Internal Medicine
Brief Review | Admission to intensive care unit after major surgery
28 Mar, 2023 | 14:39h | UTCAdmission to intensive care unit after major surgery – Intensive Care Medicine
Commentary on Twitter
? Major surgeries common reason for #ICU admission (expected/scheduled or unplanned), with varying practices & mortality. 4 major determinants driving decision
1️⃣ intrinsic procedure risk
2️⃣ patient risk
3️⃣ crashing risk
4️⃣ support outside ICU#FOAMcc
?️ https://t.co/CluprKlYM9 pic.twitter.com/PZC4zmymOp— Intensive Care Medicine (@yourICM) March 23, 2023
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 | Interventions to reduce repetitive ordering of low-value inpatient laboratory tests
27 Mar, 2023 | 13:22h | UTC
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
Outcomes of ST elevation myocardial infarction in patients with cancer: a nationwide study
27 Mar, 2023 | 13:12h | UTCOutcomes of ST elevation myocardial infarction in patients with cancer: a nationwide study – European Heart Journal – Quality of Care and Clinical Outcomes (free for a limited period)
Commentary on Twitter
Cancer and #STEMI – a worrisome combination of higher short- and long-term mortality, and bleeding risk. https://t.co/kHvhGP0PBE #EHJQCCO #cardiotwitter @cpgale3 @diogoasantosfer pic.twitter.com/SfjyizoJvQ
— European Society of Cardiology Journals (@ESC_Journals) March 26, 2023
Brief Review | Long-term outcomes of intensive care unit delirium
27 Mar, 2023 | 13:09h | UTCLong-term outcomes of intensive care unit delirium – Intensive Care Medicine
Commentary on Twitter
#ICU delirium
? well described short-term effects: ⬆️ hospital mortality, MV duration, ICU/hospital LoS
? more recent findings related to long-term outcomes (≥ 6 months post-ICU)
How to mitigate this serious acute BI & its long-term burden? #FOAMcc
?️ https://t.co/kg5TIOmVHm pic.twitter.com/Hnbc1ISKnI— Intensive Care Medicine (@yourICM) March 25, 2023
Phase 2 RCT | Semaglutide did not improve fibrosis in NASH-related cirrhosis
27 Mar, 2023 | 13:01h | UTCCommentary: Semaglutide Well-Tolerated, But Shows Lack of Improvement in Liver Fibrosis – HCP Live
Commentary on Twitter
New research – Loomba et al – Semaglutide 2·4 mg once weekly in patients with non-alcoholic steatohepatitis-related cirrhosis: a randomised, placebo-controlled phase 2 trialhttps://t.co/qkydKMpVfO#NASH #NAFLD #cirrhosis #gitwitter #livertwitter #medtwitter @DrLoomba pic.twitter.com/2A1dylSiq3
— The Lancet Gastroenterology & Hepatology (@LancetGastroHep) March 17, 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
Study shows increased bleeding complications in ESKD patients undergoing AF ablation
24 Mar, 2023 | 13:09h | UTCSummary: The study analyzed 347 procedures in 307 patients with end-stage kidney disease (ESKD) undergoing atrial fibrillation (AF) catheter ablation in 12 referral centers in Japan.
Despite a vast majority of patients having subtherapeutic international normalized ratio (INR) values during the peri-procedural period, 35 patients (10%) experienced major complications, with the majority being major bleeding events (19 patients; 5.4%), including 11 cases of cardiac tamponade (3.2%). There were also two peri-procedural deaths (0.6%), both related to bleeding events. A pre-procedural INR value of 2.0 or higher was identified as the only independent predictor of major bleeding.
Current peri-procedural anticoagulation guidelines state that patients undergoing AF ablation should be under therapeutic anticoagulation throughout the peri-procedural period. The findings of this study suggest that these guidelines may not be appropriate for ESKD patients undergoing the procedure, and the role of peri-procedural anticoagulation in this population should be further investigated.
Commentary on Twitter
Peri-procedural anticoagulation in patients with end-stage kidney disease undergoing #afib ablation ? despite undertreatment with warfarin, the rate of haemorrhagic complications is high! https://t.co/3W8gEtZYdy#kidney #afib #anticoagulation #ablation #cardiotwitter #europace pic.twitter.com/vI27UeIpRf
— European Society of Cardiology Journals (@ESC_Journals) March 16, 2023
Consensus Paper | Connective tissue disease-associated pulmonary arterial hypertension
24 Mar, 2023 | 13:06h | UTC
M-A | Prevalence, imaging patterns and risk factors of interstitial lung disease in connective tissue disease
24 Mar, 2023 | 13:02h | UTC
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 high rates of nonadherence to antimicrobial prophylaxis guidelines, often due to unnecessary vancomycin use
23 Mar, 2023 | 13:13h | UTCSummary: The study evaluated adherence to surgical antimicrobial prophylaxis guidelines in 825 US hospitals for elective surgeries from 2019-2020. The study found that 41% of surgical prophylaxis regimens were nonadherent to the American Society of Health-System Pharmacists guidelines.
Unnecessary vancomycin use was the most common reason for nonadherence to surgical antimicrobial prophylaxis guidelines, accounting for 77% of nonadherent regimens and occurring in 31% of all surgeries. It’s noteworthy that when vancomycin was used, it was often unnecessarily combined with cefazolin, and patients who received this combination had a 19% higher risk of acute kidney injury compared to those who received cefazolin alone.
The authors suggest that quality-improvement efforts aimed at reducing unnecessary vancomycin use and potential guideline revisions may offer impactful strategies for improving the risk-benefit profile of antimicrobial prophylaxis.
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
Survey | Perspectives of patients about immediate access to test results through an online patient portal
23 Mar, 2023 | 13:02h | UTCSummary: This study aimed to assess patient and caregiver attitudes and preferences related to receiving immediately released test results through an online patient portal.
In a survey of 8,139 respondents across 4 US academic medical centers, 95,7% of patients preferred to receive immediately released test results through an online patient portal, even if their healthcare practitioner had not yet reviewed the result. However, 7.5% of respondents reported that reviewing results before being contacted by a healthcare practitioner increased worry. This worry was more common among respondents who received abnormal results (16.5%) compared to those whose results were normal (5%).
The authors concluded that balancing patients’ expectations of immediate access to their information with the need to manage increased worry and healthcare practitioner burden is important as healthcare systems navigate this new era of health information transparency.
News Release: Patients prefer immediate access to medical test results online, even if it’s bad news – UT Southwestern Medical Center
Commentary from one of the authors on Twitter
Do patients prefer immediate access to test results, even when the news may not be good?
Multi-site survey of 8,139 patients says: YES ✅
Patients overwhelmingly supported receiving results immediately…But WHY does this matter?? https://t.co/KSD5qOJKdd#hcldr #healthIT pic.twitter.com/vz8DYBlVu7
— Liz Salmi (@TheLizArmy) March 21, 2023
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
Guideline | Diagnosis and treatment of myocarditis
23 Mar, 2023 | 12:55h | UTCJCS 2023 Guideline on the Diagnosis and Treatment of Myocarditis – Circulation Journal (see PDF)
Guideline | Diagnosis and treatment of vasospastic angina and coronary microvascular dysfunction
23 Mar, 2023 | 12:53h | UTCJCS/CVIT/JCC 2023 Guideline Focused Update on Diagnosis and Treatment of Vasospastic Angina (Coronary Spastic Angina) and Coronary Microvascular Dysfunction – Circulation Journal (see PDF)