Annals - Blood Pressure Reduction in Mild Hypertension

"Effects of Blood Pressure Reduction in Mild Hypertension: A Systematic Review and Meta-analysis"

"Conclusion: Blood pressure–lowering therapy is likely to prevent stroke and death in patients with uncomplicated grade 1 hypertension."  

http://annals.org/article.aspx?articleid=2085847 

NEJM - Progesterone for Acute Traumatic Brain Injury

"Very Early Administration of Progesterone for Acute Traumatic Brain Injury"

"CONCLUSIONS

This clinical trial did not show a benefit of progesterone over placebo in the improvement of outcomes in patients with acute TBI. (Funded by the National Institute of Neurological Disorders and Stroke and others; PROTECT III ClinicalTrials.gov number, NCT00822900.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1404304?query=featured_home 

JAMA - Cooling Among Neonates With Hypoxic Ischemic Encephalopathy

"Effect of Depth and Duration of Cooling on Deaths in the NICU Among Neonates With Hypoxic Ischemic Encephalopathy"

"Conclusions and Relevance  Among neonates who were full-term with moderate or severe hypoxic ischemic encephalopathy, longer cooling, deeper cooling, or both compared with hypothermia at 33.5°C for 72 hours did not reduce NICU death. These results have implications for patient care and design of future trials."


http://jama.jamanetwork.com/article.aspx?articleid=2084890

Weekly Guideline - 2014 AHA Prevention of Stroke in Women

"AHA/ASA Guideline Guidelines for the Prevention of Stroke in Women"

http://stroke.ahajournals.org/content/45/5/1545

CIRC - Sexual Activity After Acute Myocardial Infarction

"Sexual Activity and Counseling in the First Month After Acute Myocardial Infarction Among Younger Adults in the United States and Spain"

"Conclusions—Very few patients reported counseling for sexual activity after AMI. Those who did were commonly given restrictions not supported by evidence or guidelines."

http://circ.ahajournals.org/content/130/25/2302.full

BMJ - TV Medical Talk Shows— Evidence of Recommendations

"Televised medical talk shows—what they recommend and the evidence to support their recommendations: a prospective observational study"

"Conclusions Recommendations made on medical talk shows often lack adequate information on specific benefits or the magnitude of the effects of these benefits. Approximately half of the recommendations have either no evidence or are contradicted by the best available evidence. Potential conflicts of interest are rarely addressed. The public should be skeptical about recommendations made on medical talk shows.

Additional details of methods used and changes made to study protocol"

http://www.bmj.com/content/349/bmj.g7346

NEJM - Cytisine v Nicotine for Smoking Cessation

""Cytisine versus Nicotine for Smoking Cessation"

"CONCLUSIONS

When combined with brief behavioral support, cytisine was found to be superior to nicotine-replacement therapy in helping smokers quit smoking, but it was associated with a higher frequency of self-reported adverse events. (Funded by the Health Research Council of New Zealand; Australian New Zealand Clinical Trials Registry number,ACTRN12610000590066.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1407764

JAMA - Glycemic Index and CVD Risk Factors

"Effects of High vs Low Glycemic Index of Dietary Carbohydrate on Cardiovascular Disease Risk Factors and Insulin Sensitivity The OmniCarb Randomized Clinical Trial "

"Conclusions and Relevance  In this 5-week controlled feeding study, diets with low glycemic index of dietary carbohydrate, compared with high glycemic index of dietary carbohydrate, did not result in improvements in insulin sensitivity, lipid levels, or systolic blood pressure. In the context of an overall DASH-type diet, using glycemic index to select specific foods may not improve cardiovascular risk factors or insulin resistance."

http://jama.jamanetwork.com/article.aspx?articleid=2040224

AHA - "Cervical Arterial Dissections and Association With Cervical Manipulative Therapy"

"AHA/ASA Scientific Statement
Cervical Arterial Dissections and Association With Cervical Manipulative Therapy"

http://stroke.ahajournals.org/content/45/10/3155

CIRC - Endovascular Treatment of Mycotic Aortic Aneurysm

"Endovascular Treatment of Mycotic Aortic Aneurysms A European Multicenter Study"

"Conclusions—Endovascular treatment of MAA is feasible and for most patients a durable treatment option. Late infections do occur, are often lethal, and warrant long-term antibiotic treatment and follow-up. Patients with non-Salmonella–positive blood cultures were more likely to die from late infection." 

http://circ.ahajournals.org/content/130/24/2136.abstract

BMJ - Non-publication of Surgical Trials

"Discontinuation and non-publication of surgical randomised controlled trials: observational study"

"Conclusions One in five surgical randomised controlled trials are discontinued early, one in three completed trials remain unpublished, and investigators of unpublished studies are frequently not contactable. This represents a waste of research resources and raises ethical concerns regarding hidden clinical data and futile participation by patients with its attendant risks. To promote future efficiency and transparency, changes are proposed to research governance frameworks to overcome these concerns."  


http://www.bmj.com/content/349/bmj.g6870

NEJM - Angiotensin Blockade in PKD

"Angiotensin Blockade in Late Autosomal Dominant Polycystic Kidney Disease"

"CONCLUSIONS

Monotherapy with an ACE inhibitor was associated with blood-pressure control in most patients with ADPKD and stage 3 chronic kidney disease. The addition of an ARB did not alter the decline in the estimated GFR. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; HALT-PKD [Study B] ClinicalTrials.gov number, NCT01885559.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1402686

JAMA - Resident Duty Hours & Mortality and Readmissions

"Association of the 2011 ACGME Resident Duty Hour Reforms With Mortality and Readmissions Among Hospitalized Medicare Patients"

"Conclusions and Relevance  Among Medicare beneficiaries, there were no significant differences in the change in 30-day mortality rates or 30-day all-cause readmission rates for those hospitalized in more intensive relative to less intensive teaching hospitals in the year after implementation of the 2011 ACGME duty hour reforms compared with those hospitalized in the 2 years before implementation."


