Internal Medicine
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)
An evidence-based guide to the efficacy and safety of isometric resistance training in hypertension
23 Mar, 2023 | 12:42h | UTC
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
Best practice in the use of peripheral venous catheters: a scoping review and expert consensus
23 Mar, 2023 | 12:37h | UTC
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
RCT | Hydrocortisone reduces mortality in severe community-acquired pneumonia
22 Mar, 2023 | 13:44h | UTCSummary: Practice-changing! In a phase 3, multicenter, double-blind, randomized controlled trial involving 800 patients with severe community-acquired pneumonia admitted to the ICU, hydrocortisone treatment was found to reduce the risk of death by day 28 compared to a placebo group. The hydrocortisone group had a 6.2% death rate, while the placebo group had an 11.9% death rate.
Hydrocortisone also led to fewer endotracheal intubations among patients not on mechanical ventilation at baseline and reduced the need for vasopressor therapy in patients not receiving it at baseline. There was no significant difference in hospital-acquired infections or gastrointestinal bleeding between the two groups, but patients in the hydrocortisone group required higher daily doses of insulin during the first week of treatment.
Article: Hydrocortisone in Severe Community-Acquired Pneumonia – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Steroid drug reduces death rate in severe pneumonia, study shows – STAT
Commentary on Twitter
In this randomized trial, hydrocortisone treatment decreased mortality among patients with severe community-acquire pneumonia in the ICU. https://t.co/DZadFMcA5o#ISICEM23 pic.twitter.com/yhkVCjBMWX
— NEJM (@NEJM) March 21, 2023
Review | Diagnosis and treatment of chronic lymphocytic leukemia
22 Mar, 2023 | 13:39h | UTCDiagnosis and Treatment of Chronic Lymphocytic Leukemia: A Review – JAMA (free for a limited period)
Audio clinical review: Diagnosis and Management of Chronic Lymphocytic Leukemia – JAMA
Elevated pre- & postoperative BNP tied to complications in hypertensive & diabetic patients undergoing surgery
22 Mar, 2023 | 13:28h | UTCSummary: This study aimed to assess if preoperative and postoperative serum B-type natriuretic peptide levels (BNP) could predict postoperative complications in hypertensive and diabetic patients after non-cardiac surgery. The study involved 260 adult participants and measured BNP levels before and after surgery. The primary outcome was the change in BNP levels and the development of postoperative complications within 30 days of surgery.
Results showed that patients who developed postoperative complications had significantly higher serum BNP levels both before and after surgery. The preoperative BNP levels (baseline BNP) in patients with complications were 152.02 pg/mL ± 106.56 compared to 44.90 pg/mL ± 44.22 in patients without complications. Similarly, postoperative BNP levels in patients with complications were 313.99 pg/mL ± 121.29, while in patients without complications, they were 83.95 pg/mL ± 70.19.
Although the study does not provide specific cutoff values, higher BNP levels both preoperatively and postoperatively are associated with an increased risk of complications in hypertensive and diabetic patients undergoing non-cardiac surgery. Further multicenter prospective studies with a larger population are needed to confirm the role of BNP in predicting surgical prognosis.
Related:
Phase 2b RCT | New oral PCSK9 inhibitor reduces LDL cholesterol by 40% to 60%
22 Mar, 2023 | 13:20h | UTCCommentary: Oral PCSK9 Inhibitor Reduces LDL Cholesterol in Phase IIb Study – TCTMD
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
Position Paper | Patient sleep during hospitalization
21 Mar, 2023 | 13:47h | UTCSociety of Anesthesia and Sleep Medicine Position Paper on Patient Sleep During Hospitalization – Anesthesia & Anesthesia (free for a limited period)
Comparative study highlights women’s lower susceptibility to sudden cardiac arrest during sports
21 Mar, 2023 | 13:44h | UTCSummary: This study assessed the incidence, characteristics, and outcomes of sports-related sudden cardiac arrest (Sr-SCA) in women. Data from three European registries were analyzed, identifying 34,826 SCA cases between 2006 and 2017, with 760 cases (2.2%) being Sr-SCA, including 54 in women.
The average annual incidence of Sr-SCA in women was 0.19 per million, over 10 times lower than in men (2.63 per million). When extrapolated to the European population, this translates to 98 cases per year in women and 1,350 cases in men.
Characteristics, bystander response, time to defibrillation, and survival rates did not significantly differ between women and men. The findings highlight the considerably lower risk of Sr-SCA in women compared to men and should be considered when designing preparticipation screening strategies in the future.
