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Specialty: Internal Medicine
Source: Evidence-Based Medicine
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Total 156 results found since Jan 2013.
Limited impact of omega-3 fatty acids in patients with multiple cardiovascular risk factors
Commentary on: Roncaglioni MC, Tombesi M, et al.. Risk and Prevention Study Collaborative Group. n-3 fatty acids in patients with multiple cardiovascular risk factors. N Engl J Med 2013;368:1800–8 Context Ecological, case–control and prospective studies consistently demonstrate reduced cardiovascular morbidity and mortality associated with higher intake of fish and their constituent omega-3 fatty acids and with higher omega-3 fatty acid status.1 This effect has been ascribed to improvement of the cardiovascular risk profile resulting in disease prevention.1 Trials in patients following myocardial infarction (MI...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Calder, P. Tags: Clinical trials (epidemiology), Epidemiologic studies, General practice / family medicine, Immunology (including allergy), Drugs: cardiovascular system, Stroke, Hypertension, Ischaemic heart disease, Arrhythmias Therapeutics Source Type: research
Dietary salt reduction; further lowering of target lowers blood pressure but may increase risk
Commentary on: He FJ, Li J, Macgregor GA. Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev 2013;(4):CD004937. Context Numerous studies have shown that a high dietary salt intake increases blood pressure (BP) and the risk of cardiovascular events.1 2 Conversely, a moderate and even low-level salt intake lowers BP in a dose-dependent way. Methods He and colleagues have performed a thorough and comprehensive meta-analysis of 34 randomised controlled trials (RCTs) assessing the impact of modest reduction in salt intake with a trial duration of at least 4 weeks. Findings The present...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Messerli, F. H., Bangalore, S. Tags: Clinical trials (epidemiology), Drugs: cardiovascular system, Drugs: CNS (not psychiatric), Heart failure, Stroke, Hypertension, Diet, Ischaemic heart disease Therapeutics Source Type: research
Two-thirds of female smokers aged over 50 die from smoking-related causes, but quitting before 40 decreases this by 90%
Commentary on: Pirie K, Peto R, Reeves GK, et al.. Million Women Study Collaborators. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet 2013;381:133–41. Context Smoking is the leading cause of preventable death. Given that women born after 1940 smoked throughout their lifespan, studies of mortality during the 21st century are needed to understand the hazards associated with prolonged smoking and cessation. Methods In this prospective cohort study, participants completed mailed questionnaires about lifestyle, medical history and demographic factors...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Cooley, M. E., Park, E. R. Tags: EBM Prognosis, Patients, Smoking and tobacco, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Contraception, Drugs: obstetrics and gynaecology, Menopause (including HRT), Pregnancy, Drugs misuse (including addiction), Tobacco related disease, Source Type: research
Perioperative {beta}-blockade improves outcomes in higher risk patients following non-cardiac surgery
Commentary on: London MJ, Hur K, Schwartz GG, et al.. Association of perioperative β-blockade with mortality and cardiovascular morbidity following major noncardiac surgery. JAMA 2013;309:1704–13. Context There has been recent controversy in the perioperative community amid allegations of scientific misconduct and there remains uncertainty about the effectiveness and safety of perioperative β-blockade in patients undergoing non-cardiac surgery.1 Current American Heart Association/American College of Cardiology Foundation (AHA/ACCF) Guidelines on perioperative evaluation and care for non-cardiac surgery limi...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Vaishnava, P., Eagle, K. A. Tags: EBM Aetiology, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Interventional cardiology, Ischaemic heart disease, Ethics Source Type: research
Randomised controlled trial: extended-duration dabigatran is non-inferior to warfarin and more effective than placebo for symptomatic VTE
Commentary on: Schulman S, Kearon C, Kakkar AK, et al.. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med 2013;368:709–718. RE-MEDY and RE-SONATE trials. Context In patients with idiopathic deep vein thrombosis (DVT) or pulmonary embolism (PE), extending the duration of warfarin beyond the initial 3–6 months of anticoagulation significantly reduces the risk for recurrence.1 2 Dabigatran is an oral direct-thrombin inhibitor that has been shown to be as effective as warfarin in the first 6 months after a venous thromboembolism (VTE).3 However, its efficacy and safe...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Liem, T. K., DeLoughery, T. G. Tags: EBM Aetiology, Clinical trials (epidemiology), Drugs: cardiovascular system, Stroke, Venous thromboembolism, Pulmonary embolism Source Type: research
Lower sodium intake reduces blood pressure in adults and children, but is not associated with a reduced risk of all CVD or all cause mortality
