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Questioning Medicine
Questioning Medicine
Category: Medicine
Location: Florida
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August 12, 2019 08:56 PM PDT

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

August 02, 2019 03:03 PM PDT

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
--

July 23, 2019 07:08 PM PDT

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-----

July 12, 2019 06:09 AM PDT

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-

June 27, 2019 03:23 PM PDT

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%
--

June 13, 2019 05:18 PM PDT

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

June 04, 2019 08:08 PM PDT

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/2728676
https://jamanetwork.com/journals/jama/article-abstract/2728675 ablation lead to happier (5 pts on 100 pt scale) but no other improvement

https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0196064419301398?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0196064419301398%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.jwatch.org%2Fna48926%2F2019%2F04%2F16%2Fshould-we-add-muscle-relaxants-ibuprofen-acute-low-back
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

May 21, 2019 04:56 PM PDT

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 own
https://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 with increase exercise in your midlife crisis.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2727269

if a person has an arterial blood clot they dont always have cancer but most likely they have cancer and we have not found it... yet

http://www.bloodjournal.org/content/133/8/781?sso-checked=true

UTI and foley cath- probably dont need to replace the foley cath give the correct antibiotic

https://www.ncbi.nlm.nih.gov/pubmed/30094820

May 09, 2019 02:00 PM PDT

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.

April 22, 2019 06:48 PM PDT

shared decision making for lung cancer rarely happens in the community and when it does happen 2/5 said no thanks to cancer screening
https://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 anyone
https://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 1/33
https://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 expensive
https://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

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