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Systematic Review | Management of High-Need, High-Cost Patients.

9 Nov, 2021 | 01:20h | UTC

Management of High-Need, High-Cost Patients: A “Best Fit” Framework Synthesis, Realist Review, and Systematic Review – Agency for Healthcare Research and Quality

Lessons from a Superb Clinical Trial – commentary on a recent randomized trial testing left atrial appendage occlusion during cardiac surgery to prevent stroke.

9 Nov, 2021 | 01:08h | UTC

Lessons from a Superb Clinical Trial – by Dr. John Mandrola

Original Study: #ACC21 – Practice Changing RCT: In patients with atrial fibrillation (75% maintained on anticoagulation), left atrial appendage occlusion during cardiac surgery reduces the incidence of stroke and systemic embolism (4.8 vs. 7.0%) in the following years.

Choosing Wisely for Thyroid Conditions: Ten things clinicians and patients should question – “Do not order thyroid ultrasound for nodule detection in patients without thyroid anatomic anomalies on clinical examination”.

9 Nov, 2021 | 01:11h | UTC

Choosing Wisely for Thyroid Conditions: Recommendations of the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism

See complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada

Making Sense of a Complex Disease: A Practical Approach to Managing Neuroendocrine Tumors.

9 Nov, 2021 | 01:04h | UTC

Making Sense of a Complex Disease: A Practical Approach to Managing Neuroendocrine Tumors – JCO Oncology Practice

Commentary on Twitter

#Neuroendocrine tumors are heterogeneous with a complex treatment landscape. This #JCOOP Clinical Review discusses optimal management of #NET and key patient/tumor characteristics that can guide treatment selection https://t.co/zZF36E93w8 pic.twitter.com/2xqwOlwIvw

— Journal of Clinical Oncology (@JCO_ASCO) October 28, 2021

FDA Pooled Analysis: Overall survival in patients with hormone receptor-positive, HER2-negative, advanced or metastatic breast cancer treated with a cyclin-dependent kinase 4/6 inhibitor plus fulvestrant.

9 Nov, 2021 | 01:05h | UTC

Overall survival in patients with hormone receptor-positive, HER2-negative, advanced or metastatic breast cancer treated with a cyclin-dependent kinase 4/6 inhibitor plus fulvestrant: a US Food and Drug Administration pooled analysis – The Lancet Oncology (link to abstract – $ for full-text)

Commentary on Twitter

A pooled analysis of phase III trials of fulvestrant plus either CDK4/6 inh or placebo in pts with HR+/HER2- advanced-stage #breastcancer shows an mOS benefit of 7.1 months (over a mFU of 43.7 months) favouring CDK4/6i (HR 0.77, 95% CI 0.68–0.88): https://t.co/ZMa0J8gS8Q #bcsm

— NatureRevClinOncol (@NatRevClinOncol) October 21, 2021

[Press release – not published yet] RCT: Pfizer’s novel Covid-19 oral antiviral treatment candidate reduced risk of hospitalization or death by 89% in interim analysis of phase 2/3 EPIC-HR study.

7 Nov, 2021 | 20:35h | UTC

Pfizer’s novel Covid-19 oral antiviral treatment candidate reduced risk of hospitalization or death by 89% in interim analysis of phase 2/3 EPIC-HR Study

Commentaries:

Expert reaction to press release from Pfizer giving interim analysis of their Phase 2/3 EPIC-HR study of PAXLOVID™ in non-hospitalized high-risk adults with COVID-19 – Science Media Centre

Pfizer’s Good News Is the World’s Good News – Science

Experimental Pfizer pill prevents Covid hospitalizations and deaths – STAT

Pfizer Says New Anti-Viral Drug Combination Cuts Risks Of Serious COVID-19 By 89% – Health Policy Watch

Pfizer reports good results against severe COVID-19 for its antiviral pill – CIDRAP

Covid: Pfizer says antiviral pill 89% effective in high-risk cases – BBC

Pfizer says COVID-19 pill cut hospital, death risk by 90% – Associated Press

Pfizer’s COVID-19 pill treatment reduces risk of being hospitalized or dying by 89%, company says – ABC News

Commentary on Twitter (thread – click for more)

Pfizer’s oral protease inhibitor PF-07321332 for #COVID19 Reduced Risk of Hospitalization or Death from 6.7% (41/612) to 1.0% (6/607) when starting within 5 days of symptom onset.
10 vs 0 deaths. #idtwitter https://t.co/ZAIm6Y5mAt

— David Boulware, MD MPH (@boulware_dr) November 5, 2021

Myocarditis Following COVID-19 mRNA Vaccine: A Case Series and Incidence Rate Determination.

