"Association Between Postresuscitation Partial Pressure of Arterial Carbon Dioxide and Neurological Outcome in Patients With Post–Cardiac Arrest Syndrome"
Circ April 2013
http://circ.ahajournals.org/content/127/21/2107.full 
"Conclusions—Hypocapnia and hypercapnia were common after cardiac arrest and were independently associated with poor neurological outcome. These data suggest that PaCO₂ derangements could be potentially harmful for patients after resuscitation from cardiac arrest."

"Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial"
Lancet May 29
http://www.lancet.com/journals/lancet/article/PIIS0140-6736(13)60852-1/fulltext
"Interpretation

Although the reduction in stroke was not significant, our results support that in patients with recent lacunar stroke, the use of a systolic-blood-pressure target of less than 130 mm Hg is likely to be beneficial."

"Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians" 
BMJ May 2013
http://www.bmj.com/content/346/bmj.f2360
"Conclusions The increased incidence of cancer after CT scan exposure in this cohort was mostly due to irradiation. Because the cancer excess was still continuing at the end of follow-up, the eventual lifetime risk from CT scans cannot yet be determined. Radiation doses from contemporary CT scans are likely to be lower than those in 1985-2005, but some increase in cancer risk is still likely from current scans. Future CT scans should be limited to situations where there is a definite clinical indication, with every scan optimised to provide a diagnostic CT image at the lowest possible radiation dose."

"Notice to Health Care Providers: Updated Guidelines for Evaluation of Severe Respiratory Illness Associated with a Novel Coronavirus"
CDC HAN Mar 2013
http://www.bt.cdc.gov/HAN/han00343.asp
"Summary

The Centers for Disease Control and Prevention (CDC) is working closely with the World Health Organization (WHO) and other partners to better understand the public health risk posed by a novel coronavirus that was first reported to cause human infection in September 2012.  The purpose of this HAN Advisory is to provide guidance to state health departments and health care providers in the evaluation of patients for novel coronavirus infection.  Please disseminate this information to infectious diseases specialists, intensive care physicians, internists, infection preventionists, as well as to emergency departments and microbiology laboratories."

"Results of Initial Low-Dose Computed Tomographic Screening for Lung Cancer" 
NEJM May 23
http://www.nejm.org/doi/full/10.1056/NEJMoa1209120?query=featured_home 
"CONCLUSIONS

The NLST initial screening results are consistent with the existing literature on screening by means of low-dose CT and chest radiography, suggesting that a reduction in mortality from lung cancer is achievable at U.S. screening centers that have staff experienced in chest CT. (Funded by the National Cancer Institute; NLST ClinicalTrials.gov number,NCT00047385.)"

"Effects of Targeting Higher vs Lower Arterial Oxygen Saturations on Death or Disability in Extremely Preterm InfantsA Randomized Clinical Trial"
JAMA May 5
http://jama.jamanetwork.com/article.aspx?articleid=1684963 
"Conclusion and Relevance  In extremely preterm infants, targeting oxygen saturations of 85% to 89% compared with 91% to 95% had no significant effect on the rate of death or disability at 18 months. These results may help determine the optimal target oxygen saturation."

"Triple Therapy With Aspirin, Prasugrel, and Vitamin K Antagonists in Patients With Drug-Eluting Stent Implantation and an Indication for Oral AnticoagulationCME"
JACC May 2013
http://content.onlinejacc.org/article.aspx?articleid=1673104 "Conclusions  These findings suggest that substitution of prasugrel for clopidogrel in patients needing triple therapy increases the risk of bleeding. However, specific randomized trials are needed to define the role of newer adenosine diphosphate receptor antagonists in this setting"

"Sex Differences in the Effectiveness of Early Coronary CT Angiography Compared to Standard Emergency Department Evaluation for Acute Chest Pain: The ROMICAT II Trial"
Circ May 17
http://circ.ahajournals.org/content/early/2013/05/17/CIRCULATIONAHA.113.001736.abstract
"Conclusions—This trial provides data supporting an early CCTA strategy as an attractive option in women presenting to the ED with symptoms suggestive of ACS. The findings may be explained by lower CAD prevalence and severity in women than men."

