Quitting smoking is safer that cutting down.

low cigarette use and CVD.pdf

light smoking CVD risk.pdf  

Smoking only about one cigarette per day carriesa risk of developing coronary heart disease and stroke much greater than expected: around halfthat for people who smoke 20 per day. No safelevel of smoking exists for cardiovascular disease. Smokers should aim to quit instead of cutting down to significantly reduce their risk of these two common major disorders.

Long-acting insulin vs NPH and hypoglycemia.pdf

NPH insulin for diabetes-JAMA editorial.pdf  

In preschool-age children, an intensive 6-month behavioral skills-based intervention is necessary to reduce obesity.

intervention for obesity in preschoolers.pdf  

Healthy Fit Clinic at UNM:  https://hsc.unm.edu/health/patient-care/pediatrics/doc/healthy-fit-childrens-clinic.pdf

https://hsc.unm.edu/health/patient-care/pediatrics/doc/healthy-fit-childrens-clinic-spanish.pdf

Outpatinent PE article.PDF

PE-Outpatient vs inpatient Treatment- Cochrane SR.pdf  

Outpatient treatment of hemodynamically stable PE patients seems to be associated with a lower rate of adverse events than hospitalization and, if confirmed, may be considered as first-line management in patients not requiring specific in-hospital care, regardless of their initial risk stratification, if proper outpatient care can be provided.

Vaginal estrogen and vaginal moisturizer not more effective than placebo.

https://www.aafp.org/afp/2018/1115/od3.html

 Efficacy of Vaginal Estradiol.pdf

Our results suggest that neither prescribed vaginal estradiol tablet nor over-the-counter vaginal moisturizer provides additional benefit over placebo vaginal tablet and gel in reducing postmenopausal vulvovaginal symptoms.

Expressive writing is a useful supplement to treatment for depression.

Expressive writing.pdf  

This is the first study to demonstrate the efficacy of expressive writing among people formally diagnosed with current MDD. These data suggest that expressive writing may be a useful supplement to existing interventions for depression.

PSA screening for prostate cancer-JAMA.pdf  

PSA screening may reduce prostate cancer mortality risk but is associated with false-positive results, biopsy complications, and overdiagnosis. Compared with conservative approaches, active treatments for screen-detected prostate cancer have unclear effects on long-term survival but are associated with sexual and urinary difficulties.

Davidson et al. CBT for insomnia in primary care. 2019.pdf  

The findings support the effectiveness of multicomponent CBT-I in general primary care. Future studies should use standard sleep measures, examine daytime symptoms, and investigate the impact of hypnotic tapering interventions delivered in conjunction with CBT-I. 

Compared q monthly SQ buprenorphine injections to placebo.  Success with opioid abstinence more than twice as likely with the bup injection.

Treating Subthreshold Depression in Primary Care:

A Randomized Controlled Trial of Behavioral Activation

With Mindfulness

For women of average weight in developed countries, 5 years of MHT, starting at age 50 years, would increase breast cancer incidence at ages 50–69 years by about one in every 50 users of estrogen plus daily progestin preparations.

This study suggests that the addition of breakfast might not be a good strategy for weight loss, regardless of established breakfast habit. Caution is needed when recommending breakfast for weight loss in adults, as it could have the opposite effect.

Misoprostol alone is effective and safe and is a reasonable option for women seeking abortion in the first trimester. Research is indicated to further refine the regimen and to establish efficacy in the late first trimester.

Miso alone for first tri med ab.pdf

Med ab in late first tri- SR.pdf  

E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support.  However, this will need to be reviewed in light of new vaping related lung injury cases.

NEJM E-Cigarettes.pdf

Vaping related lung injury:  https://www.nejm.org/doi/full/10.1056/NEJMoa1911614?query=recirc_curatedRelated_article​ 

CDC report: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

Single low dose corticosteroids can provide pain

relief in patients with sore throat, with no increase in serious adverse effects.

https://www.aafp.org/afp/2018/0215/od1.html​ 

Steroids for sore throat.pdf

Bedtime HTN treatment-RCT.pdf  

Routine ingestion by hypertensive patients of all BP-lowering medications at bedtime, as opposed to morning, results in improved BP control and most importantly markedly diminished occurrence of major CVD events 

HPV testing done with a clinically validated PCR-based assay had similar accuracy on self-collected and clinician-collected samples in terms of the detection of CIN2+ or CIN3+ lesions.

Risk of bleeding counterbalanced benefits in patients with DM and no CVD.