7 Nov, 2021 | 20:29h | UTC

Myocarditis Following COVID-19 mRNA Vaccine: A Case Series and Incidence Rate Determination – Clinical Infectious Diseases

Heart-inflammation risk from Pfizer COVID vaccine is very low.

Large cohort study with over 2.5 million individuals showed the incidence of myocarditis after the Pfizer vaccine was 2.13 cases per 100,000 persons.

Study with over 5.1 million vaccinated individuals showed the incidence of myocarditis after the receipt of the Pfizer vaccine was low and more common after the second dose in young male recipients.

Large Observational study shows Pfizer Covid vaccine is mostly safe but is associated with increased risk of myocarditis, adenopathy, appendicitis, and herpes zoster.

Viewpoint | Pediatric COVID-19 Vaccines: What Parents, Practitioners, and Policy Makers Need to Know.

7 Nov, 2021 | 20:31h | UTC

Pediatric COVID-19 Vaccines: What Parents, Practitioners, and Policy Makers Need to Know – JAMA

Viewpoint | Children and COVID-19 in schools.

7 Nov, 2021 | 20:24h | UTC

Children and COVID-19 in schools – Science

Instead of quarantine for Covid-exposed students, some schools are trying test-to-stay.

Cluster RCT: Daily contact testing of school-based contacts was non-inferior to self-isolation for control of COVID-19 transmission.

Kids are losing school days to quarantines. Here’s a way to keep them in classrooms – “Test-to-stay could dramatically reduce close contact quarantines”.

Opinion | Data from routine Covid testing can help schools stay open this year.

CDC Report: Schools without mask requirements were more likely to have Covid-19 outbreaks.

Perspective | Schools have begun mass testing for COVID-19. But hurdles and uncertainties remain.

COVID and schools: the evidence for reopening safely.

COVID studies note online learning stress, fewer cases in schools with protocols

[Not published yet] Chinese drug firm Sinovac says Covid-19 vaccine safe for children and babies as young as six months old.

7 Nov, 2021 | 20:32h | UTC

Chinese drug firm Sinovac says Covid-19 vaccine safe for children, babies as young as six months old; submits data to Hong Kong government – South China Morning Post

Randomized phase 1/2 trial: Safety and immunogenicity of an inactivated COVID-19 vaccine, BBIBP-CorV, in children and adolescents aged 3–17 years.

Phase 1/2 RCT: CoronaVac is well tolerated and safe and induces strong humoral responses in children and adolescents aged 3–17 years.

COVID-19 vaccination in pregnancy, pediatrics, immunocompromised patients, and persons with history of allergy or prior SARS-CoV-2 infection: overview of current recommendations and pre- and post-marketing evidence for vaccine efficacy and safety.

7 Nov, 2021 | 20:27h | UTC

COVID-19 Vaccination in Pregnancy, Paediatrics, Immunocompromised Patients, and Persons with History of Allergy or Prior SARS-CoV-2 Infection: Overview of Current Recommendations and Pre- and Post-Marketing Evidence for Vaccine Efficacy and Safety – Drug Safety

RCT: In patients with chronic kidney diseases and anemia undergoing dialysis, Daprodustat (oral drug) was noninferior to darbepoetin alfa to increase hemoglobin levels and regarding cardiovascular outcomes.

7 Nov, 2021 | 20:18h | UTC

Daprodustat for the Treatment of Anemia in Patients Undergoing Dialysis – New England Journal of Medicine (link to abstract – $ for full-text)

News Release: Oral pill as safe, efficacious as conventional treatment for anemia in patients with kidney disease – Brigham and Women’s Hospital

Commentary on Twitter

In this phase 3 clinical trial, daprodustat was effective as a treatment for anemia in patients with CKD who were undergoing maintenance hemodialysis or peritoneal dialysis. #KidneyWk https://t.co/ykzSsUlJci pic.twitter.com/0zdlMyOlTf

— NEJM (@NEJM) November 5, 2021

Germany offers booster shots to everyone amid ‘very worrying’ surge in cases.

7 Nov, 2021 | 20:22h | UTC

Germany offers booster shots to everyone amid ‘very worrying’ surge in cases – CNN

RCT: In patients with chronic kidney diseases and anemia not undergoing dialysis, Daprodustat (oral drug) was noninferior to darbepoetin alfa in increasing hemoglobin levels and regarding cardiovascular outcomes.

