Family Medicine
Practical guide to glucocorticoid induced hyperglycemia and diabetes
28 Mar, 2023 | 14:35h | UTCPractical Guide to Glucocorticoid Induced Hyperglycaemia and Diabetes – Diabetes Therapy
Pulmonary hypertension | An update of Dx and Tx guidelines
28 Mar, 2023 | 14:32h | UTCPulmonary hypertension: An update of Dx and Tx guidelines – Journal of Family Practice
Coffee consumption vs. caffeine avoidance: cardiac ectopy, daily steps, and sleep impacts
27 Mar, 2023 | 13:32h | UTCSummary: A prospective, randomized, case-crossover trial studied the acute health effects of caffeinated coffee consumption in 100 ambulatory adults.
Participants were monitored using continuous electrocardiogram devices, wrist-mounted accelerometers, and ongoing glucose monitoring systems for 14 days. They received daily text messages instructing them to either consume caffeinated coffee or abstain from caffeine.
The primary outcome was the mean number of daily premature atrial contractions. Results indicated that caffeinated coffee consumption didn’t lead to significantly more daily premature atrial contractions compared to caffeine avoidance. However, it was associated with a higher number of daily premature ventricular contractions, increased daily steps, and reduced nightly sleep.
Article: Acute Effects of Coffee Consumption on Health among Ambulatory Adults – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries:
What to know about new research on coffee and heart risks – Associated Press
CRAVE Trials Offers Most Comprehensive Overview Yet of Impact of Coffee, Caffeine Intake – HCP Live
Acute Effects of Coffee Consumption on Health – American College of Cardiology
M-A | Examining shorter antibiotic treatment durations for community acquired pneumonia in adults
27 Mar, 2023 | 13:29h | UTCSummary: The systematic review and duration-effect meta-analysis included nine randomized trials with a total of 2,399 patients, analyzing antibiotic treatment durations for community-acquired pneumonia (CAP) in adults. The primary outcome was clinical improvement on day 15, with secondary outcomes including all-cause mortality, serious adverse events, and clinical improvement on day 30.
The study found that shorter treatment durations (3–9 days) were likely to be non-inferior to the standard 10-day treatment, and no significant difference in all-cause mortality or serious adverse events was observed. The study suggests that a 3–5 day treatment duration likely offers the optimal balance between efficacy and treatment burden if patients are clinically stable. However, the results are limited by the small number of included studies, the overall moderate-to-high risk of bias, and the varying severity of CAP among patients in the studies. Therefore, further research focusing on the shorter duration range is required.
Related:
Top POEMs (Patient-Oriented Evidence that Matters) of 2022 for choosing wisely in practice
27 Mar, 2023 | 13:30h | UTCSummary: Top POEMs of 2022 for choosing wisely in practice are based on Canadian Medical Association member ratings. These recommendations promote evidence-based and cost-effective clinical practices while reducing unnecessary treatments and diagnostic procedures.
Key recommendations from the article:
- Hypnotic agents are effective for insomnia but have adverse effects; avoid benzodiazepines as the first choice for older adults.
- For type 2 diabetes in older adults, avoid medications causing hypoglycemia to achieve A1c <7.5%; moderate control is better.
- Postoperative opioids provide no better pain relief than nonopioids; avoid prolonged use beyond the immediate postoperative period.
- Arthroscopic debridement is not recommended as the primary treatment for knee osteoarthritis.
- Proton pump inhibitor (PPI) use is associated with an increased risk of gastric cancer, although the association is observational and does not imply causation. Use the lowest dose and duration possible.
- For children with community-acquired pneumonia, low-dose amoxicillin for 3 days is noninferior to high-dose for 7 days.
- White blood cells in urine do not equate to bacterial cells; avoid urine dip tests or cultures unless urinary tract symptoms are present.
- Avoid measuring vitamin D in low-risk adults as a routine test.
- Antidepressants should not be routinely used as first-line treatment for mild or subsyndromal depressive symptoms in adults.
- ACG guideline for GERD management: try discontinuing PPIs after an 8-week trial in patients with classic GERD symptoms & no alarming symptoms.
- British Society of Gastroenterology guidelines for IBS management: colonoscopy only for alarming signs or microscopic colitis risk.
- USPSTF advises against ASA initiation for primary prevention of cardiovascular disease in adults >60.
Top POEMs of 2022 for choosing wisely in practice – Canadian Family Physician
See complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada
Dissecting coffee’s impact: high consumption lowers blood pressure, raises LDL-cholesterol
27 Mar, 2023 | 13:25h | UTC
SR | Post-tuberculosis sequelae in children and adolescents
27 Mar, 2023 | 13:16h | UTCPost-tuberculosis sequelae in children and adolescents: a systematic review – The Lancet Infectious Diseases (free registration required)
Indian consensus statements on irritable bowel syndrome in adults
27 Mar, 2023 | 13:18h | UTCRelated:
Diet and irritable bowel syndrome: an update from a UK consensus meeting – BMC Medicine
M-A | Efficacy of a restrictive diet in irritable bowel syndrome.
