Let's look at the numbers behind CAC! The best evidence is found here https://jamanetwork.com/journals/jama/fullarticle/2687224 but the largest study is found here https://www.sciencedirect.com/science/article/pii/S0735109715072253?via%3Dihub but in the end they use this https://en.wikipedia.org/wiki/Net_reclassification_improvement which might trick many people but I know it won't trick the smart people that listen to questioning medicine
https://www.ncbi.nlm.nih.gov/pubmed/30874755 - ACC/AHA and ESC are still not evidence based
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.939.1670&rep=rep1&type=pdf -- only need to check every ten years-- it is the other risk factors that matter!
https://www.ncbi.nlm.nih.gov/pubmed/26680162 Signal to noise is around 1 in 10 yrs
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2739056 not all guidelines are equal, think for yourself. Some guidelines even do harm when you actually look at the evidence.
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2740207 doacs and surgery what do you do-- low risk surgery stop one day prior and start one day after surgery. with high risk surgery you stop two days prior and start two days after
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2747871?guestAccessKey=90abe76b-3a15-4b95-9b42-4f751c5fbe64&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=etoc&utm_term=081919 Pt in the hospital for a non-cardiac condition and they have a high bp== don't worry about it- no evidence for what one week of high bp will do but we do have evidence that starting medications while in an acute state will cause harm. just let it be!!
GINA guidelines- budesonide formoterol prn OR SABA plus ICS prn for stage 1 or for stage two still budesonide formoterol prn OR scheduled ICS twice daily with prn SABA
https://www.nejm.org/doi/full/10.1056/NEJMoa1813959 even when we dont know where the stroke is coming from- aspirin is still king all these years later
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30840-2/fulltext Aspirin is such a king that is doesn't matter if you have a spontaneous brain bleed or intracerebral hemorrhage it does appear safe to restart aspirin after a 2-3 month break
https://jamanetwork.com/journals/jama/article-abstract/2736564 smart-choice trial looked 3 months compared to 12 months of DAPT and
https://jamanetwork.com/journals/jama/article-abstract/2736563 STOPDAPT-2 trial looked at 1 months followed by monotherapy clopidogrel compaed to 12 months of DAPT and BOOM 1 month is winner winner chicken dinner
https://www.ncbi.nlm.nih.gov/pubmed/31063082 all of medicine has variation- some pcp will give an antibiotic for otitis media. some will not. Some radiologist will say follow up is needed and some will not
https://ginasthma.org/pocket-guide-for-asthma-management-and-prevention/ new asthma guidelines from the global initiative for asthma says NO MORE EVER solo albuterol it is now soooooooo simple you get budesonide/fomotorol PRN
https://www.cdc.gov/mmwr/volumes/68/wr/mm6825a2.htm we are not testing people for HIV even though guidelines https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/human-immunodeficiency-virus-hiv-infection-screening1 since 2006 have recommended that everyone be tested! 13yrs later!! Time to do it!!
https://www.ncbi.nlm.nih.gov/pubmed/30658933 The self swab is as good if not better than provider or clinician testing- it is time to educate the population and move to at home cancer screening- save the office visits for important things- like what to do in the 7% of women that are hpv positive.
https://www.fda.gov/drugs/medication-health-fraud/public-notification-big-penis-contains-hidden-drug-ingredient?utm_campaign=CDER%20New%2007%2F17%2F2019&utm_medium=email&utm_source=Eloqua&elqTrackId=6371f8c053574a478fea3a734e8041ed&elq=1631be58825d49e3803c4b92a2cb8553&elqaid=8776&elqat=1&elqCampaignId=7246 Big Penis is a drug that has the drug Viagra in it- over the counter medications are not regulated and this is a perfect example of you really have no idea what you are taking even if you think it is 'all natural'
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2737752 everyone thinks they will live forever, including those on dialysis but in reality 60% will die within 5yrs-- have the end of life conversation sooner than later
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2737844 want to live longer and longer without disability then be happy
https://www.ncbi.nlm.nih.gov/pubmed/30608562 A1C level low is not good and high is not good cause both seem to wind up have you the pt. in the hospital for hypoglycemia- the low point of the U curve is around 7-8% which ironically seems to fit perfectly with recent guidelines
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2735985 pts don't take the medications and if they have hypertension at least in this candania study 1/3 were magically curred of their hypertension one they were monitored
https://www.ncbi.nlm.nih.gov/pubmed/31147311 PPI are still a drug with real side effects and should not be given out like candy but if your patient needs them they lets make no mistake about it they do work really really well
http://cancerpreventionresearch.aacrjournals.org/content/12/5/305 smoking puts you at 2-3 times risk of bladder cancer-- peeing blood is not for me so I choose not to smoke
https://www.ncbi.nlm.nih.gov/pubmed/31112386 no more PRN albuterol -- instead when you want to write for albuterol inhaler you will instead right for daily ICS or PRN ICS/LABA --- GAME CHANGING!! Lets have a moment of silence for prn albuterol in mild asthma-----
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 hospitaliazation by about 33%
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 varibility
https://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
http://www.bloodadvances.org/content/3/5/789?sso-checked=true#T1 if not bleeding nad on warfarin with supertheraputic INR then you can likely hold off on vit k
https://jamanetwork.com/journals/jama/article-abstract/2728675 ablation lead to happier (5 pts on 100 pt scale) but no other improvement
yep acute back pain- 7 days later- just give ibprofen
https://onlinelibrary.wiley.com/doi/10.1002/oby.22347 Gelesis100 made you lose 4 pounds in 24wks--- I guess it is better than nothing but it is still something
https://www.fda.gov/news-events/press-announcements/first-fda-approved-vaccine-prevention-dengue-disease-endemic-regions dengue vaccine is out- make sure it is confirmed first
http://www.onlinejacc.org/content/73/16/2025 skipping breakfast is still likely a good idea- unless you are overweight, smoke, htn, and overall poor picture of health then in this study you seem to have some protective benefit for eat breakfast
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733171 if you get your appt. later in the day you dont get cancer screening as much maybe cause it is not ordered or cause you are smart or cause better shared decision making conversation
A doctor "fired" me for refusing screening mammography: Here's why I decline: Gotzsche RCT >600,000 no mortality benefit; Canadian Study, Miller 25 year follow up-no mortality benefit; Danish-Norwegian study 2018 - no mortality benefit