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Specialty: Internal Medicine
Source: Evidence-Based Medicine
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Total 156 results found since Jan 2013.
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
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
Citalopram decreases agitation in the context of Alzheimer's disease, but at doses higher than those commonly prescribed and at the expense of side effects
Commentary on: Porsteinsson AP, Drye LT, Pollock BG, et al.. Effect of citalopram on agitation in Alzheimer disease. The CitAD randomised clinical trial. JAMA 2014;311:682–91. Context By 2050, an estimated 135 million people will suffer from dementia globally.1 Caring for those with Alzheimer's disease (AD)—by far the most common form of dementia—is expensive, costing an estimated £23 billion per annum in the UK. As the disease progresses, neuropsychiatric symptoms such as depression, agitation and behavioural disturbance appear. The incidence of these symptoms, which predict institutionalisation an...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Underwood, B. R., Fox, C. Tags: Neurogastroenterology, Geriatric medicine, Dementia, Drugs: CNS (not psychiatric), Sleep disorders (neurology), Stroke, Drugs: psychiatry, Eating disorders, Memory disorders (psychiatry), Psychiatry of old age, Psychotic disorders (incl schizophrenia), Sl Source Type: research
Non-vitamin-K oral anticoagulants reduce mortality, stroke and intracranial haemorrhage when compared with warfarin in randomised trials of patients with non-valvular atrial fibrillation
Commentary on: Ruff CT, Giugliano RP, Braunwald E, et al.. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014;383:955–62. Context Historically, the standard medication for stroke prevention in atrial fibrillation (AF) has been a vitamin-K antagonist (warfarin). However, several non-vitamin-K oral anticoagulants (NOACs) have been developed and shown to be at least as effective as dose-adjusted warfarin in their respective phase-3 clinical trials.1–4 These include the direct thrombin inhibitor dabig...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Steinberg, B. A. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Connective tissue disease, Musculoskeletal syndromes, Diabetes, Arrhythmias 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
Overenthusiastic stroke risk factor modification in the over-80s: Are we being disingenuous to ourselves, and to our oldest patients?
Statins and antihypertensive therapy are widely used in our oldest patients (ie, those aged over 80 years). The epidemiology suggests that, by this age, hypertension is not an attributable risk factor for stroke, and hypercholesterolaemia has little effect on stroke risk overall. The largest trials of antihypertensive therapy and statins in this age group show at best a marginal clinical reduction in stroke and very modest clinical reductions in other cardiovascular end points. Older patients have very diverse views on the relative importance of stroke and death as end points, and these differ from physicians’ views....
Source: Evidence-Based Medicine - July 18, 2014 Category: Internal Medicine Authors: Byatt, K. Tags: Geriatric medicine, Clinical trials (epidemiology), Editor's choice, Press releases, Drugs: cardiovascular system, Stroke, Hypertension, Ethics, Legal and forensic medicine, Lipid disorders Perspective Source Type: research
Dual antiplatelet therapy in recurrent stroke prevention: do the benefits outweigh the risks?
This study assessed seven randomised controlled trials, comprising 39 574 patients and comparing dual versus single antiplatelet therapies. Medications used included aspirin (50–325 mg daily), clopidogrel (75 mg daily), aspirin plus dipyridamole (50/400 mg daily) and ticlopidine (100 mg daily). Patients had a history of ischaemic stroke (three trials) or TIA (four...
Source: Evidence-Based Medicine - July 18, 2014 Category: Internal Medicine Authors: Farooq, M. U., Gorelick, P. B. Tags: Clinical trials (epidemiology), Stroke Therapeutics 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
Seven days of non-invasive cardiac monitoring early postischaemic stroke or TIA increases atrial fibrillation detection rate compared with current guideline-based practice
Commentary on: Higgins P, Macfarlane PW, Dawson J, et al.. Non-invasive cardiac event monitoring to detect atrial fibrillation after ischemic stroke: a randomized, controlled trial. Stroke 2013;44:2525–31. Context Atrial fibrillation (AF) is an established risk factor for stroke, and anticoagulation treatment is effective in reducing recurrent stroke risk. Guidelines recommend the use of clinical prediction tools to select patients with AF for anticoagulation therapy. It has long been recognised that paroxysmal AF (PAF) may pose a similar stroke risk to persistent AF, but the association between the duration of PAF a...
Source: Evidence-Based Medicine - July 18, 2014 Category: Internal Medicine Authors: Coutts, S. B., Choi, P. M. C. Tags: EBM Diagnosis, Clinical trials (epidemiology), Drugs: cardiovascular system, Stroke, Radiology, Clinical diagnostic tests, Radiology (diagnostics), Screening (epidemiology), Screening (public health) Source Type: research
Migraine is a marker for risk of both ischaemic and haemorrhagic stroke
This study summarises the available evidence. Methods Sacco...
Source: Evidence-Based Medicine - July 18, 2014 Category: Internal Medicine Authors: Kurth, T. Tags: EBM Aetiology, Epidemiologic studies, Headache (including migraine), Pain (neurology), Stroke 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
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
Meta-analysis finds benefit for dual antiplatelet therapy but limitations preclude changing standard mono antiplatelet therapy approach for acute non-cardioembolic ischaemic stroke or transient ischaemic attack
Commentary on: Wong KSL, Wang Y, Leng X, et al.. Early dual versus mono antiplatelet therapy for acute non-cardioembolic ischemic stroke or transient ischemic attack. An updated systematic review and meta-analysis. Circulation 2013;128:1656–66. Context Current guidelines recommend aspirin, aspirin plus clopidogrel or aspirin plus extended-release dipyridamole for treatment of acute ischaemic stroke (IS) or transient ischaemic attack (TIA) to prevent recurrent stroke, myocardial infarction and cardiovascular death.1 The Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial ra...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Aronow, W. S. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease Therapeutics Source Type: research
