Questioning Medicine

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

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