iStock_000022542067_sizedCataract surgery seems to be almost a rite of passage among elderly people in the United States, with the procedure itself complicated by the sometimes endless round of preoperative evaluations and procedures some ophthalmologists require, even though a Johns Hopkins study done over 10 years ago clearly establishes both the safety of the procedure and the lack of benefit seen with additional testing preoperatively.  Now, as Rick and I discuss on PodMed this week, a study in the New England Journal of Medicine reiterates these facts and adds more to the the body of evidence.

Researchers took a random sample of 500,000 Medicare beneficiaries who had cataract surgery in 2011 and identified preoperative tests they underwent.  The results reveal an astonishing 53% had at least one preoperative test, with both costs relative to the testing and subsequent physician follow-up in the millions of dollars.  Even more revealing was the identification of a cohort of ophthalmologists who were ordering the overwhelming majority of preoperative testing, causing me to quip to Rick that perhaps now that we know who's doing it, just like the opioid prescribing docs in Florida, we can target interventions to get them to stop. In any case, Rick feels strongly that persons who are planning cataract surgery should cite safety statistics of a less than 1% rate of complications and just say no to preoperative testing.

Other topics this week include a look at gestational diabetes and offspring autism risk, and mechanical versus tissue valves for mitral valve replacement, both in JAMA, and back to NEJM for a novel target for lowering cholesterol.  Until next week, y'all live well.

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iStock_000012458973_LargeWhen it comes to heart health, taller is better, a study in this week's New England Journal of Medicine confirms, at least as far as coronary artery disease goes.  And as Rick and I discuss on PodMed this week, as tall people we're happy to hear it!  But a closer look at the study also reveals that the authors use 'genetic variants,' aka, single nucleotide polymorphisms or SNPs, already known to be associated with height or with coronary artery disease to define the association. That's a novel approach that may prove quite useful in nailing down other long-observed but not proven associations. It may prove fruitful in generating ideas on possible mechanisms whereby coronary artery disease risk and height are linked as well.  As I opine to Rick, of course, the study doesn't provide a target for intervention or lifestyle modification to reduce risk, so is somewhat limited in terms of practicability, but gets the gee whiz prize for this week.

Other topics include 2 studies on exercise intensity and mortality in JAMA Internal Medicine, sudden cardiac death and exercise in Circulation, and open versus microsurgical laminectomy in the BMJ along with surgery versus physical therapy in Annals of Internal Medicine.  Until next week, y'all live well.

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iStock_000016849937_LargeBrunis edwardii, as Rick reveals on PodMed this week, is more commonly known as the 'teddy bear,' and at least one of this species resides in the majority of households in the US.  Therefore, it is important to be familiar with conditions and diseases that may impact the bears, he opines, along with hearty wishes for a happy April Fool's Day!  Exact reference to this paper, published in 1972, found below.

On a somewhat more serious note, we also discuss whether an apple a day really keeps the doctor away, as published in JAMA Internal Medicine based on NHANES data.  And two more rigorous studies are also discussed: use of acetaminophen for low back pain, hip and knee osteoarthritis from the BMJ, and encouraging results from an Ebola vaccine candidate published in NEJM.  Until next week, y'all live well.

Some observations on the diseases of Brunus edwardii (Species nova)

DK Blackmore, DG Owen, CM Young

Veterinary Record 1972;90:14 382-385doi:10.1136/vr.90.14.3

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iStock_000022176290_MediumWho wouldn't want a chef to prepare their meals?  As Rick and I discuss on PodMed this week, I most certainly would, and I'm in agreement with denizens of public schools, who made healthy changes to their dietary choices when a chef got involved  in food preparation.  That's according to a study in JAMA Pediatrics, where a couple of thousand kids enrolled in 14 urban school districts were the beneficiaries of chef-inspired school lunches for a period of three months, or not. After this time period, an additional variable called 'food architecture' was also introduced, where strategic placement of food items to encourage purchase and consumption was attempted.  Lo and behold, after 7 months consumption of vegetables increased quite a bit, with the chef being the winning variable. Rick and I were both tickled to observe that the chef needed to be on board for a while before the students, and even teachers and administrators, adopted the new menu.

Other topics this week include treatment for macular edema and diabetic retinopathy in NEJM, stents versus medical therapy for prevention of recurrent stroke in JAMA, and exercise, vitamin D and falls in elderly women in JAMA Internal Medicine.  Until next week, y'all live well.

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iStock_000021636699_LargeIf you have blocked blood vessels in your heart, should you have them opened with stent placement or undergo coronary artery bypass grafting, abbreviated CABG, a much more lengthy and complicated process but which previous study has shown has more durable results than stent placement?  On PodMed this week, Rick and I examine that question again based on results of two studies in the New England Journal of Medicine with so-called 'second generation' drug-eluting stents that purportedly resist blockage formation and the need for additional procedures. Results indicate that there are risks and benefits to both treatments, with Rick of the opinion that these studies will assist caregivers and patients to make informed choices based on their personal preference, while I opine that the quest for the perfect stent continues.  No doubt there will be plenty more on this subject.

