Questioning Medicine

Characteristics and Strength of Evidence of COVID-19 Studies Registered on ClinicalTrials.gov Looked at ClinicalTrials.gov identified 1551 studies registered fromMarch 1, 2011, to May 19, 2020, Lets look at the gold standard RCT Of the 664 RCT (76.1%) were single center. PROBLEM! Weather analysis! Only half of the rct looked at clinical course with only 8% of the rct looking at mortality and this...

Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline https://www.atsjournals.org/doi/full/10.1164/rccm.202005-1982ST ultimate take home- varenicline is first line!! For Tobacco-Dependent Adults in Whom Treatment Is Being InitiatedShould Treatment Be Started with Varenicline or a Nicotine Patch? 40 more per 1,000 patients;...

https://www.youtube.com/watch?v=EBhEjYhVoZk Goggin K et al. Reductions in parent interest in receiving antibiotics following a 90-second video intervention in outpatient pediatric clinics. J Pediatr 2020 Jun 15; [e-pub]. (https://doi.org/10.1016/j.jpeds.2020.06.027) acute respiratory tract illnesses (ARTIs; cough, congestion, sore throat, and earache) is a PROBLEM with a capital P. or maybe I shou...

Orkaby AR et al. Association of statin use with all-cause and cardiovascular mortality in US veterans 75 years and older. JAMA 2020 Jul 7; 324:68. (https://doi.org/10.1001/jama.2020.7848) retrospective cohort study of about 327,000 patients (age, ≥75; mean age, 81; mostly white men) without prior statin use, without a prior cardiovascular event; in total 326K vets that were 75yr old and older and...

Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report (RECOVERY) trial is a randomized, controlled, open-label, comparison of dexamethasone 6 mg given once daily for up to ten days vs. usual care alone. 2104 patients randomly allocated to receive dexamethasone were compared with 4321 patients concurrently allocated to usual care. The primary outcome was 28-day mortalit...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3792273/ Does Rewording MRI Reports Improve Patient Understanding and Emotional Response to a Clinical Report? Remember few weeks ago when I talked about 50% of people knew that broken bone and fracture were the same thing or that 1 in 5 pts couldn’t describe nonweight baring? Well this study looked o see what would happen if we changed the language in...

Covid info https://melwy.com/blog/lancet-paper-on-chloroquine-is-overhyped-real-world-data-should-not-be-a-black-box So I couldn’t miss the largest observational study published to date on the effects of (hydroxy-)chloroquine, in 96 032 hospitalised Covid-19 patients, from an international registry comprising 671 hospitals in six continents: Surgisphere is the company that put it all together is i...

Prostate Cancer Incidence 5 Years After US Preventive Services Task Force Recommendations Against Screening JNCI: Journal of the National Cancer Institute, djaa068,——Published: 20 May 2020 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2762575?guestAccessKey=1c75486d-f2a4-4e1b-ac99-25ca247be690&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamain...

Fox MT et al. Comparative effectiveness of antibiotic treatment duration in children with pyelonephritis. JAMA Netw vOpen 2020 May 1; 3:e203951. (https://doi.org/10.1001/jamanetworkopen.2020.3951) Rates of treatment failure did not differ significantly between the short and prolonged courses (11.2% and 9.4%). https://jamanetwork.com/journals/jama/fullarticle/2765729?guestAccessKey=2169ba8b-43fc-43...

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2762699 Association Between Renin-Angiotensin System Blockade Discontinuation and All-Cause Mortality Among Persons With Low Estimated Glomerular Filtration Rate The answer was no; In a 5-year follow-up, ACE-I/ARB discontinuation was associated with an increased risk of both mortality (hazard ratio, 1.39; 95% CI, 1.20-1.60) and...

https://science.sciencemag.org/content/early/2020/04/24/science.abb5793 read an interesting paper title- Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period. Science 14 Apr 2020. First, some basics but still things that I learned: • The two corona virus currently in cirulation are HKU1 and OC43 and they are seasonal- mainly the winter months with peaks around oct, no...

https://covid19treatmentguidelines.nih.gov/ A National Institutes of Health panel has released new guidelines against use of hydroxychloroquine plus azithromycin outside of clinical trials https://www.ncbi.nlm.nih.gov/pubmed/32001253 Anaphylaxis—a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis Epinephrine i...

