Questioning Medicine Questioning Medicine

https://www.acpjournals.org/doi/10.7326/M23-3225researchers randomized 160 patients with mostly unilateral hip OA to two 60-minute sessions weekly for 12 weeks,you were randomized to receive either neuromuscular exercise (NEMEX; focusing on postural and functional stability) or progressive resistance training (PRT; focusing on muscle strength).  primary outcome was the “chair stand test,” in which patients go from sitting to standing as many times as possible within 30 seconds. At 12 weeks, this outcome did not differ between the NEMEX and PRT groups; mean improvement in both groups was 1.5 repetitions (from a baseline of ≈11.5 repetitions). 1.5 repetitions did not meet anyones expections or criteria for clinically meaningful improvement.

adult smokers who are given e-cigarettes are significantly more likely to be abstinent at 6 months from a target quit date with a  (NNT = 8) but those individuals were not more likely to be abstinent from any nicotine product. In this study, the cost of e-cigarettes was paid by the study, so in the real world where patients have to buy their own e-cigarettes the results may be less favorable. The best nicotine replacement is the one the patient will actually use as the nnt is around 10 give or take for all of them.https://pubmed.ncbi.nlm.nih.gov/38354139/

However, screening is not recommended because it has not been shown to improve patient outcomes.. Lifestyle recommendations include moderating alcohol use, quitting smoking, exercising, and losing weight if obese. Good news: Coffee need not be restricted.The authors recommend using a risk score such as CHADS2-VASC to determine the patient’s risk of stroke; if the annual risk of stroke is between 1% and 2% anticoagulation should be considered, and if the annual risk of stroke is greater than 2% then anticoagulation is strongly recommended.For patients who are low risk ( 1%) — for example, younger than 65 years and without any risk factors for stroke — anticoagulation is not recommended. The guidelines also do not recommend aspirin or aspirin plus clopidogrel for these patients unless there is another indication, such as coronary heart disease.  With regard to the choice of anticoagulant, a standard dose of a direct oral anticoagulant (DOAC) is recommended over vitamin K antagonists like warfarin. The exceptions are patients who those with moderate to several mitral stenosis, and those with a mechanical heart valve.

https://journals.lww.com/ajg/fulltext/2024/03000/american_college_of_gastroenterology_guidelines_.14.aspx2 of the 3 following criteria: (i) abdominal pain consistent with the disease, (ii) serum amylase and/or lipase greater than 3 times the upper limit of normal, and/or (iii) characteristic findings from abdominal imaging Fluid--Moderately aggressive fluid resuscitation with lactated Ringer's solution should be started (NEJM JW Gen Med Oct 1 2023 and Am J Gastroenterol 2023; 118:2258), defined as a bolus of 10 mL/kg followed by infusion of 1.5 mL/kg/hour (NEJM JW Gen Med Oct 15 2022 and N Engl J Med 2022; 387:989), and additional boluses can be given if a patient has evidence of hypovolemia.Feeding-- Early oral feeding (within 24–48 hours) should begin with a low-fat solid diet (as opposed to liquid) for patients with mild AP.Surgery- Patients with mild acute biliary pancreatitis should undergo cholecystectomy early, preferably before discharge. Following a second episode of AP with no identifiable cause, in patients fit for surgery, we suggest performing a cholecystectomy to reduce the risk of recurrent episodes of AP.

Bottom line-Elevated cholesterol as a child into an adult is bad but we still don’t know if treating children with medication improves this badness but we can say if you have elevated cholesterol as a child and it resolves as an adult then that is a good sign and puts you at equal risk to someone who never had dyslipidemiahttps://jamanetwork.com/journals/jama/article-abstract/2817700

Weight gain 5 kg was not associated with risk for the composite outcome among women with class 1 and 2 obesity (BMIs, ≥30–39.9 kg/m2).Weight gain 5 kg and weight loss were associated with lower risk for the composite outcome, compared with recommended weight gain, in women with class 3 obesity (BMIs, ≥40 kg/m2; rate ratio, 0.81)As the authors suggest—my take away bottom lineThese findings suggest that a low amount of weight gain or weight loss is safe in pregnant women with obesity, and might even be beneficial for those with class 3 obesity.https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0140673624002551?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0140673624002551%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.jwatch.org%2F