Awareness of current research is a big component of staying up to date in nursing and healthcare and providing evidence-based care. Here’s a look at a selection of the latest studies and practice-changing recommendations.
Outcomes Examined for Advanced CKD Patients Who Forgo Dialysis
JAMA Network Open
In a systematic review of 41 cohort studies with 5,102 patients, Susan P. Y. Wong, M.D., from the Veterans Affairs Puget Sound Health Care System in Seattle, and colleagues examined survival, health care resource use, changes in quality of life, and end-of-life care among patients with advanced kidney disease who forgo dialysis.
GLP-1 RA Use May Up Risk for Gallbladder, Biliary Diseases
JAMA Internal Medicine
Use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is associated with increased risks for gallbladder or biliary diseases, with a higher risk for GLP-1 RA use in weight loss. Liyun He, from the Peking Union Medical College Hospital in China, and colleagues conducted a systematic review of randomized controlled trials (RCTs) comparing the use of GLP-1 RA drugs with placebo or with non-GLP-1 RA drugs in adults to examine the association with gallbladder and biliary diseases. Data from 76 RCTs with 103,371 patients were included in the meta-analysis.
USPSTF: Evidence Lacking for OSA Screening in Asymptomatic Adults
The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to recommend screening for obstructive sleep apnea (OSA) in asymptomatic adults. Cynthia Feltner, M.D., M.P.H., from the University of North Carolina at Chapel Hill Evidence-based Practice Center in Research Triangle Park, and colleagues conducted a systematic review of the evidence on screening and treating asymptomatic adults with OSA or those with unrecognized symptoms of OSA. The researchers found that none of the randomized controlled trials that were reviewed directly compared screening with no screening. The accuracy and clinical utility of potential tools that could be used to screen for OSA in the primary care setting currently are uncertain. Trials of positive airway pressure have not established whether treatment of OSA reduces mortality.
Guidelines & Recommendations
Management of Antithrombotics in GI Bleed, Endoscopy Addressed
Journal of Gastroenterology
In a clinical practice guideline issued jointly by the American College of Gastroenterology and the Canadian Association of Gastroenterology, updated recommendations are presented for the periendoscopic management of anticoagulants and antiplatelets during acute gastrointestinal (GI) bleeding and in the elective endoscopy setting.
For patients presenting with acute GI bleeding, the authors suggest against giving fresh frozen plasma or vitamin D for patients on warfarin; prothrombin complex concentrate (PCC) is suggested if needed, rather than fresh frozen plasma administration. The authors suggest against PCC administration for patients on direct oral anticoagulants. For patients on antiplatelet agents, the authors suggest against platelet transfusions. For patients in the elective endoscopy setting, continuation of warfarin is suggested as opposed to temporary interruption; however, for procedures with a high risk for GI bleeding in whom it is held, the guideline suggests against bridging anticoagulation, unless the patient has a mechanical heart valve.
Universal HepB Vaccination Recommended for Adults Age 19 to 59
U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report
Hepatitis B (HepB) vaccination should be administered to adults aged 19 to 59 years and to those aged 60 years or older with risk factors for HepB.
Mark K. Weng, M.D., from the CDC in Atlanta, and colleagues updated recommendations for HepB vaccination for adults based on a review and discussion of the relevant scientific evidence. The review was informed by 263 studies deemed eligible.
Molnupiravir for Nonsevere COVID-19 Added to Living Guideline
Molnupiravir is recommended for patients with nonsevere COVID-19 who are at the highest risk for hospitalization, according to the updated World Health Organization living guideline on drugs for COVID-19. Based on data from six randomized controlled trials with 4,796 patients, the researchers added a new recommendation for molnupiravir in patients with nonsevere illness. Molnupiravir is recommended for those at highest risk for hospitalization and should be combined with implementation of mitigation strategies to reduce potential harms.
ACR Updates Guidelines for Juvenile Idiopathic Arthritis
Arthritis & Rheumatology
Karen B. Onel, M.D., from the Hospital for Special Surgery in New York City, and colleagues conducted a systematic literature review and updated the guidelines for pharmacologic management of JIA The authors provide recommendations for initial and subsequent treatment of JIA with oligoarthritis, temporomandibular joint arthritis, and systemic JIA. None of the recommendations were supported by moderate- or high-quality evidence.
In a second set of recommendations, Onel and colleagues focused on nonpharmacologic therapies, medication monitoring, immunizations, and imaging, regardless of JIA phenotype. The authors recommended use of physical therapy and occupational therapy interventions; an age-appropriate, well-balanced diet; laboratory monitoring for medications; and widespread immunization us. They also emphasized the importance of shared decision making with patients/caregivers. The low quality of evidence supporting most of these recommendations underscores the importance of clinical judgment and emphasizes the need for more high-quality evidence to support current practice and improve disease management