Commentary on: Aburto NJ, Ziolkovska A, Hooper L, et al.. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ 2013;346:f1326 Context More than half a century has passed since the idea that the lower blood pressure (BP) associated with lower sodium intake justifies reduced intake for all. Authoritative bodies have subsequently endorsed this view with increasingly ambitious reduction goals. The US Department of Agriculture and US Department of Health and Human Services currently recommend <1.5 g sodium/day for virtually half the population, with <2.3 g1 levels for the remainder. ...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Alderman, M. H., Cohen, H. Tags: EBM Aetiology, Epidemiologic studies, Drugs: cardiovascular system, Drugs: CNS (not psychiatric), Stroke, Hypertension, Diet, Obesity (nutrition), Ischaemic heart disease, Health education Source Type: research
Conservative management for low-risk prostate cancer improves quality-adjusted life expectancy at lower cost compared with initial treatment
Commentary on: Hayes JH, Ollendorf DA, Pearson SD, et al.. Observation versus initial treatment for men with localized, low-risk prostate cancer: a cost-effectiveness analysis. Ann Intern Med 2013;158:853–60. Context What is the best treatment for localised prostate cancer? This simple question, for a common disease now affecting about one in six North American men, does not have a clear answer. This is not a ‘normal’ situation in medicine. For most common diseases, including most primary cancers, there is usually a consensus as to the best therapeutic approach. Not so for localised prostate cancer. Surge...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Klotz, L. Tags: Epidemiologic studies, Stroke, Screening (oncology), Radiology, Surgical diagnostic tests, Clinical diagnostic tests, Prostate Economic analysis Source Type: research
Suggestions for improving guideline utility and trustworthiness
Several underemphasised limitations of guidelines need proactive remediation in meeting the contemporary needs of clinicians Clinical practice guideline (CPG) panels are expected to abide by standards that ensure their processes are multidisciplinary, systematic and unbiased.1 Unfortunately, many CPGs fail to satisfy these standards. Only a third of 130 US guidelines produced by subspecialty societies between 2006 and 2011,2 satisfied more than 50% of standards set by the Institute of Medicine (IOM—see table 1),1 relating to panel composition, conflicts of interest, evidence synthesis, reconciliation of different int...
Source: Evidence-Based Medicine - March 19, 2014 Category: Internal Medicine Authors: Scott, I. A., Guyatt, G. H. Tags: Medical education, Editor's choice, Drugs: cardiovascular system, Stroke, Hypertension, Screening (oncology), Ischaemic heart disease, Prostate, Screening (epidemiology), Ethics, Legal and forensic medicine, Medical humanities, Guidelines, Screening (publ Source Type: research
Cardiovascular benefits of HRT may differ by patient age
Commentary on: Main C, Knight B, Moxham T, et al.. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev 2013;(4):CD002229. Context In early postmenopausal women oestrogen and/or hormone replacement therapy (ERT/HRT) are used to alleviate symptoms and reduce the probability of diseases related to ovarian hormones deprivation. However, in late postmenopausal women the initiation of HRT has a negative risk/benefit balance mainly because of the increased risk of cardiovascular diseases (CVD). Methods Main et al performed a meta-analysis of randomised controlled trials (RCTs...
Source: Evidence-Based Medicine - March 19, 2014 Category: Internal Medicine Authors: Rosano, G., Vitale, C. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Contraception, Drugs: obstetrics and gynaecology, Menopause (including HRT), Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Radiology Source Type: research
Symptoms of obstructive sleep apnoea are treated by adenotonsillectomy, but without change in neurocognitive outcome
Commentary on: Marcus CL, Moore RH, Rosen CL, et al.. A randomised trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 2013;368:2366–76. Context Adenotonsillectomy (T&A) in children is a very common surgical intervention for sleep disordered breathing and obstructive sleep apnoea (OSA). OSA in children causes cardiovascular, behavioural, developmental and cognitive sequelae. Controversies exist about many aspects of this condition including diagnosis, treatment and perioperative management. In children with severe OSA there are neurocognitive deficits and altered brain development.1 There is a bod...
Source: Evidence-Based Medicine - March 19, 2014 Category: Internal Medicine Authors: Ramsden, J. D. Tags: Clinical trials (epidemiology), Sleep disorders (neurology), Stroke, Obesity (nutrition), Child and adolescent psychiatry, Sleep disorders, Sleep disorders (respiratory medicine), Ear, nose and throat/otolaryngology, Health education Therapeutics Source Type: research
Modest weight loss does not decrease cardiovascular morbidity and mortality in adults with type 2 diabetes
Commentary on: Wing RR, Bolin P, Brancati FL, et al.. Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013;369:145–54. Context Diet, physical activity and weight loss are recommended in the management of type 2 diabetes. This recommendation is largely based on short-term intervention studies which show improvements in cardiovascular risk factors including glycaemic control, lipids, blood pressure and inflammation. The Look AHEAD (Action for Health in Diabetes) randomised controlled trial (RCT) studied the impact of long-term weight loss through an...
