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J o u r n a l R e v i e w Dec 20, 2011

J o u r n a l R e v i e w Dec 20, 2011. NEJM. “ Dronedarone in High-Risk Permanent Atrial Fibrillation.” – Dec 15 Dronedarone class III antiarrythmic (Na+, K+, antiadrenergic ) Adult use:

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J o u r n a l R e v i e w Dec 20, 2011

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  1. JournalReview Dec 20, 2011

  2. NEJM • “Dronedarone in High-Risk Permanent Atrial Fibrillation.” – Dec 15 • Dronedarone • class III antiarrythmic (Na+, K+, antiadrenergic) • Adult use: • “Indicated to reduce risk for CV hospitalization in patients with paroxysmal AF or AFL, with a recent episode of AF/AFL and associated CV risk factors (eg: age >70yr, HTN, DM, h/o CVA, EF <40%) • ATHENA: • placebo-controlled double blind study enrolling those with persistent or paroxysmal AF showed that there was a: • highly significant reduction unplanned hospitalization for CV causes or death & • significant reduction in rates of death from CV causes & stroke, w/o a significant incr in rate of HF.

  3. NEJM (cont) • This study’s hypothesis: • dronedaronewould reduce major vascular events in high-risk permanent AF • Method: • 65yo or older w/ a 6-mo h/o permanent AF & RF for major vascular events received either dronedarone or placebo • Primary outcome: stroke, MI, embolism, or death from CV causes • Secondary outcome: unplanned hospitalization for CV cause or death • Results: 3236 pts enrolled. Study stopped for safety reasons • Deaths from CV causes: 21 vs 10 • Stroke: 23 vs 10 • Hospitalization for HF: 43 vs 24 • Conclusion: • Dronedaroneincr rates of HF, stroke, & death from CV causes in patients with permanent AF who were at risk for major vascular events

  4. Internal Medicine News • “Generation Gap Separates Doctors’ Vaccine views” – Nov 15 • Newly minted docs appear to have less faith in efficacy & safety of vaccinations than older colleagues. • Nat’l Vaccine Program at US Dept of Human Services surveyed docs identified by parents (for & against vaccines) • 551 docs. Included year of training in 5yr intervals b/t 1954-2002 • Results: • Every 5y increase in the graduation date was associated with a 20% incrin odds ratio that docs would agree w/ statement that “children get more immunizations than are good for them.” • Every 5y increase there was 20% decrin the OR that providers would agree w/ “immunizations are getting better & safer all the time as the result of medical research.” • Overall, younger physicians, like younger parents, rarely encounter once-commonplace childhood ailments, and may be less optimistic about benefits of immunization than more seasoned providers.

  5. Internal Medicine News • “U.S. Measles Cases at Highest Level Since 1996”- Nov 15 • By mid-October 2011, was the worst year for measles cases in the U.S. since 1996. • 214 cases identified by CDC • 20% in infants 6-15 months • 27% in young adults (20-39 years) • 1/3 attributed to direct importations (roughly similar to prior years) • the CDC traced about ½ of the 2011 importations into the European Union • European Union has reported 28,000 measles cases (1/2 in France)

  6. http://www.youtube.com/watch?feature=player_detailpage&v=RfdZTZQvuCohttp://www.youtube.com/watch?feature=player_detailpage&v=RfdZTZQvuCo

  7. JAOA • “Treatment of Adults with ADHD”- Nov 2011 • 2-5% of adult population has it & only 11% have received treatment • Untreated patients face serious disabilities & morbidities • Lower education levels • Poorer employment records • Partner separation/divorce • More traffic tickets, accidents & arrests • Difficulties w/ executive functioning (Brown ADD Scale for Adults) • Activation, focus, effort, emotion, memory • Symptoms: • Children: motor hyperactivity, aggressive, frustrated easy, impulsive • Adults: easily distracted, inattentive, shifts activities, easily bored, impatient, restless • Treatment: • Drugs: • Stimulants (amphetamine & methylphenidate) • Non-stimulants (atomoxetine & guanfacine) • CBT: learn to manage problems of focus, organization, motivation & memory

  8. JAMA • “ADHD Medications and Risk of Serious Cardiovascular Events in Young and Middle-aged Adults.” - Dec 14 • Serious CV events: • MI, stroke, SCD • Design: • Retrospective, population based cohort study using EHR from 4 sites from 1986-2005 • Participants 25-64yo w/ prescriptions for methylphenidate, amphetamine or atomoxetine. • Each user was matched to 2 nonusers on study site, birth year, sex, & calendar year • Results: • current or new use of these meds (compared w/ nonuse or remote use) was not associated w/ an increased risk of serious cardiovascular events.

  9. "Sir, it appears that you may have Bieber fever."

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