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2041. When and How Would You Screen This Patient for Cervical Cancer? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center.
作者: Eileen E Reynolds.;Amy Weinstein.;Huma Farid.;Howard Libman.
来源: Ann Intern Med. 2022年175卷2期267-275页
Successful screening programs based on cervical cytology have dramatically reduced the incidence of cervical cancer in the United States. Human papillomavirus immunization is poised to reduce it further as an increasing percentage of vaccinated women reach adulthood. A recent guideline from the American Cancer Society advises that cervical cancer screening begin at age 25 and that high-risk human papillomavirus testing is the preferred screening test. The U.S. Preventive Services Task Force recommends screening begin at age 21 and that cytology remain incorporated into screening. Here, 2 experts debate how to apply these guidelines to Ms. L, a 22-year-old woman who has never undergone cervical cancer screening.
2042. Acute Gastrointestinal Bleeding.
Acute gastrointestinal bleeding (GIB) is a common clinical entity. Expert management of acute GIB requires collaborative care between internists and other specialists. This article reviews the presentation, treatment, and prevention of acute GIB using recommendations from recent guidelines and expert panel reviews. The article acknowledges the pivotal role played by primary care providers in the inpatient and outpatient management of acute GIB.
2043. Association of AZD1222 and BNT162b2 COVID-19 Vaccination With Thromboembolic and Thrombocytopenic Events in Frontline Personnel : A Retrospective Cohort Study.
作者: Anders Hviid.;Jørgen Vinsløv Hansen.;Emilia Myrup Thiesson.;Jan Wohlfahrt.
来源: Ann Intern Med. 2022年175卷4期541-546页
In March 2021, several European countries suspended the use of the AZD1222 (Oxford-AstraZeneca) COVID-19 vaccine because of thromboembolic safety concerns. Reports from Norway and Germany subsequently described patients with venous thrombosis and thrombocytopenia within 5 to 16 days of vaccination.
2044. In patients with stable CVD receiving statins, evolocumab reduced acute arterial events across all vascular territories.
Oyama K, Giugliano RP, Tang M, et al. Effect of evolocumab on acute arterial events across all vascular territories: results from the FOURIER trial. Eur Heart J. 2021;42:4821-9. 34537830.
2047. In AF after TAVR, edoxaban was noninferior to VKAs for a composite of adverse events but increased major bleeding.
Van Mieghem NM, Unverdorben M, Hengstenberg C, et al. Edoxaban versus vitamin K antagonist for atrial fibrillation after TAVR. N Engl J Med. 2021;385:2150-60. 34449183.
2048. In mild acute diverticulitis, outpatient therapy without antibiotics was noninferior to antibiotics.
Mora-López L, Ruiz-Edo N, Estrada-Ferrer O, et al. Efficacy and safety of nonantibiotic outpatient treatment in mild acute diverticulitis (DINAMO-study): a multicentre, randomised, open-label, noninferiority trial. Ann Surg. 2021;274:e435-42. 34183510.
2049. In patients hospitalized with COVID-19, therapeutic- vs. prophylactic-dose heparin did not reduce a composite outcome at 28 d.
Sholzberg M, Tang GH, Rahhal H, et al. Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial. BMJ. 2021;375:n2400. 34649864.
2050. In COVID-19, escalated- vs. prophylactic-dose anticoagulation does not reduce mortality and increases major bleeding.
Ortega-Paz L, Galli M, Capodanno D, et al. Safety and efficacy of different prophylactic anticoagulation dosing regimens in critically and non-critically ill patients with COVID-19: a systematic review and meta-analysis of randomized controlled trials. Eur Heart J Cardiovasc Pharmacother. 2021. [Epub ahead of print.] 34519777.
2051. Historically High Excess Mortality During the COVID-19 Pandemic in Switzerland, Sweden, and Spain.
作者: Kaspar Staub.;Radoslaw Panczak.;Katarina L Matthes.;Joël Floris.;Claudia Berlin.;Christoph Junker.;Rolf Weitkunat.;Svenn-Erik Mamelund.;Marcel Zwahlen.;Julien Riou.
