Internal Medicine
Why Physician Burnout Is Endemic, and How Health Care Must Respond
24 Apr, 2017 | 15:24h | UTCSurvey and commentaries: Why Physician Burnout Is Endemic, and How Health Care Must Respond – NEJM Catalyst (free)
Increased in clerical burden seems to be one of the leading causes, heavily influenced by expanded and more comprehensive use of electronic health records. More on the burden of administrative tasks in healthcare in our April 21 issue, see #5.
Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes
21 Apr, 2017 | 15:22h | UTCFrequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes – New England Journal of Medicine (link to abstract – $ for full-text)
See also: Researchers Propose Extending Diabetic Retinopathy Screening Interval – Physician’s First Watch (free) AND Research from long-term study advocates individualized eye screenings in type 1 diabetes – Diabetes.co.uk (free)
In patients who have had type 1 diabetes for 5 years, annual retinal examinations are currently recommended. Based on their findings, the authors suggest an individualized screening schedule, with less frequent screening for patients at low risk and more frequent screening for patients at higher risk, leading to decreased cost without delaying the diagnosis of clinically significant disease.
Syncope and Its Impact on Occupational Accidents and Employment
20 Apr, 2017 | 14:29h | UTCNews release: Fainting spells may increase risk of workplace accidents, job loss – American Heart Association News (free)
See also: 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (free PDF) AND First fainting guidelines issued to diagnose life-threatening heart conditions – American Heart Association News (free)
Use of Medications of Questionable Benefit at the End of Life
20 Apr, 2017 | 14:34h | UTCUse of Medications of Questionable Benefit at the End of Life in Nursing Home Residents with Advanced Dementia – Journal of the American Geriatrics Society (link to abstract – $ for full-text)
See also: Use of Medications of Questionable Benefit at the End of Life in Nursing Home Residents with Advanced Dementia – CBCNews (free) AND Many With Advanced Dementia Receiving Drugs of Uncertain Benefit – Medscape (free registration required)
“Too much use of meds of questionable benefit at the end of life: Just Stop.” (RT @DeeMangin see Tweet)
Approaches for Evaluation of Asymptomatic Microscopic Hematuria
20 Apr, 2017 | 14:27h | UTCInvited commentary: Asymptomatic Microscopic Hematuria – Rethinking the Diagnostic Algorithm (free)
Routine urinalysis for screening is not presently recommended by any major health organization, but asymptomatic microscopic hematuria is a common incidental finding. This study suggests that the combination of renal ultrasound and cystoscopy is the most cost-effective approach for the evaluation of these patients.
β-Blocker Exposure in Pregnancy and Risk of Fetal Cardiac Anomalies
20 Apr, 2017 | 14:28h | UTCβ-Blocker Exposure in Pregnancy and Risk of Fetal Cardiac Anomalies – JAMA Internal Medicine (link to abstract – $ for full-text)
See also: No Fetal Heart Risk from Mom’s Beta-Blocker Use – MedPage Today (free registration required)
Australasian Society for Infectious Diseases: low value interventions
20 Apr, 2017 | 14:30h | UTCAustralasian Society for Infectious Diseases: low value interventions – The Medical Journal of Australia (free) (RT @ChooseWiselyAU and @ASIDANZ see Tweet)
See also: Choosing Wisely initiative was launched 5 years ago in our April 5 issue.
The society has just released a selection of 5 low value interventions (details in the text):
– Prescribing antibiotics for asymptomatic bacteriuria.
– Taking a swab of a leg ulcer without signs of clinical infection and treating the patient with antibiotics against the identified bacteria.
– Treating upper respiratory tract infections with antibiotics.
– Investigation for fecal pathogens in the absence of diarrhea or other gastrointestinal symptoms.
– Ordering multiple serological investigations for patients with fatigue without a clinical indication or relevant epidemiology.
Preventing Sports Injury and Illness: Key Resources for Family Physicians
19 Apr, 2017 | 14:18h | UTCSelection of resources for primary care providers to improve their ability to prevent and treat injuries from sports and physical activity.
Irritable bowel syndrome in adults: diagnosis and management
20 Apr, 2017 | 14:26h | UTCUpdated Guideline: Irritable bowel syndrome in adults: diagnosis and management – National Institute for Health and Care Excellence (NICE – UK) (free)
Alcohol-use disorders: diagnosis and management of physical complications
20 Apr, 2017 | 14:25h | UTCUpdated Guideline: Alcohol-use disorders: diagnosis and management of physical complications – National Institute for Health and Care Excellence (NICE – UK) (free)
Associations of Maternal Antidepressant Use and Complications in Offspring
19 Apr, 2017 | 14:12h | UTCAssociations of Maternal Antidepressant Use During the First Trimester of Pregnancy With Preterm Birth, Small for Gestational Age, Autism Spectrum Disorder, and Attention-Deficit/Hyperactivity Disorder in Offspring – JAMA (link to abstract – $ for full-text)
Contradicting a previous study showing increased risk of autism with antidepressant use during pregnancy (free), this large retrospect cohort study of 1 580 629 Swedish offspring did not show an association of antidepressant use during pregnancy and autism or other neurodevelopment problems.
