Family Medicine
M-A | Efficacy of flash glucose monitoring in type 1 and type 2 diabetes
5 Apr, 2023 | 12:46h | UTC
RCT | Mindfulness therapy proves more effective and affordable than cognitive behavioral therapy for depression
4 Apr, 2023 | 14:04h | UTCSummary: The LIGHTMind Randomized Clinical Trial studied 410 adults with mild to moderate depression, comparing the clinical effectiveness and cost-effectiveness of practitioner-supported mindfulness-based cognitive therapy self-help (MBCT-SH) to practitioner-supported cognitive behavioral therapy self-help (CBT-SH). The trial provided participants with either an MBCT-SH or CBT-SH workbook and six support sessions with a trained practitioner. Depressive symptom severity was measured using the Patient Health Questionnaire (PHQ-9) score at 16 weeks after randomization.
Results showed that MBCT-SH led to significantly greater reductions in depressive symptoms and was more cost-effective than CBT-SH. The between-group difference was 1.5 PHQ-9 points, and MBCT-SH cost health services £526 ($631) less per participant over a 42-week follow-up period. A substantial portion of this cost difference was due to additional face-to-face individual psychological therapy accessed by CBT-SH participants outside of the study intervention.
The trial concluded that offering practitioner-supported MBCT-SH for mild to moderate depression could improve outcomes and save money compared to CBT-SH. To translate these findings into practice, proper training and supervision for practitioners delivering MBCT-SH are necessary. Future research should focus on corroborating and extending these findings, exploring factors contributing to MBCT-SH’s relative effectiveness, and examining potential barriers and facilitators for successful implementation in routine clinical practice.
Commentary:
Mindfulness better than CBT for treating depression, study finds – The Guardian
Practitioner-Supported Mindfulness-Based Cognitive Therapy Aids Depression – HealthDay
Commentary on Twitter
Practitioner-supported mindfulness-based cognitive therapy self-help for mild-moderate depression is clinically- and cost-effective compared to currently recommended practitioner-support CBT self-help. https://t.co/H23AfwiO7X pic.twitter.com/xTHzYG4oqg
— JAMA Psychiatry (@JAMAPsych) March 22, 2023
RCT | No significant fracture reduction from monthly 60,000 IU vitamin D3 supplementation
4 Apr, 2023 | 13:58h | UTCThe effect of monthly vitamin D supplementation on fractures: a tertiary outcome from the population-based, double-blind, randomised, placebo-controlled D-Health trial – The Lancet Diabetes & Endocrinology (link to abstract – $ for full-text)
Related:
RCT | Supplemental Vitamin D does not reduce incident fractures in midlife and older adults.
Contrary to prior studies, new research finds no heightened postoperative risk after a recent covid-19 infection
4 Apr, 2023 | 13:54h | UTCCommentaries:
COVID infection within 60 days not tied to adverse postsurgical outcomes – CIDRAP
Adverse Postoperative Outcomes Not Increased With Recent COVID-19 – HealthDay
Related:
ASA and APSF statement on perioperative testing for the COVID-19 virus.
Guideline: SARS‐CoV‐2 infection, COVID‐19 and timing of elective surgery
BJS commission on surgery and perioperative care post-COVID-19.
ASA Guidance: Preoperative testing for COVID-19 is essential, regardless of vaccination.
Position statement: Perioperative management of post-COVID-19 surgical patients.
M-A | Rapid antigen-based and rapid molecular tests for the detection of SARS-CoV-2
4 Apr, 2023 | 13:52h | UTCRelated:
Interpreting a lateral flow SARS-CoV-2 antigen test – The BMJ
RCT | Vitamin D supplementation shows no significant impact on psoriasis severity
4 Apr, 2023 | 13:51h | UTCSummary: In a randomized, double-blind, placebo-controlled clinical trial involving 122 participants with plaque psoriasis, researchers investigated the effects of vitamin D supplementation on psoriasis severity during winter. Participants received either vitamin D (cholecalciferol, 100,000 IU loading dose followed by 20,000 IU/week) or a placebo for four months. The primary outcome was Psoriasis Area Severity Index (PASI) scores, with secondary outcomes including Physician Global Assessment, self-administered PASI, and Dermatology Life Quality Index scores.
The study found no significant difference in PASI scores or secondary outcomes between the two groups. The results suggest that vitamin D supplementation does not affect psoriasis severity. However, low baseline severity scores and a lower than expected increase in 25-hydroxyvitamin D levels in the intervention group may have influenced the findings, indicating that further research may be needed to account for these factors.
