Internal Medicine
M-A | Combination of multiple low-risk lifestyle behaviors and incident type 2 diabetes
1 Mar, 2023 | 14:06h | UTCSummary: This systematic review and meta-analysis assessed the association between multiple low-risk lifestyle behaviors (LRLBs) and the incidence of type 2 diabetes. The study examined 30 cohort comparisons involving 1,693,753 participants and 75,669 cases of type 2 diabetes. The LRLBs evaluated in the study were maintaining a healthy body weight, healthy diet, regular exercise, smoking abstinence or cessation, and light alcohol consumption. Results showed that the highest adherence to these LRLBs was associated with an 80% lower risk of type 2 diabetes compared to the lowest adherence group. Thus, targeting these LRLBs could be an effective strategy for the primary prevention of type 2 diabetes. However, the authors recommend promoting only four LRLBs, excluding alcohol intake, due to its association with increased harm. The potential benefits of small alcohol intake remain a controversial issue since most studies on the subject are observational and subject to residual confounding.
Article: Combination of Multiple Low-Risk Lifestyle Behaviors and Incident Type 2 Diabetes: A Systematic Review and Dose-Response Meta-analysis of Prospective Cohort Studies – Diabetes Care (free for a limited period)
Commentary from the author on Twitter (thread – click for more)
https://twitter.com/tauseefkhan/status/1628510003853131776
Review | Borderline personality disorder
1 Mar, 2023 | 14:04h | UTCBorderline Personality Disorder: A Review – JAMA (free for a limited period)
JAMA Patient Page: Borderline Personality Disorder
Review | Platelet aggregation inhibitors and anticoagulants in gastroenterological and visceral surgical procedures
1 Mar, 2023 | 14:03h | UTC
Virtual wards: a rapid evidence synthesis and implications for the care of older people
1 Mar, 2023 | 13:52h | UTC
Review | The golden grapes of wrath – Staphylococcus aureus bacteremia
1 Mar, 2023 | 13:46h | UTC
RCT | Physician-led medication reviews in polypharmacy patients with Type 2 DM treated with at least 12 medications
1 Mar, 2023 | 13:36h | UTC
Choosing Wisely in Cardiology | New ACC list of five things physicians and patients should question
28 Feb, 2023 | 14:03h | UTCSummary: The American College of Cardiology (ACC) has released a list of “Five Things Physicians and Patients Should Question” in cardiology as part of the Choosing Wisely campaign, which encourages conversations between clinicians and patients about potentially unnecessary tests, treatments, and procedures. The list includes recommendations to:
- Avoid the routine use of invasive hemodynamic monitoring with pulmonary artery catheters in patients with uncomplicated acute decompensated heart failure.
- Avoid performing atrial fibrillation ablation for the sole purpose of discontinuing chronic anticoagulation.
- Avoid routine imaging stress tests or coronary CT angiography for the workup of palpitations or presyncope.
- Avoid obtaining a coronary artery calcium score in patients with known clinical atherosclerotic cardiovascular disease.
- Avoid obtaining routine serial echocardiograms for chronic heart failure if there has been no change in signs, symptoms, or management.
The recommendations are based on published national guidelines and aim to broadly represent the field of cardiology.
Commentary: ACC Releases New List of Choosing Wisely Recommendations – American College of Cardiology
See complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada
Review | Antiphospholipid syndrome: advances in diagnosis, pathogenesis, and management
28 Feb, 2023 | 14:00h | UTCAntiphospholipid syndrome: advances in diagnosis, pathogenesis, and management – The BMJ
M-A | Which adverse events and which drugs are implicated in drug-related hospital admissions
28 Feb, 2023 | 13:59h | UTCSummary: This systematic review and meta-analysis aimed to provide an updated estimation of drug-related hospital admissions, the types and frequency of drug-induced harm, and the drugs involved. The review included 17 studies that examined acute admissions to emergency departments or inpatient wards resulting from drug-induced harm in the general population. These studies were published between January 2012 and December 2021. The estimated rates of admissions resulting from adverse drug reactions* (ADRs) and adverse drug events* (ADEs) were 8.3% and 13.9%, respectively. Almost half of the admissions related to ADRs and over two-thirds of those related to ADEs were possibly preventable. Gastrointestinal disorders, electrolyte disturbances, bleeding events, and renal and urinary disorders were the most frequently involved categories of drug-induced harm. The most frequently involved drug groups were nervous system drugs, followed by cardiovascular and antithrombotic agents.
