Monday, June 30, 2014

JAMA - Breast Cancer Screening Using Tomosynthesis




 "Breast Cancer Screening Using Tomosynthesis in Combination With Digital Mammography"
http://jama.jamanetwork.com/article.aspx?articleid=1883018
"Conclusions and Relevance  Addition of tomosynthesis to digital mammography was associated with a decrease in recall rate and an increase in cancer detection rate. Further studies are needed to assess the relationship to clinical outcomes."

Thursday, June 26, 2014

JACC - "Metabolically-Healthy Obesity and Coronary Artery Calcification"

"Metabolically-Healthy Obesity and Coronary Artery Calcification"

"Conclusions  MHO participants had a higher prevalence of subclinical coronary atherosclerosis than metabolically-healthy normal-weight participants, which supports the idea that MHO is not a harmless condition. This association, however, was mediated by metabolic risk factors at levels below those considered abnormal, which suggests that the label of metabolically healthy for obese subjects may be an artifact of the cutoff levels used in the definition of metabolic health."  

JACC June 2014 http://jacc.org/

Wednesday, June 25, 2014

BMJ - Antidepressant Use in Young People After Warnings


"Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage"

"Conclusions Safety warnings about antidepressants and widespread media coverage decreased antidepressant use, and there were simultaneous increases in suicide attempts among young people. It is essential to monitor and reduce possible unintended consequences of FDA warnings and media reporting."   

http://www.bmj.com/content/348/bmj.g3596

Tuesday, June 24, 2014

NEJM - Antidepressants & Cardiac Birth Defects

"Antidepressant Use in Pregnancy and the Risk of Cardiac Defects"

"CONCLUSIONS
The results of this large, population-based cohort study suggested no substantial increase in the risk of cardiac malformations attributable to antidepressant use during the first trimester. (Funded by the Agency for Healthcare Research and Quality and the National Institutes of Health.)"   
http://www.nejm.org/doi/full/10.1056/NEJMoa1312828?query=featured_home

Monday, June 23, 2014

JAMA - Thrombolysis for PE Meta-analysis



"Thrombolysis for Pulmonary Embolism and Risk of All-Cause Mortality, Major Bleeding, and Intracranial Hemorrhage A Meta-analysis"

"Conclusions and Relevance  Among patients with pulmonary embolism, including those who were hemodynamically stable with right ventricular dysfunction, thrombolytic therapy was associated with lower rates of all-cause mortality and increased risks of major bleeding and ICH. However, findings may not apply to patients with pulmonary embolism who are hemodynamically stable without right ventricular dysfunction."
http://jama.jamanetwork.com/article.aspx?articleid=1881311

Friday, June 20, 2014

Weekly Guideline - Noninvasive Testing for IHD in Women


"Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Ischemic Heart Disease: A Consensus Statement From the American Heart Association"
AHA 2014
http://circ.ahajournals.org/content/early/2014/06/16/CIR.0000000000000061

Thursday, June 19, 2014

JACC - 6 Min Walk and ICD and Amiodarone Tx

"Use of the 6-Min Walk Distance to Identify Variations in Treatment Benefits From Implantable Cardioverter-Defibrillator and Amiodarone"
JACC http://jacc.org/
Volume 63, Issue 23, June 2014
"Conclusions  A baseline 6MW distance <288 m identified a subgroup of SCD-HeFT patients who were harmed by amiodarone therapy and did not benefit from ICD.
(Sudden Cardiac Death in Heart Failure Trial [SCD-HeFT]; NCT00000609)"

Wednesday, June 18, 2014

BMJ - Screening for IHD


"Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population"
http://www.bmj.com/content/348/bmj.g3617 
"Conclusion A community based, individually tailored intervention programme with screening for risk of ischaemic heart disease and repeated lifestyle intervention over five years had no effect on ischaemic heart disease, stroke, or mortality at the population level after 10 years."

Tuesday, June 17, 2014

NEJM - CPAP & Weight Loss for OSA

"CPAP, Weight Loss, or Both for Obstructive Sleep Apnea"    
http://www.nejm.org/doi/full/10.1056/NEJMoa1306187
"CONCLUSIONS

In adults with obesity and obstructive sleep apnea, CPAP combined with a weight-loss intervention did not reduce CRP levels more than either intervention alone. In secondary analyses, weight loss provided an incremental reduction in insulin resistance and serum triglyceride levels when combined with CPAP. In addition, adherence to a regimen of weight loss and CPAP may result in incremental reductions in blood pressure as compared with either intervention alone. (Funded by the National Heart, Lung, and Blood Institute; ClinicalTrials.gov number, NCT0371293.)"

