unmfm / the articles of 2013
TRANSCRIPT
Slide 1W H A T W A S I M P O R T A N T …
… A T L E A S T T O S O M E O F U S
The Articles of 2013
Essential Evidence
Journal Watch
Our faculty
might be leading to paradigm changes
Fun
C H O L E S T E R O L A N D B P
Important New Guidelines
Industry connections Good risk calculator? Low 10 year risk cutoff
for treatment (7.5%) Failure to communicate
risks/harms of treatment Most Panelists
subspecialists No draft recs and time
for public comment
Known ASCVD (Atherosclerotic cardiovascular disease)
Start HIGH potency statin Known CHD or CHD equivalent (Coronary heart disease)
Goal LDL <100 *<70 for “highest risk individuals” Start meds at 130
LDL >190 Start HIGH potency statin 10yr Framingham risk >20% Goal LDL <100 Start meds at 130
Diabetes Age 40-75
Start MODERATE potency statin 2+ CHD risk factors (10 yr Framingham risk <20%)
Goal LDL <130 Start meds at 160
10yr risk ASCVD >7.5% using Pooled Cohort Equation
Start MODERATE to HIGH potency statin
0-1 CHD risk factors Goal LDL <160 Start meds at 190
SmartPhone App
Statins Specified
High potency statin (lower chol by >50%) Atorvastatin 80mg (40 if can’t tolerate) Rosuvastatin 20mg Moderate potency statin (lower chol by ~30-50%) Atorvastatin 10-20mg Rosuvastatin 5-10mg Simvastatin 20-40mg Pravastatin 40-80mg Lovastatin 40mg Fluvastatin 40mg bid
More Controversy/Perspectives
UK (and other) guidelines uses risk cutoff of 20% for statin initiation
Pretest 20%->16%. (NNT 25)
Pretest 7.5%->5% (NNT 67)
Risk calculator puts all men >70 and all African- American men >65 on statins (even with nl BP/chol)
JNC8
More controversy? (endorsed by………..)
5 of 17 JNC8 authors wrote commentary rejecting 150mmHg target for >60
Others say “There is no evidence supporting drug treatment for patients of any age with mild hypertension” (SBP: 140-159 and/or DBP 90-99)
Jackson T. Wright Jr., MD, PhD; Lawrence J. Fine, et al. “Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view.” Ann Intern Med. Published online 14 January 2014 doi:10.7326/M13-2981.
Diao D, Wright JM, Cundiff DK, Gueyffier F. Pharmacotherapy for mild hypertension. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD006742. DOI: 10.1002/14651858.CD006742.pub2.
Will JNC8 Last?
AHA President-Elect: "We are concerned that relaxing the recommendations may expose more persons to the problem of inadequately controlled blood pressure."
ACC/AHA anticipates new guideline in 2015
Controversial Guidelines…What’s Our Job?
unmfm.pbworks.com
Glucocorticoids help COPD exacerbations.
All: day 1 dose of methylprednisolone (40mg)
Then 40mg pred D2-14, vs
40mg D2-5 + placebo D6-14
JAMA
Increasing focus on diagnosis (including effusion)
AAFP
AAFP
Strongest evidence yet to support a specific diet
Large Spanish Study, 5 years
RCT (single blinded)
3 Arms: Med. diet + nuts, Med. diet + olive oil, Low fat diet
97% European Whites, 57% Women
50% Type 2 DM
Reduction in combined endpoint (driven by CVA reduction)
NNT ~70
USPSTF: Grade B
Recs: Age 55-80
Pts with >50 pack-year hx of smoking
Used 4 trials, only 1 “good quality”
53k pts screened yearly for 3 years
6.7% decrease in overall mortality. 20% decrease in Lung CA mortality (vs XR),
Smaller studies did not find benefit
Lots of false positives, incidental findings (7.5%)
Payment Implications?
