Los mejores artículos del 2010 para Medicina Familiar y General, por Journal Watch

Adjuntamos la nota y links de Jounal Watch, con los mejores artículos para Medicina Familiar y General en 2010.

Esperamos les sean de interés, y les deseamos un excelente 2011 a todos. ¡Felicidades!

General Medicine Most-Read Stories of 2010

Our readers choose their favorite stories from 2010.

Each year, the editors of Journal Watch General Medicine select and comment on the most important themes in clinical research; we’ll continue this tradition with our 2010 Year in Review. We’re also repeating a feature that we introduced in 2009 — highlighting the 10 stories that our online readers (both generalists and specialists) visited most often. No dominant theme or pattern emerged in the 2010 Most-Read list — this fact probably reflects the heterogeneity of the topics we cover, and the breadth of interests of our online readership — but we hope you’ll enjoy looking back at these stories and considering how they influenced your practice in 2010.

Best wishes for 2011.

— Allan S. Brett, MD, Editor-in-Chief, Journal Watch General Medicine and the Journal Watch General Medicine Editors

General Medicine Top Stories of 2010: Most Read

SUMMARY AND COMMENT

Analgesia: Are Acetaminophen/NSAID Combinations More Effective Than One Drug Alone?

• April 9, 2010
• Emily L. Brown, MD, and Ron M. Walls, MD, FRCPC, FAAEM
• Emergency Medicine

A systematic review indicates that combinations are more effective for relieving acute pain.

• Reviewing:
• Ong CK et al. Anesth Analg 2010 Apr; 110:1170.

SUMMARY AND COMMENT

Dopamine vs. Norepinephrine in Treatment of Shock

• March 3, 2010
• J. Stephen Bohan, MD, MS, FACP, FACEP
• Emergency Medicine

A large randomized trial shows no difference in death rates with the two agents overall but significantly higher mortality with dopamine among patients with cardiogenic shock.

• Reviewing:
• De Backer D et al. N Engl J Med 2010 Mar 4; 362:779.
  Levy JH. N Engl J Med 2010 Mar 4; 362:841.

SUMMARY AND COMMENT

Proton-Pump Inhibitor Dosing and Negative Consequences

• June 8, 2010
• Jamaluddin Moloo, MD, MPH
• General Medicine

Four studies about the effects of PPI therapy

• Reviewing:
• Wang C-H et al. Arch Intern Med 2010 May 10; 170:751.
  Gray SL et al. Arch Intern Med 2010 May 10; 170:765.
  Linsky A et al. Arch Intern Med 2010 May 10; 170:772.
  Howell MD et al. Arch Intern Med 2010 May 10; 170:784.
  Katz MH. Arch Intern Med 2010 May 10; 170:747.

SUMMARY AND COMMENT

The ACCORD Lipid Study: Fenofibrate Doesn’t Help

• March 14, 2010
• Harlan M. Krumholz, MD, SM
• Cardiology

Although triglyceride levels improved markedly with fenofibrate, incidence of adverse cardiovascular events was not affected.

• Reviewing:
• The ACCORD Study Group. N Engl J Med 2010 Mar 14.

SUMMARY AND COMMENT

Aspirin for Primary Prevention in Patients with Diabetes

• July 8, 2010
• Allan S. Brett, MD
• General Medicine

Recommendations from three professional organizations

• Reviewing:
• Pignone M et al. Circulation 2010 Jun 22; 121:2694.

SUMMARY AND COMMENT

Monoarticular Arthritis: Which Patients to Treat for Gout?

• September 10, 2010
• J. Stephen Bohan, MD, MS, FACP, FACEP
• Emergency Medicine

A new clinical score supports decision making.

• Reviewing:
• Janssens HJEM et al. Arch Intern Med 2010 Jul 12; 170:1120.

SUMMARY AND COMMENT

Self-Management for Hypertension

• December 3, 2009
• Richard Saitz, MD, MPH, FACP, FASAM
• General Medicine

Two interventions helped patients reach blood pressure goals.

