Interesting Articles: A Weekly Review of the "Big Five" Medical Journals

This is a collection of articles I have found interesting in the weekly editions of the "big five" medical journals: NEJM, JAMA, Annals, Lancet and BMJ (a few more journals are included occasionally). The review is a weekly feature of Clinical Cases and Images - Blog. Please see the end of the post for a suggested time-efficient way to stay up-to-date with the medical literature.

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Ezetimibe and Cancer — An Uncertain Association
10.1056/NEJMe0807200

An excess of incident cancers was observed in the simvastatin–ezetimibe group, with 105 in that group as compared with 70 in the placebo group (P=0.01).

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Hyponatremia and Mortality among Patients on the Liver-Transplant Waiting List
NEJM Volume 359:1018-1026 September 4, 2008 Number 10

Both the MELD score and the serum sodium concentration were significantly associated with mortality (hazard ratio for death, 1.21 per MELD point and 1.05 per 1-unit decrease in the serum sodium concentration)

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Prognostic Importance of Defibrillator Shocks in Patients with Heart Failure
NEJM Volume 359:1009-1017 September 4, 2008 Number 10

Among patients with heart failure in whom an ICD is implanted for primary prevention, those who receive shocks for any arrhythmia have a substantially higher risk of death.

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Stroke Prevention — Insights from Incoherence: NEJM stroke prevention haiku: "Use an antiplatelet drug/Treat hypertension"
10.1056/NEJMe0806806

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Smoke-free Legislation and Hospitalizations for Acute Coronary Syndrome: It Works.
NEJM Volume 359:482-491 July 31, 2008 Number 5

Previous studies have suggested a reduction in the total number of hospital admissions for acute coronary syndrome after the enactment of legislation banning smoking in public places. It was confirmed by this study: 67% of the decrease involved nonsmokers. However, fewer admissions among smokers also contributed to the overall reduction.

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FDA Regulation of Tobacco — Pitfalls and Possibilities.
NEJM Volume 359:445-448 July 31, 2008 Number 5

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Teaching Rounds: Teaching in an ambulatory care setting
BMJ 2008;337:a1156

Ideas for effective teaching in busy ambulatory settings:
Hot seating
Directed observation
Productive diversion
Educational prescriptions
Hot review

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BMJ asks the question: Should primary care be nurse led?
BMJ 2008;337:a1169

Yes
No

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25-Hydroxyvitamin D Levels and the Risk of Mortality in the General Population
Arch Intern Med. 2008;168(15):1629-1637

Low 25-hydroxyvitamin D levels (25[OH]D) are associated with diabetes mellitus, hypertension, and cancers. The lowest quartile of 25(OH)D level is associated with all-cause mortality in the general population.

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Burnout and Suicidal Ideation among U.S. Medical Students
Annals of Int Med, 2 September 2008 | Volume 149 Issue 5 | Pages 334-341

50% of students experience burnout and 10% experience suicidal ideation during medical school.

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A time efficient way to stay up-to-date with medical literature

"How do you eat in elephant? In small bites." The same rule probably applies to staying current with the ever expanding avalanche of medical literature. One can try the following approach:

1. Subscribe to the RSS feeds of the 5 major medical journals (NEJM, JAMA, BMJ, Lancet and Annals) plus 2-3 subpecialty journals in your field of interest.


Medical Journals tab: A screenshot of iGoogle with RSS feeds from the major medical journals.

2. Read the journal on the day it is published online, for example, NEJM on Wednesdays.

3. Use text-to-speech to listen to the articles you do not have time to read.

4. Listen to journal podcasts. Click here to subscribe the podcasts of the 4 major journals in iGoogle.

Related:
5 Tips to Stay Up-to-Date with Medical Literature
Make Your Own "Medical Journal" with iGoogle Personalized Page
Share iGoogle Tabs with Medical Journals, Podcasts and Gadgets
Text-to-Speech Programs and Continuous Medical Education
Image source: OpenClipArt, public domain.