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RCT: No difference in ICU length of stay or 90-day mortality between tight and liberal glucose control
2 Oct, 2023 | 11:25h | UTCStudy Design and Population: This randomized controlled trial assessed the effects of tight versus liberal glucose control on the length of ICU stay in critically ill patients. A total of 9,230 patients were included, with 4,622 in the liberal-control group (insulin initiation when blood glucose levels exceeded 215 mg/dL) and 4,608 in the tight-control group (blood glucose targeted between 80 and 110 mg/dL). In both groups, parenteral nutrition was withheld during the first week of ICU admission. The primary endpoint was the duration of ICU stay, and 90-day mortality served as a key safety outcome.
Main Findings: No significant differences were observed in the primary endpoint, the length of ICU stay, between the two groups (hazard ratio 1.00; 95% CI, 0.96 to 1.04; P=0.94). The 90-day mortality rates were also similar (10.1% in the liberal-control group vs. 10.5% in the tight-control group, P=0.51). Incidences of severe hypoglycemia were low and statistically similar in both groups (1.0% in the tight-control group vs. 0.7% in the liberal-control group). Secondary outcomes, including new infections and the duration of respiratory and hemodynamic support, showed no significant differences. However, lower incidences of severe acute kidney injury and cholestatic liver dysfunction were observed in the tight-control group.
Implications & Limitations: The study supports existing evidence that tight glucose control doesn’t provide substantial benefits in reducing ICU stay duration or mortality. This suggests that a more liberal approach to glucose control may be preferable in most ICU settings, especially to minimize hypoglycemia risk. Key limitations of the study include its narrow focus on the absence of early parenteral nutrition, which could limit generalizability, and the inability to blind caregivers to treatment assignments. Future research should investigate the impact of tight glucose control in various patient subgroups and under different nutritional conditions.
RCT: Propafenone leads to quicker sinus rhythm restoration than amiodarone in supraventricular arrhythmias related to septic shock
1 Oct, 2023 | 15:19h | UTCStudy Design & Population: The research was a two-center, prospective, controlled parallel-group, double-blind trial involving 209 septic shock patients who had new-onset supraventricular arrhythmia and a left ventricular ejection fraction above 35%. Patients were randomized to receive either intravenous propafenone (70 mg bolus followed by 400–840 mg/24 h) or amiodarone (300 mg bolus followed by 600–1800 mg/24 h).
Main Findings: The primary outcomes focused on the proportion of patients in sinus rhythm 24 hours post-infusion, time to the first sinus rhythm restoration, and arrhythmia recurrence rates. No significant difference was observed in 24-hour sinus rhythm rates between the propafenone (72.8%) and amiodarone (67.3%) groups (p=0.4). Time to the first rhythm restoration was significantly shorter for the propafenone group (median 3.7 hours) compared to the amiodarone group (median 7.3 hours, p=0.02). Recurrence of arrhythmia was notably lower in the propafenone group (52%) than in the amiodarone group (76%, p<0.001). In the subgroup of patients with a dilated left atrium, amiodarone appeared to be more effective.
Implications & Limitations: The study suggests that while propafenone doesn’t offer better rhythm control at 24 hours compared to amiodarone, it does provide faster cardioversion and fewer arrhythmia recurrences, especially in patients with a non-dilated left atrium. No significant differences were observed in clinical outcomes, such as ICU or long-term mortality, between propafenone and amiodarone in the trial. Limitations include potential underpowering of the study and the inability to fully account for the impact of multiple covariates involved in the complex therapy of septic shock.
Commentary on Twitter:
Propafenone💉70 mg bolus+ 400-840 mg/24h vs amiodarone💉300 mg + by 600-1800 mg/24h for SVA in septic shock, RCT
🫀propafenone not better for rhythm control at 24h but excellent hemodynamic safety profile, cardioverting faster & fewer recurrences#FOAMCc
🔓https://t.co/GVuoxPD7Hy pic.twitter.com/rRlj00x71p— Intensive Care Medicine (@yourICM) September 13, 2023
LinksMedicus.com: operations paused for the foreseeable future.
