2 Minute Medicine Rewind: June 10 – June 17

June 10 – June 17, 2013

In this section, we will highlight the some of the high-impact studies, updates, and analyses published in medicine during the past week.

Targeted versus Universal Decolonization to Prevent ICU Infection

In this multicenter cluster randomized control trial, investigators compared the MRSA and all bloodstream infection rates in ICUs utilizing strategies of either 1) MRSA screening and isolation, 2) screening, isolation, and decolonization, or 3) universal decolonization (w/ chlorhexidine bath or intranasal mupirocin). Hazard ratios of repeat MRSA positive testing for each intervention compared to a baseline of 12 months before were 0.92, 0.75, and 0.63 respectively, suggesting universal decolonization was more effective than MRSA screening at reducing rates of bloodstream infections.

Clinical Ascertainment of Health Outcomes Among Adults Treated for Childhood Cancer

This analysis of participants of the St Jude Lifetime Cohort Study suggests significant adverse health outcomes of adult survivors of childhood cancers. The study authors estimate that at age 50, the prevalence of cardiomyopathy is 21.6%, heart valve disease is 83.5%, pulmonary dysfunction is 81.6%, hearing loss is 86.5%, and breast cancer is 40.9%. Using a systematic medical assessment, a substantial number of previously undiagnosed problems were identified during the study.

Maternal Obesity and Risk of Preterm Delivery

In this analysis of singleton births between 1992 and 2010 in the Swedish Medical Birth Register, investigators found an increased risk of spontaneous preterm deliveries and medically indicated preterm deliveries in overweight and obese mothers. For women with BMI 18.5 to 24, the rate of delivery between 22 and 27 weeks was 0.17% vs. 0.21% for BMI 25-30, 0.27% for BMI 30-35, 0.35% for BMI 35-40, and 0.52% for BMI >40.

Racemic Adrenaline and Inhalation Strategies in Acute Bronchiolitis

In this multicenter double-blinded RCT, racemic adrenaline was compared against normal saline for the treatment of acute bronchiolitis in infants (n = 404, mean age 4.2 months). There was not a statistically significant difference in length of stay, oxygen requirement, or ventilatory support between racemic adrenaline and normal saline. For both inhalation interventions, on-demand treatment was associated with decreased length of stay (difference  = 13.7hrs, p= 0.01) and less oxygen supplementation (38% vs. 49%, p = 0.04) compared to scheduled treatments.

Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial

In this multicenter, double-blinded RCT, HIV-negative patients who reported injection drug use in the past year were randomized to directly observed tenofovir or placebo. Of the 1204 participants were randomized to receive tenofovir, 17 subsequently became infected (0.35 per 100 person-years) and of the 1209 randomized to receive placebo, 33 subsequently became infected (0.68 per 100 person-years) – suggesting a 48.9% reduction in HIV incidence (95% CI 9·6—72·2; p=0·01).

By David Ouyang

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