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Internal Medicine

Scanxiety among adults with cancer: a scoping review to guide research and interventions

14 Mar, 2023 | 13:55h | UTC

Summary: The article presents a scoping review of existing literature on scanxiety, which refers to the anxiety and distress experienced by cancer patients before and after medical imaging scans. The authors identified and synthesized findings from 36 articles on scanxiety among adults diagnosed with current or prior cancer.

The authors observed that scanxiety is a prevalent issue throughout the cancer continuum and may be linked to various factors related to the procedure itself or the uncertainty surrounding the possible outcomes of the scans.

The waiting period between the scan procedure and receipt of the results was described as particularly stressful, with participants reporting feeling overwhelmed by negative thoughts and fears about the potential outcomes of the scan. Some participants even found it difficult to focus on daily activities or responsibilities during this time.

The authors suggest that implementing supportive measures during scan experiences, including examining the waiting period between scans and scan results, could enhance the well-being for individuals with cancer who are going through different stages of treatment.

Article: Scanxiety among Adults with Cancer: A Scoping Review to Guide Research and Interventions – Cancers

 

SR | Environmental interventions can reduce falls in high-risk older adults

14 Mar, 2023 | 13:58h | UTC

Summary: Falls and fall-related injuries are common among older adults and can have serious consequences, such as restricting activity or institutionalization. The Cochrane review aimed to assess the effects of environmental interventions, such as fall-hazard reduction, assistive technology, home modifications, and education, on preventing falls in older adults living in the community.

The review included 22 randomized controlled trials from 10 countries involving 8,463 community-residing older people. The study found that home fall-hazard interventions, which involve evaluating potential fall hazards and implementing safety adaptations or behavioral strategies, can reduce the rate of falls by 26% and the number of people who experience one or more falls by 11% in people at a higher risk of falling.

On the other hand, the study did not find any evidence of a decrease in the rate of falls when the interventions were not targeted toward individuals at higher risk. Additionally, the study suggests that these interventions are unlikely to have a significant impact on health-related quality of life, and there may be little or no difference in the risk of fall-related fractures, hospitalizations due to falls, or the rate of falls that require medical attention.

Article: Environmental interventions for preventing falls in older people living in the community – Cochrane Library

Summary: Reducing fall hazards within the environment – Cochrane Library

Editorial: Preventing falls in older people: the evidence for environmental interventions and why history matters – Cochrane Library

Commentary: Preventing falls in older people: new evidence on what helps – Evidently Cochrane

 

M-A | Ionizing radiation and cardiovascular disease

14 Mar, 2023 | 13:49h | UTC

Ionising radiation and cardiovascular disease: systematic review and meta-analysis – The BMJ

News Release: Low dose radiation linked to increased lifetime risk of heart disease – BMJ Newsroom

 

Review | Orthostatic tachycardia after covid-19

14 Mar, 2023 | 13:48h | UTC

Orthostatic tachycardia after covid-19 – The BMJ

Commentary: Key steps for diagnosis and management of orthostatic tachycardia after COVID-19 – News Medical

 

Mortality rates and clinical manifestations of severe hypothyroidism in the ICU: a French multicenter cohort study

14 Mar, 2023 | 13:44h | UTC

Summary: This article presents the findings of a retrospective multicenter cohort study conducted over 18 years in 32 French ICUs to investigate severe hypothyroidism (SH) requiring ICU admission.

The study included 82 patients with SH, with thyroiditis and thyroidectomy being the primary causes, and levothyroxine discontinuation, sepsis, and amiodarone-related hypothyroidism being the most frequent triggers.

Patients with SH presented with various clinical symptoms, including hypothermia, hemodynamic failure, and coma, with in-ICU and 6-month mortality rates being 26% and 39%, respectively. The study also found that patients with hemodynamic and respiratory failure on admission to the ICU had a higher likelihood of mortality.

Levothyroxine replacement was provided to all patients, but the administration route and loading dose varied. The authors recommend early diagnosis, prompt levothyroxine administration, and close monitoring of cardiac and hemodynamic parameters for SH patients admitted to the ICU.

Article: Critically ill severe hypothyroidism: a retrospective multicenter cohort study – Annals of Intensive Care

 

SR | Myocardial revascularization in patients with ischemic cardiomyopathy: for whom and how

14 Mar, 2023 | 13:46h | UTC

Myocardial Revascularization in Patients With Ischemic Cardiomyopathy: For Whom and How – Journal of the American Heart Association

 

Risk factors for Carbapenem-Resistant Enterobacterales infections: a matched case-control study

14 Mar, 2023 | 13:43h | UTC

Summary: The study aimed to investigate risk factors for infections caused by carbapenem-resistant Enterobacterales (CRE) and identify variables that increase the probability of CRE infection among admitted patients in hospitals with high CRE incidence.

