"Vaccine for Prevention of Mild and Moderate-to-Severe Influenza in Children"
NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa1215817?query=featured_home 
"CONCLUSIONS

The QIV was efficacious in preventing influenza in children. (Funded by GlaxoSmithKline Biologicals; ClinicalTrials.gov number,NCT01218308.)"

"Prolonged Exposure vs Supportive Counseling for Sexual Abuse–Related PTSD in Adolescent Girls"
JAMA
http://jama.jamanetwork.com/article.aspx?articleid=1793800 
"Conclusion and Relevance  Adolescents girls with sexual abuse–related PTSD experienced greater benefit from prolonged exposure therapy than from supportive counseling even when delivered by counselors who typically provide supportive counseling."

Weekly Guideline

"Treatment of Anemia in Patients With Heart Disease: A Clinical Practice Guideline From the American College of Physicians"
Annals
http://annals.org/article.aspx?articleid=1784292
"Recommendation 1: ACP recommends using a restrictive red blood cell transfusion strategy (trigger hemoglobin threshold of 7 to 8 g/dL compared with higher hemoglobin levels) in hospitalized patients with coronary heart disease. (Grade: weak recommendation; low-quality evidence)

Recommendation 2: ACP recommends against the use of erythropoiesis-stimulating agents in patients with mild to moderate anemia and congestive heart failure or coronary heart disease. (Grade: strong recommendation; moderate-quality evidence)"

"Renoprotective Effect of Renin-Angiotensin-Aldosterone System Blockade in Patients With Predialysis Advanced Chronic Kidney Disease, Hypertension, and Anemia"

"Renoprotective Effect of Renin-Angiotensin-Aldosterone System Blockade in Patients With Predialysis Advanced Chronic Kidney Disease, Hypertension, and Anemia"
JAMA IM
http://archinte.jamanetwork.com/article.aspx?articleid=1787693
"Conclusions and Relevance  Patients with stable hypertension and advanced CKD who receive therapy with ACEIs/ARBs exhibit an association with lower risk for long-term dialysis or death by 6%. This benefit does not increase the risk of all-cause mortality."

"Discordance of LDL Cholesterol with Alternative LDL-Related Measures and Future Coronary Events"
Circ
http://circ.ahajournals.org/content/early/2013/12/17/CIRCULATIONAHA.113.005873.abstract
"Conclusions—For women with discordant LDL-related measures, coronary risk may be under or overestimated when relying on LDL-C alone."

"Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis"
BMJ
http://www.bmj.com/content/347/bmj.f6879 
"Conclusions Greater dietary fibre intake is associated with a lower risk of both cardiovascular disease and coronary heart disease. Findings are aligned with general recommendations to increase fibre intake. The differing strengths of association by fibre type or source highlight the need for a better understanding of the mode of action of fibre components."

"Use of Selective Serotonin Reuptake Inhibitors during Pregnancy and Risk of Autism"  
NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa1301449
"CONCLUSIONS

We did not detect a significant association between maternal use of SSRIs during pregnancy and autism spectrum disorder in the offspring. On the basis of the upper boundary of the confidence interval, our study could not rule out a relative risk up to 1.61, and therefore the association warrants further study."

"Low-Dose Dopamine or Low-Dose Nesiritide in Acute Heart Failure With Renal Dysfunction"  
JAMA
http://jama.jamanetwork.com/article.aspx?articleid=1779722
"Conclusion and Relevance  In participants with acute heart failure and renal dysfunction, neither low-dose dopamine nor low-dose nesiritide enhanced decongestion or improved renal function when added to diuretic therapy."

Weekly Guideline Update: HTN

"2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)"
JAMA
http://jama.jamanetwork.com/article.aspx?articleid=1791497

"Oral High-Dose Multivitamins and Minerals After Myocardial Infarction: A Randomized Trial"
Annals
http://annals.org/article.aspx?articleid=1789248
"Conclusion: High-dose oral multivitamins and multiminerals did not statistically significantly reduce cardiovascular events in patients after MI who received standard medications. However, this conclusion is tempered by the nonadherence rate."  

"Treatment of Acute Venous Thromboembolism with Dabigatran or Warfarin and Pooled Analysis"   
Circ
http://circ.ahajournals.org/content/early/2013/12/10/CIRCULATIONAHA.113.004450.abstract 
"Conclusions—Dabigatran has similar effect on VTE recurrence and a lower risk of bleeding compared to warfarin for the treatment of acute VTE."

"Vitamin D status and ill health: a systematic review"
Lancet
http://www.thelancet.com/journals/landia/article/PIIS2213-8587(13)70165-7/fulltext?_eventId=login 
"Conclusions

Many prospective studies have shown associations between low 25(OH)D concentrations and a wide range of acute and chronic health disorders. However, an equally similar number of randomised trials have not confirmed that raising of 25(OH)D concentrations can modify the occurrence or clinical course of these disorders. Hence, associations between 25(OH)D and health disorders reported by investigators of observational studies are not causal. Low 25(OH)D could be the result of inflammatory processes involved in the occurrence and progression of disease. An exception would be slight gains in survival after the restoration of vitamin D deficits due to lifestyle changes induced by ageing and ill health. Five trials including 2150—20 000 patients aged 50 years or older are in progress, testing whether vitamin D supplementation at 40—80 μg per day can reduce the risk of cancer, cardiovascular diseases, diabetes, infections, declining cognitive functions, and fractures.63 The first results are not expected before 2017, but these studies have the potential to test our hypotheses."

