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.aspx


2 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 dyslipidemia


https://jamanetwork.com/journals/jama/article-abstract/2817700

As the authors suggest—my take away bottom line

These 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

Chair placement was not associated with a difference in patients’ ability to name their physician (P=1.0), ability to successfully identify their reason for hospital admission (P=0.82), or perceptions of time (P=0.2) (see supplemental table 5).

Overall if you put a chair at bedside and have medstudents following then yes a provider is more likely to sit down. However- this only minimally changes patient satisfaction score 3.9% on a 100 point scale. This would take hospital change. And set up change. This although touted as positive is a negative trial for those in HR and admin


https://www.bmj.com/content/383/bmj-2023-076309

primary outcome was Duration of the first stage of labor was the primary outcome.

AND It was 179 minutes shorter (95% CI 146 - 213) in the intervention group than in the control group (392 minutes; standard deviation [SD] 122 vs 571 minutes; SD 188). 

Intensity of pain, was reported on a visual analog scale of 0 to 10 at several points in time, was on average 2.0 to 2.7 points lower in the intervention group.

The absolute rate of cesarean delivery was reduced by 14 percentage points in the intervention group (26 vs 12; absolute risk reduction = 14; 3 - 25; number needed to treat = 7).

Main limitation here was that those in the intervention group were trained and had a professional physiotherapist with them at all times. This is not reasonable. 

https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1836955323001212?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1836955323001212%3Fshowall%3Dtrue&referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2F

In older adults, mildly elevated TSH levels normalized in about 50% of cases during 1 to 2 years of observation.



https://academic.oup.com/jcem/article/109/3/e1167/7325863?login=true

A study that was done before the widespread use of troponin only measurements for ACS (and certainly before high sensitively trop  EVER EXISTED), a trial that took place before the first statin was even FDA approved,  a trial that had no idea what DAPT was and took place PRIOR to the publication of the trial that would ultimately make aspirin post MI a standard of care, a trial that existed before a standard 90 minute door to balloon time.

As a reminder this trial (ISIS) didn’t demonstrate a huge mortality benefit despite all of the things that were missing from it that are now considered standard of care. The mortality number needed to treat was 143 (13.3% vs 14.0%) 


https://www.nejm.org/doi/abs/10.1056/NEJMoa2401479

This translates into an absolute excess risk of ≈9 events per 1000 person-years or 1 per 110 person years. Sad differently if you treat 110 people for 1 year with a doac and an SSRI you will have one more bleed that requires hospitalization or death than if there was no SSRI.

This  Risk was similar for various types of bleeding (e.g., intracranial, gastrointestinal) and did not vary with potency of SSRI.

In patients with strong indications for both drugs, the relatively small absolute excess risk might be acceptable. However, in patients for whom the indication for either the SSRI or the anticoagulant is marginal, the excess bleeding risk might be a reason to avoid prescribing both drugs together.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2816687