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Study shows insufficient decrease in wound complications with sutured versus stapled skin closure in gastrointestinal operations
Commentary on: Tsujinaka T, Yamamoto K, Fujita J, et al.. Subcuticular sutures versus staples for skin closure after open gastrointestinal surgery: a phase 3, multicentre, open-label, randomised controlled trial. Lancet 2013;382:1105–12. Context Postoperative wound complications can occur in 9–26% of gastrointestinal operations.1–3 Skin closure with subcuticular sutures in clean operations, such as caesarean sections, are associated with decreased wound complications and increased patient satisfaction when compared with skin closure using staples.4 5 Whether these results are applicable to clean–con...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Vo, H., Kin, C. Tags: Patients, Clinical trials (epidemiology), Immunology (including allergy), Drugs: cardiovascular system, Stroke, Dermatology, Diabetes, Injury Therapeutics Source Type: research

Neither ibuprofen nor steam improves symptom control compared with paracetamol in patients with acute respiratory tract infections in primary care
Commentary on: Little P, Moore M, Kelly J, et al.. Ibuprofen, paracetamol, and steam for patients with respiratory tract infections in primary care: pragmatic randomised factorial trial. BMJ 2013;347:f6041. Context The achievement of symptom control in patients with respiratory infections is an ongoing challenge, particularly within primary care. Patients and clinicians often view antibiotics, alongside other supportive medication, as the most expeditious intervention to achieve this goal. While we have learnt that antibiotics provide only very limited benefit in cases when bacterial infection is not suspected,1 2 the effe...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Schuetz, P. Tags: General practice / family medicine, Influenza, Otitis, Pain (neurology), Stroke, Ischaemic heart disease, Pain (palliative care), Drugs: musculoskeletal and joint diseases, Ear, nose and throat/otolaryngology Therapeutics Source Type: research

Intermittent pneumatic compression is effective in reducing venous thromboembolism risk in hospitalised patients
Commentary on: Ho KM, Tan JA. Stratified meta-analysis of intermittent pneumatic compression of the lower limbs to prevent venous thromboembolism in hospitalized patients. Circulation 2013;128:1003–20. Context The Center for Disease Control and Prevention reports incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in 1–2 patients/1000/year. A total of 60–100 000 patients in the USA die of DVT or PE annually, with 10–30% expiring within 1 month of diagnosis. Recurrence rates of DVT/PE are as high as 33% within 10 years.1 Increased incidence of DVT and PE has been report...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Pascarella, L. Tags: EBM Prognosis, Medical education, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Venous thromboembolism, Pulmonary embolism, Medical humanities Prevention Source Type: research

Menopausal hormone therapy has risks and benefits during the intervention and poststopping phase
This report summarises the previous WHI reports alongside 13 years of follow-up in 81.1% of surviving participants. Some selection bias may have occurred in the postintervention phase due to occurrences in the intervention phase. Methods Women were recruited from 1993 to 1998...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Warren, M. P. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Menopause (including HRT), Ischaemic heart disease, Venous thromboembolism, Pulmonary embolism, Injury Prevention Source Type: research

Lung cancer screening with low-dose CT (LDCT) is ready for prime time in the USA
Commentary on: Humphrey LL, Deffebach M, Pappas M, et al.. Screening for lung cancer with low-dose computed tomography: a systematic review to update the US Preventive Services Task Force recommendation. Ann Intern Med 2013;159:411–20. Context The US Preventative Services Task Force (USPSTF) has published their long-awaited, updated systematic review of low-dose CT (LDCT) screening for lung cancer. Last reviewed in 2004, lung cancer screening has been under intense study worldwide for the past decade. The issue of lung cancer screening is important because lung cancer is the leading cause of cancer mortality in the U...
Source: Evidence-Based Medicine - July 18, 2014 Category: Internal Medicine Authors: Wilson, D. O. Tags: Smoking and tobacco, Health policy, Clinical trials (epidemiology), Epidemiologic studies, Immunology (including allergy), Stroke, Screening (oncology), Radiology, Clinical diagnostic tests, Radiology (diagnostics), Screening (epidemiology), Health econom Source Type: research