Monday, June 16, 2014

JAMA - Intensive DM Tx and CV Events

"Association Between Intensification of Metformin Treatment With Insulin vs Sulfonylureas and Cardiovascular Events and All-Cause Mortality Among Patients With Diabetes"
http://jama.jamanetwork.com/article.aspx?articleid=1878717
"Conclusions and Relevance  Among patients with diabetes who were receiving metformin, the addition of insulin vs a sulfonylurea was associated with an increased risk of a composite of nonfatal cardiovascular outcomes and all-cause mortality. These findings require further investigation to understand risks associated with insulin use in these patients."

Thursday, June 12, 2014

Circ - Troponin Interpretation

"Clinician Update How to Interpret Elevated Cardiac Troponin Levels"
http://circ.ahajournals.org/content/124/21/2350.full
"Assays for cTn, namely cTnI and cardiac troponin T (cTnT), are the preferred diagnostic tests for ACS, in particular non–ST-segment–elevation myocardial infarction, because of the tissue-specific expression of cTnI and cTnT in the myocardium. The results of cTn testing often guide the decision for coronary intervention. However, although the increasing sensitivity of cTn assays lowers the number of potentially missed ACS diagnoses, it presents a diagnostic challenge because the gains in diagnostic sensitivity have inevitably come with a decrease in specificity. For instance, the replacement of the cTn assay (Siemens Healthcare Diagnostics) by the more sensitive TnI-UItra assay in the Brigham and Women's Hospital Clinical Laboratories in early 2007 resulted in a doubling of positive cTn results in samples collected in the emergency department2 even though there was no change in the frequency of final diagnoses of ACS."

Wednesday, June 11, 2014

BMJ - Protein Sources & Breast CA


 "Dietary protein sources in early adulthood and breast cancer incidence: prospective cohort study"
http://www.bmj.com/content/348/bmj.g3437
"Conclusion Higher red meat intake in early adulthood may be a risk factor for breast cancer, and replacing red meat with a combination of legumes, poultry, nuts and fish may reduce the risk of breast cancer."

Tuesday, June 10, 2014

NEJM - Rosuvastatin for ARDS


"Rosuvastatin for Sepsis-Associated Acute Respiratory Distress Syndrome"
http://www.nejm.org/doi/full/10.1056/NEJMoa1401520
"CONCLUSIONS
Rosuvastatin therapy did not improve clinical outcomes in patients with sepsis-associated ARDS and may have contributed to hepatic and renal organ dysfunction."

Monday, June 9, 2014

JAMA - Azithromycin & Mortality


"Association of Azithromycin With Mortality and Cardiovascular Events Among Older Patients Hospitalized With Pneumonia"
http://jama.jamanetwork.com/article.aspx?articleid=1877208
"Conclusions and Relevance  Among older patients hospitalized with pneumonia, treatment that included azithromycin compared with other antibiotics was associated with a lower risk of 90-day mortality and a smaller increased risk of myocardial infarction. These findings are consistent with a net benefit associated with azithromycin use."

Thursday, June 5, 2014

Circ - Stroke After AVR


"Stroke After Aortic Valve Surgery"
http://circ.ahajournals.org/content/129/22/2253.abstract
"Conclusions—Clinical stroke after AVR was more common than reported previously, more than double for this same cohort in the Society for Thoracic Surgery database, and silent cerebral infarctions were detected in more than half of the patients undergoing AVR. Clinical stroke complicating AVR is associated with increased length of stay and mortality."

Wednesday, June 4, 2014

BMJ - Statins & Diabetes


"Higher potency statins and the risk of new diabetes"
http://www.bmj.com/content/348/bmj.g3244  /
"Conclusions Higher potency statin use is associated with a moderate increase in the risk of new onset diabetes compared with lower potency statins in patients treated for secondary prevention of cardiovascular disease. Clinicians should consider this risk when prescribing higher potency statins in secondary prevention patients."

Tuesday, June 3, 2014

NEJM - Dalbavancin for Skin Infections


"Once-Weekly Dalbavancin versus Daily Conventional Therapy for Skin Infection"
http://www.nejm.org/doi/full/10.1056/NEJMoa1310480?query=featured_home
"CONCLUSIONS
Once-weekly intravenous dalbavancin was not inferior to twice-daily intravenous vancomycin followed by oral linezolid for the treatment of acute bacterial skin and skin-structure infection,"

Monday, June 2, 2014

JAMA - Kidney Function after CABG



"Kidney Function After Off-Pump or On-Pump Coronary Artery Bypass Graft Surgery"
http://jama.jamanetwork.com/article.aspx?articleid=1877182
"Conclusions and Relevance  Use of off-pump compared with on-pump CABG surgery reduced the risk of postoperative acute kidney injury, without evidence of better preserved kidney function with off-pump CABG surgery at 1 year. In this setting, an intervention that reduced the risk of mild to moderate acute kidney injury did not alter longer-term kidney function."