Questioning Medicine

recipients were more likely than placebo recipients to report much or very much improvement (55% vs. 25%) which isn’t shocking because half of the people were not getting medicine they also report that the medication arm had improvement on CT imaging of the sinuses which also seems like another Duh moment as I am sure it was better than nothing   my concern is this new drug or deliver of the drug...

https://onlinelibrary.wiley.com/doi/10.1111/joim.13757 ECG abnormalities were present in 40% of hypokalemic patients and included t-wave flattening/inversion, ST-segment depression, QTc prolongation, longer QRS duration, and high heart rate.       after adjustment for potential confounders, only heart rate >100 beats per minute and not the ECG abnormalities was associated with those adverse out...

https://www.acpjournals.org/doi/10.7326/M23-3225 researchers randomized 160 patients with mostly unilateral hip OA to two 60-minute sessions weekly for 12 weeks, you were randomized to receive either neuromuscular exercise (NEMEX; focusing on postural and functional stability) or progressive resistance training (PRT; focusing on muscle strength).    primary outcome was the “ chair stand test ,” in...

adult smokers who are given e-cigarettes are significantly more likely to be abstinent at 6 months from a target quit date with a  (NNT = 8) but those individuals were not more likely to be abstinent from any nicotine product. In this study, the cost of e-cigarettes was paid by the study, so in the real world where patients have to buy their own e-cigarettes the results may be less favorable. The...

However, screening is not recommended because it has not been shown to improve patient outcomes..  Lifestyle recommendations include moderating alcohol use, quitting smoking, exercising, and losing weight if obese. Good news: Coffee need not be restricted. The authors recommend using a risk score such as CHADS2-VASC to determine the patient’s risk of stroke; if the annual risk of stroke is between...

https://journals.lww.com/ajg/fulltext/2024/03000/american_college_of_gastroenterology_guidelines_.14.aspx 2 of the 3 following criteria: (i) abdominal pain consistent with the disease, (ii) serum amylase and/or lipase greater than 3 times the upper limit of normal, and/or (iii) characteristic findings from abdominal imaging  Fluid-- Moderately aggressive fluid resuscitation with lactated Ringer's...

Bottom line- Elevated cholesterol as a child into an adult is bad but we still don’t know if treating children with medication improves this badness but we can say if you have elevated cholesterol as a child and it resolves as an adult then that is a good sign and puts you at equal risk to someone who never had dyslipidemia https://jamanetwork.com/journals/jama/article-abstract/2817700

Weight gain <5 kg was not associated with risk for the composite outcome among women with class 1 and 2 obesity (BMIs, ≥30–39.9 kg/m2). Weight gain <5 kg and weight loss were associated with lower risk for the composite outcome , compared with recommended weight gain, in women with class 3 obesity (BMIs, ≥40 kg/m2; rate ratio, 0.81) As the authors suggest—my take away bottom line These findi...

Chair placement was not associated with a difference in patients’ ability to name their physician (P=1.0), ability to successfully identify their reason for hospital admission (P=0.82), or perceptions of time (P=0.2) (see supplemental table 5).     Overall if you put a chair at bedside and have medstudents following then yes a provider is more likely to sit down. However- this only minimally chang...

primary outcome was Duration of the first stage of labor was the primary outcome.   AND It was 179 minutes shorter (95% CI 146 - 213) in the intervention group than in the control group (392 minutes; standard deviation [SD] 122 vs 571 minutes; SD 188).  Intensity of pain, was reported on a visual analog scale of 0 to 10 at several points in time, was on average 2.0 to 2.7 points lower in the inter...

In older adults, mildly elevated TSH levels normalized in about 50% of cases during 1 to 2 years of observation. https://academic.oup.com/jcem/article/109/3/e1167/7325863?login=true

A study that was done before the widespread use of troponin only measurements for ACS (and certainly before high sensitively trop  EVER EXISTED), a trial that took place before the first statin was even FDA approved,  a trial that had no idea what DAPT was and took place PRIOR to the publication of the trial that would ultimately make aspirin post MI a standard of care, a trial that existed before...

This translates into an absolute excess risk of ≈9 events per 1000 person-years or 1 per 110 person years. Sad differently if you treat 110 people for 1 year with a doac and an SSRI you will have one more bleed that requires hospitalization or death than if there was no SSRI. This  Risk was similar for various types of bleeding (e.g., intracranial, gastrointestinal) and did not vary with potency o...