The study was performed in 50 hospitals in Southern Europe from March 2016 to November 2018 and included patients with complicated urinary tract infection, complicated intraabdominal infection, pneumonia, or bacteremia from other sources due to CRE. Control groups were patients with infection caused by carbapenem-susceptible Enterobacterales and non-infected patients, matched according to the same criteria as the CRE group (type of infection, ward, and duration of hospital admission).

The results showed that the main risk factors for CRE infections were previous colonization with CRE, use of urinary catheters, and exposure to broad-spectrum antibiotics.

The study’s findings offer evidence to inform decisions about preventive measures and empirical treatment for patients with suspected CRE infections. Additionally, the study can guide the efficient design of future randomized trials focusing on high-risk patients.

Article: Risk factors for infections caused by carbapenem-resistant Enterobacterales: an international matched case-control-control study (EURECA) – eClinicalMedicine

Related:

Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli – Journal of Microbiology, Immunology and Infection

A position paper for the diagnosis and management of infections caused by multidrug-resistant bacteria: Endorsed by the Italian Society of Infection and Tropical Diseases (SIMIT), the Italian Society of Anti-Infective Therapy (SITA), the Italian Group for Antimicrobial Stewardship (GISA), the Italian Association of Clinical Microbiologists (AMCLI), and the Italian Society of Microbiology (SIM) – International Journal of Antimicrobial Agents

IDSA Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections: Version 2.0 – Infectious Diseases Society of America

IDSA Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections: Version 1.0 – Infectious Diseases Society of America

RCT | Colistin monotherapy vs. combination therapy for carbapenem-resistant organisms

The threat of multidrug-resistant/extensively drug-resistant Gram-negative respiratory infections: another pandemic – European Respiratory Review

 

Review | Pathogenesis, epidemiology and control of Group A Streptococcus infection

14 Mar, 2023 | 13:38h | UTC

Pathogenesis, epidemiology and control of Group A Streptococcus infection – Nature Reviews Microbiology

 

Commentary on Twitter

 

Podcast and Brief Review | TIA/Stroke pearls for the hospitalist

14 Mar, 2023 | 13:36h | UTC

#385 TIA/Stroke for the Hospitalist featuring Dr. Karima Benameur – The Curbsiders

 

Review | Role of precision medicine in obstructive sleep apnea

14 Mar, 2023 | 13:28h | UTC

Role of precision medicine in obstructive sleep apnoea – BMJ Medicine

 

Commentary on Twitter

 

SR | Parathyroidectomy for adults with primary hyperparathyroidism

14 Mar, 2023 | 13:22h | UTC

Parathyroidectomy for adults with primary hyperparathyroidism – Cochrane Library

Summary: Parathyroidectomy for adults with primary hyperparathyroidism – Cochrane Library

 

Findings of daily point-of-care ultrasound assessment of CVC-related thrombosis in critically ill patients

14 Mar, 2023 | 13:19h | UTC

Daily point-of-care ultrasound-assessment of central venous catheter-related thrombosis in critically ill patients: a prospective multicenter study – Intensive Care Medicine (free for a limited period)

 

Commentary on Twitter

 

CDC recommends HBV screening at least once in a lifetime for all adults aged ≥18 years

13 Mar, 2023 | 15:14h | UTC

Summary: The Centers for Disease Control and Prevention (CDC) has issued new recommendations for screening and testing for hepatitis B virus (HBV) infection in the US.

The recommendations include screening for HBV infection at least once in a lifetime for adults aged ≥18 years and more frequent testing for persons at increased risk for HBV infection. The risk groups include:

  • Persons incarcerated or formerly incarcerated in jail, prison, or other detention settings.
  • Persons with a history of sexually transmitted infections or multiple sex partners.
  • Persons with a history of hepatitis C virus infection.

The CDC recommends using the triple panel (HBsAg, anti-HBs, and total anti-HBc) for initial screening to help identify persons who have an active HBV infection, have resolved infection and might be susceptible to reactivation, are susceptible and need vaccination, or are vaccinated.

Article: Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations — United States, 2023 – Morbidity and Mortality Weekly Report

Commentaries:

Universal Adult Hepatitis B Screening and Vaccination as the Path to Elimination – JAMA

CDC recommends hepatitis B screening for all adults – CIDRAP

CDC Recommends Universal Screening for Hepatitis B Virus – HCP Live

 

Commentary on Twitter

 

RCT | Localized prostate cancer treatment options have similar 15-year survival outcomes

13 Mar, 2023 | 15:12h | UTC

Summary: The study followed 1643 men diagnosed with localized prostate cancer (diagnosed by screening with PSA) in the United Kingdom between 1999 and 2009 who were randomly assigned to receive active monitoring, prostatectomy, or radiotherapy.