"Intravenous and inhaled MgSO4 for acute asthma"
Lancet May 17
http://www.lancet.com/journals/lanres/article/PIIS2213-2600(13)70097-3/fulltext
"Numerous national and international guidelines exist to guide management of acute asthma.3—5 Most recommend short-acting β-agonists such as salbutamol with metered-dose inhalers or nebulisers,6 short-acting anticholinergics such as ipratropium, and systemic corticosteroids (either by oral or intravenous routes)7 for the treatment of acute asthma. In severe asthma, additional treatment such as intravenous magnesium sulphate (MgSO4),8 inhaled corticosteroids, and epinephrine (intramuscular or nebulised) can be considered. In the most severe cases, clinicians require interventions that reduce the risk of airway complications (ie, intubation), hospital admissions, and other serious sequelae.. . . "

"Helmet legislation and admissions to hospital for cycling related head injuries in Canadian provinces and territories: interrupted time series analysis"
BMJ April 15
http://www.bmj.com/content/346/bmj.f2674
"Conclusions Reductions in the rates of admissions to hospital for cycling related head injuries were greater in provinces with helmet legislation, but injury rates were already decreasing before the implementation of legislation and the rate of decline was not appreciably altered on introduction of legislation. While helmets reduce the risk of head injuries and we encourage their use, in the Canadian context of existing safety campaigns, improvements to the cycling infrastructure, and the passive uptake of helmets, the incremental contribution of provincial helmet legislation to reduce hospital admissions for head injuries seems to have been minimal."

"Sofosbuvir for Previously Untreated Chronic Hepatitis C Infection"   
NEJM May 16
http://www.nejm.org/doi/full/10.1056/NEJMoa1214853
"CONCLUSIONS

In a single-group study of sofosbuvir combined with peginterferon–ribavirin, patients with predominantly genotype 1 or 4 HCV infection had a rate of sustained virologic response of 90% at 12 weeks. In a noninferiority trial, patients with genotype 2 or 3 infection who received either sofosbuvir or peginterferon with ribavirin had nearly identical rates of response (67%). Adverse events were less frequent with sofosbuvir than with peginterferon. (Funded by Gilead Sciences; FISSION and NEUTRINO ClinicalTrials.gov numbers, NCT01497366 andNCT01641640, respectively.)"

"Association of Single- vs Dual-Chamber ICDs With Mortality, Readmissions, and Complications Among Patients Receiving an ICD for Primary Prevention"  
JAMA May 15
http://jama.jamanetwork.com/article.aspx?articleid=1687578
"Conclusions and Relevance  Among patients receiving an ICD for primary prevention without indications for pacing, the use of a dual-chamber device compared with a single-chamber device was associated with a higher risk of device-related complications and similar 1-year mortality and hospitalization outcomes. Reasons for preferentially using dual-chamber ICDs in this setting remains unclear."

"The Energy Content of Restaurant Foods Without Stated Calorie Information"  
JAMA IM May 13
http://archinte.jamanetwork.com/article.aspx?articleid=1687518
"Conclusions and Relevance  National chain restaurants have been criticized for offering meals with excess dietary energy. This study finds that independent and small-chain restaurants, which provide no nutrition information, also provide excessive dietary energy in amounts apparently greater than popular meals from chain restaurants or information in national food databases. A national requirement for accurate calorie labeling in all restaurants may discourage menus offering unhealthy portions and would allow consumers to make informed choices about ordering meals that promote weight gain and obesity."