http://jama.jamanetwork.com/article.aspx?articleid=2020371

Weekly Guideline - 2014 ESC "Hypertrophic Cardiomyopathy"

2014 ESC "Hypertrophic Cardiomyopathy"

http://www.escardio.org/guidelines-surveys/esc-guidelines/Pages/hypertrophic-cardiomyopathy.aspx

CIRC - BMI & Mortality in DM-2

"Body Mass Index and the Risk of All-Cause Mortality Among Patients With Type 2 Diabetes Mellitus"

"Conclusions—The present study indicated a U-shaped association of BMI with all-cause mortality risk among black and white patients with type 2 diabetes mellitus. A significantly increased risk of all-cause mortality was observed among blacks with BMI <30 kg/m2 and ≥35 kg/m2 and among whites with BMI <25 kg/m2 and ≥40 kg/m2 compared with patients with BMI of 30 to 34.9 kg/m2."

http://circ.ahajournals.org/content/130/24/2143.full

BMJ - Press Releases and Medical News Exaggeration

"The association between exaggeration in health related science news and academic press releases: retrospective observational study"

"Conclusions Exaggeration in news is strongly associated with exaggeration in press releases. Improving the accuracy of academic press releases could represent a key opportunity for reducing misleading health related news."


http://www.bmj.com/content/349/bmj.g7015

NEJM - Factor XI ASO and Veonous Thrombosis

 "Factor XI Antisense Oligonucleotide for Prevention of Venous Thrombosis"

"RESULTS  

Around the time of surgery, the mean (±SE) factor XI levels were 0.38±0.01 units per milliliter in the 200-mg FXI-ASO group, 0.20±0.01 units per milliliter in the 300-mg FXI-ASO group, and 0.93±0.02 units per milliliter in the enoxaparin group. The primary efficacy outcome occurred in 36 of 134 patients (27%) who received the 200-mg dose of FXI-ASO and in 3 of 71 patients (4%) who received the 300-mg dose of FXI-ASO, as compared with 21 of 69 patients (30%) who received enoxaparin. The 200-mg regimen was noninferior, and the 300-mg regimen was superior, to enoxaparin (P<0.001). Bleeding occurred in 3%, 3%, and 8% of the patients in the three study groups, respectively."  

http://www.nejm.org/doi/full/10.1056/NEJMoa1405760?query=featured_home

JAMA - Sodium Zirconium Cyclosilicate for Hyper K+

"Effect of Sodium Zirconium Cyclosilicate on Potassium Lowering for 28 Days Among Outpatients With Hyperkalemia The HARMONIZE Randomized Clinical Trial"

"Conclusions and Relevance  Among outpatients with hyperkalemia, open-label sodium zirconium cyclosilicate reduced serum potassium to normal levels within 48 hours; compared with placebo, all 3 doses of zirconium cyclosilicate resulted in lower potassium levels and a higher proportion of patients with normal potassium levels for up to 28 days. Further studies are needed to evaluate the efficacy and safety of zirconium cyclosilicate beyond 4 weeks and to assess long-term clinical outcomes."   


http://jama.jamanetwork.com/article.aspx?articleid=1936753

Weekly Guideline - 2014 ESC Aortic Diseases

2014 ESC  "Aortic Diseases"

http://www.escardio.org/guidelines-surveys/esc-guidelines/Pages/aortic-dissection.aspx

CIRC - Coronary CTA in ED

"Clinician Update"
"Coronary Computed Tomographic Angiography Its Role in Emergency Department Triage"

"Conclusions

Coronary CTA is now an established, noninvasive technique that can rapidly exclude obstructive CAD and identify patients who can be safely discharged from the ED. Although CTA appears to lower ED costs and may lead to intensification in preventive therapies, concern remains about the potential for this test to increase invasive angiography and coronary revascularizations. Ultimately, appropriate patient selection will remain essential for ensuring optimal test use and patient management."

http://circ.ahajournals.org/content/130/23/2052.full

BMJ - Overweight in Pregnancy

"Maternal overweight and obesity in early pregnancy and risk of infant mortality: a population based cohort study in Sweden"  

"Conclusions 
Maternal overweight and obesity are associated with increased risks of infant mortality due to increased mortality risk in term births and an increased prevalence of preterm births. Maternal overweight and obesity may be an important preventable risk factor for infant mortality in many countries." 

http://www.bmj.com/content/349/bmj.g6572 

NEJM - Ebola Vaccine

"Chimpanzee Adenovirus Vector Ebola Vaccine — Preliminary Report"

"CONCLUSIONS

Reactogenicity and immune responses to cAd3-EBO vaccine were dose-dependent. At the 2×1011 particle-unit dose, glycoprotein Zaire–specific antibody responses were in the range reported to be associated with vaccine-induced protective immunity in challenge studies involving nonhuman primates. Clinical trials assessing cAd3-EBO are ongoing. (Funded by the Intramural Research Program of the National Institutes of Health; VRC 207 ClinicalTrials.gov number,NCT02231866.)" 

http://www.nejm.org/doi/full/10.1056/NEJMoa1410863?query=featured_home

JAMA - Cost-effectiveness of Dalteparin vs Unfractionated Heparin

 "Cost-effectiveness of Dalteparin vs Unfractionated Heparin for the Prevention of Venous Thromboembolism in Critically Ill Patients"

"Conclusions and Relevance  From a health care payer perspective, the use of the LMWH dalteparin for VTE prophylaxis among critically ill medical-surgical patients was more effective and had similar or lower costs than the use of UFH. These findings were driven by lower rates of pulmonary embolus and heparin-induced thrombocytopenia and corresponding lower overall use of resources with LMWH."


http://jama.jamanetwork.com/article.aspx?articleid=1921813

Weekly Guideline Update - 2013 ESC Cardiac Pacing

2013 ESC "Cardiac Pacing and Cardiac Resynchronization Therapy"

http://www.escardio.org/guidelines-surveys/esc-guidelines/Pages/cardiac-pacing-and-cardiac-resynchronisation-therapy.aspx

