Primary Care Corner with Geoffrey Modest MD: New vs old OCPs and thromboembolism

By: Dr. Geoffrey Modest The BMJ just published a large analysis of the relationship between combined oral contraceptives OCPs and the risk of venous thromboembolism VTE (see BMJ 2015;350:h2135). They analyzed 2 nested case-control studies from 2 different UK databases, with a combined input from 1340 general practices, assessing the first diagnosis of VTE in women aged 15-49 from 2001-2013, and comparing […]

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Primary Care Corner with Geoffrey Modest MD: Melanoma increasing (a lot)

By: Dr. Geoffrey Modest MMWR just released an analysis of melanoma incidence, mortality trends, and projections in the US from 1982-2030 (see here). Melanoma is common (5th most common cancer in men and 7th in women) and is associated with the most skin cancer deaths, with deaths occurring most frequently in younger people (average of 20.4 years of potential life lost). Costs […]

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Primary Care Corner with Geoffrey Modest MD: Mass med society opioid prescription guidelines

By: Dr. Geoffrey Modest The Massachusetts Medical Society just sent out guidelines on opioid therapy prescribing (see here).  A brief summary: –most of the guidelines are pretty self-evident: –for initiation of opiates: screen the female patients for pregnancy (and counsel re: risks) –do some form of screening for risk of opiate abuse [i would add that […]

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Primary Care Corner with Geoffrey Modest MD: Bridge therapy for patients on warfarin and invasive procedures

By: Dr. Geoffrey Modest  A pretty common primary care conundrum is what to do with patients who are on warfarin but have impending surgery: stop the warfarin and hope they don’t get a pulmonary embolus, or do bridge therapy (there are several different ways to do the bridging: for those at high risk of venous […]

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Primary Care Corner with Geoffrey Modest MD: Prednisone for acute sciatica

By: Dr. Geoffrey Modest JAMA just had an article on the utility of oral steroids in patients with acute sciatica (see JAMA. 2015;313(19):1915-1923). The goal of this study was to see if short-term oral prednisone was effective in improving disability and pain, as well as decrease the need for invasive procedures. Details: –randomized controlled trial […]

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Primary Care Corner with Geoffrey Modest MD: H. pylori and NSAIDs = increased GI bleeding

By: Dr. Geoffrey Modest A recent Spanish study looked at the risk of peptic ulcer bleeding in patients with H Pylori (HP) infection and in patients also using NSAIDs/low-dose aspirin (see Am J Gastroenterol 2015; 110:684–689). This case-control study looked at 666 patients with endoscopically-confirmed major peptic ulcer bleeding and 666 controls (matched by age, sex, month of admission), assessing medication use […]

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Primary Care Corner with Geoffrey Modest MD: Low risk chest pain, dangerous to admit

By: Dr. Geoffrey Modest A prospective observational study looked at a large number of low-risk patients admitted for chest pain and their outcomes (See doi:10.1001/jamainternmed.2015.1674). Data was collected from July 2008 until July 2013 from the emergency depts (EDs) of  3 academic mid-Western US hospitals. Details: –45,416 patients were seen for chest pain, and 22,457 (49.5%) were admitted, of whom 11,230 met inclusion criteria of: primary presenting […]

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Primary Care Corner with Geoffrey Modest MD: Lung ultrasound to diagnose pneumonia?

By: Dr. Geoffrey Modest An Italian prospective study was just published looking at the merits of ultrasound in diagnosing pneumonia (see Am J Emerg Med 2015 May; 33:620.). Prior studies have found that chest xray (CXR) is not so sensitive, 43.5% in one study when compared to chest CT (which is considered the gold standard). […]

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Primary Care Corner with Geoffrey Modest MD: SGLT2 inhibitors for diabetes may cause ketoacidosis

By: Dr. Geoffrey Modest  The FDA just came out with a warning on the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors, including canagliflozin dapagliflozin, and empagliflozin (and the combo drugs including them) because of 20 cases of ketoacidosis. these drugs lead to increased urinary excretion of glucose, thereby lowering hemoglobin A1C. see here for the press release. findings of FDA:  –from March […]

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