Thursday, October 29, 2015

CIRC - "Rate-Control Treatment and Mortality in Atrial Fibrillation"

"Rate-Control Treatment and Mortality in Atrial Fibrillation"

"Conclusions—In this nationwide atrial fibrillation cohort, the risk of mortality was lower for patients receiving rate-control treatment with β-blockers or calcium channel blockers, and the use of β-blockers was associated with the largest risk reduction. Digoxin use was associated with greater mortality. Prospective, randomized trials are necessary to confirm these findings."
http://circ.ahajournals.org/content/132/17/1604.abstract

Wednesday, October 28, 2015

BMJ - "Risk of cancer from occupational exposure to ionising radiation: retrospective cohort study of workers in France, the United Kingdom, and the United States (INWORKS)"

 "Risk of cancer from occupational exposure to ionising radiation: retrospective cohort study of workers in France, the United Kingdom, and the United States (INWORKS)"

"What this study adds The study provides a direct estimate of the association between protracted low dose exposure to ionising radiation and solid cancer mortality. Although high dose rate exposures are thought to be more dangerous than low dose rate exposures, the risk per unit of radiation dose for cancer among radiation workers was similar to estimates derived from studies of Japanese atomic bomb survivors. Quantifying the cancer risks associated with protracted radiation exposures can help strengthen the foundation for radiation protection standards."

http://www.bmj.com/content/351/bmj.h5359

Tuesday, October 27, 2015

NEJM - "A Randomized, Controlled Trial of Total Knee Replacement"

NEJM - "A Randomized, Controlled Trial of Total Knee Replacement"

"CONCLUSIONS
In patients with knee osteoarthritis who were eligible for unilateral total knee replacement, treatment with total knee replacement followed by nonsurgical treatment resulted in greater pain relief and functional improvement after 12 months than did nonsurgical treatment alone. However, total knee replacement was associated with a higher number of serious adverse events than was nonsurgical treatment, and most patients who were assigned to receive nonsurgical treatment alone did not undergo total knee replacement before the 12-month follow-up. (Funded by the Obel Family Foundation and others; MEDIC ClinicalTrials.gov number, NCT01410409.)"
http://www.nejm.org/doi/full/10.1056/NEJMoa1505467

Monday, October 26, 2015

JAMA - (REVIEW) "Evaluation and Treatment of Pericarditis A Systematic Review"

JAMA - (REVIEW)  "Evaluation and Treatment of Pericarditis A Systematic Review"

"Findings  The etiology of pericarditis may be infectious (eg, viral and bacterial) or noninfectious (eg, systemic inflammatory diseases, cancer, and post–cardiac injury syndromes). Tuberculosis is a major cause of pericarditis in developing countries but accounts for less than 5% of cases in developed countries, where idiopathic, presumed viral causes are responsible for 80% to 90% of cases. The diagnosis is based on clinical criteria including chest pain, a pericardial rub, electrocardiographic changes, and pericardial effusion. Certain features at presentation (temperature >38°C [>100.4°F], subacute course, large effusion or tamponade, and failure of nonsteroidal anti-inflammatory drug [NSAID] treatment) indicate a poorer prognosis and identify patients requiring hospital admission. The most common treatment for idiopathic and viral pericarditis in North America and Europe is NSAID therapy. Adjunctive colchicine can ameliorate the initial episode and is associated with approximately 50% lower recurrence rates. Corticosteroids are a second-line therapy for those who do not respond, are intolerant, or have contraindications to NSAIDs and colchicine. Recurrences may occur in 30% of patients without preventive therapy.

Conclusions and Relevance  Pericarditis is the most common form of pericardial disease worldwide and may recur in as many as one-third of patients who present with idiopathic or viral pericarditis. Appropriate triage and treatment with NSAIDs may reduce readmission rates for pericarditis. Treatment with colchicine can reduce recurrence rates."
http://jama.jamanetwork.com/article.aspx?articleid=2456172

Thursday, October 22, 2015

CIRC - "Prognostic Value of Late Gadolinium Enhancement Cardiovascular Magnetic Resonance in Cardiac Amyloidosis"

CIRC - "Prognostic Value of Late Gadolinium Enhancement Cardiovascular Magnetic Resonance in Cardiac Amyloidosis"

"Conclusions—There is a continuum of cardiac involvement in systemic AL and ATTR amyloidosis. Transmural LGE is determined reliably by PSIR and represents advanced cardiac amyloidosis. The PSIR technique provides incremental information on outcome even after adjustment for known prognostic factors."

http://circ.ahajournals.org/content/132/16/1570.full 

Wednesday, October 21, 2015

BMJ - "Calcium intake and risk of fracture: systematic review"

BMJ - "Calcium intake and risk of fracture: systematic review"

"Conclusions Dietary calcium intake is not associated with risk of fracture, and there is no clinical trial evidence that increasing calcium intake from dietary sources prevents fractures. Evidence that calcium supplements prevent fractures is weak and inconsistent."

http://www.bmj.com/content/351/bmj.h4580 

Tuesday, October 20, 2015

NEJM - "A Trial of Calcium and Vitamin D for the Prevention of Colorectal Adenomas"

NEJM - "A Trial of Calcium and Vitamin D for the Prevention of Colorectal Adenomas"

"CONCLUSIONS
Daily supplementation with vitamin D3 (1000 IU), calcium (1200 mg), or both after removal of colorectal adenomas did not significantly reduce the risk of recurrent colorectal adenomas over a period of 3 to 5 years. (Funded by the National Cancer Institute; ClinicalTrials.gov number, NCT00153816.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1500409