• Reviewing:
• Bosworth HB et al. Ann Intern Med 2009 Nov 17; 151:687.

SUMMARY AND COMMENT

The ACCORD Blood Pressure Study: What Target for High-Risk Diabetic Patients?

• March 14, 2010
• Harlan M. Krumholz, MD, SM
• Cardiology

Achieving systolic blood pressure levels lower than 140 mm Hg does not prevent adverse cardiovascular events.

• Reviewing:
• The ACCORD Study Group. N Engl J Med 2010 Mar 14.

SUMMARY AND COMMENT

Lipids, Apolipoproteins, and Vascular Disease: What to Measure?

• November 24, 2009
• Thomas L. Schwenk, MD
• General Medicine

Either total and HDL cholesterol, or apolipoproteins, fasting or not, are equally accurate.

• Reviewing:
• Di Angelantonio E et al. for the Emerging Risk Factors Collaboration. JAMA 2009 Nov 11; 302:1993.

SUMMARY AND COMMENT

Tranexamic Acid Reduces Mortality After Major Trauma

• June 15, 2010
• Kristi L. Koenig, MD, FACEP
• Emergency Medicine

This promising new therapy is inexpensive and easy to administer.

• Reviewing:
• CRASH-2 trial collaborators. Lancet 2010 Jun 15.
  Levy JH. Lancet 2010 Jun 15.

Published in Journal Watch General Medicine December 28, 2010

Sesgo de publicaciones y conflictos de interés

les dejamos un link a un artículo muy interesante y didáctico publicado en www.trialsjournal.com

Agradecemos a Juan Gervás de Equipo CESCA, España, por haberlo hacercado a la lista MEDFAM de Argentina.

Saludos

Link: http://www.trialsjournal.com/content/pdf/1745-6215-11-37.pdf

Diabetes, Hipertensón Arterial y Dislipemia: conclusiones del estudio ACCORD (NEJM)

Se adjuntan los links para bajar las notas recientemente publicadas en New England Journal of Medicine (NEJM), referidas al conocido estudio ACCORD sobre Diabetes tipo 2 e HTA y/o DLP.

Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus: http://content.nejm.org/cgi/reprint/NEJMoa1001282v3.pdf

Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus: http://content.nejm.org/cgi/reprint/NEJMoa1001286v1.pdf

ACCORD and Risk-Factor Control in Type 2 Diabetes: http://content.nejm.org/cgi/reprint/NEJMe1002498v1.pdf

esperamos les sea de interés y utilidad

 

PREVENCIÓN y PRECAUCIÓN

Siempre interesante para leer y debatir, el Dr. Juan Gervás nos hace reflexionar sobre el tema de la “PREVENCIÓN”.

¿A quién?, ¿Cuándo?, ¿Cómo?, ¿Con qué costo ecónomico?, ¿Ycosto/riesgos para el paciente?

Este es el abstract del artículo y el link para bajarlo:

“La prevención es parte de la respuesta sanitaria a los problema de salud. La prevención tiene una historia y un presente honorables, que justifican un aura positiva de beneficio sin riesgos. Sin embargo, la prevención y las actividades preventivas se han vuelto peligrosas para la salud individual y colectiva por cuatro factores clave: la búsqueda de la salud perfecta y permanente, la irrupción del concepto de factor de riesgo, la creencia en un riesgo nulo, la salud obligatoria y las cascadas diagnósticas y terapéuticas que desencadenan. En este texto empleamos varios ejemplos para que el lector se forme su propia opinión respecto a los daños que provocan la prevención y las actividades preventivas: el consejo para que los bebés duerman boca abajo, los chequeos, la prevención de la endocarditis, la terapia hormonal en la menopausia y la colonoscopia “virtual” en el cribado del cáncer de colon. La prevención puede ser beneficiosa, pero ante la prevención hay que tener gran precaución.”

http://pub.bsalut.net/cgi/viewcontent.cgi?article=1033&context=risai

Resúmenes de los Mejores temas del 2009:Journal Watch top stories en Medicina General, Pediatría y Salud de la Mujer

General Medicine Top Stories for 2009

The editors’ and readers’ top stories from the past year

Everyone seems to enjoy “Top 10″ lists. So, this year, in addition to our usual practice of providing an Annual Review of what the Journal Watch General Medicine editors considered to be the most important thematic areas in clinical research, we’re also introducing a new feature: Top Editors’ Choices and Top Readers’ Choices.

