Internal Medicine
The Challenge of Polypharmacy
21 Jun, 2017 | 15:10h | UTCA medicine review is about stopping medicine as much as it is about prescribing – Royal Pharmaceutical Society of Great Britain (free) (RT @MaryanneDemasi see Tweet)
Original report: The Challenge of Polypharmacy: From Rhetoric to Reality – Royal Pharmaceutical Society and Royal College of General Practitioners Partnership (free PDF)
Related: Current and future perspectives on the management of polypharmacy – BMC Family Practice (free)
Yoga, Physical Therapy, or Education for Chronic Low Back Pain
21 Jun, 2017 | 02:13h | UTCYoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentaries: Yoga Vs. Physical Therapy For Chronic Low Back Pain: Which Is More Effective? – Forbes (free) AND Yoga Noninferior to Physical Therapy for Low Back Pain – Physician’s First Watch (free) AND Yoga as Good for Low Back Pain as Physical Therapy – Medscape (free registration required)
Corticosteroids not helpful for acute urticaria
21 Jun, 2017 | 02:12h | UTCCommentaries: No Benefit From Corticosteroids for Acute, Simple Urticaria – Medscape (free registration required) AND Got hives? Hold the steroids – American College of Emergency Physicians, via EurekAlert (free)
Screening for Obesity in Children and Adolescents
21 Jun, 2017 | 02:19h | UTCEditorial 1: Putting the US Preventive Services Task Force Recommendation for Childhood Obesity Screening in Context (free)
Editorial 2: Practical Considerations for the US Preventive Services Task Force Recommendations on Obesity in Children and Adolescents (free)
Author interview: USPSTF Recommendation: Screening for Obesity in Children and Adolescents (free audio)
The JAMA Network – for the media: Screening for Obesity in Children and Adolescents Recommended (free)
Commentary: USPSTF Recommends Screening For Obesity in Children and Adolescents – American College of Cardiology, Latest in Cardiology (free)
“The USPSTF recommends that clinicians screen for obesity in children and adolescents 6 years and older and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status”
Your vitamin D tests and supplements are probably a waste of money
21 Jun, 2017 | 02:08h | UTCYour vitamin D tests and supplements are probably a waste of money – VOX (free)
Related: Why Are So Many People Popping Vitamin D? – The New York Times (10 articles per month are free)
“Screening for vitamin D has exploded — with no good evidence that it helps people.”
Review: Differentiating lower motor neuron syndromes
20 Jun, 2017 | 19:09h | UTC
Antiplatelet Therapy in Patients With Coronary Stents Undergoing Elective Noncardiac Surgery
20 Jun, 2017 | 18:23h | UTCGlucose targets for preventing diabetic kidney disease and its progression
20 Jun, 2017 | 12:49h | UTCGlucose targets for preventing diabetic kidney disease and its progression – Cochrane Library (link to summary – $ for full review)
Sources: EvidenceAlerts and @anupam1623
Intensive glycemic control had no effect on risks of kidney failure, death and major cardiovascular events. “The clinical impact of targeting an HbA1c < 7% or blood glucose < 6.6 mmol/L (120 mg/dL) is unclear and the potential harms of this treatment approach are largely unmeasured.
Patients with opioid disorders frequently have other comorbidities
20 Jun, 2017 | 12:30h | UTCTreating patients with opioid disorders is not just about treating addiction. Here’s why – STAT News (free)
Original analysis: What data from 205 million private health insurance claims reveals about America’s opioid crisis – Amino (free)
Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management
20 Jun, 2017 | 12:47h | UTCNews Release: Healthcare providers should individualize patient education (free)
AHA statement: Doctors’ orders should include tailored health education for patients (free)
Commentary: Sharpening the Focus on Therapeutic Patient Education and Self-management (free)
Top Ten Things to Know: Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management (free PDF)
Antibiotic stewardship reduces the incidence of antibiotic-resistant bacteria
20 Jun, 2017 | 12:41h | UTCEffect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis – The Lancet Infectious Diseases (link to abstract – $ for full-text)
Commentaries: Antibiotic Stewardship Programs Linked to Lower Rates of Drug-Resistant Infections – Physician’s First Watch (free) AND Review ties stewardship to sharp drop in resistant bacteria – CIDRAP (free)
Richard Lehman’s weekly review of medical journals
20 Jun, 2017 | 12:26h | UTCRichard Lehman’s weekly review of medical journals, 19 June 2017 – The BMJ Blogs (free)
Why overtreatment and overdiagnosis can be bad for your health
20 Jun, 2017 | 12:19h | UTCWhy overtreatment and overdiagnosis can be bad for your health – CBC Radio (free text and audio)
See more on the Choosing Wisely initiative in our April 5 issue, see #6.
“Choosing Wisely on CBC Sunday about overdiagnosis & importance of speaking with your doc about tests/treatments” (RT @ChooseWiselyCA see Tweet)
Who Should Assess the Needs of and Care for a Dementia Patient’s Caregiver?