CIRC - Trends in Survival From Out-of-Hospital Cardiac Arrest

 "Recent Trends in Survival From Out-of-Hospital Cardiac Arrest in the United States"

"Conclusions—Data drawn from a large subset of U.S communities suggest that rates of survival from out-of-hospital cardiac arrest have improved among sites participating in a performance improvement registry."

http://circ.ahajournals.org/content/130/21/1876.full

BMJ - Co-trimoxazole and sudden death

 "Co-trimoxazole and sudden death in patients receiving inhibitors of renin-angiotensin system: population based study"

"Conclusions |
In older patients receiving angiotensin converting enzyme inhibitors or angiotensin receptor blockers, co-trimoxazole is associated with an increased risk of sudden death. Unrecognized severe hyperkalemia may underlie this finding. When appropriate, alternative antibiotics should be considered in such patients."

http://www.bmj.com/content/349/bmj.g6196

NEJM - Atenolol versus Losartan in Marfan's

 "Atenolol versus Losartan in Children and Young Adults with Marfan's Syndrome"

"CONCLUSIONS

Among children and young adults with Marfan's syndrome who were randomly assigned to losartan or atenolol, we found no significant difference in the rate of aortic-root dilatation between the two treatment groups over a 3-year period. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number,NCT00429364.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1404731

JAMA -β-Blockers in Heart Failure and Preserved EF

"Association Between Use of β-Blockers and Outcomes in Patients With Heart Failure and Preserved Ejection Fraction"

"Conclusions and Relevance  In patients with HFPEF, use of β-blockers was associated with lower all-cause mortality but not with combined all-cause mortality or heart failure hospitalization. β-Blockers in HFPEF should be examined in a large randomized clinical trial."

http://jama.jamanetwork.com/article.aspx?articleid=1935124

Weekly Guideline - 2014 ESC Noncardiac Surgery

 "2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management"


http://www.escardio.org/guidelines-surveys/esc-guidelines/Pages/perioperative-cardiac-care.aspx

CIRC - Survival in Hospital Cardiac Arrest and Use of AED

"Improved Survival After Out-of-Hospital Cardiac Arrest and Use of Automated External Defibrillators"

"Conclusions—Increased AED use is associated with increased survival in patients with a shockable initial rhythm. We recommend continuous efforts to introduce or extend AED programs."

http://circ.ahajournals.org/content/130/21/1868.abstract 

BMJ - Vitamin D and Mortality

"Genetically low vitamin D concentrations and increased mortality: mendelian randomisation analysis in three large cohorts"

"Conclusions Genetically low 25-hydroxyvitamin D concentrations were associated with increased all cause mortality, cancer mortality, and other mortality but not with increased cardiovascular mortality. These findings are compatible with the notion that genetically low 25-hydroxyvitamin D concentrations may be causally associated with cancer and other mortality but also suggest that the observational association with cardiovascular mortality could be the result of confounding."

http://www.bmj.com/content/349/bmj.g6330

NEJM - Pancreatitis

"Early versus On-Demand Nasoenteric Tube Feeding in Acute Pancreatitis"

"CONCLUSIONS

This trial did not show the superiority of early nasoenteric tube feeding, as compared with an oral diet after 72 hours, in reducing the rate of infection or death in patients with acute pancreatitis at high risk for complications. (Funded by the Netherlands Organization for Health Research and Development and others; PYTHON Current Controlled Trials number, ISRCTN18170985.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1404393?query=featured_home

JAMA - Closure Devices vs Compression for Femoral Artery Puncture

"Comparison of Vascular Closure Devices vs Manual Compression After Femoral Artery Puncture"

"Conclusions and Relevance  In patients undergoing transfemoral coronary angiography, VCDs were noninferior to manual compression in terms of vascular access-site complications and reduced time to hemostasis." 



http://jama.jamanetwork.com/article.aspx?articleid=1935125

Weekly Guideline - 2012/ 2013 IDSA Sepsis

"International  Guidelines for Management of Severe Sepsis  and Septic Shock: 2012"

http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/IDSA_Practice_Guidelines/Fever_and_Infections/2013%20Sepsis%20Guidelines.pdf

JACC - The QT Interval & Incident Cardiovascular Events

"The QT Interval Is Associated With Incident Cardiovascular Events"

"Conclusions  The QT interval was associated with incident cardiovascular events in middle-aged and older adults without prior CVD." 
http://content.onlinejacc.org/article.aspx?articleID=1934902 

BMJ - Oral Contraceptive and Mortality

"Oral contraceptive use and mortality after 36 years of follow-up in the Nurses’ Health Study: prospective cohort study"

"Conclusions
All cause mortality did not differ significantly between women who had ever used oral contraceptives and never users. Oral contraceptive use was associated with certain causes of death, including increased rates of violent or accidental death and deaths due to breast cancer, whereas deaths due to ovarian cancer were less common among women who used oral contraceptives. These results pertain to earlier oral contraceptive formulations with higher hormone doses rather than the now more commonly used third and fourth generation formulations with lower estrogen doses."

http://www.bmj.com/content/349/bmj.g6356 

NEJM - Cost-Effectiveness of CT Screening for Lung CA

"Cost-Effectiveness of CT Screening in the National Lung Screening Trial"

"CONCLUSIONS

We estimated that screening for lung cancer with low-dose CT would cost $81,000 per QALY gained, but we also determined that modest changes in our assumptions would greatly alter this figure. The determination of whether screening outside the trial will be cost-effective will depend on how screening is implemented. (Funded by the National Cancer Institute; NLST ClinicalTrials.gov number,NCT00047385.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1312547?query=featured_home

JAMA - Nonobstructive CAD and MI Risk

 "Nonobstructive Coronary Artery Disease and Risk of Myocardial Infarction"

