MD Consult - Find The Answer

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This week, the news that drinking coffee may be associated with a lower overall risk of death has been making many merry; it seems that the potential benefit comes with both caffeinated and decaffeinated coffee. The paper, published in The New England Journal of Medicine and summarized on MD Consult, noted that the amount of coffee required is not insignificant, though – six or more cups a day– which implies many trips to Starbucks, your preferred indie coffee house or to the office kitchen. The actual mechanism involved is still unclear, however, and readers were reminded that correlation is not causation. Also making the news, albeit in a more worrying way, is the antibiotic azithromycin. It was associated with an increased risk of cardiovascular death, and more caution was urged for those who prescribe the popular drug regularly. Patients who ask for antibiotics in situations that do not really warrant them may want to consider a cup of coffee instead.

The May issue of Chest features an interesting commentary on lung cancer screening, in which the authors note that while it has been demonstrated that CT scans for smokers clearly reduces mortality, it is very expensive; a lower-cost, but still-effective, approach is proposed as an alternative. An article with a critical care focus explores the use of macrolide antibiotics for patients with acute lung injury, and the results are encouraging. Also of note is a piece of original research describing a novel drug delivery system for pleural cavity chest infections – biodegradable beads that gradually release antibiotics. While the findings are at a preliminary stage, it certainly offers an interesting direction for future research. Other new research in this issue looks at sleep-disordered breathing and community-acquired alveolar pneumonia in children and an examination of COPD patients using a ‘new’ walking aid – and of course there are many other topics covered in this issue as well. Another new journal this week is the May 15 American Family Physician. A practical guide to the ‘well male’ examination is offered, together with a handout for patients, and there is also an article on the importance of preventing malaria in travelers – a handout is available for that subject as well. READ MORE >>

MD Consult gained another new book edition this week – the latest Obstetrics: Normal and Problem Pregnancies is now available on the site. Produced by an integrated team of editors, this sixth edition has been revised with the wants and needs of the reader very much in mind. Before work was undertaken, a reader survey was conducted to pinpoint areas that needed a closer look, and as a result there are four new chapters: Developmental Origins of Adult Health and Disease, Nutritional Management During Pregnancy, Trauma and Related Surgery in Pregnancy, and Patient Safety and Quality Measurement in Obstetrical Care. Throughout the book, figures and tables have been refined and the appendices are updated as well. Published since 1986, the title continues to serve not only as an introduction to obstetrics, but also as a useful tool for review and discovery of new trends in patient care.

Regular readers may have also noticed a number of changes to the Recommended Resources pages: they have a cleaner, more modern look and feel, and (in some cases) their content is expanding. Icons now indicate whether links are from a book or journal article, or if they include an image or table. The pages load more quickly, and are easier to view on a tablet or mobile device. In addition, depending on your subscription type, you may begin seeing a wider array of book-related links; this feature is being rolled out slowly across the section, but it can be viewed now on a number of pages, including breast cancer, cholelithiasis, hepatocellular carcinoma, pulmonary embolism and ulcerative colitis, to name just a few – see if you can spot the others! Keep an eye out for more additions to this section over the coming weeks and months. READ MORE >>

MD Consult added a new book edition this week – the third edition of Integrative Medicine by Dr. David Rakel. Like the previous edition, the text offers an evidence-based guide for the inclusion of complementary and conventional therapies within a modern medical practice. Some of the conditions not covered in the last edition that are now addressed are multiple sclerosis, Parkinson’s disease, insomnia, Lyme disease, polycystic ovarian syndrome, and a number of other hormonal disorders. Rakel notes that while the book’s coverage has expanded, it has actually reduced in page count, resulting in a more targeted approach. Maintained in this edition are the useful Evidence-Versus-Harm Grading Icons that offer the clinician a quick overview to the subjects at hand.

