Sensible Medicine

Sally: Henry said you could have a year.Betty: And what would that year be like?Sally: I’d be with you. I won’t let you give up.Betty: I know that. But I watched my mother die. I won’t do that to you. And I don’t want you to think I’m a quitter. I fought for plenty in my life. And that’s how I know when it’s over. It’s not a weakness. It’s been a gift to me. To know when to move on.Betty (handing Sally an envelope): These are instructions...

Predictive Utility of Coronary Artery Calcium Score Added to the PREVENT Atherosclerotic Cardiovascular Disease Equations

Continuous Glucose Monitoring in Non–Insulin-Treated Type 2 Diabetes

Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults

Catheter ablation for symptomatic atrial fibrillation (PVI-SHAM-AF): a randomised, double-blind, sham-controlled, multicentre trial

* This Week in Cardiology with John M. Mandrola MD

* Cardiology Trials

And a special treat/rescouce we have covered nearly 100 articles at this point on the podcast. Here is an active list of all the articles we have discussed. Take a look, read the articles, and refer to our conversation if you wish!

Colorectal Cancer and Mortality Risk Among Older Adults With vs Without Adenoma on Prior Colonoscopy

* The Hubris of Screening for Disease — Again

Prognostic Value of Blood-Based P-Tau217 Levels for Progression to Cognitive Impairment

* Why Blood Tests Are a Poor Screening Tool for Alzheimer’s

Cancer-Related Mortality Among US Pilots and Flight Attendants

Response-Tailored or Standard-Duration Antibiotic Treatment for Infective Endocarditis

Our free series is almost over

New lectures coming soon (after part 9)

A royal mistake

we are making all the old episodes available for free, and then on to the new ones

-v

New episodes coming soon. First 9 parts free now.

Coronary-Artery Revascularization before Elective Major Vascular Surgery

Discontinuation of statins for primary prevention of atherosclerotic cardiovascular disease in adults aged 75 years or older (SAGA/SITE): a multicentre, open-label, pragmatic, non-inferiority randomised trial

I notice that someone was angry that we are re-posting old episodes BEFORE we post the new ones. Just a reminder, we said we would do this! We will make the old ones available for free, and then post the new ones. Bear with us.

In the meantime, enjoy.

And here is lecture 3 of How Not to Be Fooled series

19 parts coming! 9 for free, and 10 for subscribers.

Dapagliflozin and Acute Kidney Injury Following Cardiac Surgery: A Randomized Clinical Trial

Impact of cognitive training on claims-based diagnosed dementia over 20 years: evidence from the ACTIVE study

Tamsulosin Deprescribing for Lower Urinary Tract Symptoms in Older Men A Randomized Clinical Trial

* Side Effect Patterns in a Crossover Trial of Statin, Placebo, and No Treatment

Cost-Effectiveness of Fecal Immunochemical Testing Alone vs Co-Testing With Helicobacter pylori Stool Antigen

Polypill for heart failure with reduced ejection fraction: the POLY-HF randomized trial

John Mandrola: I am torn on the PolyPill concept

Cefazolin for Methicillin-Susceptible Staphylococcus aureus Bacteremia

* Stopping randomized trials early for benefit and estimation of treatment effects: systematic review and meta-regression analysis

The Impact of Midodrine on Guideline-Directed Medical Therapy in Patients Admitted With Systolic Heart Failure

TR is an 88-year-old man who is disabled and in chronic pain from spinal stenosis and knee osteoarthritis. He has multiple other medical issues, including coronary artery disease and COPD.

He has been through years of treatment for his knees and back, including physical therapy, multiple joint injections, and an in-office procedure for spinal stenosis. He has been on multiple regimens of oral pain medications. He is not interested in surgery (and probably would not be considered a reasonable candidate if he were).

He comes to a visit and asks what can be done.

Amoxicillin-Clavulanate vs Amoxicillin for Acute Sinusitis in Adults

* Prespecified Falsification End Points: Can They Validate True Observational Associations?

* Ultrasonography versus Computed Tomography for Suspected Nephrolithiasis

GLP-1 receptor agonist use and cancer risk in obese nondiabetic adults

* Risk for Cancer With Glucagon-Like Peptide-1 Receptor Agonists and Dual Agonists: A Systematic Review and Meta-analysis

Reduced Melanoma After Regular Sunscreen Use: Randomized Trial Follow-Up

GLP-1 Receptor Agonists or SGLT2 Inhibitors and Nonarteritic Anterior Ischemic Optic Neuropathy

* Previously discussed on Fornight XXII: Glucagon-like peptide-1 receptor agonists and risk of substance use disorders among US veterans with type 2 diabetes: cohort study

Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation

Oral Nirmatrelvir–Ritonavir for Covid-19 in Higher-Risk Outpatients

* Real-World Effectiveness of Nirmatrelvir–Ritonavir Against Severe Outcomes of COVID-19 in Taiwan: A Nationwide Population-Based Cohort Study

Three Low-Dose Antihypertensive Agents in a Single Pill after Intracerebral Hemorrhage

* Effect of Combination Therapy on Adherence Among US Patients Initiating Therapy for Hypertension: a Cohort Study

RSV Prefusion F Vaccine for Prevention of Hospitalization in Older Adults

Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism

* Endovascular management of intermediate-risk pulmonary embolism: evidence, outstanding questions, drivers of utilization, and the horizon

Dengue Suppression by Male Wolbachia-Infected Mosquitoes

* World Mosquito Program

Antibiotic Therapy for Uncomplicated Acute Appendicitis

* Glucagon-like peptide-1 receptor agonists and risk of substance use disorders among US veterans with type 2 diabetes: cohort study

* Immediate or Deferred Nonculprit-Lesion PCI in Myocardial Infarction

* Andrew’s previous SM post on the subject: How a Meta-Analysis can Mislead—The Story of Complete vs Culprit-only PCI in STEMI

And, a bunch of the other studies we discussed.

