Doc my heart is racing—

Stop drinking—or so says this article in NEJM that found when they took 140 pts who severed from paroxysmal afib and who drank 17 drinks a week that when randomized to complete alcohol abstinence for 6 months there was significant reduction in afib recurrence.. how much of a difference?? 20% ABSOLUTE DIFFERENCE….. I have a rule of thumb that anytime someone says the improvement is any percent over 10% I almost always assume they are talking relative risk reduction, but this was 20% ABSOLUTE risk reduction. That is a NNT of 5. So when your patient says my heart goes piter pat pitter piter pat pat pat pitter what should I do, the answer is to stop drinking. Now let me grab a sip of bourbon and onto the next article.


DOC there is a puddle on the floor..
https://journals.lww.com/optvissci/Fulltext/2020/07000/Validation_of_a_More_Reliable_Method_of_Eye_Drop.7.aspx

Tell them to close their eyes or so say this article in optometry and vision science that had 30 pts and on one visit, eye drop were placed by a trained clinician, and on the other, patient placed eye drops. The Intraocular pressure was measured before drop instillation and 2 hours after drop instillation.

I know this doenst sound like a big deal but the clinician eye drop test was exactly as it sounds- open your eye and let me drop in the eye drop. The patient drop was different and awesome

for patient self-administration of an eye drop, one in which the lids of the eye that is receiving the drop are closed at the time of administration.

An eye drop placed anywhere over the medial area of a gently closed eyelid with the theory being that the eye drop will fall into the naturally occurring anatomical funnel and right into the eye. Basically the most midline part of the the eye, the part right next to the nose has a little opening and the eye drop should just funnel right in there or at least that was the theory


THE RESULTS

An average reduction in intraocular pressure was 3.75 ± 2.36 mmHg was found with clinician administration, and an average reduction of 3.32 ± 2.31 mmHg for closed eyed patient administration.

THERE WAS NO DIFFERENCE intraocular pressure!!! AMAZING!!

THIS IS BRILLIANT—larger trials are needed but for me this is all the evidence I NEED. I hate hate hate hate trying to put I drop in my eye. I feel like I waste the whole bottle
In a recent report, a glaucoma specialist reviewed videotapes of 300 patients trying to self-administer eye drops using the traditionally taught method. It was concluded that patients released an average of seven drops before they felt confident that one had hit the eye

So when your pt says there is a puddle on the floor, its from their eye drops, just have them close their eyes

Doc I have pain---

Take turmeric. Or at least says this trial annals of internal medicine that took 70 adults with painful knee OA and randomized them to turmeric 1000mg daily or placebo for 12 weeks. The primary outcomes was change in knee pain on a 100 point visual analog scale. Those randomized to turmeric saw a 24 point reduction while those in the placebo saw a 15 point reduction. The difference between a 24point reduction on a 100 point scale and a 15 point reduction on a 100 point scale is statistically significant. And if you listen to questioning medicine at all you might expect me to say this is not clinically significant and the real difference between the active arm and the control arm is the difference between 24-15= 9.

BUT this is game changing or at least I think it should be because the harms of 500mg of turmeric twice a day is almost nothing that I think it is worth prescribing for a 2 and a half point change on a 10 point scale. If you can get a pt with a pain score of 7 down to 4.5 just by prescribing turmeric that is a win and while it is not much better than placebo, sadly we am not allowed to write for placebo and have an pharmacist fill the script so until that happen. Turmeric 500mg bid for knee OA pain.


https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770959

Incidence, Characteristics, and Outcomes of Interval Breast Cancers Compared With Screening-Detected Breast Cancers

Invasive breast cancer is associated with a higher mortality rate than cancer detected during a routine screening mammogram—

70,000 women in Canadian health registries

Roughly 700 breast cancers were detected on screening, 200 were detected in the 2-year interval after a normal screening mammogram. Which means 500 were detected outside the screening program.

The bad high grade cancers were way way more likely to be an interval cancer odds ratio of 6.33!! that is huge!!! And terrible!! Right??

Of course it is bad—because when you looked at 7 yr follow up for breast cancer specific death you were also more likely to die with hazard ratio of 3.55


Authors say, "Improvement of breast cancer deaths and overall population mortality requires strategies above and beyond conventional screening mammography."

Rabbits, turtles, birds are all in a cage….its a small cage on 10 foot by 10 foot but no roof…..(go on to explain)

We want to catch the rabbits

If it is an interval cancer that means it is growing so fast it is a bird. It is flying away! Of course that is a worst outcome





It is often joked that size matters and clearly seen in this article

Waist Circumference Change During Intensive Lifestyle Intervention and Cardiovascular Morbidity and Mortality in the Look AHEAD Trial
https://onlinelibrary.wiley.com/doi/full/10.1002/oby.22942?af=R

this secondary analaysis of the look AHEAD trial sough to find the association between change in weight and waist circumference (WC) and CVD outcomes. They found that size matters and particularly waist size.
They found that “participants with increased WC had increased risk of cardiovascular outcomes, regardless of weight loss (hazard ratio: 1.55 [95% CI: 1.11‐2.17]) or weight gain (hazard ratio: 1.76 [95% CI: 1.07‐2.89]),”
In the analysis of 4590 individuals, 2840 had reductions in both weight and waist, 782 individuals had increases in weight and waist, but that only accounts for 79% of the sample. Which means 21% or one-fifth of participants had discordant responses in weight/waist. Lost weight but gained waist or gained weight but lost waist but the individuals who gained waist were in the big trouble regardless of the what scale said. So I guess its true, size matters, your waist size