After a median follow-up of 15 years, the study found that while prostatectomy and radiotherapy decreased metastasis, local progression, and the need for long-term androgen deprivation therapy, death from prostate cancer was low regardless of the treatment assigned, with 17 deaths (3.1%) in the active-monitoring group, 12 deaths (2.2%) in the prostatectomy group, and 16 (2.9%) deaths in the radiotherapy group (P=0.53). Additionally, the study found that overall deaths were similar between the groups.

The authors suggest that the choice of therapy for localized prostate cancer involves weighing the benefits and harms associated with each treatment option.

Article: Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer – New England Journal of Medicine (link to abstract – $ for full-text)

News Release: Delaying treatment for localised prostate cancer does not increase mortality risk, trial shows – University of Bristol

 

Commentary on Twitter

 

Review | Commonly missed findings on chest radiographs: causes and consequences

13 Mar, 2023 | 15:07h | UTC

Commonly Missed Findings on Chest Radiographs: Causes and Consequences – CHEST (free for a limited period)

See also: Reducing Errors Resulting From Commonly Missed Chest Radiography Findings – CHEST (free for a limited period)

 

Review | Reducing errors resulting from commonly missed chest radiography findings

13 Mar, 2023 | 15:06h | UTC

Reducing Errors Resulting From Commonly Missed Chest Radiography Findings – CHEST (free for a limited period)

See also: Commonly Missed Findings on Chest Radiographs: Causes and Consequences – CHEST (free for a limited period)

 

M-A | Routine anaerobic coverage for aspiration pneumonia: limited evidence of benefit

13 Mar, 2023 | 15:03h | UTC

Summary: Treating aspiration pneumonia with antibiotics that cover anaerobic bacteria has become common practice in many services, but recent studies suggest that this may not necessarily improve prognosis.

Out of 2523 publications, this systematic review and meta-analysis only included one randomized control trial and two observational studies. The study found no clear benefit of anaerobic coverage and concluded that there is not enough data to evaluate the necessity of anaerobic coverage in the antibiotic treatment of aspiration pneumonia.

The authors suggest that covering anaerobic bacteria with antibiotics may not be needed as an initial treatment for aspiration pneumonia if there is no formation of abscess or empyema and the patient has good oral hygiene.

Article: The Clinical Significance of Anaerobic Coverage in the Antibiotic Treatment of Aspiration Pneumonia: A Systematic Review and Meta-Analysis – Journal of Clinical Medicine

Related: BTS clinical statement on aspiration pneumonia – Thorax

 

M-A | Strength of association between comorbidities and asthma

13 Mar, 2023 | 15:01h | UTC

Summary: The study investigated the strength of association between comorbidities and asthma, as the presence of comorbidities is related to poor asthma outcomes. A comprehensive literature search was conducted for observational studies reporting data on comorbidities in asthma and nonasthma populations.

A total of 5,493,776 subjects were analyzed, and several comorbidities were found to be strongly or very strongly associated with asthma and severe asthma, including allergic conjunctivitis, allergic rhinitis, bronchiectasis, hypertensive cardiomyopathy, nasal congestion, COPD, and other chronic respiratory diseases.

The study supports the relevance of individualized strategies for disease management that look beyond asthma and suggests a comprehensive approach should be used to assess whether poor symptom control is related to uncontrolled asthma or other underlying comorbidities.

Article: Strength of association between comorbidities and asthma: a meta-analysis – European Respiratory Review

 

ISCCM Guidelines for the use of procalcitonin for rational use of antibiotics

13 Mar, 2023 | 14:57h | UTC

Guidelines for the Use of Procalcitonin for Rational Use of Antibiotics – Indian Journal of Critical Care Medicine

 

ISCCM Consensus Statement | Prevention of venous thromboembolism in the critical care unit

13 Mar, 2023 | 14:53h | UTC

Indian Society of Critical Care Medicine Consensus Statement for Prevention of Venous Thromboembolism in the Critical Care Unit – Indian Journal of Critical Care Medicine

 

Decrease in hospitalizations and liver failure after FDA mandate limiting paracetamol dosage in prescription opioid combinations.

