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PODCAST

Questioning Medicine

Questioning Medicine

Join Andrew on a medical rollercoaster as we ask a medical question and answer it based on recent published papers.

health & fitness medicine

All Episodes

5:52

Episode 340: 339. Reaction Risk to Direct Penicillin...

Questioning Medicine ·

2024/10/29

10% of hospitalized patients have penicillin allergy listed in their records, fewer than 1% of patients have true allergies. Use of more-expensive and broader-spectrum antibiotics is associated with longer and more-expensive hospital stays and more side effects, nosocomial infections, and resistant organisms. Blumenthal KG et al. Reaction risk to direct penicillin challenges: A systematic review and meta-analysis. JAMA Intern Med 2024 Sep 16; [e-pub].

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9:00

Episode 339: 338. Hypertension Treatment With New...

Questioning Medicine ·

2024/10/25

Efficacy and Safety of a Novel Low-Dose Triple Single-Pill Combination Compared With Placebo for Initial Treatment of HypertensionJ Am Coll Cardiol 2024 Aug 30;[EPub Ahead of Print], A Rodgers, A Salam, AE Schutte, WC Cushman, HA de Silva, GL Di Tanna, D Grobbee, K Narkiewicz, DB Ojji, NR Poulter, MP Schlaich, S Oparil, W Spiering, B Williams, JT Wright, A Gutierez, A Sanni, P Lakshman, D McMullen, G Ranasinghe, C Gianacas, M Shanthakumar, X Liu, N Wang, P Whelton randomized,

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5:59

Episode 338: 337. What is the ideal Vitamin D Level...

Questioning Medicine ·

2024/10/22

In 2011, the Endocrine Society published a guideline on “Evaluation, Treatment, and Prevention of Vitamin D Deficiency” Now, the Society has issued an updated guideline, Demay MB et al. Vitamin D for the prevention of disease: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2024 Aug; 109:1907. (https://doi.org/10.1210/clinem/dgae290) Previously, the Endocrine Society had labeled vitamin D status as “deficient” when serum hydroxyvitamin D (25[OH]D) was lower than

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6:24

Episode 337: 336. 24 Hours After a Stroke for EVT- 2...

Questioning Medicine ·

2024/10/18

Huijberts I et al. Collateral-based selection for endovascular treatment of acute ischaemic stroke in the late window (MR CLEAN-LATE): 2-year follow-up of a phase 3, multicentre, open-label, randomised controlled trial in the Netherlands. Lancet Neurol 2024 Sep; 23:893. (https://doi.org/10.1016/S1474-4422(24)00228-X) The modified Rankin Scale (mRS) score at 2 years was the primary outcome. The median mRS at 2 years was 4 in the EVT group and 6 in the control group. For functional

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5:18

Episode 336: 335. Do GLP-1 Cause Residual Gastric...

Questioning Medicine ·

2024/10/10

Because glucagon-like peptide-1 (GLP-1) receptor agonists can slow gastric emptying, they might confer risk for residual gastric contents — and possibly aspiration!!!! Should we stop the glp-1 Should we stop the glp-1-- Anesthesiologists and gastroenterologists have weighed in on this concern and on QM I say just do whatever the anesthesiologist want because they have the final say!! Sen S et al. Glucagon-like peptide-1 receptor agonist use and residual gastric content before anesthesia

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5:22

Episode 335: 334. Do Thicken Liquids Prevent Dysphagia?

Questioning Medicine ·

2024/10/08

Oropharyngeal dysphagia is highly prevalent in hospitalized patients with Alzheimer disease or other dementias. These patients often are prescribed thick liquid diets Makhnevich A et al. Thick liquids and clinical outcomes in hospitalized patients with Alzheimer disease and related dementias and dysphagia. JAMA Intern Med 2024 May 6; [e-pub]. Researchers conducted a retrospective propensity-matched analysis, ≈4500 patients with Alzheimer disease or other dementias who were hospitalized with

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8:11

Episode 334: 333. Cell Phone Use While Driving and...

Questioning Medicine ·

2024/10/02

Feedback and Financial Incentives for Reducing Cell Phone Use While Driving: A Randomized Clinical Trial | Public Health | JAMA Network Open | JAMA Network Question Can behavioral interventions decrease handheld cell phone–based driver distraction? 17663 and ended up with 2020 participantsProgressive email--- already a select population Outcome-- Proportion of drive time engaged in handheld phone use in seconds per hour (s/h) of driving. Median baseline handheld phone use was 216 (IQR,

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6:20

Episode 333: 331. Noncontrast CT Selected...

Questioning Medicine ·

2024/09/24

Noncontrast CT Selected Thrombectomy vs Medical Management for Late-Window Anterior Large Vessel Occlusion | Neurology Most studies that have shown a benefit from endovascular thrombectomy (EVT) for ischemic stroke in the late time window (6 to 24 hours after time last known well) have used either perfusion imaging or advanced imaging to identify core infarct volume. Whether plain CT alone can identify EVT candidates in the late time window is unknown. multinational cohort study that looked

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6:08

Episode 332: 330. Does a Multivitamine a Day Keep The...

Questioning Medicine ·

2024/09/18

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820369With as many as 1 in 3 US adults using multivitamin supplements, the question as to whether these supplements reduce mortality They usedthree large observational cohort studies with nearly 400,000 participants (median age, 62) who were followed for as long as 27 years (mean, 20 years); these studies included data on diet, self-reported multivitamin use, and mortality. In adjusted analyses, daily multivitamin use was

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7:18

Episode 331: 329. Should We Give AceI or ARBs to...

Questioning Medicine ·

2024/09/17

https://www.acpjournals.org/doi/10.7326/M23-3236Angiotensin-converting–enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) seldom are initiated among patients with chronic kidney disease (CKD) stage 4 or 5, despite guideline recommendations for these agents--- 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart

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11:53

Episode 330: 328. Methods Monday, Composite Endpoints

Questioning Medicine ·

2024/09/16

Composite outcomes You add multiple outcomes together… this is great because you can increase the event rate.. if you are just looking at death lots of people might now die but if you look at death and hospitalizations well then it is easier to get to your expected event rate because its much easier to be hospitalized. This make it so you can have smaller sample sizes and it wont be nearly as expensive. The problem is all the events are given the same importance and we know they are not the

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12:14

Episode 329: 327. A Cell-free DNA Blood-Based Test...

Questioning Medicine ·

2024/08/23

ening, the offer of a blood-based screening test boosted CRC screening by 17.5 percentage points over usual care.That is becauseCRC screening proportions were 17.5 percentage points higher in the blood test group versus usual care (30.5% vs 13.0%; OR 2.94, 95% CI 2.34 to 3.70; p<0.001). So more people are screened for colon cancer but who cares if they get screened if your screening test does a terrible job of telling me stage 1 or precancer lesions. A history and physical will tell you

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7:34

Episode 328: 327. Lowering systolic blood pressure to...

Questioning Medicine ·

2024/08/02

https://pubmed.ncbi.nlm.nih.gov/38945140/The primary outcome was a composite of myocardial infarction, revascularisation, hospitalisation for heart failure, stroke, or death from cardiovascular causes The mean systolic blood pressure throughout the follow-up (except the first 3 months of titration) was 119·1 mm Hg (SD 11·1) in the intensive treatment group and 134·8 mm Hg (10·5) in the standard treatment group. During a median of 3·4 years of follow-up, the primary outcome event occurred

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7:45

Episode 327: 326. Should We Prescribe Inhaled...

Questioning Medicine ·

2024/08/01

INHALE-3, a randomized trial, 123patients with type 1 dm that compared the efficacy of an inhaled insulin regimen (Afrezza) plus degludec insulin (Tresiba®) against usual care over 17 weeks The study's primary endpoint was a change in HbA1c levels, a critical marker of long-term blood glucose control. More participants using the inhaled insulin regimen experienced significant improvements in HbA1c levels compared to those on usual care.21% of those on inhaled insulin had an HbA1c

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7:37

Episode 326: 325. The Mysterious NNT

Questioning Medicine ·

2024/07/30

What is a quick and easy way to calculate the NNT

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8:50

Episode 325: 324. METHODS MONDAY

Questioning Medicine ·

2024/07/29

What is the different between Absolute and Relative risk reduction

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13:09

Episode 324: 323. Is Calcium Bad For You? Calcium...

Questioning Medicine ·

2024/07/26

https://heart.bmj.com/content/108/12/964https://www.ahajournals.org/doi/10.1161/JAHA.116.003815We have a study that says leads to increase all cause death with calcium supplementsWe have a study that says calcium supplement leads to increase in coronary artery calcium Foods that are high in calcium besides dairy include things like kale, spinach, broccoli, chia sees, collard greens…Hard for me to believe someone with a diet of excess kale and spinach will have an increase in all cause

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5:58

Episode 323: 322. Follow-up to Adolescence after...

Questioning Medicine ·

2024/07/24

https://evidence.nejm.org/doi/full/10.1056/EVIDoa2300311Peanut consumption, starting in infancy and continuing to age 5 years, provided lasting tolerance to peanut into adolescence irrespective of subsequent peanut consumption, demonstrating that long-term prevention and tolerance can be achieved in food allergy. (Funded by the National Institute of Allergy and Infectious Diseases and others; ITN070AD, ClinicalTrials.gov number, NCT03546413.)

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6:04

Episode 322: 321. Long-Term Outcomes in Patients with...

Questioning Medicine ·

2024/07/23

https://jamanetwork.com/journals/jama/article-abstract/2819352Conclusions and Relevance In this study, 10 years after diagnosis, 49% of men remained free of progression or treatment, less than 2% developed metastatic disease, and less than 1% died of their disease. Later progression and treatment during surveillance were not associated with worse outcomes. These results demonstrate active surveillance as an effective management strategy for patients diagnosed with favorable-risk prostate

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8:34

Episode 321: 320. What is the Association of Blood...

Questioning Medicine ·

2024/07/19

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11179824/This study did something smart in that they broke it down by white black Chinese and then also had 36 lab test they were looking at and they then found look for a black male this one particular blood test apo2 or whatever had better predictive value but that is cherry picking data with lots of data points and we don’t have risk calculators just for black or just for white or just for Chinese population. Blood test are hot things – we

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