"Bivalirudin Started during Emergency Transport for Primary PCI"
NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa1311096 
"CONCLUSIONS

Bivalirudin, started during transport for primary PCI, improved 30-day clinical outcomes with a reduction in major bleeding but with an increase in acute stent thrombosis."

"Effect of CPAP on Blood Pressure in Patients With Obstructive Sleep Apnea and Resistant Hypertension The HIPARCO Randomized Clinical Trial'
JAMA
http://jama.jamanetwork.com/article.aspx?articleid=1788459 
"Conclusions and Relevance  Among patients with OSA and resistant hypertension, CPAP treatment for 12 weeks compared with control resulted in a decrease in 24-hour mean and diastolic blood pressure and an improvement in the nocturnal blood pressure pattern. Further research is warranted to assess longer-term health outcomes."

Weekly Guideline

"Lipid Management in Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2013 Clinical Practice Guideline"   
http://annals.org/article.aspx?articleid=1788220

"Overdiagnosis in Low-Dose Computed Tomography Screening for Lung Cancer"
JAMA IM
http://archinte.jamanetwork.com/article.aspx?articleid=1785197 
"Conclusions and Relevance  More than 18% of all lung cancers detected by LDCT in the NLST seem to be indolent, and overdiagnosis should be considered when describing the risks of LDCT screening for lung cancer."

"Patient and Hospital Characteristics Associated With Inappropriate Percutaneous Coronary Interventions"
http://content.onlinejacc.org/article.aspx?articleid=1738849   
JACC
"Conclusions  For nonacute indications, PCIs categorized as inappropriate were more commonly performed in men, whites, and those who had private insurance. Higher rates of PCI in these patient populations may, in part, be due to procedural overuse."

"Role of diuretics, β blockers, and statins in increasing the risk of diabetes in patients with impaired glucose tolerance: reanalysis of data from the NAVIGATOR study"  
BMJ  
http://www.bmj.com/content/347/bmj.f6745   
"Conclusions Among people with impaired glucose tolerance and other cardiovascular risk factors and with serial glucose measurements, diuretics and statins were associated with an increased risk of new onset diabetes, whereas the effect of β blockers was non-significant."  

"Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest"
NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa1310519 
"CONCLUSIONS

In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33°C did not confer a benefit as compared with a targeted temperature of 36°C."

"Rates of Medical Errors and Preventable Adverse Events Among Hospitalized Children Following Implementation of a Resident Handoff Bundle"
JAMA
http://jama.jamanetwork.com/article.aspx?articleid=1787406 
"Conclusions and Relevance  Implementation of a handoff bundle was associated with a significant reduction in medical errors and preventable adverse events among hospitalized children. Improvements in verbal and written handoff processes occurred, and resident workflow did not change adversely."

Weekly Guideline

"International Expert Consensus Statement
Percutaneous Transluminal Renal Denervation for the Treatment of Resistant Hypertension"
JACC
http://content.onlinejacc.org/article.aspx?articleid=1738851

"Are Metabolically Healthy Overweight and Obesity Benign Conditions?: A Systematic Review and Meta-analysis"
Annals
http://annals.org/article.aspx?articleid=1784291
"Conclusion: Compared with metabolically healthy normal-weight individuals, obese persons are at increased risk for adverse long-term outcomes even in the absence of metabolic abnormalities, suggesting that there is no healthy pattern of increased weight."

"Syncope Without Prodromes in Patients With Normal Heart and Normal Electrocardiogram"
JACC
http://content.onlinejacc.org/article.aspx?articleid=1709459   
"Conclusions  Common clinical features and a low adenosine plasmatic level define a distinct form of syncope, distinguish it from VVS, and suggest a causal role of the adenosine pathway."

"Association between cardiovascular events and sodium-containing effervescent, dispersible, and soluble drugs: nested case-control study"
BMJ
http://www.bmj.com/content/347/bmj.f6954
"Conclusions Exposure to sodium-containing formulations of effervescent, dispersible, and soluble medicines was associated with significantly increased odds of adverse cardiovascular events compared with standard formulations of those same drugs. Sodium-containing formulations should be prescribed with caution only if the perceived benefits outweigh these risks."

"Edoxaban versus Warfarin in Patients with Atrial Fibrillation"
NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa1310907
"CONCLUSIONS

Both once-daily regimens of edoxaban were noninferior to warfarin with respect to the prevention of stroke or systemic embolism and were associated with significantly lower rates of bleeding and death from cardiovascular causes. (Funded by Daiichi Sankyo Pharma Development; ENGAGE AF-TIMI 48 ClinicalTrials.gov number,NCT00781391.)"

"Induced Hypothermia in Severe Bacterial Meningitis"  JAMA
http://jama.jamanetwork.com/article.aspx?articleid=1748835 
"Conclusions and Relevance  Moderate hypothermia did not improve outcome in patients with severe bacterial meningitis and may even be harmful. Careful evaluation of safety issues in future trials on hypothermia are needed and may have important implications in patients presenting with septic shock or stroke."

