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Research summaries with expert commentary
In a small multicenter trial, vitamin C did not improve organ failure scores.
Diabetic patients with hypoglycemia on the last day of hospitalization had higher readmission rates and postdischarge mortality.
Individualized risk assessment might help determine whether a patient could benefit from aspirin.
In a large randomized trial, a small but statistically significant rise in this adverse event was noted.
Oral lefamulin performed as well as moxifloxacin but with considerably more gastrointestinal toxicity.
In a retrospective study, cardiovascular risk was lower with metformin than with sulfonylureas.
In patients with rheumatoid arthritis, shingles risk doubled when tofacitinib-treated patients also used glucocorticoids.
Thyroid-stimulating hormone levels can be maintained anywhere in the normal range.
Admissions are down, but observation stays and emergency department visits are up.
In patients with chronic kidney disease and resistant hypertension, patiromer lowered the frequency of spironolactone-induced hyperkalemia.
Lung function testing does not correlate well with patients' asthma control questionnaire answers.
This approach was better at limiting exacerbations than was daily corticosteroid therapy.
Life's Simple 7 score at age 50 predicted risk for later dementia.
According to a meta-analysis of randomized trials, some patients derive substantial benefit.
In a randomized trial, higher doses unexpectedly were associated with greater declines in bone-mineral density.
Another study says, “please, don't do it!”
Diagnoses of chronic obstructive pulmonary disease were incorrect in about 62% of cases.
In an Iranian study, a fixed-dose combination of four medications lowered the incidence of adverse cardiovascular events.
Despite a suggestion of lower mortality with bisphosphonate treatment in some studies, a meta-analysis does not support it.
Urinary tract infections were not more common in patients who took sodium–glucose cotransporter-2 inhibitors.
A systematic review shows that focused cardiac ultrasonography improves sensitivity for detecting left ventricular dysfunction.
Direct-acting oral anticoagulants were safer than warfarin, but efficacy varies based on indication.
In an observational study of patients with venous thromboembolism, short-term rates of recurrence and major bleeding were similar with the two drugs.
For elective procedures, briefly holding direct-acting oral anticoagulants is associated with acceptable levels of bleeding and thromboembolism.
In an observational study, taking aspirin within 3 days of biopsy was associated with excess risk for bleeding complications.
When anticoagulation is stopped after initial treatment, cumulative incidence of recurrent VTE is 10%, 16%, 25%, and 36% at 1, 2, 5, and 10 years, respectively.
A bundled intervention that included corticosteroids did not improve outcomes and was associated with gastrointestinal bleeding.
In an observational study of prostate cancer patients who received androgen deprivation therapy, excess risks for dementia and Alzheimer disease were noted.
Treatment beyond guideline-recommended shortest effective duration for hospitalized patients is associated with antibiotic-related adverse events.
Benign-appearing, nonfunctioning incidentalomas virtually never progressed to cancer or to clinically evident hormonal excess.
And most older patients are amenable to stopping unnecessary medications.
The association was significant for antidepressants and many other drugs.
More patients were extubated successfully after a 30-minute trial of pressure support ventilation.
Gabapentinoids and tricyclic antidepressants might predispose these patients to falling.
A personalized self-management program reduced exacerbations and improved quality of life.
Among patients with type 2 diabetes, the association between HbA1c and serious hypoglycemia was U-shaped.
A study suggests that overprescribing is common.
The most common adverse GI event was intestinal ischemia or thrombosis, although the absolute incidence was low.
An observational study suggests that risks were higher with tramadol than with hydrocodone.
Patients who read visit notes had a better understanding of prescribed medications.
Regular glucosamine use was associated with lower cardiovascular risk.
In an observational study, surgery was associated with lower risk for recurrent small bowel obstruction.
In a longitudinal study, drinking a lot of sugar-sweetened beverages and 100% fruit juice was not healthful.
Patients with prior VTEs have 5% risk for recurrence by 6 months after major surgery, even if they receive recommended postoperative anticoagulation.
Aclidinium did not worsen cardiovascular outcomes in patients with chronic obstructive pulmonary disease.
Patients with diabetes are particularly susceptible to this generally painful asymmetric neuropathy.
Two studies describe quality-improvement efforts to avoid inappropriate antihypertensive use.
A meta-analysis reveals that direct-acting oral anticoagulants better manage recurrent VTE, whereas low-molecular-weight heparins confer less bleeding risk.
Among patients older than 65, about 50% died during the first year of dialysis.
A cutoff score ≥10 maximized sensitivity and specificity.
In an observational study, outcomes of active surveillance were equally favorable in men older and younger than 60.
An observational study illustrates tradeoffs between VTE prevention and bleeding.
