Interesting Articles: A Weekly Review of the "Big Five" Medical Journals

This is a collection of articles I have found interesting in the weekly editions of the "big five" medical journals: NEJM, JAMA, Annals, Lancet and BMJ (a few more journals are included occasionally). The review is a weekly feature of Clinical Cases and Images - Blog. Please see the end of the post for a suggested time-efficient way to stay up-to-date with the medical literature.

------------------------------------------------------------------------------

Statins reduce blood pressure? Arch Intern Med. 2008;168(7):721-727.

Statins modestly but significantly reduced BP relative to placebo, by 2.2 mm Hg for SBP and 2.4mm Hg for DBP. Reductions in SBP and DBP extended to normotensive subjects. These modest effects may contribute to the reduced risk of stroke and cardiovascular events reported with statins.

------------------------------------------------------------------------------

DASH-Style Diet Reduces Risk of Coronary Heart Disease and Stroke in Women. Arch Intern Med. 2008;168(7):713-720.

The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to lower blood pressure, but little is known about its long-term effect on cardiovascular end points. In this study, adherence to the DASH-style diet was associated with a lower risk of CHD and stroke among middle-aged women during 24 years of follow-up.

This is a suggested mnemonic:

DASH
Diet
Decreases risk of CAD and CVA

CAD and CVA are 2 of the RCRI components used to evaluate perioperative risk. 4CD is a mnemonic to remember the risk factors in RCRI:

CAD
CHF
CVA
CKD
DM

------------------------------------------------------------------------------

Don't discharge too fast: Short Length of Hospital Stay Increases Postdischarge Mortality in Patients With Pulmonary Embolism. Arch Intern Med. 2008;168(7):706-712.

The optimal length of stay (LOS) for patients with pulmonary embolism (PE) is unknown. In this study, patients with a very short LOS (4 days or less) had greater postdischarge mortality relative to patients with a typical LOS (5 to 6 days), suggesting that physicians may inappropriately select patients with PE for early discharge who are at increased risk of complications.

According to the current ACP guidelines for treatment of VTE, selected patients with PE do not need to be admitted to the hospital at all and can be treated as outpatients.

------------------------------------------------------------------------------

Pharmacist Care of Patients With Heart Failure. Arch Intern Med. 2008;168(7):687-694.

Pharmacist care in the treatment of patients with HF greatly reduces the risk of all-cause and HF hospitalizations.

------------------------------------------------------------------------------

The Lancet Seminar: Prevalence, pathogenesis, and causes of chronic cough and Management of chronic cough. The Lancet 2008; 371:1375-1384.

In 2001, while studying for USMLE, I made up a mnemonic for differential diagnosis of cough - BAD CAT TOM:

Bronchitis or pneumonia
Asthma
Drugs, e.g. ACEi

Cardiogenic, e.g. mitral stenosis
Aspiration, e.g in achalasia, foreign body
TB

Thyroid enlargement, e.g. goiter
Other, e.g. PE
Malignancy, e.g. lung cancer


Mind map of differential diagnosis of cough. See more Allergy and Immunology mind maps here.

------------------------------------------------------------------------------

150 years of Gray's Anatomy: Breathing life into Gray's Anatomy. The Lancet 2008; 371:1327-1328.

Gray's Anatomy is now one of the world's best known medical books, having been constantly in print since its birth 150 years ago.

------------------------------------------------------------------------------

Can you pay people to be healthy? The Lancet 2008; 371:1325-1326.

Examples of success include a US program which boosted the number of people with depression who attend counseling appointments by offering $10 per session; money, transport vouchers, and food baskets to improve completion of tuberculosis treatment in Russia and Latin America.

------------------------------------------------------------------------------

Good deeds and Google. The Lancet 2008; 371:1310.

Google and the UN High Commissioner for Refugees (UNHCR) launched an online site that enables users to get a bird's eye view of displacement camps in Chad, Darfur, Iraq, and Colombia. Read more from PC Magazine and Google.


USHMM Crisis in Darfur in Google Earth

------------------------------------------------------------------------------

Related:
Make Your Own "Medical Journal" with iGoogle Personalized Page
Share iGoogle Tabs with Medical Journals, Podcasts and Gadgets
Annals of Internal Medicine Launches Podcast and Audio Summaries
Text-to-Speech Programs and Continuous Medical Education
Image source: OpenClipArt, public domain.