Editor's Choice
Cluster RCT | Early detection and treatment bundle reduces postpartum hemorrhage complications
16 May, 2023 | 15:02h | UTCSummary: An international, cluster-randomized trial assessed the effectiveness of a multicomponent clinical intervention for postpartum hemorrhage in patients having vaginal delivery. The study involved 80 secondary-level hospitals across Kenya, Nigeria, South Africa, and Tanzania, with 210,132 patients. The intervention group utilized a calibrated blood-collection drape for early detection of postpartum hemorrhage and a first-response treatment bundle, while the control group received usual care.
The primary outcome measured was a composite of severe postpartum hemorrhage (blood loss ≥1000 ml), laparotomy for bleeding, or maternal death from bleeding. The results showed a significant reduction in primary-outcome events in the intervention group (1.6%) compared to the usual-care group (4.3%) with a risk ratio of 0.40 (95% CI, 0.32 to 0.50; P<0.001). Postpartum hemorrhage detection rates were 93.1% and 51.1% in the intervention and usual-care groups, respectively, and treatment bundle adherence was 91.2% and 19.4%, respectively.
These findings demonstrate that early detection of postpartum hemorrhage and the use of a bundled treatment approach can significantly reduce the risk of severe postpartum hemorrhage, laparotomy for bleeding, or death from bleeding among patients having vaginal delivery. The results have important implications for improving clinical practice and reducing postpartum hemorrhage complications globally.
Article: Randomized Trial of Early Detection and Treatment of Postpartum Hemorrhage – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Lifesaving solution dramatically reduces severe bleeding after childbirth – World Health Organization
Commentary on Twitter
In a large, cluster-randomized trial involving patients with PPH after vaginal delivery, a multicomponent intervention lowered the risk of severe PPH, laparotomy for bleeding, or maternal death from bleeding. Full results of the E-MOTIVE trial: https://t.co/NjcE4Q1rxM#IMNHC2023
— NEJM (@NEJM) May 9, 2023
Practice Guidance | Differential diagnosis of suspected COPD exacerbations in the acute care setting
15 May, 2023 | 13:26h | UTC
Commentary on Twitter
Differential Diagnosis of Suspected Chronic Obstructive Pulmonary Disease Exacerbations in the Acute Care Setting: Best Practice
🔓 Open Access
🔗 https://t.co/aPiT06E2g4 pic.twitter.com/kF40aSS7Oo— ATS Blue Journal (@ATSBlueEditor) May 12, 2023
Canadian Task Force advises fragility fracture screening for women over 65, but not for men or younger women
15 May, 2023 | 13:23h | UTCRelated USPSTF Statement: Screening Osteoporosis to Prevent Fractures
Guideline | Acute dizziness and vertigo in the emergency department
15 May, 2023 | 13:25h | UTC
RCT | Rivaroxaban doesn’t reduce thrombotic events, hospitalization, or death in outpatients with COVID-19
15 May, 2023 | 13:19h | UTCSummary: The PREVENT-HD trial, a double-blind, placebo-controlled randomized study, was conducted to evaluate the effectiveness of prophylactic anticoagulation in reducing venous and arterial thrombosis, hospitalization, and death in nonhospitalized patients with symptomatic COVID-19 and at least one thrombosis risk factor. The trial took place between August 2020 and April 2022 across 14 US integrated healthcare delivery networks, with 1,284 patients enrolled and randomly assigned to receive either 10 mg of oral rivaroxaban or placebo daily for 35 days.
However, the study was terminated prematurely due to enrollment challenges and lower-than-expected event rates. The primary efficacy outcome, a composite of various hazardous events, occurred in 3.4% of the rivaroxaban group and 3.0% of the placebo group, with no significant difference between the two groups (hazard ratio, 1.16 [95% CI, 0.63–2.15]; P=0.63). No critical-site or fatal bleeding was observed, and only one patient in the rivaroxaban group experienced a major bleed.
In conclusion, rivaroxaban prescribed for 35 days in nonhospitalized patients with symptomatic COVID-19 at risk for thrombosis does not appear to reduce the composite end point of venous and arterial thrombotic events, hospitalization, and death. The study’s premature termination and lower-than-expected event rates may limit the generalizability of these findings.
