Molecule of the Year:
Autier P and Gandini S. Vitamin D supplementation and total mortality: A meta-analysis of randomized controlled trials. Arch Intern Med 2007. 167:1730.
Dobnig H, et al. Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med 2008. 168:1340.
Tang BM, et al. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 2007. 379:657.
Magic 8 Ball: Risk stratification
Kanis JA, et al. FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporosis Int 2008. 19:385.
Tosteston ANA, et al. Cost-effective osteoporosis treatment thresholds: The United States perspective. Osteoporos Int 2008. 19:437.
Robbins J, et al. Factors associated with 5-year risk of hip fracture in postmenopausal women. JAMA 2007. 298:2389.
So Many Guidelines, So Little Time…:
U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008. 149:185.
Discontinue screening at age 75.
Qaseem A, et al. Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: A clinical practice guideline from the American College of Physicians. Ann Intern Med 2008. 149:404.
Hammer SM, et al. Antiretroviral treatment of adult HIV infection: 2008 recommendations of the International AIDS Society – USA panel. JAMA 2008. 300:555.
Hirsh J, et al. Antithrombotic and thrombolytic therapy, 8th Ed: ACCP Guidelines. Chest 2008. 133(suppl 6):67S-968S.
The definitive work (now tome) on all things antithrombotic and thrombolytic.
U.S. Preventive Services Task Force. Screening for type 2 diabetes mellitus in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008. 149:147
Screen for diabetes in patients with elevated blood pressure (> 135/80).
Qaseem A, et al. Evidence-based interventions to improve the palliative care of pain, dyspnea, and depression at the end of life: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2008. 148:141.
An affirmation of our active and positive role at the end of life.
Wilson W, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on the Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007. 116:1736-54.
Fleisher LA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2007. 116:418-99.
Qaseem A, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2007. 147:633.
Chou R, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007. 147:478.
The Asymptotic Patient: Increasing intensity of therapy results in diminishing returns
The Action to Control Cardiovascular Risk in Diabetes Study Group (ACCORD). Effects of intensive glucose lowering in type 2 diabetes. New Engl J Med 2008. 358:2545.
No reduction in composite outcome of macrovascular events with intensive therapy; stopped early for increased mortality in intensive group.
The ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. New Engl J Med 2008. 358:2560.
No reduction in macrovascular events with intensive therapy; more severe hypoglycemia.
Wang TH, et al. An analysis of mortality rates with dual-antiplatelet therapy in the primary prevention population of the CHARISMA trial. Eur Heart J 2007. 28:2200.
No benefit to dual platelet inhibition in persons with cardiovascular risk factors, but no overt disease.
Yusuf S, et al (ONTARGET). Telmisartan, ramipril, or both in patients at high risk for vascular events. New Engl J Med 2008. 358:1547.
No benefit to dual inhibition of RAS axis and an increased risk of renal insufficiency.
Patient Safety:
Budnitz DS, et al. Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med 2007. 147:755.
3 groups of drugs (antithrombotic/anticoagulant, diabetes, “narrow therapeutic” agents like phenytoin & digoxin) responsible for almost ½ of ED visits for adverse drug events.
Weissman JS, et al. Comparing patient-reported hospital adverse events with medical record review: do patients know something that hospitals do not? Ann Intern Med 2008. 149:100
Patients surveys/interviews & medical record review identify different types of medical errors. About 5% of serious & potentially preventable adverse events were identified only by patient report.
Food for thought:
Shai I, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. New Engl J Med 2008. 359:229.
Strate LL, et al. Nut, corn, and popcorn consumption and the incidence of diverticular disease. JAMA 2008. 300:907.
Nuts/seeds not associated with incident diverticulosis or bleeding.
Whimsy:
Dunn EW, Aknin LB, and Norton MI. Spending money on others promotes happiness. Science 2008. 319:1687.