May journals are arriving in good numbers, and among them is the American Journal of Obstetrics and Gynecology. One paper looks at the growing trend of elective early term deliveries. The authors emphasize that they are only addressing truly elective deliveries in this article, but they do point out the need for solid policies to frame the issue. Also of interest is a look at how labor patterns have changed over the past 50 years; another change in the field is the huge rise in the number of superobese women requiring obstetrical care. A study on the subject found a significant increase in risk for perinatal complications for such patients and their infants, even when compared to other overweight women. Also new for May is General Hospital Psychiatry. One study examines how frequently general practitioners recognize anxiety disorders, while another looks at the prevalence of depression in diabetic patients. A case report looks at a man with severe, frequent yawning that was treated with propranolol, while another covers the use of pregabalin for Tourette’s syndrome patients who have not responded well to other therapies. READ MORE >>

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MD Consult’s News section featured a dispatch from the complementary and alternative medicine realm; the results of a trial presented at the annual meeting of the Society of Behavioral Medicine suggested that hypnosis may be an effective treatment for severe postmenopausal hot flashes. It was noted that the reduction in symptoms was stronger than that seen in many pharmacological approaches, and the lack of side effects was another positive. However, there are challenges involved in making the strategy widely-available, so further steps would be needed in that regard. Reports also issue from the Society of Hospital Medicine’s meeting, with talks on hospital readmissions, recertification issues and an exploration of the possible effects of statins on pneumonia mortality.

This week also saw a new issue of Chest appear in the Journals, and it covers a wide array of pulmonology-related topics. The impact of ischemic heart disease on COPD was analyzed; patients with both conditions frequently exhibited worse health status, lower exercise capacity, and more dyspnea compared to other COPD patients. And while the many risks of smoking during pregnancy are well-known, another paper looked at the relationship between maternal smoking and subsequent wheezing among preschool children; unsurprisingly, the association was not a positive one. Another study examining children’s health looked at pediatric obesity-associated asthma and noted that it was significantly different from atopic asthma, and considerably less well-understood. Another article looked at chronic mountain sickness – a public health issue for communities at altitude, and not simply a disease of mountaineers – and role of exercise in rapid interstitial lung fluid accumulation in CMS sufferers. The authors suggests that it is a contributing factor for exercise intolerance in these populations. Also new in the Journals is the May 1 issue of The American Journal of Cardiology. It features a twin study comparing obese and non-obese siblings and their rates of cardiovascular disease – the extra epicardial fat seemed to make quite a difference. Another article looked at an unusual group of hypertrophic cardiomyopathy patients – those over 90 years of age. While still noting its well-known dangers in younger patients, the authors found that it was quite different in this elderly population. Of course, there is much more to discover beyond these articles. READ MORE >>

Joplin's St. John's Hospital, post-tornado

It’s tornado season in the Midwest, and it is just a month shy of the 1-year anniversary of Joplin, MO’s massive tornado strike. The town’s St. John’s Hospital was rendered unusable in the disaster, but it is being reborn as Mercy-Joplin – this time with an even stronger disaster plan (and windows that can withstand winds of up to 200 mph). Elsewhere it was noticed that an Institute of Medicine report found most hospitals unprepared to handle major catastrophic events, even among those that have a response plan. The report included a guide for better disaster planning in the future.

The April issue of Neurology appeared recently and it covers a range of topics. One article suggests that a high intake of some flavonoids (obtained from tea, berries, apples, red wine, and oranges) may reduce the risk of developing Parkinson’s disease (particularly for men), although the exact mechanism was unclear. For those who have the condition, activity was shown to improve the response to levadopa, although the authors recommended further studies to explore the notion. Also examined in this issue is whether children who experience febrile seizures are at a higher risk of developing epilepsy later; the results of this long-term follow-up seem to show that risk decreasing over time, but again, the authors recommend further research to confirm their findings. Pediatric Neurology is new this week as well; the May issue is quite global in its approach. One study looked at American children with epileptic spasms, while another explored the use of antiepileptic drugs in Hong Kong. Optic neuritis in Malaysian children was examined, and, heading to Turkey, we find an article on head circumference growth reference charts. READ MORE >>