Article: Effect of Vitamin D Supplementation on Psoriasis Severity in Patients With Lower-Range Serum 25-Hydroxyvitamin D Levels: A Randomized Clinical Trial – JAMA Dermatology (free for a limited period)
Commentary on Twitter
This RCT, performed in North-Norway, found no measurable effect of vitamin D supplementation on psoriasis severity during winter. Low baseline severity, & lower-than-expected rise in 25(OH)D levels in intervention group, may have affected the results. https://t.co/ip17uFQsgM
— JAMA Dermatology (@JAMADerm) March 29, 2023
M-A | No significant health benefits found for low-volume alcohol intake
4 Apr, 2023 | 13:48h | UTCSummary: This systematic review and meta-analysis aimed to investigate the association between alcohol use and all-cause mortality, taking into account potential sources of bias. The study analyzed data from 107 cohort studies published between January 1980 and July 2021, which included 4,838,825 participants and 425,564 deaths.
The study found no significant reductions in all-cause mortality risk for drinkers who consumed less than 25 grams of ethanol per day compared to lifetime nondrinkers. However, there was a significantly increased risk of all-cause mortality among female drinkers who drank 25 or more grams per day and male drinkers who drank 45 or more grams per day.
The analysis highlighted the importance of controlling for former drinker bias and misclassification errors and found sex differences in the risk of all-cause mortality.
In conclusion, the updated meta-analysis found no significantly reduced risk of all-cause mortality associated with low-volume alcohol consumption after adjusting for potential confounding factors. The study recommends that future longitudinal studies in this field should attempt to minimize lifetime selection biases by not including former and occasional drinkers in the reference group and by using younger cohorts at baseline.
Commentary: Drinking Alcohol Brings No Health Benefits, Study Finds – HealthDay
Related:
Prioritising action on alcohol for health and development – The BMJ
Cohort study | Younger stroke survivors show elevated cancer risk for up to 8 years
4 Apr, 2023 | 13:46h | UTCSummary: In this cohort study, 390,398 patients aged 15 years or older in the Netherlands, without a history of cancer and with a first-ever ischemic stroke or intracerebral hemorrhage (ICH), were analyzed between January 1, 1998, and January 1, 2019. The primary outcome was the cumulative incidence of first-ever cancer after the index stroke, stratified by stroke subtype, age, and sex, compared with age-, sex-, and calendar year-matched peers from the general population.
The findings revealed that, in the first year after a stroke, patients aged 15 to 49 years had a 3- to 5-fold increased risk of cancer compared to individuals without a stroke. In contrast, the risk was only slightly elevated for patients aged 50 years or older. The cancer risk remained elevated for up to 8 years after an ischemic stroke and 6 years after an ICH in the younger age group, with the highest risks observed for lung cancer, gastrointestinal cancer, and hematologic cancer.
The findings may be confounded by shared risk factors, such as smoking. Alternatively, the increased cancer risk may have a causal mechanism between cancer and stroke, possibly related to the hypercoagulable state induced by cancer. However, the study design does not allow for conclusions about causal mechanisms, and the researchers called for further studies investigating the usefulness of cancer screening after a stroke.
Cross-sectional study | Association between sodium intake and coronary and carotid atherosclerosis
4 Apr, 2023 | 13:42h | UTCEditorial: Dietary salt intake and atherosclerosis: an area not fully explored – European Heart Journal Open
News Release: High salt diet associated with hardened arteries even in people with normal blood pressure – European Society of Cardiology
Cochrane Library | Hearing conditions: evidence, experience and resources
4 Apr, 2023 | 13:36h | UTCHearing conditions: evidence, experience and resources – Evidently Cochrane
Two FITs better than one: enhancing diagnostic performance for colorectal cancer in symptomatic populations
4 Apr, 2023 | 13:32h | UTC
Cohort Study | Preoperative depression has minimal impact on 5-year bariatric surgery outcomes
4 Apr, 2023 | 13:23h | UTC
AHA Scientific Statement | Pediatric primary hypertension: An underrecognized condition
3 Apr, 2023 | 14:05h | UTCTop Things to Know: Pediatric Primary Hypertension: An Underrecognized Condition – American Heart Association
News Release: Children with high blood pressure often become adults with high blood pressure – American Heart Association
Commentaries:
The Birth of Pediatric Primary Hypertension – American Heart Association
AHA Highlights Pediatric Hypertension in Scientific Statement – HCP Live
M-A | Mediterranean & low-fat diets may reduce mortality and non-fatal MI in patients with high cardiovascular risk
3 Apr, 2023 | 13:59h | UTCSummary: This systematic review and network meta-analysis aimed to determine the relative efficacy of different diets for preventing mortality and major cardiovascular events in patients at increased risk of cardiovascular disease. The study identified 40 randomized trials with 35,548 participants across seven dietary programs.
