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https://www.readbyqxmd.com/read/29150464/testosterone-therapy-in-hypogonadal-men-a-systematic-review-and-network-meta-analysis
#1
Jesse Elliott, Shannon E Kelly, Adam C Millar, Joan Peterson, Li Chen, Amy Johnston, Ahmed Kotb, Becky Skidmore, Zemin Bai, Muhammad Mamdani, George A Wells
OBJECTIVE: To assess the relative effects of individual testosterone products among hypogonadal men. DESIGN: Systematic review and network meta-analysis. METHODS: We searched MEDLINE, Embase, Cochrane CENTRAL, and grey literature (25 May 2017) for randomised-controlled trials (RCTs) and non-randomised studies (NRS) that involved hypogonadal men given testosterone replacement therapy (TRT) for ≥3 months. Comparators were placebo, another TRT, or the same product at a different dose...
November 16, 2017: BMJ Open
https://www.readbyqxmd.com/read/29147720/anticoagulation-in-atrial-fibrillation-current-evidence-and-guideline-recommendations
#2
J W Erath, S H Hohnloser
Atrial fibrillation (AF) is the most frequently encountered sustained arrhythmia with a prevalence of 0.5-10%, depending predominantly on age. The arrhythmia is associated with significant morbidity and mortality, mainly due to thromboembolic events including stroke and systemic embolisms. These complications can be effectively prevented with anticoagulation therapy either with vitamin K antagonists (VKA) or with non-vitamin K antagonists (NOAC). VKA therapy is effective in preventing strokes but these medications are difficult to use, are associated with significant bleeding risk, and have pharmacokinetic/dynamic properties that make their use cumbersome...
November 17, 2017: Herz
https://www.readbyqxmd.com/read/29146534/systematic-review-for-the-2017-acc-aha-aapa-abc-acpm-ags-apha-ash-aspc-nma-pcna-guideline-for-the-prevention-detection-evaluation-and-management-of-high-blood-pressure-in-adults-a-report-of-the-american-college-of-cardiology-american-heart-association-task
#3
David M Reboussin, Norrina B Allen, Michael E Griswold, Eliseo Guallar, Yuling Hong, Daniel T Lackland, Edgar Pete R Miller, Tamar Polonsky, Angela M Thompson-Paul, Suma Vupputuri
OBJECTIVE: To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? METHODS: Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question...
November 7, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29143367/risk-of-death-associated-with-new-benzodiazepine-use-among-persons-with-alzheimer-disease-a-matched-cohort-study
#4
Laura Saarelainen, Anna-Maija Tolppanen, Marjaana Koponen, Antti Tanskanen, Jari Tiihonen, Sirpa Hartikainen, Heidi Taipale
OBJECTIVE: To investigate the risk of death associated with new benzodiazepine and related drug (BZDR) use in a nationwide cohort of persons with Alzheimer disease (AD). METHODS: The register-based MEDALZ cohort, including all community-dwelling Finns diagnosed with AD during 2005 to 2011 (n = 70 718), was used. Clinically verified AD diagnoses were obtained from the Special Reimbursement Register. Drug use periods were modeled from BZDR purchases, derived from the Prescription Register...
November 15, 2017: International Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/29141890/british-thoracic-society-clinical-statement-on-pulmonary-arteriovenous-malformations
#5
Claire L Shovlin, Robin Condliffe, James W Donaldson, David G Kiely, Stephen J Wort
Pulmonary arteriovenous malformations (PAVMs) are structurally abnormal vascular communications that provide a continuous right-to-left shunt between pulmonary arteries and veins. Their importance stems from the risks they pose (>1 in 4 patients will have a paradoxical embolic stroke, abscess or myocardial infarction while life-threatening haemorrhage affects 1 in 100 women in pregnancy), opportunities for risk prevention, surprisingly high prevalence and under-appreciation, thus representing a challenging condition for practising healthcare professionals...
