Questioning Medicine

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...

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...