What did we learn in 2009?
The editors of Journal Watch, a publication of The New England Journal of Medicine, have compiled a top ten list for the most important clinical pearls of 2009. These stories and findings are consequential and should effect the daily practice of physicians. Although patients may sometimes be frustrated to learn that once-sage advice can be rendered obsolete with new evidence, it is good that modern medicine keeps striving for proof that what we practice is beneficial to health.
Here are the editors’ choices for top medical stories of 2009.
[Hopefully Journal Watch won’t mind that I’ve reproduced them here, since I find great value in my $99 subscription and encourage other clinicians to join, too!]
PSA Screening: Initial Reports from Two Randomized Trials
Screening reduced prostate cancer–specific mortality slightly in one study, and not at all in the other.
Reviewing: Andriole GL et al. N Engl J Med 2009 Mar 26; 360:1310
Schröder FH et al. N Engl J Med 2009 Mar 26; 360:1320
Barry MJ. N Engl J Med 2009 Mar 26; 360:1351
Intensive Glucose Control Harms Critically Ill Patients
More evidence that just keeping glucose levels <180 mg/dL is better than striving for very low levels.
Reviewing: The NICE-SUGAR Study Investigators. N Engl J Med 2009 Mar 26; 360:1283
Inzucchi SE and Siegel MD. N Engl J Med 2009 Mar 26; 360:1346
Revascularization Is Ineffective for Atherosclerotic Renal Artery Stenosis
This procedure conferred substantial risk without clinical benefit.
Reviewing: The ASTRAL Investigators. N Engl J Med 2009 Nov 12; 361:1953
Vertebroplasty Strikes Out
This procedure yielded no improvements in two randomized placebo-controlled trials.
Reviewing: Kallmes DF et al. N Engl J Med 2009 Aug 6; 361:569
Buchbinder R et al. N Engl J Med 2009 Aug 6; 361:557
Screening for Cardiac Disease in Asymptomatic Patients with Type 2 Diabetes
Overall cardiac risk was relatively low, and screening was of no benefit.
Reviewing: Young LH et al. JAMA 2009 Apr 15; 301:1547
No Clear Benefit for Aspirin in Primary Prevention of Cardiovascular Disease
Risks might outweigh benefits in patients who receive other modern preventive therapies.
Reviewing: Antithrombotic Trialists’ (ATT) Collaboration. Lancet 2009 May 30; 373:1849
Clinical Course of Advanced Dementia
As we suspected: Advanced dementia is a terminal illness.
Reviewing: Mitchell SL et al. N Engl J Med 2009 Oct 15; 361:1529
Gastric Bypass vs. Banding — A Randomized Trial
Bypass led to greater weight loss but was associated with more complications.
Reviewing: Nguyen NT et al. Ann Surg 2009 Oct; 250:631
Breast Cancer Screening: Who, When, and How?
New USPSTF guidelines narrow the proposed age range for screening mammography and recommend biennial screening.
Reviewing: U.S. Preventive Services Task Force. Ann Intern Med 2009 Nov 17; 151:716
Mandelblatt JS et al. for the Breast Cancer Working Group of the Cancer Intervention and Surveillance Modeling Network (CISNET). Ann Intern Med 2009 Nov 17; 151:738
Kerlikowske K. Ann Intern Med 2009 Nov 17; 151:750
New Human Illness from Swine Flu Virus
Certain features suggest the risk for a pandemic.
(published in April, 2009 just as the H1N1 virus was being discovered)