Weekly Guideline

"2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines"
Circ
http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437740.48606.d1.full.pdf+html

"Association Between Exposure to Low to Moderate Arsenic Levels and Incident Cardiovascular Disease"
Annals IM
http://annals.org/article.aspx?articleid=1770701 
"Conclusion: Long-term exposure to low to moderate arsenic levels was associated with cardiovascular disease incidence and mortality."  

"Benefits of Statins in Elderly Subjects Without Established Cardiovascular Disease
A Meta-Analysis"
JACC
http://content.onlinejacc.org/article.aspx?articleid=1732396 
"Conclusions  In elderly subjects at high CV risk without established CV disease, statins significantly reduce the incidence of MI and stroke, but do not significantly prolong survival in the short-term."

"Effect of β blockers on mortality after myocardial infarction in adults with COPD: population based cohort study of UK electronic healthcare records"
BMJ
http://www.bmj.com/content/347/bmj.f6650 
"Conclusions The use of β blockers started either at the time of hospital admission for myocardial infarction or before a myocardial infarction is associated with improved survival after myocardial infarction in patients with COPD."

"Association of Nut Consumption with Total and Cause-Specific Mortality"  
NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa1307352 

"Effect of Weight Reduction and Cardiometabolic Risk Factor Management on Symptom Burden and Severity in Patients With Atrial Fibrillation" 
JAMA
http://jama.jamanetwork.com/article.aspx?articleid=1779533
"Conclusions and Relevance  In this study, weight reduction with intensive risk factor management resulted in a reduction in atrial fibrillation symptom burden and severity and in beneficial cardiac remodeling. These findings support therapy directed at weight and risk factors in the management of atrial fibrillation."

Weekly Guidelines

"2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines"
Circ
http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437741.48606.98.full.pdf+html

"Myocardial Infarction and Ischemic Heart Disease in Overweight and Obesity With and Without Metabolic Syndrome" 
JAMA IM
http://archinte.jamanetwork.com/article.aspx?articleid=1770522 
"Conclusions and Relevance  These findings suggest that overweight and obesity are risk factors for MI and IHD regardless of the presence or absence of metabolic syndrome and that metabolic syndrome is no more valuable than BMI in identifying individuals at risk."

"Automated External Defibrillators Inaccessible to More Than Half of Nearby Cardiac Arrests in Public Locations During Evening, Nighttime, and Weekends"
Circ
http://circ.ahajournals.org/content/128/20/2224.abstract
"Conclusions—Limited AED accessibility at the time of cardiac arrest decreased AED coverage by 53.4% during the evening, nighttime, and weekends, which is when 61.8% of all cardiac arrests in public locations occurred. Thus, not only strategic placement but also uninterrupted AED accessibility warrant attention if public-access defibrillation is to improve survival after out-of-hospital cardiac arrest."

"Brown adipose tissue volume in healthy lean south Asian adults compared with white Caucasians: a prospective, case-controlled observational study"
Lancet
http://www.thelancet.com/journals/landia/article/PIIS2213-8587(13)70156-6/fulltext
"Interpretation  

Lower resting energy expenditure, non-shivering thermogenesis, and BAT volumes in south Asian populations might underlie their high susceptibility to metabolic disturbances, such as obesity and type 2 diabetes. Development of strategies to increase BAT volume and activity might help prevent and treat such disorders, particularly in south Asian individuals."

"Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest"  
NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa1310519?query=featured_home   
"CONCLUSIONS  

In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33°C did not confer a benefit as compared with a targeted temperature of 36°C."

"Outcomes Following Transcatheter Aortic Valve Replacement in the United States"
JAMA
http://jama.jamanetwork.com/article.aspx?articleid=1779535 
"Conclusions and Relevance  Among patients undergoing TAVR at US centers in the STS/ACC TVT Registry, device implantation success was achieved in 92% of cases, the overall in-hospital mortality rate was 5.5%, and the stroke rate was 2.0%. Although these postmarket US approval findings are comparable with prior published trial data and international experience, long-term follow-up is essential to assess continued efficacy and safety."

Weekly Guidelines - Obesity, Lipids, Back Pain

"Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society" 
Annals IM
http://annals.org/article.aspx?articleid=736814

"2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines"
Circ
http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a.full.pdf+html

"2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society"
Circ
http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437739.71477.ee.full.pdf+html

"Gabapentin Treatment for Alcohol Dependence"
JAMA IM Nov 4
http://archinte.jamanetwork.com/article.aspx?articleid=1764009 
"Conclusions and Relevance  Gabapentin (particularly the 1800-mg dosage) was effective in treating alcohol dependence and relapse-related symptoms of insomnia, dysphoria, and craving, with a favorable safety profile. Increased implementation of pharmacological treatment of alcohol dependence in primary care may be a major benefit of gabapentin as a treatment option for alcohol dependence."

"2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines" 
Circ
http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a.full.pdf+html

"Perinatal outcomes after bariatric surgery: nationwide population based matched cohort study"  
BMJ
http://www.bmj.com/content/347/bmj.f6460 
"Conclusion Women with a history of bariatric surgery were at increased risk of preterm and small for gestational age births and should be regarded as a risk group during pregnancy."

