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https://www.nejm.org/doi/full/10.1056/NEJMoa2405923?query=clinical-medicine   Mineralocorticoid receptor antagonists have been shown to reduce mortality in patients after myocardial infarction with congestive heart failure. Whether routine use of spironolactone is beneficial after myocardial infarction is uncertain.     Recent attempts to improve outcomes with intensified renin–angiotensin–aldoste...

Estimated 5-year incidence of recurrent VTE was similar in the reduced-dose and full-dose groups (2.2% and 1.8%). Estimated 5-year bleeding incidence was significantly lower with reduced-dose than with full-dose treatment (2.1% vs. 4.0% for major bleeding; 8.6% vs. 11.5% for clinically relevant nonmajor bleeding). Outcomes with apixaban and rivaroxaban were similar. Couturaud F et al. Extended tre...

https://www.nejm.org/doi/full/10.1056/NEJMoa2405404 NNT of 4! systemic metronid and topical clinda bid for one week

What Was Studied? The EMPA-KIDNEY trial followed 6,609 CKD patients at risk of disease progression. Participants were randomly assigned to receive empagliflozin (10 mg daily) or a placebo for a median of 2 years. After this ‘active’ phase, 4,891 patients entered a 2-year post-trial observational period where neither group received the trial drug, but doctors could prescribe open-label SGLT2 inhibi...

Metformin while not necessarily first line therapy for diabetes depending on the patients co-morbid conditions it is certainly highly ranked on the list of medications!   I know often metformin is stopped while coming into the hospital for fear of potentially lactic acidosis or an increase in AKI with contrast studies however this ‘belief’ is largely based on myth and misconception. Metformin's co...

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2825813 Conclusions and Relevance   In this randomized clinical trial assessing simultaneous vs sequential administration of mRNA COVID-19 and IIV4 vaccines, reactogenicity was comparable in both groups. These findings support the option of simultaneous administration of these vaccines.

https://www.bmj.com/content/388/bmj-2024-081164 systematic review and meta-analysis on prehabilitation before surgery, published in the BMJ in February 2025.Prehabilitation aims to prepare patients for surgery through interventions like exercise, nutrition, and psychological support. This study looked at which prehabilitation components are most effective for improving key outcomes after surgery....

Mammograms

379. REPORT mammogram part 1

https://jamanetwork.com/journals/jama/article-abstract/2828218 DCIS is a non-invasive form of breast cancer, meaning the abnormal cells are contained within the milk ducts. For years, the standard treatment has been surgery, often followed by radiation and/or hormone therapy - the same treatments used for invasive breast cancer. But is this aggressive approach always necessary for low-risk DCIS? (...

Association of Duration of Recognized Hypertension and Stroke Risk: The REGARDS Study       (Transition Music - Short and subtle - 2 seconds)Host:    Hypertension is a well-known risk factor for stroke, but this study, led by Dr. George Howard and colleagues, asks a fascinating question: Does the duration of hypertension matter, even when blood pressure is managed?   (Transition Music - Short and...

Bloom CI et al. Association of dose of inhaled corticosteroids and frequency of adverse events. Am J Respir Crit Care Med 2025 Jan; 211:54. ( https://doi.org/10.1164/rccm.202402-0368OC )     Bloom and colleagues' study, published in the American Journal of Respiratory and Critical Care Medicine in January 2025, provides significant insights into the safety profile of inhaled corticosteroids (ICS)...

Gao FM et al. A systematic review and meta-analysis on the safety and efficacy of sodium–glucose cotransporter 2 inhibitor use in hospitalized patients. Diabetes Care 2024 Dec 1; 47:2275. ( https://doi.org/10.2337/dc24-0946 )   Trial Results SGLT-2 inhibitors, crucial in managing diabetes, kidney disease, and heart failure, have shown promising results in hospitalized patients 1 . The meta-analysi...

Is accelerated surgery for hip fracture better for high-risk patients?   A recent substudy of the HIP ATTACK trial has shed new light on this topic. The original trial, published in 2020, compared accelerated surgery (within 6 hours) to standard-timing surgery (within 24 hours) for hip fracture patients. While the initial results showed only marginal benefits, this new analysis focuses on a specif...

Today, we're discussing two groundbreaking studies from 2024 that challenge our understanding of β-blocker therapy for secondary prevention after myocardial infarction, or MI.Let's start with a Swedish study Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction | New England Journal of Medicine that included over 5,000 patients with normal left ventricular ejection fraction aft...

Methods Monday  --- Accuracy of Event Rate and Effect Size Estimation in Major Cardiovascular Trials: A Systematic Review | Cardiology | JAMA Network Open | JAMA Network     During the design of a randomized clinical trial (RCT), estimation of the expected event rate and effect size is a key component to calculating the sample size. Overly optimistic estimation of event rates and effect sizes may...

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821168 A team of researchers set out to change that by developing a comprehensive algorithm. The process involved a multidisciplinary panel of 11 expertss with extensive experience in managing urinary retention. These experts evaluated about 100 clinical scenarios to create an initial flow sheet. The algorithm was then refined through i...

https://jamanetwork.com/journals/jama/article-abstract/2822097 Design, Setting, and Participants   Nested case-control study using population-based linked administrative datasets among adults aged 66 years or older who received at least 1 oral antibiotic between 2002 and 2022 in Ontario, Canada. Cases were those who had an emergency department (ED) visit or hospitalization for serious cADRs within...

https://www.nejm.org/doi/full/10.1056/NEJMoa2407001 Conclusions No participants receiving twice-yearly lenacapavir acquired HIV infection. HIV incidence with lenacapavir was significantly lower than background HIV incidence and HIV incidence with F/TDF.  Among 5338 participants who were initially HIV-negative, 55 incident HIV infections were observed: 0 infections among 2134 participants in the le...

Allaudeen N et al. Medications for alcohol-use disorder and follow-up after hospitalization for alcohol withdrawal: A multicenter study. J Hosp Med 2024 Dec; 19:1122. ( https://doi.org/10.1002/jhm.13458 )       Hospital admission for alcohol withdrawal is a problem when it comes to readmission. They just come back---   In this retrospective study of ≈600 patients (96% men) admitted for alcohol wit...

Real‐world use of glucocorticoids and clinical outcomes in adults hospitalized with community‐acquired pneumonia on medical wards - Malecki - 2024 - Journal of Hospital Medicine - Wiley Online Library   This was a retrospective cohort study of 11,500 patients with CAP who were admitted to general medicine units in 7 Canadian hospitals, researchers compared outcomes for patients who received system...