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Internal Medicine

BTS Clinical Guidance | Prevention and management of community-acquired pneumonia in people with learning disability

6 Mar, 2023 | 14:34h | UTC

BTS Clinical Statement on the prevention and management of community-acquired pneumonia in people with learning disability – Thorax

 

#ACC23 – RCT | Transcatheter repair for patients with tricuspid regurgitation

6 Mar, 2023 | 14:29h | UTC

Transcatheter Repair for Patients with Tricuspid Regurgitation – New England Journal of Medicine (link to abstract – $ for full-text)

Commentaries:

The TRILUMINATE Transcatheter Tricuspid Repair Trial: Positive but No Benefit? – Medscape (recommended reading – free registration required)

TRILUMINATE Pivotal: TEER With the TriClip Benefits Patients With Severe TR – TCTMD

Transcatheter Repair Benefits Quality of Life in Patients with Severe Tricuspid Regurgitation – HCP Live

 

Commentary on Twitter

 

RCT | Hydrochlorothiazide is not effective for the prevention of kidney-stone recurrence

6 Mar, 2023 | 14:26h | UTC

Summary:

This study aimed to assess the effectiveness of hydrochlorothiazide, a thiazide diuretic, in preventing the recurrence of calcium-containing kidney stones. The trial randomly assigned 416 patients with recurrent kidney stones to receive hydrochlorothiazide at a dose of 12.5 mg, 25 mg, or 50 mg once daily, or a placebo once daily, and followed them for a median of 2.9 years.

The results showed that the incidence of kidney stone recurrence did not differ significantly between the hydrochlorothiazide and placebo groups, regardless of the dose. Furthermore, patients who received hydrochlorothiazide were more likely to experience side effects such as hypokalemia, gout, new-onset diabetes mellitus, skin allergy, and a plasma creatinine level exceeding 150% of the baseline level.

Therefore, the effectiveness of hydrochlorothiazide in preventing kidney stone recurrence may be limited, and the common practice of prescribing it for these patients should be reevaluated.

 

Article: Hydrochlorothiazide and Prevention of Kidney-Stone Recurrence – New England Journal of Medicine (link to abstract – $ for full-text)

Video Summary: Hydrochlorothiazide and Kidney-Stone Recurrence | NEJM

Commentary: Hydrochlorothiazide and Prevention of Kidney Stones – NEJM Resident 360

 

RCT | Antipsychotic association seems better than antidepressant switch in treatment-resistant geriatric depression

6 Mar, 2023 | 14:23h | UTC

Summary:

This open-label randomized trial compared the benefits and risks of augmenting therapy vs. switching antidepressants in older adults with treatment-resistant depression. In the first step, 619 patients were randomly assigned to augmentation of existing antidepressant medication with aripiprazole (an antipsychotic), augmentation with bupropion, or a switch from existing antidepressant medication to bupropion. In step 2, 248 patients who did not benefit from or were ineligible for step 1 were randomly assigned to augmentation with lithium or a switch to nortriptyline.

The aripiprazole-augmentation group showed significant improvement in well-being compared to the switch-to-bupropion group. Remission occurred in 28.9% of patients in the aripiprazole-augmentation group, 28.2% in the bupropion-augmentation group, and 19.3% in the switch-to-bupropion group. In step 2, similar remission rates occurred in the lithium-augmentation group (18.9%) and the switch-to-nortriptyline group (21.5%).

 

Article: Antidepressant Augmentation versus Switch in Treatment-Resistant Geriatric Depression – New England Journal of Medicine (link to abstract – $ for full-text)

News Release: Adding antipsychotic med to antidepressant may help older adults with treatment-resistant depression – Washington University School of Medicine in St. Louis

 

Commentary on Twitter

 

Cluster RCT | Effectiveness of a non-physician community health-care provider-led intensive BP intervention vs. usual care on CVD

6 Mar, 2023 | 14:20h | UTC

Summary:

The study evaluated the effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention on cardiovascular disease compared to usual care. The trial randomly assigned 326 villages to the intervention or usual care, and recruited individuals aged at least 40 years with hypertension. Trained non-physician community health-care providers initiated and titrated antihypertensive medications according to a simple stepped-care protocol and delivered health coaching for patients in the intervention group during the 36-month follow-up.