Other USPSTF-Related Items
No change in Mammography rates since 2009 when new recs came out
Recommended Hep C screening for high risk pts, and a one-time screen for all adults born between 1945-1965. Grade B (Updated from 2004)
Cancer
Meta-analysis of RCTs Trials comparing dual therapy vs monotherapy (various ailments) Heterogenous data
Good(?) Endpoints Slight decrease in hosp readmissions for HF
Not-so-good Endpoints No improvement in other HF endpoints No difference in all cause mortality Slight increase in mortality (RR 1.07) for non HF conditions Increased Renal Failure in pts with HF (RR 2.19) Increased hyperkalemia (9.6% vs 4.9%) Increased withdrawal from treatment
BMJ
RCT 1448 Veterans with DM2
GFR 30-89.9 and proteinuria
Started Losartan, added lisinopril
Median follow-up 2.2 years
AKI and Renal Failure rates were higher in combo group
Trend towards less ESRD (p=.07) but no real other differences (including mortality)
NEJM
Probiotics
Where Things Are
2012 Meta Analysis: probiotics decrease abx associated diarrhea in adults and children.
2013 Meta-Analysis: reduce Cdif diarrhea in adults/children taking abx. No evidence of increased risk of adverse events. (7 Studies, 3.8k pts)
2013 RCT: Probiotics appear not to reduce abx associated diarrhea or cdif in hospitalized older adults. (n= 2900)
Aliment Phamacol Ther
Ann Int Med
Cardiovascular
<1% of CP pts who get stress tests after 2 negative troponins will have benefit from revascularization (retrospective cohort, n=4.1k)
No benefit to stenting atherosclerotic RAS (over med management)
JAMA
NEJM
decreased mortality
1. “Consensus Statement on Concussion in Sport.”
2. “Overuse Injuries and Burnout in Youth Sports: A Position Statement from the American Medical Society for Sports Medicine”
Onto Maternity Care
Some fun things…
ED clinicians (MDs, NPs) overidentify drug-seeking behavior. (PPV 41.2%). Drug seeking definition was 4 rx’s in 12 months from ≥4 providers. (Ann Emerg Med)
Portable US accurate in diagnosis of long bone fractures with 15 mins of training. Sens 90%, spec 96%. (Am J Emerg Med)
Gapabentin and Alcohol Dependence
12-week double blinded RCT of 150 men and women (JAMA):
gabapentin helped abstinence and heavy drinking rates
particularly as dose increased to 1800mg/d.
Misc tidbits, cont…
significantly associated with increased tanning lamp use and outdoor tanning
especially among whites and women.
Misc tidbits, cont…
Diagnostic testing does not reassure patients with low probability of serious disease. (JAMA)
Mean duration of cough in adults is 18days, pts expect a week (Ann Fam Med)
50% of kids will be free of ear pain within 3 days, 90% will take 7-8 days. Cough resolves in 50% of kids within 10 days, but 90% will take 25 days. (Pediatrics)
Misc tidbits, cont…
There seems to be an association between nut consumption and lower all-cause mortality, perhaps even a dose response curve. Study done in health professionals. (NEJM)
References
Guidelines
Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation 2013 Nov 12
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults. Report from the panel members appointed to the eighth joint national committee (JNC 8). JAMA 2014; ;311(5):507-520
Lieberthal AS, Carroll AE, Chonmaitree T, et al. Clinical practice guideline. The diagnosis and management of acute otitis media. Pediatrics 2013;131(13):e964-e999.
Difiori JP, Benjamin HJ, Brenner J, et al. Overuse Injuries and Burnout in Youth Sports: A Position Statement from the American Medical Society for Sports Medicine. Clin J Sport Med 2014;24:3–20
McCrory P, et al. Consensus Statement on Concussion in Sport: the 4th International Conference on Concussion in Sport held in Zurich, Novemeber 2012. Br J Sports Med 2013;47:250–258. doi:10.1136/bjsports-2013-092313
Additional Important Studies
Cooper CJ, Murphy TP, Cutlip DE, et al. Stenting and medical therapy for atherosclerotic renal-artery stenosis. N Engl J M
Makani H, Bangalore S, Desouza KA, Sha A, Messerli FH. Efficacy and safety of dual blockade of the renin-angiotensin system: meta-analysis of randomised trials. BMJ 2013;346:f360.ed 2013 Nov 13
Leuppi JD, Schuetz P, Bingisser R, et al. Short-term vs. conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease. The REDUCE randomized clinical trial. JAMA 2013;309(21):2223-2231
References, continued
Shekelle PG, Pronovost PJ, Wachter RM, et al. The top patient safety strategies that can be encouraged for adoption now. Ann Intern Med 2013;158(5 Pt 2):365-368.
