2 Minute Medicine Rewind July 8 – July 14, 2013

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

Geographic Variation in Cardiovascular Procedure Use Among Medicare Fee-for-Service vs Medicare Advantage Beneficiaries 

In this retrospective analysis of patients in capitated and fee-for-service Medicare plans, investigators found the capitated Medicare Advantage plans had fewer angiograms (16.5 vs. 25.9 per 1000 person-years, p < 0.001)  and percutaneous coronary interventions (6.8 vs. 9.8 per 1000 person-years, p < 0.001) but similar rates of coronary artery bypass graft (CABG) surgeries (3.1 vs. 3.4 per 1000 person-years, p = 0.33). There was substantial regional variation in rates for procedures in both capitated and fee-for-service Medicare programs.

Retinoic Acid and Arsenic Trioxide for Acute Promyelocytic Leukemia

In this multicenter RCT, patients with low-to-intermediate risk acute promyelocytic leukemia was randomized to all-trans retinoic acid with arsenic trioxide vs. all-trans retinoic acid with idarubicin. Complete remission was found in 77 (100%) patients treated with all-trans retinoic acid and arsenic trioxide vs. 75 (95%) patients treated with all-trans retinoic acid and idarubicin. Two year event-free survival was superior in the all-trans retinoic acid with arsenic trioxide group (97% vs. 86%, p = 0.02).

U.S. Hospitalizations for Pneumonia after a Decade of Pneumococcal Vaccination

In this retrospective analysis of US hospital admissions, investigators compared rates of pneumonia related hospitalizations between 1997-1999 (before introduction of the 7-valent pneumococcal conjugate vaccine) and 2007-2009 (after introduction of pneumococcal vaccine). The investigators found the annual rate of hospitalization for pneumonia among children younger than 2 years of age declined by 551.1 per 100,000 children (95% confidence interval [CI], 445.1 to 657.1) and the hospitalization rate for adults 85 years of age or older declined by 1300.8 per 100,000 (95% CI, 984.0 to 1617.6).

Nivolumab plus Ipilimumab in Advanced Melanoma

In this non-blinded stage I trial, 86 patients with metastatic melanoma received ipilimumab (anti CTLA-4 antibody) and nivolumab (anti PD1 receptor antibody). At maximum doses, 53% of patients had an objective response with a tumor size reduction of 80% or more.

Effect of Soy Protein Isolate Supplementation on Biochemical Recurrence of Prostate Cancer After Radical Prostatectomy

In this multicenter RCT, investigators compared soy protein isolate vs. placebo in men after radical prostatectomy at high risk for risk of recurrence. This study was stopped early due to futility with 28.3% of subjects developing recurrence at 2 years (27.2% vs. 29.5%, p = 0.89).

By David Ouyang

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