In the absence of diagnosed concussion in collegiate contact sport athletes, a relationship is suggested between the effects of head impact exposure, white matter diffusivity measures and cognition
Commentary on: McAllister TW, Ford JC, Flashman LA, et al.. Effect of head impacts on diffusivity measures in a cohort of collegiate contact sport athletes. Neurology 2014;82:63–9. Context There is growing concern that head impacts sustained during contact sports may lead not only to concussion but also to increased susceptibility to concussion, long-term cognitive decline and chronic traumatic encephalopathy. Study findings on this matter have been contradictory. A previous study by this group suggested that collegiate contact sport athletes are vulnerable to the cognitive effects of repetitive head impacts.1 Method...
Source: Evidence-Based Medicine - July 18, 2014 Category: Internal Medicine Authors: Stone, J. L., Bailes, J. E. Tags: EBM Aetiology, Stroke, Memory disorders (psychiatry), Radiology, Sports and exercise medicine, Clinical diagnostic tests, Radiology (diagnostics) Source Type: research

Similar 5-year clinical outcomes in patients with stable coronary artery disease and myocardial ischaemia managed with an initial approach of medical therapy compared with medical therapy plus percutaneous coronary intervention
Commentary on: Stergiopoulos K, Boden WE, Hartigan P, et al.. Percutaneous coronary intervention outcomes in patients with stable obstructive coronary artery disease and myocardial ischaemia: a collaborative meta-analysis of contemporary randomized clinical trials. JAMA Intern Med 2014;174:232–40. Context In patients with stable coronary artery disease (CAD), the presence of myocardial ischaemia is associated with increased cardiac event rates. Percutaneous coronary intervention (PCI) achieves greater short-term reductions in myocardial ischaemia and angina than medical therapy. In contrast to patients with acute cor...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Archbold, R. A. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Radiology, Clinical diagnostic tests, Radiology (diagnostics) Therapeutics Source Type: research

Trial suggests yoga and exercise lead to modest improvements in menopause-related quality of life: longer term studies are needed
Commentary on: Reed SD, Guthrie KA, Newton KM, et al.. Menopausal quality of life: RCT of yoga, exercise, and omega-3 supplements. Am J Obstet Gynecol 2014;210:244.e1–11. Context Since publication of the Women's Health Initiative Study, the potential benefits of non-pharmacological therapies for menopause-related symptoms have gained increased interest among midlife women, clinicians and researchers.1 Interventions requiring behavioural change have yielded mixed outcomes, owing to small sample sizes, a variety of outcome measures, lack of control groups and limited follow-up.2–4 Methods To assess the effects of...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Woods, N. F. Tags: Pain (neurology), Sleep disorders (neurology), Stroke, Menopause (including HRT), Anxiety disorders (including OCD and PTSD), Mood disorders (including depression), Sleep disorders, Sleep disorders (respiratory medicine) Therapeutics Source Type: research

Evidence suggests dabigatran is an effective and safe treatment for patients with VTE requiring early parenteral therapy
Commentary on: Schulman S, Kakkar AK, Goldhaber SZ, et al.. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation 2014;129:764–72. Context Until recently, an initial course of parenteral anticoagulation followed by vitamin K antagonist (VKA) was the standard of care for the treatment of venous thromboembolism (VTE). In the past few years, direct oral anticoagulants (DOAC) have been found to be non-inferior to VKA.1–3 The RE-COVER study found dabigatran to be non-inferior to warfarin, with a reduced risk for clinically relevant bleeding.4 In order to confirm these...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Granziera, S., Cohen, A. T. Tags: Drugs: cardiovascular system, Stroke, Venous thromboembolism, Radiology, Pulmonary embolism, Clinical diagnostic tests Therapeutics Source Type: research

Low failure rate reported of diagnosis algorithm for suspected upper extremity deep vein thrombosis
Commentary on: Kleinjan A, Di Nisio M, Beyer-Westendorf J, et al.. Safety and feasibility of a diagnostic algorithm combining clinical probability, d-dimer testing and ultrasonography for suspected upper extremity deep venous thrombosis: a prospective management study. Ann Intern Med 2014;160:451–7. Context Upper extremity deep vein thrombosis (UEDVT) is an infrequent type of venous thromboembolism with an estimated incidence of 0.4–1 case per 10 000 persons.1 UEDVT may cause pulmonary embolism but this risk is lower than with lower extremity DVT. Accurate ruling out of UEDVT is mandatory in order to avert...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Delluc, A., Wells, P. S. Tags: EBM Diagnosis, Drugs: cardiovascular system, Pain (neurology), Stroke, Venous thromboembolism, Radiology, Pulmonary embolism, Clinical diagnostic tests, Radiology (diagnostics) Source Type: research