"Combined Angiotensin Inhibition for the Treatment of Diabetic Nephropathy"  "The study was stopped because of increased risks of hyperkalemia and acute kidney injury with combination therapy."
NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa1303154?query=featured_home 
"CONCLUSIONS

Combination therapy with an ACE inhibitor and an ARB was associated with an increased risk of adverse events among patients with diabetic nephropathy."

"Association of Testosterone Therapy With Mortality, Myocardial Infarction, and Stroke in Men With Low Testosterone Levels"
JAMA Nov 5
http://jama.jamanetwork.com/article.aspx?articleid=1764051
"Conclusions and Relevance  Among a cohort of men in the VA health care system who underwent coronary angiography and had a low serum testosterone level, the use of testosterone therapy was associated with increased risk of adverse outcomes. These findings may inform the discussion about the potential risks of testosterone therapy."

Weekly Guideline

"AHA Scientific Statement
Beyond Medications and Diet: Alternative Approaches to Lowering Blood Pressure"     Hypertension
http://hyper.ahajournals.org/content/early/2013/04/22/HYP.0b013e318293645f

"Better Diet Quality and Decreased Mortality Among Myocardial Infarction Survivors"
JAMA IM
http://archinte.jamanetwork.com/article.aspx?articleid=1733453
"Conclusions and Relevance  Myocardial infarction survivors who consume a higher-quality diet, which has been associated with a lower risk of coronary heart disease in primary prevention, have lower subsequent all-cause mortality."

"Low Levels of High-Density Lipoprotein Cholesterol and Increased Risk of Cardiovascular Events in Stable Ischemic Heart Disease Patients"  
JACC
http://content.onlinejacc.org/article.aspx?articleid=1731137
"Conclusions  In this post-hoc analysis, patients with SIHD continued to experience incremental cardiovascular risk associated with low HDL-C levels despite OMT during long-term follow-up. This relationship persisted and appeared more prominent even when LDL-C was reduced to optimal levels with intensive dyslipidemic therapy."

"Sofosbuvir and ledipasvir fixed-dose combination with and without ribavirin in treatment-naive and previously treated patients with genotype 1 hepatitis C virus infection (LONESTAR):
an open-label, randomised, phase 2 trial"
Lancet
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62121-2/fulltext
"Interpretation

These findings suggest that the fixed-dose combination of sofosbuvir-ledipasvir alone or with ribavirin has the potential to cure most patients with genotype-1 HCV, irrespective of treatment history or the presence of compensated cirrhosis. Further clinical trials are needed to establish the best treatment duration and to further assess the contribution of ribavirin."

"Autologous Transplantation as Consolidation for Aggressive Non-Hodgkin's Lymphoma"
NEJM
"CONCLUSIONS

Early autologous stem-cell transplantation improved progression-free survival among patients with high-intermediate-risk or high-risk disease who had a response to induction therapy. Overall survival after transplantation was not improved, probably because of the effectiveness of salvage transplantation."
http://www.nejm.org/doi/full/10.1056/NEJMoa1301077

"Effect of Statin Therapy on Mortality in Patients With Ventilator-Associated Pneumonia"
JAMA Oct 23/30
http://jama.jamanetwork.com/article.aspx?articleid=1752244 
"Conclusions and Relevance  In adults with suspected VAP, adjunctive simvastatin therapy compared with placebo did not improve day-28 survival. These findings do not support the use of statins with the goal of improving VAP outcomes."

Weekly Guideline

"Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease"
Annals Oct 2013
http://annals.org/article.aspx?articleid=1757302

"A 2-Hour Diagnostic Protocol for Possible Cardiac Chest Pain in the Emergency Department"
JAMA IM Nov 1
http://archinte.jamanetwork.com/article.aspx?articleid=1748796 
"Conclusions and Relevance  Using the accelerated diagnostic protocol in the experimental pathway almost doubled the proportion of patients with chest pain discharged early. Clinicians could discharge approximately 1 of 5 patients with chest pain to outpatient follow-up monitoring in less than 6 hours. This diagnostic strategy could be easily replicated in other centers because no extra resources are required."

"Pre-Pregnancy Obesity and Associations with Stroke and Myocardial Infarction in Women in the Years after Childbirth: A Nationwide Cohort Study"

"Pre-Pregnancy Obesity and Associations with Stroke and Myocardial Infarction in Women in the Years after Childbirth: A Nationwide Cohort Study"
Circ
http://circ.ahajournals.org/content/early/2013/10/20/CIRCULATIONAHA.113.003142.abstract
"Conclusions—In apparently healthy women of fertile age, obesity was associated with increased risks of ischemic stroke and myocardial infarction."

"Acarbose compared with metformin as initial therapy in patients with newly diagnosed type 2 diabetes: an open-label, non-inferiority randomised trial"  
Lancet
http://www.thelancet.com/journals/landia/article/PIIS2213-8587(13)70021-4/fulltext 
"Interpretation

This study provides evidence that acarbose is similar to metformin in efficacy, and is therefore a viable choice for initial therapy in Chinese patients newly diagnosed with type 2 diabetes."

"Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction"
NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa1308789
"CONCLUSIONS

Routine thrombus aspiration before PCI as compared with PCI alone did not reduce 30-day mortality among patients with STEMI."

"Effect of Heart Rate Control With Esmolol on Hemodynamic and Clinical Outcomes in Patients With Septic Shock"
JAMA Oct 2013
http://jama.jamanetwork.com/article.aspx?articleid=1752246 
"Conclusions and Relevance  For patients in septic shock, open-label use of esmolol vs standard care was associated with reductions in heart rates to achieve target levels, without increased adverse events. The observed improvement in mortality and other secondary clinical outcomes warrants further investigation."

Weekly Guideline

"CLINICAL PRACTICE GUIDELINES FOR HEALTHY EATING FOR  THE PREVENTION AND TREATMENT OF METABOLIC AND ENDOCRINE DISEASES IN ADULTS"Endocrine Practice Sep/Oct 2013
http://www.medpagetoday.com/upload/2013/10/17/clinical-practice-guidelines.pdf

"Screening for Cognitive Impairment in Older Adults: A Systematic Review for the U.S. Preventive Services Task Force"
Annals Oct 2013
http://annals.org/article.aspx?articleid=1760977
"Conclusion: Brief instruments to screen for cognitive impairment can adequately detect dementia, but there is no empirical evidence that screening improves decision making. Whether interventions for patients or their caregivers have a clinically significant effect in persons with earlier detected cognitive impairment is still unclear."

"Survival After Shock Therapy in Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy-Defibrillator Recipients According to Rhythm Shocked"
JACC
http://content.onlinejacc.org/article.aspx?articleid=1709453
"Conclusions  Compared with no shock, those who received their first shock for ventricular rhythms and atrial fibrillation had an increased risk of death. There was no significant difference in survival after inappropriate shocks for sinus tachycardia or noise/artifact/oversensing. In this study, the adverse prognosis after first shock appears to be more related to the underlying arrhythmia than to an adverse effect from the shock itself."

"Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis"
BMJ Oct 27
http://www.bmj.com/content/347/bmj.f5980
"Conclusion One additional infant could survive to 36 weeks without bronchopulmonary dysplasia for every 25 babies treated with nasal CPAP in the delivery room rather than being intubated."

"Increased Survival in Pancreatic Cancer with nab-Paclitaxel plus Gemcitabine"
NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa1304369?query=featured_home
"CONCLUSIONS

In patients with metastatic pancreatic adenocarcinoma, nab-paclitaxel plus gemcitabine significantly improved overall survival, progression-free survival, and response rate, but rates of peripheral neuropathy and myelosuppression were increased. (Funded by Celgene; ClinicalTrials.gov number, NCT00844649.)"

"Metoclopramide in Pregnancy and Risk of Major Congenital Malformations and Fetal Death" 
JAMA Oct 16 2013
http://jama.jamanetwork.com/article.aspx?articleid=1752754
"Conclusions and Relevance  Metoclopramide use in pregnancy was not associated with increased risk of major congenital malformations overall, any of the 20 individual malformation categories assessed, spontaneous abortion, or stillbirth. These safety data may help inform decision making when treatment with metoclopramide is considered in pregnancy."

"Lifestyle Interventions for Patients With and at Risk for Type 2 Diabetes: A Systematic Review and Meta-analysis"
Annals Oct 15http://annals.org/article.aspx?articleid=1748845
"Conclusion: Comprehensive lifestyle interventions effectively decrease the incidence of type 2 diabetes in high-risk patients. In patients who already have type 2 diabetes, there is no evidence of reduced all-cause mortality and insufficient evidence to suggest benefit on cardiovascular and microvascular outcomes."

"AHA Scientific Statement
Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches A Scientific Statement From the American Heart Association"
Circ (online Sep 9)
http://circ.ahajournals.org/content/128/15/1689.full
"Severe obesity afflicts between 4% and 6% of all youth in the United States, and the prevalence is increasing. Despite the serious immediate and long-term cardiovascular, metabolic, and other health consequences of severe pediatric obesity, current treatments are limited in effectiveness and lack widespread availability. Lifestyle modification/behavior-based treatment interventions in youth with severe obesity have demonstrated modest improvement in body mass index status, but participants have generally remained severely obese and often regained weight after the conclusion of the treatment programs. The role of medical management is minimal, because only 1 medication is currently approved for the treatment of obesity in adolescents. Bariatric surgery  . . . "

"Ambient air pollution and low birthweight: a European cohort study (ESCAPE)"
Lancet Oct 15
http://www.thelancet.com/journals/lancet/article/PIIS2213-2600(13)70192-9/fulltext
"Interpretation

Exposure to ambient air pollutants and traffic during pregnancy is associated with restricted fetal growth. A substantial proportion of cases of low birthweight at term could be prevented in Europe if urban air pollution was reduced."

"Autoimmune, neurological, and venous thromboembolic adverse events after immunisation of adolescent girls with quadrivalent human papillomavirus vaccine in Denmark and Sweden: cohort study"
BMJ Oct 9
http://www.bmj.com/content/347/bmj.f5906
"Conclusions This large cohort study found no evidence supporting associations between exposure to qHPV vaccine and autoimmune, neurological, and venous thromboembolic adverse events. Although associations for three autoimmune events were initially observed, on further assessment these were weak and not temporally related to vaccine exposure. Furthermore, the findings need to be interpreted considering the multiple outcomes assessed."

