Questioning Medicine

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31942-1/fulltext If you are over 70 or 75 and primary prevention then likely no benefit in statins and secondary benefit is very small https://www.nejm.org/doi/full/10.1056/NEJMoa1806802 Get the glucose down! After you max out other risk factors as intensive control doesn't have a legacy effect https://www.nejm.org/doi/full/10.1056/NEJMoa1809944 vit d doesnt beat placebo for anything- ever. Except for the vit d lab number https://www.fda.gov/news-events/press-announcements/fda-approves-new-treatment-hypoactive-sexual-desire-disorder-premenopausal-women Vyleesi (bremelanotide) will make you have more sexual desire on a sexual desire scale but not more sex-

https://www.ahajournals.org/doi/10.1161/JAHA.118.011318 energy drinks prolong the QT just ever so slightly in healthy 22yr olds so if you are thinking of telling grandma to slam 32ounces of energy drink and she is on QT prolonging medication then you probably shouldnt https://www.nejm.org/doi/full/10.1056/NEJMoa1808082 zolendranae is not a magic drug that cures osteopenia they just have magic trial makers the rigged the trial to show benefit https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2734709 in a study that looked at 7 days of step for 70 plus year old women it seemed that over 2000 seem to have a cardiac benefit and the benefit significantly leveled off around 4000 steps https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2734798 if going to the dentist and you have a fake heart or fake heart valve or previous endocarditis then you need antibiotics else you dont https://jamanetwork.com/journals/jama/fullarticle/2717474 give a ppi with anticoag to prevent GI bleed

vitamin d- if you cant give up on it then give up on checking the lab value- fire and forget. https://www.nejm.org/doi/full/10.1056/NEJMoa1800566 induction at 39 weeks is okay with me https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2698631 cardio test and all test have varibilityhttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31131-0/fulltext our evaluation of you prior to surgery is basically worthless based on current evaluation or stress test https://annals.org/aim/article-abstract/2708163/kidney-damage-biomarkers-incident-chronic-kidney-disease-during-blood-pressure kidney disease from lower bp doesnt seem to be actual damage just hemodynaic effect https://www.ncbi.nlm.nih.gov/pubmed/30688979 lower that bp and doesnt seem to have an effect on dement and might even be protective https://www.gastrojournal.org/article/S0016-5085(18)35193-X/fulltext pt going for elective colonoscopy- keep the clopidogril

afib- new guidelines! https://www.google.com/search?q=2019+American+Heart+Association%2C+American+College+of+Cardiology+and+the+American+Rhythm+Society+focused+update+from+their+2014+guidelines+for+the+management+of+patients+with+atrial+fibrillation&rlz=1C1CHFX_enUS708US708&oq=2019+American+Heart+Association%2C+American+College+of+Cardiology+and+the+American+Rhythm+Society+focused+update+from+their+2014+guidelines+for+the+management+of+patients+with+atrial+fibrillation&aqs=chrome..69i57.1079j0j7&sourceid=chrome&ie=UTF-8 FIT test has high sensitivity and specificity for crc and it gets more people to do colon cancer screening and lets be honest it is only a good test or a good drug if people actually do it https://www.ncbi.nlm.nih.gov/pubmed/30802902 afib can wait to be converted and over 50% of the time will convert on its ownhttps://www.nejm.org/doi/full/10.1056/NEJMoa1900353 good news for you lazy people listening to this on the couch you can still inprove your all cause mortality

https://www.bmj.com/content/364/bmj.l42 skip breakfast- it doesn't help you 'lose weight' https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2723074 Automated BP cuffs are the new rage and for good reason they are about equal to awake ambulatory blood pressure https://www.ncbi.nlm.nih.gov/pubmed/30653040 if you have a pt. going to surgery for their knee because of osteoarthritis-- let it be and DONT do an injection. https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(18)30191-1/fulltext if you have a choice-- give apixaban https://jamanetwork.com/journals/jama/article-abstract/2719307 you can not pay physicians for readmission but then they will try and game the system and in the pt. misses out and dies more often-- oops https://jamanetwork.com/journals/jama/article-abstract/2727448 tramadol increase mortality! WOW shocker-- maybe this isn't real but it is really is worthing making us stop to think.

shared decision making for lung cancer rarely happens in the community and when it does happen 2/5 said no thanks to cancer screeninghttps://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2720126 vit d. - does not work on a bus it doesn't work with white women or black women anyonehttps://www.ncbi.nlm.nih.gov/pubmed/29905969 achilles tendon rupture- if you go to surgery NNT for rerupture of 1 and 66 but risk of infection 1/33https://www.bmj.com/content/364/bmj.k5120 Topical pain creams dont work for chronic pain- BUT low risk of side effects and still getting almost 2 point decrease on 10 point scale-- I will take it!https://annals.org/aim/article-abstract/2724041/compounded-topical-pain-creams-treat-localized-chronic-pain-randomized-controlled Alirocumab is still way too expensivehttps://www.ncbi.nlm.nih.gov/pubmed/30597485 concussion in an athlete-- get them to the sub-symptom heart rate https://jamanetwork.com/journals/jamapediatrics/article-abstract/2723523