The Editor’s Choices are 10 summaries that the Journal Watch General Medicine editors believe are especially important single summaries that were published in Journal Watch General Medicine this year. The Editors’ Choices essentially reflect the stories in our Annual Review feature and highlight what we considered to be the most compelling article that was discussed in each reviewed area.

In contrast, the Readers’ Choices are the summaries that were viewed most often by online registered users and subscribers. The Readers’ Choices lean more toward summaries that answer point-of-care questions (“Should I prescribe vitamin D to all of my older patients?”). As the top pick, readers chose an essay on tight glucose control (“How Much Evidence Do We Need to Change Practices in Which We Firmly Believe?”) that generated an international discussion on the “Reader Remarks” portion of our website.

We hope that you’ll examine these lists and consider reviewing the summaries that they comprise. In each case, our readers, editors, or both feel that the selected summaries are important to your practice. You might find your own personal favorite in one of these lists or discover some hidden pearls that escaped your attention. If you would like to express your personal opinions on any of these summaries, please feel free to use our “Reader Remarks” feature, which is available for every Journal Watch summary.

Best wishes for 2010.

— Allan S. Brett, MD

Our Year in Review stories for 2009 are:

• PSA for Prostate Cancer Screening: Controversy Continues in 2009
• Novel Influenza Strain Challenges Researchers and Clinicians
• Altered Approach to Mammographic Screening for Breast Cancer
• Diabetic Patients and Cardiac Risk: What Works, and What Doesn’t?
• Glucose Control Among Critically Ill Patients
• Randomized Trials of Vertebroplasty for Vertebral Fractures
• Aspirin for Primary Prevention of Cardiovascular Disease? Still a Very Close Call.
• Dementia, Dialysis, and CPR in Elders
• Randomized Trials of Revascularization for Atherosclerotic Renal Artery Stenosis
• Vitamin D Deficiency: A Major Public Health Problem?
• Comparing Surgical Procedures for Treatment of Obesity
• Ionizing Radiation Associated with Medical Imaging
• Lost in (Care) Transition

Published in Journal Watch General Medicine December 29, 2009

 

Pediatrics and Adolescent Medicine Top Stories of 2009

Three perspectives on the top stories of the year and a fond farewell to two board members

Dear Readers,

Each year, the editors of Journal Watch Pediatrics and Adolescent Medicine choose the top 10 pediatric stories from our published summaries. This year, we again provide three top 10 lists. Our editors chose the stories that they believe to be most important to you and your practices to create the Editors’ Choice list. Our resident editor, Sara Bergman Lewis, MD, polled her resident colleagues to create the Residents’ Choice list. Finally, we looked to you, our readers, to compile the Most Read Online list.

The three lists have some overlap and some expected differences. Clearly, the 2009 pandemic influenza A (H1N1) virus dominated our medical landscape in 2009. The resident list represents a mix of resident interests: practical, prudent, and forward thinking. According to Sarah, residents seek evidence that supports what they do, or refrain from doing, in the hospital and clinic, and are interested in novel ideas to improve their practices.

In 2010, two editors will end their terms on the Journal Watch Pediatrics and Adolescent Medicine editorial board. Both editors have been writing for Journal Watch since its inception. William P. Kanto, MD, has provided insightful coverage of neonatal medicine and has injected a historical perspective into many summaries throughout the years. Judith G. Hall, OC, MD, has taught us and kept us informed about the rapidly evolving field of genetics. Their insights have added greatly to our publication, and we will continue to seek their unique perspectives as contributing editors in the future.

We hope that you will peruse the top 10 lists and consider reading the stories, even if you have read them before. Let us know what you think by sending us an e-mail at jwpeds@mms.org.

