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