Questioning Medicine

https://www.nejm.org/doi/full/10.1056/NEJMoa2307563Semaglutide 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 gainhttps://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 implementation of rhythm control strategies is an important factor for improving AF ablation success rates I know we use to be all about rhythm and rate control are ‘equal’ and don’t worry the guidelines still say, “Although selection of a rhythm-control therapy within a year of AF diagnosis may be considered to reduce the risk of adverse cardiovascular outcomes, early rate control may still be appropriate.” (aka you can do it acutely but that is only to get a hold of the acute situation)  BUT Catheter ablation of AF is now a strong class 1 recommendation—FIRST LINE in selected patients which includes those with heart fa

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 NetworkEnteric 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 erosion5 but has not been shown to reduce gastrointestinal bleeding. We say take enteric coated but no study has shown that enteric coated formulation is safer then uncoated aspirin  post hoc secondary analysis of 10 678 participants with atherosclerotic cardiovascular disease from the ADAPTABLE randomized clinical trial—a reminder, (Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-term Effectiveness). In that trial they randomized 15,000 patients with coronary artery disease to take 81 mg or 325 mg of aspirin daily.  Roughly half of the pts using 81mg and half of the pts using 325mg were on enteric coated aspirin an

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 Psychiatry.org - Genetic Testing to Improve Psychiatric Medication ChoiceHarvard https://www.health.harvard.edu/blog/gene-testing-to-guide-antidepressant-treatment-has-its-time-arrived-2019100917964First primeAs I mention in my response email PRIME the primary outcomes per clinnicaltrials.gov were depression remission at 24 weeks, which was not statically significant. And then a use of fewer medications that have a potential gene-drug interaction which from what I can find was a ‘theoretical’ interaction not an actual increase in adverse events. Effect of Pharmacogenomic Testing for Drug-Gene Interactions on Medication Sel

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 polysaccharide 150 mg twice daily and placebo in 225 patients with symptomatic systolic HF (median left ventricular ejection fraction, 25%) At 16 weeks, the groups did not differ on the primary endpoint of peak oxygen consumption (VO2) or on secondary endpoints, including 6-minute walk distance and quality of life as measured with the Kansas City Cardiomyopathy Questionnaire. Thus as you mentioned not only is it not well tolerated it also doesn’t appear to work which might be a better reason to not give it.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0279166Vitamin D2 supplementation was associated with a 48.

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 randomly assigned to receive an invitation to screening or usual careThe screening program included non-contrast electrocardiographically gated CT to measure coronary artery calcium, look for aneurysms, and detect atrial fibrillation; ankle-brachial index measurements for peripheral arterial disease (PAD) and hypertension; and blood tests for diabetes and hyperlipidemiaThose who accepted screening were more educated, more likely to be employed, and had a somewhat lower rate of hospitalization for cardiovascular events in the previous 5 years. (the rich white gullible ceo male)The screened group was more likely to b

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 basal/bolus insulin; both the starting dose and subsequent changes were specified by the study protocol. Additional premeal SSI was added to scheduled premeal bolus doses.randomized to either intensive SSI (at BG >140 mg/dL) or nonintensive SSI (at BG >260 mg/dL) before meals and at bedtime.  Mean baseline glycosylated hemoglobin (HbA1c) was 9%, and 60% of patients were using insulin at home. Patients with a presenting glucose level of >400 mg/dL or diabetic ketoacidosis were excluded.  Outcome---Mean daily BG level, hypoglycemia, severe hyperglycemia, percent of BGs in the target range (70–180 mg/dL), and the amo

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". -https://abcnews.go.com/Health/ActiveAging/story?id=3247773&page=1https://www.acpjournals.org/doi/10.7326/M19-0882?_ga=2.162179964.190727375.1667239768-1195431333.1667239768&"It is estimated that approximately 35% of men older than 45 years of age and 30-50% of men with obesity or type 2 diabetes have hypogonadism". from endocrine.org. https://www.endocrine.org/patient-engagement/endocrine-library/hypogonadism However, for a 30 yr old male the low end of normal is around 300 ng/dL! YET this is what most websites and recommendations use as the treatment cutoff for all men. 50, 60, 70 yr olds. we compare those

coffee saves your life-- maybe, careful for confounders heart failure hospital admission is really hard to preventmoderate dose statin is most important..but ezetmibe and moderate dose is equal to high dose statinI think we should take out all kidney stones and the evidence says there will be lest hospitalizations if we do thatEHR can help us and remind us to check and PTHrobotic surgery is not all that is seems to be-- or at least not yetvit. D and fish oil dont help dry eyes....or much of anything for that matterstop injecting Hyaluronic acid into the knee

 skin exam, ddp4, IUD, oral hypertension medication

https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.122.059410?af=RThe Biomarkers say REDUCE-IT was a scamhttps://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2791663NO! Just NO-- stick with the calculator for nowhttps://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.059038start the SLGT-2 inhibitors early! maybe an early dischargehttps://pubmed.ncbi.nlm.nih.gov/35849407/If we could get the EMR to do it automatically else you cant expect providers tohttps://pubmed.ncbi.nlm.nih.gov/35727595/the head CT for psych stuff can probably be put on holdhttps://eprints.whiterose.ac.uk/180135/continue the disease modifying agents

mammograms and pink ribbons-- lets talk evidence

mammograms-- we all know them, but lets discuss

Association of Receipt of the Fourth BNT162b2 Dose With Omicron Infection and COVID-19 Hospitalizations Among Residents of Long-term Care Facilities | Geriatrics | JAMA Internal Medicine | JAMA Networkcareful what you believe and always question medicine- even if it is about covid vaccineUse and Cost of Low-Value Health Services Delivered or Paid for by the Veterans Health Administration | Cancer Screening, Prevention, Control | JAMA Internal Medicine | JAMA Network low value care exist in the VA but also in the community-- you need a comparative arm to figure out how bad you are doing or good you are doing. Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults | NEJM You can also check a level if you are trying to make the diagnosis of rickets. ELSE no need to check anyone, if you really believe in it or your patient really believes in in then just start 2000IU and continue to take as long as they feel indicated because it likely is not doing any benefit but realistically it is not doing

Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension - Wilding - - Diabetes, Obesity and Metabolism - Wiley Online Library   “”””One year after withdrawal of once-weekly subcutaneous semaglutide 2.4 mg and lifestyle intervention, participants regained two-thirds of their prior weight loss, with similar changes in cardiometabolic parameters.”””  investigators assessed the changes in body weight among patients who were started on semaglutide therapy and subsequently stopped.  The weight regain was accelerated immediately after treatment withdrawal and slowed at week 80.   The results showed that while on semaglutide, participants lost an average of 17.3% of their baseline weight. However, once semaglutide was discontinued, participants regained 11.6% of lost weight by the 1-year follow-up.  The net weight changes at week 120 were 5.6% (SD, 8.9) in the semaglutide arm and 0.1% (SD, 5.8) in the placebo arm.  Furthermore, cardiovascular in htn and glycemic category