Other topics this week include cardiac screening in low risk patients in Annals of Internal Medicine, breast biopsy results in JAMA, and imaging for low back pain in older folks in the same journal.  Until next week, y'all live well.

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iStock_000017052299_LargeWhen an adult breaks a bone, 5 to 6% of the time it's the upper arm bone known as the humerus. Now a study in JAMA Rick and I discuss on PodMed this week shows that despite increasingly popular surgical management of the fracture, the good old-fashioned sling works just as well.  And that's in a group of people in whom the bone pieces are not in alignment, known as displacement, where the a priori hypothesis would be that getting those halves back in alignment would result in better outcomes.  Not so, by a variety of measures.  Including, perhaps most importantly, the patient's own assessment of treatment.

Other topics this week include liberal versus restrictive use of transfusions in patients undergoing cardiovascular surgery in NEJM, back to JAMA for transaortic valve replacement outcomes, and to JAMA Internal Medicine for the benefits of vegetarian diets on colorectal cancer risk.  Until next week, y'all live well.

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187541883Let's face it.  For most patients surgery is a nerve-wracking experience.  Enter then the practice of providing preoperative anti-anxiety medications to keep people calmed down before general anesthesia is employed.  But what of this practice?  Does it help or does it result in other outcomes that aren't desirable?  As Rick and I discuss on PodMed this week, that's the gist of a study in JAMA this week.  Basically the study shows that compared with either placebo or no medication, patients were no more satisfied with their experience when given lorazepam prior to surgery than either placebo or nothing.  They did however take longer to get off the ventilator and to recover cognitive function early.  Hmmm.  Sounds like the practice should be abandoned except perhaps in the very, very anxious, the only group who did seem to benefit in this study.  And as I comment in the podcast, this is a timely topic as factors that may end in delirium for elderly surgical patients are being scrutinized, and this may well contribute.

Other topics this week include improved air quality and growth of lungs in adolescents in NEJM, drugs to cope with shift work in JAMA, and the dangers of testosterone supplements per an FDA warning.  Until next week, y'all live well.

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GettyImages_464671264Should you begin exposing your infant to peanuts very early in life?  The answer may well be yes, even and especially if your baby is at risk to develop peanut allergy, a study Rick and I examine on PodMed this week  and published in the New England Journal of Medicine concludes.  How can babies at risk to develop peanut allergy be identified?  Turns out if they have the skin rash known as eczema, or have siblings or parents with the condition, this can be predictive.  Clearly parents will want to know about risk before exposing their infants, and skin testing may also help.  Finally, we conclude that peanut butter rather than whole peanuts may be the right vehicle, and Rick suggests that parents may want to attempt this in a physician's office so help is available if the baby has a reaction.  Since this is such a big and growing problem, seems like an 80% reduction in development of the condition is well worth attempting.

Other topics this week include pregnancy after bariatric surgery in the same journal, a report from the CDC and other federal agencies on common bugs and foods that cause food borne illness, and the risk of NSAIDs in those who've had a heart attack in JAMA.  Until next week, y'all live well.

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459903291Are electric fans any help in the prevention of overheating?  Rick and I consider that 'hot' topic this week on PodMed, and for me as well as my colleagues here in Baltimore, thinking of hot things is a welcome respite from the Arctic conditions outside!  The study is a small one published in JAMA, but shows that up to certain levels of humidity fans indeed help reduce increases in core temperature and sweating in subjects exposed to heat and humidity.  Surprisingly, this runs counter to the current public health notion that fans aren't helpful in these circumstances and may in fact be harmful.  Hmmm, as I opine in the podcast, good to have a cheaper alternative to AC or going to a shelter.

Other topics this week include steroid use in pneumonia and varenecline use in people who have doubts about quitting smoking, both in JAMA, and Fusobacterium as a common cause of sore throats in a group of teenagers and young adults, in Annals of Internal Medicine.  Until next week, y'all live well.

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200570995-001If you want to improve your health, even if you're an avid exerciser, you need to avoid sitting for prolonged periods of time, Rick and I discuss on PodMed this week.  That's according to a study in Annals of Internal Medicine, where irrespective of whether regular exercise was a part of the regimen, those who sat for prolonged periods experienced greater all-cause mortality as well as that from specific diseases.  Rick offers a number of practical ideas for getting moving in the workplace, which is, of course, where most of us spend a lot of time at the desk.

Other topics this week include a lack of benefit seen with bathing patients in the ICU with chlorhexidine daily, exciting results from an uncontrolled trial using stem cells in folks with multiple sclerosis, and lackluster results from intracytoplasmic sperm injection versus standard techniques for infertility. Until next week, y'all live well.

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