By: Dr. Geoffrey Modest There have been a few articles in the past years which have questioned the utility of steroid joint injections. One recent one looked at knee injections in patients with osteoarthritis (OA) to see if injections improved outcomes in those about to enroll in physical therapy (see doi:10.1001/jamainternmed.2015.0461). Details: –100 patients (61% female, mean age 63, BMI […]
Category: Archive
Primary Care Corner with Geoffrey Modest MD: Prescribing buprenorphine in the emergency room
By: Dr. Geoffrey Modest A recent study tested the hypothesis that it might be useful to initiate buprenorphine/naloxone treatment in the emergency room for patients with opioid dependence (see JAMA. 2015;313(16):1636-1644). Details: –329 opioid-dependent patients coming into a large urban teaching hospital emergency department in New Haven CT (mean age 31, 76% men, 75% white/7% black/16% hispanic, 41% high school grads/41% […]
Primary Care Corner with Geoffrey Modest MD: Placebo genetics and the “placebome”
By: Dr. Geoffrey Modest -A new article just came out of the Program in Placebo Studies in Boston that link the “placebo effect” to specific genes in the newly-defined “placebome” (see here), also noted in a more popular forum. Background, promoting the concept that placebo effects are legitimate biological responses to environmental cues: –studies on placebos have […]
Primary Care Corner with Geoffrey Modest MD: Sitagliptin — more drug company shenanigans.
By: Dr. Geoffrey Modest The preliminary results of the TECOS trial (Trial Evaluating Cardiovascular Outcomes with Sitagliptin) was just released by the drug company (Merck), though formal release is expected in June at the Am Diabetes Assn meeting (and, I do not have an advanced copy to critique in detail). This issue takes on added importance since […]
Primary Care Corner with Geoffrey Modest MD: MMR vaccination and autism, again
By: Dr. Geoffrey Modest Yet another study on the relationship (or lack thereof) between MMR vaccination and autism. I bring this up since this is a large study but includes kids at higher risk of autism (see JAMA. 2015;313(15):1534-1540). This is a retrospective cohort study from a large health insurer (Optum) database, using claims data (the insurer is […]
Primary Care Corner with Geoffrey Modest MD: Dolutegravir and lipids
By: Dr. Geoffrey Modest Several of the HIV drugs are associated with adverse lipid effects, as well as metabolic (eg, insulin resistance/diabetes) and cardiovascular complications. A recent study looked at the effects of dolutegravir (an integrase strand transfer inhibitor, INSTI) on cholesterol ( see Clin Drug Investig (2015) 35:211–219). In this analysis they looked at 4 clinical trials of Rx-naive patients put on […]
Primary Care Corner with Geoffrey Modest MD: Guideline on treating first seizure
By: Dr. Geoffrey Modest The Am Acad of Neurology and Am Epilepsy Society just released an evidence-based guideline on the management of an unprovoked first seizure in adults (see Neurology. 84;16: 1705-1713). Background: in the US, there are 150K adults annually who have a first unprovoked seizure, defined as a seizure (sz) of unknown etiology, or a […]
Primary Care Corner with Geoffrey Modest MD: USPSTF breast cancer screening recommendations
By: Dr. Geoffrey Modest The US Preventive Services Task Task Force just published a draft recommendation for breast cancer screening in women after age 50 (see here), as follows. For women 50-74 years old, screening mammography every 2 years, grade B recommendation (moderate certainty that there is net benefit): –meta-analysis suggests that screening 10,000 women age […]
Primary Care Corner with Geoffrey Modest MD: E-cigarettes
By: Dr. Geoffrey Modest So, no great surprise. E-cigarettes are taking over our youth… The latest MMWR reviewed tobacco use in middle and high school students in the US, from 2011-2014, revealing profound changes (see here for full MMWR report). In brief: –the CDC and FDA reviewed data of trends in current tobacco use (defined as: use […]
Primary Care Corner with Geoffrey Modest MD: PCSK9 inhibitors and general observations
PCSK9 inhibitors and general observations […]