"Texting While Driving and Other Risky Motor Vehicle Behaviors Among US High School Students"
Pediatrics May 18
http://pediatrics.aappublications.org/content/early/2013/05/08/peds.2012-3462.abstract
"CONCLUSIONS: Nearly half of US high school students aged ≥16 years report TWD during the past 30 days; these students are more likely to engage in additional risky MV behaviors. This suggests there is a subgroup of students who may place themselves, their passengers, and others on the road at elevated risk for a crash-related injury or fatality by engaging in multiple risky MV behaviors."

"Evaluation of Ranolazine in Patients With Type 2 Diabetes Mellitus and Chronic Stable Angina"
JACC May 2013
http://content.onlinejacc.org/article.aspx?articleid=1666389 
"Conclusions  Among patients with diabetes and chronic angina despite treatment with up to 2 agents, ranolazine reduced angina and sublingual nitroglycerin use and was well tolerated. (Type 2 Diabetes Evaluation of Ranolazine in Subjects With Chronic Stable Angina [TERISA]; NCT01425359)"

"High-Dose Statin Therapy in Patients with Stable Coronary Artery Disease: Treating the Right Patients Based on Individualized Prediction of Treatment Effect"  
Circ May 14
http://circ.ahajournals.org/content/early/2013/05/14/CIRCULATIONAHA.112.000712.abstract
"Conclusions—Estimation of the incremental treatment effect of high-dose versus usual-dose statin therapy in individual coronary artery disease patients enables selection of high-risk patients that benefit most from more aggressive therapy."

"Pertuzumab, trastuzumab, and docetaxel for HER2-positive metastatic breast cancer (CLEOPATRA study): overall survival results from a randomised, double-blind, placebo-controlled, phase 3 study" 
Lancet Oncology May 2013
http://www.lancet.com/journals/lanonc/article/PIIS1470-2045(13)70130-X/fulltext
"Interpretation

Our analysis shows a significant improvement in overall survival with pertuzumab, trastuzumab, and docetaxel in patients with HER2-positive metastatic breast cancer, compared with placebo, trastuzumab, and docetaxel. Since this effect was not achieved at the expense of adverse events, this regimen represents a substantial improvement on the standard of care for this population of patients.
Funding F Hoffmann-La Roche, Genentech."

"Derivation and validation of QStroke score for predicting risk of ischaemic stroke in primary care and comparison with other risk scores: a prospective open cohort study"

BMJ May 2 

http://www.bmj.com/content/346/bmj.f2573
Conclusion QStroke provides a valid measure of absolute stroke risk in the general population of patients free of stroke or transient ischaemic attack as shown by its performance in a separate validation cohort. QStroke also shows some improvement on current risk scoring methods, CHADS₂ and CHA₂DS₂VASc, for the subset of patients with atrial fibrillation for whom anticoagulation may be required. Further research is needed to evaluate the cost effectiveness of using these algorithms in primary care.

"n–3 Fatty Acids in Patients with Multiple Cardiovascular Risk Factors" 
NEJM May 9
http://www.nejm.org/doi/full/10.1056/NEJMoa1205409?query=featured_home 
"CONCLUSIONS

In a large general-practice cohort of patients with multiple cardiovascular risk factors, daily treatment with n−3 fatty acids did not reduce cardiovascular mortality and morbidity. (Funded by Società Prodotti Antibiotici and others; ClinicalTrials.gov number, NCT00317707.)"

"Treatment of Nonfatal Conditions at the End of Life 

Nonmelanoma Skin Cancer" 

JAMA IM April 29
http://archinte.jamanetwork.com/article.aspx?articleid=1682360 
"Conclusions and Relevance  Most NMSCs are treated surgically, regardless of the patient's life expectancy. Given the very low tumor recurrence rates and high mortality from causes unrelated to NMSC in patients with LLE, clinicians should consider whether these patients would prefer less invasive treatment strategies."