Fogel J, Krausz F. Watching reality television beauty shows is associated with tanning lamp use and outdoor tanning among college students. J Am Acad Dermatology 2013;68(5):784-789.
Hesselmar B, Sjoberg F, Saalman R, et al. Pacifier cleaning practices and risk of allergy development. Pediatrics 2013;131(6):e1829-e1837.
Ebell MH, Lundgren J, Youngpairoj S. How long does a cough last? Comparing patients' expectations with data from a systematic review of the literature. Ann Fam Med 2013;11(1):5-13.
Thompson M, Vodicka TA, Blair PS, et al, for the TARGET Programme Team. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ 2013;347:f2027.
Rolfe A, Burton C. Reassurance after diagnostic testing with a low probability of serious disease. Systematic review and meta-analysis. JAMA Intern Med 2013;173(6)407-416.
Nderitu P, Doos L, Jones PW, Davies SJ, Kadam UT. Non-steroidal anti-inflammatory drugs and chronic kidney disease progression: a systematic review. Fam Pract 2013;30(3):247-255.
Bao Y, Han J, Hu FB, et al. Association of nut consumption with total and cause-specific mortality. N Engl J Med 2013;369(21):2001-2011.
Waterbrook AL, Adhikari S, Stolz U, Adrion C. The accuracy of point-of-care ultrasound to diagnose long bone fractures in the ED. Am J Emerg Med 2013;31(9):1352-1356.
Mason BJ, Quello S, Goodell V, Shadan F, Kyle M, Begovic A. Gabapentin treatment for alcohol dependence: A randomized clinical trial. JAMA Intern Med 2014 Nov 4
References, continued
Aliti GB, Rabelo ER, Clausell N, Rohde LE, Biolo A, Beck-da-Silva L. Aggressive fluid and sodium restriction in acute decompensated heart failure. JAMA Intern Med 2013;173(12):1058-1064.
Hermann LK, Newman DH, Pleasant WA, et al. Yield of routine cardiac testing among patients in an emergency department-based chest pain unit. JAMA Intern Med 2013; 173(12):1128-1133.
Probiotics
Allen SJ, Wareham K, Wang D, et al. Lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea and Clostridium difficile diarrhoea in older inpatients (PLACIDE): a randomised, double-blind, placebo-controlled, multicentre trial. Lancet 2013;382(9900):1249-1257.
Johnston BC, Ma SS, Goldenberg JZ, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea: a systematic review and meta- analysis. Ann Intern Med 2012 Nov 13.
Videlock EJ, Cremonini F. Meta-analysis: probiotics in antibiotic-associated diarrhoea. Aliment Pharmacol Ther 2012;35(12):1355-1369.
USPSTF Related
Moyer VA, for the U.S. Preventive Services Task Force. Screening for hepatitis C virus infection in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013;159(5):349-357.
Moyer VA, on behalf of the U.S. Preventive Services Task Force. Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013
Pace LE, He Y, Keating NL. Trends in mammography screening rates after publication of the 2009 US Preventive Services Task Force recommendations. Cancer 2013;119(14):2518-2523.
Johnston BC, Ma SS, Goldenberg JZ, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea: a systematic review and meta- analysis. Ann Intern Med 2012 Nov 13.
References, continued
Knottnerus BJ, Geerlings SE, Moll van Charante EP, Ter Riet G. Toward a simple diagnostic index for acute uncomplicated urinary tract infections. Ann Fam Med 2013;11(5):442-451.
Weiner SG, Griggs CA, Mitchell PM, et al. Clinician impression versus prescription drug monitoring program criteria in the assessment of drug- seeking behavior in the emergency department. Ann Emerg Med 2013;62(4):281-289.
Torke AM, Schwartz PH, Holtz LR, Montz K, Sachs GA. Older adults and forgoing cancer screening: "i think it would be strange." JAMA Intern Med 2013;173(7):526-531.
Shorr RI, Chandler AM, Mion LC, et al. Effects of an intervention to increase bed alarm use to prevent falls in hospitalized patients. Ann Intern Med 2012;157(10):692-699.
Humphrey LL, Deffebach M, Pappas M, et al. Screening for lung cancer with low-dose computed tomography: a systematic review to update the U.S. Preventive Services Task Force Recommendation. Ann Intern Med 2013;159(6):411-420
Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013;368(1):11-21.
Estruch R, Ros E, Salas-Salvadó J, et al, for the PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; Feb 25.