"Conclusions and Relevance  In this cohort of patients undergoing elective coronary angiography, nonobstructive CAD, compared with no apparent CAD, was associated with a significantly greater 1-year risk of MI and all-cause mortality. These findings suggest clinical importance of nonobstructive CAD and warrant further investigation of interventions to improve outcomes among these patients."

http://jama.jamanetwork.com/article.aspx?articleid=1920971

Weekly Guideline - 2014 AHA/ASA Prevention of Stroke

"AHA/ASA Guideline Guidelines for the Primary Prevention of Stroke"

http://stroke.ahajournals.org/content/early/2014/10/28/STR.0000000000000046

CIRC - Endocarditis Outcomes

"Long-Term Clinical Outcome of Major Adverse Cardiac Events in Survivors of Infective Endocarditis"

"Conclusion—Despite treatment, the risk of long-term major adverse cardiac events was substantially increased in IE survivors."

http://circ.ahajournals.org/content/130/19/1684.abstract

BMJ - Milk and Fractures in Men & Women

"Milk intake and risk of mortality and fractures in women and men: cohort studies"

"Conclusions High milk intake was associated with higher mortality in one cohort of women and in another cohort of men, and with higher fracture incidence in women. Given the observational study designs with the inherent possibility of residual confounding and reverse causation phenomena, a cautious interpretation of the results is recommended."


http://www.bmj.com/content/349/bmj.g6015

NEJM - Ebola

"Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone"

"CONCLUSIONS

The incubation period and case fatality rate among patients with EVD in Sierra Leone are similar to those observed elsewhere in the 2014 outbreak and in previous outbreaks. Although bleeding was an infrequent finding, diarrhea and other gastrointestinal manifestations were common. (Funded by the National Institutes of Health and others.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1411680?query=featured_home

JAMA - Dalteparin vs Unfractionated Heparin for the Prevention of VTE

"Cost-effectiveness of Dalteparin vs Unfractionated Heparin for the Prevention of Venous Thromboembolism in Critically Ill Patients"

"Conclusions and Relevance  From a health care payer perspective, the use of the LMWH dalteparin for VTE prophylaxis among critically ill medical-surgical patients was more effective and had similar or lower costs than the use of UFH. These findings were driven by lower rates of pulmonary embolus and heparin-induced thrombocytopenia and corresponding lower overall use of resources with LMWH."

http://jama.jamanetwork.com/article.aspx?articleid=1921813

Weekly Guideline - 2014 AHA Postthrombotic Syndrome

"The Postthrombotic Syndrome: Evidence-Based Prevention, Diagnosis, and Treatment Strategies"

http://circ.ahajournals.org/content/130/18/1636

CIRC - Linoleic Acid and Risk of CHD

"Dietary Linoleic Acid and Risk of Coronary Heart Disease: A Systematic Review and Meta-Analysis of Prospective Cohort Studies"

"Conclusions—In prospective observational studies, dietary LA intake is inversely associated with CHD risk in a dose–response manner. These data provide support for current recommendations to replace saturated fat with polyunsaturated fat for primary prevention of CHD."

http://circ.ahajournals.org/content/130/18/1568.abstract

BMJ - Thoracoscopic versus Open Lobectomy

"Long term survival with thoracoscopic versus open lobectomy: propensity matched comparative analysis using SEER-Medicare database"

"Conclusion This propensity matched analysis showed that patients undergoing thoracoscopic lobectomy had similar overall, cancer specific, and disease-free survival compared with patients undergoing thoracotomy lobectomy. Thoracoscopic techniques do not seem to compromise these measures of outcome after lobectomy."

http://www.bmj.com/content/349/bmj.g5575

NEJM - Blood-Pressure Lowering and Glucose Control in Type 2 Diabetes

"Follow-up of Blood-Pressure Lowering and Glucose Control in Type 2 Diabetes"

"CONCLUSIONS

The benefits with respect to mortality that had been observed among patients originally assigned to blood-pressure–lowering therapy were attenuated but still evident at the end of follow-up. There was no evidence that intensive glucose control during the trial led to long-term benefits with respect to mortality or macrovascular events. (Funded by the National Health and Medical Research Council of Australia and others; ADVANCE-ON ClinicalTrials.gov number, NCT00949286.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1407963 

JAMA - Vancomycin & Staphylococcus aureus Bloodstream Infections

"Association Between Vancomycin Minimum Inhibitory Concentration and Mortality Among Patients With Staphylococcus aureus Bloodstream Infections"

"Conclusions and Relevance  In this meta-analysis of SAB episodes, there were no statistically significant differences in the risk of death when comparing patients with S aureus exhibiting high-vancomycin MIC (≥1.5 mg/L) to those with low-vancomycin MIC (<1.5 mg/L), although the findings cannot definitely exclude an increased mortality risk. These findings should be considered when interpreting vancomycin susceptibility and in determining whether alternative antistaphylococcal agents are necessary for patients with SAB with elevated but susceptible vancomycin MIC values."

http://jama.jamanetwork.com/article.aspx?articleid=1913620

JACC - Fractional Flow Reserve

 "Prognostic Value of Fractional Flow Reserve"

"Conclusions  FFR demonstrates a continuous and independent relationship with subsequent outcomes, modulated by medical therapy versus revascularization. Lesions with lower FFR values receive larger absolute benefits from revascularization. Measurement of FFR immediately after stenting also shows an inverse gradient of risk, likely from residual diffuse disease. An FFR-guided revascularization strategy significantly reduces events and increases freedom from angina with fewer procedures than an anatomy-based strategy."

http://content.onlinejacc.org/article.aspx?articleID=1915294

BMJ - Industry Sponsorship Bias in Statin Trials

 "Industry sponsorship bias in research findings: a network meta-analysis of LDL cholesterol reduction in randomised trials of statins"

