Aspirin in the Treatment and Prevention of Migraine | Proton Pump Inhibitors and the Kidney | Clinical practice variation and overtreatment risk in women with abnormal cervical cytology in the Netherlands; two-step versus see-and-treat approach
April 2, 2020
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In treatment and prevention of migraine headache, prescription drugs of proven benefit may not be available or affordable, poorly tolerated, or contraindicated. The relatively favorable side effect profile of aspirin and extremely low costs compared with other prescription drug therapies may provide additional options for primary healthcare providers in the treatment of both acute and recurrent migraine headaches.
Full Story: The American Journal of Medicine (4/2020) 
Clinical Updates
Proton pump inhibitors are associated with a number of adverse kidney outcomes. They are abundantly prescribed, rarely deprescribed, often purchased over the counter, frequently used without medical indication, and when medically indicated, they are often used for much longer than needed. In this issue of AJKD, Ziyad Al-Aly and colleagues summarize evidence linking PPI use with adverse events in general, and adverse kidney outcomes in particular. They provide an assessment of how this evidence should inform clinical practice, and provide recommendations on how to approach PPI use and deprescription.
Full Story: American Journal of Kidney Diseases (4/2020) 
See-and-treat is only justified in women with high-grade cytology and completed childbearing, otherwise a biopsy must be performed before treatment is considered to avoid overtreatment.
Full Story: American Journal of Obstetrics & Gynecology (4/2020) 
This RCT compared an integrated collaborative care intervention for obesity and depression to usual care in adult primary care patients, measuring weight and depressive symptoms, quality of life, and psychosocial functioning. Intervention group participants experienced significant improvements in obesity-specific problems, mental health-related quality of life, sleep disturbance, sleep-related impairment, and functional disability at 6 months but not at 12 months. These improvements were associated with lower BMI and fewer depressive symptoms.
Full Story: American Journal of Preventive Medicine (4/2020) 
This study analyzed anticholinergic burden and its relationship to delirium and mortality in elderly acutely ill medical patients. Using the Anticholinergic Cognitive Burden Scale (ACB), researchers found an association between anticholinergic burden and the presence of delirium, but not with mortality at, 12 months. However, a very high 12-month mortality rate might have been an obstacle for association recognition. Clinician awareness of possible drug side effects, especially in older populations, is crucial.
Full Story: Journal of the American Medical Directors Association (4/2020) 
More information is needed about the risk factors associated with community-associated Clostridioides difficile infection (CDI) in children. This retrospective review of the electronic health records aimed to describe and explore trends in the incidence rates, and address risk factors of community-acquired CDI in children. The risk factors for community-acquired CDI included non-Hispanic ethnicity; amoxicillin-clavulanate, cephalosporin, and clindamycin use within the previous 12 weeks; a previous positive C difficile test within 6 months; and increased health care visits in the last year. Enhanced antibiotic stewardship and recognition of health care disparities may ease the burden of community-acquired CDI.
Full Story: The Journal of Pediatrics (4/2020) 
Medical News
US coronavirus deaths top 5K, cases surpass 216K
San Francisco (Justin Sullivan/Getty Images)
Data from Johns Hopkins University showed the number of confirmed coronavirus cases in the US has risen beyond 216,000, and there have been more than 5,100 COVID-19-related fatalities, prompting Florida, Georgia and Mississippi to issue stay-at-home orders. Twelve states have not issued stay-at-home orders, and President Donald Trump declined to issue a nationwide stay-at-home order.
Full Story: CNBC (4/2),  CNN (4/2),  The Hill (4/1) 
CDC researchers analyzed 7,162 confirmed COVID-19 cases in the US and found that the risk of developing severe complications is higher among people with cardiovascular disease, chronic lung disease or diabetes and those who smoke. Data showed 78% of COVID-19 patients admitted to intensive care units and 71% who were hospitalized had one or more underlying health conditions.
Full Story: CNBC (3/31) 
A study of patients with and without diabetes published in Circulation found that patients who took rivaroxaban twice a day plus a daily aspirin had a consistent and similar relative risk reduction for cardiovascular death, myocardial infarction or stroke, compared with those who took placebo and aspirin. Based on data from 18,278 patients, the findings also revealed that those with diabetes had greater absolute risk reductions with rivaroxaban for the primary efficacy endpoint at three years and for all-cause mortality, compared with those without the disease.
Full Story: Medscape (free registration) (3/29) 
Business Practice News
A new study on the medRxiv preprint server found that 30.2% of 985,026 licensed physicians in the US are ages 60 and older, which puts them at increased risk of developing severe COVID-19. Researchers examined the 2018 physician database from the Federation of State Medical Boards and found California and New York had the most doctors ages 60 and older, while North Dakota and Vermont had the fewest.
Full Story: Becker's Hospital Review (4/1) 
Officials: National stockpile of PPE nearly exhausted
(Misha Friedman/Getty Images)
Two Department of Homeland Security sources and Connecticut Gov. Ned Lamont said the country's emergency medical stockpile is nearly out of respirators, face shields, masks, gowns, gloves and other personal protective equipment as demand surges. The Federal Emergency Management Agency said almost 12 million N95 masks, 26 million surgical masks, over 8,000 ventilators, and many surgical gowns, gloves and face shields had been taken from the stockpile and distributed across the country as of Saturday.
Full Story: Reuters (3/31) 
Sharing clinical notes with patients takes time, but health care providers generally approve of the concept and say it helps engage patients in their own care, according to the results of a survey published in JAMA Network Open. Clinicians who participate in the OpenNotes initiative say it has increased the amount of time they spend documenting, likely because they augmented their notes to make them more easily understood, and many said they would like a way to find out which patients view clinical notes.
Full Story: Patient Engagement HIT (3/31) 
Patient's Perspective
Data from 121 clinical trials found that 14 popular diets led to some modest weight loss and improvements in blood pressure at six months for people with overweight or obesity, but by 12 months the effects had decreased to negligible, researchers reported in The BMJ. The top three diets for weight loss and BP reduction at six months were Atkins, Zone and DASH.
Full Story: MedPage Today (free registration) (4/1) 
If you can't go straight ahead, you go around the corner.
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