How can you stay current?
… A T L E A S T T O S O M E O F U S
The Articles of 2013
Essential Evidence
Journal Watch
Our faculty
might be leading to paradigm changes
Fun
C H O L E S T E R O L A N D B P
Important New Guidelines
Industry connections Good risk calculator? Low 10 year risk cutoff
for treatment (7.5%) Failure to communicate
risks/harms of treatment Most Panelists
subspecialists No draft recs and time
for public comment
Known ASCVD (Atherosclerotic cardiovascular disease)
Start HIGH potency statin Known CHD or CHD equivalent (Coronary heart disease)
Goal LDL <100 *<70 for “highest risk individuals” Start meds at 130
LDL >190 Start HIGH potency statin 10yr Framingham risk >20% Goal LDL <100 Start meds at 130
Diabetes Age 40-75
Start MODERATE potency statin 2+ CHD risk factors (10 yr Framingham risk <20%)
Goal LDL <130 Start meds at 160
10yr risk ASCVD >7.5% using Pooled Cohort Equation
Start MODERATE to HIGH potency statin
0-1 CHD risk factors Goal LDL <160 Start meds at 190
SmartPhone App
Statins Specified
High potency statin (lower chol by >50%) Atorvastatin 80mg (40 if can’t tolerate) Rosuvastatin 20mg Moderate potency statin (lower chol by ~30-50%) Atorvastatin 10-20mg Rosuvastatin 5-10mg Simvastatin 20-40mg Pravastatin 40-80mg Lovastatin 40mg Fluvastatin 40mg bid
More Controversy/Perspectives
UK (and other) guidelines uses risk cutoff of 20% for statin initiation
Pretest 20%->16%. (NNT 25)
Pretest 7.5%->5% (NNT 67)
Risk calculator puts all men >70 and all African- American men >65 on statins (even with nl BP/chol)
JNC8
More controversy? (endorsed by………..)
5 of 17 JNC8 authors wrote commentary rejecting 150mmHg target for >60
Others say “There is no evidence supporting drug treatment for patients of any age with mild hypertension” (SBP: 140-159 and/or DBP 90-99)
Jackson T. Wright Jr., MD, PhD; Lawrence J. Fine, et al. “Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view.” Ann Intern Med. Published online 14 January 2014 doi:10.7326/M13-2981.
Diao D, Wright JM, Cundiff DK, Gueyffier F. Pharmacotherapy for mild hypertension. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD006742. DOI: 10.1002/14651858.CD006742.pub2.
Will JNC8 Last?
AHA President-Elect: "We are concerned that relaxing the recommendations may expose more persons to the problem of inadequately controlled blood pressure."
ACC/AHA anticipates new guideline in 2015
Controversial Guidelines…What’s Our Job?
unmfm.pbworks.com
Glucocorticoids help COPD exacerbations.
All: day 1 dose of methylprednisolone (40mg)
Then 40mg pred D2-14, vs
40mg D2-5 + placebo D6-14
JAMA
Increasing focus on diagnosis (including effusion)
AAFP
AAFP
Strongest evidence yet to support a specific diet
Large Spanish Study, 5 years
RCT (single blinded)
3 Arms: Med. diet + nuts, Med. diet + olive oil, Low fat diet
97% European Whites, 57% Women
50% Type 2 DM
Reduction in combined endpoint (driven by CVA reduction)
NNT ~70
USPSTF: Grade B
Recs: Age 55-80
Pts with >50 pack-year hx of smoking
Used 4 trials, only 1 “good quality”
53k pts screened yearly for 3 years
6.7% decrease in overall mortality. 20% decrease in Lung CA mortality (vs XR),
Smaller studies did not find benefit
Lots of false positives, incidental findings (7.5%)
Payment Implications?