"Edoxaban versus Warfarin for the Treatment of Symptomatic Venous Thromboembolism"
NEJM Oct 10
http://www.nejm.org/doi/full/10.1056/NEJMoa1306638?query=featured_home
"CONCLUSIONS 

Edoxaban administered once daily after initial treatment with heparin was noninferior to high-quality standard therapy and caused significantly less bleeding in a broad spectrum of patients with venous thromboembolism, including those with severe pulmonary embolism."

"Evaluation of Surveillance Bias and the Validity of the Venous Thromboembolism Quality Measure"  
JAMA Oct 9  
http://jama.jamanetwork.com/article.aspx?articleid=1748150 
"Conclusions and Relevance  Hospitals with higher quality scores had higher VTE prophylaxis rates but worse risk-adjusted VTE rates. Increased hospital VTE event rates were associated with increasing hospital VTE imaging use rates. Surveillance bias limits the usefulness of the VTE quality measure for hospitals working to improve quality and patients seeking to identify a high-quality hospital."

"Screening for Primary Hypertension in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement"
Annals Oct 2013
http://annals.org/article.aspx?articleid=1747317 
"Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for primary hypertension in asymptomatic children and adolescents to prevent subsequent cardiovascular disease in childhood or adulthood."

"Optimal Duration of Dual Antiplatelet Therapy after Drug-Eluting Stent Implantation: A Randomized Controlled Trial"  
Circ Oct 4
http://circ.ahajournals.org/content/early/2013/10/04/CIRCULATIONAHA.113.003303.abstract
"Conclusions—Among patients who were on 12-month dual antiplatelet therapy without complications, an additional 24 months of dual antiplatelet therapy versus aspirin alone did not reduce the risk of the composite end point of death from cardiac causes, myocardial infarction or stroke."

"Prevalence of extracranial venous narrowing on catheter venography in people with multiple sclerosis, their siblings, and unrelated healthy controls: a blinded, case-control study"
Lancet Oct 9 
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61747-X/fulltext
"Interpretation

This study shows that chronic cerebrospinal venous insufficiency occurs rarely in both patients with multiple sclerosis and in healthy people. Extracranial venous narrowing of greater than 50% is a frequent finding in patients with multiple sclerosis, unaffected siblings, and unrelated controls. The ultrasound criteria are neither sensitive nor specific for narrowing on catheter venography. The significance of venous narrowing to multiple sclerosis symptomatology remains unknown."

"Association between body mass index and cardiovascular disease mortality in east Asians and south Asians: pooled analysis of prospective data from the Asia Cohort Consortium"
BMJ Oct 2013
http://www.bmj.com/content/347/bmj.f5446
"Conclusions Body mass index shows a U shaped association with death from overall cardiovascular disease among east Asians: increased risk of death from cardiovascular disease is observed at lower and higher ranges of body mass index. A high body mass index is a risk factor for mortality from overall cardiovascular disease and for specific diseases, including coronary heart disease, ischaemic stroke, and haemorrhagic stroke in east Asians. Higher body mass index is a weak risk factor for mortality from cardiovascular disease in south Asians."

"A Randomized Trial of Planned Cesarean or Vaginal Delivery for Twin Pregnancy"
NEJM Oct 9
http://www.nejm.org/doi/full/10.1056/NEJMoa1214939?query=featured_home 
"CONCLUSIONS

In twin pregnancy between 32 weeks 0 days and 38 weeks 6 days of gestation, with the first twin in the cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery."

"Association of National Initiatives to Improve Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest" 
JAMA Oct 2
http://jama.jamanetwork.com/article.aspx?articleid=1745678 
"Conclusions and Relevance  In Denmark between 2001 and 2010, an increase in survival following out-of-hospital cardiac arrest was significantly associated with a concomitant increase in bystander CPR. Because of the co-occurrence of other related initiatives, a causal relationship remains uncertain."

"Management of Obstructive Sleep Apnea in Adults: A Clinical Practice Guideline From the American College of Physicians"  
Annals Oct 1
http://annals.org/article.aspx?articleid=1742606
"Recommendation 1: ACP recommends that all overweight and obese patients diagnosed with OSA should be encouraged to lose weight. (Grade: strong recommendation; low-quality evidence)

Recommendation 2: ACP recommends continuous positive airway pressure treatment as initial therapy for patients diagnosed with OSA. (Grade: strong recommendation; moderate-quality evidence)

Recommendation 3: ACP recommends mandibular advancement devices as an alternative therapy to continuous positive airway pressure treatment for patients diagnosed with OSA who prefer mandibular advancement devices or for those with adverse effects associated with continuous positive airway pressure treatment. (Grade: weak recommendation; low-quality evidence)"

"State-Of-The-Art Paper

Childhood Obesity and Cardiovascular Dysfunction"

JACC Oct 2013
http://content.onlinejacc.org/article.aspx?articleid=1729180
"Obesity-related cardiovascular disease in children is becoming more prevalent in conjunction with the rise in childhood obesity. Children with obesity are predisposed to an increased risk of cardiovascular morbidity and mortality in adulthood. Importantly, research in children with obesity over the last decade has demonstrated that children may exhibit early signs of cardiovascular dysfunction as a result of their excess adiposity, often independent of other obesity-related comorbidities such as dyslipidemia and insulin resistance. The clinical evidence is accumulating to suggest that the cardiovascular damage, once observed only in adults, is also occurring in obese children. The objective of this review is to provide a synopsis of the current research on cardiovascular abnormalities in children with obesity and highlight the importance and need for early detection and prevention programs to mitigate this potentially serious health problem." 