23 Aug, 2023 | 12:44h | UTCDear LinksMedicus Subscribers,
I regret to inform you that LinksMedicus.com will be pausing operations for the foreseeable future. After 12 years and over 30.000 curated articles in all specialties, I will now focus on my clinical practice.
Best regards to all.
Euclides Cavalcanti
São Paulo, Brazil
Crossover RCT | Using one-size cuff results in major inaccuracy in BP readings across varying arm sizes
11 Aug, 2023 | 15:41h | UTCEffects of Cuff Size on the Accuracy of Blood Pressure Readings: The Cuff(SZ) Randomized Crossover Trial – JAMA Internal Medicine (free for a limited period)
Commentaries:
When it comes to blood pressure cuffs, size matters – MedicalResearch.com
One-size-fits-all blood pressure cuffs ‘strikingly inaccurate,’ study says – CNN
Related:
Commentary on Twitter
Using a regular blood pressure (BP) cuff regardless of individual’s arm size resulted in 3.6 mmHg lower systolic BP when a regular cuff was one size too-large, and 4.8 and 19.5 mmHg higher when a regular cuff was one and two sizes too small. https://t.co/ZKnGfWc9fy
— JAMA Internal Medicine (@JAMAInternalMed) August 7, 2023
Perspective | Clinicians debate the usefulness of NAFLD name change
11 Aug, 2023 | 15:39h | UTCClinicians debate the usefulness of NAFLD name change – MDedge
Original article: From NAFLD to MASLD | New consensus changes fatty liver disease terminology to avoid stigmatization
Presented at ASRS Meeting | Studies link GLP-1 agonists to progression of diabetic retinopathy
11 Aug, 2023 | 15:38h | UTCStudies link GLP-1 agonists to progression of diabetic retinopathy – MDedge
Study | The high financial and human cost of quality metric reporting in hospitals
11 Aug, 2023 | 15:36h | UTCThe Volume and Cost of Quality Metric Reporting – JAMA (link to abstract – $ for full-text)
Author Interview: The Costs of Quality Reporting – JAMA
Commentaries:
The Cost of “Quality” – Emergency Medicine Literature of Note
How John Hopkins spent $5m and 108,478 hours on quality reporting in one year – HealthLeaders
The cost of quality metric reporting – Becker’s Hospital Review
Study | Uncovering the potential overuse of laboratory tests by combining cost, abnormal result proportion, and physician variation
11 Aug, 2023 | 15:34h | UTC
Guideline | Closure of laparotomy in emergency settings
11 Aug, 2023 | 15:33h | UTC
ERS statement on protracted bacterial bronchitis in children
11 Aug, 2023 | 15:32h | UTCERS statement on protracted bacterial bronchitis in children – European Respiratory Journal
Perspective | AI predicted to play major role in cardiac CT and CV care in the coming decade
11 Aug, 2023 | 15:30h | UTCAI Predicted to Play Major Role in Cardiac CT and CV Care in the Coming Decade – TCTMD
M-A | Pharmacist-led home BP telemonitoring enhances control over usual care
11 Aug, 2023 | 15:29h | UTC
RCT | Superior PFS with avelumab vs. chemotherapy in second-line treatment for mCRC with microsatellite instability
11 Aug, 2023 | 15:25h | UTCSee also: Visual Abstract
Commentary: Avelumab Outperforms Standard Second-Line Therapy in dMMR/MSI Metastatic CRC – Cancer Therapy Advisor
Review | An approach to non-left main bifurcation lesions
11 Aug, 2023 | 15:22h | UTCAn Approach to Non-left Main Bifurcation Lesions: A Contemporary Review – US Cardiology Review
Commentary on Twitter
🤔Do you know how to classify, assess, and treat non-left main bifurcation lesions with PCI?
