years.
Out of the 9,831 adults included in the study, 8% had advanced polyps or CRC. Among the 5,281 patients with available recommendations, 86.9% were advised to return for a future colonoscopy. Surprisingly, 58.1% of older adults with less than 5 years of life expectancy were also recommended to return for future surveillance colonoscopy.
The study concluded that many older adults with limited life expectancy are still recommended for future surveillance colonoscopy. This data could help refine decision-making about pursuing or stopping surveillance colonoscopy in older adults with a history of polyps.
Article: Association of Life Expectancy With Surveillance Colonoscopy Findings and Follow-up Recommendations in Older Adults – JAMA Internal Medicine (link to abstract – $ for full-text)
JAMA Patient Page: What Should I Know About Stopping Routine Cancer Screening?
Commentary on Twitter
Findings suggest that recommending against future surveillance colonoscopy in older adults with low-risk colonoscopy findings and/or limited life expectancy should be considered more frequently than is currently practiced. https://t.co/7jKpYyuZON
— JAMA Internal Medicine (@JAMAInternalMed) March 13, 2023
Cohort Study | Opioid use for pain relief after birth appears to pose no significant risk to breastfed infants
23 Mar, 2023 | 13:08h | UTCSummary: This large study from Canada found that infants born to mothers prescribed opioids after delivery, mainly following a cesarean, are at no greater risk of harm shortly after birth than infants of mothers not prescribed opioids. This suggests that breastfeeding is likely safe for babies whose mothers are taking opioids for pain relief.
The study included 865,691 mother-infant pairs discharged from Ontario hospitals within seven days of delivery between September 2012 and March 2020. Researchers matched mothers who filled an opioid prescription within seven days of discharge to those who did not.
Among the infants admitted to the hospital within 30 days, 2,962 (3.5%) were born to mothers who filled an opioid prescription compared with 3,038 (3.5%) born to mothers who did not, showing that infants of mothers prescribed opioids were no more likely to be admitted to the hospital for any reason. These children were only marginally more likely to visit the emergency department in the subsequent 30 days, and no differences were found for other serious outcomes, including breathing problems or admission to a neonatal intensive care unit, and no infant deaths occurred.
Although the study has some limitations, the high initial breastfeeding rates in Canada (90%) and the consistency of the findings with the fact that millions of new mothers are prescribed opioids after delivery each year provide confidence in the conclusions.
Editorial: Opioid analgesia for breastfeeding mothers – The BMJ
News Release: Infants of mothers given opioids after birth are at low risk of harm – BMJ Newsroom
Guidelines for the prevention of cancer-associated venous thromboembolism in thoracic surgery
23 Mar, 2023 | 13:06h | UTC
Survey | Perspectives of patients about immediate access to test results through an online patient portal
23 Mar, 2023 | 13:02h | UTCSummary: This study aimed to assess patient and caregiver attitudes and preferences related to receiving immediately released test results through an online patient portal.
In a survey of 8,139 respondents across 4 US academic medical centers, 95,7% of patients preferred to receive immediately released test results through an online patient portal, even if their healthcare practitioner had not yet reviewed the result. However, 7.5% of respondents reported that reviewing results before being contacted by a healthcare practitioner increased worry. This worry was more common among respondents who received abnormal results (16.5%) compared to those whose results were normal (5%).
The authors concluded that balancing patients’ expectations of immediate access to their information with the need to manage increased worry and healthcare practitioner burden is important as healthcare systems navigate this new era of health information transparency.
News Release: Patients prefer immediate access to medical test results online, even if it’s bad news – UT Southwestern Medical Center
Commentary from one of the authors on Twitter
Do patients prefer immediate access to test results, even when the news may not be good?
Multi-site survey of 8,139 patients says: YES ✅
Patients overwhelmingly supported receiving results immediately…But WHY does this matter?? https://t.co/KSD5qOJKdd#hcldr #healthIT pic.twitter.com/vz8DYBlVu7
— Liz Salmi (@TheLizArmy) March 21, 2023
Cohort Study | Retinal artery occlusion linked to a 7-fold higher mortality rate from CV and cerebrovascular diseases
23 Mar, 2023 | 13:04h | UTCSummary: This nationwide cohort study analyzed the incidence of retinal artery occlusion (RAO) in Korea from 2002 to 2018, along with related mortality and causes of death. The incidence of RAO was found to be 7.38 per 100,000 person-years, with a higher incidence of noncentral RAO compared to central RAO.
Patients with RAO had a mortality rate about 7 times higher than the general population, primarily due to cardiovascular or cerebrovascular diseases. The findings emphasize the need to address the risk of cardiovascular or cerebrovascular disease in patients newly diagnosed with RAO.