Commentary on Twitter
#OriginalArticle: In this #RCT, Rivaroxaban did not appear to reduce a composite endpoint of venous and arterial thrombotic events, hospitalization, and death among non‐hospitalized patients with symptomatic COVID‐19 #AHAJournals https://t.co/PhdXnTJ0V9 pic.twitter.com/f04uYu2M5f
— Circulation (@CircAHA) May 10, 2023
RCT | Prophylactic antibiotics show no statistically significant survival improvement in severe alcohol-related hepatitis
15 May, 2023 | 13:21h | UTCSummary: This multicenter, randomized, double-blind clinical trial aimed to determine the efficacy of amoxicillin-clavulanate combined with prednisolone compared to placebo combined with prednisolone on mortality in patients hospitalized with severe alcohol-related hepatitis. The study involved 284 patients from 25 centers in France and Belgium with biopsy-proven severe alcohol-related hepatitis, who were followed up for 180 days.
The primary outcome was all-cause mortality at 60 days, while secondary outcomes included mortality at 90 and 180 days, infection rates, hepatorenal syndrome, and changes in Model for End-stage Liver Disease (MELD) and Lille scores. The results showed no statistically significant difference in 60-day mortality between the two groups, with 17.3% in the amoxicillin-clavulanate group and 21.3% in the placebo group. However, infection rates at 60 days were significantly lower in the amoxicillin-clavulanate group compared to the placebo group.
It is worth noting that the study may have been underpowered, as the absolute risk difference of 4% did not achieve statistical significance. In conclusion, the combination of amoxicillin-clavulanate and prednisolone did not show a statistically significant improvement in 2-month survival in patients hospitalized with severe alcohol-related hepatitis compared to prednisolone alone. These findings do not support the use of prophylactic antibiotics to improve survival in this patient population, but the potential underpowered nature of the study should be considered.
Article: Effect of Prophylactic Antibiotics on Mortality in Severe Alcohol-Related Hepatitis: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Commentary on Twitter
Among patients with severe alcohol-related #hepatitis receiving prednisolone, amoxicillin-clavulanate did not improve survival at 60-day follow-up compared with placebo. https://t.co/4XkVL2CTsP #DDW pic.twitter.com/9sh5vennkK
— JAMA (@JAMA_current) May 9, 2023
RCT | Cognitive behavioral therapy proves effective for severe post-COVID-19 fatigue
15 May, 2023 | 13:16h | UTCNews Release: Cognitive behavioral therapy lessens post-viral fatigue after COVID-19 – Amsterdam UMC
Commentary on Twitter
Efficacy of Cognitive Behavioral Therapy Targeting Severe Fatigue Following COVID-19: Results of a Randomized Controlled Trial
✅ Just Accepted
🔓 Open Access@amsterdamUMChttps://t.co/P1jwLOcfvw— Clinical Infectious Diseases (@CIDJournal) May 13, 2023
Hoarding disorder: evidence and best practice in primary care
12 May, 2023 | 13:45h | UTCHoarding disorder: evidence and best practice in primary care – British Journal of General Practice
News Release: New guidance to help diagnose hoarding disorder – Anglia Ruskin University
M-A | Endovascular therapy for stroke presenting beyond 24 hours
12 May, 2023 | 13:44h | UTC
Commentary on Twitter
Endovascular therapy for stroke presenting at >24 hours was associated with favorable clinical, safety, and procedural outcomes in this meta-analysis of 569 patients. https://t.co/DjoDDcr1mf
— JAMA Network Open (@JAMANetworkOpen) May 4, 2023
Cohort Study | Adverse outcomes and rehospitalization more common for young women after acute myocardial infarction
11 May, 2023 | 12:18h | UTCSex Difference in Outcomes of Acute Myocardial Infarction in Young Patients – Journal of the American College of Cardiology (link to abstract – $ for full-text)
News Releases:
Commentaries:
Rehospitalizations After Acute MI: Young Women Outpace Young Men – TCTMD
Commentary on Twitter
Young women with #AMI face higher risk for repeat hospitalization after discharge compared to men. https://t.co/QC9NjCflnU#JACC #cvAMI #VIRGO #WomensHealth @MitsuakiSawano @hmkyale pic.twitter.com/iHorGCDoDF
— JACC Journals (@JACCJournals) May 6, 2023