"Conclusions Our analysis shows that the findings obtained from industry sponsored statin trials seem similar in magnitude as those in non-industry sources. There are actual differences in the effectiveness of individual statins at various doses that explain previously observed discrepancies between industry and non-industry sponsored trials."


http://www.bmj.com/content/349/bmj.g5741

NEJM - Ebola

"Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections"

"RESULTS

The majority of patients are 15 to 44 years of age (49.9% male), and we estimate that the case fatality rate is 70.8% (95% confidence interval [CI], 69 to 73) among persons with known clinical outcome of infection. The course of infection, including signs and symptoms, incubation period (11.4 days), and serial interval (15.3 days), is similar to that reported in previous outbreaks of EVD. On the basis of the initial periods of exponential growth, the estimated basic reproduction numbers (R0 ) are 1.71 (95% CI, 1.44 to 2.01) for Guinea, 1.83 (95% CI, 1.72 to 1.94) for Liberia, and 2.02 (95% CI, 1.79 to 2.26) for Sierra Leone. The estimated current reproduction numbers (R) are 1.81 (95% CI, 1.60 to 2.03) for Guinea, 1.51 (95% CI, 1.41 to 1.60) for Liberia, and 1.38 (95% CI, 1.27 to 1.51) for Sierra Leone; the corresponding doubling times are 15.7 days (95% CI, 12.9 to 20.3) for Guinea, 23.6 days (95% CI, 20.2 to 28.2) for Liberia, and 30.2 days (95% CI, 23.6 to 42.3) for Sierra Leone. Assuming no change in the control measures for this epidemic, by November 2, 2014, the cumulative reported numbers of confirmed and probable cases are predicted to be 5740 in Guinea, 9890 in Liberia, and 5000 in Sierra Leone, exceeding 20,000 in total.
CONCLUSIONS
These data indicate that without drastic improvements in control measures, the numbers of cases of and deaths from EVD are expected to continue increasing from hundreds to thousands per week in the coming months."

http://www.nejm.org/doi/full/10.1056/NEJMoa1411100

JAMA - Obstetric Quality Indicators and Maternal and Neonatal Morbidity

"Association Between Hospital-Level Obstetric Quality Indicators and Maternal and Neonatal Morbidity"

"Conclusions and Relevance  Rates for the quality indicators elective delivery before 39 weeks of gestation and cesarean delivery performed in low-risk mothers varied widely in New York City hospitals, as did rates of maternal and neonatal complications. However, there were no correlations between the quality indicator rates and maternal and neonatal morbidity. Current quality indicators may not be sufficiently comprehensive for guiding quality improvement in obstetric care."


http://jama.jamanetwork.com/article.aspx?articleid=1915608

Weekly Guidleline Update - Non-ST Elevation ACS

"2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: Executive Summary"

http://content.onlinejacc.org/article.aspx?articleid=1910085

CIRC - Postablation A Fib Recurrences

"Central Sympathetic Inhibition to Reduce Postablation Atrial Fibrillation Recurrences in Hypertensive Patients"

"Conclusions—Treatment with moxonidine is associated with less AF recurrences after ablation treatment for drug-refractory AF in patients with hypertension. The observed effect does not appear to depend on the antihypertensive action of this agent."
http://circ.ahajournals.org/content/130/16/1346.abstract

BMJ - Universal Meningitis Vaccination

"Re-evaluating cost effectiveness of universal meningitis vaccination (Bexsero) in England: modelling study"

"Conclusions Routine infant vaccination is the most effective short term strategy and could be cost effective with a low vaccine price. Critically, if the vaccine reduces carriage acquisition in teenagers, the combination of infant and adolescent vaccination could result in substantial long term reductions in cases and be cost effective with competitive vaccine pricing."


http://www.bmj.com/content/349/bmj.g5725

NEJM - Transfusion in Septic Shock

 "Lower versus Higher Hemoglobin Threshold for Transfusion in Septic Shock"

"CONCLUSIONS

Among patients with septic shock, mortality at 90 days and rates of ischemic events and use of life support were similar among those assigned to blood transfusion at a higher hemoglobin threshold and those assigned to blood transfusion at a lower threshold; the latter group received fewer transfusions. (Funded by the Danish Strategic Research Council and others; TRISS ClinicalTrials.gov number,NCT01485315.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1406617

JAMA - Frozen Fecal Transplant for C dif

"Oral, Capsulized, Frozen Fecal Microbiota Transplantation for Relapsing Clostridium difficile Infection"

"Conclusions and Relevance  This preliminary study among patients with relapsing C difficileinfection provides data on adverse events and rates of resolution of diarrhea following administration of FMT using frozen encapsulated inoculum from unrelated donors. Larger studies are needed to confirm these results and to evaluate long-term safety and effectiveness."  

http://jama.jamanetwork.com/article.aspx?articleid=1916296

Weekly Guideline - ECG in Healthy 12-25 Y.O.

"Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12−25 Years of Age): A Scientific Statement From the American Heart Association and the American College of Cardiology"



http://circ.ahajournals.org/content/early/2014/09/15/CIR.0000000000000025.full.pdf+html

JACC - Diet, Lifestyle and MI Prevention

"Low-Risk Diet and Lifestyle Habits in the Primary Prevention of Myocardial Infarction in Men"

"Conclusions  Almost 4 of 5 MIs in men may be preventable with a combined low-risk behavior."
"Results  During 11 years of follow-up, we ascertained 1,361 incident cases of MI. The low-risk dietary choice together with moderate alcohol consumption was associated with a relative risk of 0.65 (95% confidence interval [CI]: 0.48 to 0.87) compared with men having 0 of 5 low-risk factors. Men having all 5 low-risk factors compared with those with 0 low-risk factors had a relative risk of 0.14 (95% CI: 0.04 to 0.43). This combination of healthy behaviors, present in 1% of the men, could prevent 79% (95% CI: 34% to 93%) of the MI events on the basis of the study population."