Lifestyle modification and shared decision making are emphasized heavily.
SMT provided similar pain relief and improved function compared with recommended therapies.
Cohort studies demonstrated this finding but fall short of proving a causal relation exists.
Primary care follow-up within 7 days of hospital discharge lowered rates of 30-day and 90-day readmissions.
A novel glucose monitoring system offers automated guidance on insulin dose adjustments.
Using low-dose aspirin for 5 to 9 years was associated with modestly reduced relative risk.
Mortality was higher with tramadol than with nonsteroidal anti-inflammatory drugs.
Capillary refill–guided treatment compared favorably to lactate measurement.
A meta-analysis and guideline make the case for nonsurgical management.
Hospitalizations for chronic obstructive pulmonary disease were less common in patients who received β-blockers.
Preoperative revised cardiac risk index predicts postoperative cardiac complications and death following posterior lumbar decompression.
The biggest changes in this annual publication are welcome improvements to graphics.
In a new model, predicted 5-year recurrence rates can range from 1% to 94%.
Intrinsic platelet function and inhibition by aspirin appear similar in diabetic and nondiabetic patients.
Pregabalin, given for postoperative pain, was associated with some adverse effects on cognition.
Benefit was modest in a meta-analysis of 96 trials.
In studies with low risk for bias, only glucosamine showed benefit, and it was small.
5α-reductase inhibitors don't appear to confer excess risk for high-grade prostate cancer.
Risk was significantly higher with angiotensin-converting–enzyme inhibitors than with angiotensin-receptor blockers.
Some hospitalizations and emergency department visits related to chronic obstructive pulmonary disease were prevented.
Bedside procedures were less painful when lidocaine was dripped on the skin before subcutaneous lidocaine injections.
Among adults with type 1 diabetes, cannabis users were more likely to be hospitalized for ketoacidosis than were nonusers.
A meta-analysis suggests more toxicity but better efficacy from the recombinant vaccine.
Theophylline didn't prevent chronic obstructive pulmonary disease exacerbations in a randomized trial.
No, according to a new analysis of SPRINT data.
In an observational study, aspirin was as effective as an anticoagulant.
Several clinical factors predict diagnostic delay, and delays worsen prognosis.
High-risk patients might benefit, but the relative reduction in mortality is a guideline-stated “low certainty” finding.
Don't forget about noninfectious complications.
Mean short-term disability score was lower for patients who received amitriptyline, but pain scores did not improve.
Long-acting anticoagulants may accentuate the high but can lead to severe and prolonged hemorrhagic complications.
During 5 years of follow-up, recurrence rate was 39%, with few complications.
Replacement did not improve outcomes in a hospital-based observational study.
Despite many studies and media attention, causes and measurement of burnout are unclear.
Older patients with type 2 diabetes might benefit.
In high-risk elders, tai chi lowered the rate of falls substantially.
A prospective cohort study affirms that this practice is safe.
A cohort study shows no association between direct discharge and 1-year mortality or healthcare use in select patients.
A large Dutch observational study says not very well.
Two observational studies support improving cardiovascular health to lower dementia risk.
Among moderate-risk, nondiabetic patients, aspirin did not prevent cardiovascular events, and it raised risk slightly for gastrointestinal bleeding.
In a small study, clinicians neglected to discuss potential adverse effects of lung cancer screening.
In a U.K. study, diclofenac — but not naproxen — was associated with excess risk for myocardial infarction.
However, billing codes to support this approach are used infrequently.
Perhaps surprisingly, antibiotic therapy did not improve outcomes in two randomized trials.
The hospital-at-home care model has potential to improve outcomes in low-risk patients.
Switching from metformin to a sulfonylurea alone was associated with more adverse cardiovascular events and hypoglycemia.
Many diabetic elders are at excess risk for serious hypoglycemia.
Breast, ovary, thyroid, and kidney “incidentalomas” were most likely to be malignant.
Low-dose aspirin was effective only in patients who weighed <70 kg; higher doses were effective in heavier patients.
Critically ill patients with metabolic acidosis were less likely to require RRT when treated with sodium bicarbonate.
Rivaroxaban was an effective alternative to low-molecular-weight heparin for managing VTE in many — but not all — patients with active cancer.
The task force also found insufficient evidence for ankle-brachial index screening for peripheral artery disease.
Giving two or more antihypertensive drugs on the morning of surgery increased risk for postoperative kidney injury.
Serious hypoglycemic events and glycemic control were no better with expensive new basal insulin analogs than with neutral protamine Hagedorn insulin.
In a series of 113 patients, gallbladder cancer was diagnosed in only 2 cases.
In a prospective cohort study, elevated fasting glucose plus elevated glycosylated hemoglobin levels in a single sample confirmed diabetes.
