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Specialty: Internal Medicine
Source: Evidence-Based Medicine
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Total 156 results found since Jan 2013.
Long-term aspirin use and neovascular age-related macular degeneration: association or causation?
Commentary on: Liew G, Mitchell P, Wong TY, et al.. The association of aspirin use with age-related macular degeneration. JAMA Intern Med 2013;173:258–64. Context Aspirin is used by many for temporary pain relief, rheumatological conditions and where indicated, cardioprotection. However, recent findings from observational studies have raised the possibility that regular aspirin use may also increase the risk of some forms of age-related macular degeneration (AMD). Methods Liew and colleagues examined the relationship between long-term, low-dose aspirin use and risk of AMD in an Australian population-based cohort of 2...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Christen, W. G. Tags: EBM Aetiology, Smoking and tobacco, Epidemiologic studies, Immunology (including allergy), Drugs: cardiovascular system, Pain (neurology), Stroke, Hypertension, Ophthalmology, Pain (palliative care), Pain (anaesthesia), Diabetes, Health education, Smoking Source Type: research
Presence during cardiopulmonary resuscitation is beneficial to family members in the out-of-hospital setting
Commentary on: Jabre P, Belpomme V, Azoulay E, et al.. Family presence during cardiopulmonary resuscitation. N Engl J Med 2013;368:1008–18. Context Inviting family members to be present during cardiopulmonary resuscitation (CPR) is increasingly common; however, it is still a controversial practice and has not been widely adopted in the USA. While a number of studies suggest that family members are amenable to this practice, robust, scientifically rigorous evidence demonstrating the psychological impact of witnessing a family member's resuscitation is lacking. Methods A total of 570 first-degree, adult family members ...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Compton, S., Fernandez, R. Tags: Epidemiologic studies, Stroke, Interventional cardiology, Anxiety disorders (including OCD and PTSD), Child and adolescent psychiatry, Legal and forensic medicine Therapeutics Source Type: research
Ramipril improves walking times and quality of life in patients with stable intermittent claudication
Commentary on: Ahimastos AA, Walker PJ, Askew C, et al.. Effect of ramipril on walking times and quality of life among patients with peripheral artery disease and intermittent claudication: a randomized controlled trial. JAMA 2013;309:453–60. Context Intermittent claudication (IC) is a common condition that may be associated with significant disability and reduction in quality of life. Pharmacological options for the treatment of the symptoms of this condition are very limited. Naftidrofuryl oxalate is recommended in the National Institute for Health and Care Excellence (NICE) guidelines,1 and while this has been sho...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Brittenden, J. Tags: Health policy, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Health service research Therapeutics Source Type: research
Limited impact of omega-3 fatty acids in patients with multiple cardiovascular risk factors
Commentary on: Roncaglioni MC, Tombesi M, et al.. Risk and Prevention Study Collaborative Group. n-3 fatty acids in patients with multiple cardiovascular risk factors. N Engl J Med 2013;368:1800–8 Context Ecological, case–control and prospective studies consistently demonstrate reduced cardiovascular morbidity and mortality associated with higher intake of fish and their constituent omega-3 fatty acids and with higher omega-3 fatty acid status.1 This effect has been ascribed to improvement of the cardiovascular risk profile resulting in disease prevention.1 Trials in patients following myocardial infarction (MI...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Calder, P. Tags: Clinical trials (epidemiology), Epidemiologic studies, General practice / family medicine, Immunology (including allergy), Drugs: cardiovascular system, Stroke, Hypertension, Ischaemic heart disease, Arrhythmias Therapeutics Source Type: research
Dietary salt reduction; further lowering of target lowers blood pressure but may increase risk
Commentary on: He FJ, Li J, Macgregor GA. Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev 2013;(4):CD004937. Context Numerous studies have shown that a high dietary salt intake increases blood pressure (BP) and the risk of cardiovascular events.1 2 Conversely, a moderate and even low-level salt intake lowers BP in a dose-dependent way. Methods He and colleagues have performed a thorough and comprehensive meta-analysis of 34 randomised controlled trials (RCTs) assessing the impact of modest reduction in salt intake with a trial duration of at least 4 weeks. Findings The present...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Messerli, F. H., Bangalore, S. Tags: Clinical trials (epidemiology), Drugs: cardiovascular system, Drugs: CNS (not psychiatric), Heart failure, Stroke, Hypertension, Diet, Ischaemic heart disease Therapeutics Source Type: research
Two-thirds of female smokers aged over 50 die from smoking-related causes, but quitting before 40 decreases this by 90%
