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Internal Medicine

RCT: No difference in ICU length of stay or 90-day mortality between tight and liberal glucose control

2 Oct, 2023 | 11:25h | UTC

Study 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.

Article: Tight Blood-Glucose Control without Early Parenteral Nutrition in the ICU – New England Journal of Medicine


RCT: Propafenone leads to quicker sinus rhythm restoration than amiodarone in supraventricular arrhythmias related to septic shock

1 Oct, 2023 | 15:19h | UTC

Study 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.

Article: Balik, M., Maly, M., Brozek, T. et al. Propafenone versus amiodarone for supraventricular arrhythmias in septic shock: a randomised controlled trial. Intensive Care Med (2023)


Commentary on Twitter:


Crossover RCT | Using one-size cuff results in major inaccuracy in BP readings across varying arm sizes

11 Aug, 2023 | 15:41h | UTC

Effects of Cuff Size on the Accuracy of Blood Pressure Readings: The Cuff(SZ) Randomized Crossover Trial – JAMA Internal Medicine (free for a limited period)


When it comes to blood pressure cuffs, size matters –

One-size-fits-all blood pressure cuffs ‘strikingly inaccurate,’ study says – CNN


Brief Review | Why is cuff size so important and other factors that affect accurate blood pressure measurement

[News release – not published yet] Study finds blood pressure cuff size matters, affects blood pressure readings


Commentary on Twitter


Perspective | Clinicians debate the usefulness of NAFLD name change

11 Aug, 2023 | 15:39h | UTC

Clinicians 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 | UTC

Studies 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 | UTC

The Volume and Cost of Quality Metric Reporting – JAMA (link to abstract – $ for full-text)

Author Interview: The Costs of Quality Reporting – JAMA


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


Cohort Study | U-shaped relationship between BMI and mortality in heart failure patients

11 Aug, 2023 | 15:12h | UTC

Body mass index and survival in people with heart failure – Heart


Commentary on Twitter


Survival ≠ Recovery | A narrative review of post-intensive care syndrome

11 Aug, 2023 | 15:11h | UTC

Survival ≠ Recovery: A Narrative Review of Post-Intensive Care Syndrome – CHEST Critical Care


Review | Primary ciliary dyskinesia

11 Aug, 2023 | 15:10h | UTC

Primary Ciliary Dyskinesia – CHEST Pulmonary


[News Release] RCT | Semaglutide 2.4 mg reduces cardiovascular risk by 20% in adults with CVD & obesity

9 Aug, 2023 | 15:40h | UTC

Novo Nordisk A/S: Semaglutide 2.4 mg reduces the risk of major adverse cardiovascular events by 20% in adults with overweight or obesity in the SELECT trial – Novo Nordisk


SELECT: Semaglutide Cuts CV Events in Adults With Overweight or Obesity – TCTMD

Expert reaction to Novo Nordisk press release announcing the headline results from their SELECT cardiovascular outcomes semaglutide trial – Science Media Centre

Related: Role of Glucagon‐Like Peptide‐1 Receptor Agonists in Achieving Weight Loss and Improving Cardiovascular Outcomes in People With Overweight and Obesity – Journal of the American Heart Association


Perspective | Creation and adoption of large language models in medicine

9 Aug, 2023 | 15:38h | UTC

Creation 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 | UTC

An 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 | UTC

Large Language Models Answer Medical Questions Accurately, but Can’t Match Clinicians’ Knowledge – JAMA (free for a limited period)


Cohort Study | Moderate to heavy drinking linked to increased risk of early-onset colorectal cancer

9 Aug, 2023 | 15:27h | UTC

Sex and Tumor-Site Differences in the Association of Alcohol Intake With the Risk of Early-Onset Colorectal Cancer – Journal of Clinical Oncology

Commentary: Association of Alcohol Intake With Risk of Early-Onset Colorectal Cancer – The ASCO Post


Commentary on Twitter


M-A | Most dengue infections are asymptomatic and could significantly contribute to the transmission of the disease

9 Aug, 2023 | 15:21h | UTC

Global prevalence of asymptomatic dengue infections – a systematic review and meta-analysis – International Journal of Infectious Diseases


Cohort Study | Vegetarian diet linked to elevated hip fracture risk; BMI plays a partial role

9 Aug, 2023 | 15:16h | UTC

Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: a prospective cohort study of 413,914 UK Biobank participants – BMC Medicine