Moderate certainty evidence showed that Mediterranean and low-fat diets, with or without physical activity or other interventions, reduced all-cause mortality and non-fatal myocardial infarction in patients with increased cardiovascular risk. Mediterranean diet programs were also likely to reduce stroke risk.
Other dietary programs generally were not superior to minimal intervention. When compared with one another, no convincing evidence was found that the Mediterranean diet was superior to the low-fat diets in preventing mortality or non-fatal myocardial infarction.
News Release: Benefits of Mediterranean and low fat diet programmes in patients at risk of cardiovascular disease – BMJ Newsroom
Commentary: Mediterranean, Low-Fat Diets Both Good for Health: Network Meta-analysis – TCTMD
SR | Adding ultrasound to mammography increases breast cancer detection, but increases false-positives and biopsies
3 Apr, 2023 | 13:55h | UTCSummary: The systematic review examined the effectiveness and safety of combining mammography with breast ultrasonography versus mammography alone for breast cancer screening in women at average risk. The research included one randomized controlled trial, two prospective cohort studies, and five retrospective cohort studies, involving a total of 209,207 women.
High certainty evidence from one trial indicated that combining mammography with ultrasonography led to the detection of more breast cancer cases than mammography alone (5 vs. 3 per 1000 women). However, this combination also led to a higher number of false-positive results and biopsies. For every 1000 women screened with the combined approach, 37 more received a false-positive result, and 27 more women underwent a biopsy.
Secondary analysis of the trial data revealed that in women with dense breasts, the combined screening detected more cancer cases than mammography alone, while cohort studies for women with non-dense breasts showed no statistically significant difference between the two screening methods.
The included studies did not analyze whether the higher number of detected cancers with the combined screening method resulted in lower mortality rates compared to mammography alone. Further research, including randomized controlled trials or prospective cohort studies with longer observation periods, is needed to assess the impact of the two screening interventions on morbidity and mortality.
Cohort Study | Infections requiring hospitalization linked to increased short- and long-term cardiovascular risks
3 Apr, 2023 | 13:57h | UTCSummary: The study examined the association between severe infections and the risk of cardiovascular disease in people without prior cardiovascular issues. Data from 331,683 UK Biobank participants and 271,533 Finnish participants were analyzed. Cardiovascular risk factors were measured at baseline, and infectious diseases and subsequent cardiovascular events were diagnosed through the linkage of participants to hospital and mortality registers.
Results showed that hospitalization for infection was associated with an increased risk of major cardiovascular events, regardless of the type of infection. The risk was highest during the first month after infection, with hazard ratios of 7.87 and 7.64 in the UK Biobank and Finnish cohorts, respectively. However, the risk remained elevated throughout the follow-up period, with hazard ratios of 1.47 in the UK Biobank and 1.41 in the Finnish cohort.
The study suggests that severe infections requiring hospital treatment are associated with increased risks for major cardiovascular disease events both immediately after hospitalization and in the long-term. However, it is important to note that residual confounding cannot be excluded, and further research is needed to establish causality.
Article: Severe Infection and Risk of Cardiovascular Disease: A Multicohort Study – Circulation
Commentary: Severe Infections Linked to a Variety of CV Events, Both Acute and Long-term – TCTMD
Commentary on Twitter
#OriginalResearch: In this multicohort study, hospital-treated infections associated w/ significant increase in short-term risk and modest long-term risk of major CVD events. @MikaKivimaki @nellimarikki@PyrySipila #AHAJournals https://t.co/51JSJkS6l4 pic.twitter.com/U21U2IgYCO
— Circulation (@CircAHA) March 29, 2023
Lateral flow devices maintain detection sensitivity across Alpha, Delta, and Omicron waves
3 Apr, 2023 | 13:53h | UTCSummary: The study assessed the performance of antigen lateral flow devices (LFDs) during the alpha, delta, and omicron waves of the SARS-CoV-2 pandemic in the UK. Researchers aimed to understand LFD performance concerning changes in variant infections, vaccination, viral load, and LFD use, as well as the devices’ ability to detect infectious individuals. Paired LFD and RT-PCR test results were collected from both asymptomatic and symptomatic participants between November 2020 and March 2022.
