Questioning Medicine

2024 ESC guidelines propose a simple new BP categorization: Non-elevated: less than 120/70 mm Hg in the office (pharmacological treatment is not recommended). Elevated: 120 to 139/70 to 89 mm Hg (pharmacological treatment is recommended for some, depending on cardiovascular disease [CVD] risk and follow-up BP measurements). Hypertension: 140/90 mm Hg or greater (confirmation and prompt pharmacolog...

Question   Does adding centralized mailed fecal immunochemical testing and patient navigation to usual care improve colorectal cancer (CRC) screening in US federally qualified health centers?   pragmatic randomized clinical trial was conducted   Patients were enrolled and randomly assigned to usual care alone (control group) or intervention (2,001 participants per group). Intervention participants...

Packer M et al. Tirzepatide for heart failure with preserved ejection fraction and obesity. N Engl J Med 2024 Nov 16; [e-pub]. https://doi.org/10.1056/NEJMoa2410027     In the industry-funded SUMMIT trial ( NCT04847557 ), investigators examined cardiovascular outcomes of tirzepatide — an agonist of glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptors — over a longer period in pat...

Wang Z et al. Safety of triptans in patients who have or are at high risk for cardiovascular disease: A target trial emulation. Mayo Clin Proc 2024 Nov; 99:1722. ( https://doi.org/10.1016/j.mayocp.2024.03.023 )   How unsafe are triptans   triptans — the mainstays of migraine therapy — are vasoactive, the U.S. FDA considers them to be contraindicated in patients with cardiovascular (CV) disease or...

STROKE part 3 CME

CME FOR FREEE 

CME --- Stroke- UIA, CHAD-VASC, HAS-BLED, SPARC, PFO

Beran A et al. Early diagnostic paracentesis improves outcomes of hospitalized patients with cirrhosis and ascites: A systematic review and meta-analysis. Am J Gastroenterol 2024 Nov; 119:2259. ( https://doi.org/10.14309/ajg.0000000000002906 )   BOTTOM LINE (if you don’t like to read)- While it might not be fun to have the conversation with the ER provider saying you NEED A DIAGNOSTIC PARACENTESIS...

Acupuncture vs Sham Acupuncture for Chronic Sciatica From Herniated Disk: A Randomized Clinical Trial | Complementary and Alternative Medicine | JAMA Internal Medicine | JAMA Network     In a randomized trial, acupuncture reduced pain and disability better than a sham procedure did.     In this trial from China, 216 adults (mean age, 51) were randomized to undergo 10 sessions of acupuncture or sha...

And now a secondary analysis of the trial focused on the timing of major ischemic events and the potential tradeoffs of benefits and risks,------ maybe there is magic sauce where the benefit is drastically greater than risk and vice versa!   Guan L et al. Duration of benefit and risk of dual antiplatelet therapy up to 72 hours after mild ischemic stroke and transient ischemic attack. Neurology 202...

The full podcast -- not sure why the last one cut off early.  Question and answer from ACOI

Liu H et al. Arm position and blood pressure readings: The ARMS crossover randomized clinical trial. JAMA Intern Med 2024 Oct 7; [e-pub]. ( https://doi.org/10.1001/jamainternmed.2024.5213 )       study replicated some of the “real-world” shortcuts that often occur when we check BP, such as measuring BP while the patient is sitting up on an exam table.=== In this U.S. trial of 133 adults, researche...

Stopping Trials Early for Benefit: Insights From Recent Pivotal Trials in Chronic Kidney Disease - ScienceDirect       There are 4 major reasons why trials might be stopped early: 1) unequivocal benefit; 2) unacceptable harm; 3) futility; and 4) administrative reasons (enrollment or funding concerns).     trials stopped early for benefit tend to overestimate benefit, a phenomenon referred to as ra...

You get the CME knowledge without the CME payment!