M-A | Percutaneous catheter drainage superior to needle aspiration for liver abscess treatment success

9 Aug, 2023 | 15:12h | UTC

Percutaneous catheter drainage versus percutaneous needle aspiration for liver abscess: a systematic review, meta-analysis and trial sequential analysis – BMJ Open


M-A | Nearly 37% of elderly outpatients are at risk due to potentially inappropriate medication use

8 Aug, 2023 | 13:37h | UTC

Prevalence of Use of Potentially Inappropriate Medications Among Older Adults Worldwide: A Systematic Review and Meta-Analysis – JAMA Network Open


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

Optimal dose and type of physical activity to improve functional capacity and minimise adverse events in acutely hospitalised older adults: a systematic review with dose-response network meta-analysis of randomised controlled trials – British Journal of Sports Medicine (free for a limited period)


Proposed algorithm for appropriate fluid management in acute pancreatitis

8 Aug, 2023 | 13:33h | UTC

Fluid treatment in acute pancreatitis: a careful balancing act – British Journal of Surgery


Update on the management of acute pancreatitis – Current Opinion in Critical Care

Intravenous fluid therapy in patients with severe acute pancreatitis admitted to the intensive care unit: a narrative review – Intensive Care Medicine

Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis – New England Journal of Medicine

Acute Pancreatitis: Diagnosis and Treatment – Drugs

Revised Clinical Practice Guidelines of the Korean Pancreatobiliary Association for Acute Pancreatitis – Gut and Liver

Guidelines for the management of patients with severe acute pancreatitis, 2021 – Anaesthesia Critical Care & Pain Medicine

Evidence-Based Disposition of Acute Pancreatitis – emDocs

2019 WSES guidelines for the management of severe acute pancreatitis – World Journal of Emergency Surgery

American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis

Pancreatitis – National Institute for Health and Care Excellence

The optimal timing and intervention to reduce mortality for necrotizing pancreatitis: a systematic review and network meta-analysis – World Journal of Emergency Surgery

Long-term follow-up of a RCT | Endoscopic versus surgical step-up approach for infected necrotizing pancreatitis.

RCT: Immediate drainage did not improve outcomes compared to postponed intervention in patients with infected necrotizing pancreatitis.

An Endoscopic Transluminal Approach, Compared With Minimally Invasive Surgery, Reduces Complications and Costs for Patients With Necrotizing Pancreatitis – Gastroenterology

Research: Endoscopic or Surgical Step-up Approach for Infected Necrotising Pancreatitis

Evidence-Based Approach to the Surgical Management of Acute Pancreatitis – The Surgery Journal


Perspective | Will unpredictable side effects dim the promise of new Alzheimer’s drugs?

8 Aug, 2023 | 13:30h | UTC

Will unpredictable side effects dim the promise of new Alzheimer’s drugs? – Science (a few articles per month are free)


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


Cohort Study | Habitual calcium supplementation linked to higher CVD incidence and mortality in diabetics

8 Aug, 2023 | 13:24h | UTC

Associations of Habitual Calcium Supplementation With Risk of Cardiovascular Disease and Mortality in Individuals With and Without Diabetes – Diabetes Care (link to abstract – $ for full-text)

Related: The Evidence and Controversy Between Dietary Calcium Intake and Calcium Supplementation and the Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Cohort Studies and Randomized Controlled Trials – Journal of the American College of Nutrition


Commentary on Twitter


NICE Updated Guideline | Venous thromboembolic diseases

7 Aug, 2023 | 15:05h | UTC

Venous thromboembolic diseases: diagnosis, management and thrombophilia testing  – National Institute for Health and Care Excellence


Review | Management of worsening heart failure with reduced ejection fraction

7 Aug, 2023 | 15:03h | UTC

Management of Worsening Heart Failure With Reduced Ejection Fraction: JACC Focus Seminar 3/3 – Journal of the American College of Cardiology


Commentary on Twitter


Cohort Study | High-sensitivity troponin’s role in assessing MI and CV death risk in stable CAD patients

7 Aug, 2023 | 15:01h | UTC

High-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)


High-Sensitivity Troponin Assays May Stratify Risk in Chronic CAD – TCTMD

High-Sensitivity Cardiac Troponin for Risk Assessment in Chronic CAD – Journal of the American College of Cardiology


Commentary on Twitter


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