Commentary on: Pirie K, Peto R, Reeves GK, et al.. Million Women Study Collaborators. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet 2013;381:133–41. Context Smoking is the leading cause of preventable death. Given that women born after 1940 smoked throughout their lifespan, studies of mortality during the 21st century are needed to understand the hazards associated with prolonged smoking and cessation. Methods In this prospective cohort study, participants completed mailed questionnaires about lifestyle, medical history and demographic factors...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Cooley, M. E., Park, E. R. Tags: EBM Prognosis, Patients, Smoking and tobacco, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Contraception, Drugs: obstetrics and gynaecology, Menopause (including HRT), Pregnancy, Drugs misuse (including addiction), Tobacco related disease, Source Type: research
Perioperative {beta}-blockade improves outcomes in higher risk patients following non-cardiac surgery
Commentary on: London MJ, Hur K, Schwartz GG, et al.. Association of perioperative β-blockade with mortality and cardiovascular morbidity following major noncardiac surgery. JAMA 2013;309:1704–13. Context There has been recent controversy in the perioperative community amid allegations of scientific misconduct and there remains uncertainty about the effectiveness and safety of perioperative β-blockade in patients undergoing non-cardiac surgery.1 Current American Heart Association/American College of Cardiology Foundation (AHA/ACCF) Guidelines on perioperative evaluation and care for non-cardiac surgery limi...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Vaishnava, P., Eagle, K. A. Tags: EBM Aetiology, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Interventional cardiology, Ischaemic heart disease, Ethics Source Type: research
Randomised controlled trial: extended-duration dabigatran is non-inferior to warfarin and more effective than placebo for symptomatic VTE
Commentary on: Schulman S, Kearon C, Kakkar AK, et al.. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med 2013;368:709–718. RE-MEDY and RE-SONATE trials. Context In patients with idiopathic deep vein thrombosis (DVT) or pulmonary embolism (PE), extending the duration of warfarin beyond the initial 3–6 months of anticoagulation significantly reduces the risk for recurrence.1 2 Dabigatran is an oral direct-thrombin inhibitor that has been shown to be as effective as warfarin in the first 6 months after a venous thromboembolism (VTE).3 However, its efficacy and safe...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Liem, T. K., DeLoughery, T. G. Tags: EBM Aetiology, Clinical trials (epidemiology), Drugs: cardiovascular system, Stroke, Venous thromboembolism, Pulmonary embolism Source Type: research
Lower sodium intake reduces blood pressure in adults and children, but is not associated with a reduced risk of all CVD or all cause mortality
Commentary on: Aburto NJ, Ziolkovska A, Hooper L, et al.. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ 2013;346:f1326 Context More than half a century has passed since the idea that the lower blood pressure (BP) associated with lower sodium intake justifies reduced intake for all. Authoritative bodies have subsequently endorsed this view with increasingly ambitious reduction goals. The US Department of Agriculture and US Department of Health and Human Services currently recommend <1.5 g sodium/day for virtually half the population, with <2.3 g1 levels for the remainder. ...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Alderman, M. H., Cohen, H. Tags: EBM Aetiology, Epidemiologic studies, Drugs: cardiovascular system, Drugs: CNS (not psychiatric), Stroke, Hypertension, Diet, Obesity (nutrition), Ischaemic heart disease, Health education Source Type: research
Conservative management for low-risk prostate cancer improves quality-adjusted life expectancy at lower cost compared with initial treatment
Commentary on: Hayes JH, Ollendorf DA, Pearson SD, et al.. Observation versus initial treatment for men with localized, low-risk prostate cancer: a cost-effectiveness analysis. Ann Intern Med 2013;158:853–60. Context What is the best treatment for localised prostate cancer? This simple question, for a common disease now affecting about one in six North American men, does not have a clear answer. This is not a ‘normal’ situation in medicine. For most common diseases, including most primary cancers, there is usually a consensus as to the best therapeutic approach. Not so for localised prostate cancer. Surge...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Klotz, L. Tags: Epidemiologic studies, Stroke, Screening (oncology), Radiology, Surgical diagnostic tests, Clinical diagnostic tests, Prostate Economic analysis Source Type: research
Long-term supplementation with multivitamins and minerals did not improve male US physicians' cardiovascular health or prolong their lives
Commentary on: Sesso HD, Christen WG, Bubes V, et al.. Multivitamins in the prevention of cardiovascular disease in men: the Physicians’ Health Study II randomized controlled trial. JAMA 2012;308:1751–60. Context Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Behavioural risk factors, including tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol, are estimated to be responsible for about 80% of coronary heart disease and cerebrovascular disease.1 Until 2000, observational studies found inverse associations between vitamin intake and CVD outcomes....