10 mistakes in dietary management of irritable bowel syndrome and how to avoid them.
Supplement: Irritable bowel syndrome and related conditions.
RCT: FODMAPs, but not gluten, elicit modest symptoms of irritable bowel syndrome.
British Society of Gastroenterology guidelines on the management of irritable bowel syndrome
Guidelines for the treatment of irritable bowel syndrome
ACG Clinical Guideline: Management of irritable bowel syndrome
M-A: Efficacy of a low-FODMAP diet in adult irritable bowel syndrome
M-A | Completion, safety, and efficacy of tuberculosis preventive treatment regimens containing rifampicin or rifapentine
27 Mar, 2023 | 13:14h | UTCCompletion, safety, and efficacy of tuberculosis preventive treatment regimens containing rifampicin or rifapentine: an individual patient data network meta-analysis – The Lancet Respiratory Medicine (free registration required)
Invited Commentary: Shorter regimens for tuberculosis preventive treatment: piecing together the global implementation jigsaw – The Lancet Respiratory Medicine (free registration required)
Commentary on Twitter
NEW Research—3HP provided an increase in treatment completion vs 4R but was associated with a higher risk of adverse events. The trade-off between completion and safety must be considered when deciding TPT
From Prof Dick Menzies & colleagues#WorldTBDayhttps://t.co/UY7l9OuI03 pic.twitter.com/GoKnu9BXoi
— The Lancet Respiratory Medicine (@LancetRespirMed) March 24, 2023
Brief Review | Bronchodilators or inhaled corticosteroids for postinfectious cough
27 Mar, 2023 | 13:00h | UTCBronchodilators or inhaled corticosteroids for postinfectious cough – Canadian Family Physician
Epidural-related maternal fever: incidence, pathophysiology, outcomes, and management
24 Mar, 2023 | 13:07h | UTCEpidural-related maternal fever: incidence, pathophysiology, outcomes, and management – American Journal of Obstetrics & Gynecology (free for a limited period)
Commentary on Twitter
AJOG Expert Review in Labor: Epidural-related maternal fever: incidence, pathophysiology, outcomes and management – Proposed mechanisms of sterile inflammation resulting in epidural-related maternal fever https://t.co/iTaQTKBlc3 pic.twitter.com/z0yrxzoMlh
— AJOG (@AJOG_thegray) March 19, 2023
Role of sleep in peripheral artery disease risk: Insights from cohort and mendelian randomization studies
24 Mar, 2023 | 13:01h | UTCNews Release: Short night-time sleep linked with nearly doubled risk of clogged leg arteries – European Society of Cardiology
Study reveals overuse of surveillance colonoscopy in older adults with limited life expectancy
23 Mar, 2023 | 13:11h | UTCSummary: This study investigated the association between estimated life expectancy, surveillance colonoscopy findings, and follow-up recommendations among older adults. The study utilized data from the New Hampshire Colonoscopy Registry and included adults over 65 who underwent colonoscopy for surveillance after prior polyps.
Life expectancy was estimated using a validated prediction model and categorized into three groups: less than 5 years, 5 to less than 10 years, and 10 or more years.
Out of the 9,831 adults included in the study, 8% had advanced polyps or CRC. Among the 5,281 patients with available recommendations, 86.9% were advised to return for a future colonoscopy. Surprisingly, 58.1% of older adults with less than 5 years of life expectancy were also recommended to return for future surveillance colonoscopy.
The study concluded that many older adults with limited life expectancy are still recommended for future surveillance colonoscopy. This data could help refine decision-making about pursuing or stopping surveillance colonoscopy in older adults with a history of polyps.
Article: Association of Life Expectancy With Surveillance Colonoscopy Findings and Follow-up Recommendations in Older Adults – JAMA Internal Medicine (link to abstract – $ for full-text)
JAMA Patient Page: What Should I Know About Stopping Routine Cancer Screening?
Commentary on Twitter
Findings suggest that recommending against future surveillance colonoscopy in older adults with low-risk colonoscopy findings and/or limited life expectancy should be considered more frequently than is currently practiced. https://t.co/7jKpYyuZON
— JAMA Internal Medicine (@JAMAInternalMed) March 13, 2023
Cohort Study | Opioid use for pain relief after birth appears to pose no significant risk to breastfed infants
23 Mar, 2023 | 13:08h | UTCSummary: This large study from Canada found that infants born to mothers prescribed opioids after delivery, mainly following a cesarean, are at no greater risk of harm shortly after birth than infants of mothers not prescribed opioids. This suggests that breastfeeding is likely safe for babies whose mothers are taking opioids for pain relief.
The study included 865,691 mother-infant pairs discharged from Ontario hospitals within seven days of delivery between September 2012 and March 2020. Researchers matched mothers who filled an opioid prescription within seven days of discharge to those who did not.
