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Specialty: Internal Medicine
Source: Evidence-Based Medicine
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Total 156 results found since Jan 2013.
Elucidating the use of enoxaparin in non-ST-elevation acute coronary syndromes (NSTE-ACS)
The guidelines The new joint guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC) for non-ST-elevation acute coronary syndromes (NSTE-ACS) represent the culmination of a massive undertaking to synthesise a large body of evidence, and the guideline writing committee is to be applauded for their efforts in preparing these guidelines.1 2 As is the current standard, the online version of these guidelines was published ahead of print, and review of the electronic publication ahead of print revealed that the handling of enoxaparin was problematic.1 The problem concerned the discussion...
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Mayer, M. Tags: Clinical trials (epidemiology), Editor's choice, Drugs: cardiovascular system, Stroke, Ischaemic heart disease Perspective Source Type: research
Longer dual antiplatelet therapy (DAPT) after percutaneous coronary intervention has higher anti-ischaemic efficacy than shorter DAPT but is associated with more frequent bleeding
Commentary on: Spencer FA, Prasad M, Vandvik PO, et al.. Longer- versus shorter-duration dual-antiplatelet therapy after drug-eluting stent placement: a systematic review and meta-analysis. Ann Intern Med 2015;163:118–26. Context Dual antiplatelet therapy (DAPT) with aspirin plus a P2Y12 receptor antagonist is recommended after drug eluting stent implantation (DES) for at least 12 months by the American College of Cardiology/American Heart Association1 and for 6–12 months by European guidelines. Recent randomised controlled trials (RCT) suggested comparable efficacy of short-term DAPT versus therapy o...
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Navarese, E. P. Tags: Journalology, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Radiology, Clinical diagnostic tests, Ethics Therapeutics/Prevention Source Type: research
Low to moderate quality evidence demonstrates the potential benefits and adverse events of cannabinoids for certain medical indications
Commentary on: Whiting PF, Wolff RF, Deshpande S, et al.. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA 2015;313:2456–73. Context As of September 2015, 23 states and the District of Columbia in the USA legalised the medicinal use of marijuana, underscoring the need for physicians to understand the science underlying medical marijuana as well as the practical issues associated with it. For years policymakers, scientists and physicians alike have debated the potential risks associated with marijuana use.1 Now marijuana's utility as a treatment for certain medical indications has taken focus....
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Hill, K. P., Hurley-Welljams-Dorof, W. M. Tags: Sexual transmitted infections (viral), Clinical trials (epidemiology), General practice / family medicine, Genetics, Immunology (including allergy), HIV/AIDS, Drugs: CNS (not psychiatric), Pain (neurology), Sleep disorders (neurology), Stroke, Ophthalmolo Source Type: research
Supplemental oxygen in patients without hypoxia in ST segment elevation myocardial infarction increases myocardial injury and infarct size
Commentary on: Stub D, Smith K, Bernard S, et al.. AVOID Investigators. Air versus oxygen in ST-segment-elevation myocardial infarction. Circulation 2015;131:2143–50. Context In patients with ST segment elevation myocardial infarction (STEMI), timely reperfusion, best obtained with primary percutaneous coronary intervention (pPCI), is a mainstay to reduce infarct size (IS) and improve clinical outcome. Routine oxygen administration in normoxic patients with STEMI before pPCI, while mentioned by international guidelines,1 is not supported by randomised evidence. Stub and colleagues performed the AVOID study to compare...
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Crimi, G. Tags: Clinical trials (epidemiology), Drugs: cardiovascular system, Pain (neurology), Stroke, Interventional cardiology, Ischaemic heart disease, Drugs: respiratory system Therapeutics/Prevention Source Type: research
Observational studies are compatible with an association between saturated and trans fats and cardiovascular disease
Commentary on: de Souza RJ, Mente A, Maroleanu A, et al.. Intake of saturated and trans unsaturated fatty acids and risk of all-cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ 2015;351:h3978. Context What is the relationship between saturated or trans fats in our food and cardiovascular risk? To find out we must examine the totality of interventional and observational evidence and all appropriate outcomes. The WHO Nutrition Guidance Advisory Group (WHO NUGAG) recently commissioned systematic reviews of randomised controlled trials (RCTs) which ...