"AHA Scientific Statement
Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions: A Scientific Statement From the American Heart Association"
Circ Sep 30
http://circ.ahajournals.org/content/early/2013/09/30/CIR.0b013e3182a88099.full.pdf+html 

"Preclinical Alzheimer's disease and its outcome: a longitudinal cohort study" 
Lancet Neurology Oct 2013 (online Sep 2013)
http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(13)70194-7/fulltext
"Findings

Of 311 participants, 129 (41%) were classed as normal, 47 (15%) as stage 1, 36 (12%) as stage 2, 13 (4%) as stage 3, 72 (23%) as SNAP, and 14 (5%) remained unclassified. The 5-year progression rate to CDR at least 0·5, symptomatic Alzheimer's disease was 2% for participants classed as normal, 11% for stage 1, 26% for stage 2, 56% for stage 3, and 5% for SNAP. Compared with individuals classed as normal, participants with preclinical Alzheimer's disease had an increased risk of death after adjusting for covariates (hazard ratio 6·2, 95% CI 1·1—35·0; p=0·040).

Interpretation

Preclinical Alzheimer's disease is common in cognitively normal elderly people and is associated with future cognitive decline and mortality. Thus, preclinical Alzheimer's disease could be an important target for therapeutic intervention."

"Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis"
BMJ Sep 20
http://www.bmj.com/content/347/bmj.f5555
"Conclusions As of 2002 sufficient evidence had accumulated to show significant benefit of exercise over no exercise in patients with osteoarthritis, and further trials are unlikely to overturn this result. An approach combining exercises to increase strength, flexibility, and aerobic capacity is likely to be most effective in the management of lower limb osteoarthritis. The evidence is largely from trials in patients with knee osteoarthritis."

"CMX001 to Prevent Cytomegalovirus Disease in Hematopoietic-Cell Transplantation"
NEJM Sep 26
http://www.nejm.org/doi/full/10.1056/NEJMoa1303688
"CONCLUSIONS

Treatment with oral CMX001 at a dose of 100 mg twice weekly significantly reduced the incidence of CMV events in recipients of hematopoietic-cell transplants. Diarrhea was dose-limiting in this population at a dose of 200 mg twice weekly. (Funded by Chimerix; CMX001-201 ClinicalTrials.gov number, NCT00942305.)"

"Repeat Bone Mineral Density Screening and Prediction of Hip and Major Osteoporotic Fracture" 
JAMA Sep 25
http://jama.jamanetwork.com/article.aspx?articleid=1741821 
"Conclusions and Relevance  In untreated men and women of mean age 75 years, a second BMD measure after 4 years did not meaningfully improve the prediction of hip or major osteoporotic fracture. Repeating a BMD measure within 4 years to improve fracture risk stratification may not be necessary in adults this age untreated for osteoporosis. . . . "

"Association Between Exposure to Low to Moderate Arsenic Levels and Incident Cardiovascular Disease"
Annals Sep 24
http://annals.org/article.aspx?articleid=1740759
"Conclusion: Long-term exposure to low to moderate arsenic levels was associated with cardiovascular disease incidence and mortality."

"Impact of Periprocedural Bleeding on Incidence of Contrast-Induced Acute Kidney Injury in Patients Treated With Percutaneous Coronary Intervention"
JACC Oct 2013
http://content.onlinejacc.org/article.aspx?articleid=1699333
"Conclusions  Periprocedural bleeding was significantly associated with CI-AKI, with CI-AKI incidence correlating with bleeding severity."

"Fractional Flow Reserve–Guided Versus Angiography-Guided Coronary Artery Bypass Graft Surgery"
Circ Aug 28
http://circ.ahajournals.org/content/128/13/1405.abstract
"Conclusions—FFR-guided coronary artery bypass graft surgery was associated with a lower number of graft anastomoses and a lower rate of on-pump surgery compared with angiography-guided coronary artery bypass graft surgery. This did not result in a higher event rate during up to 36 months of follow-up and was associated with a lower rate of angina."

"Global implementation of WHO's multimodal strategy for improvement of hand hygiene: a quasi-experimental study"
Lancet Aug 23
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(13)70163-4/fulltext 
"Interpretation

Implementation of WHO's hand-hygiene strategy is feasible and sustainable across a range of settings in different countries and leads to significant compliance and knowledge improvement in health-care workers, supporting recommendation for use worldwide."