"Elective Cesarean Delivery on Maternal Request"  
JAMA May 8  
http://jama.jamanetwork.com/article.aspx?articleid=1685873 
"Conclusions and Relevance  There is no immediate expectation for CDMR to reduce the health risks of mothers or infants. Accordingly, counseling and decisions regarding CDMR should be made after considering a woman's full reproductive plans."

"Treatment of Idiopathic Pulmonary Fibrosis With Ambrisentan: A Parallel, Randomized Trial"  
Annals May 7
http://annals.org/article.aspx?articleid=1684850
"Conclusion: Ambrisentan was not effective in treating IPF and may be associated with an increased risk for disease progression and respiratory hospitalizations."

"Efficacy and Safety of Apixaban Compared with Warfarin at Different Levels of Predicted INR Control for Stroke Prevention in Atrial Fibrillation"  
Circ May 2  
http://circ.ahajournals.org/content/early/2013/05/02/CIRCULATIONAHA.112.142158.abstract 
"Conclusions—The benefits of apixaban compared with warfarin on stroke or systemic embolism, bleeding and mortality appear similar across the range of center and patient predicted quality of INR control."

"Human infections with the emerging avian influenza A H7N9 virus from wet market poultry: clinical analysis and characterisation of viral genome"  
Lancet April 25
http://www.lancet.com/journals/lancet/article/PIIS0140-6736(13)60903-4/fulltext
"Interpretation

Cross species poultry-to-person transmission of this new reassortant H7N9 virus is associated with severe pneumonia and multiorgan dysfunction in human beings. Monitoring of the viral evolution and further study of disease pathogenesis will improve disease management, epidemic control, and pandemic preparedness."

"Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis"  
BMJ Mar 25  
http://www.bmj.com/content/346/bmj.f2492 
"Conclusions The application of age adjusted cut-off values for D-dimer tests substantially increases specificity without modifying sensitivity, thereby improving the clinical utility of D-dimer testing in patients aged 50 or more with a non-high clinical probability."

"EHRA Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial
fibrillation: executive summary" 
Eur Heart Journ Aprl 26
http://eurheartj.oxfordjournals.org/content/early/2013/04/25/eurheartj.eht134.full.pdf+html

"EARLY DETECTION OF PROSTATE CANCER: AUA GUIDELINE" 

April 2013
http://www.auanet.org/common/pdf/education/clinical-guidance/Prostate-Cancer-Detection.pdf

"Association Between Efavirenz-Based Compared With Nevirapine-Based Antiretroviral Regimens and Virological Failure in HIV-Infected Children" 
JAMA  May 1
http://jama.jamanetwork.com/article.aspx?articleid=1682940 
"Conclusions and Relevance  Among children aged 3 to 16 years infected with HIV and treated at 
a clinic in Botswana, the use of efavirenz compared with nevirapine as initial antiretroviral  
treatment was associated with less virological failure. These findings may warrant additional 
research evaluating the use of efavirenz and nevirapine for pediatric patients."


"Use of Azithromycin and Death from Cardiovascular Causes"
NEJM May 2 http://www.nejm.org/doi/full/10.1056/NEJMoa1300799?query=featured_home
"CONCLUSIONS

Azithromycin use was not associated with an increased risk of death from cardiovascular causes in a general population of young and middle-aged adults. (Funded by the Danish Medical Research Council"

Clinical Update: "Treatment of Acute and Recurrent Idiopathic Pericarditis"  
Circ April 23 2013
http://circ.ahajournals.org/content/127/16/1723.full
"Summary

Appropriate therapy for acute idiopathic pericarditis is an NSAID for ≈2 weeks, and it is also reasonable to prescribe colchicine for up to 3 months (the duration used in clinical trials), especially to reduce the rate of recurrence. For initially refractory symptoms, the parenteral NSAID ketorolac may be beneficial. For recurrent episodes of pericarditis, treatment with an NSAID plus colchicine is recommended, but for a more prolonged course. During NSAID treatment, concurrent gastric protection therapy should be considered. Only for truly refractory cases should glucocorticoid therapy be used."