The study found that the intervention effectively reduced the risk of cardiovascular disease and all-cause death. There was a significant reduction in systolic blood pressure (23.1 mm Hg) and diastolic blood pressure (9.9 mm Hg) in the intervention group compared to the usual care group, with an increased risk of hypotension in the intervention group.

 

Article: Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention versus usual care on cardiovascular disease (CRHCP): an open-label, blinded-endpoint, cluster-randomised trial – The Lancet (link to abstract – $ for full-text)

Related:

Approaches and outcomes of community health worker’s interventions for hypertension management and control in low-income and middle-income countries: systematic review – BMJ Open

Cluster Randomized Trial: A Community-Based Intervention for Managing Hypertension in Rural South Asia

#ESCCongress – Randomized Trial: A Community-based Comprehensive Intervention to Reduce Cardiovascular Risk in Hypertension

Cohort Study: Impact of Community Based Screening for Hypertension in Older Adults

Randomized Trial: Community-Based Interventions to Improve Cardiovascular Risk in High-Risk Patients

Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops

Research: Effect of a Community Health Worker–Led Multicomponent Intervention on Blood Pressure Control

 

Perspective | Why functional neurological disorder is not feigning or malingering

6 Mar, 2023 | 14:17h | UTC

Why functional neurological disorder is not feigning or malingering – Nature Reviews Neurology (free for a limited period)

 

Perspective | Diagnostic stewardship to prevent diagnostic error

6 Mar, 2023 | 14:18h | UTC

Diagnostic Stewardship to Prevent Diagnostic Error – JAMA (free for a limited period)

 

Commentary on Twitter

 

Guideline | Diagnosis, management, and follow-up of the incidentally discovered adrenal mass

6 Mar, 2023 | 14:16h | UTC

Canadian Urological Association guideline: Diagnosis, management, and follow up of the incidentally discovered adrenal mass – Canadian Medical Association Journal

 

M-A | Sugar-sweetened beverage consumption and weight gain in children and adults

6 Mar, 2023 | 14:04h | UTC

Article: Sugar-sweetened beverage consumption and weight gain in children and adults: a systematic review and meta-analysis of prospective cohort studies and randomized controlled trials – The American Journal of Clinical Nutrition

News Release: More evidence that sugary drinks cause weight gain – University of Toronto

 

Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews

3 Mar, 2023 | 14:11h | UTC

Summary: This umbrella review summarized the evidence on the effects of physical activity interventions on symptoms of depression, anxiety, and psychological distress in adult populations. The study included 97 systematic reviews comprising 1039 randomized controlled trials and 128,119 participants. The results showed that physical activity had medium effects on depression, anxiety, and psychological distress compared to usual care across all populations. Higher-intensity physical activity was associated with greater improvements in symptoms, and the effectiveness of physical activity interventions diminished with longer-duration interventions. The authors concluded that physical activity is highly beneficial for improving symptoms of depression, anxiety, and distress in a wide range of adult populations, including those with mental health disorders and chronic diseases, and should be a mainstay approach in their management.

Article: Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews – British Journal of Sports Medicine (link to abstract – $ for full-text)

News Release: Exercise more effective than medicines to manage mental health – University of South Australia

Commentary from the authors: Exercise is even more effective than counselling or medication for depression. But how much do you need? – The Conversation

 

Commentary on Twitter

 

An overview of systematic reviews and meta-analyses on the effect of medication interventions targeting polypharmacy for frail older adults

3 Mar, 2023 | 14:07h | UTC

Summary: This overview of published systematic reviews examined the effectiveness of medication reviews on managing polypharmacy in frail older adults. The overview identified 10 systematic reviews, which included 154 studies. Medication reviews were the most common intervention, and the evidence suggests that they help reduce inappropriate medication use in frail older adults, but their impact on frailty scores and hospital admission is unclear. Pharmacist-led medication interventions were the most common, reducing inappropriate prescriptions in various settings. Tools, such as clinical decision-making computer support tools, were also found to be effective. The evidence quality ranged from moderate to critically low, highlighting the need for further research to establish if interventions directed at polypharmacy could have an impact on frailty syndromes.

