Daily Archives: March 27, 2023
Coffee consumption vs. caffeine avoidance: cardiac ectopy, daily steps, and sleep impacts
27 Mar, 2023 | 13:32h | UTCSummary: A prospective, randomized, case-crossover trial studied the acute health effects of caffeinated coffee consumption in 100 ambulatory adults.
Participants were monitored using continuous electrocardiogram devices, wrist-mounted accelerometers, and ongoing glucose monitoring systems for 14 days. They received daily text messages instructing them to either consume caffeinated coffee or abstain from caffeine.
The primary outcome was the mean number of daily premature atrial contractions. Results indicated that caffeinated coffee consumption didn’t lead to significantly more daily premature atrial contractions compared to caffeine avoidance. However, it was associated with a higher number of daily premature ventricular contractions, increased daily steps, and reduced nightly sleep.
Article: Acute Effects of Coffee Consumption on Health among Ambulatory Adults – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries:
What to know about new research on coffee and heart risks – Associated Press
CRAVE Trials Offers Most Comprehensive Overview Yet of Impact of Coffee, Caffeine Intake – HCP Live
Acute Effects of Coffee Consumption on Health – American College of Cardiology
M-A | Examining shorter antibiotic treatment durations for community acquired pneumonia in adults
27 Mar, 2023 | 13:29h | UTCSummary: The systematic review and duration-effect meta-analysis included nine randomized trials with a total of 2,399 patients, analyzing antibiotic treatment durations for community-acquired pneumonia (CAP) in adults. The primary outcome was clinical improvement on day 15, with secondary outcomes including all-cause mortality, serious adverse events, and clinical improvement on day 30.
The study found that shorter treatment durations (3–9 days) were likely to be non-inferior to the standard 10-day treatment, and no significant difference in all-cause mortality or serious adverse events was observed. The study suggests that a 3–5 day treatment duration likely offers the optimal balance between efficacy and treatment burden if patients are clinically stable. However, the results are limited by the small number of included studies, the overall moderate-to-high risk of bias, and the varying severity of CAP among patients in the studies. Therefore, further research focusing on the shorter duration range is required.
Related:
Top POEMs (Patient-Oriented Evidence that Matters) of 2022 for choosing wisely in practice
27 Mar, 2023 | 13:30h | UTCSummary: Top POEMs of 2022 for choosing wisely in practice are based on Canadian Medical Association member ratings. These recommendations promote evidence-based and cost-effective clinical practices while reducing unnecessary treatments and diagnostic procedures.
Key recommendations from the article:
- Hypnotic agents are effective for insomnia but have adverse effects; avoid benzodiazepines as the first choice for older adults.
- For type 2 diabetes in older adults, avoid medications causing hypoglycemia to achieve A1c <7.5%; moderate control is better.
- Postoperative opioids provide no better pain relief than nonopioids; avoid prolonged use beyond the immediate postoperative period.
- Arthroscopic debridement is not recommended as the primary treatment for knee osteoarthritis.
- Proton pump inhibitor (PPI) use is associated with an increased risk of gastric cancer, although the association is observational and does not imply causation. Use the lowest dose and duration possible.
- For children with community-acquired pneumonia, low-dose amoxicillin for 3 days is noninferior to high-dose for 7 days.
- White blood cells in urine do not equate to bacterial cells; avoid urine dip tests or cultures unless urinary tract symptoms are present.
- Avoid measuring vitamin D in low-risk adults as a routine test.
- Antidepressants should not be routinely used as first-line treatment for mild or subsyndromal depressive symptoms in adults.
- ACG guideline for GERD management: try discontinuing PPIs after an 8-week trial in patients with classic GERD symptoms & no alarming symptoms.
- British Society of Gastroenterology guidelines for IBS management: colonoscopy only for alarming signs or microscopic colitis risk.
- USPSTF advises against ASA initiation for primary prevention of cardiovascular disease in adults >60.
Top POEMs of 2022 for choosing wisely in practice – Canadian Family Physician
See complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada
Dissecting coffee’s impact: high consumption lowers blood pressure, raises LDL-cholesterol
27 Mar, 2023 | 13:25h | UTC
Expanding Organ Usage: UK study finds organs from patients with a primary brain tumor are a viable option
27 Mar, 2023 | 13:27h | UTCSummary: A national cohort study in the UK investigated the risk of cancer transmission from deceased donors with primary brain tumors to organ recipients. The study found no cases of brain tumor transmission among 778 transplants from 282 donors with primary brain tumors, including 262 from donors with high-grade tumors. Organ transplant survival was equivalent to that in matched controls, and some organs from donors with high-grade tumors were less likely to be transplanted.