A review of bicarbonate use in common clinical scenarios
11 May, 2023 | 12:17h | UTCA Review of Bicarbonate Use in Common Clinical Scenarios – The Journal of Emergency Medicine
FDA approves first Respiratory Syncytial Virus (RSV) vaccine
11 May, 2023 | 12:15h | UTCFDA Approves First Respiratory Syncytial Virus (RSV) Vaccine – U.S. Food & Drug Administration
Commentary: US FDA Approves First-Ever RSV Vaccine – Health Policy Watch
Ear-related balance disorders: evidence and resources
11 May, 2023 | 12:14h | UTCEar-related balance disorders: evidence and resources – Evidently Cochrane
Blood pressure variability in clinical practice: past, present and the future
11 May, 2023 | 12:13h | UTC
Care plan for individuals at risk for preeclampsia: shared approach to education, strategies for prevention, surveillance and follow up
10 May, 2023 | 16:04h | UTCCommentary: Care Plan Developed for Individuals at Risk for Preeclampsia – HealthDay
Review | Diagnosis and management of cirrhosis and its complications
10 May, 2023 | 16:06h | UTCDiagnosis and Management of Cirrhosis and Its Complications: A Review – JAMA (free for a limited period)
Author Interview: Management of Cirrhosis in 2023
M-A | Association of SARS-CoV-2 vaccination or infection with Bell palsy
10 May, 2023 | 16:03h | UTC
Single-arm study | Halting endocrine therapy for pregnancy not linked to increased breast cancer events vs. a control cohort
10 May, 2023 | 16:01h | UTCInterrupting Endocrine Therapy to Attempt Pregnancy after Breast Cancer – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter
In women with previous breast cancer who temporarily discontinued adjuvant endocrine therapy to attempt pregnancy, the frequency of breast cancer events was below the prespecified safety threshold and similar to that in controls (POSITIVE trial). https://t.co/zM3f4SbgjE
— NEJM (@NEJM) May 3, 2023
FDA warns of use of selective androgen receptor modulators (SARMs) among teens, young adults
10 May, 2023 | 16:00h | UTCCommentaries:
FDA issues warning for bodybuilding products marketed to teens, young adults – AAP News
Young Men Are Using Banned ‘SARM’ Supplements to Bulk Up, With Harmful Results – HealthDay
RCT | Cognitive functional therapy with or without biofeedback outperforms usual care for chronic low back pain relief
10 May, 2023 | 15:58h | UTCCognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial – The Lancet (link to abstract – $ for full-text)
News Release: Fresh hope for Australians living with chronic back pain – Curtin University
Consensus Statement | Comprehensive type 2 diabetes management algorithm – 2023 update
9 May, 2023 | 15:10h | UTCRelated: Guideline | ADA 2023 Standards of Medical Care in Diabetes
Consensus | Addressing stigma/bias in diagnosing, managing obesity-based chronic disease, and evaluating determinants of severity
9 May, 2023 | 15:08h | UTC
Study shows unenhanced CT shows 30% lower diagnostic accuracy in abdominal pain evaluation
9 May, 2023 | 15:02h | UTCDiagnostic Accuracy of Unenhanced Computed Tomography for Evaluation of Acute Abdominal Pain in the Emergency Department – JAMA Surgery (free for a limited period)
Editorial: Intravenous Contrast in Computed Tomography Imaging for Acute Abdominal Pain – JAMA Surgery (free for a limited period)
Commentary: New data suggest clinicians should think twice before foregoing contrast-enhanced imaging – Health Imaging
Commentary on Twitter
In a general population of emergency department patients with abdominal pain, using unenhanced CT to avoid risks of intravenous contrast medium administration is associated with a large diagnostic penalty. https://t.co/CVg04763yd
— JAMA Surgery (@JAMASurgery) May 3, 2023
Video | Keeping up with the literature: special discussion of masking evidence
9 May, 2023 | 14:56h | UTCKeeping up with the literature | Special discussion of Masking Evidence
RCT | Early treatment of gestational diabetes slightly lowers risk of adverse neonatal outcomes
9 May, 2023 | 14:55h | UTCTreatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy – New England Journal of Medicine (link to abstract – $ for full-text)
News Release: Early treatment of gestational diabetes for those at higher risk beneficial, study finds – Western Sidney University