Best wishes for 2010,

— F. Bruder Stapleton, MD

Published in Journal Watch Pediatrics and Adolescent Medicine December 30, 2009

 

Journal Watch Women’s Health Events of 2009

A new perspective on the most important research in the field from the past year

Dear Readers,

In 2009, Journal Watch Women’s Health saw a number of changes to its Editorial Board. I am pleased to tell you that the latest of these developments is the promotion of Wendy Biggs, MD, to the position of Deputy Editor. This appointment is timely and well deserved; since Wendy joined our board as an Associate Editor in 2006, she has consistently applied her expertise in family medicine to strengthen our coverage of the broadening spectrum of issues in women’s health.

This year, we also introduce a new feature to our readers: Journal Watch Women’s Health Top Stories of 2009. We compiled two lists generated from two sources. First, Wendy and I selected the stories that we believe to be most important to you and your practice to create a list of Editors’ Top Choices. Second, we looked to you, our readers, for the Readers’ Top Choices list. In the Readers’ Choices list, you’ll find the 10 summaries that were viewed most often by online registered users and subscribers.

The two lists have some overlap and some interesting differences. The novel influenza A (H1N1) virus has dominated the clinical landscape; other topics that are found on both lists are the evolving perspectives on hormone therapy and the new options in emergency contraception. The updated screening guidelines for breast cancer and cervical cytology have garnered much attention; these stories probably would have appeared on the Readers’ Choices list had they not emerged so late in 2009.

We hope that you will peruse these lists and consider reading the stories, even if you have read them before. Please enjoy this new feature — and feel free to send us an e-mail at jwwh@mms.org or use our “Reader Remarks” feature, which is available at the bottom of this letter (and every Journal Watch Women’s Health summary), to let us know what you think.

Best wishes for 2010,

— Andrew M. Kaunitz, MD and Wendy S. Biggs, MD

Published in Journal Watch Women’s Health December 31, 2009

Ginecología en APS: actualizaciones en Guía de Cancer de Cuello Uterino, y Screening de Cancer de mama

El Colegio Americano de Ginecólogos y Obstetras (ACOG) publicó un boletín con las nuevas recomendaciones para este grupo de especialistas en referencia al cribado de Cancer de Cuello Uterino.

Para leer, considerar, y luego cotejar con las recomendaciones de Médicos de Familia referidas al tema.

Link de acceso al documento: http://journals.lww.com/greenjournal/documents/PB109_Cervical_Cytology_Screening.pdf

Por su parte la American Task Force (USPSTF) nos informa (¿o  sorprende?) con los cambios en el cribado de Cancer de Mama, a realizar ahora en las mujeres a partir de los 50 años, cada 2 años, y hasta los 74 años. (recomendación B)

Link al informe de las recomendaciones: http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm

GPC: Insuficiencia Cardíaca actualizada en Circulation

ACCF/AHA Guidelines on Diagnosing and Treating Heart Failure

The American College of Cardiology Foundation and the American Heart Association have jointly issued updated guidelines for the management of heart failure. The guidelines, which replace those from 2005, appear online in Circulation.

 

The revised guidelines:

• emphasize the role of natriuretic peptides in stratifying risk;
• slightly downgrade the benefit (relative to risk) of exercise testing in designing rehab programs;
• recommend use of hydralazine and nitrates in combination for African Americans on optimal therapy having moderate-to-severe symptoms;
• recommend either controlling ventricular rate or maintaining sinus rhythm in patients with atrial fibrillation and heart failure;
• offer advice on eligibility for implantable cardioverter-defibrillators and cardiac resynchronization therapy; and
• provide recommendations for patients hospitalized with heart failure.

 

Circulation article with updated guidelines (Free PDF)

Circulation article with full guidelines (Free PDF)

Guías de práctica clínica (GPC) y su aplicación concreta en la comunidad: ¡ NICE dice cómo hacerlo !

Publicado en NICE el documento de cómo llevar las guías del papelito a la práctica para mejorar la salud de la comunidad.