Maternal asthma: Management strategies
19 Apr, 2017 | 14:16h | UTCMaternal asthma: Management strategies – Cleveland Clinic Journal of Medicine (free)
Dexamethasone versus for postoperative nausea and vomiting in GI surgery
19 Apr, 2017 | 14:15h | UTCA single dose of 8 mg intravenous dexamethasone at induction of anesthesia reduced postoperative nausea and vomiting with no increase in adverse events.
ACC/AHA vs. USPSTF statin guidelines
19 Apr, 2017 | 14:11h | UTCComparison of Recommended Eligibility for Primary Prevention Statin Therapy Based on the US Preventive Services Task Force Recommendations vs the ACC/AHA Guidelines – JAMA (link to abstract – $ for full-text)
See also: ACC/AHA vs. USPSTF statin guidelines – Cardiology News (free)
Although recommended by most guidelines for individuals at high risk, there is still some controversy over prescribing statins for primary prevention and over what patients benefit the most – see related commentary: Cholesterol-lowering statin therapy for healthy people is not as simple as ‘yes’ or ‘no’ – The Pharmaceutical Journal (free)
Adherence to the 2016 USPSTF recommendations for statin therapy, compared with the 2013 ACC/AHA guidelines, could lead to a lower number of individuals (an estimated difference of 9.3 million individuals in the U.S. population) recommended for primary prevention statin therapy.
Value-Based Reforms Linked to Readmission Reductions
18 Apr, 2017 | 14:02h | UTCAssociation Between Hospitals’ Engagement in Value-Based Reforms and Readmission Reduction in the Hospital Readmission Reduction Program – JAMA Internal Medicine (link to abstract – $ for full-text)
Sources: Value-Based Reforms Linked to Readmission Reductions – Medscape (free registration required) AND Richard Lehman’s weekly review(free – see below)
A program of incentives (Medicare Hospital Readmission Reduction Program in the US) was effective in reducing 30 day readmissions following infarction, heart failure, and pneumonia.
Insulin pump didn’t improve glycemic control compared to training on injections
18 Apr, 2017 | 13:58h | UTCSee also: Insulin pump didn’t improve glycemic control compared to training on injections – ACP Diabetes Monthly (free)
Too Clean for Our Children’s Good?
18 Apr, 2017 | 14:04h | UTCToo Clean for Our Children’s Good? – The New York Times (10 articles per month are free)
According to the “hygiene hypothesis”, some exposure to germs and microorganisms might be good for us because it helps develop the immune system.
New drugs, new toxicities: severe side effects of modern targeted and immunotherapy of cancer and their management
18 Apr, 2017 | 14:05h | UTCSource: Critical Care Reviews Newsletter
Life after breast, prostate, and colon cancer: Primary care’s role
17 Apr, 2017 | 13:53h | UTC
Banning trans fats in New York prevented thousands of heart attacks
13 Apr, 2017 | 16:08h | UTCHospital Admissions for Myocardial Infarction and Stroke Before and After the Trans-Fatty Acid Restrictions in New York – JAMA Cardiology (link to abstract – $ for full-text)
Sources: Banning trans fats in New York prevented thousands of heart attacks, study finds – STAT News (free) AND Trans Fat Bans Tied to Fewer Heart Attacks and Strokes – The New York Times (10 articles per month are free)
Other localities might consider doing the same as well.
Guidelines for the diagnosis and treatment of drug-induced liver injury
17 Apr, 2017 | 13:54h | UTC
Screening for Endocrine Hypertension
14 Apr, 2017 | 16:27h | UTCScreening for Endocrine Hypertension: An Endocrine Society Scientific Statement (free)
Source: Screen for Endocrine Hypertension, Endocrine Society Says – Medscape (free registration required)
“The statement provides guidance on screening for 15 hormonal disorders that present with hypertension and that can be potentially cured with surgery or treated with medication” (from Medscape commentary above).
European Association of Urology releases its 1st thromboprophylaxis guideline
14 Apr, 2017 | 16:10h | UTCEuropean Association of Urology releases its 1st thromboprophylaxis guideline (free)
“Extended thromboprophylaxis is warranted in some procedures (eg, open and robotic cystectomy) but not others (eg, robotic prostatectomy without pelvic lymph node dissection in low-risk patients)”
“Extended prophylaxis is warranted for some procedures (eg, kidney transplantation procedures in high-risk patients) but not others (transurethral resection of the prostate and reconstructive female pelvic surgery in low-risk patients)”
Screening to Prevent Invasive Cervical Cancer Guideline
13 Apr, 2017 | 16:03h | UTCScreening to Prevent Invasive Cervical Cancer: ASCO Resource-Stratified Clinical Practice Guideline (free)
“The ASCO guidelines outline the minimum standards for HPV-based screening for each resource strata; additional and more frequent screening may be added as the resources become available”.
Prostate Cancer Screening – Conflicting views on the new USPSTF draft recommendations
13 Apr, 2017 | 16:06h | UTCProstate Cancer Screening – Conflicting views on the new USPSTF draft recommendations
In favor of screening: New Official Prostate Cancer Screening Guidelines Announced: Too Little, Too Late? – Forbes (free) AND Federal Task Force Softens Opposition To Routine Prostate Cancer Screening – NPR
Against screening: The new recommendations for prostate cancer screenings are a bad deal – STAT News (free)
See also: Original USPSTF draft recommendations and related commentaries in yesterday’s issue