Culture Shock: Web-Based Hep C Tx Guidelines

Practice guidelines are a fact of life in modern medicine. They provide clinicians with the best data and the latest consensus on what the data mean for the care of patients.

But they are — or have been — rather slow to react to changes.

Enter HCVguidelines.org, a website that aims to keep up with one of the fastest-moving fields in medicine today — the treatment of hepatitis C virus (HCV) with what are called direct-acting agents.

The website was developed and will be run jointly by the American Association for the Study of Liver Diseases, the Infectious Diseases Society of America, and the International Antiviral Society-USA.

Read more at MedPage Today

Study Dispels “Obesity Paradox” in Diabetes

A study in the New England Journal of Medicine finds no evidence of a so-called “obesity paradox” in type 2 diabetes — that is, the suggestion that mortality is lower among diabetics who are overweight or obese than among those who are normal weight.

Researchers studied over 11,000 healthcare professionals who were free of cardiovascular disease or cancer at the time of diabetes diagnosis. During 16 years’ follow-up, roughly 3000 participants died.

Overall, the association between baseline BMI and all-cause mortality was J-shaped: Compared with normal-weight participants, underweight participants and those with BMIs of 30 or above had significantly increased mortality risks, with the highest risk at BMIs of 35 or higher (hazard ratio, 1.33).

Previous studies that suggested an obesity paradox were limited by short follow-ups and few deaths, the authors write. They conclude that maintaining a healthy weight “should remain the cornerstone of diabetes management.”

– See more at: http://www.nejm.org/doi/full/10.1056/NEJMoa1304501

How Technology Will Create a Safer Healthcare System

healthIt’s one of those great conundrums. Despite medicine being a highly intellectual field often at the cutting edge of science, we all too often remain near the bottom in terms of our information technology use. Maybe it’s the culture of medicine, a view that one should master everything and do everything despite knowing that this is an impossible goal? Maybe it’s lagging on the part of administration who may not understand the potential role of technology in the daily workflow of their physicians? Or maybe it’s just that we as a profession have never sat down and tried to understand what we’re missing, what we can do, and where we should go with the incorporation of informatics technology?

I choose to believe it is largely the last of these: that we as a profession have not yet began to put proper thought and action to purpose in terms of intelligently using technology to augment our abilities as clinicians.

Think about this scenario: You are on the wards covering 16 patients. Most of your patients are receiving multiple medications – anti-hypertensives, antibiotics, etc. – and let’s say one of them was getting a transfusion overnight as often happens. The team notices that patient begins having trouble breathing and chooses to administer a dose of Lasix which causes resolution of the problem. However, this same patient has a reaction to Lasix and develops allergic interstitial nephritis, which manifests with increased creatinine and reduced GFR on the next set of labs. Continue reading

Should We Lower Blood Pressure in Acute Ischemic Stroke?

In a randomized trial, outcomes were neither better nor worse with early antihypertensive therapy.

A 2013 guideline from the American Stroke Association recommends that we avoid antihypertensive drug therapy during the first 24 hours after onset of acute ischemic stroke unless systolic or diastolic blood pressure (BP) exceeds 220 mm Hg or 120 mm Hg, respectively. (The threshold is 185/110 mm Hg for patients receiving thrombolytic therapy; Stroke 2013; 44:870) The concern is that early BP lowering might worsen stroke outcomes. However, no large randomized trials have tested this theory, until now.

Read the full article

[PMID]24240777[/PMID]

How Good Is the New ACC/AHA Risk Calculator?

Is the new calculator for assessing the 10-year risk of atherosclerotic cardiovascular disease flawed, as suggested by a recent news article, or does it work exactly as the committee members of the risk-assessment guidelines expected it to?