A new Endocrine Society guideline reviews diagnosis and management of hypogonadism.
Vertebroplasty was no better than sham procedures in a randomized trial.
Metformin appears to be safe when glomerular filtration rates are as low as 30 mL/minute/1.73 m2.
A recalibration of risk-estimation equations reflects individual risk more accurately.
A meta-analysis showed lower short-term mortality and higher ejection fractions with these agents.
Second rapid responses within 1 day are more likely among recent intensive care transfers.
Thirty-day mortality was dramatically higher in PE patients with syncope or presyncope.
Physicians who received speaking fees, meals, and other nonresearch payments were more likely to prescribe opioids.
The magnitude of improvement was small, but it persisted for as long as 6 months.
A meta-analysis shows significantly higher mortality with liberal use of supplemental oxygen in acutely ill patients.
A retrospective study suggests mortality and morbidity might be lower with surgical repair.
In a multisite European study, nitrofurantoin won for treating women with urinary tract infections.
Sodium–glucose cotransporter-2 inhibitors and glucagon-like peptide-1 agonists conferred benefit, but dipeptidyl peptidase 4 inhibitors didn't have this effect.
Preoperative glycosylated hemoglobin didn't predict 30-day mortality, and the relation between immediate postoperative glycemic control and mortality was not straightforward.
A large randomized trial showed no excess risk for serious adverse CV or peripheral vascular events with varenicline, bupropion, or nicotine patches.
Does the gut microbiome influence neurological and neoplastic diseases?
The vast majority of tests contribute nothing to patient management.
In one quarter of patients who became pain free, the stone remained in the ureter.
In a retrospective study, relatively low cumulative doses were associated with adverse events.
A trial supports self-monitoring over clinic readings for titrating antihypertensive therapy.
In asymptomatic patients with no history of cancer, these lesions are invariably benign.
Nearly 70% of prescriptions had durations of 10 days or longer, exceeding expert recommendations.
In a large case series, none were malignant.
Screening colonoscopy is associated with fewer cancer-related deaths, and a targeted educational tool can persuade patients to ask for screening.
This Veterans Affairs study showed no benefit over nonopioid medication regimens.
A Swedish cohort study shows that oral fluoroquinolone is associated with higher risks than is amoxicillin.
rtCGM might be a valid less-expensive alternative to insulin pumps for type 1 diabetics.
In older men, lean body mass was unchanged by protein intake, with or without concomitant testosterone therapy.
Two meta-analyses support systemic corticosteroids for hospitalized patients with CAP — especially severe CAP.
In a placebo-controlled trial, prophylactic haloperidol in the ICU did not affect incidence of delirium or risk for death.
Nearly 11% of ARTI patients received corticosteroid prescriptions according to a national database.
In this cohort study, higher odds of hyperkalemia and kidney injury with TMP weren't dependent on drug interactions.
A meta-analysis showed low sensitivity and good specificity when the quick Sequential Organ Failure Assessment is used as a screening tool for sepsis.
The new recombinant zoster vaccine plays a starring role.
Smoking one cigarette daily accounted for one third to one half of excess risk associated with smoking 20 cigarettes daily.
In two observational studies, bariatric surgery patients had higher risk for suicide than nonsurgical patients, although absolute risk was small.
Among patients with chronic obstructive pulmonary disease, starting therapy with long-acting bronchodilators might be associated with excess cardiovascular disease.
In this series, 24 biopsy-proven cases of AIN were associated temporally with quinolone use.
Observation remains a reasonable option in minimally symptomatic patients.
This intervention did not improve outcomes in a randomized trial.
Repair within 24 hours was associated with lower complication rates and lower 30-day mortality.
Definitely more than necessary at teaching centers compared with nonteaching centers.
DOACs appeared to be at least as effective as warfarin, with less bleeding risk.
Does Low-Dose Aspirin Increase Risk for Intracranial Bleeding?
Many of these products, marketed to athletes and muscle builders, aren't what they seem to be.
At 6 months, shoulder pain outcomes were similar among patients who underwent ASD and those who did not.
Contradicting a recent, high-profile study, a meta-analysis suggests that only 1% of syncope patients have pulmonary embolus.
A national database provides a snapshot of palliative care−team involvement in clarifying goals of care.
For common surgical procedures, 7 days usually sufficed for opioid-naive patients, but duration depended on the type of procedure performed.
Interviews with nephrologists from the U.S. and England describe barriers to withholding dialysis, especially in frail elders.
Routine evaluation might be equivalent to extensive screening.
A research team suggests that a 25-hydroxyvitamin D level of 12 ng/mL (30 nmol/L) might be a more appropriate cutoff.
