Questioning Medicine

Doxy 100mg BID x7days for chlamydia- and consider treating the partner unless you live in West Virginia.  https://www.cdc.gov/std/treatment-guidelines/chlamydia.htm

Overall incidence of zoster (defined as the presence of the specific diagnostic code in the medical record, accompanied by a prescription for acyclovir) was lower among vaccine recipients, with vaccine protective efficacy estimated to be 64% after a single dose and 76% after two doses. Zerbo O et al. Effectiveness of recombinant zoster vaccine against herpes zoster in a real-world setting. Ann Int...

Compared with complication rates in the National Lung Screening Trial, this real-world study had approximately twice the rate of procedural complications (31% vs. 18%) and major complications (i.e., acute respiratory failure, lung collapse or cardiac arrest; 21% vs. 9%). Rendle KA et al. Rates of downstream procedures and complications associated with lung cancer screening in routine clinical prac...

Ask about and stop aspirin in patients taking it for primary prevention Li DK et al. Trends in upper gastrointestinal bleeding in patients on primary prevention aspirin: A nationwide emergency department sample analysis, 2016–2020. Am J Med 2023 Dec; 136:1179. ( https://doi.org/10.1016/j.amjmed.2023.08.010 )

At 25yrs the odds of still having your appendix if you were initially managed nonoperatively was 60%. https://jamanetwork.com/journals/jamasurgery/article-abstract/2808133

Although an observational trial, it appears lactated ringers is better than normal saline for those individuals with acute pancreatitis to prevent organ failure or local complications.  https://journals.lww.com/ajg/fulltext/2023/12000/lactated_ringers_use_in_the_first_24_hours_of.29.aspx

2300 steps daily was needed to decrease cardiovascular-related mortality. 4000 steps daily decreased all-cause mortality. Each additional step seem to lower mortality risk.  https://pubmed.ncbi.nlm.nih.gov/37555441/#:~:text=Conclusion%3A%20This%20meta%2Danalysis%20demonstrates,2337%20steps%20for%20CV%20mortality.

Consider ablation in patients who have an EF < 35% and atrial fibrillation the NNT for all cause mortality was 7 at 18 months  https://www.nejm.org/doi/full/10.1056/NEJMoa2306037

Sleep restriction therapy led by nurses with only 4 hours of education significantly improved patients insomnia at 6 months. More info HERE ___> https://thrive.kaiserpermanente.org/care-near-you/northern-california/sanjose/wp-content/uploads/sites/7/2015/10/sleep-restriction-rev2_tcm28-557887.pdf https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00683-9/fulltext#:~:text=Results...

Kansas City Cardiomyopathy Questionnaire clinical summary score was improved by 7.8 in those individuals with HFpEF that took semaglutide for one year compared to those that took placebo. This is a small difference on a validated score and would cost 16-20K per year. more research is needed.  https://www.nejm.org/doi/full/10.1056/NEJMoa2306963

When taking Ferrous Fumarate a little bit of vitamin C or an 8 ounce glass of orange juice with an otherwise empty stomach will improve the absorption- this absorption is decreased with food and coffee.   https://onlinelibrary.wiley.com/doi/10.1002/ajh.26987

https://www.nejm.org/doi/full/10.1056/NEJMoa2307563 Semaglutide and CAD but no diabetes decreases events NNT of 66 at 40 months but a predicted price tag of 3.5 million dollars.

Olanzapine 2.5mg for weight gain with advance cancer NNT of 50 for >5% weight gain https://pubmed.ncbi.nlm.nih.gov/36977285/

ACC/AHA just came out with new guidelines on AFIB if you need some light reading material! (big take home rhythm not rate, and not equal, read below for more information)   A HUGE piece of new is that now ablation is the cool kid on the block!! More recent information has shown that ablation for AF is more effective than antiarrhythmic drugs for both persistent and paroxysmal AF and that earlier i...

Effectiveness and Safety of Enteric-Coated vs Uncoated Aspirin in Patients With Cardiovascular Disease: A Secondary Analysis of the ADAPTABLE Randomized Clinical Trial | Clinical Pharmacy and Pharmacology | JAMA Cardiology | JAMA Network Enteric coating of aspirin delays the breakdown of the tablet until it is in the higher pH of the duodenum and has been shown to reduce gastric erosion 5 but has...

214. NEW FORMAT-- What is the best drunk for alcohol use disorder? https://jamanetwork.com/journals/jama/article-abstract/2811435

systolic

CME for the cost of free fifty free

 ( https://www.healthquality.va.gov/guidelines/MH/mdd/VADoDMDDCPGFinal508.pdf ) clearly state there is insufficient evidence to support this activity and testing. This is mainly because of low quality evidence and concern of bias given commercially funded studies.   ( https://www.aafp.org/pubs/afp/issues/2023/0100/poems-pharmacogenic-testing-antidepressants.html ) American Psychiatric Association...

I give CME and you listen for free. You can't collect the CME but YOU CAN be a little smarter. These are some must know articles you need to know if you are a hospitalist. 

What about oral??   Lewis GD et al. Effect of oral iron repletion on exercise capacity in patients with heart failure with reduced ejection fraction and iron deficiency: The IRONOUT HF randomized clinical trial. JAMA 2017 May 16; 317:1958. ( http://dx.doi.org/10.1001/jama.2017.5427. opens in new tab )   randomized, 225 patients with symptomatic systolic HF for 16-weeks to either  oral iron polysac...

Lindholt JS, Søgaard R, Rasmussen LM, et al. Five-year outcomes of the Danish cardiovascular screening (DANCAVAS) trial. N Engl J Med 2022;387(15):1385-1394.     Study design: Randomized controlled trial (nonblinded) Looking to see if intensive screening protocol for cardiovascular disease reduce cardiovascular events or mortality in older men? Danish study, 46,611 men aged 65 to 74 years were ran...

Efficacy and Safety of Intensive Versus Nonintensive Supplemental Insulin With a Basal-Bolus Insulin Regimen in Hospitalized Patients With Type 2 Diabetes: A Randomized Clinical Study | Diabetes Care | American Diabetes Association (diabetesjournals.org)      randomized noninferiority study from Emory University, 224 hospitalized patients with longstanding type 2 diabetes   Both groups received ba...

YES!! Marketing!! No man wants to admit his gonads dont work so they would never say I have hypogonadism. Most men would never say I have andropause cause that is too close to menopause but if you call it low testosterone then all of a sudden men come out of the wood work like cave men to get some of this magical drug they have heard so much about. YES LIKE LOW T WILL KILL YOU!!!! "could kill you"...

coffee saves your life-- maybe, careful for confounders  heart failure hospital admission is really hard to prevent moderate dose statin is most important..but ezetmibe and moderate dose is equal to high dose statin I think we should take out all kidney stones and the evidence says there will be lest hospitalizations if we do that EHR can help us and remind us to check and PTH robotic surgery is n...