20 Jun, 2017 | 12:20h | UTCWho Should Assess the Needs of and Care for a Dementia Patient’s Caregiver? – AMA Journal of Ethics (free)
“Physicians have an obligation to check in on dementia patients’ caregivers, and provide support if necessary” (RT @JournalofEthics see Tweet)
ACR Thyroid Imaging and Reporting
20 Jun, 2017 | 12:09h | UTCACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee – Journal of the American College of Radiology (free, and legal, PDF via Unpawall)
Commentary: New ultrasound scoring system for thyroid nodules to reduce unnecessary biopsies – University of Alabama at Birmingham, via EurekAlert (free)
Incretin based treatments and mortality in patients with type 2 diabetes
20 Jun, 2017 | 12:06h | UTC“The current evidence provides no support for the hypothesis that incretin based treatment increases all-cause mortality in patients with type 2 diabetes”
Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association
19 Jun, 2017 | 13:00h | UTCDietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association (free PDF)
Invited Commentary: Trimming the Fat on Diet Recommendations for a Healthy Heart: Emphasis on Eating Patterns over Dietary Restrictions (free)
Top Ten Things to Know: Dietary Fats and Cardiovascular Disease: A Presidential Advisory from the American Heart Association (free PDF)
AHA News: Advisory: Replacing saturated fat with healthier fat could lower cardiovascular risks (free)
News release: Replacing saturated fat with healthier fat may lower cholesterol as well as drugs in context of a healthy diet (free)
AHA no longer recommends decreasing total fat, but to replace saturated fats with polyunsaturated or monounsaturated fats. “Replacing saturated fat with healthier fat in the diet lowers cardiovascular disease risk as much as cholesterol-lowering statin drugs”
Comparison of sputum collection methods for tuberculosis diagnosis
19 Jun, 2017 | 13:01h | UTCInvited commentary: Remembering the basics: interventions to improve sputum collection for tuberculosis diagnosis (free)
Pooled sputum collection (sputum that was pooled from each spontaneous expectoration into the same sputum container over a period of several hours) increased the diagnostic performance of smear microscopy 1.6 times and the delivery of standardized instruction emphasizing the difference between sputum and saliva (verbally or visually) increased the odds of a positive microscopy result 1.4 times. “The effect of these simple, inexpensive strategies on diagnostic performance was similar to that of the relatively expensive GeneXpert MTB/RIF test, which, in the largest published studies, increased the odds of diagnosing tuberculosis by 1.3–1.5 times”
Evolocumab for Treatment of High Cholesterol: Clinical Effectiveness
19 Jun, 2017 | 12:55h | UTCEvolocumab for Treatment of High Cholesterol: Clinical Effectiveness (free PDF) (RT @AnilMakam see Tweet 1, Tweet 2, Tweet 3 and Tweet 4)
News release: Institute for Clinical and Economic Review’s “New Evidence Update” on PCKS9 Inhibitors Highlights Lack of Mortality Benefit With Evolocumab (free)
Lack of mortality benefit in a recent large trial is highlighted in this updated review. Se more on the FOURIER trial and commentaries in our March 20th issue, see #2.
Racial Differences in the Relationship of Glucose Concentrations and Hemoglobin A1c Levels
19 Jun, 2017 | 12:59h | UTCRacial Differences in the Relationship of Glucose Concentrations and Hemoglobin A1c Levels – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentaries: Glycation of Hemoglobin Differs by Race – Physician’s Briefing (free) AND Hemoglobin A1c Overestimates Average Glucose in Blacks – Medscape (free registration required) AND Why a key diabetes test may work differently depending on your race – CNN (free)
In this study with 104 black patients and 104 white patients with type 1 diabetes, HbA1c values in black persons were 0.4 percentage points higher than those in white persons for a given mean glucose concentration.
EULAR/EFORT recommendations for the management of fragility fractures
19 Jun, 2017 | 12:54h | UTC
Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty
19 Jun, 2017 | 12:57h | UTCPress release: New Guideline Aims to Reduce Infections in Total Hip & Knee Replacement Patients (free)
Commentaries: New medication guidelines for rheumatic disease patients having joint replacement – Hospital for Special Surgery, via EurekAlert (free) AND New Guidelines Issued on Antirheumatic Drugs for Patients Undergoing Knee or Hip Replacement – Physician’s First Watch (free)
Why are doctors killing themselves
19 Jun, 2017 | 12:55h | UTCWhy are doctors killing themselves? – by Anne Malatt, via MJA Insight (free)
Related: Why are doctors plagued by depression and suicide? A crisis comes into focus – STAT News (free)
PSA Test for Prostate Cancer
19 Jun, 2017 | 12:50h | UTCOpinion: Why I Won’t Get a PSA Test for Prostate Cancer – Scientific American (free)
Guidelines for the Chronic Use of Opioid Analgesics
19 Jun, 2017 | 12:50h | UTCGuidelines for the Chronic Use of Opioid Analgesics – Federation of State Medical Boards (FSMB) (free PDF)
Commentary: Chronic Pain Opioid Guidelines Updated for State Medical Boards – Medscape (free registration required)