* Complete Revascularization with Multivessel PCI for Myocardial Infarction

* FFR-Guided Complete or Culprit-Only PCI in Patients with Myocardial Infarction

* Initial Invasive or Conservative Strategy for Stable Coronary Disease

Sodium Correction Rates and Associated Outcomes Among Patients With Severe Hyponatremia: A Retrospective Cohort Study

* A Randomized Trial of Targeted Hyponatremia Correction in Hospitalized Patients

Effect of Neuromuscular Warm-up on Injuries in Female Soccer and Basketball Athletes in Urban Public High Schools

* Why Are So Many Teen Girls Still Tearing Their A.C.L.s?

* Injury prevention programs that include plyometric exercises reduce the incidence of anterior cruciate ligament injury: a systematic review of cluster randomised trials

Most conversations about “AI in Medicine” bore me. I think this is because either we lack the imagination to consider how AI will change medicine in the next decade, or we are not being specific enough about how small parts of medicine could be productively affected.

Dr. Shantanu Nundy, MD, MBA, is a practicing physician whom I like to think of as a serial innovator. He is currently an advisor on artificial intelligence to the FDA in the Commissioner’s Office. He has spent a great deal of time and energy thinking deeply about what AI can bring...

High-Dose Influenza Vaccine Effectiveness against Hospitalization in Older Adults

* High-Dose Influenza Vaccine to Reduce Hospitalizations

* Efficacy of high-dose versus standard-dose influenza vaccine in older adults

Beta-blockers after myocardial infarction: effects according to sex in the REBOOT trial

Today on the podcast, I am joined by Dr. Jennifer Rusiecki. Dr. Rusiecki is an Associate Professor of Medicine at the University of Chicago. She is the Director of Women’s Health and Gender-Based Care in the internal medicine residency program and the assistant clinic director overseeing gender-based care.

Dr. Rusiecki and I discussed the article appraised in the other post today, and also discussed the issues of screening for breast cancer in women with dense breasts and breast cancer screening more generally. Dr. Rusieki and I don’t agree on everything, and you might leave more conf...

A Conservative Dialysis Strategy and Kidney Function Recovery in Dialysis-Requiring Acute Kidney Injury: The Liberation From Acute Dialysis (LIBERATE-D) Randomized Clinical Trial

Beta-Blockers after Myocardial Infarction with Normal Ejection Fraction

* Should Evidence Come with an Expiration Date?

No video this week — we had a bit of a computer meltdown — but two interesting articles.

As always, thanks for listening. If you have articles you would like us to cover, please send us a suggestion at [email protected].

This Substack is reader-supported. If you appreciate our work, consider becoming a free or paid subscriber.

In a lifetime of possible memories, only some are accessible. There are a few comments — made by mentors, co-residents, and patients — that have lingered and shaped my medical practice.

I was shocked at the comments on this post.

Many people, some of them I know to be smart, thought I was nuts for suggesting two middle-aged women who had isolated high LDL-C needn’t take meds because their calculated 10-year risk was less than 3%

What shocked me is that our guidelines suggest treatment with statins when 10-year risk is ≥ 7.5%. You may not know this but clinicians are supposed to consider cholesterol (and BP) based on overall risk, which include things like age, blood pressure, smoking status as well as HDL. Here is a link to t...

Medical Management and Revascularization for Asymptomatic Carotid Stenosis

Vagus nerve-mediated neuroimmune modulation for rheumatoid arthritis: a pivotal randomized controlled trial

We spent quite a bit of time talking about blinding. This is the table on the adequacy of blinding from the supplement. It does seem like blinding was less than perfect.

We try to answer the remainder of your AUA questions. We will be back in the new year with more article discussions!

Here are a few of the things we referenced.

GDMT Bugs Me: A bit of a rant against the standard of care

A Plan to Refocus Primary Care

Sacrificing patient care for prevention: distortion of the role of general practice

The Great Colonoscopy Debate

Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear

We cover questions from Amy J, Benjamin Hourani, Diana Stiles Friou, Chris Costas, Errol Laurie, Jim Healthy, Elizabeth Fama, Never Dull, Rod Rodriguez, Ellison Burns, David Araujo, and George.

We have more to come!

One nice reference I found while looking into some of the topics:

DMSO Is Not a Cure-All. But the FDA’s Panic Over It Birthed a Myth

Vascular and inflammatory diseases after COVID-19 infection and vaccination in children and young people in England: a retrospective, population-based cohort study using linked electronic health records

Comparison of an Initial Risk-Based Testing Strategy vs Usual Testing in Stable Symptomatic Patients With Suspected Coronary Artery Disease: The PRECISE Randomized Clinical Trial

European Study of Prostate Cancer Screening — 23-Year Follow-up

Association Between Baseline Diastolic Blood Pressure and the Efficacy of Intensive vs Standard Blood Pressure–Lowering Therapy

Further Reading

* Effects of intensive blood-pressure control in type 2 diabetes mellitus

* A Randomized Trial of Intensive versus Standard Blood-Pressure Control

Sensible Medicine is 100% reader-supported. If you appreciate our work, consider becoming a free or paid subscriber.