More cover 19 information based on antibody testing, pregnancy and pre-symptomatic spread https://www.medrxiv.org/content/10.1101/2020.03.30.20047365v1.full.pdf https://www.nejm.org/doi/full/10.1056/NEJMc2009316?utm_source=The+Scope&utm_campaign=86f20fbd35-Weekly_Scope_Jan_12_2018_COPY_01&utm_medium=email&utm_term=0_809ad7d22b-86f20fbd35-180869057

Remdesivir for compassionate use?? Recently published in the New England Journal of Medicine- Is this the COVID19 treatment we have all be hoping for. https://www.nejm.org/doi/full/10.1056/NEJMoa2007016 https://jamanetwork.com/journals/jama/fullarticle/2764727?guestAccessKey=72e8a5f3-3754-4bf8-bb17-8c2f1cf358b0&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&amp...

Treatment that works-- MASK! https://annals.org/aim/fullarticle/2764367/effectiveness-surgical-cotton-masks-blocking-sars-cov-2-controlled-comparison High Velocity Nasal Insufflation (HVNI) Therapy Application in Management of COVID-19 Have patients wear a surgical mask—in this computer study it showed that mask do help but not necessarily mask on you but mask on the pt.

Id be happy to send you links to any of the articles talked about in this podcast but I cover the new test on the corona virus that claims to be great but the devil in the details as well as talk about more hear-say medicine and the ever popular ACE inhibitor debate

https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v1.full.pdf https://www.sciencedirect.com/science/article/pii/S0399077X20300858 https://first10em.com/chloroquine-for-covid-no-good-evidence-yet/

https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-000890-25/FR https://www.sciencedirect.com/science/article/pii/S0924857920300996?via%3Dihub

Question Everything-- EBM not hear-say medicine

A listener wrote in with a question about a drug, this is my response. Let me know your thoughts? Would you prescribe this drug? Andrewbuelt@gmail.com https://www.nejm.org/doi/pdf/10.1056/NEJMoa1705848

There was a paper to start the year that got a lot of hype saying that just maybe we should target an LDL but that is not what the study actually showed and I will tell you why I think it is wrong.

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2757311?widget=personalizedcontent&previousarticle=2757307 Prior authorization requirements increased from 8% to approximately 24% of covered drugs on Medicare Part D plans between 2007 and 2019. Solutions- First, focus prior authorization on its intended purpose. Health plans should eliminate prior authorization requirements fo...

https://annals.org/aim/fullarticle/2760034/disclosure-form-work-submitted-medical-journals-proposal-from-international-committee. disclose everything for the papers that you keep..or write Patient comprehension of common orthopedic terminology Cosic F, Kimmel L, Edwards E. Heal Lit Res Pract. 2019;3(3):e187-e193. patients don't understand all that we say https://acsjournals.onlinelibrary.wiley.com...

Try not to read these all at once!! https://www.ncbi.nlm.nih.gov/pubmed/30715088 https://www.bmj.com/content/365/bmj.l2006 https://www.ncbi.nlm.nih.gov/pubmed/30359476 https://www.ncbi.nlm.nih.gov/pubmed/30964526 https://www.ncbi.nlm.nih.gov/pubmed/30415629 https://www.ncbi.nlm.nih.gov/pubmed/31454046 https://jamanetwork.com/journals/jamapediatrics/article-abstract/2723523 https://ginasthma.org/ h...

No summary YET! I promise it is coming, but here are a few more articles I think were pretty impressive from 2019.