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June 16, 2009
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Volume 4
Issue 24
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DynaMed Systematic Literature Surveillance
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For the week ending June 12, 2009
This week, 815 articles were considered for inclusion in DynaMed and 339 met criteria for inclusion.
Based on the criteria of selecting “articles most likely to change clinical practice,” two articles of significant interest are included in this weekly update.
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Intensive Preoperative Smoking Cessation Interventions Reduce Risk of Postoperative Complications
A recent systematic review evaluated smoking cessation interventions in 9 randomized trials with 1,194 patients with planned surgery. Although an overall meta-analysis was reported, the data is more accurately summarized by 2 subgroups. In 1 subgroup, 2 high-quality trials evaluated intensive smoking cessation interventions with 4 - 8 weeks of weekly counseling sessions and nicotine replacement therapy. Intensive smoking cessation interventions reduced the rate of postoperative complications from 46% to 19% in a pooled analysis (NNT 4) (level 1 [likely reliable] evidence). Complications reduced were wound complications, prolonged hospital stay, unscheduled postoperative checkups, and events causing additional treatment or investigations. The other trials evaluated less intensive interventions and did not find a significant reduction in postoperative complications (Br J Surg 2009 May;96(5):451).
For more information, see the Tobacco use disorder topic in DynaMed.
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Thrombolysis May Increase Risk of Major Complications Compared to Surgery in Acute Limb Ischemia
A Cochrane review of 5 randomized trials compared thrombolysis to surgery as initial treatments in 1,283 patients with acute limb ischemia. There were no significant differences in limb salvage or mortality at 30 days, 6 months or 1 year. However, thrombolysis was associated with higher 30-day rates of stroke (1.3% vs. 0, p = 0.0097, NNH 76), major hemorrhage (8.8% vs. 3.3%, p = 0.000049, NNH 18) and distal embolization (12.4% vs. 0 , p < 0.00001, NNH 8) (
level 2 [mid-level] evidence). Meta-analyses were limited by clinical heterogeneity, differing reporting methods and differing thrombolytic techniques (Cochrane Database Syst Rev 2009 Apr 15;(2):CD002784).
For more information, see the Peripheral artery diseases (PAD) topic in DynaMed.
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DYNAMED EXTRA – Influenza A (H1N1) Update
On June 11, 2009, the World Health Organization declared that Influenza A (H1N1) is now pandemic, indicated by ongoing community-level outbreaks in multiple regions of the world. As of June 15, 35,928 cases have been reported in 76 countries, with 163 deaths.
The DynaMed topic, Influenza A (H1N1), with links to information about testing, treatment and clinical management, remains freely available at http://www.ebscohost.com/dynamed.
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DYNAMED EXTRA – International Expert Committee Recommends HbA1c Assay for Diagnosing Diabetes
A committee, with members appointed by the American Diabetes Association, the European Association for the Study of Diabetes and the International Diabetes Federation, has issued a report recommending HbA1c level ≥ 6.5% as a diagnostic criterion for diabetes. The report represents the consensus view of the committee members but not necessarily the views of the appointing organizations (Diabetes Care 2009 Jul;32(7):1327).
For more information, see the Diabetes mellitus type 2 screening topic in DynaMed.
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DynaMed Medical Calculators
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DynaMed now includes more than 500 clinical calculators, decision rules and statistics calculators to give clinicians even more decision making tools to use at the point of care.
After logging in, click on Calculators in the upper right corner of the screen to access this new feature.
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Subscribe FREE to DynaMed Weekly Update
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DynaMed Weekly Update is a compilation of 1 to 5 articles that are of significant interest to clinicians. Articles are selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice. Updates are prepared by the DynaMed Editorial Team which includes 28 clinicians from multiple disciplines. Send comments to DynaMedEditor@epnet.com. To learn more about DynaMed, go to www.dynamicmedical.com.
Published by
Copyright © 2009 EBSCO Publishing. All rights reserved.
DynaMed® is a registered trademark of and published by DynaMed LLC. Original date of on-line publication December 15, 1995 with continuous daily updating. ISSN: 1554-1177. Subscriptions and queries can be addressed to DynaMed LLC, EBSCO Publishing, 10 Estes St., Ipswich, Massachusetts, USA 01938-0602, telephone (978) 356-6500, facsimile (978) 356-6565, e-mail Editor@DynamicMedical.com.
The opinions expressed herein are solely those of the authors and editors and may or may not represent the official position of cooperating or endorsing Medical Societies.
Development of DynaMed was supported in part by the National Science Foundation through a Small Business Innovative Research grant. (All other support comes from subscriptions. No advertisements are accepted.) 
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