7 Nov, 2021 | 20:17h | UTC

Daprodustat for the Treatment of Anemia in Patients Not Undergoing Dialysis – New England Journal of Medicine (link to abstract – $ for full-text)

News Release: Oral pill as safe, efficacious as conventional treatment for anemia in patients with kidney disease – Brigham and Women’s Hospital

Commentary on Twitter

In this trial, daprodustat was as effective as darbepoetin alfa in increasing and maintaining hemoglobin levels in patients with CKD and anemia who were not receiving dialysis. #KidneyWk https://t.co/D2unQFLH6T pic.twitter.com/KqdLfVlkuD

— NEJM (@NEJM) November 5, 2021

Among patients with atrial fibrillation, 4-year outcomes of PRAGUE-17 randomized trial showed that left atrial appendage closure was noninferior to non-warfarin oral anticoagulation for preventing net ischemic and bleeding events.

7 Nov, 2021 | 20:15h | UTC

Left Atrial Appendage Closure versus Non-Warfarin Oral Anticoagulation in Atrial Fibrillation: 4-Year Outcomes of PRAGUE-17 – Journal of the American College of Cardiology (link to abstract – $ for full-text)

Commentaries:

PRAGUE-17: LAA Occlusion Noninferior to DOACs Over Longer Term – TCTMD

PRAGUE-17: LAAC Noninferior to NOACs For Major AFib-Related CV, Neurological Events Longer-Term – American College of Cardiology

Left Atrial Appendage Closure vs. Novel Anticoagulation Agents in High-Risk Atrial Fibrillation Patients – PRAGUE-17 – American College of Cardiology

Commentary on Twitter

📌 The PRAGUE-17 trial showed that left atrial appendage occlusion was noninferior to a #NOAC at preventing net ischemic & bleeding events. Check out ACC’s Visual Abstract from #TCT2021 to learn more here: https://t.co/NTVc4wpH6W pic.twitter.com/9EBWRvs72O

— American College of Cardiology (@ACCinTouch) November 6, 2021

RCT: In patients with advanced chronic kidney disease and poorly controlled hypertension, Chlortalidone had a significant impact in blood-pressure control (−11.0 mm Hg vs. −0.5 mm Hg in the placebo group).

7 Nov, 2021 | 20:20h | UTC

Chlorthalidone for Hypertension in Advanced Chronic Kidney Disease – New England Journal of Medicine (link to abstract – $ for full-text)

Commentary: Cheap Diuretic, Chlorthalidone, Drops BP in Advanced Kidney Disease – Medscape (free registration required)

Commentary on Twitter

In this placebo-controlled trial involving patients with advanced chronic kidney disease and poorly controlled hypertension, chlorthalidone therapy improved blood-pressure control at 12 weeks as compared with placebo. #KidneyWk https://t.co/iNZc2mYy2c pic.twitter.com/7svX4RVtPI

— NEJM (@NEJM) November 5, 2021

New study challenges the idea that a coronary artery calcium score of 0 is enough for ruling out coronary stenosis in symptomatic patients, especially in young adults.

7 Nov, 2021 | 20:09h | UTC

Association of Age With the Diagnostic Value of Coronary Artery Calcium Score for Ruling Out Coronary Stenosis in Symptomatic Patients – JAMA Cardiology (link to abstract – $ for full-text)

Commentary: Zero CAC Questionable for Ruling Out Obstructive CAD in Young Adults – TCTMD

Commentary from the author on Twitter (thread – click for more)

There has been a lot of discussion about our recent paper in JAMA Cardiology. In my opinion, much of the discussion is caused by a troublesome extrapolation of the results to the value of CAC in risk assessment in primary prevention. I will go through our findings in these tweets https://t.co/O0Rl12XYmV

— Martin Bødtker Mortensen (@MaBMortensen) November 1, 2021

Mapping conflict of interests: scoping review.

7 Nov, 2021 | 20:10h | UTC

Mapping conflict of interests: scoping review – The BMJ

Press release: Study reveals “extensive network” of industry ties with healthcare – BMJ

NICE draft guideline recommends SGLT2 inhibitor dapagliflozin for some patients with chronic kidney disease.

7 Nov, 2021 | 20:14h | UTC

NICE recommend dapagliflozin for people with chronic kidney disease – National Institute for Health and Care Excellence

See draft guideline:

Appraisal consultation document (online commenting)

Appraisal consultation document (PDF version)

NICE Guideline: Assessment and management of chronic kidney disease.

Secondary analysis of RCT finds Dapagliflozin is safe for patients with stage 4 chronic kidney disease.

Randomized trial: Dapagliflozin in patients with chronic kidney disease

A cohort study with 287 patients showed that those who fulfill 5 criteria 2 or 3 days after laparoscopic colorectal surgery (a CRP below 150 mg/dL, a return of bowel function, tolerance of a diet, little pain, and afebrile during the entire stay) have a low risk of developing an anastomotic leak. These criteria have the potential to allow for safe early discharge.