Other USPSTF-Related Items
No change in Mammography rates since 2009 when new recs came out
Recommended Hep C screening for high risk pts, and a one-time screen for all adults born between 1945-1965. Grade B (Updated from 2004)
Cancer
Meta-analysis of RCTs Trials comparing dual therapy vs monotherapy (various ailments) Heterogenous data
Good(?) Endpoints Slight decrease in hosp readmissions for HF
Not-so-good Endpoints No improvement in other HF endpoints No difference in all cause mortality Slight increase in mortality (RR 1.07) for non HF conditions Increased Renal Failure in pts with HF (RR 2.19) Increased hyperkalemia (9.6% vs 4.9%) Increased withdrawal from treatment
BMJ
RCT 1448 Veterans with DM2
GFR 30-89.9 and proteinuria
Started Losartan, added lisinopril
Median follow-up 2.2 years
AKI and Renal Failure rates were higher in combo group
Trend towards less ESRD (p=.07) but no real other differences (including mortality)
NEJM
Probiotics
Where Things Are
2012 Meta Analysis: probiotics decrease abx associated diarrhea in adults and children.
2013 Meta-Analysis: reduce Cdif diarrhea in adults/children taking abx. No evidence of increased risk of adverse events. (7 Studies, 3.8k pts)
2013 RCT: Probiotics appear not to reduce abx associated diarrhea or cdif in hospitalized older adults. (n= 2900)
Aliment Phamacol Ther
Ann Int Med
Cardiovascular
<1% of CP pts who get stress tests after 2 negative troponins will have benefit from revascularization (retrospective cohort, n=4.1k)
No benefit to stenting atherosclerotic RAS (over med management)
JAMA
NEJM
decreased mortality
1. “Consensus Statement on Concussion in Sport.”
2. “Overuse Injuries and Burnout in Youth Sports: A Position Statement from the American Medical Society for Sports Medicine”
Onto Maternity Care
Some fun things…
ED clinicians (MDs, NPs) overidentify drug-seeking behavior. (PPV 41.2%). Drug seeking definition was 4 rx’s in 12 months from ≥4 providers. (Ann Emerg Med)
Portable US accurate in diagnosis of long bone fractures with 15 mins of training. Sens 90%, spec 96%. (Am J Emerg Med)
Gapabentin and Alcohol Dependence
12-week double blinded RCT of 150 men and women (JAMA):
gabapentin helped abstinence and heavy drinking rates
particularly as dose increased to 1800mg/d.
Misc tidbits, cont…
significantly associated with increased tanning lamp use and outdoor tanning
especially among whites and women.
Misc tidbits, cont…
Diagnostic testing does not reassure patients with low probability of serious disease. (JAMA)
Mean duration of cough in adults is 18days, pts expect a week (Ann Fam Med)
50% of kids will be free of ear pain within 3 days, 90% will take 7-8 days. Cough resolves in 50% of kids within 10 days, but 90% will take 25 days. (Pediatrics)
Misc tidbits, cont…
There seems to be an association between nut consumption and lower all-cause mortality, perhaps even a dose response curve. Study done in health professionals. (NEJM)
References
Guidelines
Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation 2013 Nov 12
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults. Report from the panel members appointed to the eighth joint national committee (JNC 8). JAMA 2014; ;311(5):507-520
Lieberthal AS, Carroll AE, Chonmaitree T, et al. Clinical practice guideline. The diagnosis and management of acute otitis media. Pediatrics 2013;131(13):e964-e999.
Difiori JP, Benjamin HJ, Brenner J, et al. Overuse Injuries and Burnout in Youth Sports: A Position Statement from the American Medical Society for Sports Medicine. Clin J Sport Med 2014;24:3–20
McCrory P, et al. Consensus Statement on Concussion in Sport: the 4th International Conference on Concussion in Sport held in Zurich, Novemeber 2012. Br J Sports Med 2013;47:250–258. doi:10.1136/bjsports-2013-092313
Additional Important Studies
Cooper CJ, Murphy TP, Cutlip DE, et al. Stenting and medical therapy for atherosclerotic renal-artery stenosis. N Engl J M
Makani H, Bangalore S, Desouza KA, Sha A, Messerli FH. Efficacy and safety of dual blockade of the renin-angiotensin system: meta-analysis of randomised trials. BMJ 2013;346:f360.ed 2013 Nov 13
Leuppi JD, Schuetz P, Bingisser R, et al. Short-term vs. conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease. The REDUCE randomized clinical trial. JAMA 2013;309(21):2223-2231
References, continued
Shekelle PG, Pronovost PJ, Wachter RM, et al. The top patient safety strategies that can be encouraged for adoption now. Ann Intern Med 2013;158(5 Pt 2):365-368.
Fogel J, Krausz F. Watching reality television beauty shows is associated with tanning lamp use and outdoor tanning among college students. J Am Acad Dermatology 2013;68(5):784-789.