December 2017: Thorax
https://www.readbyqxmd.com/read/29141842/treatment-of-atrial-fibrillation-and-concordance-with-the-american-heart-association-american-college-of-cardiology-heart-rhythm-society-guidelines-findings-from-orbit-af-outcomes-registry-for-better-informed-treatment-of-atrial-fibrillation
#6
Adam S Barnett, Sunghee Kim, Gregg C Fonarow, Laine E Thomas, James A Reiffel, Larry A Allen, James V Freeman, Gerald Naccarelli, Kenneth W Mahaffey, Alan S Go, Peter R Kowey, Jack E Ansell, Bernard J Gersh, Elaine M Hylek, Eric D Peterson, Jonathan P Piccini
BACKGROUND: It is unclear how frequently patients with atrial fibrillation receive guideline-concordant (GC) care and whether guideline concordance is associated with improved outcomes. METHODS AND RESULTS: Using data from ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation), we determined how frequently patients received care that was concordant with 11 recommendations from the 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society atrial fibrillation guidelines pertaining to antithrombotic therapy, rate control, and antiarrhythmic medications...
November 2017: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/29141649/number-and-type-of-guideline-implementation-tools-varies-by-guideline-clinical-condition-country-of-origin-and-type-of-developer-organization-content-analysis-of-guidelines
#7
Laurel Liang, Jhoni Abi Safi, Anna R Gagliardi
BACKGROUND: Guideline implementation tools (GI tools) can improve clinician behavior and patient outcomes. Analyses of guidelines published before 2010 found that many did not offer GI tools. Since 2010 standards, frameworks and instructions for GI tools have emerged. This study analyzed the number and types of GI tools offered by guidelines published in 2010 or later. METHODS: Content analysis and a published GI tool framework were used to categorize GI tools by condition, country, and type of organization...
November 15, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/29139115/risk-of-stroke-associated-with-use-of-estrogen-containing-contraceptives-in-women-with-migraine-a-systematic-review
#8
REVIEW
Huma U Sheikh, Jelena Pavlovic, Elizabeth Loder, Rebecca Burch
OBJECTIVE: Migraine with aura has been associated with increased risk of ischemic and hemorrhagic stroke. Prior studies have shown a further increase in risk in women using combined hormonal contraceptives (CHCs). This has led to guidelines recommending against use of CHCs in this population. We sought to assess whether the risk of stroke is associated with the dose of estrogen and whether there is evidence of synergism between migraine and CHCs. We also sought to assess whether an interaction effect exists between migraine and CHCs...
November 15, 2017: Headache
https://www.readbyqxmd.com/read/29138143/minimally-invasive-stand-alone-cox-maze-procedure-for-persistent-and-long-standing-persistent-atrial-fibrillation-perioperative-safety-and-5-year-outcomes
#9
Niv Ad, Sari D Holmes, Ted Friehling
BACKGROUND: Rhythm control is challenging in patients with extended atrial fibrillation (AF) duration and persistent/long-standing persistent AF. Among surgical approaches to treat AF, the Cox maze procedure performed using alternative energy sources remains superior to other beating heart techniques. We examined permanence of safety and success for the on-pump, minimally invasive, stand-alone Cox maze procedure 5 years after surgery. METHODS AND RESULTS: Stand-alone, right 5 cm minithoracotomy, Cox maze III/IV procedure for nonparoxysmal AF was conducted in 133 patients (mean follow-up=65±34 months)...
November 2017: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/29133355/systematic-review-for-the-2017-acc-aha-aapa-abc-acpm-ags-apha-ash-aspc-nma-pcna-guideline-for-the-prevention-detection-evaluation-and-management-of-high-blood-pressure-in-adults-a-report-of-the-american-college-of-cardiology-american-heart-association-task
#10
REVIEW
David M Reboussin, Norrina B Allen, Michael E Griswold, Eliseo Guallar, Yuling Hong, Daniel T Lackland, Edgar Pete R Miller, Tamar Polonsky, Angela M Thompson-Paul, Suma Vupputuri
OBJECTIVE: To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? METHODS: Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question...