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Hooper, L., Mann, J. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Diet, Ischaemic heart disease, Diabetes Aetiology/Harm Source Type: research
Aerobic exercise training reduces bronchial hyper-responsiveness and serum pro-inflammatory cytokines in patients with asthma
Commentary on: Franca-Pinto A, Mendes FAR, de Carvalho-Pinto RM, et al.. Aerobic training decreases bronchial hyper-responsiveness and systemic inflammation in patients with moderate or severe asthma: a randomised controlled trial. Thorax 2015;70:732–9. Context Exercise is a well-known trigger for asthma symptoms. In patients with asthma, strenuous physical activity increases the risk of an asthma attack, with a ‘U’-shaped curve showing that moderate exercise training carries a lower risk of asthma compared to high-intensity exercise training. Lack of physical activity appears to be independently associat...
Source: Evidence-Based Medicine - March 21, 2016 Category: Internal Medicine Authors: del Giacco, S. R., Garcia-Larsen, V. Tags: Clinical trials (epidemiology), Immunology (including allergy), Drugs: CNS (not psychiatric), Stroke, Asthma Therapeutics/Prevention Source Type: research
Complete revascularisation in patients with ST-segment elevation myocardial infarction and multivessel disease: contemporary data in context
Commentary on: Engstrøm T, Kelbæk H, Helqvist S, et al.. DANAMI-3—PRIMULTI Investigators. Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI-3—PRIMULTI): an open-label, randomised controlled trial. Lancet 2015;386:665–71. Context Primary percutaneous coronary intervention is recommended in patients presenting with ST-segment Elevation Myocardial infarction (STEMI).1 In 40–60% of STEMI patients there is disease in non-infarct-related arteries (IRAs).2 Such patients have higher ...
Source: Evidence-Based Medicine - March 21, 2016 Category: Internal Medicine Authors: Banning, A. S., Gershlick, A. H. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Radiology, Clinical diagnostic tests, Radiology (diagnostics) Therapeutics/Prevention Source Type: research
Drug-eluting stents and drug-eluting balloons are the best strategies to treat coronary in-stent restenosis
Commentary on: Giacoppo D, Gargiulo G, Aruta P, et al.. Treatment strategies for coronary in-stent restenosis: systematic review and hierarchical Bayesian network meta-analysis of 24 randomised trials and 4880 patients. BMJ 2015;351:h5392. Context Drug-eluting stents (DES) drastically improved the efficacy of percutaneous coronary intervention by reducing the risk of in-stent restenosis (ISR) and subsequent need of target lesion revascularisation (TLR). However, despite the advances in DES technology, the incidence of ISR is still significant and considering that more than five million DES are implanted each year worldwide...
Source: Evidence-Based Medicine - May 22, 2016 Category: Internal Medicine Authors: Giustino, G., Mehran, R. Tags: Clinical trials (epidemiology), Immunology (including allergy), Stroke, Interventional cardiology, Radiology, Clinical diagnostic tests, Radiology (diagnostics) Therapeutics/Prevention Source Type: research
Revascularisation plus supervised exercise is superior to supervised exercise alone for the treatment of intermittent claudication
This study was a multicentre (10 sites), parallel-design randomised controlled trial of supervised exercise plus endovascular revascularisation versus supervised exercise alone for IC.4 Patients with IC and one or more stenotic lesions at the aortoiliac and/or femoropopliteal level amenable to endovascular therapy were eligible. Supervised exercise was provided 2–3 times per week for 30–45 min per session for 3 months and then continued...
Source: Evidence-Based Medicine - May 22, 2016 Category: Internal Medicine Authors: Vemulapalli, S. Tags: Clinical trials (epidemiology), Drugs: cardiovascular system, Stroke, Interventional cardiology, Radiology, Clinical diagnostic tests Therapeutics/Prevention Source Type: research
High-sensitivity troponin predicts coronary disease outcomes in type 2 diabetes but yields no benefit in selecting patients for revascularisation
Commentary on: Everett BM, Brooks MM, Vlachos HE, et al.., BARI 2D Study Group. Troponin and cardiac events in stable ischemic heart disease and diabetes. N Engl J Med 2015;373:610–20. Context High-sensitivity troponin (hs-TnT) assays have been developed for early recognition of patients with acute coronary syndrome (ACS). Additionally, hs-TnT has been shown to be a feasible tool for assessing risk among patients with heart failure. Even though efforts have been made to improve prognosis among patients with coronary artery disease (CAD) with high-risk features, most adverse events occur in patients without these feat...