Source: Evidence-Based Medicine - March 19, 2014 Category: Internal Medicine Authors: Davis, N. J., Goswami, G. Tags: Clinical trials (epidemiology), Epidemiologic studies, Immunology (including allergy), Drugs: cardiovascular system, Stroke, Hypertension, Diet, Ischaemic heart disease, Diabetes Therapeutics Source Type: research
Perioperative selective serotonin reuptake inhibitor administration is a marker of poor outcomes after surgery
Commentary on: Auerbach AD, Vittinghoff E, Maselli J, et al.. Perioperative use of selective serotonin reuptake inhibitors and risks for adverse outcomes of surgery. JAMA Intern Med 2013;173:1075–81. Context With a lifetime prevalence of 6–11%, depression is a common comorbidity in surgical patients. Owing to their high efficacy and safety, selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants.1 Some studies suggest that SSRIs may increase surgical bleeding. However, SSRI discontinuation may exacerbate psychiatric illness or precipitate withdrawal symptoms. Therefore, ...
Source: Evidence-Based Medicine - March 19, 2014 Category: Internal Medicine Authors: Holt, N. F. Tags: EBM Aetiology, Epidemiologic studies, Drugs: cardiovascular system, Drugs: CNS (not psychiatric), Heart failure, Stroke, Obesity (nutrition), Interventional cardiology, Drugs: musculoskeletal and joint diseases, Health education Source Type: research
Peripartum antidepressant use is associated with an increased risk of postpartum haemorrhage
Commentary on: Palmsten K, Hernández-Díaz S, Huybrechts KF, et al.. Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the United States. BMJ 2013;347:f4877. Context Increased incidence of postpartum haemorrhage (PPH) is reported in a number of high-resource settings since the 1990s. The increase appears unrelated to factors such as rising rates of caesarean sections or increasing maternal age.1 Recent studies have investigated the association between antidepressant use at different stages of pregnancy and PPH, with two studies demonstrating a 1.20-fol...
Source: Evidence-Based Medicine - March 19, 2014 Category: Internal Medicine Authors: Ford, J. B., Morris, J. M. Tags: EBM Aetiology, Health policy, Epidemiologic studies, Drugs: CNS (not psychiatric), Stroke, Pregnancy, Anxiety disorders (including OCD and PTSD), Child and adolescent psychiatry, Mood disorders (including depression), Drugs: musculoskeletal and joint dise Source Type: research
Statins do not improve cardiovascular outcomes for dialysis patients
Commentary on: Palmer SC, Navaneethan SD, Craig JC, et al.. HMG CoA reductase inhibitors (statins) for dialysis patients: a systematic review and meta-analysis. Cochrane Database Syst Rev 2013;(9):CD004289. Context Chronic kidney disease affected nearly 19 million people in the USA, with incidence increasing globally at an annual rate of 8%, most of which were unrecognised or undiagnosed. Cardiovascular events are common among patients with chronic kidney disease and highest in dialysis patients. While dialysis patients experience a high prevalence of traditional risk factors for cardiovascular disease (CVD), such as hyper...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Olyaei, A. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Neuromuscular disease, Stroke, Hypertension, Obesity (nutrition), Ischaemic heart disease, Unwanted effects / adverse reactions, Renal medicine, Musculoskeletal syndromes Source Type: research
Percutaneous coronary intervention of culprit and non-culprit coronary arteries in acute ST-elevation MI may improve outcomes
Commentary on: Wald DS, Morris JK, Wald NJ, et al.. Randomised trial of preventive angioplasty in myocardial infarction. N Engl J Med 2013;369:1115–23. Context The paramount goal of the treatment for acute ST-elevation myocardial infarction (STEMI) is the emergent restoration of blood flow through percutaneous coronary intervention (PCI) of the infarct-related or ‘culprit artery’, generally identified as an occluded vessel from a thrombotic lesion. However, multivessel coronary artery disease (CAD) is frequently present in patients with STEMI and portends a worse prognosis. The optimal revascularisation s...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Chen, S. H., Chakrabarti, A. K. Tags: Clinical trials (epidemiology), Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Radiology, Clinical diagnostic tests Therapeutics Source Type: research