*Adverse drug events (ADEs) and adverse drug reactions (ADRs) are two terms that are often used interchangeably, but they actually have different meanings. Adverse drug events (ADEs) refer to any negative effect that results from medication exposure and can be caused by a variety of factors, including medication errors, overdose, drug interactions, or allergic reactions. In contrast, adverse drug reactions (ADRs) are a specific type of ADE that occur as unintended effects of medication at normal therapeutic doses.
Guidelines | Efficacy and safety of non-steroidal anti-inflammatory drugs for the treatment of acute pain after orthopedic trauma
28 Feb, 2023 | 13:48h | UTC
Review | Embracing complexity: making sense of diet, nutrition, obesity and type 2 diabetes
28 Feb, 2023 | 13:42h | UTCEmbracing complexity: making sense of diet, nutrition, obesity and type 2 diabetes – Diabetologia
Commentary on Twitter
Comprehensive Review @DiabetologiaJnl by my very talented friend Prof Nita Forouhi
Embracing complexity: making sense of diet, nutrition, obesity & T2 diabeteshttps://t.co/PxGOZL0XkB pic.twitter.com/x2GaDPClfi
— Prof Kamlesh Khunti (@kamleshkhunti) February 24, 2023
Under a http://creativecommons.org/licenses/by/4.0/ license
RCT | Effects of an exercise and physical activity program in patients with atrial fibrillation
28 Feb, 2023 | 13:38h | UTCAn Exercise and Physical Activity Program in Patients With Atrial Fibrillation: The ACTIVE-AF Randomized Controlled Trial – JACC: Clinical Electrophysiology (link to abstract – $ for full-text)
Commentary: ACTIVE-AF Suggests Physical Activity May Reduce Atrial Fibrillation Risk – HCP Live
The adult and pediatric palliative care: differences and shared issues
28 Feb, 2023 | 13:30h | UTC
Review | (Mal)nutrition in critical illness and beyond
28 Feb, 2023 | 13:28h | UTC(Mal)nutrition in critical illness and beyond: a narrative review – Anaesthesia
Choosing Wisely internationally – 213 helpful recommendations for antimicrobial stewardship!
27 Feb, 2023 | 13:19h | UTCSummary: The article discusses the importance of antimicrobial stewardship (AMS) in the face of increasing antimicrobial resistance and the role of the Choosing Wisely campaign in promoting the rational use of antibiotics. The study evaluated 213 Choosing Wisely recommendations related to AMS practices in six countries (Australia/New Zealand, Canada, Italy, Switzerland, the USA, and Germany) and categorized them according to six categories: diagnostics, indication, choice of anti-infective drugs, dosing, application, and duration of therapy. Topics related to indication and diagnostics were most frequently addressed, and avoiding antibiotic treatment of asymptomatic bacteriuria and upper respiratory tract infections were central topics across all countries.
Article: Choosing Wisely internationally – helpful recommendations for antimicrobial stewardship! – Infection
See complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada
Perspective | Beware of overdiagnosis harms from screening, lower diagnostic thresholds, and incidentalomas
27 Feb, 2023 | 13:18h | UTCSummary: This article discusses the concept of overdiagnosis and its relevance to clinical practice guidelines. Overdiagnosis is the diagnosis of a condition that, if unrecognized, would not result in symptoms or cause a patient harm during their lifetime, such as discovering a low-grade cancer that will never lead to symptoms at the end of life. But, unlike false positives, overdiagnosed individuals truly have the condition; they just don’t benefit from the diagnosis. Overdiagnosis can also result from lowering diagnostic thresholds for diagnosing a disease, which inflates diagnosis rates among patients and leads to recommendations for subsequent interventions without clear benefits. The article highlights the importance of providing accurate information to patients about the possibility and burden of overdiagnosis to inform shared decision-making and minimize the harms of screening interventions.
Related:
Overdiagnosis: it’s official – The BMJ
Overdiagnosis: what it is and what it isn’t – BMJ Evidence Based Medicine
Overdiagnosis across medical disciplines: a scoping review – The BMJ Open
Too much medical care: bad for you, bad for health care systems – STAT News
Overdiagnosis: causes and consequences in primary health care – Canadian Family Physician
Five warning signs of overdiagnosis – The Conversation
What is overdiagnosed cancer? And why does it matter? – Croakey
Blame rising cancer overdiagnosis on ‘irrational exuberance’ for early detection – STAT
A food allergy epidemic… or just another case of overdiagnosis?
