Saturday, August 31, 2013

"Primary Care Interventions to Prevent Tobacco Use in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement" 
Annals Aug 26
http://annals.org/article.aspx?articleid=1731189 
"Recommendation: The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents."

Friday, August 30, 2013

"Non-HDL Cholesterol, Guideline Targets, and Population Percentiles for Secondary Prevention in a Clinical Sample of 1.3 Million Adults The Very Large Database of Lipids (VLDL-2 Study)"
JACC Aug 2013
http://content.onlinejacc.org/article.aspx?articleID=1731125 
"Conclusions  There is significant patient-level discordance between non-HDL-C and LDL-C percentiles at lower LDL-C and higher triglycerides; a finding with implications for treatment of high-risk patients. Current non-HDL-C cutpoints for high-risk patients may need to be lowered to match percentiles of LDL-C cutpoints. Relatively small absolute reductions in non-HDL-C cutpoints result in substantial reclassification of patients to higher treatment categories with potential implications for risk assessment and treatment."

Thursday, August 29, 2013

"Safety and Efficacy of a Totally Subcutaneous Implantable-Cardioverter Defibrillator" 
Circ Aug 27
http://circ.ahajournals.org/content/128/9/944.full 
"Background—The most frequent complications associated with implantable cardioverter-defibrillators (ICDs) involve the transvenous leads. A subcutaneous implantable cardioverter-defibrillator (S-ICD) has been developed as an alternative system. This study evaluated the safety and effectiveness of the S-ICD System (Cameron Health/Boston Scientific) for the treatment of life-threatening ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation)."
"Conclusions—The findings support the efficacy and safety of the S-ICD System for the treatment of life-threatening ventricular arrhythmias."

Wednesday, August 28, 2013

"Air pollution and lung cancer incidence in 17 European cohorts: prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE)"
Lancet Aug 2013
http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(13)70279-1/fulltext
"Interpretation

Particulate matter air pollution contributes to lung cancer incidence in Europe."

Tuesday, August 27, 2013

"Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the United States"
BMJ Aug 21
http://www.bmj.com/content/347/bmj.f4877
"Conclusions
Exposure to serotonin and non-serotonin reuptake inhibitors, including selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and tricyclics, close to the time of delivery was associated with a 1.4 to 1.9-fold increased risk for postpartum hemorrhage. While potential confounding by unmeasured factors cannot be ruled out, these findings suggest that patients treated with antidepressants during late pregnancy are more likely to experience postpartum hemorrhage."

Monday, August 26, 2013

"Vedolizumab as Induction and Maintenance Therapy for Ulcerative Colitis" 
NEJM Aug 22
http://www.nejm.org/doi/full/10.1056/NEJMoa1215734?query=featured_home 
"CONCLUSIONS

Vedolizumab was more effective than placebo as induction and maintenance therapy for ulcerative colitis. (Funded by Millennium Pharmaceuticals; GEMINI 1 ClinicalTrials.gov number, NCT00783718.)"

Sunday, August 25, 2013

"Association Between Urinary Albumin Excretion and Coronary Heart Disease in Black vs White Adults" 
JAMA Aug 21
http://jama.jamanetwork.com/article.aspx?articleid=1730510 
"Conclusions and Relevance   Higher urinary ACR was associated with greater risk of incident but not recurrent CHD in black individuals when compared with white individuals. These data confirm that black individuals appear more susceptible to vascular injury."

Saturday, August 24, 2013

"Personalized Estimates of Benefit From Preventive Care Guidelines"
Annals Aug 6
http://annals.org/article.aspx?articleid=1722496 
"Results of Base-Case Analysis: Increases in life expectancy varied more than 100-fold across USPSTF recommendations, and the rank order of benefits varied considerably among patients. For an obese man aged 62 years who smoked and had hypercholesterolemia, hypertension, and a family history of colorectal cancer, the model's top 3 recommendations (from most to least gain in life expectancy) were tobacco cessation (adding 2.8 life-years), weight loss (adding 1.6 life-years), and blood pressure control (adding 0.8 life-year). Lower-ranked recommendations were a healthier diet, aspirin use, cholesterol reduction, colonoscopy, screening for abdominal aortic aneurysm, and HIV testing (each adding 0.1 to 0.3 life-years). For a person with the same characteristics plus uncontrolled type 2 diabetes mellitus, the model's top 3 recommendations were diabetes control, tobacco cessation, and weight loss (each adding 1.4 to 1.8 life-years)."

