💊 Digest #40: A DoxyPEP in your Step

Working more hours–worse for residents and patients? A recent study published in BMJ Medicine found that residents who worked more weekly hours or extended duration shifts (≥24 hours) were more prone to errors affecting patients and themselves. This nationwide prospective cohort study surveyed 4,826 U.S. resident-physicians (PGY-2 or beyond) monthly over eight years about work hours and patient/resident safety outcomes. Working over 48 hours per week was associated with an increased risk of medical errors, preventable adverse events, and fatal preventable adverse events as well as safety events affecting residents–including near-crashes, occupational exposures, percutaneous injuries and attentional failures (P<0.001). These risks increased even further for those working 60-70 hours weekly or more, and for those working any extended shifts (>24 hours) in a month. (LG)
A new bacterial treatment for Clostridioides difficile infection (CDI)? The latest innovation in treating the hard-to-treat C.Diff, VE303 is a novel biotherapeutic consisting of 8 commensal strains of Clostridia given orally once daily for 14 days. In this phase 2, double-blind, placebo-controlled trial just published in JAMA, high-dose VE303, low-dose, and placebo capsules were administered to 79 adults with CDI and ≥1 prior CDI in the past 6 months or at high risk of recurrence. CDI rates at 8 weeks of treatment were 13.8% for high-dose VE303, 37.0% for low-dose VE303, and 45.5% for placebo (P = .006, high-dose VE303 vs placebo). VE303 was well-tolerated, with less than half of recipients reporting a treatment-related gastrointestinal adverse effect. Stay tuned for the phase 3 trial! (JD)
Not quite time to add routine skin checks to the annual physical. According to the US Preventive Services Task Force (USPSTF) systematic review published in JAMA, there remains insufficient evidence to recommend a visual skin examination to screen asymptomatic adolescents and adults for skin cancer without a history of premalignant or malignant skin lesions. The USPSTF found limited and inconsistent data to support the benefits or harms of universal skin screening exams for early detection and treatment of skin cancer, without sufficient data to support a mortality benefit. This is, in part, because studies have not historically included an adequate diversity of skin types and colors. There is a need for better skin color inclusion in future studies in order to adequately reflect the US population and determine overall benefits and harms of screening skin examination. (JD)
Should patients with type 2 diabetes mellitus (T2DM) avoid NSAIDs? A recent study published in JACC evaluated the risk of heart failure, and its association with Non-Steroidal Anti-Inflammatory Drug (NSAID) use, in > 300,000 Danish patients with T2DM. In this case-crossover design, patients were considered exposed to NSAIDs if a prescription was claimed within 28 days before a first-time heart failure hospitalization. NSAID use in patients with T2DM was associated with an increased risk of first-time heart failure (HF) hospitalization, especially in patients ≥80 years, those with elevated hemoglobin A1c levels on ≤1 anti-diabetic medications, and those without prior NSAID use. (JD)
Does the sex of blood donors affect mortality outcomes in transfusion recipients? In a recent double-blind, randomized, multicenter study published in NEJM, researchers in Canada randomized over 8000 patients already set to receive blood transfusion to units of blood from either male or female donors. There were no differences in mortality between those who received male and female donor blood over a mean follow-up of 11.2 months. Previous theories and observational studies had suggested potential differences in mortality based on theorized sex-related differences in red-cell deformability, oxygen-carrying capacity, susceptibility to lysis, immunomodulatory activity, and induction of vasculopathy. (HS)

Palate Cleanser

The melon part. To get rid of the taste of those pesky apps. And to fill your brain with some fun facts.

The Urine Tells The Story

There’s a whole history to “reading urine,” as we learn in Katherine Harvey’s riveting essay, “Troubled Waters”--an exploration of uroscopy in medieval times, just published in The Public Domain Review. The practice of examining urine in medical practice dates back to the Babylonians and was such an important component of medicine that many medieval illustrations featured physicians peering closely at flasks of urine. Texts such as The Dome of Uryne were widely used to assist in uroscopic interpretation, from diagnosis of disease and imbalance of the humors to assistance with fertility. It took practice, and education, to learn how to read the color, the smell, the texture and layering of the urine–for the urine could tell a story that the experienced physician could interpret. Read the article, and see excerpts from these medieval uroscopic texts and illustrations, here!

– Nora Taranto MD

Appetizers

Palate Cleanser

The Main Course

Digestifs

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