by Geoffrey Modest MD A recent review of the data from the Nurses’ Health Study and the Health Professionals Follow-up Study from 1998 to 2010 found that mortality tracks with changes in diet (see DOI: 10.1056/NEJMoa1613502). Details: — 47,994 women in the Nurses’ Health Study and 25,745 men in the Health Professionals Follow-up Study were assessed, correlating […]
Primary Care Corner: Initial orthostatic hypotension and adverse outcomes
by Geoffrey Modest MD Yet another article came out indicating that initial orthostatic hypotension, measured immediately after standing, had a strong association with dizziness as well as long-term adverse outcomes measurement (see doi:10.1001/jamainternmed.2017.2937). Details: — cohort study of 11,429 participants in the Atherosclerosis Risk in Communities Study (1987-1989) — mean age 54, 54% women, […]
Primary Care Corner: A new atherosclerosis risk calculator – QRISK3
by Dr Geoffrey Modest In prior blogs I commented in a not particularly quantitative fashion that it made sense to have a gestalt about how aggressive to be in coronary artery disease prevention (see https://stg-blogs.bmj.com/bmjebmspotlight/2014/05/09/primary-care-corner-with-geoffrey-modest-md-aha-lipid-guidelines-again/ or https://stg-blogs.bmj.com/bmjebmspotlight/2016/07/01/primary-care-corner-with-geoffrey-modest-md-migraine-and-heart-disease-in-women/ for example). The point was that the available atherosclerotic risk calculators did not include many conditions that confer increased risk, including such things as peripheral artery disease, chronic […]
Primary Care Corner with Geoffrey Modest MD: Prostatectomy not help for localised CA
by Dr Geoffrey Modest The 19.5 year follow-up of the PIVOT study (Prostate Cancer Intervention vs Observation Trial) confirmed their prior observations at the 12-year mark, showing that for men with localized prostate cancer, surgery was not significantly associated with decreases in all-cause or prostate cancer specific mortality (see Wilt TJ. N Engl J Med 2017;377:132). Details: — From […]
Primary Care Corner with Geoffrey Modest MD: Take the full course of antibiotics???
A recent BMJ analysis article argued that taking the “full course of antibiotics” is often likely counterproductive (see doi: 10.1136/bmj.j3418 ). Details: –international health organizations and the WHO have pushed for completing antibiotic regimens: a 2016 WHO advisory to patients stated “always complete the full prescription, even if you feel better, because stopping treatment early promotes the growth of […]
Primary Care Corner with Geoffrey Modest MD: PPIs and increased mortality
A large longitudinal study of US veterans found a 25% increased risk of death associated with proton pump inhibitor (PPI) usage (see doi.org/ 10.1136/ bmjopen-2016-015735). Details: — the researchers assessed three cohorts of patients, with 5.7 years of follow-up after the first acid suppression therapy prescription was written, and all patients had at least one outpatient serum creatinine […]
Primary Care Corner with Geoffrey Modest MD: Decreasing opiate prescriptions
by Dr Geoffrey Modest Some (likely) good news about prescription opioids from the CDC (see https://www.cdc.gov/mmwr/volumes/66/wr/mm6626a4.htm?s_cid=mm6626a4_w ). — Opioid prescribing in the United States between 2006 and 2015 peaked in 2010 at 782 morphine milligrams equivalents (MME) per capita then decreased annually to 640 MME per capita in 2015 — there was pretty striking variation by US county, from […]
Primary Care Corner with Geoffrey Modest MD: Dyspepsia guidelines
by Dr Geoffrey Modest The American College Of Gastroenterology and the Canadian Association of Gastroenterology updated their guidelines on the management of dyspepsia (see doi: 10.1038/ajg.2017.154) Recommendations (note: the recommendation is much weaker when they use the word “suggest” vs “recommend”): — they suggest endoscopy for dyspepsia patients greater than 60 years old: conditional recommendation/very low-quality evidence. […]
Primary Care Corner with Geoffrey Modest MD: Benzos may not increase mortality risk
Benzos may not increase mortality risk […]
Primary Care Corner: Decreasing sudden-death in heart failure
Decreasing sudden-death in heart failure […]