7 Nov, 2021 | 20:06h | UTC

Assessing Criteria for a Safe Early Discharge After Laparoscopic Colorectal Surgery – JAMA Surgery (free for a limited period)

Commentary on Twitter

A prospective observational study on 287 adults showing that patients with CRP<150mg/dL, bowel function, diet tolerance, pain<5/10 and no fever, 2-3 days after laparoscopic colorectal surgery have a low anastomotic leak risk and may be discharged early https://t.co/zq8lvHPoQ1

— JAMA Surgery (@JAMASurgery) November 5, 2021

Study compares the decline in effectiveness for Moderna, Pfizer, and Janssen vaccines and consequences for mortality.

5 Nov, 2021 | 09:59h | UTC

Original study: SARS-CoV-2 vaccine protection and deaths among US veterans during 2021 – Science

News release: Breakthrough Infection Study Compares Decline in Vaccine Effectiveness and Consequences for Mortality – Public Health Institute

Commentary on Twitter

A new study of more than 780,000 United States Veterans shows that, although vaccination remains protective against #SARSCoV2 infection, protection waned as the Delta variant emerged in America.

Read more: https://t.co/8qRlKE107H #ScienceResearch pic.twitter.com/XmDQ7frIlT

— Science Magazine (@ScienceMagazine) November 4, 2021

M-A: Comparison of outcomes between neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy in patients with locally advanced esophageal cancer.

7 Nov, 2021 | 20:07h | UTC

Comparison of outcomes between neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy in patients with locally advanced esophageal cancer: A network meta-analysis – EClinicalMedicine

Review: SARS-CoV-2 indoor air transmission is a threat that can be addressed with science.

5 Nov, 2021 | 09:55h | UTC

SARS-CoV-2 indoor air transmission is a threat that can be addressed with science – Proceedings of the National Academies of Sciences

Ten scientific reasons in support of airborne transmission of SARS-CoV-2

Editorial: Covid-19 has redefined airborne transmission

Covid-19: What do we know about airborne transmission of SARS-CoV-2?

Real-world data show that filters clean COVID-causing virus from air.

Perspective | The plan to stop every respiratory virus at once – “The benefits of ventilation reach far beyond the coronavirus. What if we stop taking colds and flus for granted, too?”

Recommendations for ventilation of indoor spaces to reduce COVID-19 transmission.

We studied how to reduce airborne COVID spread in hospitals. Here’s what we learnt.

Report: Improved ventilation essential to safe use of buildings and public spaces, say leading engineers.

WHO: Roadmap to improve and ensure good indoor ventilation in the context of COVID-19

CDC releases new ventilation guidelines for indoor environments to reduce Covid-19 risk

Guidance: Using Ventilation and filtration to reduce aerosol transmission of COVID-19 in long-term care homes

It’s not just SARS-CoV-2: Most respiratory viruses spread by aerosols.

Commentary on Twitter

Addressing #CovidisAirborne with sciencehttps://t.co/puzxHQ6xGD
proceedings of a workshop with the experts @PNASNews w/ @Smogdr @linseymarr @kprather88 @Lakdawala_Lab @Prof_Lowe pic.twitter.com/xdjjFZ8Uto

— Eric Topol (@EricTopol) November 5, 2021

Effects of the Covid-19 pandemic on life expectancy and premature mortality in 2020 – this time series analysis showed there were more than 28 million excess years of life lost in 2020 in 31 countries.

5 Nov, 2021 | 09:56h | UTC

Effects of covid-19 pandemic on life expectancy and premature mortality in 2020: time series analysis in 37 countries – The BMJ

Global Covid-19 deaths surpass five million.

Under-reporting of deaths limits our understanding of true burden of covid-19.

Study shows COVID-19 has caused the biggest decrease in life expectancy since World War II.

Just how do deaths due to COVID-19 stack up?

Tracking excess mortality across countries during the COVID-19 pandemic with the World Mortality Dataset.

Exploring the gap between excess mortality and COVID-19 deaths in 67 countries.

Report: Three new estimates of India’s all-cause excess mortality during the COVID-19 Pandemic – pandemic death toll estimated to be between 3.4 million and 4.9 million excess deaths.

COVID-19 has caused 6.9 million deaths globally, more than double what official reports show

Commentary from the author on Twitter (thread – click for more)

THREAD:

Our new #BMJ @bmj_latest study: >28 million EXCESS years of life were lost in 31 countries in 2020 alone! (more below)

w/ @martinwhite33 @kamleshkhunti @DmitriJdanov @Oxford_NDPH @bdi_oxford @UniofOxford @MRC_Epid @Cambridge_Uni @LDC_tweets @uniofleicester @MPIDRnews https://t.co/FGZau2Fg75

— Nazrul Islam (@_Nazrul_Islam) November 4, 2021