New #USCardiology Review by @ANazmiCalik, @mirvatalasnag et al. @radcliffeCARDIO
🔗https://t.co/PeUcLxUerx pic.twitter.com/qh2FdUTbdE
— Amit Goyal MD MAS (@AmitGoyalMD) August 4, 2023
Cohort Study | Mortality risk in anti-MDA5 dermatomyositis linked to rapid ILD progression and anti-Ro52 antibody levels
11 Aug, 2023 | 15:21h | UTC
Commentary on Twitter
High mortality risk predictors in patients with anti-MDA5 dermatomyositis include:
– rapidly progressive interstitial lung disease
– anti-Ro52 antibody
– age > 57 years
(based on study of 126 MDA-5+ DM pts)https://t.co/JLGIgALUip pic.twitter.com/boTTzrixk9— Dr. John Cush (@RheumNow) August 5, 2023
Systematic Review | Poor handling of continuous predictors in clinical prediction models using logistic regression
11 Aug, 2023 | 15:19h | UTC
RCT – 2ry analysis | Aerobic exercise intervention shows potential to reduce chemotherapy-induced peripheral neuropathy
11 Aug, 2023 | 15:17h | UTCSee also: Visual Abstract
Commentary: Aerobic Exercise Cuts Chemotherapy-Induced Peripheral Neuropathy Symptoms – HealthDay
Commentary on Twitter
Aerobic exercise improves chemotherapy-induced peripheral neuropathy (CIPN) in women who were treated for ovarian cancer. Incorporating referral to exercise programs as a part of standard of oncology care is recommended. https://t.co/lp9C9seyM6 @anlan_cao
— JAMA Network Open (@JAMANetworkOpen) August 1, 2023
Cohort Study | Younger age at hypertrophic cardiomyopathy diagnosis, male sex among predictors of developing LV systolic dysfunction
11 Aug, 2023 | 15:16h | UTC
Commentary on Twitter
@sarahaboualaiwi and colleagues provide new #clinicalresearch; Left Ventricular Systolic Dysfunction in #HCM diagnosed in childhood, Important insights into prevalence and prognosis from the SHaRe Registry #Circulation @sday_hcm @CSHeartResearch @tikuowens https://t.co/2TJ0XMe3B7 pic.twitter.com/o2mhcNjUfw
— Circulation (@CircAHA) June 2, 2023
RCT | Field sobriety tests display insufficient accuracy for detecting THC-specific driving impairment
11 Aug, 2023 | 15:14h | UTCSee also: Visual Abstract
News Release: Can field sobriety tests identify drivers under the influence of cannabis? – University of California – San Diego
Commentary on Twitter
This randomized clinical trial investigates the accuracy of field sobriety tests administered by law enforcement officers to assess functional impairment and driving performance among individuals who have smoked cannabis. https://t.co/pThOOdZGUh
— JAMA Psychiatry (@JAMAPsych) August 2, 2023
Cohort Study | U-shaped relationship between BMI and mortality in heart failure patients
11 Aug, 2023 | 15:12h | UTCBody mass index and survival in people with heart failure – Heart
Commentary on Twitter
Body mass index and survival in people with heart failurehttps://t.co/W20GR5qjTM pic.twitter.com/s2nX2sBZj7
— Heart_BMJ (@Heart_BMJ) August 2, 2023
Survival ≠ Recovery | A narrative review of post-intensive care syndrome
11 Aug, 2023 | 15:11h | UTCSurvival ≠ Recovery: A Narrative Review of Post-Intensive Care Syndrome – CHEST Critical Care
Review | Primary ciliary dyskinesia
11 Aug, 2023 | 15:10h | UTCPrimary Ciliary Dyskinesia – CHEST Pulmonary
RCT | Restrictive vs. liberal red blood cell transfusion strategy for critically injured patients
11 Aug, 2023 | 15:08h | UTC
[News Release] RCT | Semaglutide 2.4 mg reduces cardiovascular risk by 20% in adults with CVD & obesity
9 Aug, 2023 | 15:40h | UTCCommentaries:
SELECT: Semaglutide Cuts CV Events in Adults With Overweight or Obesity – TCTMD
Perspective | Creation and adoption of large language models in medicine
9 Aug, 2023 | 15:38h | UTCCreation and Adoption of Large Language Models in Medicine – JAMA (free for a limited period)
Commentary: Rethinking large language models in medicine – Stanford Medicine