Article: An Overview of Systematic Reviews and Meta-Analyses on the Effect of Medication Interventions Targeting Polypharmacy for Frail Older Adults – Journal of Clinical Medicine

Related:

Physician-led medication reviews in polypharmacy patients treated with at least 12 medications in a type 2 diabetes outpatient clinic: a randomised trial – Diabetic Medicine

RCT | A deprescribing intervention reduced medication burden among older adults in post-acute care

Achieving sustainable healthcare through deprescribing of unnecessary medications: making sense of the evidence – Cochrane Library

Deprescribing medicines in older people living with multimorbidity and polypharmacy: the TAILOR evidence synthesis – Health Technology Assessment

Barriers and facilitators to deprescribing of cardiovascular medications: a systematic review – BMJ Open

A National Modified Delphi Consensus Process to Prioritize Experiences and Interventions for Antipsychotic Medication Deprescribing Among Adult Patients With Critical Illness – Critical Care Explorations

Deprescribing proton pump inhibitors – Australian Journal of General Practice

Medication reviews and deprescribing as a single intervention in falls prevention: a systematic review and meta-analysis – Age and Ageing

Optimizing Medication Use in Older Adults With Rheumatic Musculoskeletal Diseases: Deprescribing as an Approach When Less May Be More – ACP Open Rheumatology

Facing the challenge of polypharmacy when prescribing for older people with cardiovascular disease. A review by the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy – European Heart Journal – Cardiovascular Pharmacotherapy

Deprescribing in Older Adults with Cardiovascular Disease – Journal of the American College of Cardiology

Multimorbidity in Older Adults with Cardiovascular Disease – American College of Cardiology, Latest in Cardiology

Antihypertensive Deprescribing in Older Adults: a Practical Guide – Current Hypertension Reports

How-to guide for medication reviews in older adults with cancer: A Young International Society of Geriatric Oncology and Nursing & Allied Health Interest Group initiative – Journal of Geriatric Oncology

Deprescribing in Palliative Cancer Care – Life

Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review – Kidney360

Process evaluation of implementation strategies to reduce potentially inappropriate medication prescribing in older population: A scoping review – Research in Social and Administrative Pharmacy

AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review – Gastroenterology

Development of a Metric to Detect and Decrease Low-Value Prescribing in Older Adults – JAMA Network Open

The MedSafer Study—Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial – JAMA Internal Medicine

Quantifying Anticholinergic Burden and Sedative Load in Older Adults with Polypharmacy: A Systematic Review of Risk Scales and Models – Drugs & Aging

Deprescribing in palliative patients with cancer: a concise review of tools and guidelines – Supportive Care in Cancer

Prescribing practices, patterns, and potential harms in patients receiving palliative care: A systematic scoping review – Exploratory Research in Clinical and Social Pharmacy

A narrative review of evidence to guide deprescribing among older adults – Journal of General and Family Medicine

Polypharmacy, inappropriate prescribing, and deprescribing in older people: through a sex and gender lens – The Lancet Health Longevity

Polypharmacy Management in Older Patients – Mayo Clinic Proceedings

Psychopharmacological Treatment in Older People: Avoiding Drug Interactions and Polypharmacy – Deutsches Ärzteblatt international

Eliminating Medication Overload: A National Action Plan – Lown Institute

International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP): Position Statement and 10 Recommendations for Action – Drugs & Aging

Common ED Medication Errors: Polypharmacy – emDocs

Current and future perspectives on the management of polypharmacy – BMC Family Practice

Routine deprescribing of chronic medications to combat polypharmacy – Therapeutic Advances in Drug Safety

Polypharmacy—an Upward Trend with Unpredictable Effects – Deutsches Ärzteblatt international

Clinical Consequences of Polypharmacy in Elderly – Expert Opinion on Drug Safety

 

Drug allergy | A 2022 practice parameter update

3 Mar, 2023 | 13:59h | UTC

Drug allergy: A 2022 practice parameter update – The Journal of Allergy and Clinical Immunology

 

Consensus Statement on the definition and classification of metabolic hyperferritinemia

3 Mar, 2023 | 13:58h | UTC

Consensus Statement on the definition and classification of metabolic hyperferritinaemia – Nature Reviews Endocrinology (if the link is paywalled, try this one)

 

SR | Interventions for preventing and treating kidney disease in IgA vasculitis

3 Mar, 2023 | 13:47h | UTC

Interventions for preventing and treating kidney disease in IgA vasculitis – Cochrane Library

Summary: Interventions for preventing and treating kidney disease in IgA vasculitis (Henoch-Schönlein Purpura) – Cochrane Library

 

Cohort Study | Long-term changes in the size of pituitary microadenomas

3 Mar, 2023 | 13:49h | UTC

Summary: The prevalence of pituitary lesions in radiologic studies is estimated to be 10% to 38.5%. However, it is unclear how frequently incidental lesions should be monitored by serial pituitary MRI. A retrospective longitudinal cohort study was conducted to evaluate changes in pituitary microadenomas over time. During the study period (from 2003 to 2021), 414 patients with pituitary microadenomas were identified, and 177 patients had more than 1 MRI. Approximately two-thirds of the microadenomas demonstrated no change or a decrease in size, while the rest exhibited a slow growth rate, indicating that less frequent monitoring could be considered safe.