Source: Evidence-Based Medicine - May 22, 2016 Category: Internal Medicine Authors: Junttila, J. Tags: Clinical trials (epidemiology), Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Radiology, Clinical diagnostic tests, Diabetes Therapeutics/Prevention Source Type: research
In hypertensive patients with elevated risk of cardiovascular disease, targeting systolic blood pressure to less than 120 mm Hg significantly reduces the rate of fatal and non-fatal cardiovascular events as well as death from any cause
Commentary on: Wright JT, Williamson JD, Whelton PK, et al.., SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015;373:2103–16. Context Hypertension is among the most significant modifiable risk factor for cardiovascular disease, yet there is considerable debate on the optimal blood pressure (BP) goal. Observational studies1 and the ACCORD trial2 suggest a target organ heterogeneity in that with lower systolic BP goals (<120 mm Hg) the risk of cerebrovascular events are reduced, but not coronary events. As such, systolic BP goals of <130, <...
Source: Evidence-Based Medicine - May 22, 2016 Category: Internal Medicine Authors: Owlia, M., Bangalore, S. Tags: Geriatric medicine, Clinical trials (epidemiology), Drugs: cardiovascular system, Stroke, Hypertension, Ischaemic heart disease, Renal medicine Therapeutics/Prevention Source Type: research
Benefits of blood pressure lowering are seen across levels of baseline blood pressure, comorbidity and drug class
Commentary on: Ettehad D, Emdin CA, Kiran A, et al.. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis Lancet 2016;387:957–967 . Context It has been long established that reducing blood pressure with pharmacotherapeutic agents prevents adverse cardiovascular disease events, but questions remain about which patients warrant antihypertensive therapy. Historically, this has been determined by the level of blood pressure alone. However, the evidence suggests that individuals most likely to benefit from blood pressure lowering therapy are those at greatest ab...
Source: Evidence-Based Medicine - September 22, 2016 Category: Internal Medicine Authors: Nelson, M. R. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Ischaemic heart disease, Renal medicine, Drugs: musculoskeletal and joint diseases Therapeutics/Prevention Source Type: research
Transfemoral transcatheter aortic-valve replacement should be preferred over surgery in most intermediate-risk patients
Commentary on: Leon MB, Smith CR, Mack MJ, et al.., PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 2016;374:1609–20 . Context Evidence derived from randomised clinical trials support transcatheter aortic valve replacement (TAVR) as a choice for patients with aortic stenosis with a prohibitive surgical risk and as a valid alternative therapy for those at high-risk of surgical mortality. Owing to increases in operator experience as well as improvements with transcatheter techniques and devices associated with reduction in procedural complications,...
Source: Evidence-Based Medicine - September 22, 2016 Category: Internal Medicine Authors: Tamburino, C., Capranzano, P. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Arrhythmias Therapeutics/Prevention Source Type: research
Erythropoietin corrects anaemia and reduces the risk of blood transfusion in people with chronic kidney disease, but has uncertain effects on other patient-level outcomes
Commentary on: Cody JD, Hodson EM. Recombinant human erythropoietin versus placebo or no treatment for the anaemia of chronic kidney disease in people not requiring dialysis. Cochrane Database Syst Rev 2016;(1):CD003266 Context Anaemia frequency and severity worsen with advancing chronic kidney disease (CKD) and are associated with quality-of-life (QOL) impairment, morbidity and mortality.1 Deficient renal erythropoietin production is a major cause and can be corrected by recombinant human erythropoietin (rhEPO) administration.1 This may improve clinical outcomes, including delaying dialysis. Conversely, rhEPO therapy caus...
Source: Evidence-Based Medicine - September 22, 2016 Category: Internal Medicine Authors: Johnson, D. W. Tags: Clinical trials (epidemiology), Epidemiologic studies, Haematology (incl blood transfusion), Stroke, Hypertension, Venous thromboembolism, Renal medicine Therapeutics/Prevention Source Type: research
Risk score developed from routinely collected data by primary healthcare practitioners is useful to rule out dementia in 60-79 year-olds
Commentary on: Walters K, Hardoon S, Petersen I, et al.. Predicting dementia risk in primary care: development and validation of the Dementia Risk Score using routinely collected data. BMC Medicine 2016;14:6 . Context In spite of major repercussions on the life of patients and caregivers, dementia remains a neglected domain in primary care setting. Previous studies have shown that only a third of new dementia cases occurring in the general population were referred to a specialist1 and that too at a severe stage of the disease, 25% of cases were ignored.2 A great proportion of primary care practitioners (PCPs) consider deme...
Source: Evidence-Based Medicine - September 22, 2016 Category: Internal Medicine Authors: Dartigues, J. F., Helmer, C. Tags: EBM Diagnosis, Health policy, General practice / family medicine, Drugs: cardiovascular system, Dementia, Drugs: CNS (not psychiatric), Stroke, Memory disorders (psychiatry), Psychiatry of old age, Health service research Source Type: research