13 Mar, 2023 | 14:45h | UTC

Association of FDA Mandate Limiting Acetaminophen (Paracetamol) in Prescription Combination Opioid Products and Subsequent Hospitalizations and Acute Liver Failure – JAMA (free for a limited period)

Editorial: Moving the Needle to Reduce Acetaminophen (Paracetamol) Hepatotoxicity – JAMA (free for a limited period)

Author Interview: Limiting Acetaminophen in Prescription Combination Opioid Products – JAMA

Video Summary: Acetaminophen (Paracetamol) and Acute Liver Failure – JAMA

News Release: FDA mandate to limit acetaminophen in acetaminophen-opioid medications is associated with reduced serious liver injury – University of Alabama at Birmingham

 

Commentary on Twitter

 

Hospitalist comanagement reduces patients’ length of stay and improves oncologist experience, preliminary evidence suggests

13 Mar, 2023 | 14:33h | UTC

Outcomes on an inpatient oncology service after the introduction of hospitalist comanagement – Journal of Hospital Medicine (link to abstract – $ for full-text)

News Release: Involving hospitalists in inpatient cancer care reduces patient stays, oncologist stress – Yale School of Medicine

 

WHO urges countries to implement comprehensive sodium reduction policies to combat cardiovascular disease

10 Mar, 2023 | 14:43h | UTC

Summary:

A new report from the World Health Organization (WHO) has shown that the world needs to catch up to achieve its global target of reducing sodium intake by 30% by 2025. The report highlights that only 5% of WHO member states have mandatory and comprehensive sodium reduction policies.

Sodium, found in table salt and other condiments, increases the risk of heart disease, stroke, and premature death when eaten in excess. Implementing highly cost-effective sodium reduction policies could save an estimated seven million lives globally by 2030.

WHO suggests a number of policies, such as reducing the amount of sodium in food products, introducing front-of-pack labeling, launching mass media campaigns, and enforcing public policies related to food service and sales.

The report urges member states to implement sodium intake reduction policies without delay, and calls on food manufacturers to set ambitious targets for sodium reduction in their products.

Article: WHO global report on sodium intake reduction – World Health Organization

News Release: Massive efforts needed to reduce salt intake and protect lives – World Health Organization

Related:

Reducing daily salt intake in China by 1 g could prevent almost 9 million cardiovascular events by 2030: a modelling study – BMJ Nutrition Prevention & Health

Adding salt to foods and hazard of premature mortality – European Heart Journal

New WHO benchmarks help countries reduce salt intake and save lives – World Health Organization

WHO global sodium benchmarks for different food categories – World Health Organization

 

Commentary on Twitter

 

RCT | Treat-to-target strategy is noninferior to high-intensity statin therapy in patients with coronary artery disease

10 Mar, 2023 | 14:44h | UTC

Summary: This randomized, multicenter, noninferiority trial in South Korea enrolled 4,400 patients with known coronary artery disease. Patients were randomly assigned to one of two groups: a treat-to-target group and a high-intensity statin group.

The treat-to-target group received moderate or high-intensity statins and titrated their medication to achieve an LDL-C goal of 50-70 mg/dL, while the high-intensity statin group received rosuvastatin 20 mg or atorvastatin 40 mg. The primary endpoint was a 3-year composite of death, myocardial infarction, stroke, or coronary revascularization.

The study found that the primary endpoint occurred in 8.1% of the treat-to-target group and 8.7% of the high-intensity statin group, indicating that the treat-to-target strategy was noninferior to the high-intensity statin strategy.

Overall, the results of this study indicate that a treat-to-target strategy could be an appropriate substitute for high-intensity statin therapy in patients with coronary artery disease. This approach enables a personalized treatment plan that accounts for variations in individual drug response to statin therapy.

Article: Treat-to-Target or High-Intensity Statin in Patients With Coronary Artery Disease: A Randomized Clinical Trial – JAMA (free for a limited period)

Commentaries:

Investigating treat-to-target low-density lipoprotein-cholesterol versus high-intensity statins for coronary artery disease – News Medical

Not all patients with coronary artery disease require high intensity statins – MedicalResearch.com

 

Commentary on Twitter

 

AASLD guidance on the clinical assessment and management of nonalcoholic fatty liver disease

10 Mar, 2023 | 14:36h | UTC

AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease – Hepatology

Related:

Management of NAFLD in primary care settings – Liver International

Updated S2k Clinical Practice Guideline on Non-alcoholic Fatty Liver Disease (NAFLD) issued by the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) – Zeitschrift für Gastroenterologie

AGA Clinical Practice Update | Diagnosis and management of nonalcoholic fatty liver disease in lean individuals.

Quality standards for the management of non-alcoholic fatty liver disease (NAFLD): consensus recommendations from the British Association for the Study of the Liver and British Society of Gastroenterology NAFLD Special Interest Group – The Lancet Gastroenterology & Hepatology (free registration required)

Nonalcoholic Fatty Liver Disease and Cardiovascular Risk: A Scientific Statement From the American Heart Association – Arteriosclerosis, Thrombosis, and Vascular Biology

Advancing the global public health agenda for NAFLD: a consensus statement – Nature Reviews Gastroenterology & Hepatology

Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease – Gastroenterology

Non-alcoholic fatty liver disease: A patient guideline – JHEP Reports

 

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