Questioning Medicine

ening, the offer of a blood-based screening test boosted CRC screening by 17.5 percentage points over usual care. That is because CRC screening proportions were 17.5 percentage points higher in the blood test group versus usual care (30.5% vs 13.0%; OR 2.94, 95% CI 2.34 to 3.70; p<0.001).   So more people are screened for colon cancer but who cares if they get screened if your screening test do...

https://pubmed.ncbi.nlm.nih.gov/38945140/ The primary outcome was a composite of myocardial infarction, revascularisation, hospitalisation for heart failure, stroke, or death from cardiovascular causes   The mean systolic blood pressure throughout the follow-up (except the first 3 months of titration) was 119·1 mm Hg (SD 11·1) in the intensive treatment group and 134·8 mm Hg (10·5) in the standard...

INHALE-3, a randomized trial, 123patients with type 1 dm that compared the efficacy of an inhaled insulin regimen (Afrezza) plus degludec insulin (Tresiba®) against usual care over 17 weeks   The study's primary endpoint was a change in HbA1c levels, a critical marker of long-term blood glucose control.    More participants using the inhaled insulin regimen experienced significant improvements in...

What is a quick and easy way to calculate the NNT

What is the different between Absolute and Relative risk reduction

https://heart.bmj.com/content/108/12/964 https://www.ahajournals.org/doi/10.1161/JAHA.116.003815 We have a study that says leads to increase all cause death with calcium supplements We have a study that says calcium supplement leads to increase in coronary artery calcium   Foods that are high in calcium besides dairy include things like kale, spinach, broccoli, chia sees, collard greens… Hard for...

https://evidence.nejm.org/doi/full/10.1056/EVIDoa2300311 Peanut consumption, starting in infancy and continuing to age 5 years, provided lasting tolerance to peanut into adolescence irrespective of subsequent peanut consumption, demonstrating that long-term prevention and tolerance can be achieved in food allergy. (Funded by the National Institute of Allergy and Infectious Diseases and others; ITN...

https://jamanetwork.com/journals/jama/article-abstract/2819352 Conclusions and Relevance   In this study, 10 years after diagnosis, 49% of men remained free of progression or treatment, less than 2% developed metastatic disease, and less than 1% died of their disease. Later progression and treatment during surveillance were not associated with worse outcomes. These results demonstrate active surve...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11179824/ This study did something smart in that they broke it down by white black Chinese and then also had 36 lab test they were looking at and they then found look for a black male this one particular blood test apo2 or whatever had better predictive value but that is cherry picking data with lots of data points and we don’t have risk calculators jus...

https://www.nejm.org/doi/full/10.1056/NEJMoa2309002 In this placebo-controlled trial, postexposure prophylaxis with nirmatrelvir–ritonavir for 5 or 10 days did not significantly reduce the risk of symptomatic SARS-CoV-2 infection. https://www.nejm.org/doi/full/10.1056/NEJMoa2309003 https://www.nejm.org/doi/full/10.1056/NEJMoa2118542 Pfizer has some serious problems! #pfizer

Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide this paper out in JAMA makes you think this is an issue but likely just too much noise with only 17 patietns and didnt control for confounders https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2820255

Be careful, most observational data have a large amount of confounders not accounted for and even when accounted for you can never account for all the confounders

https://www.ahajournals.org/doi/10.1161/CIR.0000000000001251.  Diagnosis: To establish a PAD diagnosis, the resting ankle–brachial index (ABI) remains the initial test of choice in patients with suggestive history or exam findings. The ABI result should be reported as normal (1–1.4), borderline (0.91–0.99), abnormal (≤0.9) or noncompressible (>1.4).   TREATMET Low-dose rivaroxaban 2.5mg BID, in...

https://jamanetwork.com/journals/jama/article-abstract/2818624 Conclusion-- “Cardiovascular biomarkers were strongly associated with fatal and nonfatal cardiovascular events and mortality. The addition of biomarkers to established risk factors led to only a small improvement in risk prediction metrics for atherosclerotic cardiovascular disease, but was more favorable for heart failure and mortalit...

What are c statistics C-statistic gives the probability a randomly selected patient who experienced an event (e.g. a disease or condition) had a higher risk score than a patient who had not experienced the event. Obviously there are people with low scores that still have events and people with high scores that never have events but the goal is the decision score gives us an idea of who is most lik...

https://pubmed.ncbi.nlm.nih.gov/38598573/ In fully vaccinated adults with a risk factor or unvaccinated patients without a risk factor who have symptomatic COVID-19, does paxlovid--nirmatrelvir-ritonavir reduce the duration of symptoms or the likelihood of hospitalization?       Nirmatrelvir-ritonavir (Paxlovid) was shown in its initial randomized trial to reduce hospitalization and death in unvac...

https://www.nejm.org/doi/10.1056/NEJMoa2314063 Randomized trials have shown the benefit of endovascular thrombectomy in patients with acute stroke due to large-artery occlusion in the anterior circulation and a large baseline infarct (core) In these trials, 1-5 a large core was defined by an ASPECTS value of 5 or less, but because of concerns about the deleterious effects associated with the reper...

https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.124.047438 We studied the risk of IS and ICH in women using LG-IUDs—aka mirana-- compared to women not using hormonal contraceptives.     The commonly used combined hormonal contraceptives with progestins and ethinylestradiol are associated with an increased risk of ischemic stroke (IS).      In this Danish historical cohort study (2004-2021)...

  A noninferiority trial is a type of randomized trial that aims to establish if treatmenet X effectiveness is not substantially less than the existing standard . Unlike superiority trials that are designed to show that one treatment is better than another, a non-inferiority trial is designed to show that a new treatment is ‘not unacceptably worse’ than the current standard therapy . You want to s...

https://shmpublications.onlinelibrary.wiley.com/doi/abs/10.1002/jhm.13350 Xu J et al. Hospital-associated venous thromboembolism prophylaxis use by risk assessment at a large integrated health care network in Northern California. J Hosp Med 2024 Jun; 19:449.   Authors took 850,000 adult nonsurgical, non–intensive care unit (ICU) hospitalizations at 21 Kaiser Permanente hospitals in northern Califo...

https://www.bmj.com/content/385/bmj-2024-079329 Overprescription of antibiotics by primary care clinicians is a major modifiable driver of antibiotic resistance. Evidence suggests that peer-comparison feedback can reduce antibiotic overprescription, but the optimal content and delivery of such feedback is unclear       Researchers randomized 5000 family physicians in Ontario, Canada, to receive ei...

Kityo C et al. Switch to long-acting cabotegravir and rilpivirine in virologically suppressed adults with HIV in Africa (CARES): Week 48 results from a randomised, multicentre, open-label, non-inferiority trial. Lancet Infect Dis 2024 May 28; [e-pub]. ( https://doi.org/10.1016/S1473-3099(24)00289-5 )307

95% CI does NOT mean there is a 95% chance the true value is in the interval. It means that if you continually resample, 95% of your confidence intervals (which will vary every time you resample), will contain the true or real value of the intervention. 

https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgae290/7685305?login=true Children aged 1-18 years to prevent rickets and to potentially lower the risk for respiratory tract infections Pregnant people to lower the risk for maternal and fetal or neonatal complicatio Adults older than 75 years to lower the risk for mortality Adults with prediabetes to lower the risk for type 2 diab...

  What is the power of a study—what is the power calculation?   Often say it is the number of people in a study. Power is the probably to correctly reject the null hypothesis. Said differently power is the probability we will correctly get a small pvalue   But a power calculation is slightly more than that it is the number of people required to adequetyly statistically calculate the number of peop...