Questioning Medicine

primary outcome was Duration of the first stage of labor was the primary outcome.   AND It was 179 minutes shorter (95% CI 146 - 213) in the intervention group than in the control group (392 minutes; standard deviation [SD] 122 vs 571 minutes; SD 188).  Intensity of pain, was reported on a visual analog scale of 0 to 10 at several points in time, was on average 2.0 to 2.7 points lower in the inter...

In older adults, mildly elevated TSH levels normalized in about 50% of cases during 1 to 2 years of observation. https://academic.oup.com/jcem/article/109/3/e1167/7325863?login=true

A study that was done before the widespread use of troponin only measurements for ACS (and certainly before high sensitively trop  EVER EXISTED), a trial that took place before the first statin was even FDA approved,  a trial that had no idea what DAPT was and took place PRIOR to the publication of the trial that would ultimately make aspirin post MI a standard of care, a trial that existed before...

This translates into an absolute excess risk of ≈9 events per 1000 person-years or 1 per 110 person years. Sad differently if you treat 110 people for 1 year with a doac and an SSRI you will have one more bleed that requires hospitalization or death than if there was no SSRI. This  Risk was similar for various types of bleeding (e.g., intracranial, gastrointestinal) and did not vary with potency o...

During follow-up participants walked on average 8300 steps and those individuals in the lowest genetic risk score developed obesity defined as a BMI greater than 30 approximately 13% of the time while those individuals in the highest genetic risk or developed obesity 43% of the time.    participants at the 75th percentile of PRS risk needed to walk 2280 more steps daily than participants at the 50...

And in the end it did not really matter because at 3 months individuals only reported a 0.16 difference in pain and a 1.6 difference in function which both were well within the noninferiority boundary.  In case you are wondering there is no difference in adverse events. bottom line For the outcomes of pain and function Telerehabilitation with a physiotherapist is non-inferior to in-person rehabili...

At 1 year 50% of those individuals who had bariatric surgery were able to achieve diabetic remission but after 12 years the very same individuals that received bariatric surgery had just a 13% success rate in the remission of diabetes. Bariatric surgery certainly has an improvement in hemoglobin A1c and diabetic remission that is most evident in the first year but remains after 12 years of follow-...

The company that developed Cologuard also developed this “next generation” multitarget stool DNA test, and has applied for U.S. FDA approval . The new test appears to have similar sensitivity and higher specificity than its predecessor — which means fewer false positives.  Positive predictive value (the proportion of positive tests that were true positives for cancer or advanced neoplasia) was 11%...

730 Patients were randomized to receive daily oral aprocitentan or placebo, plus a fixed-dose combination of amlodipine, valsartan, and hydrochlorothiazide. After 4 weeks, mean change in office systolic BP was 15 mm Hg with aprocitentan and 11 mm Hg with placebo; this 4 mm difference was statistically significant. What is the cost? What is the long term effects? Why didn't they compare this to the...

The trial was terminated after  1015 patients with atrial cardiopathy had been randomized to receive either apixaban or aspirin for a mean follow-up of 1.8 years, recurrent stroke rates were identical  (40 events per group; 4.4% annualized rate). There were 7 symptomatic intracranial hemorrhages in the aspirin group and none in the apixaban group, though other major hemorrhages occurred at similar...

 TJA should not be delayed for trials of physical therapy, anti-inflammatory drug use, bracing, intra-articular steroid injections, or hyaluronic acid injections. For patients with obesity, proceed to TJA without delay, regardless of BMI. For patients with poorly controlled diabetes, recommend delaying TJA to improve glycemic control, but don't define poor control or specific HbA1c requirements. F...

randomized trial comparingbeta-blocker therapy (metoprolol or bisoprolol) with no beta-blocker in 5020 patients who had a normal left-ventricular ejection fraction (LVEF) after AMI  median follow-up of 3.5 years, the primary composite endpoint — all-cause death or recurrent AMI — did not differ significantly between participants randomized to a beta-blocker versus no beta-blocker (7.9% vs. 8.3%, r...