During follow-up participants walked on average 8300 steps and those individuals in the lowest genetic risk score developed obesity defined as a BMI greater than 30 approximately 13% of the time while those individuals in the highest genetic risk or developed obesity 43% of the time.    participants at the 75th percentile of PRS risk needed to walk 2280 more steps daily than participants at the 50...

And in the end it did not really matter because at 3 months individuals only reported a 0.16 difference in pain and a 1.6 difference in function which both were well within the noninferiority boundary.  In case you are wondering there is no difference in adverse events. bottom line For the outcomes of pain and function Telerehabilitation with a physiotherapist is non-inferior to in-person rehabili...

At 1 year 50% of those individuals who had bariatric surgery were able to achieve diabetic remission but after 12 years the very same individuals that received bariatric surgery had just a 13% success rate in the remission of diabetes. Bariatric surgery certainly has an improvement in hemoglobin A1c and diabetic remission that is most evident in the first year but remains after 12 years of follow-...

The company that developed Cologuard also developed this “next generation” multitarget stool DNA test, and has applied for U.S. FDA approval . The new test appears to have similar sensitivity and higher specificity than its predecessor — which means fewer false positives.  Positive predictive value (the proportion of positive tests that were true positives for cancer or advanced neoplasia) was 11%...

730 Patients were randomized to receive daily oral aprocitentan or placebo, plus a fixed-dose combination of amlodipine, valsartan, and hydrochlorothiazide. After 4 weeks, mean change in office systolic BP was 15 mm Hg with aprocitentan and 11 mm Hg with placebo; this 4 mm difference was statistically significant. What is the cost? What is the long term effects? Why didn't they compare this to the...

The trial was terminated after  1015 patients with atrial cardiopathy had been randomized to receive either apixaban or aspirin for a mean follow-up of 1.8 years, recurrent stroke rates were identical  (40 events per group; 4.4% annualized rate). There were 7 symptomatic intracranial hemorrhages in the aspirin group and none in the apixaban group, though other major hemorrhages occurred at similar...

 TJA should not be delayed for trials of physical therapy, anti-inflammatory drug use, bracing, intra-articular steroid injections, or hyaluronic acid injections. For patients with obesity, proceed to TJA without delay, regardless of BMI. For patients with poorly controlled diabetes, recommend delaying TJA to improve glycemic control, but don't define poor control or specific HbA1c requirements. F...

randomized trial comparingbeta-blocker therapy (metoprolol or bisoprolol) with no beta-blocker in 5020 patients who had a normal left-ventricular ejection fraction (LVEF) after AMI  median follow-up of 3.5 years, the primary composite endpoint — all-cause death or recurrent AMI — did not differ significantly between participants randomized to a beta-blocker versus no beta-blocker (7.9% vs. 8.3%, r...

During a mean 11 years of follow-up, current smokers' risks for cardiovascular-, cancer-, and respiratory-related deaths were 2, 3, and 13 times higher, respectively, than never smokers' risks. Former smokers who had quit <10 years before enrollment avoided roughly 50% to 60% of these excess risks. By 30 years after quitting, excess mortality was virtually eliminated. https://jamanetwork.com/jo...

The primary cardiovascular end point was a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke in a time-to-first-event analysis. Improvement in nonfatal stroke was not statistically significant death from cardiovascular causes was no significant but hold on it does appear nonfatal MI was significant and is what really drove the entire composite outcom...

Bottom line (ZTLido 1.8%) is a brand name lidocaine patch currently approced for postherpetic neuralgia and will stay that why for now as it did not beat placebo for the treatment of patients with chronic nonspecific neck pain For both pain scores the pain decreased by 1.0 point with lidocaine and by 0.5 points with placebo. These differences were neither statistically significant nor deemed to be...

 patients who have new-onset transient AF detected during a hospitalization for noncardiac surgery or medical illness and are discharged in sinus rhythm, approximately 1 in 3 have AF detected in the year after hospital discharge. Those that did not have afib only had a 5% risk (1 in 20) -- we dont know what this means for rates of patient oriented outcomes https://www.acpjournals.org/doi/10.7326/M...