Journal Club Articles - Choose One

Does This Patient Have Dementia?
JAMA. 2007;297(21):2391-2404 (doi:10.1001/jama.297.21.2391)

Thiazolidinediones and Cardiovascular Outcomes in Older Patients With Diabetes
JAMA. 2007;298(22):2634-2643 (doi:10.1001/jama.298.22.2634)

Warfarin plus Aspirin after Myocardial Infarction or the Acute Coronary Syndrome: Meta-Analysis with Estimates of Risk and Benefit.
Annals of Int Med 16 August 2005 Volume 143 Issue 4 Pages 241-250

Radical Prostatectomy versus Watchful Waiting in Early Prostate Cancer
NEJM, 352:1977-1984, May 12, 2005
Is surgery better?

Factor VII for Acute Intracerebral Hemorrhage
NEJM - February 24, 2005
Treatment with rFVIIa (NovoSeven) within 4 hours of hemorhagic stroke limits the hematoma, reduces mortality, and improves function.
This is the first real treatment for this type of stroke in addition to neurosurgery.

Effect of Antihypertensive Agents on Cardiovascular Events in Patients With CAD and Normal BP
JAMA - 2004; 292: 2217-2225
Should we treat even a normal BP?
Amlodipine reduced the adverse cardiovascular events. Enalapril was not that good. Also, amlodipine slowed atherosclerosis progression as verified by IVUS.

Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery
N Engl J Med - 2004 Dec 23

Diagnostic Strategies after Normal Proximal Vein U/S for Suspected DVT: D-Dimer Compared with Repeated U/S
Annals of Int Med - 5 April 2005

Effect of Metformin and Lifestyle Intervention on the Metabolic Syndrome
Annals of Int Med - April 2005

Atenolol in hypertension: is it a wise choice?
Lancet - 11/04
In four studies there were no outcome differences between atenolol and placebo on all-cause mortality or myocardial infarction. Risks of death from were 13 per cent higher for atenolol than for other treatments, deaths from heart attack or stroke were 16 per cent higher, and strokes 30 per cent higher. Even The Times mentioned this.

Optimism and All-Cause and Cardiovascular Mortality in the Elderly
Arch Gen Psychiatry - 2004; 61:1126-1135
Optimism may help you live longer. After nearly 10 years of follow-up, researchers found that compared with people who reported a high level of pessimism, those who were very optimistic had a 55% lower risk of death from all causes and a 23% lower risk of heart-related death - WebMD

Metabolic Effects of Carvedilol vs Metoprolol in Patients With Type 2 DM and HTN
JAMA - 2004; 292: 2227-2236
Finally, which one is better - Coreg or Toprol XL?
Carvedilol did not affect glycemic control and improved some components of the metabolic syndrome as compared to metoprolol.

Mediterranean Diet, Lifestyle, and 10-Year Mortality in the Elderly.
JAMA - September 22/29, 2004
We are what we eat, aren't we? Living a healthy lifestyle can decrease the risk of death from CAD by 64%, from cardiovascular diseases by 61%, from cancer by 60%. This is better than any drugs. It is amazing what 10 years of TLC (tender, love and care) can achieve...Just kidding. Actually the new TLC acronym stands for Therapeutic Lifestyle Changes.
How does that happen? For a start, this diet has an effect on the endothelial dysfunction and markers of vascular inflammation.
Click here for the JAMA editorial or the WebMD story.

Alcohol and Risk for Ischemic Stroke in Men
Ann of Int Med 1/4/05
Men who consumed 3 or more alcoholic drinks were nearly 45% more likely to suffer a stroke compared with non-drinkers. Men who consumed 1 or 2 drinks on 3 to 4 days of the week had a 32% lower stroke risk. Is it all in the dose? Is there a U- or J-shaped relation between alcohol and the risk of stroke (similar to the J-shaped relationship between BP/weight and mortality).
The study followed 38,000 male physicians over 14 years. The first phase was published in NEJM in 1999, and this is the follow-up. The same research group from Harvard published a substudy focused on the alcohol effect on cardiovascular mortality (NEJM 2003).

Diabetes Mellitus as a Predictor of Cancer Mortality in a Large Cohort of US Adults
Am J Epidemiol 2004; 159:1160-1167
Is it true that DM causes cancer? Somebody who wants to look into the matter?
This article was published just recently by the Johns Hopkins research group.
Click on the title to explore it.
Do not forget the EMB toolkit posted above.

Sweetened drinks increase chances of having DM - JAMA 2004
Dr Apovian: "This study should help convince the US Department of Agriculture to redefine guidelines for sugar consumption, especially in soft drinks. In addition, the government should support local efforts to banish soda machines from schools."

Treatment with once-weekly alendronate 70 mg compared with once-weekly risedronate 35 mg in women with postmenopausal osteoporosis
J Bone Miner Res. 2005 Jan

Working night shifts increases risk of colorectal CA - J Natl Cancer Institute 6/03
Researchers found that women who worked 15 or more years of rotating night shifts faced a 35% increased risk of developing colon CA compared with those who never worked such shifts (relative risk 1.35, 95% confidence interval 1.03 to 1.770). Check out the BMJ comment.

Noninvasive Positive-Pressure Ventilation (NIPPV) for Respiratory Failure after Extubation
NEJM Volume 350:2512-2515 June 10, 2004
NIPPV did not prevent the need for reintubation or reduce mortality in patients with respiratory failure after extubation.
Check the editorial - Don't Push Too Hard or When BiPAP is really not helping at all.

Suggested by Dr.Sopko:

Higher versus Lower PEEP in Patients with the ARDS.
NEJM Volume 351:327-336 July 22, 2004
PEEP in ARDS — How Much Is Enough? Outcomes are similar whether lower or higher PEEP levels are used. No specific PEEP startegy is necessary in treating patients with ARDS.

Daily interruption of sedation reduces ICU complications in ventilated patients.
A Wake-Up Call in the Intensive Care Unit - NEJM editorial on the same subject.

Swan-Ganz and CVP catheters fail to predict ventricular filling volume and cardiac performance
Crit Care Med. 2004 Mar;32(3):691-9

Albumin and Saline produce similar outcomes in fluid resuscitation
NEJM Volume 350:2247-2256 May 27, 2004

Go to the Archive of Discussed Articles - Previous Journal Clubs

More article suggestions on Journal - a blog published by Michael Jacobson, MD, MPH, a NYC cardiologist

ACP Journal Club - you need to be an ACP member to have access to the articles


Anonymous said...

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Anonymous said...

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Enjoyed the style of presentation of the informative journal club articles & Case presentation/EKG interpretation examples.
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