{"id":37905,"date":"2013-08-12T11:17:25","date_gmt":"2013-08-12T15:17:25","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=37905"},"modified":"2013-08-12T11:17:25","modified_gmt":"2013-08-12T15:17:25","slug":"selections-from-richard-lehmans-literature-review-august-12th","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/08\/12\/selections-from-richard-lehmans-literature-review-august-12th\/","title":{"rendered":"Selections from Richard Lehman\u2019s Literature Review: August 12th"},"content":{"rendered":"

CardioExchange is pleased to reprint this selection from Dr. Richard Lehman\u2019s\u00a0weekly journal review blog<\/a>\u00a0at\u00a0BMJ.com<\/a>. Selected summaries are relevant to our audience, but we encourage members to engage with the\u00a0entire blog<\/a>.<\/em><\/p>\n

Lancet\u00a0 10 Aug 2013\u00a0 Vol 382<\/strong><\/p>\n

BP Targets in Patients with Recent Lacunar Stroke (pg. 507):<\/strong>\u00a0 \u201cSmall subcortical brain infarcts, commonly known as lacunar strokes, comprise about 25% of ischaemic strokes. Most result from disease of the small penetrating arteries.\u201d The SP3 trial<\/a> looked at the effect of blood pressure lowering to a systolic blood pressure target above or below 130 in this specific type of stroke. There was no significant difference in outcomes. Nonetheless, the authors hold to the principle \u201cthe lower the better\u201d because for recurrent stroke and cardiovascular death the trend was towards reduction, and \u201ctreatment-related serious adverse events were infrequent.\u201d I can go with this so far, but when you are talking about giving stroke patients lifelong medication on the basis of numbers-needed-to-treat which are incalculably large, even non-serious adverse effects such as tiredness, cough, polyuria and dizziness on getting up are hard to justify. Treat the patient, not the target.<\/p>\n

Effectiveness of Intermittent Pneumatic Compression in Reduction of Risk of DVT in Patients Who have had a Stroke (pg. 516):<\/strong> CLOTS 3 is the acronym of a trial<\/a> of intermittent pneumatic compression to reduce DVT on patients immobilized by stroke. If you try really hard you can extract these letters from \u201cClots in Legs Or sTockings after Stroke.\u201d Going by initials, that should really be CILOSAS; but enough of acronyms, which provide innocent fun for researchers in the hope that they will help readers remember the trial. Preventing DVT after severe stroke is probably worthwhile, and these inflating stockings do reduce venous clots by about a third. The median age of the patients was 76, and a lot of them died: 33 fewer in the intervention group, which was not statistically significant given the large size of this UK trial.<\/p>\n

BMJ\u00a0 10 Aug 2013\u00a0 Vol 347<\/strong><\/p>\n

Effect of Telephone Health Coaching on Hospital Use and Associated Costs:<\/strong> \u201c2698 patients (were) recruited from local general practices before 2009 with heart failure, coronary heart disease, diabetes, or chronic obstructive pulmonary disease; and a history of inpatient or outpatient hospital use.\u201d They were then individually randomized to usual care or \u201ctelephone health coaching<\/a> (which) involved a personalised care plan and a series of outbound calls usually scheduled monthly.\u201d The aim was to reduce hospital admissions. The result was to increase them. Since then, the most popular research idea seems to be to hand out iPads for education and monitoring to reduce admissions for chronic disease. Will this have any effect? Yes, I think it will increase disease awareness, anxiety, and iPad ownership.<\/p>\n","protected":false},"excerpt":{"rendered":"

This week’s topics include BP targeting in patients with recent lacunar stroke, intermittent pneumatic compression for reducing DVT risk in patients who’ve had a stroke, and more.<\/p>\n","protected":false},"author":475,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[1915,1585,1443,1916,253,1917],"class_list":["post-37905","post","type-post","status-publish","format-standard","hentry","category-general","tag-blood-pressure-targets","tag-deep-vein-thrombosis","tag-lacunar-stroke","tag-pneumatic-compression","tag-stroke","tag-telephone-health-coaching"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/37905","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/475"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=37905"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/37905\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=37905"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=37905"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=37905"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}