How to put NICE guidance into practice to improve the health andwellbeing of communities

El documento se presenta como de referencia para las autoridades locales: implantación de las guías disminuyendo desigualdades en salud, con la participación multidisciplinar e intersectorial, utilidad de indicadores referenciadose en las guias de salud pública de NICE y procedimientos para posibilitar y hacer cierta la participación de las comunidades en todas aquellas decisiones que afectan a su salud.

Tomado del blog “Salud Comunitaria”. Saludos

El síndrome del túnel carpiano: Cómo no tratarlo.

Cuando hablamos del Servicio Irracional de Salud, parece que solo criticamos las terapias de la “medicina alternativa”. Pues no, dentro de la medicina “científica” se ven aberraciones de considerable talla, que dan vergüenza mostrar, pero que se siguen produciendo.

Se relata el caso de un paciente de 35 años de edad, que concurre a un Hospital Universitario de Madrid, España,  con una historia de  2 años de evolución de un síndrome del túnel carpiano bilateral, derivado para cirugía de la mano al servicio hospitalario correspondiente. Un cirujano le dice que sí , a operar, pero el segundo que le atiende tras evaluar las pruebas que confirman la severidad del síndrome, decide esperar y que tome el siguiente tratamiento. Además, la mano del cirujano le permite escribir este compendio de “medicina basada en la evidencia” pero no le sirve para rellenar las correspondientes recetas, no sea que se le canse su valorada mano.

Tratamiento indicado: Etoricoxib COX2 selectivo. No se le ocurre otro antiinflamatorio antes que éste. Indicaciones oficiales (alivio sintomático de la artrosis, artritis reumatoide y dolor y signos de inflamación de la artritis gotosa. Últimamente autorizado para espondilitis anquilopoyética. La dosis recomendada es para artrosis. La principal ventaja es que es igual en eficacia y seguridad que el diclofenac. El paciente ni tiene antecedentes de problemas digestivos ni es mayor de 65 años. Justificación de uso: ninguna -

Lansoprazol. Justificación de gastroprotección asociada a un COX2: ninguna -

Pregabalina. Le propone ir subiendo la dosis hasta 300mg en 3 semanas. En PubMed no aparece un solo artículo con las palabras “carpal” “tunnel” “pregabalin”. Es un dolor neuropático por atrapamiento, diferente a otros dolores neuropáticos.

 En resumen, tratamiento irracional para hacer esperar a un paciente una cirugía que le soluciona el problema. Un repaso sencillo del abordaje del síndrome del túnel del carpo.

Tomado del blog: “El Supositorio”, siempre con aportes interesantes. Saludos

Diabetes: actualización 2009

En  una nueva  publicación clásica, de todos los inicios de año, el primer número del Diabetes Care nos da su revisión de los Standards of Medical Care in Diabetes, la cual nos pone al día de las recomendaciones de la American Diabetes Association.

 Tiene las actualizaciones con los últimos datos de los estudios ADVANCE (Action in Diabetes and Vascular Disease- Preterax and Diamicron Modified Release Controlled Evaluation), VADT (Veterans Affairs Diabetes Trial), donde no se observó una reducción significativa de los episodios cardiovasculares con un control glucémico más intensivo. Además del estudio ACCORD (Action to Control Cardiovascular Risk in Diabetes) que fuera oportunamente suspendido de forma temprana dado que se observó un incremento de la mortalidad en los participantes aleatorizados a un control glucémico “muy intensivo”. Parece que la prudencia en el tema del control glucémico manda. Por ello, las recomendaciones de la ADA en el control glucémico está lleno de “consideraciones importantes”.

Un par de semanas antes, en el número del 17 de diciembre de 2008 se publicaron unas recomendaciones consensuadas entre la American Diabetes Association y la European Association for the Study of Diabetes tituladas: Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy con comentarios muy adecuados y que ordena las múltiples terapias que compiten actualmente por ser de “primera línea”.

Links:

http://care.diabetesjournals.org/cgi/reprint/32/Supplement_1/S13

http://care.diabetesjournals.org/cgi/reprint/dc08-9025v2

Agradecemos al blog “El supositorio” por la información