What's New
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Cardiovascular Medicine - Arrhythmias
Surgical left atrial appendage occlusion for patients undergoing cardiac surgery (June 2021)
The left atrial appendage (LAA) is the primary source of thromboembolism in patients with atrial fibrillation (AF). When patients with AF undergo cardiac surgery, LAA occlusion is commonly performed with limited supporting evidence. The effects of surgical LAA occlusion were studied in a trial enrolling nearly 4800 patients with AF (with >=2 risk factors for thromboembolism) undergoing cardiac surgery, in which patients were randomly assigned to surgical LAA occlusion or no occlusion and most continued oral anticoagulation after the procedure.3 At nearly four years of follow-up, stroke or systemic embolism was about one-third less frequent in the occlusion group than in the no-occlusion group, and perioperative complications were similar in the two groups. These results support use of surgical LAA occlusion as an adjunct to long-term anticoagulation for patients undergoing cardiac surgery for another indication who have AF and a CHA2DS2-VASc risk score of at least 2.
Primary Care - Prevention
CDC updated recommendations on masking during COVID-19 pandemic (August 2021)
In the United States, the CDC has updated recommendations to advise individuals who are fully vaccinated against COVID-19 to wear masks in indoor public settings in areas where community transmission is substantial and to advise fully vaccinated individuals who are or have household members at risk for severe COVID-19 to do so even if transmission is low. These recommendations revise previous ones stating that vaccinated individuals could forgo masks in public settings. Uncertainty about the transmission risk with the Delta variant is one of the primary reasons for this change; new evidence has suggested that vaccinated individuals with breakthrough infection with the Delta variant have similar initial viral RNA levels as unvaccinated individuals and thus may have a similar potential to transmit infection.4
Family Medicine - Adult General Internal Medicine
Home-based physical therapy for rotator cuff tendinopathy (August 2021)
Debate continues about the need for formal physical therapy to treat uncomplicated rotator cuff tendinopathy or minor tears. In a multicenter, randomized trial of over 700 individuals >=18 years with chronic rotator cuff conditions, no difference in the degree of symptomatic or functional improvement was noted at 12-month follow-up between those treated with a home-based progressive exercise program and those treated with in-person physical therapy.1 Patients in the home-based group received one session with a physical therapist, printed materials, access to instructional videos, and resistance bands, but no additional in-person sessions.2 For motivated patients with uncomplicated rotator cuff tendinopathy, a home-based rehabilitation program that begins with an in-person session conducted by a physical therapist is a reasonable approach.
REFERENCES
1. Hopewell S, Keene DJ, Marian IR, et al Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 x 2 factorial, randomised controlled trial. Lancet 2021; 398:416. [Context Link]
2. Keene DJ, Soutakbar H, Hopewell S, et al Development and implementation of the physiotherapy-led exercise interventions for the treatment of rotator cuff disorders for the 'Getting it Right: Addressing Shoulder Pain' (GRASP) trial. Physiotherapy 2020; 107:252. [Context Link]
3. Whitlock RP, Belley-Cote EP, Paparella D, et al Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke. N Engl J Med 2021; 384:2081. [Context Link]
4. Brown CM, Vostok J, Johnson H, et al Outbreak of SARS-CoV-2 Infections, Including COVID-19 Vaccine Breakthrough Infections, Associated with Large Public Gatherings - Barnstable County, Massachusetts, July 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1059. [Context Link]
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