Friday, August 23, 2013

"Relationship of Apolipoproteins A-1 and B, and Lipoprotein (a) to Cardiovascular Outcomes in the AIM-HIGH Trial"  
JACC Aug 2013
http://content.onlinejacc.org/article.aspx?articleID=1731123 
"Conclusions  Lp(a) was associated with increased CV risk in both treatment groups indicating that it contributes to residual CV risk. However, there was no evidence that ERN reduced CV risk despite favorable lipoprotein changes."

Thursday, August 22, 2013

"Fruit and Vegetable Consumption With Risk of Abdominal Aortic Aneurysm"
Circ Aug 20
http://circ.ahajournals.org/content/128/8/795.abstract
"Conclusions—We observed an inverse association between consumption of fruit, but not vegetables, and the risk of AAA, with a more pronounced association with ruptured AAA."

Wednesday, August 21, 2013

"Once-daily indacaterol versus tiotropium for patients with severe chronic obstructive pulmonary disease (INVIGORATE)"
Lancet Aug 21
http://www.lancet.com/journals/lanres/article/PIIS2213-2600(13)70158-9/fulltext 
"Interpretation

Indacaterol and tiotropium provided clinically relevant improvements in lung function with comparable safety profiles. Tiotropium afforded greater protection from exacerbations, although the absolute number of events was small and the difference between treatments is of uncertain clinical importance. The present data offer evidence consistent with current guidelines.

Funding

Novartis Pharma AG."

Tuesday, August 20, 2013

"Maternal obesity during pregnancy and premature mortality from cardiovascular event in adult offspring: follow-up of 1 323 275 person years"  
BMJ Aug 13
http://www.bmj.com/content/347/bmj.f4539 
"Conclusions
Maternal obesity is associated with an increased risk of premature death in adult offspring. As one in five women in the United Kingdom is obese at antenatal booking, strategies to optimise weight before pregnancy are urgently required"

Monday, August 19, 2013

"Long-Term Survival of Participants in the Prostate Cancer Prevention Trial"
NEJM Aug
http://www.nejm.org/doi/full/10.1056/NEJMoa1215932 
"CONCLUSIONS

Finasteride reduced the risk of prostate cancer by about one third. High-grade prostate cancer was more common in the finasteride group than in the placebo group, but after 18 years of follow-up, there was no significant between-group difference in the rates of overall survival or survival after the diagnosis of prostate cancer. (Funded by the National Cancer Institute.)"

Sunday, August 18, 2013

"Association Between Early Surgical Intervention vs Watchful Waiting and Outcomes for Mitral Regurgitation Due to Flail Mitral Valve Leaflets" 
JAMA Aug 14
http://jama.jamanetwork.com/article.aspx?articleid=1728716   
"Conclusion and Relevance   Among registry patients with mitral valve regurgitation due to flail mitral leaflets, performance of early mitral surgery compared with initial medical management was associated with greater long-term survival and a lower risk of heart failure, with no difference in new-onset atrial fibrillation."

Saturday, August 17, 2013

"Self-Measured Blood Pressure Monitoring in the Management of Hypertension: A Systematic Review and Meta-analysis"
http://annals.org/article.aspx?articleid=1722499 
"Conclusion: Self-measured BP monitoring with or without additional support lowers BP compared with usual care, but the BP effect beyond 12 months and long-term benefits remain uncertain. Additional support enhances the BP-lowering effect."

Friday, August 16, 2013

"Evaluation of C-Reactive Protein Before and On-Treatment as a Predictor of Benefit of Atorvastatin"
JACC Aug 2013
http://content.onlinejacc.org/article.aspx?articleid=1727135
"Conclusions  In these primary prevention patients, although baseline CRP independently predicted CV event risk, the achieved CRP level on while statin therapy did not predict CV events, either alone or in combination with LDL-C."

