Consider The Evidence: Med/Peds Journal Roundup This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

Insulin v. Triple oral therapy for DM
Diabetes Care 12/23/09 –   “Insulin is the most effective hypoglycemic agent in our treatment armamentarium and is now recommended by the American Diabetes Association (ADA) guidelines as the second agent added after metformin” (FTA). Despite this fact (or because some of us were unaware of this guideline), physicians often prefer to max out that second and third oral medication before turning to insulin. An article in Diabetes Care looks at a comparison between a three drug regimen and insulin + metformin for newly diagnosed DM. The study compared 2 groups of 29 subjects that were newly diagnosed diabe...
Source: Consider The Evidence: Med/Peds Journal Roundup - January 3, 2010 Category: Internists and Doctors of Medicine Authors: medblog Tags: diabetes Source Type: blogs

the (new) Gardasil controversy
JAMA 8/19/09 – In case the Gardasil vaccine wasn’t already surrounded by enough controversy – now there is concern over its safety profile and the marketing practices of Merk. An article in JAMA presents the safety surveillance data for qHPV, finding that “Most of the AEFI rates were not greater than the background rates compared with other vaccines, but there was disproportional reporting of syncope and venous thromboembolic events” An accompanying editorial discusses the extensive marketing to and through medical professional organizations via the use of manufacturer – designed educati...
Source: Consider The Evidence: Med/Peds Journal Roundup - September 11, 2009 Category: Internists and Doctors of Medicine Authors: medblog Tags: immunity JAMA pediatrics vaccines Source Type: blogs

Nail in the coffin for intensive glucose control?
NEJM 3/26/09 – The NICE-SUGAR investigators published the latest of several trials that show no benefit to intensive glucose control (see meta-analysis). In fact, this study shows increased mortality from tight gylcemic control in the ICU. This appears to be a well done study – over 6,000 subjects, multicenter, both medical and surgical patients, 90-day follow up. Withdrawals were slightly higher in the treatment arm (10 vs 7 percent) but intent-to-treat analysis was used. Insulin use was non-blinded. So should the intensive glucose control protocol be shelved next to blood-letting and COX-2 inhibitors? (Source...
Source: Consider The Evidence: Med/Peds Journal Roundup - March 26, 2009 Category: Internists and Doctors of Medicine Authors: medblog Tags: Uncategorized Source Type: blogs

Yes, Statins do everything – even lower BP
What could be crazy enough to end a 4 month hibernation of CTE? Archives Int Med 4/08 – The UCSD Statin study yielded further evidence that statin treatment reduces blood pressure (although not by much) The RCT enrolled over 900 subjects without known CVD or diabetes. The idea was to independently assess the effect on BP. There was no inclusion / exclusion criteria regarding baseline BP. Subjects were randomized to pravastatin, simvastatin, or placebo. Treatment with a statin resulted in about a 2-2.5 point drop in SBP and DBP. The treatment was stopped at 6 months, and the blood pressures returned to baseline by mo...
Source: Consider The Evidence: Med/Peds Journal Roundup - April 17, 2008 Category: Internists and Doctors of Medicine Authors: medblog Tags: archives of internal medicine hypertension Source Type: blogs

Antibiotics no good for acute sinusitis?
JAMA 12/5/07 – House of God Law #13: “The delivery of good medical care is to do as much nothing as possible.” The last time we saw this rule at work was with otitis media. A study in JAMA by Williamson et al. sought to see just what good comes from the common practice of prescribing antibiotics and nasal steroids for acute bacterial sinusitis. The study included 240 patients seen by family practitioners in the UK. To be included, the patients had to have 2 or more of the classic clinical diagnostic criteria. No radiology or lab studies were used in diagnosis. Treatment groups were randomized to receive e...
Source: Consider The Evidence: Med/Peds Journal Roundup - December 13, 2007 Category: Internists and Doctors of Medicine Authors: medblog Tags: Uncategorized Source Type: blogs

Thimerosal and Vaccines
NEJM – The latest issue contains a study and two editorial articles on the link between Thimerosal and neuropsychological dysfuntion such as autism. Short story – there is no connection. However, I think the need to find somewhere to place blame will cause many families to continue believing that there is some sort of cover-up no matter how many studies are produced. (Source: Consider The Evidence: Med/Peds Journal Roundup)
Source: Consider The Evidence: Med/Peds Journal Roundup - September 27, 2007 Category: Internists and Doctors of Medicine Authors: medblog Tags: vaccines Source Type: blogs

Review: MRSA infection
NEJM 7/26 – Not an original research article, but a worthwhile read. An article by Daum reviews skin and soft tissue MRSA infection in the Clinical Practice section of the current NEJM. An increasingly common issue for which a refresher is always helpful – I thought the paper was so solid it deserved a mention anyway. Daum, RS. Clinical practice. Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus. N Engl J Med. 2007 Jul 26;357(4):380-90. Review. PMID: 17652653 (Source: Consider The Evidence: Med/Peds Journal Roundup)
Source: Consider The Evidence: Med/Peds Journal Roundup - August 1, 2007 Category: Internists and Doctors of Medicine Authors: medblog Tags: MRSA NEJM Source Type: blogs

Food for thought: Chocolate to lower BP?
JAMA 7/4/07 –  Maybe some wizard medicine applies to muggles as well… An article in JAMA by Taubert et al. tests the theory that flavonols found in dark chocolate may lower blood pressure.   The study population consisted of 44 otherwise healthy subjects with upper-range prehypertension or stage 1 hypertension. Patients with any other major medical problems including CVD, diabetes, hyperlipidemia, etc were excluded. Study design was an RCT with investigators blinded, but subjects not – because they couldnt disguise the white and the dark chocolate. Patients were also counseled to abstain from any...
Source: Consider The Evidence: Med/Peds Journal Roundup - July 18, 2007 Category: Internists and Doctors of Medicine Authors: medblog Tags: cardiovascular hypertension JAMA Source Type: blogs

Do SSRIs reduce bone density?
ArchivesIM 6/25 – The current issue contains a pair of articles that make a connection between SSRI use and bone mineral density (BMD). The pair of observational studies by Diem et al. and Haney et al. seperately studied a cohort of men and women respectively. The study involving women showed a greater yearly decrease in BMD when compared to nonusers as well as trazodone and TCA users. The study of men simply showed overall lower mean BMD associated with SSRIs as well with no effect seen from TCAs.  Obviously both studies suffer from the typical observational methodology pitfalls – but definitely merit fu...
Source: Consider The Evidence: Med/Peds Journal Roundup - July 6, 2007 Category: Internists and Doctors of Medicine Authors: medblog Tags: Uncategorized Source Type: blogs

Changing the asthma treatment paradigm?
NEJM 5/17/07- I can’t help but wonder if this is a “welcome mat for new drug cocktail” study. Papi et al in the BEST study group publish a paper showing that using a steroid inhaler on an as-needed basis might be just as good as twice daily use. The double-blind, double dummy design seems pretty robust, although makes the data a little complicated. In short – all subjects took a regular inhaler twice daily, plus an as-needed inhaler – the design just varied what was in the inhalers among groups. The most relevant comparison was – twice daily beclamethasone plus rescue albuterol (old sko...
Source: Consider The Evidence: Med/Peds Journal Roundup - May 19, 2007 Category: Internists and Doctors of Medicine Authors: medblog Tags: Uncategorized Source Type: blogs