来源: Ann Intern Med. 2022年175卷4期523-532页
Excess mortality quantifies the overall mortality impact of a pandemic. Mortality data have been accessible for many countries in recent decades, but few continuous data have been available for longer periods.
2052. In high-risk inpatients with COVID-19, therapeutic- vs. standard-dose heparin reduced thromboembolism or death at 30 d.
Spyropoulos AC, Goldin M, Giannis D, et al. Efficacy and safety of therapeutic-dose heparin vs standard prophylactic or intermediate-dose heparins for thromboprophylaxis in high-risk hospitalized patients with COVID-19: the HEP-COVID randomized clinical trial. JAMA Intern Med. 2021;181:1612-20. 34617959.
2054. Cost-Effectiveness of Long-Acting Injectable HIV Preexposure Prophylaxis in the United States : A Cost-Effectiveness Analysis.
作者: Anne M Neilan.;Raphael J Landovitz.;Mylinh H Le.;Beatriz Grinsztejn.;Kenneth A Freedberg.;Marybeth McCauley.;Nattanicha Wattananimitgul.;Myron S Cohen.;Andrea L Ciaranello.;Meredith E Clement.;Krishna P Reddy.;Emily P Hyle.;A David Paltiel.;Rochelle P Walensky.
来源: Ann Intern Med. 2022年175卷4期479-489页
The HIV Prevention Trials Network (HPTN) 083 trial demonstrated the superiority of long-acting injectable cabotegravir (CAB-LA) compared with oral emtricitabine-tenofovir disoproxil fumarate (F/TDF) for HIV preexposure prophylaxis (PrEP).
2055. In patients hospitalized for COPD exacerbation, a PE diagnostic strategy + usual care did not improve outcomes.
Jiménez D, Agustí A, Tabernero E, et al. Effect of a pulmonary embolism diagnostic strategy on clinical outcomes in patients hospitalized for COPD exacerbation: a randomized clinical trial. JAMA. 2021;326:1277-85. 34609451.
2056. Effectiveness of Inactivated COVID-19 Vaccines Against Illness Caused by the B.1.617.2 (Delta) Variant During an Outbreak in Guangdong, China : A Cohort Study.
作者: Min Kang.;Yao Yi.;Yan Li.;Limei Sun.;Aiping Deng.;Ting Hu.;Jiayi Zhang.;Jun Liu.;Mingji Cheng.;Shen Xie.;Min Luo.;Jing Jiang.;Yawen Jiang.;Shixing Tang.;Jianfeng He.
来源: Ann Intern Med. 2022年175卷4期533-540页
Real-world evidence on inactivated COVID-19 vaccines against the highly transmissible B.1.617.2 (Delta) variant of SARS-CoV-2 is limited, leaving an important gap in the evidence base about inactivated COVID-19 vaccines for use by immunization programs.
2057. In suspected or provisionally diagnosed ACS, early CTCA did not reduce mortality or nonfatal MI at 1 y.
Gray AJ, Roobottom C, Smith JE, et al. Early computed tomography coronary angiography in patients with suspected acute coronary syndrome: randomised controlled trial. BMJ. 2021;374:n2106. 34588162.
2058. In critically ill adults, IV fluid bolus infused at slower vs. faster rates did not differ for 90-d mortality.
Zampieri FG, Machado FR, Biondi RS, et al. Effect of slower vs faster intravenous fluid bolus rates on mortality in critically ill patients: the BaSICS randomized clinical trial. JAMA. 2021;326:830-8. 34547081.
2060. In permanent AF with narrow QRS, AV junction ablation + CRT vs. rate-control drug therapy reduced mortality.
Brignole M, Pentimalli F, Palmisano P, et al. AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial. Eur Heart J. 2021;42:4731-9. 34453840.
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