Articles of Interest
JournalDoc is proud to work with a team of experts who understand the challenges faced by Healthcare Professionals and pleased to offer a weekly article of interest representing trends and new information affecting the study and practice of medicine.
What’s Interesting about this article?
- Hospital- acquired adverse events included falls, infections and other adverse events as defined by the US Centers for Medicare & Medicaid Services.
- Private equity acquisition was associated with increased falls, central line-associated bloodstream infections and surgical site infections.
- A small decrease in in-hospital mortality at private equity hospitals may be explained by a case shift to younger Medicare beneficiaries and increased transfers to other hospitals.
JournalDoc Comments:
- This is an impressive study by doctors from the Massachusetts General Hospital, one of the top hospitals in the US.
- In the past, US hospitals were urged to become more “business-like” to decrease health care costs. The findings in this article raise significant concerns that this transition may decrease the quality of care and patient outcomes.
- It is not clear whether the increase in falls and hospital-acquired infections were related to reduced staffing or other cost-cutting measures employed to increase profitability.
NEJM Original Article
The New England Journal of Medicine, December 14, 2023
A total of 17,604 patients were enrolled in a multicenter, double-blind, randomized placebo-controlled, event-driven superiority trial of individuals 45 years of age or older who had preexisting cardiovascular disease and BMI of 27 or greater, but no history of diabetes.
What’s Interesting about this article?
- In this patient group, weekly subcutaneous semaglutide at a dose of 2.4 mg was superior to placebo in reducing the incidence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke at mean follow-up pf 39.8 months.
- The study was funded by Novo Nordisk, the drug manufacturer and conducted at the Cleveland Clinic in Cleveland Ohio.
- Semaglutide improved cardiovascular outcomes in patients that had not responded to lifestyle interventions or other drug interventions.
JournalDoc Comments:
- This is a very large study group at a top tier U.S. major medical center.
- An accompanying editorial by Amit Khera, MD and Tiffany Powell-Wiley, MD, MPH, points out that the beneficial cardiac effects were obtained in addition to a 9.4% weight loss. This is a major finding for the over 20 million patients in the U.S. with coronary artery disease who are also obese.
- The editorial also considers that the current pricing of semaglutide makes this drug inaccessible for many, which may limit its overall impact on public health.
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Disclaimer: Article of the Week selections by JournalDoc physicians are independent, unbiased and have no commercial conflict of interest. JournalDoc does not support or endorse the findings or opinions expressed in the article. Findings in the article may need to be supported by further research and/or the consensus of experts.
JAMA Original Investigation
Journal of the American Medical Association, December 5, 2023
A randomized clinical trial enrolling 459 children aged 3 to 12.9 years with snoring and an obstructive apnea-hypopnea index (AHI) less than 3, enrolled at 7 U.S. academic sleep centers from June 29, 2016, to February 1, 2021, and followed up for 12 months.
What’s Interesting about this article?
- Participants were randomized to either early adenotonsillectomy or watchful waiting.
- Children with early Adenotonsillectomy (T&A) had improved secondary outcomes of snoring, sleepiness, behavior, quality of life and decreased blood pressure. However, there was no change in cognitive function or attention.
- An accompanying editorial by Inbal Hazikani, MD, Kathleen Billings, MD and Dana Thompson, MD states that poor sleep has a significant effect on the “parent-child dyad” as well as the symptoms mentioned in the article.
JournalDoc Comments:
- Childhood T&A surgical procedures were common several decades ago because doctors believed they prevented recurrent strep throats and improved breathing function.
- Pediatricians are now joining adult medicine physicians in recognizing the importance of sleep for overall health at all ages.
- The benefits noted in the study must be balanced against the costs and risks of surgery.
CLICK HERE FOR MORE INFORMATION ON THIS STUDY
Disclaimer: Article of the Week selections by JournalDoc physicians are independent, unbiased and have no commercial conflict of interest. JournalDoc does not support or endorse the findings or opinions expressed in the article. Findings in the article may need to be supported by further research and/or the consensus of experts.
JAMA Research Letter
Journal of the American Medical Association, November 14, 2023
A cohort study based on a random sample of 16 million patients in the PharMetrics Plus database, a large health claims database that captures 93% of all out-patient prescriptions and physician diagnoses in the U.S.
What’s Interesting about this article?
- Studies have found increased risks of gastrointestinal adverse events (biliary disease, pancreatitis, bowel obstruction and gastroparesis) in patients with diabetes who take GLP-1 agonists.
- Diabetics have a higher baseline risk for adverse GI effects and studies are lacking for normal adults taking this class of drugs for weight loss, so risk in latter group not known.
- This study found that use of GLP-1 agonists for weight loss, in comparison with use of bupropion-naltrexone, was associated with increased risk of pancreatitis, gastroparesis and bowel obstruction, but not biliary disease.
JournalDoc Comments:
- Doctors and patients without diabetes should be aware of adverse GI effects with the use of GLP-1 agonists.
- Large, randomized-controlled studies will be needed to establish risk of adverse GI effects with use of GLP-1 agonists in obese individuals without diabetes. However, since these adverse effects can be quite serious, caution should be used in using this class of drugs in normal adults.
- Risk-Benefit analysis GLP-1 agonists in obese individuals should balance significant weight loss of 20-30 % with cost of drugs, life-time commitment, and side effects.
CLICK HERE FOR MORE INFORMATION ON THIS STUDY
Disclaimer: Article of the Week selections by JournalDoc physicians are independent, unbiased and have no commercial conflict of interest. JournalDoc does not support or endorse the findings or opinions expressed in the article. Findings in the article may need to be supported by further research and/or the consensus of experts.
Annals of Internal Medicine Original Research Article
Annals of Internal Medicine, November 2023
A mixed-methods cohort study of 284 patients with obesity seen by 87 general practitioners at 38 primary care clinics in England.
What’s Interesting about this article?
- Researchers used conversation analysis of recorded discussions between clinicians and patients regarding referral to a 12-week behavioral weight management program.
- Three interactional approaches were identified – “good news” related to the opportunity for treatment; “bad news” based on the harms of obesity; and neutral use of language. The primary outcome was patient weight loss at 12 months.
- This study found that presenting weight loss treatment as a positive opportunity was associated with greater uptake of treatment and greater weight loss.
JournalDoc Comments:
- Effective weight loss interventions are needed to prevent people with obesity from developing type 2 diabetes, heart disease, cancer, and other adverse outcomes.
- An accompanying editorial by Christina C. Wee, M.D. and John E. Cornell comments on the importance of the language used by clinicians in making recommendations for treatment, and that the new arrival of behavioral, pharmaceutical, and surgical options gives us reason to be optimistic about positive outcomes.
- Data were audio only, so body language and nonverbal cues could not be assessed.
CLICK HERE FOR MORE INFORMATION ON THIS STUDY
Disclaimer: Article of the Week selections by JournalDoc physicians are independent, unbiased and have no commercial conflict of interest. JournalDoc does not support or endorse the findings or opinions expressed in the article. Findings in the article may need to be supported by further research and/or the consensus of experts.