http://content.onlinejacc.org/article.aspx?articleID=1909605 

BMJ - HPV Testing

"Accuracy of urinary human papillomavirus testing for presence of cervical HPV: systematic review and meta-analysis"

"Conclusions
Testing urine for HPV seems to have good accuracy for the detection of cervical HPV, and testing first void urine samples is more accurate than random or midstream sampling. When cervical HPV detection is considered difficult in particular subgroups, urine testing should be regarded as an acceptable alternative."
http://www.bmj.com/content/349/bmj.g5264

NEJM - FFR for PCI

"Fractional Flow Reserve–Guided PCI for Stable Coronary Artery Disease"

"CONCLUSIONS

In patients with stable coronary artery disease, FFR-guided PCI, as compared with medical therapy alone, improved the outcome. Patients without ischemia had a favorable outcome with medical therapy alone. (Funded by St. Jude Medical; FAME 2 ClinicalTrials.gov number, NCT01132495.)"    

http://www.nejm.org/doi/full/10.1056/NEJMoa1408758?query=featured_home

JAMA - PET FDG for Lung CA Dx

"Accuracy of FDG-PET to Diagnose Lung Cancer in Areas With Infectious Lung Disease A Meta-analysis"

"Conclusions and Relevance  The accuracy of FDG-PET for diagnosing lung nodules was extremely heterogeneous. Use of FDG-PET combined with computed tomography was less specific in diagnosing malignancy in populations with endemic infectious lung disease compared with nonendemic regions. These data do not support the use of FDG-PET to diagnose lung cancer in endemic regions unless an institution achieves test performance accuracy similar to that found in nonendemic regions."



http://jama.jamanetwork.com/article.aspx?articleid=1906615

Weekly Guideline - CVD Risk Factors in Youth with DM

"Cardiovascular Disease Risk Factors in Youth With Diabetes Mellitus"

http://circ.ahajournals.org/content/early/2014/08/28/CIR.0000000000000094

CIRC - Inoperable AS

"Long-Term Outcomes of Inoperable Patients with Aortic Stenosis Randomized to Transcatheter Aortic Valve Replacement or Standard Therapy"

"Conclusions—TAVR resulted in better survival and functional status in inoperable patients with severe AS with durable hemodynamic benefit on long-term follow-up. However, high residual mortality even in successfully treated TAVR patients highlights the need for more strategic patient selection."  
http://circ.ahajournals.org/content/early/2014/09/09/CIRCULATIONAHA.114.009834.abstract

BMJ - Sepsis & Post-Op Thrombosis

"Impact of sepsis on risk of postoperative arterial and venous thromboses: large prospective cohort study"

"Conclusions Preoperative sepsis represents an important independent risk factor for both arterial and venous thromboses. The risk of thrombosis increases with the severity of the inflammatory response and is higher in both emergent and elective surgical procedures. Suspicion of thrombosis should be higher in patients with sepsis who undergo surgery."  

http://www.bmj.com/content/349/bmj.g5334

NEJM - BP Control in DM-2 (ADVANCE)

 "Follow-up of Blood-Pressure Lowering and Glucose Control in Type 2 Diabetes"

"CONCLUSIONS

The benefits with respect to mortality that had been observed among patients originally assigned to blood-pressure–lowering therapy were attenuated but still evident at the end of follow-up. There was no evidence that intensive glucose control during the trial led to long-term benefits with respect to mortality or macrovascular events. (Funded by the National Health and Medical Research Council of Australia and others; ADVANCE-ON ClinicalTrials.gov number, NCT00949286.)"    

http://www.nejm.org/doi/full/10.1056/NEJMoa1407963?query=featured_home

JAMA - Antenatal MgSo4 in Preterm

"School-age Outcomes of Very Preterm Infants After Antenatal Treatment With Magnesium Sulfate vs Placebo"

"Conclusions and Relevance  Magnesium sulfate given to pregnant women at imminent risk of birth before 30 weeks’ gestation was not associated with neurological, cognitive, behavioral, growth, or functional outcomes in their children at school age, although a mortality advantage cannot be excluded. The lack of long-term benefit requires confirmation in additional studies."  
http://jama.jamanetwork.com/article.aspx?articleid=1904828

Weekly Guideline - e Cigarettes

"Electronic Cigarettes: A Policy Statement From the American Heart Association"

http://circ.ahajournals.org/content/early/2014/08/22/CIR.0000000000000107

CIRC - ICD Infections

"Rates of and Factors Associated With Infection in 200 909 Medicare Implantable Cardioverter-Defibrillator Implants"

"Conclusions—Patients who developed an ICD infection were more likely to have had peri-ICD implant complications requiring early reintervention, previous valve surgery, device replacement for reasons other than battery depletion, and increased comorbidity burden. Efforts should be made to carefully consider when to reenter the pocket at any time other than battery replacement."   

http://circ.ahajournals.org/content/130/13/1037.abstract

BMJ - Alzheimer's & Benzodiazepines

"Benzodiazepine use and risk of Alzheimer’s disease: case-control study"

"Conclusion
Benzodiazepine use is associated with an increased risk of Alzheimer’s disease. The stronger association observed for long term exposures reinforces the suspicion of a possible direct association, even if benzodiazepine use might also be an early marker of a condition associated with an increased risk of dementia. Unwarranted long term use of these drugs should be considered as a public health concern."  

http://www.bmj.com/content/349/bmj.g5205

NEJM - Ivabradine in Stable CAD

"Ivabradine in Stable Coronary Artery Disease without Clinical Heart Failure"

"CONCLUSIONS

Among patients who had stable coronary artery disease without clinical heart failure, the addition of ivabradine to standard background therapy to reduce the heart rate did not improve outcomes. (Funded by Servier; SIGNIFY Current Controlled Trials number,ISRCTN61576291.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1406430

JAMA - B-Agonists and Inhaled Corticosteroids in COPD

"Combination Long-Acting β-Agonists and Inhaled Corticosteroids Compared With Long-Acting β-Agonists Alone in Older Adults With Chronic Obstructive Pulmonary Disease"

