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Specialty: Internal Medicine
Source: Evidence-Based Medicine
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Total 156 results found since Jan 2013.
Ultrasound-guided corticosteroid injections for adhesive capsulitis more effective than placebo
Commentary on: Prestgaard T, Wormgoor ME, Haugen S, et al.. Ultrasound-guided intra-articular and rotator interval corticosteroid injections in adhesive capsulitis of the shoulder: a double-blind, sham-controlled randomized study. Pain 2015;156:1683–91. Context Adhesive capsulitis (frozen shoulder or painful stiff shoulder) is relatively common. It is idiopathic: known associated factors include trauma, diabetes, prolonged immobilisation, age, stroke and autoimmune disease. While self-limited, pain and decreased range of motion can last up to 2–3 years. Therefore, there is practical value in therapeutic in...
Source: Evidence-Based Medicine - March 21, 2016 Category: Internal Medicine Authors: Lebrun, C. M. Tags: Rehabilitation medicine, Immunology (including allergy), Pain (neurology), Stroke, Radiology, Degenerative joint disease, Musculoskeletal syndromes, Osteoarthritis, Sports and exercise medicine, Clinical diagnostic tests, Radiology (diagnostics), Screenin 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
ACE inhibitors in African Americans with hypertension associated with worse outcomes as compared to other antihypertensives
Commentary on: Bangalore S, Ogedegbe G, Gyamfi J, et al.. Outcomes with angiotensin-converting enzyme inhibitors vs other antihypertensive agents in hypertensive blacks. Am J Med 2015;128:1195–203. Context Hypertension affects one-third of the world's population and remains a leading cause of myocardial infarction, stroke, heart failure, renal failure and death. Although hypertension control has improved,1 the prevalence is increasing due to an ageing population, rising obesity and a shift towards western lifestyles and disease patterns in low-income and middle-income countries. Hypertension is now also a major contr...
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Lund, L. H. Tags: EBM Prognosis, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Obesity (nutrition), Ischaemic heart disease, Renal medicine, Drugs: musculoskeletal and joint diseases, Health education 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
The risk of arterial thrombosis increases with the use of combined oral contraceptives
Commentary on: Roach RE, Helmerhorst FM, Lijfering WM, et al.. Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke. Cochrane Database Syst Rev 2015;8:CD011054. Context While the risk of venous thrombosis with use of combined oral contraceptives (COC) is now convincingly quantified to be threefold to sixfold increased, depending mainly on the type of progestogen, there are few and less consistent studies on the risk of arterial endpoints. Therefore, a meta-analysis on available evidence might be relevant. Method This Cochrane review includes data from 24 studies assessing the risk of thrombot...
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Lidegaard, O. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Contraception, Drugs: obstetrics and gynaecology, Ischaemic heart disease, Venous thromboembolism Aetiology/Harm Source Type: research
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
Intra-arterial thrombectomy improves functional outcome when administered up to 6 h after stroke
Commentary on: Berkhemer OA, Fransen PS, Beumer D, et al., MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11–20 . Context Ischaemic stroke is a common cause of death and disability worldwide. Intravenous tissue plasminogen activator (tPA) reduces disability when administered up to 4.5 h after symptom onset. In severe strokes, when a proximal large vessel occlusion is present, recanalisation rates with tPA are low. Intra-arterial (IA) thrombectomy techniques, particularly stent-retriever devices, have much higher recanalisation rates. IA ther...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Mullen, M. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology Therapeutics/Prevention Source Type: research
The success of mechanical thrombectomy in acute ischaemic stroke is strictly dependent on ischaemic core size and time to treatment
Commentary on: Jovin TG, Chamorro A, Cobo E, et al., REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015;372:2296–306; Saver JL, Goyal M, Bonafe A, et al., SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015;372:2285–95 . Context Three trials showing no difference in clinical outcome between patients with acute ischaemic stroke (AIS) treated by mechanical thrombectomy (MT) and those treated by intravenous thrombolysis (IVT) had the effect of reducing the number of patients with ...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Sallustio, F., Di Legge, S. Tags: Stroke, Interventional cardiology, Radiology, Clinical diagnostic tests, Radiology (diagnostics) Therapeutics/Prevention Source Type: research
At 5 years, transcatheter aortic valve replacement had similar rates of mortality and stroke as surgical aortic valve replacement in high-risk patients
Commentary on: Kapadia SR, Leon MB, Makkar RR, et al., PARTNER trial investigators. 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet 2015;385:2485–91 and Mack MJ, Leon MB, Smith CR, et al., PARTNER 1 trial investigators. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER1): a randomised controlled trial. Lancet 2015;385:2477–84. Context When calcific aortic stenosis is as...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Reardon, M. J., Kleiman, N. S. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Heart failure, Stroke, Interventional cardiology, Valvar diseases Therapeutics/Prevention Source Type: research
Low-molecular-weight heparin offers no benefit to patients with unexplained recurrent miscarriage in future pregnancy
Commentary on: Schleussner E, Kamin G, Seliger G, et al., ETHIG II group. Low-molecular-weight heparin for women with unexplained recurrent pregnancy loss: a multicenter trial with a minimislation randomisation scheme. Ann Intern Med 2015;162:601–9 . Context Recurrent miscarriage (RM) has been shown to affect between 1% and–3% of couples trying to conceive and up to 5% of those with two consecutive miscarriages are included. While there are many known risk factors for RM no underlying cause is found in nearly 50% of couples.1 The treatment of RM is usually aimed at the cause, which leaves us with very little to...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Field, K. Tags: Journalology, Drugs: cardiovascular system, Stroke, Pregnancy, Ethics Therapeutics/Prevention Source Type: research
Interruption of all anticoagulation is non-inferior to the use of short-term parenteral bridging in patients with atrial fibrillation undergoing invasive procedures
Commentary on: Douketis JD, Spyropoulos AC, Kaatz S, et al., BRIDGE Investigators. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med 2015;373:823–33 . Context Oral anticoagulation (OAC) has been demonstrated to reduce stroke in patients with atrial fibrillation (AF), however, its use conveys an increased risk of bleeding.1 Therefore, patients receiving OAC who undergo invasive procedures often ‘interrupt’ OAC. Use of short-term ‘bridging’ anticoagulants during such interruptions has been the source of significant debate.2 Although guidelines support a ri...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Steinberg, B. A. Tags: Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Valvar diseases, Arrhythmias Therapeutics/Prevention Source Type: research
Mediterranean diet may reduce Alzheimer's risk
This study included 447...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Psaltopoulou, T., Sergentanis, T. N. Tags: Smoking and tobacco, Clinical trials (epidemiology), Dementia, Drugs: CNS (not psychiatric), Stroke, Hypertension, Diet, Memory disorders (psychiatry), Psychiatry of old age, Lipid disorders, Health education, Smoking Therapeutics/Prevention Source Type: research
