{"id":439,"date":"2011-04-13T09:09:39","date_gmt":"2011-04-13T13:09:39","guid":{"rendered":"http:\/\/blogstemp2.wpengine.com\/?p=439"},"modified":"2011-04-13T09:09:39","modified_gmt":"2011-04-13T13:09:39","slug":"practice-changing-articles-iv","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/04\/practice-changing-articles-iv\/","title":{"rendered":"Practice-Changing Articles IV"},"content":{"rendered":"<p>Recent advances and discussions in medicine are the cornerstone of <em>Journal Watch<\/em>.\u00a0Here\u2019s the fourth installment of the articles that\u00a0made the biggest impression on me in the\u00a0past 2 weeks.\u00a0I hope you enjoy the articles I selected.<\/p>\n<p>Please feel free to leave a comment on the articles \u2014 Do you like them? Dislike them? Agree, disagree, state your opinion, and participate in the discussion. And if you know of another recent interesting article, post a link to it. I would love to read it.<\/p>\n<p>Greg Bratton, MD<\/p>\n<p>Articles of Interest:<\/p>\n<ul>\n<li><strong><a href=\"http:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2011\/04\/Accucheck.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-full wp-image-440\" title=\"Accucheck\" src=\"http:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2011\/04\/Accucheck.jpg\" alt=\"glucose meter\" width=\"150\" height=\"150\" srcset=\"https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2011\/04\/Accucheck.jpg 225w, https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2011\/04\/Accucheck-150x150.jpg 150w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a><a href=\"http:\/\/hospital-medicine.jwatch.org\/cgi\/content\/full\/2011\/404\/2\" target=\"_blank\">Glycemic Control in Hospitalized Patients: Hold On Loosely?<\/a><\/strong> &#8211;\u00a0A common topic on Medicine rounds &#8211; whether in the ICU or on the wards &#8211; is blood sugar. Likely, this is because of the preponderance of diabetics that require hospitalization. However,\u00a0keeping\u00a0tight control of their sugar\u00a0in the hospital might not be as crucial as keeping tight control of it in outpatients. According to this study, <em>intensive insulin therapy <\/em>(IIT) &#8220;&#8230; did not improve short-term mortality (at 28 days), and no consistent evidence showed that long-term mortality (at 90 or 180 days), length of stay, or infection rates were better with IIT.&#8221; The major side effect of IIT was hypoglycemia, which might be associated higher mortality, dementia, and adverse cardiovascular events. The American College of Physicians have now recommended a target blood glucose level of 140 to 200 mg\/dL while\u00a0in the hospital. And suddenly, I hear nurses in the background scream in excitement as q4hr Accuchecks become a thing of the past!!<\/li>\n<li><a href=\"http:\/\/general-medicine.jwatch.org\/cgi\/content\/full\/2011\/329\/1\" target=\"_blank\"><strong>Osteoarthritis of the Hip or Knee Raises Mortality Risk<\/strong> <\/a>&#8211;\u00a0During 14 years, 1163 patients who had symptomatic x-ray confirmed osteoarthritis of the hip and knee were found to have\u00a0excess all-cause mortality\u00a0compared with the general population. Similarly, they had\u00a0excess\u00a0cardiovascular-, cancer-, and dementia-associated mortality as well.\u00a0Even as a Sports Medicine doc, I never really put 2 and 2 together when it came to OA.\u00a0But, in reading this article, it all makes perfect sense. Patients with advanced OA limit their activity to limit pain. In doing so, they become &#8220;functionally sedentary,&#8221; which equates to\u00a0increases in weight, cardiovascular risk factors, blood clots, and many other potentially dangerous conditions. In particular, the authors of this article speculate that less physical activity, smoldering inflammation, and use of nonsteroidal anti-inflammatory drugs play a large part in mortality risk. This is definitely something I will implement into my daily discussions with patients about why it is important to address OA aggressively.