Article: Incidence of Cardiac Arrest During Sports Among Women in the European Union – Journal of the American College of Cardiology (link to abstract – $ for full-text)
Commentary: Incidence of Cardiac Arrest During Sports Among Women – American College of Cardiology
Commentary on Twitter
Women are at very low risk of cardiac arrest during sports: incidence in women was calculated to be 13 times lower than in men in 3 European registries, w/ no differences in profile, circumstances, mgmt or outcomes. https://t.co/CLl6amlIHO#JACC #CardioTwitter #SportsCardio pic.twitter.com/ADpakbwUKt
— JACC Journals (@JACCJournals) March 15, 2023
The paradox of endurance training: higher coronary plaque prevalence found in lifelong athletes
21 Mar, 2023 | 13:42h | UTCSummary: The Master@Heart study aimed to investigate the relationship between lifelong endurance exercise and coronary atherosclerosis measured by computed tomography coronary angiography (CTCA) in a cohort of 191 lifelong master endurance athletes, 191 late-onset athletes, and 176 healthy non-athletes. All participants were male with a low cardiovascular risk profile.
The study found that lifelong endurance sport participation was not associated with a more favorable coronary plaque composition compared to maintaining a healthy lifestyle. In fact, lifelong endurance athletes exhibited a higher prevalence of coronary plaques, including more non-calcified plaques in proximal segments, than fit and healthy individuals with a similarly low cardiovascular risk profile.
Further research is needed to understand how these findings on CTCA might translate into clinical events in endurance athletes.
Article: Lifelong endurance exercise and its relation with coronary atherosclerosis – European Heart Journal
Commentaries:
Lifelong Endurance Exercise and Coronary Atherosclerosis – American College of Cardiology
MASTER@HEART: Long-term Endurance Athletes Not Immune to Atherosclerosis – TCTMD
RCT | Time-restricted eating not more effective than daily calorie restriction for managing nonalcoholic fatty liver disease
21 Mar, 2023 | 13:38h | UTCSummary: The TREATY-FLD randomized clinical trial investigated the effects of time-restricted eating (TRE) versus daily calorie restriction (DCR) on intrahepatic triglyceride (IHTG) content and metabolic risk factors in patients with obesity and nonalcoholic fatty liver disease (NAFLD).
Participants were randomly assigned to either TRE (eating only between 8:00 am and 4:00 pm) or DCR (habitual meal timing) and instructed to maintain a diet of 1500 to 1800 kcal/d for men and 1200 to 1500 kcal/d for women for 12 months.
The study found that the IHTG content was reduced by 6.9% in the TRE group and 7.9% in the DCR group after 12 months, a difference that was not statistically significant. Furthermore, TRE did not produce additional benefits for reducing body weight, liver stiffness, or metabolic risk factors compared with DCR.
The study supports that the main focus of a diet for managing NAFLD is caloric restriction, which can be achieved both with a TRE strategy or without a TRE strategy with similar results.
Commentary on Twitter
TREATY-FLD RCT found that time-restricted eating did not produce additional benefits for reducing intrahepatic triglyceride content, body fat and metabolic risk factors vs daily-calorie-restriction among adults with obesity and NAFLD. https://t.co/it2n4o9Th1
— JAMA Network Open (@JAMANetworkOpen) March 17, 2023
SR | Topical antibiotics modestly improve resolution of acute bacterial conjunctivitis
21 Mar, 2023 | 13:33h | UTCSummary: The Cochrane Review evaluated the benefits and potential side effects of antibiotic therapy in treating acute bacterial conjunctivitis. The authors included 21 randomized controlled trials, with a total of 8,805 participants. The trials evaluated the effectiveness of topical antibiotic treatments in the form of drops or ointments, and were heterogeneous in terms of eligibility criteria, antibiotic drug class, duration of treatment, and outcomes assessed.
The review found that antibiotics likely improved clinical cure by 26% compared with placebo, with no evidence of serious systemic side effects reported in either the antibiotic or placebo group. Fluoroquinolones were found to have fewer ocular side effects compared to non-fluoroquinolones.
Overall, the review suggests that the use of topical antibiotics may be considered to achieve better clinical and microbiologic efficacy than placebo in treating acute bacterial conjunctivitis.
Article: Antibiotics versus placebo for acute bacterial conjunctivitis – Cochrane Library