An epidemic of overdiagnosis: Melanoma diagnoses sky rocket
Study links proton pump inhibitor use to increased risk of acquiring drug-resistant bacteria in hospitalized patients
27 Feb, 2023 | 13:13h | UTCSummary: This case-control study investigated whether proton pump inhibitors (PPIs) are associated with an increased risk of acquiring extended-spectrum β-lactamase (ESBL) or carbapenemase-producing Enterobacterales among hospitalized patients. The study involved 2239 adult hospitalized patients. After controlling for confounding factors, patients who received PPIs within the previous 30 days had a nearly 50% increased risk (aIRR, 1.48) of acquiring ESBL- or carbapenemase-producing Enterobacterales compared with those who did not receive PPIs. The study has the limitations of an observational study but points to the need for judicious use of PPIs to mitigate the risk of acquiring drug-resistant Enterobacterales among hospitalized patients.
Commentaries:
Study links acid suppressants to colonization with multidrug-resistant bacteria – CIDRAP
Proton Pump Inhibitors Associated With Increased Risk of Drug-Resistant Infections – HCP Live
Cohort Study | Aggressive end-of-life care is still common among older adults with metastatic cancer in the US
27 Feb, 2023 | 13:11h | UTCSummary: The study aimed to compare the markers of aggressive end-of-life (EOL) care between older adults with metastatic cancer who are nursing home (NH) residents and those who live in community settings. The study analyzed data from 146,329 patients who died from metastatic breast, colorectal, lung, pancreas, or prostate cancer between 2013 and 2017, and found that aggressive EOL care was more common among NH residents than community-dwelling residents (63.6% vs. 58.3%). More than one hospital admission in the last 30 days of life and death in the hospital were the key markers associated with a higher prevalence of aggressive EOL care. The authors suggest that interventions targeting these factors could improve the quality of end-of-life care.
Consensus Report | Sepsis-associated acute kidney injury
27 Feb, 2023 | 13:05h | UTCSepsis-associated acute kidney injury: consensus report of the 28th Acute Disease Quality Initiative workgroup – Nature Reviews Nephrology (if the link is paywalled, try this one)
Commentary on Twitter
A Primer in @DiseasePrimers summarizes the epidemiology, mechanisms, diagnosis and treatment of pre-eclampsia, and discusses patient quality of life and open research questions for this condition. https://t.co/IO3uchSl8b pic.twitter.com/Y7Ij6jmy5a
— Nature Portfolio (@NaturePortfolio) February 25, 2023
Parkinson disease primer for the general practitioner
27 Feb, 2023 | 13:00h | UTCPart 1: Diagnosis – Canadian Family Physician
Part 2: Management of motor and nonmotor symptoms – Canadian Family Physician
Related:
Management of psychiatric and cognitive complications in Parkinson’s disease – The BMJ
Podcast | Parkinson’s Disease for primary care.
Onconephrology 2022: an update
27 Feb, 2023 | 12:58h | UTCOnconephrology 2022: An Update – Kidney360
Related:
Treatment of acute kidney injury in cancer patients – Clinical Kidney Journal
Onconephrology: Update in Anticancer Drug-Related Nephrotoxicity – Nephron
Cohort Study | Could regular laxative use be associated with an increased risk of dementia?
27 Feb, 2023 | 12:59h | UTCAssociation Between Regular Laxative Use and Incident Dementia in UK Biobank Participants – Neurology (link to abstract – $ for full-text)
News Release: Study: People Who Regularly Use Laxatives May Have an Increased Risk of Dementia – American Academy of Neurology
Commentary: Regular Use of Laxatives Linked to Risk for All-Cause Dementia – HealthDay
RCT | Single chest tube superior to double chest tube post decortication in trauma/TB patients
27 Feb, 2023 | 12:53h | UTC
Chronic low back pain: a narrative review of recent international guidelines for diagnosis and conservative treatment
27 Feb, 2023 | 12:46h | UTC
Cohort Study | Lipoprotein(a) is linked to atherothrombosis and aortic valve stenosis independent of C-reactive protein
27 Feb, 2023 | 12:44h | UTCLipoprotein(a) is linked to atherothrombosis and aortic valve stenosis independent of C-reactive protein – European Heart Journal (link to abstract – $ for full-text)
Commentary: Lp(a) Is Linked to Atherothrombosis Independent of CRP – American College of Cardiology