"Conclusions and Relevance  Among older adults with COPD, particularly those with asthma and those not receiving a long-acting anticholinergic medication, newly prescribed LABA and inhaled corticosteroid combination therapy, compared with newly prescribed LABAs alone, was associated with a significantly lower risk of the composite outcome of death or COPD hospitalization."  

http://jama.jamanetwork.com/article.aspx?articleid=1904829

Weekly Guideline - Perioperative Cardiovascular Evaluation:

"Clinical Practice Guidelines on Perioperative Cardiovascular Evaluation: Collaborative Efforts Among the ACC, AHA, and ESC"

http://content.onlinejacc.org/article.aspx?articleid=1893782

JACC - CABG vs PCI in DM

"Long-Term Outcome of PCI Versus CABG in Insulin and Non–Insulin-Treated Diabetic Patients"

"Conclusions  In patients with diabetes and multivessel coronary artery disease, the rate of major adverse cardiovascular events (death, MI, or stroke) is higher in patients treated with insulin than in those not treated with insulin. Furthermore, we did not detect a significant difference in the magnitude of PCI versus CABG treatment effect for patients treated with insulin and those not treated with insulin. (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes [FREEDOM]; NCT00086450)."
http://content.onlinejacc.org/article.aspx?articleID=1905458

BMJ - Breast CA Screening

"Effect of implementation of the mass breast cancer screening programme in older women in the Netherlands: population based study"    

"Conclusions The extension of the upper age limit to 75 years has only led to a small decrease in incidence of advanced stage breast cancer, while that of early stage tumours has strongly increased."  
http://www.bmj.com/content/349/bmj.g5410

NEJM - ALL

"Targetable Kinase-Activating Lesions in Ph-like Acute Lymphoblastic Leukemia"

"CONCLUSIONS

Ph-like ALL was found to be characterized by a range of genomic alterations that activate a limited number of signaling pathways, all of which may be amenable to inhibition with approved tyrosine kinase inhibitors. Trials identifying Ph-like ALL are needed to assess whether adding tyrosine kinase inhibitors to current therapy will improve the survival of patients with this type of leukemia. (Funded by the American Lebanese Syrian Associated Charities and others."

http://www.nejm.org/doi/full/10.1056/NEJMoa1403088?query=featured_home

JAMA - Darapladibin ACS

"Effect of Darapladib on Major Coronary Events After an Acute Coronary Syndrome"

"Conclusions and Relevance  In patients who experienced an ACS event, direct inhibition of Lp-PLA2with darapladib added to optimal medical therapy and initiated within 30 days of hospitalization did not reduce the risk of major coronary events."


http://jama.jamanetwork.com/article.aspx?articleid=1900827

Weekly Guideline Update - Beta Blockade in Noncardiac Surgery

"Perioperative : A Systematic Review for the 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery"


http://content.onlinejacc.org/article.aspx?articleid=1893783

CIRC - WPW

"Wolff-Parkinson-White Syndrome in the Era of Catheter Ablation Insights From a Registry Study of 2169 Patients"

"Conclusions—The prognosis of the Wolff-Parkinson-White syndrome essentially depends on intrinsic electrophysiological properties of AP rather than on symptoms. RFA performed during the same procedure after electrophysiological testing is of benefit in improving the long-term outcomes."  

http://circ.ahajournals.org/content/130/10/811.abstract 

BMJ - Antiepileptics in Pregnancy

"Use of antiepileptic drugs during pregnancy and risk of spontaneous abortion and stillbirth: population based cohort study"

"Conclusion Among women with epilepsy and when analysing the risk in antiepileptic drug discordant pregnancies in the same woman, we found no overall association between the use of antiepileptic drugs during pregnancy and spontaneous abortions. Therefore unmeasured confounding may explain the slight increased risk for spontaneous abortion with any antiepileptic drug use (among women both with and without epilepsy). We found no association between antiepileptic drug use during pregnancy and stillbirth, but the statistical precision was low."
http://www.bmj.com/content/349/bmj.g5159

NEJM - Influenza Vaccination of Pregnant Women

"Influenza Vaccination of Pregnant Women and Protection of Their Infants"

"CONCLUSIONS

Influenza vaccine was immunogenic in HIV-uninfected and HIV-infected pregnant women and provided partial protection against confirmed influenza in both groups of women and in infants who were not exposed to HIV. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov numbers, NCT01306669 andNCT01306682.)"  

http://www.nejm.org/doi/full/10.1056/NEJMoa1401480 

JAMA - Weight Loss with Named Diet Programs

"Comparison of Weight Loss Among Named Diet Programs in Overweight and Obese Adults A Meta-analysis"

"Conclusions and Relevance  Significant weight loss was observed with any low-carbohydrate or low-fat diet. Weight loss differences between individual named diets were small. This supports the practice of recommending any diet that a patient will adhere to in order to lose weight."  

http://jama.jamanetwork.com/article.aspx?articleid=1900510

Weekly Guideline - Worksite Health Screening

"AHA Policy Statement The Role of Worksite Health Screening A Policy Statement From the American Heart Association"

http://circ.ahajournals.org/content/130/8/719.full

JACC - "Acute Kidney Injury After CABG Versus PCI"

"Acute Kidney Injury After CABG Versus PCI"

"Conclusions  AKI is common after multivessel coronary revascularization and is more likely after CABG than after PCI. The risk for AKI should be considered when choosing a coronary revascularization strategy, and ways to prevent AKI after coronary revascularization are needed."

http://content.onlinejacc.org/article.aspx?articleID=1900736

BMJ - Commuting and BMI

"Associations between active commuting, body fat, and body mass index: population based, cross sectional study in the United Kingdom"

"Conclusions Men and women who commuted to work by active and public modes of transport had significantly lower BMI and percentage body fat than their counterparts who used private transport. These associations were not attenuated by adjustment for a range of hypothesised confounding factors."