<\/li>\n<li><a href=\"http:\/\/general-medicine.jwatch.org\/cgi\/content\/full\/2011\/308\/1\" target=\"_blank\"><strong>Antihypertensive Treatment in Patients Without Hypertension<\/strong> <\/a>&#8211;\u00a0Although this was a technically limited study, an interesting approach is brought to light. We all know the benefit of anti-hypertensive medications when it comes to blood pressure and associated adverse events (stroke, MI, etc.). But using these meds in a population without hypertension in order to prevent these outcomes seems ridiculous. Or does it? In this\u00a0meta-analysis of 25 randomized trials of antihypertensive medications,\u00a064,162 nonhypertensive patients with cardiovascular disease (CHF, MI, CVA) or risk factors for CVD were studied. The outcomes showed\u00a0&#8220;relative risk reductions for patients with known CVD were 23% for stroke, 20% for MI, 29% for CHF events, 17% for CVD-related mortality, and 13% for all-cause mortality.&#8221; The limitation being the number needed to treat to establish such reductions were 20-130 patients.\u00a0There was no\u00a0significant benefit when participants had only CVD risk factors. Whether lower-risk patients without CVD benefit from prehypertension treatment is less clear, but this study does raise some interesting questions. And as I always say, even a bonfire starts with a single flame.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Recent advances and discussions in medicine are the cornerstone of Journal Watch.\u00a0Here\u2019s the fourth installment of the articles that\u00a0made the biggest impression on me in the\u00a0past 2 weeks.\u00a0I hope you enjoy the articles I selected. Please feel free to leave a comment on the articles \u2014 Do you like them? Dislike them? Agree, disagree, state [&hellip;]<\/p>\n","protected":false},"author":18,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,5],"tags":[11,24,26,31],"class_list":["post-439","post","type-post","status-publish","format-standard","hentry","category-clinical-implications-of-research","category-journal-club","tag-arthritis","tag-diabetes","tag-evidence-based-medicine","tag-patient-care"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v17.1.2 (Yoast SEO v20.8) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Practice-Changing Articles IV - Insights on Residency Training<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/04\/practice-changing-articles-iv\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Practice-Changing Articles IV\" \/>\n<meta property=\"og:description\" content=\"Recent advances and discussions in medicine are the cornerstone of Journal Watch.\u00a0Here\u2019s the fourth installment of the articles that\u00a0made the biggest impression on me in the\u00a0past 2 weeks.\u00a0I hope you enjoy the articles I selected. Please feel free to leave a comment on the articles \u2014 Do you like them? Dislike them? Agree, disagree, state [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/04\/practice-changing-articles-iv\/\" \/>\n<meta property=\"og:site_name\" content=\"Insights on Residency Training\" \/>\n<meta property=\"article:published_time\" content=\"2011-04-13T13:09:39+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2011\/04\/Accucheck.jpg\" \/>\n<meta name=\"author\" content=\"Greg Bratton, MD\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Greg Bratton, MD\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/04\/practice-changing-articles-iv\/\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/04\/practice-changing-articles-iv\/\",\"name\":\"Practice-Changing Articles IV - Insights on Residency Training\",\"isPartOf\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\"},\"datePublished\":\"2011-04-13T13:09:39+00:00\",\"dateModified\":\"2011-04-13T13:09:39+00:00\",\"author\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/aa7ea23414872f1f891225542cb80120\"},\"breadcrumb\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/04\/practice-changing-articles-iv\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/04\/practice-changing-articles-iv\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2011\/04\/practice-changing-articles-iv\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/blogs.nejm.org\/general-medicine\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Practice-Changing Articles&nbsp;IV\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/\",\"name\":\"Insights on Residency Training\",\"description\":\"Observation of residents across diverse medical specialties\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/blogs.nejm.org\/general-medicine\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/aa7ea23414872f1f891225542cb80120\",\"name\":\"Greg Bratton, MD\",\"description\":\"Born and raised in Dallas, Texas, Dr. Bratton received his Bachelor of Science in Kinesiology-Movement Science at Texas Christian University in Fort Worth, Texas. 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