Network meta-analysis demonstrates the safety of pharmacotherapy for smoking cessation in cardiovascular patients
Commentary on: Mills EJ, Thorlund K, Eapen S, et al.. Cardiovascular events associated with smoking cessation pharmacotherapies: a network meta-analysis. Circulation 2014;129:28–41. Context The importance of smoking cessation in the prevention and management of cardiovascular disease cannot be overestimated. Exposure to tobacco products, beginning in utero, causes substantial damage to vascular health, imposing dramatic public and personal health burdens over a lifetime. Smokers lose, on average, 10 years of life expectancy.1 Smoking cessation is the most powerful preventive intervention available—particul...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Pipe, A. L. Tags: Smoking and tobacco, Clinical trials (epidemiology), Drugs: cardiovascular system, Stroke, Hypertension, Ischaemic heart disease, Unwanted effects / adverse reactions, Lipid disorders, Health education, Smoking Harm Source Type: research

Whether the use of unopposed oestrogen following a myocardial infarction is beneficial or harmful remains unclear, and in individual women the effects may vary according to the underlying risk profile
Commentary on: Cherry N, McNamee R, Heagerty A, et al.. Long-term safety of unopposed oestrogen used by women surviving myocardial infarction: a 14-year follow-up of the ESPRIT randomised controlled trial. BJOG 2014;121:700–5; discussion 705. Context There is a biological and epidemiological evidence to suggest that high oestrogen levels retard the progression of atherogenesis, reducing the risk of myocardial infarction. Whether such an effect is evident following a first myocardial infarction is unclear. A randomised controlled trial was carried out to investigate. Following completion of the trial the authors conti...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Shapiro, S. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Contraception, Drugs: obstetrics and gynaecology, Ischaemic heart disease, Vulvovaginal disorders Harm Source Type: research

New ACC-AHA cholesterol guidelines significantly increase potential eligibility for statin treatment
Commentary on: Pencina MJ, Navar-Boggan AM, D’Agostino RB, et al.. Application of new cholesterol guidelines to a population-based sample. N Engl J Med 2014;370:1422–31. Context In 2013, new guidelines for the treatment of cholesterol for the prevention of cardiovascular disease (CVD) were issued by the American College of Cardiology and the American Heart Association (ACC-AHA), based on a systematic review of lipid lowering trials and meta-analyses evaluating treatment impact on CVD morbidity and mortality, and quantitated adverse effects of lipid-lowering therapy.1 Many of these trials were reported after pub...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Bittner, V. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Diet, Ischaemic heart disease Practice guideline Source Type: research

Intensive glucose-lowering results in increased cardiovascular mortality in younger but not older individuals with type 2 diabetes
Commentary on: Miller ME, Williamson JD, Gerstein HC, et al..; ACCORD Investigators. Effects of randomization to intensive glucose control on adverse events, cardiovascular disease, and mortality in older versus younger adults in the ACCORD Trial. Diabetes Care 2014;37:634–43. Context The glycaemic portion of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial showed that an intensive glucose-lowering strategy may increase overall and cardiovascular (CV) mortality, as compared with a standard management.1 However, it is unclear whether age may influence the effects of intensive glycaemic control. Ans...
Source: Evidence-Based Medicine - November 19, 2014 Category: Internal Medicine Authors: Giorgino, F. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Diabetes Therapeutics Source Type: research

Study concludes L. reuteri not effective for infant colic, but findings may be limited by participants' heterogeneity
Commentary on: Sung V, Hiscock H, Tang ML, et al.. Treating infant colic with the probiotic Lactobacillus reuteri: double blind, placebo controlled randomised trial. BMJ 2014;348:g2107. Context Colic is a common problem in healthy, thriving infants that is associated with excessive crying over a regular period during the day and is sustained for the first few months of life.1 Colic affects between 5% and 19% of young infants, remains difficult to treat and may result in significant psychosocial consequences. Despite 40 years of research, the aetiology of infantile colic remains elusive. Recently, the composition of in...
Source: Evidence-Based Medicine - November 19, 2014 Category: Internal Medicine Authors: Indrio, F. Tags: Clinical trials (epidemiology), Immunology (including allergy), Pain (neurology), Stroke, Childhood nutrition, Pregnancy, Child and adolescent psychiatry, Mood disorders (including depression) Therapeutics Source Type: research

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