November 13, 2017: Hypertension
https://www.readbyqxmd.com/read/29132196/carotid-endarterectomy-the-change-in-practice-over-11%C3%A2-years-in-a-stroke-centre
#11
Gabrielle T W Tse, Monique F Kilkenny, Chris Bladin, Michael Grigg, Helen M Dewey
BACKGROUND: Recent research evidence has impacted the practice of carotid endarterectomy (CEA). We aim to characterize changes in the practice and outcome of CEA over time in a single large-volume stroke centre. METHODS: All patients who underwent CEA from 2004 to 2014 and carotid angioplasty and stenting (CAS) from 2003 to 2008 at an Australian metropolitan tertiary stroke centre hospital were included. Clinical data were analysed to identify time trends in choice of intervention, patient selection, preoperative imaging utilization, surgical timing and outcome...
November 13, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/29131895/association-of-blood-pressure-lowering-with-mortality-and-cardiovascular-disease-across-blood-pressure-levels-a-systematic-review-and-meta-analysis
#12
Mattias Brunström, Bo Carlberg
Importance: High blood pressure (BP) is the most important risk factor for death and cardiovascular disease (CVD) worldwide. The optimal cutoff for treatment of high BP is debated. Objective: To assess the association between BP lowering treatment and death and CVD at different BP levels. Data Sources: Previous systematic reviews were identified from PubMed, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effect...
November 13, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29129562/preoperative-use-of-oral-beta-adrenergic-blocking-agents-and-the-incidence-of-new-onset-atrial-fibrillation-after-cardiac-surgery-a-systematic-review-and-meta-analysis
#13
REVIEW
Paul Min Thein, Kyle White, Khyati Banker, Carole Lunny, Sam Mirzaee, Arthur Nasis
BACKGROUND: Current epidemiological data suggests that postoperative atrial fibrillation or atrial flutter (POAF) causes significant morbidity and mortality after cardiac surgery. The literature for prophylactic management of POAF is limited, resulting in the lack of clear guidelines on management recommendations. AIM: To examine the efficacy of prophylactic rate control agents in reducing the incidence of new-onset POAF in patients undergoing elective cardiac surgery...
October 19, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/29128265/atrial-flutter-has-less-left-atrial-spontaneous-contrast-and-higher-left-atrial-appendage-emptying-velocity-compared-with-atrial-fibrillation
#14
Jennifer J Huang, Sridhar Reddy, Tam H Truong, Prakash Suryanarayana, Joseph S Alpert
BACKGROUND: The risk of stroke and thromboembolism in atrial fibrillation is established. There are clear guidelines in anticoagulation management of patient's with atrial fibrillation, however, the evidence surrounding the risk of thromboembolism in patients with atrial flutter is not as clear. We hypothesized that atrial flutter would have indicators of less risk for thromboembolism compared with atrial fibrillation on transesophageal echocardiography (TEE); thereby possibly leading to a lower stroke risk...
November 8, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/29126361/a-survey-of-the-current-practice-of-intramuscular-botulinum-toxin-injections-for-hemiplegic-shoulder-pain-in-the-uk
#15
Richard J Holmes, Louise A Connell
PURPOSE: To describe the current UK practice for the use of intramuscular Botulinum Toxin type A injections to treat hemiplegic shoulder pain. METHOD: A UK-based cross-sectional study using an online survey. Participants (n = 68) were medical and non-medical practitioners recruited via the membership of the British Society for Rehabilitation Medicine and the British Neurotoxin Network. Data was analysed using descriptive statistics and content analysis. RESULTS: The majority of respondents would consider Botulinum Toxin type A for hemiplegic shoulder pain (86...
