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.
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?