When compared to RT-PCR testing, the overall LFD sensitivity was 63.2%, and specificity was 99.71%. The sensitivity was higher in symptomatic participants (68.7%) than in asymptomatic participants (52.8%). The study found that increased viral load was independently associated with a higher likelihood of being LFD positive. There was no evidence of a significant difference in LFD sensitivity between the alpha and delta variants, but sensitivity increased during the omicron wave. Vaccination status did not show an independent association with LFD sensitivity.
The study concluded that LFDs can detect most SARS-CoV-2 infections across different viral variants and during vaccine roll-out, contributing to reduced transmission risk. However, LFD performance is lower in asymptomatic individuals, which should be taken into account when designing testing programs.
Invited Commentary: The performance of rapid antigen tests against SARS-CoV-2 variants – The Lancet Infectious Diseases
Related:
Interpreting a lateral flow SARS-CoV-2 antigen test – The BMJ
Review | Dysfunctional labor and delivery: adverse effects on offspring
3 Apr, 2023 | 13:36h | UTCDysfunctional labor and delivery: adverse effects on offspring – American Journal of Obstetrics & Gynecology (free for a limited period)
Perspective | Teen girls are faring worse than boys on nearly all mental health measures—here’s why
3 Apr, 2023 | 13:33h | UTCTeen Girls Are Faring Worse Than Boys on Nearly All Mental Health Measures—Here’s Why – JAMA (free for a limited period)
Commentary on Twitter
The latest @CDCgov Youth Risk Behavior Survey, administered in 2021, shows that mental health has worsened for all adolescents, but especially for girls. Nearly a third of teen girls said they seriously considered suicide. https://t.co/gVHoLYtI5b #MedicalNews
— JAMA (@JAMA_current) March 28, 2023
Assessment of childhood short stature: a GP guide
3 Apr, 2023 | 13:28h | UTCAssessment of childhood short stature: a GP guide – British Journal of General Practice (free for a limited period)
Cohort Study | Associations between fetal or infancy pet exposure and food allergies
3 Apr, 2023 | 13:26h | UTC
Postoperative delirium’s linked to long-term cognitive decline in elderly patients
3 Apr, 2023 | 13:20h | UTCPostoperative Delirium’s linked to Long-term Cognitive Decline in Elderly Patients – JAMA Internal Medicine (link to abstract – $ for full-text)
News Release: Developing postoperative delirium associated with a faster rate of cognitive decline, says study – EurekAlert
Commentary: Postoperative Delirium Associated With Accelerated Cognitive Decline, Study Finds – Psychiatric News Alert
Commentary on Twitter
Delirium associated with accelerated cognitive decline that continued for 72 months following the index delirium episode; it's uncertain if delirium causes cognitive decline or if pts with preclinical brain disease are more likely to develop delirium. https://t.co/ADz7yxEZiP
— JAMA Internal Medicine (@JAMAInternalMed) March 20, 2023
Perspective | Should case management be considered a component of obstetrical interventions for pregnancies at risk of preterm birth?
3 Apr, 2023 | 13:18h | UTC
Commentary on Twitter
https://twitter.com/AJOG_thegray/status/1641380390735687680
Assessing heart failure risk: waist-to-height ratio outperforms BMI in HFrEF patients
31 Mar, 2023 | 13:49h | UTCCommentary: Study Debunks Obesity Paradox in HF, Encourages BMI Alternatives – TCTMD
RCT | Early postpartum IUD placement noninferior vs. placement at 6-8 weeks for complete expulsion, but not for partial expulsion
31 Mar, 2023 | 13:48h | UTCEarly vs Interval Postpartum Intrauterine Device Placement: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
News Release: Study: Risk of IUD Expulsion in Early Postpartum Placement – UC San Diego Health
Commentary: IUD Placement at Two to Four Weeks Postpartum Noninferior – HealthDay
Related:
Commentary on Twitter
Early IUD placement at 2 to 4 weeks postpartum compared with 6 to 8 weeks postpartum was noninferior for complete expulsion, but not partial expulsion. https://t.co/VMfWce3JJd pic.twitter.com/vdLrhCXa5Q
— JAMA (@JAMA_current) March 23, 2023