Aspirin for diabetics- RCT.pdf  

Aspirin use prevented serious vascular events in persons who had diabetes and no evident cardiovascular disease at trial entry, but it also caused major bleeding events. The absolute benefits were largely counterbalanced by the bleeding hazard.

https://www.nejm.org/doi/full/10.1056/NEJMoa1511939 

Sprint trial demonstrated that stricter control of systolic blood pressure does decrease mortality from CVD in all age groups. Therefore, our goal in treating HTN should be to get below 130 SBP. 

High dose vitamin D supplementation is not recommended.

High Dose Vitamin D Supplementation.pdf  

High dose of Vitamins D (4000-10,000 IU) dose not improve BMD in health adult without osteoporosis, and actually may cause reduction in MBD.

Combination of low dose of Vitamin D and calcium (800/ 1000) is recommended to decrease risk of fall especially for Institutionalized ‏elderly. 

https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-medications-for-risk-reduction1

The USPSTF recommends that clinicians offer to prescribe risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at increased risk for breast cancer and at low risk for adverse medication effects.

“Increased risk” means (according to USPSTF) 1.66% or more 5-year risk. This can be calculated using the NCI Breast Cancer Risk Assessment Tool: https://bcrisktool.cancer.gov/

Medication to Reduce Breast Cancer Risk- JAMA Editorial.pdf

Check non-fasting lipids.

Nonfasting Lipids- POEM.pdf  

Guidelines recommend checking lipid levels in nonfasting patients. They are easier to obtain and are equally predictive of subsequent cardiac events. Although triglyceride levels may be higher in nonfasting patients, cholesterol levels will be similar whether the patient was fasting or not.

Hospital level care at home for acutely ill adults.pdf  

https://www.evidencealerts.com/Articles/AlertedArticle/89812

Efficacy and safety of low dose colchicine after MI.pdf

https://www.evidencealerts.com/Search/Article/89380?Terms=colchicine&OrderBy=MostRecent​

Butler CC et al. C-reactive protein testing to guide antibiotic prescribing for COPD exacerbations. N Engl J Med 2019 Jul 11; 381:111. (https://doi.org/10.1056/NEJMoa1803185) 

• ​CRP >40 mg/L --> Antibiotics, CRP 20-40 mg/L --> Gray area, CRP <20 mg/L --> No antibiotics
• Participating study centers were provided POC CRP with quick turn around
• The proportion of patients receiving antibiotics was significantly lower in the CRP group than in the usual-care group (57% vs. 77%)
• Antibiotics vs. no antibiotics groups ultimately had similar clinical outcomes and eventual need for hospitalization

JAMA Internal Med- Meats, CVD, and all cause mortality.pdf  

Higher intake of processed meat, unprocessed red meat, or poultry, but not fish, was significantly associated with a small increased risk of incident CVD, whereas higher intake of processed meat or unprocessed red meat, but not poultry or fish, was significantly associated with a small increased risk of all-cause mortality 

POEM-steroids for CAP.pdf

Corticosteroids for pneumonia- Cochrane.pdf

Consider short burst of steroid 40mg-50mg 5-10 day in patient with severe PNA as it decreases mortality, NTT 18, and maybe in patient with non-severe PNA although it doesn't decrease mortality, it can lower clinical failure rate, increases clinical improvement, shorter time to cure and shorter hospital stay and fewer complications, but inconclusive for use in children at this point. 

https://www.aafp.org/afp/2020/0215/p249.html 

Heppt_et_al-2019-British_Journal_of_Dermatology.pdf

Also:  PCV13 in adults.pdf-- PCV13 is no longer routinely recommended for adults over 65.  Use shared decision making for adults without an immunocompromising condition.

POEM- As Needed Symbicort.pdf  

Concerns regarding changing practice as a result of this article:

- Funding for the study was done by industry
- Although the study was randomized controlled trial it was not blinded
- The group who was assigned to be on albuterol on the inhaler>> were sicker on baseline compared with other groups
-Symbicort is very expensive, and it would be really hard to get insurance company cover that for mild asthma

Using evidence for patient care: review of resources

Treatment of depression 

SEHC noon presentation 9Mar2020.ppt

N95 vs surgical masks.pdf  

Should antidepressants be used for major depressive disorder.pdf

Take away is not to stop prescribing antidepressants, but to assess severity, use for severe depression and assess response (because the average response to SSRIs of 2 points on the HDRS may not be clinically significant, but some patients may have a larger response than the average. For mild-moderate, "wait and watch" with supportive care (and maybe CBT) is a preferable option

Kolasinski_et_al-2020-Arthritis_&_Rheumatology.pdf

Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, hand orthoses for first carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical nonsteroidal antiinflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular glucocorticoid injections for knee OA.