Monday, October 19, 2015

JAMA - "Early Physical Therapy vs Usual Care in Patients With Recent-Onset Low Back Pain A Randomized Clinical Trial"

JAMA - "Early Physical Therapy vs Usual Care in Patients With Recent-Onset Low Back Pain A Randomized Clinical Trial"

"Conclusions and Relevance  Among adults with recent-onset LBP, early physical therapy resulted in statistically significant improvement in disability, but the improvement was modest and did not achieve the minimum clinically important difference compared with usual care."

http://jama.jamanetwork.com/article.aspx?articleid=2456165

Thursday, October 15, 2015

CIRC - "Cryoballoon Versus Open Irrigated Radiofrequency Ablation in Patients With Paroxysmal Atrial Fibrillation"

"Cryoballoon Versus Open Irrigated Radiofrequency Ablation in Patients With Paroxysmal Atrial Fibrillation"

"Conclusion—This large, prospective, randomized, controlled study demonstrates noninferiority of CB ablation versus RF ablation for treating patients with paroxysmal atrial fibrillation."  


http://circ.ahajournals.org/content/132/14/1311.full

Wednesday, October 14, 2015

BMJ - "Frequency of discrepancies in retracted clinical trial reports versus unretracted reports: blinded case-control study"

"Frequency of discrepancies in retracted clinical trial reports versus unretracted reports: blinded case-control study"

"Conclusions Discrepancies in published trial reports should no longer be assumed to be unimportant. Scientists, blinded to retraction status and with no specialist skill in the field, identify significantly more discrepancies in retracted than unretracted reports of clinical trials. Discrepancies could be an early and accessible signal of unreliability in clinical trial reports."

http://www.bmj.com/content/351/bmj.h4708 

Tuesday, October 13, 2015

NEJM - "Calcium intake and bone mineral density: systematic review and meta-analysis"

"Calcium intake and bone mineral density: systematic review and meta-analysis"

"Conclusions Increasing calcium intake from dietary sources or by taking calcium supplements produces small non-progressive increases in BMD, which are unlikely to lead to a clinically significant reduction in risk of fracture."

http://www.bmj.com/content/351/bmj.h4183 

Monday, October 12, 2015

JAMA - "Rehabilitation After Immobilization for Ankle Fracture The EXACT Randomized Clinical Trial"

"Rehabilitation After Immobilization for Ankle Fracture The EXACT Randomized Clinical Trial"

"Conclusions and Relevance  A supervised exercise program and advice did not confer additional benefits in activity limitation or quality of life compared with advice alone for patients with isolated and uncomplicated ankle fracture. These findings do not support the routine use of supervised exercise programs after removal of immobilization for patients with isolated and uncomplicated ankle fracture."

http://jama.jamanetwork.com/article.aspx?articleid=2449186

Friday, October 9, 2015

Thursday, October 8, 2015

CIRC - "How Does Cardiovascular Disease First Present in Women and Men?"

"How Does Cardiovascular Disease First Present in Women and Men?
Incidence of 12 Cardiovascular Diseases in a Contemporary Cohort of 1 937 360 People"

http://circ.ahajournals.org/content/132/14/1320.full

Wednesday, October 7, 2015

BMJ - "Comparative effectiveness and tolerance of treatments for Helicobacter pylori: systematic review and network meta-analysis"

"Comparative effectiveness and tolerance of treatments for Helicobacter pylori: systematic review and network meta-analysis"

"Conclusion Comparison of different eradication treatments for H pylori showed that concomitant treatments, 10 or 14 days of probiotic supplemented triple treatment, 10 or 14 days of levofloxacin based triple treatment, 14 days of hybrid treatment, and 10 or 14 days of sequential treatment might be better alternatives for the eradication of H pylori."


http://www.bmj.com/content/351/bmj.h4052

Tuesday, October 6, 2015

NEJM - schemic Preconditioning for Heart Surgery

"A Multicenter Trial of Remote Ischemic Preconditioning for Heart Surgery"

"CONCLUSIONS
Upper-limb RIPC performed while patients were under propofol-induced anesthesia did not show a relevant benefit among patients undergoing elective cardiac surgery. (Funded by the German Research Foundation; RIPHeart ClinicalTrials.gov number,NCT01067703.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1413579?query=featured_home

Monday, October 5, 2015

JAMA - "Effect of Dextromethorphan-Quinidine on Agitation in Patients With Alzheimer Disease Dementia"

"Effect of Dextromethorphan-Quinidine on Agitation in Patients With Alzheimer Disease Dementia"

"Conclusions and Relevance  In this preliminary 10-week phase 2 randomized clinical trial of patients with probable Alzheimer disease, combination dextromethorphan-quinidine demonstrated clinically relevant efficacy for agitation and was generally well tolerated."

http://jama.jamanetwork.com/article.aspx?articleid=2442936

Thursday, October 1, 2015

CIRC - "Impact of Institutional Volume on Outcomes of Catheter Directed Thrombolysis in the Treatment of Acute Proximal Deep Vein Thrombosis A 6-Year US Experience (2005–2010)"

"Impact of Institutional Volume on Outcomes of Catheter Directed Thrombolysis in the Treatment of Acute Proximal Deep Vein Thrombosis A 6-Year US Experience (2005–2010)"

"Conclusions—In this observational study, we found that an increase in institutional volume of CDT was associated with lower in-hospital mortality and lower intracranial hemorrhage rates. Further studies are needed to assess whether standardization of CDT protocols across all institutions in the United States improves outcomes."  

http://circ.ahajournals.org/content/132/12/1127.abstract