Hesselmar B, Sjoberg F, Saalman R, et al. Pacifier cleaning practices and risk of allergy development. Pediatrics 2013;131(6):e1829-e1837.
Ebell MH, Lundgren J, Youngpairoj S. How long does a cough last? Comparing patients' expectations with data from a systematic review of the literature. Ann Fam Med 2013;11(1):5-13.
Thompson M, Vodicka TA, Blair PS, et al, for the TARGET Programme Team. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ 2013;347:f2027.
Rolfe A, Burton C. Reassurance after diagnostic testing with a low probability of serious disease. Systematic review and meta-analysis. JAMA Intern Med 2013;173(6)407-416.
Nderitu P, Doos L, Jones PW, Davies SJ, Kadam UT. Non-steroidal anti-inflammatory drugs and chronic kidney disease progression: a systematic review. Fam Pract 2013;30(3):247-255.
Bao Y, Han J, Hu FB, et al. Association of nut consumption with total and cause-specific mortality. N Engl J Med 2013;369(21):2001-2011.
Waterbrook AL, Adhikari S, Stolz U, Adrion C. The accuracy of point-of-care ultrasound to diagnose long bone fractures in the ED. Am J Emerg Med 2013;31(9):1352-1356.
Mason BJ, Quello S, Goodell V, Shadan F, Kyle M, Begovic A. Gabapentin treatment for alcohol dependence: A randomized clinical trial. JAMA Intern Med 2014 Nov 4
References, continued
Aliti GB, Rabelo ER, Clausell N, Rohde LE, Biolo A, Beck-da-Silva L. Aggressive fluid and sodium restriction in acute decompensated heart failure. JAMA Intern Med 2013;173(12):1058-1064.
Hermann LK, Newman DH, Pleasant WA, et al. Yield of routine cardiac testing among patients in an emergency department-based chest pain unit. JAMA Intern Med 2013; 173(12):1128-1133.
Probiotics
Allen SJ, Wareham K, Wang D, et al. Lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea and Clostridium difficile diarrhoea in older inpatients (PLACIDE): a randomised, double-blind, placebo-controlled, multicentre trial. Lancet 2013;382(9900):1249-1257.
Johnston BC, Ma SS, Goldenberg JZ, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea: a systematic review and meta- analysis. Ann Intern Med 2012 Nov 13.
Videlock EJ, Cremonini F. Meta-analysis: probiotics in antibiotic-associated diarrhoea. Aliment Pharmacol Ther 2012;35(12):1355-1369.
USPSTF Related
Moyer VA, for the U.S. Preventive Services Task Force. Screening for hepatitis C virus infection in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013;159(5):349-357.
Moyer VA, on behalf of the U.S. Preventive Services Task Force. Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013
Pace LE, He Y, Keating NL. Trends in mammography screening rates after publication of the 2009 US Preventive Services Task Force recommendations. Cancer 2013;119(14):2518-2523.
Johnston BC, Ma SS, Goldenberg JZ, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea: a systematic review and meta- analysis. Ann Intern Med 2012 Nov 13.
References, continued
Knottnerus BJ, Geerlings SE, Moll van Charante EP, Ter Riet G. Toward a simple diagnostic index for acute uncomplicated urinary tract infections. Ann Fam Med 2013;11(5):442-451.
Weiner SG, Griggs CA, Mitchell PM, et al. Clinician impression versus prescription drug monitoring program criteria in the assessment of drug- seeking behavior in the emergency department. Ann Emerg Med 2013;62(4):281-289.
Torke AM, Schwartz PH, Holtz LR, Montz K, Sachs GA. Older adults and forgoing cancer screening: "i think it would be strange." JAMA Intern Med 2013;173(7):526-531.
Shorr RI, Chandler AM, Mion LC, et al. Effects of an intervention to increase bed alarm use to prevent falls in hospitalized patients. Ann Intern Med 2012;157(10):692-699.
Humphrey LL, Deffebach M, Pappas M, et al. Screening for lung cancer with low-dose computed tomography: a systematic review to update the U.S. Preventive Services Task Force Recommendation. Ann Intern Med 2013;159(6):411-420
Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013;368(1):11-21.
Estruch R, Ros E, Salas-Salvadó J, et al, for the PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; Feb 25.
How can you stay current?