"Type of stress ulcer prophylaxis and risk of nosocomial pneumonia in cardiac surgical patients: cohort study"
BMJ Sep 19
http://www.bmj.com/content/347/bmj.f5416 
"Conclusions Patients treated with proton pump inhibitors for stress ulcer had a small increase in the risk of postoperative pneumonia compared with patients treated with H2receptor antagonists; this risk remained after confounding was accounted for using multiple analytic approaches."

"Long-Term Colorectal-Cancer Incidence and Mortality after Lower Endoscopy" 
NEJM Sept 19
http://www.nejm.org/doi/full/10.1056/NEJMoa1301969
"CONCLUSIONS

Colonoscopy and sigmoidoscopy were associated with a reduced incidence of cancer of the distal colorectum; colonoscopy was also associated with a modest reduction in the incidence of proximal colon cancer. Screening colonoscopy and sigmoidoscopy were associated with reduced colorectal-cancer mortality; only colonoscopy was associated with reduced mortality from proximal colon cancer. Colorectal cancer diagnosed within 5 years after colonoscopy was more likely than cancer diagnosed after that period or without prior endoscopy to have CIMP and microsatellite instability. (Funded by the National Institutes of Health and others.)"

"Chronic Care Management for Dependence on Alcohol and Other Drugs"
JAMA Sep 18
http://jama.jamanetwork.com/article.aspx?articleid=1738895
"Conclusions and Relevance  Among persons with alcohol and other drug dependence, CCM compared with a primary care appointment but no CCM did not increase self-reported abstinence over 12 months. Whether more intensive or longer-duration CCM is effective requires further investigation."

"Cost-Effectiveness of Tolvaptan in Autosomal Dominant Polycystic Kidney Disease" 
Annals Sept 17
http://annals.org/article.aspx?articleid=1738493
"Conclusion: Assuming that the benefits of tolvaptan persist in the longer term, the drug may slow progression to ESRD and reduce mortality rates. However, barring an approximately 95% reduction in price, cost-effectiveness does not compare favorably with many other commonly accepted medical interventions."

"Effects of Nesiritide and Predictors of Urine Output in Acute Decompensated Heart Failure"
JACC Sep 2013
http://content.onlinejacc.org/article.aspx?articleid=1697391
"Conclusions  Nesiritide did not increase urine output in patients with ADHF. Higher diuretic dose was a strong predictor of higher urine output, but neurohormonal activation (as evidenced by blood urea nitrogen concentration) and lower blood pressure limited diuresis."

"Risk of Lower and Upper Gastrointestinal Bleeding, Transfusions, and Hospitalizations with Complex Antithrombotic Therapy in Elderly Patients"
Circ Sep 11
http://circ.ahajournals.org/content/early/2013/09/11/CIRCULATIONAHA.113.004747.abstract
"Conclusions—Among the elderly, CAT-related LGIE and UGIE is a clinically relevant risk resulting in increased hospitalizations and transfusions."

"Preoperative prediction of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a retrospective cohort study"
Lancet Sep 13
http://www.thelancet.com/journals/landia/article/PIIS2213-8587(13)70070-6/fulltext 
"Interpretation

The DiaRem score is a novel preoperative method to predict the probability of remission of type 2 diabetes after RYGB surgery."

"Efficacy and safety outcomes of oral anticoagulants and antiplatelet drugs in the secondary prevention of venous thromboembolism: systematic review and network meta-analysis"
BMJ Aug 30
http://www.bmj.com/content/347/bmj.f5133
"Conclusions All oral anticoagulants and antiplatelet agents investigated in this analysis were associated with a reduced recurrence of venous thromboembolism compared with placebo or observation, although acetylsalicylic acid was associated with the lowest risk reduction. Vitamin K antagonists given at a standard adjusted dose was associated with the greatest risk reduction in recurrent venous thromboembolism, but also the greatest risk of major bleeding."

"Panitumumab–FOLFOX4 Treatment and RAS Mutations in Colorectal Cancer" 
NEJM Sep 12
http://www.nejm.org/doi/full/10.1056/NEJMoa1305275?query=featured_home
"CONCLUSIONS

Additional RAS mutations predicted a lack of response in patients who received panitumumab–FOLFOX4. In patients who had metastatic colorectal cancer without RAS mutations, improvements in overall survival were observed with panitumumab–FOLFOX4 therapy. (Funded by Amgen and others; PRIME ClinicalTrials.gov number,NCT00364013.)"

"Prednisolone With vs Without Pentoxifylline and Survival of Patients With Severe Alcoholic Hepatitis"
JAMA Sep 11
http://jama.jamanetwork.com/article.aspx?articleid=1737041
"Conclusion and Relevance  In patients with alcoholic hepatitis, 4-week treatment with pentoxifylline and prednisolone, compared with prednisolone alone, did not result in improved 6-month survival. The study may have been underpowered to detect a significant difference in incidence of hepatorenal syndrome, which was less frequent in the group receiving pentoxifylline."

"Methylprednisolone Injections for the Carpal Tunnel Syndrome"
Annals Sep 3
http://annals.org/article.aspx?articleid=1733275
"Conclusion: Methylprednisolone injections for CTS have significant benefits in relieving symptoms at 10 weeks and reducing the rate of surgery 1 year after treatment, but 3 out of 4 patients had surgery within 1 year."