Thursday, August 15, 2013

"Efficacy and Safety of a Four-Factor Prothrombin Complex Concentrate (4F-PCC) in Patients on Vitamin K Antagonists Presenting with Major Bleeding" 
Circ Aug 9
http://circ.ahajournals.org/content/early/2013/08/09/CIRCULATIONAHA.113.002283.abstract
"Conclusions—4F-PCC is an effective alternative to plasma for urgent reversal of VKA therapy in major bleeding events as demonstrated by clinical assessments of bleeding and laboratory measurements of INR and factor levels."

Wednesday, August 14, 2013

"Middle East respiratory syndrome coronavirus neutralising serum antibodies in dromedary camels: a comparative serological study"
Lancet Aug 9
http://www.lancet.com/journals/laninf/article/PIIS1473-3099(13)70164-6/fulltext
"Interpretation

MERS-CoV or a related virus has infected camel populations. Both titres and seroprevalences in sera from different locations in Oman suggest widespread infection."

Tuesday, August 13, 2013

"Probable person to person transmission of novel avian influenza A (H7N9) virus in Eastern China, 2013: epidemiological investigation"
BMJ Aug 6
http://www.bmj.com/content/347/bmj.f4752 
"Conclusions The infection of the daughter probably resulted from contact with her father (the index patient) during unprotected exposure, suggesting that in this cluster the virus was able to transmit from person to person. The transmissibility was limited and non-sustainable."

Monday, August 12, 2013

"ST2 as a Marker for Risk of Therapy-Resistant Graft-versus-Host Disease and Death"  
NEJM Aug 8
http://www.nejm.org/doi/full/10.1056/NEJMoa1213299  


"CONCLUSIONS

ST2 levels measured at the initiation of therapy for GVHD and during the first month after transplantation improved risk stratification for treatment-resistant GVHD and death without relapse after transplantation. (Funded by the National Institutes of Health.)"

Sunday, August 11, 2013

"Concurrent Naltrexone and Prolonged Exposure Therapy for Patients With Comorbid Alcohol Dependence and PTSD"
JAMA Aug 7
http://jama.jamanetwork.com/article.aspx?articleid=1724275
"Conclusions and Relevance  In this study of patients with alcohol dependence and PTSD, naltrexone treatment resulted in a decrease in the percentage of days drinking. Prolonged exposure therapy was not associated with an exacerbation of alcohol use disorder."

Saturday, August 10, 2013

"Use of Antihypertensive Medications and Breast Cancer Risk Among Women Aged 55 to 74 Years"
JAMA IM  Aug 5
http://archinte.jamanetwork.com/article.aspx?articleid=1723871 
"Conclusions and Relevance  While some studies have suggested a positive association between calcium-channel blocker use and breast cancer risk, this is the first study to observe that long-term current use of calcium-channel blockers in particular are associated with breast cancer risk. Additional research is needed to confirm this finding and to evaluate potential underlying biological mechanisms."

Friday, August 9, 2013

"Obstructive Sleep Apnea and the Risk of Sudden Cardiac Death"
JACC Aug 2013
http://content.onlinejacc.org/article.aspx?articleid=1699335
"Conclusions  In a population of 10,701 adults referred for polysomnography, OSA predicted incident SCD, and the magnitude of risk was predicted by multiple parameters characterizing OSA severity. Nocturnal hypoxemia, an important pathophysiological feature of OSA, strongly predicted SCD independently of well-established risk factors. These findings implicate OSA, a prevalent condition, as a novel risk factor for SCD."

Thursday, August 8, 2013

"Impact of Aortic Valve Replacement on Outcome of Symptomatic Patients With Severe Aortic Stenosis With Low Gradient and Preserved Left Ventricular Ejection Fraction" 
Circ Jun 27
http://circ.ahajournals.org/content/128/6/622.full 
"Conclusions—AVR is associated with better survival than medical therapy in patients with symptomatic low-gradient severe AS and preserved left ventricular ejection fraction."

