Questioning Medicine

systolic

CME for the cost of free fifty free

 ( https://www.healthquality.va.gov/guidelines/MH/mdd/VADoDMDDCPGFinal508.pdf ) clearly state there is insufficient evidence to support this activity and testing. This is mainly because of low quality evidence and concern of bias given commercially funded studies.   ( https://www.aafp.org/pubs/afp/issues/2023/0100/poems-pharmacogenic-testing-antidepressants.html ) American Psychiatric Association...

I give CME and you listen for free. You can't collect the CME but YOU CAN be a little smarter. These are some must know articles you need to know if you are a hospitalist. 

What about oral??   Lewis GD et al. Effect of oral iron repletion on exercise capacity in patients with heart failure with reduced ejection fraction and iron deficiency: The IRONOUT HF randomized clinical trial. JAMA 2017 May 16; 317:1958. ( http://dx.doi.org/10.1001/jama.2017.5427. opens in new tab )   randomized, 225 patients with symptomatic systolic HF for 16-weeks to either  oral iron polysac...

Lindholt JS, Søgaard R, Rasmussen LM, et al. Five-year outcomes of the Danish cardiovascular screening (DANCAVAS) trial. N Engl J Med 2022;387(15):1385-1394.     Study design: Randomized controlled trial (nonblinded) Looking to see if intensive screening protocol for cardiovascular disease reduce cardiovascular events or mortality in older men? Danish study, 46,611 men aged 65 to 74 years were ran...

Efficacy and Safety of Intensive Versus Nonintensive Supplemental Insulin With a Basal-Bolus Insulin Regimen in Hospitalized Patients With Type 2 Diabetes: A Randomized Clinical Study | Diabetes Care | American Diabetes Association (diabetesjournals.org)      randomized noninferiority study from Emory University, 224 hospitalized patients with longstanding type 2 diabetes   Both groups received ba...

YES!! Marketing!! No man wants to admit his gonads dont work so they would never say I have hypogonadism. Most men would never say I have andropause cause that is too close to menopause but if you call it low testosterone then all of a sudden men come out of the wood work like cave men to get some of this magical drug they have heard so much about. YES LIKE LOW T WILL KILL YOU!!!! "could kill you"...

coffee saves your life-- maybe, careful for confounders  heart failure hospital admission is really hard to prevent moderate dose statin is most important..but ezetmibe and moderate dose is equal to high dose statin I think we should take out all kidney stones and the evidence says there will be lest hospitalizations if we do that EHR can help us and remind us to check and PTH robotic surgery is n...

 skin exam, ddp4, IUD, oral hypertension medication

https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.122.059410?af=R The Biomarkers say REDUCE-IT was a scam https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2791663 NO! Just NO-- stick with the calculator for now https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.059038 start the SLGT-2 inhibitors early! maybe an early discharge https://pubmed.ncbi.nlm.nih.gov/...

mammograms and pink ribbons-- lets talk evidence

mammograms-- we all know them, but lets discuss

Association of Receipt of the Fourth BNT162b2 Dose With Omicron Infection and COVID-19 Hospitalizations Among Residents of Long-term Care Facilities | Geriatrics | JAMA Internal Medicine | JAMA Network careful what you believe and always question medicine- even if it is about covid vaccine Use and Cost of Low-Value Health Services Delivered or Paid for by the Veterans Health Administration | Cance...

Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension - Wilding - - Diabetes, Obesity and Metabolism - Wiley Online Library       “”””One year after withdrawal of once-weekly subcutaneous semaglutide 2.4 mg and lifestyle intervention, participants regained two-thirds of their prior weight loss, with similar changes in cardiometabolic parameters.”””  ...

a couple points over the last podcast

Acute low back pain, chronic low back pain, back pain with sciatica in the end  unless red flags hold on imaging for 6weeks NSAIDS for acute low back pain exercise and spinal manipulative therapy for chronic low back pain be conservative and don't write for drugs that don't work like gabapentin or pregablin

196. Medical Update -- PICC lines, PRE-Diabetes, Sleep in the Hospital, Ortho Surgery!

European Heart Journal Bariatric surgery and cardiovascular disease: a systematic review and meta-analysis Eur Heart J 2022 Mar 04;[EPub Ahead of Print], SL van Veldhuisen, TM Gorter, G van Woerden, RA de Boer, M Rienstra, EJ Hazebroek, DJ van Veldhuisen     39 studies, all prospective or retrospective cohort studies, showed Bariatric surgery is associated with a reduced hazard ratio (HR) of CV mo...

SUMMARY-- What diuretic do you usually write for during CHF hospitalizations??    If you said furosemide you are not alone   One in a study in JACC 2013 looked at HF hospitalizations in 2009 and 2010 – In total 251,472 patients got a loop diuretic during their hospitalization and almost 87% got just furosemide, about 3% only got bumex, while only 0.4 received only torsemide. https://www.ncbi.nlm.n...

Gibbons RC et al. Ultrasound-versus landmark-guided medium-sized joint arthrocentesis: A randomized clinical trial. Acad Emerg Med 2022 Feb; 29:159. ( https://doi.org/10.1111/acem.14396. opens in new tab ) Use a ultrasound for arthrocentesis when possible   Circ Arrhythm Electrophysiol 2022 Mar; 15:e010646. ( https://doi.org/10.1161/CIRCEP.121.010646 ) Apple AirPods Pro and their wireless charging...

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00572-9/fulltext Old calculators use old studies and can over exaggerate the calculated effect https://pubmed.ncbi.nlm.nih.gov/33970197/ We know when to start medication but it is so hard to prospectively know when to stop medication like anticoagulation https://pubmed.ncbi.nlm.nih.gov/34074830/ 2 Kiwi a day will increase your bowe...

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2782015 coffee is ok with atrial fibrillation -- just don't go crazy is probably good advice https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781351 Hearing loss sucks and can really change your whole physical function https://www.bmj.com/content/374/bmj.n1511 elective orthopedic procedures with good evidence are l...

Extended Follow-up of Local Steroid Injection for Carpal Tunnel Syndrome: A Randomized Clinical Trial | Neuropathy | JAMA Network Open | JAMA Network   Looked at just over 100 patients with carpal tunnel syndrome and randomized them to injection of 80 mg methylprednisolone, 40 mg methylprednisolone, or saline and there was no difference except for an extra 60 days delaying surgery but still surger...

Writing Group for the CODA Collaborative. Patient factors associated with appendectomy within 30 days of initiating antibiotic treatment for appendicitis. JAMA Surg 2022 Jan 12; [e-pub].   Now, investigators have explored in a secondary analysis of  The CODA Collaborative. A randomized trial comparing antibiotics with appendectomy for appendicitis. N Engl J Med 2020 Oct 5; [e-pub]. (data from a pr...