Editor's Choice
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
[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
Perspective | An AI-enhanced electronic health record could boost primary care productivity
9 Aug, 2023 | 15:36h | UTCAn AI-Enhanced Electronic Health Record Could Boost Primary Care Productivity – JAMA (free for a limited period)
Perspective | Large language models answer medical questions accurately, but can’t match clinicians’ knowledge
9 Aug, 2023 | 15:35h | UTCLarge Language Models Answer Medical Questions Accurately, but Can’t Match Clinicians’ Knowledge – JAMA (free for a limited period)
Perspective | Artificial-intelligence search engines wrangle academic literature
9 Aug, 2023 | 15:33h | UTCArtificial-intelligence search engines wrangle academic literature – Nature
Research Letter | GPT-3.5 and GPT-4 show low accuracy in citing journal articles
9 Aug, 2023 | 15:31h | UTCAccuracy of Chatbots in Citing Journal Articles – JAMA Network Open
Commentary on Twitter
21% of medical journal articles cited by GPT-4 were found to be fake; GPT-3.5 cited an estimated 98% fake articles. Narrower topics had more fake articles than broader topics. Despite its promise, ChatGPT is currently not a reliable source of medical data. https://t.co/DCTIkT1OkZ
— JAMA Network Open (@JAMANetworkOpen) August 9, 2023
M-A | Nearly 37% of elderly outpatients are at risk due to potentially inappropriate medication use
8 Aug, 2023 | 13:37h | UTC
M-A | Approximately 25 min/day of walking can boost function and cut adverse events in acutely hospitalized elders
8 Aug, 2023 | 13:35h | UTC
Proposed algorithm for appropriate fluid management in acute pancreatitis
8 Aug, 2023 | 13:33h | UTCFluid treatment in acute pancreatitis: a careful balancing act – British Journal of Surgery
Related:
Update on the management of acute pancreatitis – Current Opinion in Critical Care
Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis – New England Journal of Medicine
Acute Pancreatitis: Diagnosis and Treatment – Drugs
Evidence-Based Disposition of Acute Pancreatitis – emDocs
Pancreatitis – National Institute for Health and Care Excellence
Research: Endoscopic or Surgical Step-up Approach for Infected Necrotising Pancreatitis
Evidence-Based Approach to the Surgical Management of Acute Pancreatitis – The Surgery Journal
Multinational Study | No correlation between Covid-19 and onset of type 1 diabetes in children
8 Aug, 2023 | 13:32h | UTC
Perspective | Will unpredictable side effects dim the promise of new Alzheimer’s drugs?
8 Aug, 2023 | 13:30h | UTCWill unpredictable side effects dim the promise of new Alzheimer’s drugs? – Science (a few articles per month are free)
Related:
RCT | Donanemab slows early symptomatic Alzheimer’s progression, but raises serious safety concerns
RCT | Lecanemab slows cognitive decline in early Alzheimer’s disease but raises safety concerns
NICE Updated Guideline | Venous thromboembolic diseases
7 Aug, 2023 | 15:05h | UTC
Review | Management of worsening heart failure with reduced ejection fraction
7 Aug, 2023 | 15:03h | UTC
Commentary on Twitter
How do you manage patients with worsening #HFrEF? This review by @SJGreene_md, @JavedButler1 and team provides the latest evidence-based guidance for the medical management of this high-risk population. https://t.co/REAqsrHDjI#JACC #CardioTwitter @ShelleyZieroth @DCRINews pic.twitter.com/rZYD25vCoG
— JACC Journals (@JACCJournals) August 5, 2023
Cohort Study | High-sensitivity troponin’s role in assessing MI and CV death risk in stable CAD patients
7 Aug, 2023 | 15:01h | UTCHigh-Sensitivity Cardiac Troponin for Risk Assessment in Patients With Chronic Coronary Artery Disease – Journal of the American College of Cardiology (link to abstract – $ for full-text)
Commentaries:
High-Sensitivity Troponin Assays May Stratify Risk in Chronic CAD – TCTMD
Commentary on Twitter
In patients with chronic CAD, an elevated #troponin identifies those more likely to have MI or CV death. Routine troponin testing in this setting could inform patient selection for additional treatment. https://t.co/T4HfidPwOA#JACC #cvCAD #CardioTwitter #cvPrev #cvMI pic.twitter.com/2IOU8jsFPj
— JACC Journals (@JACCJournals) August 1, 2023
Survey | The manifold costs of being a non-native English speaker in science
7 Aug, 2023 | 15:00h | UTCThe manifold costs of being a non-native English speaker in science – PLOS Biology
Commentary from the author: Non-native English speaking scientists work much harder just to keep up, global research reveals – The Conversation
News Releases:
The cost of being a non-native English speaker in science – PLOS
Science language barrier could cost countless careers – University of Queensland
Commentary on Twitter
Some potential solutions to reducing disadvantages for non-native English speakers in publishing & conferences
By @tatsuya_amano & colleagues from their seminal @PLOSBiology paperhttps://t.co/luBndai3FQ @PLOS pic.twitter.com/68x6rZBMW4
— Madhu Pai, MD, PhD (@paimadhu) August 5, 2023
Perspective | The paradoxical decline of geriatric medicine as a profession
7 Aug, 2023 | 14:57h | UTCThe Paradoxical Decline of Geriatric Medicine as a Profession – JAMA (free for a limited period)
Commentary on Twitter
Viewpoint: author Jerry Gurwitz discusses the attrition of geriatric medicine as a profession, attributing it in part to societal attitudes about aging and compounded by the negative effects of lower compensation and lack of career prestige. https://t.co/5uydZzMrqS pic.twitter.com/RFY5grczQ4
— JAMA (@JAMA_current) August 4, 2023
USPSTF | Reaffirming the importance of folic acid to all women planning to or who could become pregnant to prevent neural tube defects
4 Aug, 2023 | 12:15h | UTCEvidence Report: Folic Acid Supplementation to Prevent Neural Tube Defects: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force – JAMA
Patient Page: Folic Acid to Prevent Neural Tube Defects – JAMA
Commentary on Twitter
2023 Recommendation Statement from the USPSTF: all persons planning to or who could become pregnant should take a daily supplement containing 0.4 to 0.8 mg (400 to 800 μg) of folic acid (A recommendation). https://t.co/gdavbWyZZ7 pic.twitter.com/2PAjb0OCBO
— JAMA (@JAMA_current) August 1, 2023