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Inpatient Management of Heart Failure: Are We Shooting at the Right Target?

Inpatient Management of Heart Failure: Are We Shooting at the Right Target?

Ann Intern Med. 2016 Nov 29;:

Authors: Felker GM, Whellan DJ

PMID: 27894128 [PubMed - as supplied by publisher]




Enhancing the Role of Internists in the Transition From Pediatric to Adult Health Care.

Enhancing the Role of Internists in the Transition From Pediatric to Adult Health Care.

Ann Intern Med. 2016 Nov 29;:

Authors: Greenlee MC, D'Angelo L, Harms SR, Kuo AA, Landry M, McManus M, Talente GM, White P, American College of Physicians Council of Subspecialty Societies Pediatric to Adult Care Transitions Initiative Steering Committee

PMID: 27894127 [PubMed - as supplied by publisher]




Brain-Type Natriuretic Peptide and Amino-Terminal Pro-Brain-Type Natriuretic Peptide Discharge Thresholds for Acute Decompensated Heart Failure: A Systematic Review.

Brain-Type Natriuretic Peptide and Amino-Terminal Pro-Brain-Type Natriuretic Peptide Discharge Thresholds for Acute Decompensated Heart Failure: A Systematic Review.

Ann Intern Med. 2016 Nov 29;:

Authors: McQuade CN, Mizus M, Wald JW, Goldberg L, Jessup M, Umscheid CA

Abstract
Background: Acute decompensated heart failure (ADHF) requiring hospitalization is associated with high postdischarge mortality and readmission rates.
Purpose: To examine the association between achieving predischarge natriuretic peptide (NP) thresholds and mortality and readmission rates in adults hospitalized for ADHF.
Data Sources: Multiple databases from 1947 to October 2016 (English-language studies only).
Study Selection: Trials and observational studies that compared mortality and readmission outcomes between patients with ADHF achieving a specific predischarge NP goal and those not achieving the goal.
Data Extraction: Two investigators independently extracted study characteristics and assessed study risk of bias. One author graded the overall strength of evidence, with review by a second author.
Data Synthesis: One randomized trial, 3 quasi-experimental studies, and 40 observational studies were identified. The most commonly used thresholds were a brain-type NP (BNP) level of 250 pg/mL or less or an amino-terminal pro-brain-type NP (NT-proBNP) decrease of at least 30%. Achievement of absolute BNP thresholds reduced postdischarge all-cause mortality (7 of 8 studies) and the composite outcome of mortality and readmission (12 of 14 studies). Achievement of percentage-change BNP thresholds reduced the composite outcome (5 of 6 studies), and achievement of percentage-change NT-proBNP thresholds reduced all-cause and cardiovascular mortality (2 of 4 studies) and the composite outcome (9 of 9 studies). All findings were low-strength. The randomized trial, assessed as having high risk of bias, suggested that a predischarge decrease in NT-proBNP level was associated with lower risk for the composite outcome. Two quasi-experimental studies and 5 observational studies had low risk of bias. Low-risk-of-bias studies had outcome estimates similar in magnitude and direction to estimates from high-risk-of-bias studies.
Limitation: Most studies failed to adjust for critical confounders and had inadequate definition or assessment of exposures and outcomes.
Conclusion: Low-strength evidence suggests an association between achieving NP predischarge thresholds and reduced ADHF mortality and readmission.
Primary Funding Source: None.

PMID: 27894126 [PubMed - as supplied by publisher]




Targeting Functional Decline in Alzheimer Disease: A Randomized Trial.

Targeting Functional Decline in Alzheimer Disease: A Randomized Trial.

Ann Intern Med. 2016 Nov 22;:

Authors: Callahan CM, Boustani MA, Schmid AA, LaMantia MA, Austrom MG, Miller DK, Gao S, Ferguson DY, Lane KA, Hendrie HC

Abstract
Background: Alzheimer disease results in progressive functional decline, leading to loss of independence.
Objective: To determine whether collaborative care plus 2 years of home-based occupational therapy delays functional decline.
Design: Randomized, controlled clinical trial. (ClinicalTrial.gov: NCT01314950).
Setting: Urban public health system.
Patients: 180 community-dwelling participants with Alzheimer disease and their informal caregivers.
Intervention: All participants received collaborative care for dementia. Patients in the intervention group also received in-home occupational therapy delivered in 24 sessions over 2 years.
Measurements: The primary outcome measure was the Alzheimer's Disease Cooperative Study Group Activities of Daily Living Scale (ADCS ADL); performance-based measures included the Short Physical Performance Battery (SPPB) and Short Portable Sarcopenia Measure (SPSM).
Results: At baseline, clinical characteristics did not differ significantly between groups; the mean Mini-Mental State Examination score for both groups was 19 (SD, 7). The intervention group received a median of 18 home visits from the study occupational therapists. In both groups, ADCS ADL scores declined over 24 months. At the primary end point of 24 months, ADCS ADL scores did not differ between groups (mean difference, 2.34 [95% CI, -5.27 to 9.96]). We also could not definitively demonstrate between-group differences in mean SPPB or SPSM values.
Limitation: The results of this trial are indeterminate and do not rule out potential clinically important effects of the intervention.
Conclusion: We could not definitively demonstrate whether the addition of 2 years of in-home occupational therapy to a collaborative care management model slowed the rate of functional decline among persons with Alzheimer disease. This trial underscores the burden undertaken by caregivers as they provide care for family members with Alzheimer disease and the difficulty in slowing functional decline.
Primary Funding Source: National Institute on Aging.

