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Specialty: Internal Medicine
Source: Evidence-Based Medicine
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Total 156 results found since Jan 2013.
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
Novel anticoagulants in patients with mechanical heart valves
Commentary on: Eikelboom JW, Connolly SJ, Brueckmann M, et al.. Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med 2013;369:1206. Context Novel anticoagulants (including the direct thrombin inhibitor dabigatran etixilate) and oral factor Xa inhibitors have similar or superior efficacy and safety to warfarin for reducing thromboembolic stroke in patients with atrial fibrillation, and for prevention of deep venous thrombosis. Eikelboom and colleagues set out to examine whether these novel anticoagulants could be used as an alternative to warfarin in patients with mechanical heart valves. Method...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Stewart, R. A. H. Tags: Drugs: cardiovascular system, Stroke, Venous thromboembolism Therapeutics Source Type: research
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
Metformin associated with better cardiovascular outcomes than other glycaemic therapies
Context A question exists as to whether the outcome of glycaemic treatment of diabetes varies with the agent used; speculation surrounds whether metformin might be preferable to other treatments. Methods Ghotbi and colleagues performed an epidemiological analysis of 8192 obese patients with diabetes at increased cardiovascular risk participating in the Sibutramine Cardiovascular OUTcomes (SCOUT) trial. Mortality and a combined cardiovascular outcome of non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest or cardiovascular death were compared among those receiving one of the following interv...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Bloomgarden, Z. T. Tags: Smoking and tobacco, Epidemiologic studies, Drugs: cardiovascular system, Heart failure, Stroke, Hypertension, Diet, Obesity (nutrition), Ischaemic heart disease, Diabetes, Health education, Smoking 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
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
Aspirin plus clopidogrel in acute minor ischaemic stroke or transient ischaemic attack is superior to aspirin alone for stroke risk reduction: CHANCE trial
Commentary on: Wang Y, Wang Y, Zhao X, et al.. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 2013;369:11–19. Context Combination therapy with aspirin added to clopidogrel has had a disappointing record in the prevention of recurrent stroke. The management of atherothrombosis with clopidogrel in high-risk patients (MATCH)1 and the secondary prevention of small subcortical strokes (SPS3)2 randomised controlled trials (RCTs) showed that combination therapy was not more effective than clopidogrel or aspirin alone, but was associated with two to three times the risk of major or ...
Source: Evidence-Based Medicine - March 19, 2014 Category: Internal Medicine Authors: Gorelick, P. B., Farooq, M. U. Tags: Smoking and tobacco, Clinical trials (epidemiology), Genetics, Stroke, Hypertension, Diabetes, Health education, Smoking Therapeutics 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
Atrial fibrillation is associated with an increased risk of cognitive impairment and dementia with or without a history of clinical stroke
Commentary on: Kalantarian S, Stern TA, Mansour M, et al.. Cognitive impairment associated with atrial fibrillation: a meta-analysis. Ann Intern Med 2013;158(5 Pt 1):338–46. Context Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice. The estimated US prevalence of 2.7–6.1 million is expected to increase to 5.6–12.1 million by the middle of the current century. In addition, AF prevalence dramatically increases with age: <1% in individuals aged 50–59 years are affected, whereas about 10% of those aged 80–84 years and 11–18% of those ≥85 ...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Forti, P. Tags: EBM Aetiology, Epidemiologic studies, Drugs: cardiovascular system, Dementia, Drugs: CNS (not psychiatric), Stroke, Memory disorders (psychiatry), Psychiatry of old age, Arrhythmias Source Type: research
