Questioning Medicine

Question   What is the strength of association between surrogate markers used as primary end points in clinical trials to support Food and Drug Administration (FDA) approval of drugs treating nononcologic chronic diseases and clinical outcomes?       often surrogate markers are used as primary end points in clinical trials to support FDA approval of drugs   I get it    Surrogate markers offer the...

The incidence of new-onset diabetes was basically the same but statistically significantly higher for those individuals on low-to-moderate–intensity statins compared with placebo 1.2 vs 1.3% annually which is a very small difference.   But with  high-intensity statins compared with placebo (4.8% vs. 3.5% annually)   Among patients with known diabetes at baseline, glycemia worsened slightly with st...

At change in c stats of 0.007 or 0.0009 is not a meaningful change so I cant say we should use this over the PCE—yes this new calculator has the benefit of removal of race, and the use race-based algorithms.   We don’t know that this leads to better outcomes—is the the race algorithms that lead to worse outcomes or was it access to care or is it some other factor we don’t know yet.   I think this...

The problems with observation data is real—    randomized trial, U.K. researchers identified 519 patients (mean age, 68) with mostly moderate COPD (mean forced expiratory volume in 1 second [FEV1], 50%), ≥2 exacerbations during the previous year, and no cardiovascular (CV) indications for β-blockers.    Patients were randomized to receive the cardioselective β-blocker bisoprolol (initially 1.25 mg...

When you want to do an RCT but you realize there might be some cross contamination so instead of randomizing individuals you randomize cluters or groups   Lets say you want to do fluids--- what is better LR or NS instead of doing individuals and room you just put whole hospitals in either LR or NS   Or you want to test if mask work for some virus—you would say this city gets all the mask in the wo...

1° outcome: hemostatic efficacy = which was defined as; (A) Hematoma expansion ≤ 35% at 12h (B) increase in NIHSS ≤ 7 at 12h (C) No rescue therapy 3-12h         Results hemostatic efficacy: 76.7% andexanet vs 64.6% usual care     30 day mortality: no difference 30 day Modified Rankin Score ≤3: no difference Thrombotic events: almost x2 with andexanet 10.3% vs 5.6% - statistically significant. Most...

In patients with atrial fibrillation (AF), how do CHA2DS2-VASc 1 subgroups compare with one another        64 141 patients with a first AF diagnosis    Patients were categorized as CHA2DS2-VASc 1 if they had any 1 of age 65 to 74 years, congestive heart failure (HF), hypertension, diabetes, or vascular disease    found no large differences in ischemic stroke, transient cerebral ischemia, or system...

Bottom line   Do I think if you stop drinking alcohol in the next thirty days you are less likely to come to the hospital for a heart attack? A stroke? Pneumonia? copd exacerbations or CHF exacerbations?? The answer is no!! not in thirty days.. sure if you drag that out for months or years then yes you are at greater risk but for only 30 days of follow up realistically should be no difference in c...

In a retrospective cohort study of Veterans Affairs (VA) nursing home residents during 2006 to 2019, researchers identified 13,000 residents who initiated a first or additional antihypertensive medication and 52,000 propensity score–matched controls (mean age, 78). The primary outcome was a composite of pelvic fracture, surgically treated hip fracture, and fractures of the humerus, radius, and uln...

SGLT-2 inhibitors have not been evaluated in patients with stage 5 CKD (CKD 5; eGFR, ≤15 mL/minute/1.73 m2). Investigators in Taiwan retrospectively assessed 5 years of outcome data for nearly 48,000 patients with type 2 diabetes and CKD 5 — half of patients had newly initiated SGLT-2 inhibitors, and half were not taking these drugs. compared with no SGLT2i use, SGLT2i use was associated with lowe...

glucagon-like peptide-1 (GLP-1) receptor agonists can delay gastric emptying, the American Society of Anesthesiologists (ASA) say For patients on daily dosing consider holding GLP-1 agonists on the day of the procedure/surgery. For patients on weekly dosing consider holding GLP-1 agonists a week prior to the procedure/surgery.    Now, the American Gastroenterological Association (AGA) has publishe...

But now we have RCT data— 278 adults with moderate CAP who were hospitalized (but not in intensive care) to receive either a β-lactam antimicrobial plus clarithromycin or a β-lactam alone. (all patients met sepsis or severe sepsis criteria)   composite primary endpoint of improved respiratory symptoms and improved SOFA score by day 4 occurred in significantly more patients in the dual-antibiotic g...