Among the infants admitted to the hospital within 30 days, 2,962 (3.5%) were born to mothers who filled an opioid prescription compared with 3,038 (3.5%) born to mothers who did not, showing that infants of mothers prescribed opioids were no more likely to be admitted to the hospital for any reason. These children were only marginally more likely to visit the emergency department in the subsequent 30 days, and no differences were found for other serious outcomes, including breathing problems or admission to a neonatal intensive care unit, and no infant deaths occurred.
Although the study has some limitations, the high initial breastfeeding rates in Canada (90%) and the consistency of the findings with the fact that millions of new mothers are prescribed opioids after delivery each year provide confidence in the conclusions.
Editorial: Opioid analgesia for breastfeeding mothers – The BMJ
News Release: Infants of mothers given opioids after birth are at low risk of harm – BMJ Newsroom
Cohort Study | Retinal artery occlusion linked to a 7-fold higher mortality rate from CV and cerebrovascular diseases
23 Mar, 2023 | 13:04h | UTCSummary: This nationwide cohort study analyzed the incidence of retinal artery occlusion (RAO) in Korea from 2002 to 2018, along with related mortality and causes of death. The incidence of RAO was found to be 7.38 per 100,000 person-years, with a higher incidence of noncentral RAO compared to central RAO.
Patients with RAO had a mortality rate about 7 times higher than the general population, primarily due to cardiovascular or cerebrovascular diseases. The findings emphasize the need to address the risk of cardiovascular or cerebrovascular disease in patients newly diagnosed with RAO.
Invited Commentary: Long-term Management Considerations for Retinal Artery Occlusion and Cardiovascular and Cerebrovascular Mortality – JAMA Network Open
RCT | Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause
23 Mar, 2023 | 13:01h | UTCFezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1): a phase 3 randomised controlled study – The Lancet (link to abstract – $ for full-text)
Commentary on Twitter (thread – click for more)
70% of women experience hot flushes or night sweats during #menopause.
A new study investigates the role Fezolinetant, a non-hormonal treatment, could play in reducing these symptoms. https://t.co/zv4b9WU03h
— The Lancet (@TheLancet) March 15, 2023
RCT | Impact of sleep deprivation on health-related quality of life in healthy children
23 Mar, 2023 | 12:57h | UTCCommentaries:
Sleep Disruption Linked to Lower HRQOL in Children – HealthDay
How just 39 minutes of sleep can make or break your child’s health, happiness and school day – CNN
An evidence-based guide to the efficacy and safety of isometric resistance training in hypertension
23 Mar, 2023 | 12:42h | UTC
Cohort Study | Infertility in women linked to increased risk of cardiovascular disease
23 Mar, 2023 | 12:39h | UTC
Commentary on Twitter
Women with infertility may have greater risk of #coronary #heart #disease, especially those diagnosed with #ovulation disorders/#endometriosis. #AHAJournals #GoRedforWomen @l_farland https://t.co/Izaloav4Np pic.twitter.com/Iqn4eQexJL
— JAHA (@JAHA_AHA) February 27, 2023
M-A | Effects of dairy intake on markers of cardio-metabolic health in adults
23 Mar, 2023 | 12:35h | UTC
Commentary on Twitter
Working with results of 19 randomized controlled trials (1427 total participants), #AdvNutr review authors conclude "high dairy intake (irrespective of fat content) showed no detrimental effects on anthropometric outcomes, blood lipids and blood pressure." https://t.co/59EiLeTW6g pic.twitter.com/ApVtfmfpsL
— American Society for Nutrition Journals (@jnutritionorg) March 13, 2023
M-A | eHealth-based psychosocial interventions for adults with insomnia
23 Mar, 2023 | 12:31h | UTC
AHA Scientific Statement | Supervised exercise training for chronic heart failure with preserved ejection fraction
22 Mar, 2023 | 13:46h | UTCNews Release: Exercise therapy is safe, may improve quality of life for many people with heart failure – American Heart Association
Key Points: Supervised Exercise Training for Chronic HFpEF – American College of Cardiology
Exploratory analysis | Hypoglycemia incidence is lower with linagliptin vs. glimepiride in patients with early type 2 DM
22 Mar, 2023 | 13:15h | UTC
RCT | Electronic nudges resulted in modest increase in influenza vaccination uptake in older adults
22 Mar, 2023 | 13:10h | UTCElectronic nudges to increase influenza vaccination uptake in Denmark: a nationwide, pragmatic, registry-based, randomised implementation trial – The Lancet (link to abstract – $ for full-text)
News Release: Electronic Messages Improved Influenza Vaccination Rates in Nationwide Danish Study – Brigham and Women’s Hospital
Commentary: Linking Flu Vaccine to Cardiovascular Benefit Could Increase Uptake in Older Adults – HCP Live
Review | Graves’disease in children
22 Mar, 2023 | 13:08h | UTCGraves’ disease: moving forwards – Archives of Disease in Childhood