Questioning Medicine

https://www.clinicalkey.com/#!/content/journal/1-s2.0-S0140673620322339?scrollTo=%23hl0000424 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32233-9/fulltext do statins work in old people?? This study in the lancet says- “In a contemporary primary prevention cohort, people aged 70–100 years with elevated LDL cholesterol had the highest absolute risk of myocardial infarction and...

https://www.acpjournals.org/doi/10.7326/M20-2470 Pharmacologic Approaches to Glycemic Treatment of Type 2 Diabetes: Synopsis of the 2020 American Diabetes Association's Standards of Medical Care in Diabetes Clinical Guideline FREE Which is as the artciel suggest in a sypnopsis of the 2020 ADA guidelines metformin is still universal fist line but now the guideline says The choice of agent to add to...

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2771093 meta-analysis of 78 original studies, looking to find the accuracy of ECG interpretation. In this analysis they looked at studies with med students, physiciansm even cardiologist and found on average we got the right diagnosis only 55% of the time. Obviously education goes up with more education 42.0% for medical students, 5...

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2771670 trials are not real life. We know that. Realistically if your drug just barely hits 0.05 in a clinical trial then in the imperfect setting of the clinic of every day life the drug likely wont work. In this next study, in jama internal medicine titled Concordance Between Blood Pressure in the Systolic Blood Pressure Intervent...

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2771095 SO HOW DO YOU LOSE WEIGHT!! FASTING DOESN’T WORK or so says this study titled- Effects of Time-Restricted Eating on Weight Loss and Other Metabolic Parameters in Women and Men With Overweight and ObesityThe TREAT Randomized Clinical Trial 100 overweight or obese adults were randomized to regular eating or to a restricted eat...

Doc my heart is racing— Stop drinking—or so says this article in NEJM that found when they took 140 pts who severed from paroxysmal afib and who drank 17 drinks a week that when randomized to complete alcohol abstinence for 6 months there was significant reduction in afib recurrence.. how much of a difference?? 20% ABSOLUTE DIFFERENCE….. I have a rule of thumb that anytime someone says the improve...

Rapid fire articles- no deep dive. Just good a lot of questioning, questioning medicine. If you want any of the articles for your own review or have any questions you can always reach me at andrewbuelt@gmail.com

We stuck purely to the evidence. There was no evidence panel or committee to vote on the evidence like is often done by the American college of rheumatology and no expert opinion statements where their only citation is themselves like can be seen with the ACC. This was purely 100% evidence recommendations. So lets start try to make it quick because guidelines on a podcast a boring, I want to hit t...

athlete heart covid https://www.the-scientist.com/news-opinion/college-athletes-experienced-heart-damage-after-covid-19-study-67929 titiles like- “Images of the players’ hearts showed signs of inflammation consistent with myocarditis, a rare but potentially fatal condition.” “two dozen of Ohio State University players using cardiac magnetic resonance (CMR), they found evidence of myocarditis in 15...

the thing about RCT is they are random and everything is equal. its why in table one of an RCT you should never see a pvalue because they are random and should be equal but in observational studies you see pvalues because it is not equal, it can’t be, its not random. In observational studies you try to account for all the confounders but you just cant ever make it equal to an RCT but lets look a l...

Finance ethics committee, big pharma with deep pockets, mafia like arrangements, and a patient with a 40% increase risk of ischemia myocardial events have in common? I will say todays podcast was inspired by a tweet, yes a tweet from Dr. john Mandrola and he said “I am embarrassed to have not (really) known the details of the rosiglitazone affair. Teaching this to learners has to be 10x more valua...

In this study of a cohort of German patients recently recovered from COVID-19 infection, CMR revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), independent of preexisting conditions, this was a freak out statement if I have ever heard of one I mean Covid is doing something directly to the heart? and this thing it is doing to the heart is ind...

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2768888 Serial Bone Density Measurement and Incident Fracture Risk Discrimination in Postmenopausal Women Carolyn J. Crandall, MD, MS1; Joseph Larson, MS2; Nicole C. Wright, PhD3; et al OBJECTIVE To assess whether a second BMD measurement approximately 3 years after the initial assessment is associated with improved ability to estim...

Sometime I wonder how the world will change post covid- or how the board questions will change? And that is clearly seen in this article titled- Yip L et al. Serious adverse health events, including death, associated with ingesting alcohol-based hand sanitizers containing methanol — Arizona and New Mexico, May–June 2020. MMWR Morb Mortal Wkly Rep 2020 Aug 14; 69:1070. hand sanitizing gels and foam...

henry ford once said “failure is simply the opportunity to begin again, this time more intelligently” Designed to Fail? the Future of Primary Care Journal of General Internal Medicine (2020) Access to primary care has been shown to improve patient outcomes and lower cost although outcomes are debated the cost is not- its because we can be the jack of all or the referral of all. neither is wrong th...

https://twitter.com/NarducciDusty/status/1290044202852614145?s=20

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...