https://www.emrap.org/episode/rightonprime/introduction RIGHT ON PRIME IF YOU NEED CME 10% likely isn't high risk but it certainly deserves more than 0.6% of people on statins so don't forget your statinshttps://annals.org/aim/article-abstract/2725144/characteristics-high-cardiovascular-risk-1-7-million-chinese-adults Oxycodone "the best high of all" https://link.springer.com/article/10.1007/s11916-019-0751-7 Smart phones are actually being smarthttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32993-3/fulltext You lose weight and want to keep it off you better keep movinghttps://onlinelibrary.wiley.com/doi/full/10.1002/oby.22373 Dont be that guy that gives 1.2million extra days of antibioticshttps://www.bmj.com/content/364/bmj.l440

https://www.emrap.org/episode/rightonprime/introduction RIGHT ON PRIME IF YOU NEED CME https://www.bmj.com/content/364/bmj.l240 hpv is still bosshttps://jamanetwork.com/journals/jamanetworkopen/fullarticle/2724778 push up to push good healthhttps://www.bmj.com/content/364/bmj.k4681 prepping for HIV education https://www.ncbi.nlm.nih.gov/pubmed/27149090?dopt=Abstract very effective if used Still effective in san fran https://www.ncbi.nlm.nih.gov/pubmed/26334052?dopt=Abstracthttps://www.ncbi.nlm.nih.gov/pubmed/30596290 the made up time that are expiration dates https://www.nejm.org/doi/full/10.1056/NEJMoa1808779 ecigs are great but meds are better when you look at the med trials as wellhttps://www.ncbi.nlm.nih.gov/pubmed/12171809 https://www.ncbi.nlm.nih.gov/pubmed/10053177

https://www.emrap.org/rop?episode-guide-publish-date=%5B568011600000%2C1552613520000%5Dhttps://www.nejm.org/doi/full/10.1056/NEJMoa1809983?query=featured_home parkinsons and symptoms- start levadopahttps://www.nejm.org/doi/full/10.1056/NEJMoa1812851 BNP is a terrible biomarker and I hate when studies look at worthless outcomeshttps://www.gastrojournal.org/article/S0016-5085(19)30103-9/pdf warfarin doesnt change the PPV of a FIT test but -- I'd still use a DOAC, regardlesshttps://bmjopen.bmj.com/content/9/1/e023637 accupunture works for menopause if you have a bad trial but not if you have a good trial or a cochrane review https://www.ncbi.nlm.nih.gov/pubmed/26784863https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007410.pub2/full

https://annals.org/aim/article-abstract/2719218/long-term-outcomes-among-patients-discharged-from-hospital-moderate-anemia#an_fo_ho Anemia is not being fixed 6months after hospitalization but that is okay because they are not going back to the hospital or dyinghttps://jamanetwork.com/journals/jama/fullarticle/2679928 Have the shared decision making conversation with your pt about mammograms! https://www.youtube.com/watch?v=UZlY6Q4m-MM MAMMOGRAM THEATERhttps://www.nejm.org/doi/full/10.1056/NEJMoa1710926 Oral antibiotics for osteo instead of IV-- yep it looks like times are a changing!https://jamanetwork.com/journals/jama/article-abstract/2721178Aspirin time of death 2/23/2019!

https://www.bmj.com/content/363/bmj.k4823 self swabs workhttps://onlinelibrary.wiley.com/doi/full/10.1002/oby.22345 intermittent fastinghttps://jamanetwork.com/journals/jama/article-abstract/2718066 Vit D for ESRDhttp://pediatrics.aappublications.org/content/143/2/e20181902 HPV vaccine works for herd immunitiyhttp://care.diabetesjournals.org/content/early/2019/01/03/dc18-1773 cardiovascular events by glucose level

My view of some of the top articles and medical headlines from 2018.

Mechanical thrombectomy, FDA and concussion. HPV vaccine and more on this episodes covering top articles from 2018.

1 of many in which I break down what I think are articles or titles of 2018 you need to know about (hint: my have been discussed on QM before)

This is a heated debate but the numbers tell the whole story. So let's dig into the numbers a little more and find the real benefit of the screening mammogram. 

It is time to tackle screening mammograms. I warn you, this is evidence, try not to listen with emotion. 

Heading to FMX and the bags are packed!! Here is a little something to hold you down till I return! If you are going to be there then tweet me @andrewbuelt

Another hard hitting Questioning Medicine packed with all sorts of articles and gems. Times are changing for those that have to sit in a chair 3 days a week and it is coming from those with hep. C

Two big articles in this episode that have already changed my practice and I tell you how. Plus, a bunch of other articles I think people should be talking about! What is the real risk for statins? Which DOAC can you use with ESRD? So many questions and so many answers!

Another episode with lots of articles- What is the UVB protection on SPF. Atrial fib screening, should we do it? What IUD makes you not gain weight? One article on Fake news on babies sleeping and a new guideline rec. on prostate screening for which I break down all the numbers.