Questioning Medicine

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.

It is that time of year again-- Top articles of 2019 part 1. This is my opinion, but I think it is a pretty good opinion.

https://jamanetwork.com/journals/jama/fullarticle/2751726 uspstf now grade B for asymptomatic urine in preggo https://pediatrics.aappublications.org/content/144/6/e20192739kids do shoot their eye out! https://www.nejm.org/doi/full/10.1056/NEJMoa1908142Metoprolol does not treat COPD https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2754809?guestAccessKey=d3ef4800-287b-43aa-9d58...

https://www.nejm.org/doi/full/10.1056/NEJMoa1806515 -- IVC filter after a severe injury = it is ok to wait 7 days https://www.nejm.org/doi/full/10.1056/NEJMoa1904143 antithrombotic therapy with afib after a pci and 1 year == just the DOAC https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31791-X/fulltext polypill for primary prevention just might work but likely need more research...

https://www.ncbi.nlm.nih.gov/pubmed/31550435 mono and athletes -- stick with 21 days https://onlinelibrary.wiley.com/doi/abs/10.1002/ijc.32738 Hair Dye does not cause breast cancer https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2753986?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=110619 mailing the HPV kit is better because it increases scr...

https://jamanetwork.com/journals/jama/article-abstract/2753909?guestAccessKey=03d877eb-6d48-476f-9487-aa6fbbd8a8d5&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=103019 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2754091 https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz754/56...

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2753986?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=110619   mailing hpv gets more people screened! Shocking! https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32135-X/fulltext?rss%3Dyes  patiromer might work but 70% of people don't need it cause they don't get hyperkalemia!  ...

https://insights.ovid.com/crossref?an=00006396-900000000-98602 https://jamanetwork.com/journals/jama/article-abstract/2751887?guestAccessKey=8fa2f772-1ba4-40ff-9015-4fcb46d6829e&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=091819 https://www.ncbi.nlm.nih.gov/pubmed/14604741 https://jamanetwork.com/journals/jamanetworkopen/full...

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2748452    -- come one come all unless you are a kidney https://www.ncbi.nlm.nih.gov/pubmed/31054907   SURPRISE!! Women prefer to do self swab rather than clinician swab https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/hepatitis-c-screening1  If the pt. is breathing then you test for Hep C h...

https://www.ncbi.nlm.nih.gov/pubmed/30347032  Terbinafine adverse effects are rare https://www.ncbi.nlm.nih.gov/pubmed/31189511 Dulaglutide prevents MACE but at a high price tag https://www.ncbi.nlm.nih.gov/pubmed/30853124   If you punch your buddy then get some buddy tape https://www.ncbi.nlm.nih.gov/pubmed/31076416 prediabetes gibes me a headache    https://www.acog.org/Clinical-Guidance-and-Pub...