- The American College of Cardiology and the American Heart Association recently updated joint guidelines on the perioperative evaluation of cardiovascular risk and the management of patients undergoing noncardiac surgery. The new guidelines, which appears on the website of the Journal of the American College of Cardiology, recommend continuing therapy with statin and /or beta blockers in patients taking them chronically as routine practice during the perioperative period.
- In an observation a study in the October issue of JAMA Surgery, researchers compared outcomes after noncardiac surgery in patients taking beta blockers chronically. Compared to patients who discontinued beta blocker therapy during the perioperative period, those who continued therapy had lower incidence of major adverse cardiovascular or cerebrovascular events within one month and lower 30-day mortality.
- In an observational study on the website of the The BMJ, high consumption of milk only was associated with increased risk for cardiovascular and all-cause death, and elevated biomarkers for oxidative stress and inflammation, of the men and women, and increased risk for fracture in women.
- In a study in the October Journal of the American Geriatrics Society, researchers examined whether use of anticholinergic drugs was associated with a higher risk for hospitalization for altered mental status. They found that risk was significant elevated in patients taking more than one anticholinergic agent.
- Results of the survey in the October 21 Annals of Internal Medicine revealed that approximately 20% of primary patient clinicians were unaware of central venous catheters in the patient.
- In a retrospective cohort study on the website of JAMA Internal Medicine, initial treatment of type 2 diabetes with metformin was compared to other approaches. Findings of this study include a second anti-diabetic agent was more likely to be required if other classes of anti-diabetic drugs were initially prescribed and initial treatment with sulfonylureas was associated with excessive risk for new adverse cardiovascular events and for severe hypoglycemia.
- In a study on the website of the Journal of Antimicrobial Chemotherapy, researchers compared 2 approaches to managing methicillin-resistant Staphylococcus aureus. Compared with linezolid, combination therapy with rifampicin trimethoprim/sulfamethoxazole was shown to be noninferior with respect to cure rate.
- Findings from a retrospective cohort study on the website of JAMA Internal Medicine suggest that, in some patients with newly diagnosed atrial fibrillations, dabigatran therapy may be associated with increased risk for any bleeding, major bleeding and gastrointestinal bleeding, compared with warfarin therapy.
- In a study on the website of The Lancet, researchers compare lung-term outcomes in patients with ruptured intracranial aneurysm managed either by neuro surgical clipping or by endovascular coiling. They found that coiling was associated with lower morbidity and mortality.
- In a multicenter study on the website of The Lancet, patients with rheumatoid arthritis on stable medical therapy for more than 3 months were randomized to usual care or usual care plus a hand therapy program. Addition of hand therapy was associated with improvements in hand function at 4 months and 1 year, regardless of whether patients were taking biologic antirheumatic drugs.
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1.美国心脏病学院和美国心脏协会最近更新了关于围手术期心血管风险评估和非心脏手术病人管理的联合指导方针。新的指导方针刊登在美国心脏病学院杂志的网站上, 建议围手术期病人继续他汀类药物和/或β受体阻滞剂常规治疗 (J Am Coll Cardiol 2014 Aug 1; (e-pub ahead of print))。
2.在JAMA杂志十月刊的一项观察研究中, 研究人员比较了长期服用β受体阻滞剂的病人非心脏手术的结果。相较于手术期停用β受体阻滞剂治疗的患者,继续用药的患者, 一个月内严重心血管或脑血管事件的发病率以及30天死亡率均较低 (JAMA Surg 2014 Oct; 149:1031)。
3.英国医学杂志网站上一项观察性研究发现, 过多地摄入牛奶, 可导致心血管疾病风险和全因死亡率增加, 氧化应激和炎症的生物标志升高,以及女性骨折的风险增加 (BMJ 2014 Oct 28; 349:g6015)。
4.在美国老年学会杂志十月刊的一项研究中,研究人员考察了使用抗胆碱能药物是否与精神状态改变而住院相关联。他们发现,服用一种以上抗胆碱能药的患者这种风险显著升高 (J Am Geriatri Soc 2014 Oct; 62:1916)。
5. 10月21日内科年报调查结果显示, 约20％的临床主治医师不知道所管病人带有中心静脉导管 (Ann Intern Med 2014 Oct 21; 161:562)。
6.JAMA内科网站上一项回顾性队列研究，比较了使用二甲双胍或其他药物作为2型糖尿病的初始治疗。结果显示, 如果使用其他类抗糖尿病药物作为初始治疗, 则更可能需要第二种抗糖尿病药物; 使用磺酰脲类药物作为初始治疗, 新的心血管事件和严重低血糖的风险升高 (JAMA Intern Med 2014 oct 27; (e-pub ahead of print))。
7.抗菌疗法杂志网站上的一项研究, 比较了2种治疗耐甲氧西林金黄色葡萄球菌的方案。利福平 (Rifampicin)与磺胺甲恶唑 (TMP/SMX)组合治疗, 治愈率并不亚于利奈唑胺 (Linezolid) (J Antimicrob Chemother 2014 Sep 10; (e-pub ahead of print))。
- JAMA内科的网站上的回顾性队列研究表明，在部分初诊心房纤维性颤动患者, 达比加群的治疗与华法林治疗相比, 可能与任何出血，严重出血和消化道出血风险增加有关 (JAMA Intern Med 2014 Nov 3; (e-pub ahead of print))。
9.在柳叶刀网站上的一项研究中, 研究人员比较了神经外科手术夹闭或血管内卷取(endovascular coiling)治疗破裂颅内动脉瘤的长期疗效。他们发现, 卷取治疗的发病率和死亡率较低 (Lancet 2014 Oct 28; (e-pub ahead of print))。
10.在柳叶刀的网站上一项多中心研究中，类风湿关节炎患者在稳定的药物治疗3个月后，被随机分为常规治疗或常规治疗加手的治疗。结果表明, 常规治疗加手的治疗4个月和1年，无论患者是否服用生物抗风湿药物,手部功能都有攺善 (Lancet 2014 Oct 10; (e-pub ahead of print))。