Source: Evidence-Based Medicine - November 21, 2013 Category: Internal Medicine Authors: Ebbing, M., Vollset, S. E. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Diet, Ischaemic heart disease Therapeutics Source Type: research
Meta-analysis shows limited benefit of lowering blood pressure below 130/80 mm Hg in patients with type 2 diabetes
Commentary on: McBrien K, Rabi DM, Campbell N, et al.. Intensive and standard blood pressure targets in patients with type 2 diabetes mellitus: systematic review and meta-analysis. Arch Intern Med 2012;172:1296–303. Context Although lowering blood pressure (BP) to the standard target of 140/90 mm Hg improves cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM), the benefits of more intensive lowering to <130/80 mm Hg have not been conclusively demonstrated. Despite this shortcoming, most current practice guidelines recommend this lower target. Two meta-analyses of studies ev...
Source: Evidence-Based Medicine - November 21, 2013 Category: Internal Medicine Authors: Koraishy, F. M., Peixoto, A. J. Tags: Epidemiologic studies, Genetics, Drugs: cardiovascular system, Stroke, Hypertension, Ischaemic heart disease, Diabetes Therapeutics Source Type: research
Vitamin E is ineffective in preventing stroke
Stroke is a leading cause of death and long-term disability worldwide. Vitamin E (tocopherol) is an antioxidant which may protect against atherogenesis by acting as a scavenger of free radicals with subsequent reduced oxidation of low-density lipoprotein cholesterol and several other favourable effects on plaque stability, platelet aggregation and tendency to thrombosis. However, a recent meta-analysis of 13 randomised controlled trials (166 282 participants) showed that, compared with placebo, vitamin E supplementation does not significantly prevent stroke of any type (RR 1.01; 95% CI 0.96 to 1.07).1 The statistical quest...
Source: Evidence-Based Medicine - November 21, 2013 Category: Internal Medicine Authors: Brigo, F., Storti, M., Tezzon, F., Nardone, R. Tags: Letters Source Type: research
Coronary revascularisation in patients with diabetes: a chance to be better
Commentary on: Farkouh ME, Domanski M, Sleeper LA, et al.. Strategies for multivessel revascularisation in patients with diabetes. N Engl J Med 2012;367:2375–84. Context In 2009, a pooled analysis of individual patient data from randomised clinical trials comparing percutaneous coronary interventions (PCI) with coronary artery bypass grafting (CABG) showed a survival benefit in favour of CABG.1 Techniques of both PCI and CABG evolved during the last decade with the use of drug-eluting stents (DES) and novel antiplatelet agents. Methods In the FREEDOM trial, patients with diabetes and multivessel coronary artery disea...
Source: Evidence-Based Medicine - November 21, 2013 Category: Internal Medicine Authors: Windecker, S., Stefanini, G. G. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease Therapeutics Source Type: research
Modest cancer prevention benefit with long-term multivitamin supplementation: Physicians' Health Study II results warrant cautious interpretation
Commentary on Gaziano JM, Sesso HD, Christen WG, et al.. Multivitamins in the prevention of cancer in men: the Physicians’ Health Study II randomised controlled trial. JAMA 2012;308:1871–80. Context Various vitamins and minerals have been shown to inhibit carcinogenesis or reduce cancer risk in preclinical experiments and observational studies. Such work has given rise to several chemoprevention trials of isolated nutrients, many of which (eg, Alpha-Tocopherol and Beta-Carotene (ATBC) Trial, Carotene and Retinol Efficacy Trial (CARET) and Selenium and Vitamin E Cancer Prevention Trial (SELECT)) have produced d...
Source: Evidence-Based Medicine - November 21, 2013 Category: Internal Medicine Authors: Demark-Wahnefried, W. Tags: Liver disease, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Diet, Prevention, Complementary medicine, Dermatology, Prostate Therapeutics Source Type: research
