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E-cigarettes with behavioral support more effective than nicotine replacement for smoking cessation

A study of 886 randomized United Kingdom National Health Service stop-smoking service attendees showed better 1-year abstinence rates in the e-­­cigarette (18%) vs. nicotine replacement product (9%) group (risk ratio,1.83; 95% confidence interval, 1.30-2.58) when both groups received behavioral support.

Citation: Hajek P et al. A randomized trial of e-cigarettes versus nicotine-replacement therapy. N Eng J Med. 2019 Feb 14;380:629-37.

New scoring system more accurate in diagnosing sepsis than qSOFA

Using retrospective data from 2,759,529 ED patients in 49 urban hospitals, and a supervised machine-learning process, the authors developed a Risk of Sepsis score, which demonstrated significantly higher sensitivity for detecting sepsis than the qSOFA (Quick Sequential Organ Failure Assessment) score.

Citation: Delahanty R et al. Development and evaluation of a machine learning model for the early identification of patients at risk for sepsis. Ann Emerg Med. 2019 Apr;73(4):334-44.

Shared decision making may decrease risk of legal action

A randomized, controlled simulation experiment using a clinical vignette with an adverse outcome showed that when engaged in shared decision making, participants were less likely to consider taking legal action.

Citation: Schoenfeld EM et al. The effect of shared decision making on patients’ likelihood of filing a complaint or lawsuit: A simulation study. Ann Emerg Med. 2019 Jan 3. doi: 10.1016/j.annemergmed.2018.11.017.

ADA issues new inpatient diabetes care recommendations

The American Diabetes Association recommends that insulin therapy be initiated for a majority of inpatients who have persistent hyperglycemia greater than 180 mg/dL to target a blood glucose range of 140-180 mg/dL. They recommend the use of basal insulin or basal plus bolus insulin and discourage the sole use of sliding scale insulin.

Citation: American Diabetes Association. 15. Diabetes care in the hospital: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl. 1):S173-81.

Beta-blocker use may reduce risk of COPD hospitalization

In a retrospective longitudinal study of 301,542 patients newly prescribed beta-blockers and 1,000,633 patients newly prescribed any other antihypertensive drug, patients who were treated with beta-blockers continuously for more than 6 months had a significantly lower risk of chronic obstructive pulmonary disease (COPD) hospitalization, all-cause mortality, and COPD death than did patients who received alternative antihypertensives. Patients with a history of COPD hospitalization were excluded from this study.

Citation: Nielsen AO et al. Beta-blocker therapy and risk of chronic obstructive pulmonary disease: A Danish nationwide study of 1.3 million individuals. EClinicalMedicine. 2019;7:21-6. doi: 10.1016/j.eclinm.2019.01.004.

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