Questioning Medicine

Let's look at the numbers behind CAC! The best evidence is found here https://jamanetwork.com/journals/jama/fullarticle/2687224 but the largest study is found here https://www.sciencedirect.com/science/article/pii/S0735109715072253?via%3Dihub but in the end they use this https://en.wikipedia.org/wiki/Net_reclassification_improvement which might trick many people but I know it won't trick the smart...

https://www.ncbi.nlm.nih.gov/pubmed/30874755 - ACC/AHA and ESC are still not evidence based http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.939.1670&rep=rep1&type=pdf -- only need to check every ten years-- it is the other risk factors that matter! https://www.ncbi.nlm.nih.gov/pubmed/26680162 Signal to noise is around 1 in 10 yrs

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2739056 not all guidelines are equal, think for yourself. Some guidelines even do harm when you actually look at the evidence. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2740207 doacs and surgery what do you do-- low risk surgery stop one day prior and start one day after surgery. with high risk surg...

https://www.nejm.org/doi/full/10.1056/NEJMoa1813959 even when we dont know where the stroke is coming from- aspirin is still king all these years later https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30840-2/fulltext Aspirin is such a king that is doesn't matter if you have a spontaneous brain bleed or intracerebral hemorrhage it does appear safe to restart aspirin after a 2-3 m...

https://www.cdc.gov/mmwr/volumes/68/wr/mm6825a2.htm we are not testing people for HIV even though guidelines https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/human-immunodeficiency-virus-hiv-infection-screening1 since 2006 have recommended that everyone be tested! 13yrs later!! Time to do it!! https://www.ncbi.nlm.nih.gov/pubmed/30658933 The self swab is as good if no...

https://www.ncbi.nlm.nih.gov/pubmed/30608562 A1C level low is not good and high is not good cause both seem to wind up have you the pt. in the hospital for hypoglycemia- the low point of the U curve is around 7-8% which ironically seems to fit perfectly with recent guidelines https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2735985 pts don't take the medications and if they have h...

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31942-1/fulltext If you are over 70 or 75 and primary prevention then likely no benefit in statins and secondary benefit is very small https://www.nejm.org/doi/full/10.1056/NEJMoa1806802 Get the glucose down! After you max out other risk factors as intensive control doesn't have a legacy effect https://www.nejm.org/doi/full/10.1056...

https://www.ahajournals.org/doi/10.1161/JAHA.118.011318 energy drinks prolong the QT just ever so slightly in healthy 22yr olds so if you are thinking of telling grandma to slam 32ounces of energy drink and she is on QT prolonging medication then you probably shouldnt https://www.nejm.org/doi/full/10.1056/NEJMoa1808082 zolendranae is not a magic drug that cures osteopenia they just have magic tria...

vitamin d- if you cant give up on it then give up on checking the lab value- fire and forget. https://www.nejm.org/doi/full/10.1056/NEJMoa1800566 induction at 39 weeks is okay with me https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2698631 cardio test and all test have varibility https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31131-0/fulltext our evaluation of you...

afib- new guidelines! https://www.google.com/search?q=2019+American+Heart+Association%2C+American+College+of+Cardiology+and+the+American+Rhythm+Society+focused+update+from+their+2014+guidelines+for+the+management+of+patients+with+atrial+fibrillation&rlz=1C1CHFX_enUS708US708&oq=2019+American+Heart+Association%2C+American+College+of+Cardiology+and+the+American+Rhythm+Society+focused+update+f...

https://www.bmj.com/content/364/bmj.l42 skip breakfast- it doesn't help you 'lose weight' https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2723074 Automated BP cuffs are the new rage and for good reason they are about equal to awake ambulatory blood pressure https://www.ncbi.nlm.nih.gov/pubmed/30653040 if you have a pt. going to surgery for their knee because of osteoarthriti...

shared decision making for lung cancer rarely happens in the community and when it does happen 2/5 said no thanks to cancer screening https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2720126 vit d. - does not work on a bus it doesn't work with white women or black women anyone https://www.ncbi.nlm.nih.gov/pubmed/29905969 achilles tendon rupture- if you go to surgery NNT for r...

https://www.emrap.org/episode/rightonprime/introduction RIGHT ON PRIME IF YOU NEED CME 10% likely isn't high risk but it certainly deserves more than 0.6% of people on statins so don't forget your statins https://annals.org/aim/article-abstract/2725144/characteristics-high-cardiovascular-risk-1-7-million-chinese-adults Oxycodone "the best high of all" https://link.springer.com/article/10.1007/s119...

https://www.emrap.org/episode/rightonprime/introduction RIGHT ON PRIME IF YOU NEED CME https://www.bmj.com/content/364/bmj.l240 hpv is still boss https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2724778 push up to push good health https://www.bmj.com/content/364/bmj.k4681 prepping for HIV education https://www.ncbi.nlm.nih.gov/pubmed/27149090?dopt=Abstract very effective if used Still...

https://www.emrap.org/rop?episode-guide-publish-date=%5B568011600000%2C1552613520000%5D https://www.nejm.org/doi/full/10.1056/NEJMoa1809983?query=featured_home parkinsons and symptoms- start levadopa https://www.nejm.org/doi/full/10.1056/NEJMoa1812851 BNP is a terrible biomarker and I hate when studies look at worthless outcomes https://www.gastrojournal.org/article/S0016-5085(19)30103-9/pdf warfa...

https://annals.org/aim/article-abstract/2719218/long-term-outcomes-among-patients-discharged-from-hospital-moderate-anemia#an_fo_ho Anemia is not being fixed 6months after hospitalization but that is okay because they are not going back to the hospital or dying https://jamanetwork.com/journals/jama/fullarticle/2679928 Have the shared decision making conversation with your pt about mammograms! http...

https://www.bmj.com/content/363/bmj.k4823 self swabs work https://onlinelibrary.wiley.com/doi/full/10.1002/oby.22345 intermittent fasting https://jamanetwork.com/journals/jama/article-abstract/2718066 Vit D for ESRD http://pediatrics.aappublications.org/content/143/2/e20181902 HPV vaccine works for herd immunitiy http://care.diabetesjournals.org/content/early/2019/01/03/dc18-1773 cardiovascular ev...

My view of some of the top articles and medical headlines from 2018.

Mechanical thrombectomy, FDA and concussion. HPV vaccine and more on this episodes covering top articles from 2018.

1 of many in which I break down what I think are articles or titles of 2018 you need to know about (hint: my have been discussed on QM before)

This is a heated debate but the numbers tell the whole story. So let's dig into the numbers a little more and find the real benefit of the screening mammogram. 

It is time to tackle screening mammograms. I warn you, this is evidence, try not to listen with emotion. 

Heading to FMX and the bags are packed!! Here is a little something to hold you down till I return! If you are going to be there then tweet me @andrewbuelt

Another hard hitting Questioning Medicine packed with all sorts of articles and gems. Times are changing for those that have to sit in a chair 3 days a week and it is coming from those with hep. C

Two big articles in this episode that have already changed my practice and I tell you how. Plus, a bunch of other articles I think people should be talking about! What is the real risk for statins? Which DOAC can you use with ESRD? So many questions and so many answers!