ACP Journal Club: August 2008

ACP Journal Club
by Brian Haynes, MD, PhD
American College of Physicians (2008)

ACP Journal Club, published by the American College of Physicians, is the quintessential evidence-based journal and is often positioned near the top of the EBM pyramid.  Published monthly, it selects articles from the biomedical literature that report original studies and systematic reviews that warrant immediate attention by physicians attempting to keep pace with important advances in internal medicine. These articles are then summarized in value-added abstracts and commented on by clinical experts.

Volume 149, Number 2
Therapeutics

• A targeted, multifactorial intervention reduced mortality in patients with type 2 diabetes and microalbuminuria
• Metformin plus a lifestyle intervention was more effective than either alone for antipsychotic-induced weight gain

Etiology

• Nondiabetic maternal hyperglycemia was associated with adverse pregnancy outcomes

Therapeutics

• Metformin (alone or with insulin) was as effective as insulin for preventing perinatal complications in gestational diabetes
• Review: Erythropoiesis-stimulating agents increase mortality and venous thromboembolism in cancer-associated anemia
• An automated external defibrillator in the home did not reduce mortality in patients at risk for cardiac arrest
• Antihypertensive therapy with indapamide and perindopril reduced mortality in patients ≥?80 years
• Risk for cancer was still increased over 2 years after stopping hormone therapy
• Review: Limited evidence suggests that statins are safe in patients with liver disease
• Review: Systemic corticosteroids, antibiotics, and noninvasive positive pressure ventilation are effective in acute COPD
• Rapid screening for methicillin-resistant Staphylococcus aureus (MRSA) did not reduce MRSA acquisition rate

Prognosis

• Melanoma of the scalp and neck had greater risk for melanoma-specific mortality than melanoma of the extremities