During a mean 11 years of follow-up, current smokers' risks for cardiovascular-, cancer-, and respiratory-related deaths were 2, 3, and 13 times higher, respectively, than never smokers' risks. Former smokers who had quit <10 years before enrollment avoided roughly 50% to 60% of these excess risks. By 30 years after quitting, excess mortality was virtually eliminated. https://jamanetwork.com/jo...

The primary cardiovascular end point was a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke in a time-to-first-event analysis. Improvement in nonfatal stroke was not statistically significant death from cardiovascular causes was no significant but hold on it does appear nonfatal MI was significant and is what really drove the entire composite outcom...

Bottom line (ZTLido 1.8%) is a brand name lidocaine patch currently approced for postherpetic neuralgia and will stay that why for now as it did not beat placebo for the treatment of patients with chronic nonspecific neck pain For both pain scores the pain decreased by 1.0 point with lidocaine and by 0.5 points with placebo. These differences were neither statistically significant nor deemed to be...

 patients who have new-onset transient AF detected during a hospitalization for noncardiac surgery or medical illness and are discharged in sinus rhythm, approximately 1 in 3 have AF detected in the year after hospital discharge. Those that did not have afib only had a 5% risk (1 in 20) -- we dont know what this means for rates of patient oriented outcomes https://www.acpjournals.org/doi/10.7326/M...

Bottom line   Omalizumab does seem to improve allergic reactions to peanuts but comes at a steep price tag. Likely only allergist will prescribe this drug but it is worth know about If you know or take care of anyone with severe peanut allergy. After 16 weeks, 67% of patients who took omalizumab could tolerate a 600-mg peanut protein challenge (≈2 peanuts) versus 7% of controls. Variability among...

At ~24 weeks, ~80-90% of females report improvement in their acne with COCs, compared to 50-80% placebo, and 30-50% will have clear-almost clear skin versus 10-40% on placebo. Efficacy appears similar between individual COCs. Limitations: Most COC RCTs unblinded, many COC RCTs prohibited concurrent topical agents, no RCTS comparing COCs to topical agents, many industry-funded. https://cfpclearn.ca...

QM on Spring Break-- but do you like the new format? Andrewbuelt@gmail.com

Diabetic patient- Empagliflozin prevents death from cardiovascular causes: NNT 46 per 3.1 yrs ($600 a month, 1 million dollars per life saved) -HFpEF- SGLT2 inhibitors do not prevent death and cost roughly $364,000 to prevent one hospitalization -HFrEF -Using Cox models, only Dapagliflozin has mortality benefit (NNT 53) and comes at a cost of $229,914 prevent one cardiovascular death. (117,126$$$...

These findings indicate that initiation of empagliflozin in patients hospitalized for acute heart failure is well tolerated and results in significant clinical benefit in the 90 days after starting treatment. They combined HFpEF and HFrEF They used win ratios Individual trials didn’t show mortality benefit but now there is? https://pubmed.ncbi.nlm.nih.gov/35228754/

Primary Outcome: Composite of deaths from cardiovascular causes or hospitalizations and urgent visits for heart failure Death was not improved! NNT of 5 for hospitalizations and urgent visits -- However, results are not reported separately for hospitalizations and urgent visits, which are not equal events  https://www.nejm.org/doi/full/10.1056/NEJMoa2030183

NNT of 20 to prevent 1 hospitalization at 16 months of follow up They composite outcome was driven by decrease hospitalizations NOT death https://www.nejm.org/doi/full/10.1056/NEJMoa2022190

NNT of 21 over 18 months to prevent a composite of worsening heart failure or cardiovascular death NNT for hospitalization = 27 NNT for Cardiovascular Death = 53 N Engl J Med 2019; 381:1995-2008

Dapagliflozin and HFpEF did happen to improve the composite outcome but this was based mainly on hospitalizations not on death and comes at a big price tag with the NNT around 36 at 2.3yrs.  N Engl J Med 2022; 387:1089-1098