Evidence-Based Medicine

Novartis Approval for Gene Therapy Signals New Cancer Treatment Era

The U.S. Food and Drug Administration gave a green light to Novartis AG's leukemia treatment, marking the first time that a highly anticipated new type of potent gene-modifying immunotherapy has gained approval in the United States.

This Postop Outcome is the 3rd Leading Cause of Death in the U.S.

  • Postoperative myocardial infarction (MI) is the 3rd leading cause of death in the U.S.
  • Intraoperative hypotension, arterial occlusion and other phenomena appear to be part of the multifactorial causes.
  • Intraoperative clonidine is not protective against this phenomenon.
  • Perioperative aspirin use was not related to intraoperative or postoperative MI.

Treatment Choices in Atrial Fibrillation

Managing atrial fibrillation to prevent stroke: Use nothing or an oral anticoagulant. Use the CHA2DS2-VASc algorithm as well as gender to determine treatment choices. Dr. Wazni presents treatment choices in further detail.

Let the Patient Decide: Postoperative A-Fib Rhythm and Rate Strategies Are Equivalent

  • New multinational study of more than 500 patients found no clear superiority of either strategy.
  • The incidence of serious thromboembolic events was low, 2%, and did not differ between the arms.
  • More patients in the rate control arm met protocol-specified indications for anticoagulation compared with the rhythm control arm.

This Procedure Is Now First-Line A-Fib Therapy: New ACC Guidelines

  • Recent guidelines from the American college of Cardiology offer important revisions regarding the management of atrial fibrillation.
  • Ablation is now a first-line therapy.
  • Cardiologists should now use the more precise risk stratification scoring system.
  • Tight heart rate control is preferred over lenient control.
  • Antithrombotic therapy is to be individualized based on shared decision-making between patient and physician.

Predicting Risk in AF: Which Stratification Scheme Performs Best?

  • The CHA2DS2-VASc is better at discriminating truly low-risk patients and finding those at high risk as well.
  • In the first validation study from the EuroHeart survey, CHA2DS2-VASc had a similar C statistic to CHADS2 but improved prediction in truly low-risk patients and classified only a small proportion into the intermediate-risk category.
  • the more precise the risk tool is to assess future risk of stroke, the better the chance that low-risk patients can avoid anticoagulation and that those who will benefit from anticoagulation will be identified accurately.
  • The major weakness of CHADS2 is that a substantial proportion of patients (approximately 60%) are assigned a score of 1, indicating an intermediate risk of stroke, and the benefit of application of anticoagulation to this subset is uncertain.

Health Effects of Loneliness and Social Isolation: A Brief Literature Review

Following is a selection of the recent published literature on the relationship between feelings of loneliness, social isolation, and rates of morbidity and mortality.

  • Having social connections improves peoples’ odds of survival by 50% on average.
  • Living alone increased the likelihood of mortality the most, 32%, while social isolation raised the risk by 29% and loneliness by 26%.
  • Simply living with someone else increased survival by nearly 20%.
  • Extensive social integration nearly doubled the odds of survival.

 

New Guidelines Endorse Daily Aspirin, Without a Doubt

  • Daily low-dose aspirin appears to be one of the most cost-effective disease, morbidity, and mortality preventatives available.
  • Updated guidelines from U.S. Preventive Services Task Force (USPSTF) call for the use of aspirin to prevent both cardiovascular disease and gastrointestinal cancers.
  • Major medical societies endorse daily aspirin.
  • Long-term use appears necessary; greatest benefit after 7.5 years of use.
  • Cancer and cardiovascular disease are two of the leading killers of Americans.
  • Vast literature now supports the use of daily aspirin to prevent disease.

New Study Links Alcohol Consumption to Seven Types of Cancer

  • There is increasing evidence linking alcohol consumption to cancer.
  • Mechanisms by which drinking alcohol increase the risk of cancer are not yet understood.
  • New meta-analysis concludes that alcohol causes cancer of the oropharynx, larynx, esophagus, liver, colon, rectum, and breast.
  • “Current estimates suggest that alcohol-attributable cancers at these sites make up 5.8% of all cancer deaths world-wide,” the authors note.

Laparoendoscopic Single-Site Varicocelectomy Significantly Superior to Conventional Lap Approach

  • Laparoendoscopic single-site varicocelectomy found to be superior surgical approach for resolution of varicocele.
  • Cochrane meta-analysis included 6 trials
  • Laparoendoscopic single-site varicocelectomy was superior to conventional laparoscopic surgery with respect to postoperative pain scores, time to convalescence, cosmetic satisfaction, and other clinical variables.
  • Operative time was shorter with CTL-V versus LESS-V.
  • There were no differences between LESS-V and CTL-V in hospital stay and postoperative complications.

Sitting Is the New Smoking: Urge Patients to Stand, Walk, Turn Off TV

  • Prediabetes increasingly detected in middle-aged Americans with normal BMI.
  • All patients should be tested for diabetes and prediabetes.
  • Researchers attribute rise in pre-diabetes to sedentary lifestyle.
  • Studies have shown sitting and a sedentary lifestyle to be a significant health risk.
  • Sitting for more than 3 hours per day cuts life expectancy by at least 3 years.
  • Extended TV watching also tied to decreased lifespan.

Middle-Age Hearing Loss Results in 33% Higher Healthcare Costs

  • Individuals diagnosed with hearing loss had 33% higher healthcare payments.
  • Middle-aged individuals with hearing loss expended $14,165 per year in healthcare expenditures versus $10,629 for those with normal hearing over a 1.5-year period.
  • The onset of hearing loss has been found to be gradual, with prevalence tripling from the age of 50 years to 60 years.
  • Age-related hearing loss affects more than 60% of U.S. adults aged ≥70; has been linked to increased risk of hospitalization, decreased quality of life, and increased risk of functional and cognitive decline.
  • This cohort study included 561,764 individuals.

Some Antihypertensives May Be Linked to Mood Disorders

  • Patients taking beta blockers and calcium channel antagonists had 2x the risk of being hospitalized with a mood disorder.
  • Patients taking angiotensin converting enzymes for hypertension had a lower risk of developing a severe mood disorder.
  • Patients taking a diuretic had a similar mood disorder risk as did control participants.

Traffic Deaths Reach 50-Year High: Opioids and Cannabis Are Adding to the Risk

  • Deaths due to traffic collisions rose in 2015 by 7.7%—the largest increase in 1966.
  • Opioid-related overdose deaths are at epidemic levels.
  • Cannabis use is legal in 25 states.
  • The cost of these collisions and deaths is estimated at nearly $38 billion.
  • Are these phenomena related?

Oncologists Are Leading the Effort for Universal HPV Vaccination

  • HPV is thought to be responsible for more than 90% of anal and cervical cancers, 70% of vaginal, vulvar, and oropharyngeal cancers, and 60% of penile cancers.
  • The vaccine against human papillomavirus (HPV) is considered to be nearly universally effective when properly administered.
  • Pediatricians and primary care physicians have been unable to succeed in providing widespread vaccination in preteens and adolescents.
  • Studies show that physician assertion of efficacy is the most effective means of convincing parents to inoculate young patients.