AI technology was highly accurate at identifying malignancies and tumor origins — as accurate as senior pathologists, and significantly more accurate than junior pathologists.      Patients with cancer of unknown primary site who received treatment concordant with tumor origins predicted by AI had significantly longer overall survival than those whose treatment was discordant with AI predictions (...

HERE IS WHEN IT IS RECOMMENDED TO USE ALBUMIN In patients with cirrhosis and spontaneous bacterial peritonitis, to substantially limit kidney impairment and mortality (low-certainty evidence) THIS IS THE ONLY THING YOU HAVE TO REMEMBER FORGET THE REST! In patients with cirrhosis and ascites who undergo large volume paracentesis (LVP; >5 L) to significantly lower the incidence of paracentesis-in...

The results for weight loss was    Tirzepatide also known as mounjaro – 8.5 kg    Semaglutide also known as Ozempic -3.1 kg lost   Liraglutide aka Victoza – 1.3 kg lost Tirzepatide also known as mounjaro – 8.5 kg  But almost all of these weight loss drugs seem to lose the effect over time and as you increase the dose and increase the weight loss you can expect to increase the GI side effects   htt...

41 adults (mean age, 59) with obesity (mean weight, 99 kg) and prediabetes or diet-controlled diabetes – everyone got the same diet. Same  micro- and macronutrient composition; same calorie amounts   Food was prepared in a study kitchen and consumed onsite or taken home. Key difference The intervention group was instructed to eat between 8 a.m. and 6 p.m. and to consume 80% of calories by 1 p.m. T...

recipients were more likely than placebo recipients to report much or very much improvement (55% vs. 25%) which isn’t shocking because half of the people were not getting medicine they also report that the medication arm had improvement on CT imaging of the sinuses which also seems like another Duh moment as I am sure it was better than nothing   my concern is this new drug or deliver of the drug...

https://onlinelibrary.wiley.com/doi/10.1111/joim.13757 ECG abnormalities were present in 40% of hypokalemic patients and included t-wave flattening/inversion, ST-segment depression, QTc prolongation, longer QRS duration, and high heart rate.       after adjustment for potential confounders, only heart rate >100 beats per minute and not the ECG abnormalities was associated with those adverse out...

https://www.acpjournals.org/doi/10.7326/M23-3225 researchers randomized 160 patients with mostly unilateral hip OA to two 60-minute sessions weekly for 12 weeks, you were randomized to receive either neuromuscular exercise (NEMEX; focusing on postural and functional stability) or progressive resistance training (PRT; focusing on muscle strength).    primary outcome was the “ chair stand test ,” in...

adult smokers who are given e-cigarettes are significantly more likely to be abstinent at 6 months from a target quit date with a  (NNT = 8) but those individuals were not more likely to be abstinent from any nicotine product. In this study, the cost of e-cigarettes was paid by the study, so in the real world where patients have to buy their own e-cigarettes the results may be less favorable. The...

However, screening is not recommended because it has not been shown to improve patient outcomes..  Lifestyle recommendations include moderating alcohol use, quitting smoking, exercising, and losing weight if obese. Good news: Coffee need not be restricted. The authors recommend using a risk score such as CHADS2-VASC to determine the patient’s risk of stroke; if the annual risk of stroke is between...

https://journals.lww.com/ajg/fulltext/2024/03000/american_college_of_gastroenterology_guidelines_.14.aspx 2 of the 3 following criteria: (i) abdominal pain consistent with the disease, (ii) serum amylase and/or lipase greater than 3 times the upper limit of normal, and/or (iii) characteristic findings from abdominal imaging  Fluid-- Moderately aggressive fluid resuscitation with lactated Ringer's...

Bottom line- Elevated cholesterol as a child into an adult is bad but we still don’t know if treating children with medication improves this badness but we can say if you have elevated cholesterol as a child and it resolves as an adult then that is a good sign and puts you at equal risk to someone who never had dyslipidemia https://jamanetwork.com/journals/jama/article-abstract/2817700

Weight gain <5 kg was not associated with risk for the composite outcome among women with class 1 and 2 obesity (BMIs, ≥30–39.9 kg/m2). Weight gain <5 kg and weight loss were associated with lower risk for the composite outcome , compared with recommended weight gain, in women with class 3 obesity (BMIs, ≥40 kg/m2; rate ratio, 0.81) As the authors suggest—my take away bottom line These findi...

Chair placement was not associated with a difference in patients’ ability to name their physician (P=1.0), ability to successfully identify their reason for hospital admission (P=0.82), or perceptions of time (P=0.2) (see supplemental table 5).     Overall if you put a chair at bedside and have medstudents following then yes a provider is more likely to sit down. However- this only minimally chang...