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Opioids, other than codeine, were found to be more effective when compared to non-opioids for treatment of acute musculoskeletal pain after ED discharge. However, they were also associated with a higher rate of adverse outcomes.

Source
Efficacy of prescribed opioids for acute pain after being discharged from the emergency department: A systematic review and meta-analysis. Acad Emerg Med. 2023 Aug 22. doi: 10.1111/acem.14790. Online ahead of print.

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This Danish nationwide cohort study found that in reproductive-age women, NSAID use alone increased the risk of venous thromboembolism (VTE). The magnitude of risk was compounded by concomitant use of hormonal contraception.

Source
Venous thromboembolism with use of hormonal contraception and non-steroidal anti-inflammatory drugs: nationwide cohort study. BMJ 2023; 382 :e074450 doi:10.1136/bmj-2022-074450.

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The new DOAC score had stronger predictive performance for major bleeding in patients on anticoagulation for atrial fibrillation (A-fib) compared to the HAS BLED score.

Source
Development and Validation of the DOAC Score: A Novel Bleeding Risk Prediction Tool for Patients With Atrial Fibrillation on Direct-Acting Oral Anticoagulants. Circulation. 2023 Sep 19;148(12):936-946. doi: 10.1161/CIRCULATIONAHA.123.064556. Epub 2023 Aug 25.

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This prospective observational cohort study found implementing a protocol for peripheral norepinephrine (NE) decreased median number of central venous catheter (CVC) days per patient by one, and 51.6% avoided a CVC entirely. 

Source
Peripheral administration of norepinephrine: a prospective observational study. Chest, S0012-3692(23)05350-3. 21 Aug. 2023, doi:10.1016/j.chest.2023.08.019

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For pediatric patients with acute sinusitis, amoxicillin-clavulanate does not offer treatment benefit over amoxicillin alone and is more likely to be associated with gastrointestinal (GI) side effects and yeast infections than amoxicillin.

Source
Treatment Failure and Adverse Events After Amoxicillin-Clavulanate vs Amoxicillin for Pediatric Acute Sinusitis. JAMA. 2023 Sep 19;330(11):1064-1073. doi: 10.1001/jama.2023.15503.

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There was a strong association with lower mortality and hospitalization in high-risk patients with COVID-19 who were treated with either nirmatrelvir/ritonavir or molnupiravir.

Source
Nirmatrelvir or Molnupiravir Use and Severe Outcomes From Omicron Infections. JAMA Netw Open. 2023 Sep 5;6(9):e2335077. doi: 10.1001/jamanetworkopen.2023.35077.

We're trying something new! Watch quick videos, with my personal take on the articles we cover each week and more! Here's the JournalFeed YouTube channel link. ~Clay

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Modified dose nirmaltrevir-ritonavir is well-tolerated in patients with CKD as therapy for mild COVID-19 and effectively suppresses viral load.

Source
Safety Profile and Clinical and Virological Outcomes of Nirmatrelvir-Ritonavir Treatment in Patients With Advanced Chronic Kidney Disease and Coronavirus Disease 2019 (COVID-19). Clin Infect Dis. 2023 Aug 2:ciad371. doi: 10.1093/cid/ciad371. Epub ahead of print.

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Neurosyphilis is on the rise – brush up on the facts now before you miss it.

Source
State-of-the-Art Review: Neurosyphilis. Clin Infect Dis. 2023 Aug 18;ciad437. doi: 10.1093/cid/ciad437. Online ahead of print.

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Syphilis is on the rise in certain subgroups. This article provides a well-organized infographic that can be used to summarize treatment and management of patients in all stages of infection.

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Children with persistent or worsening rhinosinusitis experienced a modest improvement in symptoms when given amoxicillin-clavulanate vs. placebo.

Source
Identifying Children Likely to Benefit From Antibiotics for Acute Sinusitis: A Randomized Clinical Trial. JAMA. 2023;330(4):349-358. doi:10.1001/jama.2023.10854