Invited Commentary: Long-term Management Considerations for Retinal Artery Occlusion and Cardiovascular and Cerebrovascular Mortality – JAMA Network Open
RCT | Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause
23 Mar, 2023 | 13:01h | UTCFezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1): a phase 3 randomised controlled study – The Lancet (link to abstract – $ for full-text)
Commentary on Twitter (thread – click for more)
70% of women experience hot flushes or night sweats during #menopause.
A new study investigates the role Fezolinetant, a non-hormonal treatment, could play in reducing these symptoms. https://t.co/zv4b9WU03h
— The Lancet (@TheLancet) March 15, 2023
Guidelines | The do’s, don’ts and don’t knows of creating open educational resources
23 Mar, 2023 | 12:59h | UTC
RCT | Impact of sleep deprivation on health-related quality of life in healthy children
23 Mar, 2023 | 12:57h | UTCCommentaries:
Sleep Disruption Linked to Lower HRQOL in Children – HealthDay
How just 39 minutes of sleep can make or break your child’s health, happiness and school day – CNN
Guideline | Diagnosis and treatment of myocarditis
23 Mar, 2023 | 12:55h | UTCJCS 2023 Guideline on the Diagnosis and Treatment of Myocarditis – Circulation Journal (see PDF)
Guideline | Diagnosis and treatment of vasospastic angina and coronary microvascular dysfunction
23 Mar, 2023 | 12:53h | UTCJCS/CVIT/JCC 2023 Guideline Focused Update on Diagnosis and Treatment of Vasospastic Angina (Coronary Spastic Angina) and Coronary Microvascular Dysfunction – Circulation Journal (see PDF)
M-A | Efficacy of intraosseous access for trauma resuscitation
23 Mar, 2023 | 12:52h | UTC
M-A | Development of treatment-decision algorithms for children evaluated for pulmonary tuberculosis
23 Mar, 2023 | 12:50h | UTCNews Release: New Algorithms Could Improve Pediatric Tuberculosis Diagnosis – Yale School of Public Health
Commentary from the author on Twitter (thread – click for more)
1/ Excited to share our #openaccess work in @LancetChildAdol where we evaluate existing algorithms and develop pragmatic, evidence-based algorithms to support evaluation for #pediatric pulmonary #tuberculosis
Link: https://t.co/tjDkk9xJm2
A summary ?
— Kenneth Gunasekera (@kennyguna) March 16, 2023
Guideline | Merkel cell carcinoma
23 Mar, 2023 | 12:48h | UTC
An evidence-based guide to the efficacy and safety of isometric resistance training in hypertension
23 Mar, 2023 | 12:42h | UTC
RCT | Safety and efficacy of pitolisant in children aged 6 years or older with narcolepsy with or without cataplexy
23 Mar, 2023 | 12:44h | UTCSafety and efficacy of pitolisant in children aged 6 years or older with narcolepsy with or without cataplexy: a double-blind, randomised, placebo-controlled trial – The Lancet Neurology (link to abstract – $ for full-text)
Cohort Study | Infertility in women linked to increased risk of cardiovascular disease
23 Mar, 2023 | 12:39h | UTC
Commentary on Twitter
Women with infertility may have greater risk of #coronary #heart #disease, especially those diagnosed with #ovulation disorders/#endometriosis. #AHAJournals #GoRedforWomen @l_farland https://t.co/Izaloav4Np pic.twitter.com/Iqn4eQexJL
— JAHA (@JAHA_AHA) February 27, 2023
ATS Position Paper | Immunocompromised host pneumonia: definitions and diagnostic criteria
23 Mar, 2023 | 12:41h | UTC
M-A | Effects of dairy intake on markers of cardio-metabolic health in adults
23 Mar, 2023 | 12:35h | UTC
Commentary on Twitter
Working with results of 19 randomized controlled trials (1427 total participants), #AdvNutr review authors conclude "high dairy intake (irrespective of fat content) showed no detrimental effects on anthropometric outcomes, blood lipids and blood pressure." https://t.co/59EiLeTW6g pic.twitter.com/ApVtfmfpsL
— American Society for Nutrition Journals (@jnutritionorg) March 13, 2023
Best practice in the use of peripheral venous catheters: a scoping review and expert consensus
23 Mar, 2023 | 12:37h | UTC
Regular measurement is essential but insufficient to improve quality of healthcare
23 Mar, 2023 | 12:33h | UTCRegular measurement is essential but insufficient to improve quality of healthcare – The BMJ
Service delivery redesign is a process, not a model of care
23 Mar, 2023 | 12:32h | UTCService delivery redesign is a process, not a model of care – The BMJ
M-A | eHealth-based psychosocial interventions for adults with insomnia
23 Mar, 2023 | 12:31h | UTC