 10% of hospitalized patients have penicillin allergy listed in their records, fewer than 1% of patients have true allergies.   Use of more-expensive and broader-spectrum antibiotics is associated with longer and more-expensive hospital stays and more side effects, nosocomial infections, and resistant organisms.     Blumenthal KG et al. Reaction risk to direct penicillin challenges: A systematic r...

Efficacy and Safety of a Novel Low-Dose Triple Single-Pill Combination Compared With Placebo for Initial Treatment of Hypertension J Am Coll Cardiol 2024 Aug 30;[EPub Ahead of Print], A Rodgers, A Salam, AE Schutte, WC Cushman, HA de Silva, GL Di Tanna, D Grobbee, K Narkiewicz, DB Ojji, NR Poulter, MP Schlaich, S Oparil, W Spiering, B Williams, JT Wright, A Gutierez, A Sanni, P Lakshman, D McMulle...

In 2011, the Endocrine Society published a guideline on “Evaluation, Treatment, and Prevention of Vitamin D Deficiency”      Now, the Society has issued an updated guideline, Demay MB et al. Vitamin D for the prevention of disease: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2024 Aug; 109:1907. ( https://doi.org/10.1210/clinem/dgae290 )     Previously, the Endocrine S...

Huijberts I et al. Collateral-based selection for endovascular treatment of acute ischaemic stroke in the late window (MR CLEAN-LATE): 2-year follow-up of a phase 3, multicentre, open-label, randomised controlled trial in the Netherlands. Lancet Neurol 2024 Sep; 23:893. ( https://doi.org/10.1016/S1474-4422(24)00228-X )        The modified Rankin Scale (mRS) score at 2 years was the primary outcome...

  Because glucagon-like peptide-1 (GLP-1) receptor agonists can slow gastric emptying, they might confer risk for residual gastric contents — and possibly aspiration!!!! Should we stop the glp-1   Should we stop the glp-1-- Anesthesiologists and gastroenterologists have weighed in on this concern and on QM I say just do whatever the anesthesiologist want because they have the final say!!     Sen S...

Oropharyngeal dysphagia is highly prevalent in hospitalized patients with Alzheimer disease or other dementias. These patients often are prescribed thick liquid diets   Makhnevich A et al. Thick liquids and clinical outcomes in hospitalized patients with Alzheimer disease and related dementias and dysphagia. JAMA Intern Med 2024 May 6; [e-pub].   Researchers conducted a retrospective propensity-ma...

Feedback and Financial Incentives for Reducing Cell Phone Use While Driving: A Randomized Clinical Trial | Public Health | JAMA Network Open | JAMA Network     Question   Can behavioral interventions decrease handheld cell phone–based driver distraction?       17663 and ended up with 2020 participants Progressive email--- already a select population   Outcome-- Proportion of drive time engaged in...

Noncontrast CT Selected Thrombectomy vs Medical Management for Late-Window Anterior Large Vessel Occlusion | Neurology   Most studies that have shown a benefit from endovascular thrombectomy (EVT) for ischemic stroke in the late time window (6 to 24 hours after time last known well) have used either perfusion imaging or advanced imaging to identify core infarct volume.   Whether plain CT alone can...

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820369 With as many as 1 in 3 US adults using multivitamin supplements, the question as to whether these supplements reduce mortality   They used three large observational cohort studies with nearly 400,000 participants (median age, 62) who were followed for as long as 27 years (mean, 20 years); these studies included data on diet, self...

https://www.acpjournals.org/doi/10.7326/M23-3236 Angiotensin-converting–enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) seldom are initiated among patients with chronic kidney disease (CKD) stage 4 or 5, despite guideline recommendations for these agents--- 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of H...

Composite outcomes   You add multiple outcomes together… this is great because you can increase the event rate.. if you are just looking at death lots of people might now die but if you look at death and hospitalizations well then it is easier to get to your expected event rate because its much easier to be hospitalized. This make it so you can have smaller sample sizes and it wont be nearly as ex...