132. COVID, Hydroxychloroquine, Afib Ablation, Influenza Vaccine Notification

Covid info
https://melwy.com/blog/lancet-paper-on-chloroquine-is-overhyped-real-world-data-should-not-be-a-black-box


So I couldn’t miss the largest observational study published to date on the effects of (hydroxy-)chloroquine, in 96 032 hospitalised Covid-19 patients, from an international registry comprising 671 hospitals in six continents:
Surgisphere is the company that put it all together is in the end it showed not only no benefit with hydroxychloriquine but also possible harm!



No transparency- they dont really say how they got their data and wont release how they got there data and no review. Lancet being this all great academic journal wont mention or say who did peer review on this article. WHAT! one of the beliefs is Lancet editor-in-chief Richard Horton. Let it slip through the cracks cause he doesnt like trump. This is well known he doesnt like trump but then to intentionally release a bad or falsified study that disagrees with a drug that president trump has openly supported is just crazy!


https://www.bmj.com/content/369/bmj.m1435

Nalaxone is used to treat opiod overdose.
Nalaxone can save lives- we all know that but you have to give it early because and it has to be easy to use
What if we made it over the counter!!?? That would be awesome!!
But in order to be available over the counter you have to have easy instructions like with motrin 1-2 pills every 6 hours not to exceed 10 pills in 24hrs. but how to do you write instructions for the common man for naltrexone—I had never thought of this will they did it in this study

FDA Initiative for Drug Facts Label for Over-the-Counter Naloxone


They asked 710 particpants what the instructions meant and
Primary end points in our study corresponded to participant understanding of the key steps in naloxone administration as depicted on the label.
The label was very easy for a medical professional, thinks like check to see if they respond. Give medication, call 911 immediately, stay with patient till EMS arrives. and mainly eveyrone got all the details correct and would only mess up because when tested on it they would say call 911 and not call 911 immediately.

“Overall, the FDA found that the model label was adequate for use in the development of a naloxone product intended for over-the-counter sales.”

I think this is great news cause the medication should be over the counter it is easy as not everyone who does opiods gets it from a provider but they should have easy access to the reversal medication just incase the street pill is stronger than they thought.
https://www.nejm.org/doi/full/10.1056/NEJMsa1912403?query=primarycare-hospitalist

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2765248
some people need reminders- not me! You can ask my wife, I always so everything the first time I am asked and never leave my shoes in the middle of the room but that is not the case for everyone and this is no more clearly seen than in this study

Effect of Patient Portal Reminders Sent by a Health Care System on Influenza Vaccination RatesA Randomized Clinical Trial

randomized clinical trial of 164 205 patients served by 52 primary care practices look to see if reminders sent through a patient portal increase influenza vaccination rates

Patients were randomized within primary care practices to 1 of 4 study groups (no reminder [n = 41 070] vs 1 reminder [n = 41 055], 2 reminders [n = 41 046], or 3 reminders [n = 41 034]).
The primary outcome was receipt of 1 or more influenza vaccines as documented in the electronic health record,
37.5% for those receiving no reminders,
38.0% for those receiving 1 reminder (P = .008 vs no reminder),
38.2% for those receiving 2 reminders (P = .03 vs no reminder),
38.2% for those receiving 3 reminders (P = .02 vs no reminder).

It appears you don’t get a lot of bang or your back with the extra reminders and just like those annoying postal cards from bath and body that I get in the mail most of these notifications are ignored and trashed

SO even though the gain was very minimal .07% overall which was the difference from 37.5% to 38.2% this did reach stastical significance and the rate of arm is almost nonexistent so I am all for it especially as this can be automatically implemented into the EMR and doesn’t require any human work on the part of the pts.



I am too poor to buy this twice- the same cant be said about ablation

Mansour M et al. Persistent atrial fibrillation ablation with contact force sensing catheter: The prospective multicenter PRECEPT Trial. JACC Clin Electrophysiol 2020 May 8; [e-pub].

381 patients with persistent AF;

Efficacy, defined as freedom from any documented 30-second AF episode, was 62% at 15 months; (so basically 40% still had AF at 15months BUT
freedom from AF symptoms was 80% at 15 months. Meaning that even though 40% still had afib 20% of those individuals said, I know I am still having afib but I don’t have any symptoms. The annoying part is this is not randomized the pt. knows they get a very invasive procedure just pure placebo their symptoms will resolve especially when the symptoms are subjective things like ‘palpitations’- my other problem is when you look at the characteristics the avg chadsvasc was 2!!!! 65yr old and 2!!! That is like you are a 65 yr old male with htn and no diabetes, no previous stroke, no heart failure.. This is not my pt. population. AND
Repeat ablations were performed in 14%. – remember still 20% of individuals were in afib and had symptoms. So why isn’t this number 20% of people had repeats?

The adverse event rate within 1 week was 3.8%, which included cardiac tamponade in 1.5%, stroke or transient ischemic attack in 0.6%, diaphragmatic paralysis in 0.3%, and vascular complications in 0.9%.

If you are having a lot of symptoms of if you have severe heart failure with afib then I think there is likely benefit to ablation else you are undergoing an invasive procedure with risk so tred lightly – especially when it only works on semi health chadsvasc score of 2 individuals just over half the time. The old saying is correct “if you go to an ablation once you go to an ablation twice”