In an article published November 18, 2013 in the New York Times, two physicians testing the accuracy of the new risk calculator developed by the American College of Cardiology (ACC) and American Heart Association (AHA) found that it vastly overestimated patient risk. Drs. Paul Ridker and Nancy Cook (Brigham and Women’s Hospital, Boston, MA) calculated the 10-year risk of cardiovascular events in three large-scale primary prevention cohorts—the Women’s Health Study(WHS), the Physicians’ Health Study (PHS), and the Women’s Health Initiative Observational Study (WHI-OS) — and found the new algorithm overestimated the risk by 75% to 150%.

Read the full article.

New cardio guidelines change statin use, CVD risk assessment

The American Heart Association (AHA) and American College of Cardiology (ACC) issued 4 new cardiovascular disease prevention guidelines last week on cholesterol treatment, cardiovascular risk assessment, lifestyle management and management of overweight and obesity.

The cholesterol guideline made substantial changes to recommendations about statin use, moving away from specific cholesterol targets and likely increasing the number of patients taking the drugs, according to a press release.

See the full article

Heart Groups, CDC Issue New Algorithm for Hypertension Control

A science advisory from the American Heart Association, American College of Cardiology, and CDC — designed as a “call to action for broad-based efforts to improve hypertension awareness, treatment, and the proportion of patients treated and controlled” — includes a new, simple algorithm for controlling hypertension in adults.

The algorithm emphasizes the importance of lifestyle modification as first-line therapy for all patients with stage 1 or 2 hypertension. In addition, a thiazide may initially be considered in certain stage 1 patients (e.g., those with heart failure or diabetes), while two drugs (e.g., a thiazide plus ACE inhibitor) are preferred for stage 2 patients.

The algorithm can be found on page 14 of the free PDF linked below.

– See more at Journal Watch

http://www.sbuim.com/blog/wp-content/uploads/2013/11/Hypertension-2013.pdf

Download this file

Dolutegravir Regimen Superior to Standard Combination ART for HIV

hivReplicationCycleAn HIV treatment regimen of dolutegravir plus abacavir-lamivudine is superior to a currently recommended combination pill, according to a phase III trial published in the New England Journal of Medicine.

In the manufacturer-conducted SINGLE study, roughly 850 treatment-naive patients were randomized to dolutegravir (an integrase inhibitor) plus abacavir-lamivudine or to efavirenz-tenofovir disoproxil fumarate-emtricitabine (EFV/TDF/FTC). After 48 weeks of treatment, the dolutegravir group had a higher percentage of patients with HIV-1 RNA levels under 50 copies per milliliter (88% vs. 81%). The number of adverse events was lower in the dolutegravir group.

In his blog HIV and ID Observations, Paul Sax writes: “Up until the SINGLE study, one could argue that EFV-based treatments — especially TDF/FTC/EFV — represented the gold standard against which all other regimens must compete. Has that now changed? I think it has.”

Abstract from the NEJM: http://www.nejm.org/doi/full/10.1056/NEJMoa1215541

See also:

[PMID]24074642[/PMID]

Afib May Spark MI

Atrial fibrillationAlthough myocardial infarction is a known risk factor for the development of atrial fibrillation, the relationship might work the other way around, too, researchers found.

Among patients without a history of coronary heart disease, those with atrial fibrillation were 70% more likely to have an MI through an average of about 7 years of follow-up after accounting for other potential risk factors (HR 1.70, 95% CI 1.26-2.30), according to Elsayed Soliman, MD, of Wake Forest School of Medicine in Winston-Salem, N.C., and colleagues.

That risk was greatest among women (HR 2.16, 95% CI 1.41-3.31) and black individuals (HR 2.53, 95% CI 1.67-3.86), they reported online in JAMA Internal Medicine.

Full article: http://www.medpagetoday.com/Cardiology/Arrhythmias/42696

Acid-Base Disorders: An Overview

Acid-base disorders are commonly encountered in medicine. It is therefore important for the practitioner to know how to accurately interpret acid-base information as obtained from arterial blood gases, serum chemistries, urine electrolytes, and other sources. The below table can be used to quickly evaluate acid-base disorders. Continue reading

<span>%d</span> bloggers like this: