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Southeast Heights Teaching

Page history last edited by kmccalmont@salud.unm.edu 3 days, 12 hours ago

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Table of Contents


 

Monday Teaching

Teaching sessions are held on Mondays from 12:30 to 1:15 pm. All residents from morning or afternoon session should be present unless they have a conflicting clinical/residency obligation.

Please select a recent article from one of the sources below.  Presentations should be 15-20 minutes long with time for discussion afterward.

 

IDEAS FOR TOPICS

Evidence Alerts (McMaster and DynaMed-- register for free to receive alerts):  https://plus.mcmaster.ca/EvidenceAlerts/Default.aspx

ACP Journal Club (find journal on HSLIC website, through WorldCat search)-- select an article to review (includes commentary/analysis!)

POEMs from Essential Evidence Plus-- can sign up for email updates (subscription does cost $96/year)

AFP POEMS (Patient Oriented Evidence that Matters):  http://www.aafp.org/afp/viewRelatedDepartmentsByDepartment.htm?departmentId=111

Evidence Based Medicine Journal (through BMJ):  https://ebm-bmj-com.libproxy.unm.edu (log in if off site)

FPIN PURLS (Priority Updates from Research Literature):  http://www.mdedge.com/jfponline/purls

ACCESSSS:  https://plus.mcmaster.ca/ACCESSSS/Default.aspx?Page=1

 

Recommended format for presentation:

1. Discuss where you found the article and why it is relevant to your practice.

2. Present the findings of the article.

3. Lead the group through the Critical appraisal process-- discuss the quality of the evidence and whether it is applicable to your patient population.  Use the critical appraisal guides: Critical Appraisal-SYSTEMATIC REVIEW.docx or Critical appraisal of RCT.docx

 

Dr. Tomedi's Presentation on EBM and clinical questions:  SEHC noon presentation re EBM July2020.ppt

 

 

The table below lists past and upcoming teaching sessions. Please fill out your topic, pearls and links to resources after you do your teaching.

 

Past & Upcoming Teaching Sessions

Date
Presenter Topic
Pearls                    

Links and Articles

7/1/19  Jillian Moore  Affect of light versus heavy tobacco use on CVD risk

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 carries a risk of developing coronary heart disease and stroke much greater than expected: around half that for people who smoke 20 per day. No safe level 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.

7/15/19 Jaleh Akhavan Basal insulin versus NPH  Basal insulin was not associated with decreased hypoglycemia or improved glycemic control 

Long-acting insulin vs NPH and hypoglycemia.pdf

NPH insulin for diabetes-JAMA editorial.pdf  

7/22/19 Zainab Aldaoseri Intervention for childhood obesity 

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

 

7/29/19 Rory Aufderheide Outpatient Management of PE 

 

 

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.

8/5/19 Madeleine Palmer Estrogen for postmenopausal vulvovaginal symptoms 

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.

8/19/19 Hieu Nguyen Expressive writing for depression 

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.

 

8/26/19 Katy Rooney Prostate Cancer Screening Recommendations 

 

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.

9/9/19 Marcela Colom Use of CBT for treatment of chronic insomnia  CBT-I is effective in primary care.

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. 

9/16/19  Jaleh Akhavan  Efficacy and safety of a monthly buprenorphine depot injection for opioid use disorder 

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

https://www.thelancet.com/action/showPdf?pii=S0140-6736%2818%2932259-1 
9/23/19 Supreetha Gubbala

Treating Subthreshold Depression in Primary Care:

A Randomized Controlled Trial of Behavioral Activation

With Mindfulness

Behavioral Activation with Mindfulness (BAM) 8 x 2 hr weekly sessions decreased depressive symptoms on BDI and incidence of depression vs. usual medical care at 12 months post-intervention https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847348/pdf/0160111.pdf 
9/30/19 Marcela Colom Menopausal hormone therapy and breast cancer risk 

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.

menopausal hormone therapy and breast cancer risk.pdf  
10/14/19 Jaryse Harris Treatment of H. pylori  Atorvastatin added to four-drug regimen (omeprazole, clarithromycin, bismuth, and amoxicillin) is effective in eradication of H. pylori and was more effective in patients with non-ulcer dyspepsia  Sarkeshikian_et_al-2019-Journal_of_Gastroenterology_and_Hepatology_atorvastatin.pdf  
10/21/19 Sebas Soche Effect of eating breakfast on weight loss  

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.

bmj.l42.full.pdf  
10/28/19 Jillian Moore Misoprostol alone for first trimester abortions 

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  

11/4/19 Orli Florsheim E-cigarettes for smoking cessation 

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

11/11/19 Stacy Nguy Dexamethasone for throat pain 

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

11/18/19 Angelo Tomedi Timing of blood pressure medications  Take BP medications at bedtime.

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 

12/2/19  Alex Baker  HPV screening 

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.

HPV self collect vs. clinician.pdf  
12/9/19  Lucinda Rios Aspirin for primary prevention in diabetic patients 

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.

12/16/19 Farinaz Khan SPRINT trial recommendations for BP control  Goal of 130 SBP decreased mortality from CVD.

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. 

12/23/19 Zainab Aldaoseri High dose vitamin D supplementation 

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. 

 

1/6/20 Jaleh Akhavan CKD tips  CKD management in primary care  https://docs.google.com/presentation/d/1yZ23gCP1ToqGzpbLXiHiVp80qauxech1m-C06Nt0HOw/edit?usp=sharing 
1/6/20 Angelo Tomedi Medications to reduce breast cancer risk Recommend medications to women at increased risk for breast cancer.

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

1/13/20 Nathan Birnbaum Fasting and non fasting lipid levels similarly predict cardiovascular disease risk 

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.

1/20/20 Rory Aufderheide Hospital care at home for acutely ill adults  hospital level care at home in this small study of 91 patients was less costly than in-hospital care with equal safety outcomes and less repeat hospitalization in 30 days 

Hospital level care at home for acutely ill adults.pdf  

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

1/20/20 Rory Aufderheide Efficacy and safety of low dose colchicine after MI Starting Low dose colchicine within 30 days of MI can reduce composite cardiovascular outcomes over the next 2 years

Efficacy and safety of low dose colchicine after MI.pdf

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

1/27/20 Supreetha Gubbala CRP testing to guide antibiotic use for COPD exacerbations  CRP-guided treatment of outpatient COPD exacerbations is a safe way to reduce antibiotic use for approximately 1 in every 5 patients if you have access to fairly quick turn around CRP testing 

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 --> AntibioticsCRP 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

 

2/10/20 Sahi Podila  Association of processed meat, unprocessed red meat, poultry, and fish with CVD and all-cause mortality  Processed meat, unprocessed red meat, and poultry associated with CVD.

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 

2/17/20  Hieu Nguyen Addition of steroid in children and adult with severe CAP  Steroids more effective for severe PNA. 

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. 

2/24/20  Stacy Nguy  Cryotherapy plus topical treatment for AKs  Cryosurgery plus topical treatment was more effective for complete clearance of AKs 

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.

3/2/20 Zainab Aldaoseri As-Needed Budesonide/Formoterol Similar to Maintenance Budesonide Plus SABA in Patients with Mild Asthma  As needed use of combined ICS/LABA was as effective as ICS + SABA 

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

3/9/20 Angelo Tomedi

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

3/16/20 Marcela Colom Guidelines for management of OA  Review of guidelines for OA created by American College of Rheumatology and Arthritis Foundation 

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

3/23/20 Sebas Soche Lipid lowering therapy and risk reduction  Follow USPSTF guidelines for initiating statins 

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. 

3/30/20 Orli Florsheim Intensification of antihypertensive regimen in the hospital  Risk outweighed benefits 

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

4/6/20 Rory Aufderheide Treatment of asymptomatic bacteriuria   

Tx of Asymptomatic Bacteriuria.pdf

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

 

4/13/20 Brynne Latterell Physical therapy versus steroid injections for knee OA  PT was more effective at 1 year 

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.

 

4/20/20 Nathan Birnbaum Prevention of childhood obesity   

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. 

 
4/27/20 Hieu Nguyen 
Treatment of chronic sciatica   

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.

 

5/11/20  Farinaz Khan  Acupuncture for knee osteoarthritis   

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.    

6/1/20   Sebas Soche  The effect of coconut oil consumption on CV risk factors   

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.

 

6/8/20 Angelo Tomedi Treatment of H. pylori to prevent gastric cancer   

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.

6/15/20 Stacy Nguy Delayed versus immediate pushing in second stage   

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. 

6/22/20 Brynne Latterell Effect of Intensive Lifestyle Management on weight and glycemic in early type II DM  

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. 

6/29/20 Katy Rooney Association of home NIPPV with clinical outcomes in COPD   

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. 

7/13/20  Angelo Tomedi  Intro to EBM: Resources and application    SEHC noon presentation re EBM July2020.ppt  
7/20/20  Orli Florsheim  Mind-Body Therapies for Opioid Treated Pain    AAFP POEMs.pdf -- Using mindfulness, meditation, hypnosis, therapeutic suggestion, and cognitive behavior therapy, in addition to opioid treatment of acute or chronic pain, provides an additional benefit to patients by reducing pain scores. Some of these interventions will decrease the duration or amount of opioid needed. (Level of Evidence = 1a)
 jamainternal_garland_2019_oi_190084.pdf
7/27/20  Nathan Birnbaum  Cow's milk formula and food allergy   

jamapediatrics_urashima_2019_oi_190069.pdf

The evidence suggests that sensitization to cow’s milk and food allergy, including cow's milk allergy and anaphylaxis, are primarily preventable by avoiding cow's milk formula supplementation for at least the first 3 days of life.

 

8/3/20 Stacy Nguy Antenatal steroids for late preterm/early term fetuses   

bmj.i5044.full.pdf

Antenatal steroids at ≥34 weeks’ gestation reduce neonatal respiratory morbidity. A single course of

corticosteroids can be considered for women at risk of imminent late premature delivery 34.0-36.6 weeks’ gestation, as well as for women undergoing planned cesarean delivery at ≥37 weeks’ gestation. 

8/10/20 Halea Meese No Short-Term Extra Benefit when Muscle Relaxants Are Added to Ibuprofen for Acute Low Back Pain​   

RCT of ibuprofen plus muscle relaxant for acute LBP.pdf

POEM- muscle relaxant for acute LBP.pdf  

Adding a muscle relaxant to treatment with ibuprofen does not improve functional outcomes or pain, or lessen the number of people reporting moderate to severe back pain one week after starting treatment. (Level of Evidence = 1b) 

8/17/20 Anna Kistin      
8/24/20 Farinaz Khan      
8/31/20 Supreetha Gubbala      
9/14/20 Katy Rooney      
9/21/20 Rory Aufderheide       
9/28/20 Stacy Nguy       
10/5/20  Nathan Birnbaum      
10/12/20 Jillian Moore      
10/19/20 Ray Kelley      
10/26/20 Abhishek Tomar      
11/2/20 Marcela Colom      
11/9/20 Katy Rooney      
11/16/20 Farinaz Khan      
11/23/20 Orli Florsheim      
11/30/20 Abe Guimaraes      
12/7/20 Rory Aufderheide      
12/14/20 Nathan Birnbaum      
12/21/20 Supreetha Gubbala      
12/28/20  Alex Ninneman       
         

 

 

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