Only a small proportion of patients derived benefit from these drugs, and the benefit was modest.
A meta-analysis casts doubt on this enduring belief.
Earlier diuretic initiation was associated with lower mortality. But why?
A single-center study showed remarkable mortality reduction with this cocktail.
A novel schema for presenting surgical risks to frail elders might help foster better care.
In a large multicenter cohort of blunt trauma patients, 24% had rib fractures and two thirds of these were missed by plain films.
Sicker patients, and not staffing, might explain this observation.
In a group of mostly afebrile, largely nondiabetic patients, cephalexin did well by itself.
In a secondary analysis from a randomized trial, pravastatin did not lower 6-year cardiovascular-related mortality.
Overall 6-month mortality was 17% after dialysis initiation.
A single injection reduced pain at 1 month but not thereafter.
Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. (Own work) [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons
By Hopur2 (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
Appropriate use of prothrombin complex concentrate and specific reversal agents are recommended.
Excess risk for hyponatremia at 30 days was small but statistically significant.
Investigators found slightly higher risk for cardiac arrest or intensive care unit transfer in the 6 hours after an index patient's critical event.
When antibiotics for unrelated infections are needed, a short course of oral vancomycin might preempt C. diffile recurrence.
On serial chest computed tomography scans done 6 years apart, these abnormalities were detected in 8% of adults.
In a randomized trial, delirium symptoms were less severe with placebo than with risperidone or haloperidol.
This rheumatoid arthritis drug was associated with excess lower gastrointestinal perforations.
A new study shows a persistent 10% rate, in contrast to CDC data.
Home-based and nursing home–based palliative care interventions were associated with fewer hospitalizations near the end of life.
But differences in adherence between PCMH practices and other medical practices were small.
This disorder has a poor prognosis; thrombophilias frequently are associated with it.
Almost half of all antibiotics prescribed for otitis media, sinusitis, and pharyngitis were non–first-line choices.
A survey of clinicians revealed several beliefs that might explain inappropriate imaging.
Results were not particularly impressive in a real-world observational study.
Almost all low-risk patients with febrile neutropenia in this study were either unnecessarily admitted or given unnecessary parenteral antibiotics.
Compression rates of 120–140 per minute increased odds of return of spontaneous circulation relative to the guideline-recommended rate of 100–120.
From 2007–2012, sexual activity rates did not change but contraceptive use increased.
About one third of travelers acquired extended-spectrum β-lactamase–producing bacteria, but most were of low pathogenicity, and no clinical infections occurred up to 26 months later.
Core body temperature and heart rate actually rose slightly.
Triple-rule-out CT identified clinically significant, previously undiagnosed conditions in 8.9% of patients.
High concentrations of RSV were found in small-particle aerosols within 1 meter of hospitalized infants and children with bronchiolitis.
Integration of cognitive and motor training lowered the incidence of falls.
Just over a quarter of patients underwent testing for ischemia within 90 days of HF hospitalizations.
This systematic review shows a high rate of PE in patients hospitalized for exacerbation of chronic obstructive pulmonary disease.
For women discontinuing estrogen-containing contraceptives to attempt pregnancy, clinicians should consider advising use of multivitamins containing vitamin D and folic acid.
Most older adults do not use digital technologies for everyday or health-related activities.
Results support the current conservative strategy for blood transfusion in these patients.
In a meta-analysis, accuracy depended somewhat on volume and number of swallows.
In an observational study, statins were not associated with significantly lower mortality.
Coprescribing naloxone was associated with fewer opioid-related emergency room visits.
Symptoms such as cognitive troubles, bradykinesia of hands and fingers, and distal sensory neuropathy were common but transient.
Differing perceptions were driven by miscommunication and differences in beliefs.
Frailty was associated with strikingly higher 30-day and 1-year mortality after many major surgeries.
Heavy alcohol consumption and cigarette use were more common in these groups than in heterosexual peers.
Dying patients with cancer or dementia receive better care than those with other diagnoses.
Extended-spectrum antibiotics offer no advantage over narrower-spectrum antibiotics when treating appendicitis.
In a large observational study, these drugs compared favorably with warfarin.
Two studies present conflicting results.
Opioids provided some short- and intermediate-term pain control, but the effect wasn't clinically meaningful.
Early administration of antibiotics and use of objective criteria to transition from intravenous to oral therapy are beneficial.
Prolonged anticoagulation reduced VTE in high-risk patients but increased bleeding.
Waiting until bladder volume reaches 800 mL is reasonable.
One episode of hyperglycemia can be expected for every eight patients treated for 1 year with this combination.
A laboratory utilization dashboard did not change ordering habits among internal medicine residents.