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Opioid Crisis – Annals of Surgery Special Series

by jmiller on March 9, 2017

Annals of Surgery (April) includes a special series dealing with the opioid crisis which includes:  It’s time to adopt electronic prescriptions for opioids by Atul Gawande’s Preoperative opioid use is independently associated with increased costs and worse outcomes after major abdominal surgery; Predictors of in-hospital postoperative opioid overdose after major elective operations; Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures; Effect of preoperative opioid exposure on healthcare utilization and expenditures following elective abdominal surgery; and iatrogenic opioid dependence in the United States: are surgeons the gatekeepers.  Click here to read full text of these articles.

Management of sepsis and septic shock: new guidelines

by jmiller on March 2, 2017

“Management of sepsis and septic shock” and Viewpoint: “Surviving sepsis guidelines: a continuous move toward better care of patients with sepsis” (JAMA, Feb 28) and “A user’s guide to the 2016 surviving sepsis guidelines” (Critical Care Med, Feb) provide a synopsis to the new guidelines which have recently come out.  Click here to read full text.

In the news: increase in colorectal cancer in millenials. Colorectal cancer incidence patterns in the United States, 1974-2013

by jmiller on March 2, 2017

Article (JNCI, Feb 28) concludes:  “Age-specific CRC risk has escalated back to the level of those born circa 1890 for contemporary birth cohorts, underscoring the need for increased awareness among clinicians and the general public, as well as etiologic research to elucidate causes for the trend.  Further, as nearly one-third of rectal can cancer patients are younger than age 55 years, screening initiation before age 50 years should be considered.  Click here to read full text.

Assessing the risks associated with MRI in patients with a pacemaker of defibrillator

by jmiller on March 2, 2017

“The presence of a cardiovascular implantable electronic device has long been a contra-indication for the performance of MRI.  We established a prospective registry to determine the risks associated with MRI at a magnetic field strength of 1.5 tesla for patients who had a pacemaker or ICD that was “non-MRI-conditional” (i.e. not approved by the FDA for MRI scanning).  The article concludes that in this study, “device or lead failure did not occur in any patient with a non-MRI conditional pacemaker of ICD who underwent clinically indicated nonthoracic MRI at 1.5 tesla, was appropriately screened, and had the device reprogrammed in accordance with the prespecified protocol.  (NEJM, Feb 23).  Click here to read full text

Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Practice Guideline Update

by jmiller on February 2, 2017

Recommendations:  “Inpatients and outpatients with advanced cancer should receive dedicated palliative care services, early in the disease course, concurrent with active treatment.  Referral of patients to interdisciplinary palliative care teams is optimal, and services may complement existing programs.  Providers may refer family and friend caregivers of patients with early or advanced cancer to palliative care services.  (Journal of Clinical Oncology, Jan 1)  Click here to read full text.

Folic Acid Supplementation for the Prevention of Neural Tube Defects: An Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

by jmiller on February 2, 2017

“In studies conducted before the initiation of food fortification in the United States in 1998, folic acid supplementation provided protection against neural tube defects. Newer postfortification studies have not demonstrated a protective association but have the potential for misclassification and recall bias, which can attenuate the measured association of folic acid supplementation with neural tube defects”  (JAMA, Jan 10)  Click here to read full text.

Clinical Guideline: Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians

by jmiller on February 2, 2017

“ACP and AAFP recommend that clinicians consider initiating or intensifying pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk for stroke or cardiac events. (Grade: weak recommendation, low-quality evidence). ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient.”  (Ann Intern Med, Jan)   Click here to read full text.

In the news: Use of CT and chest radiography for lung cancer screening before and after publication of screening guidelines, intended and unintended uptake

by jmiller on February 2, 2017

“The National Lung Screening trial (NLST) released its main findings in 2011,concluding that the use of low-dose findings in 2011, concluding that the use of low-dose computed tomography (CT) to screen for lung cancer reduced lung cancer deaths by 20% compared with chest radiography.  The subsequent publication of new lung cancer screening (LCS) guidelines may raise the public’s awareness of the clinical application of low-dose CT in screening, leading to increased demand for screening not only by individuals who meet the eligibility criteria recommended for LCS but also by those who do not.  The first finding show a high rate of incidental findings (41%), a low rate of detection of lung cancer, and all for a highly resource-intensive program.  From the data reported, we calculate that for every 1000 people screened, 10 will be diagnosed with early-stage lung cancer (potentially curable), and 5 with advanced-stage lung cancer (incurable); 20 will undergo unnecessary invasive procedures (bronchoscopy and thoracotomy) directly related to the screening; and 550 will experience unnecessary alarm and repeated CT scanning.  Screening should be limited to patients most likely to benefit. (JAMA Intern Med, early online)  Click here to read full-text.

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