The results suggest that the risk of cancer transmission in transplants from deceased donors with primary brain tumors is lower than previously thought. Furthermore, the study indicated that donors with brain tumors provided good-quality organs with favorable risk markers and excellent transplant outcomes. Some organs from donors with high-grade tumors were underutilized, indicating a possible aversion by transplant clinicians or patients to use these organs.
These findings imply that it may be possible to safely expand organ usage from donors with primary brain tumors without negatively impacting outcomes, potentially benefiting many patients waiting for a transplant. Although this might lead to a slight rise in transplant numbers in the UK, the findings may hold particular significance for nations with stricter guidelines, such as the United States. The study’s findings can help transplant clinicians discuss the risks and benefits of accepting organ offers from such donors.
SR | Interventions to reduce repetitive ordering of low-value inpatient laboratory tests
27 Mar, 2023 | 13:22h | UTC
Selected articles from the Annual Update in Intensive Care and Emergency Medicine 2023
27 Mar, 2023 | 13:23h | UTCHemodynamic Implications of Prone Positioning in Patients with ARDS
Host Response Biomarkers for Sepsis in the Emergency Room
Quality improvement in the determination of death by neurologic criteria around the world
Setting and Monitoring of Mechanical Ventilation During Venovenous ECMO
A structured diagnostic algorithm for patients with ARDS
Interrogating the sepsis host immune response using cytomics
Managing the Physiologically Difficult Airway in Critically Ill Adults
Metagenomic Sequencing in the ICU for Precision Diagnosis of Critical Infectious Illnesses
The Role of Transcriptomics in Redefining Critical Illness
Position Paper | Prehospital hemorrhage control and treatment by clinicians
27 Mar, 2023 | 13:20h | UTC
SR | Post-tuberculosis sequelae in children and adolescents
27 Mar, 2023 | 13:16h | UTCPost-tuberculosis sequelae in children and adolescents: a systematic review – The Lancet Infectious Diseases (free registration required)
Indian consensus statements on irritable bowel syndrome in adults
27 Mar, 2023 | 13:18h | UTCRelated:
Diet and irritable bowel syndrome: an update from a UK consensus meeting – BMC Medicine
M-A | Efficacy of a restrictive diet in irritable bowel syndrome.
10 mistakes in dietary management of irritable bowel syndrome and how to avoid them.
Supplement: Irritable bowel syndrome and related conditions.
RCT: FODMAPs, but not gluten, elicit modest symptoms of irritable bowel syndrome.
British Society of Gastroenterology guidelines on the management of irritable bowel syndrome
Guidelines for the treatment of irritable bowel syndrome
ACG Clinical Guideline: Management of irritable bowel syndrome
M-A: Efficacy of a low-FODMAP diet in adult irritable bowel syndrome
M-A | Completion, safety, and efficacy of tuberculosis preventive treatment regimens containing rifampicin or rifapentine
27 Mar, 2023 | 13:14h | UTCCompletion, safety, and efficacy of tuberculosis preventive treatment regimens containing rifampicin or rifapentine: an individual patient data network meta-analysis – The Lancet Respiratory Medicine (free registration required)
Invited Commentary: Shorter regimens for tuberculosis preventive treatment: piecing together the global implementation jigsaw – The Lancet Respiratory Medicine (free registration required)
Commentary on Twitter
NEW Research—3HP provided an increase in treatment completion vs 4R but was associated with a higher risk of adverse events. The trade-off between completion and safety must be considered when deciding TPT
From Prof Dick Menzies & colleagues#WorldTBDayhttps://t.co/UY7l9OuI03 pic.twitter.com/GoKnu9BXoi
— The Lancet Respiratory Medicine (@LancetRespirMed) March 24, 2023
BRAVO Registry | Brugada substrate ablation results in a significant reduction of ventricular fibrillation events
27 Mar, 2023 | 13:11h | UTCLong-Term Outcomes of Brugada Substrate Ablation: A Report from BRAVO (Brugada Ablation of VF Substrate Ongoing Multicenter Registry) – Circulation (free for a limited period)
Outcomes of ST elevation myocardial infarction in patients with cancer: a nationwide study
27 Mar, 2023 | 13:12h | UTCOutcomes of ST elevation myocardial infarction in patients with cancer: a nationwide study – European Heart Journal – Quality of Care and Clinical Outcomes (free for a limited period)
Commentary on Twitter
Cancer and #STEMI – a worrisome combination of higher short- and long-term mortality, and bleeding risk. https://t.co/kHvhGP0PBE #EHJQCCO #cardiotwitter @cpgale3 @diogoasantosfer pic.twitter.com/SfjyizoJvQ
— European Society of Cardiology Journals (@ESC_Journals) March 26, 2023
Phase 2b RCT | Efficacy and safety of PL-5 (Peceleganan) spray for wound infections
27 Mar, 2023 | 13:08h | UTC
Brief Review | Long-term outcomes of intensive care unit delirium
27 Mar, 2023 | 13:09h | UTCLong-term outcomes of intensive care unit delirium – Intensive Care Medicine
Commentary on Twitter
#ICU delirium
? well described short-term effects: ⬆️ hospital mortality, MV duration, ICU/hospital LoS
? more recent findings related to long-term outcomes (≥ 6 months post-ICU)
How to mitigate this serious acute BI & its long-term burden? #FOAMcc
?️ https://t.co/kg5TIOmVHm pic.twitter.com/Hnbc1ISKnI— Intensive Care Medicine (@yourICM) March 25, 2023
M-A | The effect of curcumin supplementation on weight loss and anthropometric indices
27 Mar, 2023 | 13:04h | UTC
RCT | No reduction in parastomal hernia rate 3 years after stoma construction with prophylactic Mesh
27 Mar, 2023 | 13:07h | UTC
Review | Neoadjuvant therapy for pancreatic cancer
27 Mar, 2023 | 13:02h | UTCNeoadjuvant therapy for pancreatic cancer – Nature Reviews Clinical Oncology (free for a limited period)
RCT | Topical lidocaine or lidocaine/diltiazem ointment following rubber band ligation of hemorrhoids
27 Mar, 2023 | 13:05h | UTCTopical Lidocaine or Lidocaine/Diltiazem Ointment Following Rubber Band Ligation of Hemorrhoids: A Prospective Three-Armed Randomized Controlled Trial – Diseases of the Colon & Rectum (link to abstract – $ for full-text)
Phase 2 RCT | Semaglutide did not improve fibrosis in NASH-related cirrhosis
27 Mar, 2023 | 13:01h | UTCCommentary: Semaglutide Well-Tolerated, But Shows Lack of Improvement in Liver Fibrosis – HCP Live
Commentary on Twitter
New research – Loomba et al – Semaglutide 2·4 mg once weekly in patients with non-alcoholic steatohepatitis-related cirrhosis: a randomised, placebo-controlled phase 2 trialhttps://t.co/qkydKMpVfO#NASH #NAFLD #cirrhosis #gitwitter #livertwitter #medtwitter @DrLoomba pic.twitter.com/2A1dylSiq3
— The Lancet Gastroenterology & Hepatology (@LancetGastroHep) March 17, 2023
Brief Review | Bronchodilators or inhaled corticosteroids for postinfectious cough
27 Mar, 2023 | 13:00h | UTCBronchodilators or inhaled corticosteroids for postinfectious cough – Canadian Family Physician
RCT | Rituximab is superior to azathioprine for maintenance of remission for patients with ANCA vasculitis and relapsing disease
27 Mar, 2023 | 12:57h | UTC
Review | Lung transplantation for COPD/pulmonary emphysema
27 Mar, 2023 | 12:58h | UTCLung transplantation for COPD/pulmonary emphysema – European Respiratory Review
Guidelines for neuroprognostication in comatose adult survivors of cardiac arrest
27 Mar, 2023 | 12:54h | UTC
Trends of randomized clinical trials citing prior systematic reviews, 2007-2021
27 Mar, 2023 | 12:56h | UTCTrends of Randomized Clinical Trials Citing Prior Systematic Reviews, 2007-2021 – JAMA Network Open
Invited Commentary: Should a Systematic Review Be Required in a Clinical Trial Report? Perhaps, But Not Yet – JAMA Network Open
Commentary on Twitter
The percentage of RCTs citing systematic reviews increased from 36% in 2007-8 to 72% since 2020. RCTs with ≥100 participants, nonindustry funders, and authors from high-income countries were more likely to cite systematic reviews. https://t.co/rMN7eEmkqD
— JAMA Network Open (@JAMANetworkOpen) March 23, 2023