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August 4, 2009
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Volume 4
Issue 31
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DynaMed Systematic Literature Surveillance
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For the week ending July 31, 2009
This week, 706 articles were considered for inclusion in DynaMed and 287 met criteria for inclusion.
Based on the criteria of selecting “articles most likely to change clinical practice,” one article of significant interest is included in this weekly update.
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Bariatric Surgery Associated with Low Rate of Short-term Adverse Outcomes
A new study analyzed perioperative safety in a cohort of 4,610 patients (mean age 45 years) having first-time bariatric procedures. Laparoscopic Roux-en-Y gastric bypass surgery was performed in 65%, open Roux-en-Y gastric bypass surgery in 9%, and laparoscopic adjustable gastric banding in 26%. The primary endpoint was a composite of 4 outcomes over the first 30 days: death; deep vein thrombosis or venous thromboembolism; percutaneous, endoscopic or operative reintervention; and continued hospitalization. Open gastric bypass had a 30-day complication rate of 7.8%, followed by laparoscopic bypass at 4.8% and gastric banding at 1% (p < 0.0001 for comparison of all groups) (level 2 [mid-level] evidence). However, there were significant baseline differences between the groups. The open surgery group had the highest average body mass index (BMI) and the most comorbidities, while the gastric banding group had the lowest mean BMI and fewest comorbidities. Risk of the composite outcome increased with history of deep vein thrombosis or pulmonary embolus, obstructive sleep apnea, and impaired functional status. The study did not evaluate long-term efficacy of the procedures (N Engl J Med 2009 Jul 30;361(5):445).
For more information, see the new Bariatric surgery topic in DynaMed.
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DynaMed Extra: CDC and WHO Recommendations for Pandemic (H1N1) 2009 Vaccination
There is no available vaccine to protect humans from the novel influenza A (H1N1) virus, now called Pandemic (H1N1) 2009 by the World Health Organization (WHO). The US Centers for Disease Control and Prevention (CDC) and WHO have each issued recommendations for vaccination when a vaccine becomes available.
The CDC Advisory Committee on Immunization Practices recommends focusing on 5 key populations: pregnant women, people who live with or care for children < 6 months old, health care and emergency services personnel, persons aged 6 months to 24 years and persons aged 25-64 years who are at higher risk for pandemic (H1N1) 2009 due to chronic health disorders or compromised immune systems. In the event of a vaccine shortage, the CDC committee recommends prioritizing the immunization of the first 3 groups listed above, followed by children aged 6 months to 4 years and children aged 5-18 years who have chronic medical conditions (CDC Press Release 2009 Jul 29).
The WHO recommendations call for vaccinating healthcare workers as a first priority, and state that individual countries should determine priorities based on their specific conditions for pregnant women, children > 6 months old and adults with specific chronic medical conditions, healthy young adults aged 15-49 years, healthy children, healthy adults aged 50-64 years and healthy adults ≥ 65 years old (WHO Pandemic (H1N1) 2009 Briefing Note 2009 Jul 13).
Manufacturers expect to have vaccines available for use in September (WHO Pandemic (H1N1) 2009 Briefing Note 2009 Jul 24).
For more information, see the freely available Pandemic (H1N1) 2009 topic in DynaMed.
For the latest evidence-based influenza-related information available for free, visit www.ebscohost.com/flu.
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Subscribe FREE to DynaMed Weekly Update
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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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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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