Article: Long-Term Changes in the Size of Pituitary Microadenomas – Annals of Internal Medicine (link to abstract – $ for full-text)

News Release: Fewer surveillance MRIs may be appropriate for patients with incidental pituitary lesions – American College of Physicians

 

Commentary on Twitter

 

Cohort Study | Association between a healthy lifestyle and memory decline in older adults

3 Mar, 2023 | 13:44h | UTC

Summary: This study examined the association between a healthy lifestyle and memory decline in older adults over a 10-year period. The study included 29,072 participants aged 60 or older with normal cognition and apolipoprotein E (APOE) genotyping at baseline. Six healthy lifestyle factors were assessed: a healthy diet, regular physical exercise, active social contact, active cognitive activity, never or former smoker, and never drinking alcohol. Participants were categorized into three groups based on their lifestyle factors: favorable, average, and unfavorable. The results showed that participants in the favorable group had slower memory decline than those in the unfavorable group, even in the presence of the APOE ε4 allele. These findings have important implications for public health initiatives to protect older adults against memory decline.

Article: Association between healthy lifestyle and memory decline in older adults: 10 year, population based, prospective cohort study – The BMJ

Editorial: Healthy lifestyles for dementia prevention – The BMJ

News Release: Healthy lifestyle linked to slower memory decline in older adults – BMJ Newsroom

Commentary: Healthful Lifestyle May Slow Memory Loss, Even for APOE Gene Carriers – JAMA

 

Commentary on Twitter

Under a http://creativecommons.org/licenses/by-nc/4.0/ license

 

Review | Practical guide for anticoagulant and antiplatelet reversal in clinical practice

3 Mar, 2023 | 13:42h | UTC

Practical Guide for Anticoagulant and Antiplatelet Reversal in Clinical Practice – Pharmacy

 

Study shows sudden cardiac arrest during sports activity is rare among older adults

3 Mar, 2023 | 13:38h | UTC

Sudden Cardiac Arrest During Sports Activity in Older Adults – Journal of the American College of Cardiology (link to abstract – $ for full-text)

Commentaries:

Sports-related sudden cardiac arrest is rare in older adults – Cedars-Sinai Medical Center

Risk of Sports-Related Sudden Cardiac Arrest Low in Older Adults – TCTMD

 

RCT | Efficacy of Fezolinetant in moderate-to-severe vasomotor symptoms associated with menopause

3 Mar, 2023 | 13:28h | UTC

Efficacy and Safety of Fezolinetant in Moderate-to-Severe Vasomotor Symptoms Associated With Menopause: A Phase 3 RCT – The Journal of Clinical Endocrinology & Metabolism

 

Youth-onset type 2 diabetes: the epidemiology of an awakening epidemic

2 Mar, 2023 | 13:01h | UTC

Youth-Onset Type 2 Diabetes: The Epidemiology of an Awakening Epidemic – Diabetes Care

 

RCT | Empagliflozin (SGLT2i) is more effective for reducing HbA1c than linagliptin (DPP-4i) in young people with Type 2 DM

2 Mar, 2023 | 13:00h | UTC

Efficacy and safety of the SGLT2 inhibitor empagliflozin versus placebo and the DPP-4 inhibitor linagliptin versus placebo in young people with type 2 diabetes (DINAMO): a multicentre, randomised, double-blind, parallel group, phase 3 trial – The Lancet Diabetes & Endocrinology (link to abstract – $ for full-text)

Commentaries:

DINAMO: Empagliflozin shows promise for young people with type 2 diabetes – medwire News

Phase 3 trial finds oral empagliflozin provides safe glycemic control in children with type 2 diabetes – Joslin Diabetes Center

 

RCT | Endovascular ultrasound renal denervation is modestly effective in the treatment of hypertension