PMID: 27893087 [PubMed - as supplied by publisher]




Travel-Associated Zika Virus Disease Acquired in the Americas Through February 2016: A GeoSentinel Analysis.

Travel-Associated Zika Virus Disease Acquired in the Americas Through February 2016: A GeoSentinel Analysis.

Ann Intern Med. 2016 Nov 22;:

Authors: Hamer DH, Barbre KA, Chen LH, Grobusch MP, Schlagenhauf P, Goorhuis A, van Genderen PJ, Molina I, Asgeirsson H, Kozarsky PE, Caumes E, Hagmann SH, Mockenhaupt FP, Eperon G, Barnett ED, Bottieau E, Boggild AK, Gautret P, Hynes NA, Kuhn S, Lash RR, Leder K, Libman M, Malvy DJ, Perret C, Rothe C, Schwartz E, Wilder-Smith A, Cetron MS, Esposito DH, GeoSentinel Surveillance Network

Abstract
Background: Zika virus has spread rapidly in the Americas and has been imported into many nonendemic countries by travelers.
Objective: To describe clinical manifestations and epidemiology of Zika virus disease in travelers exposed in the Americas.
Design: Descriptive, using GeoSentinel records.
Setting: 63 travel and tropical medicine clinics in 30 countries.
Patients: Ill returned travelers with a confirmed, probable, or clinically suspected diagnosis of Zika virus disease seen between January 2013 and 29 February 2016.
Measurements: Frequencies of demographic, trip, and clinical characteristics and complications.
Results: Starting in May 2015, 93 cases of Zika virus disease were reported. Common symptoms included exanthema (88%), fever (76%), and arthralgia (72%). Fifty-nine percent of patients were exposed in South America; 71% were diagnosed in Europe. Case status was established most commonly by polymerase chain reaction (PCR) testing of blood and less often by PCR testing of other body fluids or serology and plaque-reduction neutralization testing. Two patients developed Guillain-Barré syndrome, and 3 of 4 pregnancies had adverse outcomes (microcephaly, major fetal neurologic abnormalities, and intrauterine fetal death).
Limitation: Surveillance data collected by specialized clinics may not be representative of all ill returned travelers, and denominator data are unavailable.
Conclusion: These surveillance data help characterize the clinical manifestations and adverse outcomes of Zika virus disease among travelers infected in the Americas and show a need for global standardization of diagnostic testing. The serious fetal complications observed in this study highlight the importance of travel advisories and prevention measures for pregnant women and their partners. Travelers are sentinels for global Zika virus circulation and may facilitate further transmission.
Primary Funding Source: Centers for Disease Control and Prevention, International Society of Travel Medicine, and Public Health Agency of Canada.

PMID: 27893080 [PubMed - as supplied by publisher]




A Reporting Tool for Practice Guidelines in Health Care: The RIGHT Statement.

A Reporting Tool for Practice Guidelines in Health Care: The RIGHT Statement.

Ann Intern Med. 2016 Nov 22;:

Authors: Chen Y, Yang K, Marušic A, Qaseem A, Meerpohl JJ, Flottorp S, Akl EA, Schünemann HJ, Chan ES, Falck-Ytter Y, Ahmed F, Barber S, Chen C, Zhang M, Xu B, Tian J, Song F, Shang H, Tang K, Wang Q, Norris SL, RIGHT (Reporting Items for Practice Guidelines in Healthcare) Working Group

Abstract
The quality of reporting practice guidelines is often poor, and there is no widely accepted guidance or standards for such reporting in health care. The international RIGHT (Reporting Items for practice Guidelines in HealThcare) Working Group was established to address this gap. The group followed an existing framework for developing guidelines for health research reporting and the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network approach. It developed a checklist and an explanation and elaboration statement. The RIGHT checklist includes 22 items that are considered essential for good reporting of practice guidelines: basic information (items 1 to 4), background (items 5 to 9), evidence (items 10 to 12), recommendations (items 13 to 15), review and quality assurance (items 16 and 17), funding and declaration and management of interests (items 18 and 19), and other information (items 20 to 22). The RIGHT checklist can assist developers in reporting guidelines, support journal editors and peer reviewers when considering guideline reports, and help health care practitioners understand and implement a guideline.

PMID: 27893062 [PubMed - as supplied by publisher]