GLOBAL HEALTH

Cochrane review: pregnant women in developing countries should receive multiple-micronutrient supplementation with iron and folic acid in order to improve birth outcomes. Link to free full text

New World Health Organization (WHO) recommendations for prevention and treatment of maternal peripartum infections. Link to free full text

Preventing youth violence: an overview of the evidence – New World Health Organization (WHO) Publication and Infographic. Link to free full text

TRIALS AND REVIEWS

SPRINT randomized controlled trial: Targeting systolic BP of < 120 mmHg (vs < 140 mmHg) reduces major CV events and death from any cause in patients older than 50 years with at least one additional high risk feature except diabetes or previous stroke. Link to free full text / Link to editorial: a SPRINT to the finish / Link to editorial: Redefining Blood-Pressure Targets — SPRINT Starts the Marathon

Missed opportunity to reduce overtreatment in older patients – In a retrospective cohort study involving 211 667 patients older than 70 years with diabetes whose treatment resulted in very low levels of Glycated hemoglobin or Blood Pressure, only 27% or fewer underwent deintensification of medication. Link to abstract (full text and editorial requires subscription) / Medscape summary and commentary / Commentary on New York Times

Cochrane review: no evidence to support routinely replacing peripheral venous catheters. Link to free full text

In a retrospective cohort study involving 46 021 patients in Canada, off-label use of prescription drugs was associated with increased incidence of adverse drug events (ADE). In the study, off-label use lacking strong scientific evidence had an even higher ADE rate. Link to abstract (full text require subscription) / Medscape summary and commentary / NEJM Journal Watch Summary

GUIDELINES

The American College of Physicians (ACP) has released new guidelines on the evaluation of patients with suspected acute pulmonary embolism. Some of the key points are:

1 – Use validated clinical prediction rules to estimate pretest probability. This calculated pretest probability will determine further evaluation. Ex: Wells Prediction Rule (Link to MdCalc Calculator) or Revised Geneva Score (Link to MdCalc Calculator).

2 – Patients with low pretest probability of PE and who meet all Pulmonary Embolism Rule-Out Criteria (Link to MdCalc Calculator) should not be ordered any further exams for the evaluation.

3 – Patients who have intermediate pretest probability or patients with low pretest probability of PE who do not meet all Pulmonary Embolism Rule-Out Criteria should do high-sensitivity d-dimer measurement as the initial diagnostic test. Clinicians should use age-adjusted d-dimer thresholds (age × 10 ng/mL rather than a generic 500 ng/mL) in patients older than 50 years to determine whether imaging is warranted. No Imaging studies should be obtained in patients with a d-dimer level below the age-adjusted cutoff.

4 – Patients with high pretest probability of PE should go directly to CT pulmonary angiography (CTPA) without D-dimer testing. Ventilation–perfusion scans should be reserved for patients who have a contraindication to CTPA or if CTPA is not available.

Link to free full text

New Guidelines and Recommendations Summaries from Several Organizations: Medscape Slideshow – November 2015. Link to presentation

Summary of 2015 European Society of Cardiology (ESC) Guidelines for the diagnosis and management of pericardial diseases. Link to free full text / Link to original guideline and related materials published in August 2015

Summary and ‘Ten Commandments’ of the 2015 European Society of Cardiology (ESC) Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Link to free full text / Link to original guideline and related materials published in August 2015 / NEJM Journal Watch Summary

2015 Guidelines for Post-resuscitation Care: European Resuscitation Council and European Society of Intensive Care Medicine. Link to free full text / NEJM Journal Watch Summary

NICE Guidelines: Caring for older people with social care needs and multiple long-term conditions. Link to free full text

Pediatric Pulmonary Hypertension: Guidelines from the American Heart Association and American Thoracic Society. Link to free full text / 10 key points to remember (guideline summary by Timothy B. Cotts, M.D., F.A.C.C.)

New Guidelines for Sports Participation Concerning Athletes with Cardiovascular Disorders. Link to free full text / Link to summary of key recommendation by David S. Bach, MD, F.A.C.C. / Medscape summary and commentary

WEEKLY REVIEWS BY OTHERS

Richard Lehman’s journal review: 9 November 2015 – Interesting evidence-based review with critical commentaries on the latest “breakthrough” articles. Link to free full text

Research and Reviews in the Fastlane, 107th edition. R&R in the Fastlane is a free resource with recommendations of what is worth reading from the published literature in critical care, emergency medicine and anestesia. Link to free full text