Questioning Medicine

 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...

https://pubmed.ncbi.nlm.nih.gov/33734980/ if you lay flat with a blood draw you may have psuedoanemia https://jamanetwork.com/journals/jama/fullarticle/2782300 Men and UTI-- 7 days https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2782461 don't get a UA prior to a procedure for screening https://www.nejm.org/doi/full/10.1056/NEJMoa2026845 cardiogenic shock- dobutamine vs milri...

Yes this is a CME lecture but yes you get it for the expensive price of Free Fifty Free....

Contraception 2021 Sep 20;[EPub Ahead of Print], D Grossman, S Raifman, N Morris, A Arena, L Bachrach, J Beaman, MA Biggs, C Hannum, S Ho, EB Schwarz, M Gold STUDY DESIGN This is an interim analysis of an ongoing prospective cohort study conducted at five sites. Clinicians assessed patients in clinic and, if they were eligible for medication abortion and ≤63 days' gestation, electronically sent pr...

Davidson KW et al. Screening for prediabetes and type 2 diabetes: US Preventive Services Task Force recommendation statement. JAMA 2021 Aug 24; 326:736. ( https://doi.org/10.1001/jama.2021.12531 )   The Task Force found moderate-certainty evidence that screening is beneficial for nonpregnant adults (age range, 35–70) who are overweight (i.e., body-mass index [BMI], ≥25 kg/m2) or obese (BMI, ≥30 kg...

I've found that I can often increase compliance with statins by having pt take them 3x/week or QOD.  I try this often especially in my secondary prevention group. I understand "any statin is better than none", but do data support this approach?   -- any is better than none! No rct with this but yes data supports every other day but that is observational.. what about vascepa in reducing CAD risk bo...

DYSh out information on DYSlipidemia: An Evidence-based Update on Cholesterol Management Please contact me for more information:    Andrew Buelt, D.O.  andrewbuelt@gmail.com Questioning Medicine Podcast Athrosclerotic Cardiovascular Disease Risk Calculator (ASCVD) 10 yr ASCVD risk calculator developed in 2013 ASCVD event defined as nonfatal myocardial infarction, coronary heart disease (CHD) death...

part 1-- you dont get the CME but you get the information

Podcast Gregory J, Huynh B, Tayler B, et al. High-dose vs standard-dose amoxicillin plus clavulanate for adults with acute sinusitis. A randomized clinical trial. JAMA Network Open 2021;4(3):e212713 Study design: Randomized controlled trial (double-blinded)  primary care offices with sinus symptoms consistent with currently accepted clinical criteria for acute bacterial sinusitis.  andomly receive...

Delay of Pregnancy Among Physicians vs Nonphysicians JAMA Intern Med 2021 May 03;[EPub Ahead of Print], MC Cusimano, NN Baxter, R Sutradhar, E McArthur, JG Ray, AX Garg, S Vigod, AN Simpson It has been hypothesized based on just rumor and people repeating it that women physicians are more likely to delay childbearing than nonphysicians. This population-based retrospective cohort study looked to se...