Research Commentary by Tom Nolan – September 28, 2023

Good night, overnight appendectomy

How long should someone with appendicitis wait before going to the theater? 1822 patients hospitalized in Norway and Finland with suspected uncomplicated appendicitis were randomly assigned to undergo appendectomy within 8 hours (which could mean overnight surgery) or within 24 hours. There were no statistically significant differences in appendectomy perforation rates (8% and 9%, respectively) or 30-day outcomes between the two groups. The findings suggest that those with uncomplicated appendicitis (which in this study means excluding those with a C-reactive protein level ≥100 mg/L, a fever >38.5°C, signs of complicated appendicitis on imaging studies, or systemic peritonitis) People) may be able to wait until morning.

lancet Number: 10.1016/S0140-6736(23)01311-9

Private IOC

Journal of the American Medical Association Enter private detective This week’s model is a research letter examining the financial conflicts of interest of doctors who comment as part of the National Coverage Determination (NCD) process for medical devices – a consultation similar to the National Institute for Health and Care Excellence (NICE) technology Process evaluation. They found from 444 physician reviewers that 76% had received financial payments from device manufacturers with an interest in NCDs, but only one of them (0.3%) stated this in their review . High pitched voice all over the place!

Journal of the American Medical Association doi:10.1001/jama.2023.14414

Exacerbating sinusitis in children

A review of the evidence for the 2017 NICE guidance on antimicrobial prescribing for acute sinusitis found conflicting evidence on whether antibiotics improve symptoms in children aged 10-14 days compared with placebo, and that cure rates were not significantly different between antibiotics. The guidance recommends that antibiotics be prescribed only if a patient is “generally very unwell, exhibiting signs and symptoms of a more serious disease or condition, or is at high risk for complications.” Antibiotics are more widely recommended in the United States, which may be why a cohort study was designed to determine whether using amoxicillin or in combination with amoxicillin, rather than not using them, relieves symptoms more quickly. Of more than 300,000 children and adolescents, 90% received antibiotics for 10 days or more. Treatment failure (defined as another course of antibiotics, an emergency room visit or hospital admission for sinusitis, or complications within 14 days of the initial prescription) occurred in less than 2% of patients. There is no discussion to what extent this is due to the effects of antibiotics or the generally self-limiting nature of the disease in most people.

Journal of the American Medical Association doi:10.1001/jama.2023.15503

Assessing covid-19 hospital admission risk

A new coronavirus treatment guideline from the American College of Physicians aims to keep things simple, making just two recommendations for drug treatments for patients with mild to moderate covid-19. The guidance recommends considering the use of monopiravir and nimaprevir-ritonavir within 5 days of symptom onset in patients with mild to moderate covid-19 who are at high risk of progression to severe disease. . This sounds simple enough, but who do we now consider to be at high risk of developing severe disease? The guidance simply points readers to a list of risk factors on the Centers for Disease Control and Prevention (CDC) website, which includes “older age” and “presence of underlying health conditions.” The World Health Organization’s Rapid Recommendation Guidelines (which make similar recommendations) define high risk as a 10% risk of hospital admission, but even this seems difficult to assess given current uncertainty about infection and hospitalization rates.

an intern doctor Number: 10.7326/M23-1636

Slows amyloid progression but doesn’t prevent Alzheimer’s disease

Last year’s U.S. Food and Drug Administration (FDA) approval of Lecanemab for the treatment of Alzheimer’s disease created such a buzz that it’s worth taking a moment to mark the end of the monoclonal antibody’s older brother, Solanezumab.A randomized controlled trial enrolled 1,169 people with so-called preclinical Alzheimer’s disease: people aged 65-85 who have elevated levels of amyloid in their brains ¹⁸Dementia was not clinically diagnosed based on F-flubetapyr positron emission tomography (PET), clinical dementia score, and Mini-Mental State Examination.

The primary outcome of change in Preclinical Alzheimer’s Cognitive Composite (PACC) score did not differ between monthly injections of drug or placebo after 240 weeks. But what about amyloid levels? At the start of the study, participants’ average amyloid burden was 66 Centiloid. The solanezumab group gained an average of 11.6 centiloids, while the placebo group gained an average of 19.3 centiloids—a slower increase in the solanezumab group, but not the reduction in amyloid seen with lecanemab, which convinced the FDA to give Its quick approval.

New England Journal of Medicine doi:10.1056/NEJMoa2305032