Questioning Medicine

Use the PE Severity Index. If low risk and that is the only reason for admission, then the patient is safe for dischargehttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60824-6/abstracthttps://www.acpjournals.org/doi/10.7326/M23-2442

american college of physicians says- No need to start colon cancer screening prior to 50. stop at age 75 or with 10 yrs of life left and FIT testing can be every other year and Cologuard is not recommended. https://www.acponline.org/acp-newsroom/acp-issues-updated-guidance-for-colorectal-cancer-screening-of-asymptomatic-adults

While weight loss may be beneficial for individuals with knee osteoarthritis, it does not see to have a protective or beneficial effect for those with hip osteoarthritis. https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18371

In patients with HIV and cv risk score of 4.5% there was a NNT of 106 at 5 yrs of follow up to prevent 1 MACEhttps://www.acpjournals.org/doi/10.7326/M22-2643?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

A cuff 1-2 sizes too large underestimated bp by 4-9mm Hg BUT a cuff 1-2 sizes too small overestimated the BP 4-20mm Hghttps://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2807853

GLP1 agonist likely lead to retained gastric products but this effect is larger for once weekly injections than once daily pills.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10204182/

During 28 months of follow-up, absolute risks for progression from CIN2 to CIN3 (or worse) were as follows: 23% among women vaccinated before age 15 32% among women vaccinated between ages 15 and 20 38% among women vaccinated after age 20 38% among unvaccinated women Krog L et al. Risk of progression of cervical intraepithelial neoplasia grade 2 in human papillomavirus–vaccinated and unvaccinated women: A population-based cohort study. Am J Obstet Gynecol 2023 Dec 30; [e-pub]. (https://doi.org/10.1016/j.ajog.2023.11.1235. opens in new tab)

>10% unintentional weight loss is most likely associated with  gastrointestinal, liver, pancreatic, and biliary cancers (relative risks, 3.1–7.4); Leukemia (RR, 4.2) Breast, prostate, and gynecologic cancers were not associated with >10% weight loss Wang Q-L et al. Cancer diagnoses after recent weight loss. JAMA 2024 Jan 23/30; 331:318. (https://doi.org/10.1001/jama.2023.25869)

PDE5i are bad if your health if you have cardiovascular disease and a provider that didn't read the paper and only looked at the abstract. Go ahead and write for PDE5i for your patients that need it and do not change your practice based on this study. https://www.sciencedirect.com/science/article/pii/S0735109723080749?via%3Dihub#mmc1

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 Intern Med 2024 Jan 9; [e-pub]. (https://doi.org/10.7326/M23-2023. opens in new tab)

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 practice: A Retrospective Cohort Study. Ann Intern Med 2024 Jan; 177:18. (https://doi.org/10.7326/M23-0653. opens in new tab)

Ask about and stop aspirin in patients taking it for primary preventionLi 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.pdfhttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00683-9/fulltext#:~:text=Results%20indicate%20superiority%20of%20nurse,at%20established%20cost%2Deffectiveness%20thresholds.

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