1 Mar, 2023 | 14:11h | UTC

Summary: The RADIANCE II randomized clinical trial investigated the efficacy and safety of endovascular ultrasound renal denervation in patients with hypertension without the influence of antihypertensive medications. The trial enrolled 224 patients who were withdrawn from such medications and randomly assigned to receive either ultrasound renal denervation or a sham procedure. Results showed that ultrasound renal denervation reduced ambulatory systolic blood pressure by 6.3 mmHg on average at 2 months, compared to the sham procedure, without any reported adverse events. While these findings suggest that ultrasound renal denervation may be modestly effective in the treatment of hypertension, the short-term follow-up period limits the generalizability of these results to daily practice. Additionally, the clinical relevance of a procedure that reduces blood pressure only after withdrawing blood pressure medications should be considered.

Article: Endovascular Ultrasound Renal Denervation to Treat Hypertension: The RADIANCE II Randomized Clinical Trial – JAMA (free for a limited period)

Editorial: Is There a Role for Renal Denervation in the Treatment of Hypertension? – JAMA Cardiology (free for a limited period)

 

RCT | Long-term effects of early antiretroviral therapy initiation in HIV infection highlight the importance of early treatment

1 Mar, 2023 | 14:12h | UTC

Summary: The article discusses the long-term results of the Strategic Timing of AntiRetroviral Treatment (START) trial, which aimed to determine the effects of early initiation of antiretroviral therapy (ART) for individuals with HIV and CD4+ counts above 500 cells/mm3 compared to those who deferred treatment until their CD4+ count was below 350 cells/mm3. The trial found that immediate ART initiation reduced the risk of AIDS and serious non-AIDS (SNA) conditions compared to deferred treatment. The study’s long-term results also found that a persistent excess risk of AIDS and SNA conditions remained even after ART was initiated in those who initially deferred treatment. The study highlights the importance of early diagnosis and prompt initiation of ART for individuals with HIV.

Article: Long-Term Benefits from Early Antiretroviral Therapy Initiation in HIV Infection – NEJM Evidence

Original Study: Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection – New England Journal of Medicine

 

Pooled analysis of 3 sham-controlled trials on ultrasound renal denervation for patients with hypertension

1 Mar, 2023 | 14:10h | UTC

Summary: The article reports a patient-level pooled analysis of 3 randomized clinical trials that aimed to determine the effectiveness and safety of ultrasound renal denervation (uRDN) in reducing blood pressure (BP) compared to a sham procedure. The analysis included 506 patients with varying severities of hypertension and found that uRDN was modestly effective in reducing daytime ambulatory systolic BP at 2 months compared to the sham procedure, with a mean difference of 5.9 mmHg. One of the limitations of this analysis is that its findings are restricted to a 2-month follow-up. Additional follow-up from the included trials will be required to examine the durability of the effect and safety data.

Article: Patient-Level Pooled Analysis of Ultrasound Renal Denervation in the Sham-Controlled RADIANCE II, RADIANCE-HTN SOLO, and RADIANCE-HTN TRIO Trials – JAMA Cardiology

Editorial: Is There a Role for Renal Denervation in the Treatment of Hypertension? – JAMA Cardiology (free for a limited period)

 

Artificial sweetener erythritol possibly implicated in increased cardiovascular risk

1 Mar, 2023 | 14:08h | UTC

Summary: A recent study published in Nature Medicine found that erythritol, a popular artificial sweetener, is possibly implicated with an increased risk of major adverse cardiovascular events (MACE) such as heart attack and stroke. Analyzing data from over 4,000 people in the US and Europe, the researchers found that those with higher blood erythritol levels were at a greater risk of MACE. The researchers also examined the effects of adding erythritol to whole blood or isolated platelets and found that it made platelets easier to activate and form clots. In addition, a pilot intervention study with healthy volunteers showed that erythritol ingestion led to a marked and sustained increase in plasma erythritol levels above those associated with heightened platelet reactivity and thrombosis potential. The authors note that further studies are needed to confirm their findings and assess the long-term safety of erythritol.

Article: The artificial sweetener erythritol and cardiovascular event risk – Nature Medicine (free for a limited period)

News Release: Cleveland Clinic study finds common artificial sweetener linked to higher rates of heart attack and stroke

Commentaries:

Zero-calorie sweetener linked to heart attack and stroke, study finds – CNN

Could a Common Sweetener Raise Heart Risks? – HealthDay

 

Commentary on Twitter

 

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