Also discussed how to evaluate validity/reliability of guidelines:

Wrong Guidelines- EBM article.pdf

Wrong Guidelines- How to Detect Them.pdf  

Conservative therapy for shoulder pain:  Conservative Therapy for SHoulder Pain - evidence summary.pdf

Intensive LDL cholesterol lowering treatment.pdf

Patients at lower cardiovascular risk and younger age might have a similar relative reduction in risk with LDL-cholesterol lowering therapies and future studies should investigate the potential benefits of earlier intervention.  **This study focused on relative risk rather than absolute risk and NNT, so although results appear statistically significant, they may not be clinically significant.

USPSTF Grade B Recommendation:  The USPSTF recommends that adults without a history of cardiovascular disease (CVD) (ie, symptomatic coronary artery disease or ischemic stroke) use a low- to moderate-dose statin for the prevention of CVD events and mortality when all of the following criteria are met: 1) they are aged 40 to 75 years; 2) they have 1 or more CVD risk factors (ie, dyslipidemia, diabetes, hypertension, or smoking); and 3) they have a calculated 10-year risk of a cardiovascular event of 10% or greater. 

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2747871 

Among older adults hospitalized for noncardiac conditions, prescription of intensified antihypertensives at discharge was not associated with reduced cardiac events or improved BP control within 1 year but was associated with an increased risk of readmission and serious adverse events within 30 days

Tx of Asymptomatic Bacteriuria.pdf

Treatment of asymptomatic bacteriuria did not improve clinical outcomes and was associated with a longer hospital stay.

NEJM- Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee.pdf

Patients with osteoarthritis of the knee who underwent physical therapy had less pain and functional disability at 1 year than patients who received an intra-articular glucocorticoid injection.

Brown_et_al-2019-Cochrane_Database_of_Systematic_Reviews.pdf

Strategies for changing diet or activity levels, or both, of children in order to help prevent them becoming overweight or obese are e ective in making modest reductions in zBMI score in children aged 0 to 5 years and in children aged 6 to 12 years. 

Chronic sciatica treatment.pdf

In this single-center trial involving patients with sciatica lasting more than 4 months and caused by lumbar disk herniation, microdiskectomy was superior to nonsurgical care with respect to pain intensity at 6 months of follow-up.

https://www.acpjournals.org/doi/pdf/10.7326/0003-4819-145-1-200607040-00005

Acupuncture does show clinical improvement in the treatment of knee OA, but this could be due to placebo effect.  There is not enough information to definitively recommend this as a treatment for knee OA.    

Effect of Coconut Oil on CV Risk Factors.pdf

Coconut oil consumption results in signi cantly higher LDL-cholesterol than nontropical vegetable oils. This should inform choices about coconut oil consumption.

H pylori eradication to prevent gastric cancer-SR.pdf -- There is moderate evidence to suggest

that H. pylori eradication therapy reduces the incidence of gastric cancer in healthy individuals and patients with gastric neoplasia in East Asian countries. There also appears to be a reduction in gastric cancer-related mortality.

FH of Gastric Cancer and H pylori treatment.pdf  --  Among persons with H. pylori infection who had a family history of gastric cancer in first-degree relatives, H. pylori eradication treatment reduced the risk of gastric cancer.

jama_cahill_2018_oi_180106.pdf

PURLs Immediate vs. Delayed pushing.pdf

Recommend immediate, rather than delayed, pushing in the second stage of labor for nulliparous women receiving epidural analgesia.  The rate of spontaneous vaginal delivery is the same, and there is a lower risk of postpartum hemorrhage and chorioamnionitis. 

Effect of Intensive Lifestyle Intervention.pdf

Our ndings show that the intensive lifestyle intervention led to significant weight loss at 12 months, and was associated with diabetes remission in over 60% of participants and normoglycaemia in over 30% of participants. The provision of this lifestyle intervention could allow a large proportion of young individuals with early diabetes to achieve improvements in key cardiometabolic outcomes, with potential long-term bene ts for health and wellbeing. 

jama_wilson_2020_oi_190154.pdf

In patients with COPD with hypercapnia, home NIPPV reduces mortality and intubations compared with no NIPPV.  However, the quality of supporting evidence is low to moderate, encouraging future studies on the benefits of NIPPV in COPD.