http://www.bmj.com/content/349/bmj.g4887

NEJM - Angiotensin–Neprilysin Inhibition

"Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure"

"CONCLUSIONS

LCZ696 was superior to enalapril in reducing the risks of death and of hospitalization for heart failure. (Funded by Novartis; PARADIGM-HF ClinicalTrials.gov number, NCT01035255.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1409077?query=featured_home

JAMA - Colchicine

"Colchicine for Prevention of Postpericardiotomy Syndrome and Postoperative Atrial Fibrillation The COPPS-2 Randomized Clinical Trial"

"Conclusions and Relevance  Among patients undergoing cardiac surgery, perioperative use of colchicine compared with placebo reduced the incidence of postpericardiotomy syndrome but not of postoperative AF or postoperative pericardial/pleural effusion. The increased risk of gastrointestinal adverse effects reduced the potential benefits of colchicine in this setting."

http://jama.jamanetwork.com/article.aspx?articleid=1900482

Weekly Guideline Update - Type 1 DM and CV Disease

"Type 1 Diabetes Mellitus and Cardiovascular Disease: A Scientific Statement From the American Heart Association and American Diabetes Association"

http://circ.ahajournals.org/content/early/2014/08/11/CIR.0000000000000034

CIRC - (ahead of print) ASA for Recurent VTE

"Aspirin for the Prevention of Recurrent Venous Thromboembolism: The INSPIRE Collaboration"

"Conclusions—Aspirin after anticoagulant treatment reduces the overall risk of recurrence by more than a third in a broad cross-section of patients with a first unprovoked VTE, without significantly increasing the risk of bleeding."
http://circ.ahajournals.org/content/early/2014/08/12/CIRCULATIONAHA.114.008828.abstract

BMJ - Clarithromycin and roxithromycin and risk of cardiac death

"Use of clarithromycin and roxithromycin and risk of cardiac death: cohort study"

"Conclusions This large cohort study found a significantly increased risk of cardiac death associated with clarithromycin. No increased risk was seen with roxithromycin. Given the widespread use of clarithromycin, these findings call for confirmation in independent populations."
http://www.bmj.com/content/349/bmj.g4930

NEJM - Transfusions for Silent Cerebral Infarcts in Sickle Cell Anemia

"Controlled Trial of Transfusions for Silent Cerebral Infarcts in Sickle Cell Anemia"

"CONCLUSIONS

Regular blood-transfusion therapy significantly reduced the incidence of the recurrence of cerebral infarct in children with sickle cell anemia. (Funded by the National Institute of Neurological Disorders and Stroke and others; Silent Cerebral Infarct Multi-Center Clinical Trial ClinicalTrials.gov number, NCT00072761, and Current Controlled Trials number, ISRCTN52713285.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1401731 

JAMA - Oximetry & Hospitalization in Infant Bronchiolitis

"Effect of Oximetry on Hospitalization in Bronchiolitis"

"Conclusions and Relevance  Among infants presenting to an emergency department with mild to moderate bronchiolitis, those with an artificially elevated pulse oximetry reading were less likely to be hospitalized within 72 hours or to receive active hospital care for more than 6 hours than those with unaltered oximetry readings. This suggests that oxygen saturation should not be the only factor in the decision to admit, and its use may need to be reevaluated."

http://jama.jamanetwork.com/article.aspx?articleid=1896981

Weekly Guideline - 2014 AHA Exercise Testing by Nonphysicians

"Supervision of Exercise Testing by Nonphysicians: A Scientific Statement From the American Heart Association"
http://circ.ahajournals.org/content/early/2014/08/18/CIR.0000000000000101.full.pdf+html

CIRC - Exercise Capacity & Mortality

"Age-Specific Exercise Capacity Threshold for Mortality Risk Assessment in Male Veterans"

"Conclusion—We defined age-specific exercise capacity thresholds to guide assessment of mortality risk in individuals undergoing a clinical exercise test."

http://circ.ahajournals.org/content/130/8/653.abstract

BMJ - QBleed Scores for Anticoagulants

"Predicting risk of upper gastrointestinal bleed and intracranial bleed with anticoagulants: cohort study to derive and validate the QBleed scores"

"Conclusion The QBleed algorithms provided valid measures of absolute risk of gastrointestinal and intracranial bleed in patients with and without anticoagulation as shown by the performance of the algorithms in a separate validation cohort. Further research is needed to evaluate the clinical outcomes and the cost effectiveness of using these algorithms in primary care."


http://www.bmj.com/content/349/bmj.g4606

NEJM - Sodium & CV Mortality

"Global Sodium Consumption and Death from Cardiovascular Causes"

"CONCLUSIONS

In this modeling study, 1.65 million deaths from cardiovascular causes that occurred in 2010 were attributed to sodium consumption above a reference level of 2.0 g per day. (Funded by the Bill and Melinda Gates Foundation.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1304127?query=featured_home

JAMA - Flex Sig for Colon CA

"Effect of Flexible Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality"

"Conclusions and Relevance  In Norway, once-only flexible sigmoidoscopy screening or flexible sigmoidoscopy and FOBT reduced colorectal cancer incidence and mortality on a population level compared with no screening. Screening was effective both in the 50- to 54-year and the 55- to 64-year age groups."

http://jama.jamanetwork.com/article.aspx?articleid=1895247

Weekly Guideline Update - Hep C

2014+ (continually updated) IDSA "Recommendations for Testing, Managing, and Treating Hepatitis C"
http://www.hcvguidelines.org/full-report-view

"Prognostic Value of Fasting Versus Nonfasting Low-Density Lipoprotein Cholesterol Levels on Long-Term Mortality"

"Conclusions—Nonfasting LDL-C has prognostic value similar to that of fasting LDL-C. National and international agencies should consider reevaluating the recommendation that patients fast before obtaining a lipid panel."

http://circ.ahajournals.org/content/130/7/546.abstract