#GeriMedJC: March 27, 2015

March was a special month as we welcomed Toronto East General Hospital and Providence Healthcare to our live version of #GeriMedJC which is broadcast through the Ontario Telemedicine Network.

The two articles critically appraised during #GeriMedJC on March 27th were:

1. Kaufmann H, Freeman R, Biaggioni I, Low P, Pedder S, Hewitt LA, Mauney J, Feirtag M, Mathias CJ. Droxidopa for neurogenic orthostatic hypotension: a randomized, placebo-controlled, phase 3 trial. Neurology. 2014 Jul 22;83(4):328-35. (link)
2. The American Geriatrics Society Clinical Practice Guideline for Postoperative Delirium in Older Adults. 2014. (link)

These were hot articles for the #GeriMedJC tweetchat as Symplur statistics reveal the growth metrics:

Missed the discussion?  You can get the transcript of the #GeriMedJC tweet chat here.

Thanks again to all those who participated in the Tweet chat:

You may also view articles discussed at prior #GeriMedJC tweetchats at PubMed Commons. (link)

The next #GeriMedJC will be on Friday, April 24, 2015 08:00 EDT / 12:00 GMT.  See you then!

Long article for March 2015 #GeriMedJC

This month, we'll take a look at a double-blind, placebo-controlled trial of droxidopa for neurogenic orthostatic hypotension.  Droxidopa is an oral norepinephrine precursor.

Kaufmann H, Freeman R, Biaggioni I, Low P, Pedder S, Hewitt LA, Mauney J, Feirtag M, Mathias CJ. Droxidopa for neurogenic orthostatic hypotension: a randomized, placebo-controlled, phase 3 trial. Neurology. 2014 Jul 22;83(4):328-35. 

Engage in the discussion on Twitter on March 27, 2015 at 08:00 EDT / 12:00 GMT and don't forget to use the hashtag #GeriMedJC.

Did you know that the live version of #GeriMedJC runs for an hour and is broadcast to nine different hospitals in four different cities via the Ontario Telemedicine Network?  

• Toronto: Mount Sinai Hospital, Sunnybrook Hospital, St. Michael’s Hospital, Baycrest Hospital, North York General Hospital, St. Joseph’s Hospital
• Mississauga: Trillium Hospital
• Kitchener-Waterloo: Grand River Hospital
• Orillia: Soldier's Memorial Hospital

The full text of the article can be found here and the abstract is posted below:

OBJECTIVE:

To determine whether droxidopa, an oral norepinephrine precursor, improves symptomatic neurogenic orthostatic hypotension (nOH).

METHODS:

Patients with symptomatic nOH due to Parkinson disease, multiple system atrophy, pure autonomic failure, or nondiabetic autonomic neuropathy underwent open-label droxidopa dose optimization (100-600 mg 3 times daily), followed, in responders, by 7-day washout and then a 7-day double-blind trial of droxidopa vs placebo. Outcome measures included patient self-ratings on the Orthostatic Hypotension Questionnaire (OHQ), a validated, nOH-specific tool that assesses symptom severity and symptom impact on daily activities.

RESULTS:

From randomization to endpoint (n = 162), improvement in mean OHQ composite score favored droxidopa over placebo by 0.90 units (p = 0.003). Improvement in OHQ symptom subscore favored droxidopa by 0.73 units (p = 0.010), with maximum change in "dizziness/lightheadedness." Improvement in symptom-impact subscore favored droxidopa by 1.06 units (p = 0.003), with maximum change for "standing a long time." Mean standing systolic blood pressure (BP) increased by 11.2 vs 3.9 mm Hg (p < 0.001), and mean supine systolic BP by 7.6 vs 0.8 mm Hg (p < 0.001). At endpoint, supine systolic BP >180 mm Hg was observed in 4.9% of droxidopa and 2.5% of placebo recipients. Adverse events reported in ≥ 3% of double-blind droxidopa recipients were headache (7.4%) and dizziness (3.7%). No patients discontinued double-blind treatment because of adverse events.

CONCLUSIONS:

In patients with symptomatic nOH, droxidopa improved symptoms and symptom impact on daily activities, with an associated increase in standing systolic BP, and was generally well tolerated.

Short Article for March #GeriMedJC

This month's #GeriMedJC  short article is sure to bring forth a lot of discussion, if any previous #GeriMedJC on delirium is any indication.  After many months of consultation, the American Geriatrics Society recently put forth The Clinical Practice Guideline for Postoperative Delirium in Older Adults.

The comprehensive guideline and evidence tables are now available for free on GeriatricsCareOnline.org (link). A guideline summary is also available online in the Journal of the American Geriatrics Society (link). The Best Practice Statement is also available through open access on the American College of Surgeons website (link).

Engage in the discussion on Twitter on March 27, 2015 at 08:00 EDT / 12:00 GMT and don't forget to use the hashtag #GeriMedJC.

What does a short article mean?  In the live version of the Geriatric Medicine Journal Club held at the University of Toronto, the last 15 minutes of the hour is devoted to the presentation and discussion of the article.

Tweet us your ideas for a new #GeriMedJC avatar!

Please send us your ideas on how we should re-design the Geriatric Medicine Journal Club avatar. We've added a little Twitter logo:

An example of how PubMedCommons is used.

#GeriMedJC recently joined PubMed Commons.  PubMed Commons is an initiative to capture discussions of scientific publications and connect to citations in PubMed. You can see how Dr. Edward Marcantonio, the first author on the 3D-CAM paper, which was critically appraised in the November 2014 #GeriMedJC tweet chat, was able to weigh in on some of questions raised.

See the PubMeds link here for this article.

#GeriMedJC is global!

We just had to capture this data.  The breakdown of where viewers of this blog are coming from this past week span 5 continents.

The @GeriMedJC Twitter account now has over 260 followers!  Thanks for following!