Wednesday, August 7, 2013

"Cervical pessaries for prevention of preterm birth in women with a multiple pregnancy (ProTWIN): a multicentre, open-label randomised controlled trial"
Lancet Aug 5
http://www.lancet.com/journals/lancet/article/PIIS0140-6736(13)61408-7/fulltext
"Interpretation

In unselected women with a multiple pregnancy, prophylactic use of a cervical pessary does not reduce poor perinatal outcome."

Tuesday, August 6, 2013

"Impact of wound edge protection devices on surgical site infection after laparotomy: multicentre randomised controlled trial (ROSSINI Trial)"
BMJ Jul 31
http://www.bmj.com/content/347/bmj.f4305
"Conclusions Wound edge protection devices do not reduce the rate of surgical site infection in patients undergoing laparotomy, and therefore their routine use for this role cannot be recommended."

Monday, August 5, 2013

"Lenalidomide plus Dexamethasone for High-Risk Smoldering Multiple Myeloma"NEJM Aug 1
http://www.nejm.org/doi/full/10.1056/NEJMoa1300439 
"RESULTS

After a median follow-up of 40 months, the median time to progression was significantly longer in the treatment group than in the observation group (median not reached vs. 21 months; hazard ratio for progression, 0.18; 95% confidence interval [CI], 0.09 to 0.32; P<0.001). The 3-year survival rate was also higher in the treatment group (94% vs. 80%; hazard ratio for death, 0.31; 95% CI, 0.10 to 0.91; P=0.03). A partial response or better was achieved in 79% of patients in the treatment group after the induction phase and in 90% during the maintenance phase. Toxic effects were mainly grade 2 or lower."

Sunday, August 4, 2013

"Raccoon Rabies Virus Variant Transmission Through Solid Organ Transplantation"
JAMA Jul 24/31
http://jama.jamanetwork.com/article.aspx?articleid=1719738 
"Conclusions and Relevance  Unlike the 2 previous clusters of rabies virus transmission through solid organ transplantation, there was a long incubation period in the recipient who developed rabies, and survival of 3 other recipients without pretransplant rabies vaccination. Rabies should be considered in patients with acute progressive encephalitis of unexplained etiology, especially for potential organ donors. A standard evaluation of potential donors who meet screening criteria for infectious encephalitis should be considered, and risks and benefits for recipients of organs from these donors should be evaluated."

Saturday, August 3, 2013

"Screening for Lung Cancer With Low-Dose Computed Tomography: A Systematic Review to Update the U.S. Preventive Services Task Force Recommendation"
Annals Jul 30
http://annals.org/article.aspx?articleid=1721248 
"Conclusion: Strong evidence shows that LDCT screening can reduce lung cancer and all-cause mortality. The harms associated with screening must be balanced with the benefits."

"Screening for Lung Cancer: U.S. Preventive Services Task Force Recommendation Statement DRAFT" USPSTF   http://www.uspreventiveservicestaskforce.org./draftrec.htm   "The U.S. Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in persons at high risk for lung cancer based on age and smoking history."


Friday, August 2, 2013

"A Direct Comparison of Early and Late Outcomes with Three Approaches to Carotid Revascularization and Open Heart Surgery"
JACC Jul 2013
http://content.onlinejacc.org/article.aspx?articleID=1723266
"Conclusions  Staged CAS-OHS and combined CEA-OHS are associated with similar risk of death, stroke or MI in the short term, with both being better than staged CEA-OHS. However, the outcomes are significantly in favor of staged CAS-OHS after the first year."

Thursday, August 1, 2013

"Thrombolytic Therapy for the Treatment of Prosthetic Heart Valve Thrombosis in Pregnancy With Low-Dose, Slow Infusion of Tissue-Type Plasminogen Activator"
Circ Jun 28
http://circ.ahajournals.org/content/128/5/532.full
"Conclusions—Low-dose, slow infusion of tissue-type plasminogen activator with repeated doses as needed is an effective therapy with an excellent thrombolytic success rate for the treatment of prosthetic valve thrombosis in pregnant women. This protocol also seems to be safer than cardiac surgery or any alternative medical strategies published to date. Thrombolytic therapy should be considered first-line therapy in pregnant patients with prosthetic valve thrombosis."