November 10, 2017: Disability and Rehabilitation
https://www.readbyqxmd.com/read/29123838/prehospital-triage-for-endovascular-clot-removal-in-acute-stroke-patients
#16
Yu Suzuki, Yasuhiro Hasegawa, Kohtaro Tsumura, Toshihiro Ueda, Kazunari Suzuki, Makoto Sugiyama, Hiroyuki Nozaki, Shojiro Kawaguchi, Makoto Nakane, Goro Nagashima, Takayuki Kitamura, Kengo Yokomine, Jinichi Sasanuma
Aim: To establish prehospital triage in accordance with the new guidelines for endovascular therapy, we retrospectively analyzed the monitoring data of the city-wide transportation system using the Maria Prehospital Stroke Scale (MPSS), a novel prehospital stroke scale for emergency medical technicians (EMTs) to predict the likelihood of thrombolytic therapy after transportation. Methods: Kawasaki City, Japan, has six comprehensive stroke centers (CSCs) and six primary stroke centers (PSCs)...
January 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29123485/intensifying-functional-task-practice-to-meet-aerobic-training-guidelines-in-stroke-survivors
#17
Liam P Kelly, Augustine J Devasahayam, Arthur R Chaves, Elizabeth M Wallack, Jason McCarthy, Fabien A Basset, Michelle Ploughman
Objective: To determine whether stroke survivors could maintain workloads during functional task practice that can reach moderate levels of cardiometabolic stress (i.e., ≥40% oxygen uptake reserve ([Formula: see text]O2R) for ≥20 min) without the use of ergometer-based exercise. Design: Cross-sectional study using convenience sampling. Setting: Research laboratory in a tertiary rehabilitation hospital. Participants: Chronic hemiparetic stroke survivors (>6-months) who could provide consent and walk with or without assistance...
2017: Frontiers in Physiology
https://www.readbyqxmd.com/read/29122997/level-of-moderate-intensity-leisure-time-physical-activity-and-reduced-mortality-in-middle-aged-and-elderly-chinese
#18
Ying Liu, Wanqing Wen, Yu-Tang Gao, Hong-Lan Li, Gong Yang, Yong-Bing Xiang, Xiao-Ou Shu, Wei Zheng
BACKGROUND: Few studies have prospectively evaluated the association of leisure-time physical activity (LTPA) with mortality in Asians, who are more susceptible to insulin resistance than their Caucasian counterparts. METHODS: Data from two large prospective cohort studies conducted in Shanghai were evaluated. After excluding participants who had a history of cancer, coronary heart disease or stroke at baseline, or who died within the first 3 years after study enrolment, 53 839 men and 66 888 women, followed for an average of 9...
November 9, 2017: Journal of Epidemiology and Community Health
https://www.readbyqxmd.com/read/29120921/pregnancy-and-ischemic-stroke-a-practical-guide-to-management
#19
Mayte E van Alebeek, Roel de Heus, Anil M Tuladhar, Frank-Erik de Leeuw
PURPOSE OF REVIEW: Ischemic stroke during pregnancy or the puerperium is a devastating disease during a crucial period in life and warrants a specific approach. To date, current practice is mainly based on expert opinion because of a lack of randomized controlled trials and high-quality observational studies. The present review is intended as a practical guide to (acute) management of ischemic stroke during pregnancy and puerperium. RECENT FINDINGS: Recent findings showed that the incidence of stroke during pregnancy is rising...
November 7, 2017: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29117959/barriers-and-facilitators-to-provide-quality-tia-care-in-the-veterans-healthcare-administration
#20
Teresa M Damush, Edward J Miech, Jason J Sico, Michael S Phipps, Greg Arling, Jared Ferguson, Charles Austin, Laura Myers, Fitsum Baye, Cherie Luckhurst, Ava B Keating, Eileen Moran, Dawn M Bravata
OBJECTIVE: To identify key barriers and facilitators to the delivery of guideline-based care of patients with TIA in the national Veterans Health Administration (VHA). METHODS: We conducted a cross-sectional, observational study of 70 audiotaped interviews of multidisciplinary clinical staff involved in TIA care at 14 VHA hospitals. We de-identified and analyzed all transcribed interviews. We identified emergent themes and patterns of barriers to providing TIA care and of facilitators applied to overcome these barriers...
November 8, 2017: Neurology
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