Episode 200: 200. COVID 4th Vaccine, Vitamin D, Statin

Episode 200: 200. COVID 4th Vaccine, Vitamin D, Statin

Association of Receipt of the Fourth BNT162b2 Dose With Omicron Infection and COVID-19 Hospitalizations Among Residents of Long-term Care Facilities | Geriatrics | JAMA Internal Medicine | JAMA Network


careful what you believe and always question medicine- even if it is about covid vaccine

Use and Cost of Low-Value Health Services Delivered or Paid for by the Veterans Health Administration | Cancer Screening, Prevention, Control | JAMA Internal Medicine | JAMA Network

low value care exist in the VA but also in the community-- you need a comparative arm to figure out how bad you are doing or good you are doing.

Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults | NEJM

You can also check a level if you are trying to make the diagnosis of rickets. ELSE no need to check anyone, if you really believe in it or your patient really believes in in then just start 2000IU and continue to take as long as they feel indicated because it likely is not doing any benefit but realistically it is not doing any harm at that dose either (there has been harm seen at super high doses 50,000IU)


listener question---- My question is what is the smallest doses statin I need to convince patient to take to benefit.

For me the answer is that yes high dose is better than moderate dose for those needing secondary prevention, but any dose is better than no dose for both primary and secondary prevention. If the patient isn’t taking the medication it doesn’t matter how good the drug is so ultimately if they are very serious about their risk reduction then go ahead and try and push higher dose statin else just take any dose the patient is willing to take and be happy they are you getting some sort of risk reduction that drastically beat ‘nothing’/placebo.


Episoder(386)

Episode 376: 387. Methods Monday and an Example of Subgroup Analysis

Episode 376: 387. Methods Monday and an Example of Subgroup Analysis

https://www.nejm.org/doi/full/10.1056/NEJMoa2405923?query=clinical-medicine Mineralocorticoid receptor antagonists have been shown to reduce mortality in patients after myocardial infarction with cong...

17 Mar 20258min

Episode 375: 386. Could half dose anticoagulation be the answer?

Episode 375: 386. Could half dose anticoagulation be the answer?

Estimated 5-year incidence of recurrent VTE was similar in the reduced-dose and full-dose groups (2.2% and 1.8%). Estimated 5-year bleeding incidence was significantly lower with reduced-dose than wi...

14 Mar 20258min

Episode 374: 385. PRACTICE CHANGER! Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis

Episode 374: 385. PRACTICE CHANGER! Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis

https://www.nejm.org/doi/full/10.1056/NEJMoa2405404NNT of 4! systemic metronid and topical clinda bid for one week

12 Mar 20256min

Episode 373: 384. Chronic Kidney Disease and Empagliflozin Legacy Effect

Episode 373: 384. Chronic Kidney Disease and Empagliflozin Legacy Effect

What Was Studied?The EMPA-KIDNEY trial followed 6,609 CKD patients at risk of disease progression. Participants were randomly assigned to receive empagliflozin (10 mg daily) or a placebo for a median ...

11 Mar 20259min

Episode 372: 383. What is the GFR at which we stop metforin?

Episode 372: 383. What is the GFR at which we stop metforin?

Metformin while not necessarily first line therapy for diabetes depending on the patients co-morbid conditions it is certainly highly ranked on the list of medications! I know often metformin is stopp...

6 Mar 202510min

Episode 371: 382. Is it safe to give the flu and covid vaccine at the same time?

Episode 371: 382. Is it safe to give the flu and covid vaccine at the same time?

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2825813Conclusions and Relevance  In this randomized clinical trial assessing simultaneous vs sequential administration of mRNA COVID-19 an...

4 Mar 20257min

Episode 370: 381. Relative efficacy of prehabilitation interventions and their components

Episode 370: 381. Relative efficacy of prehabilitation interventions and their components

https://www.bmj.com/content/388/bmj-2024-081164systematic review and meta-analysis on prehabilitation before surgery, published in the BMJ in February 2025.Prehabilitation aims to prepare patients for...

27 Feb 20257min

Episode 369: 380. REPOST mammo part 2

Episode 369: 380. REPOST mammo part 2

Mammograms

24 Feb 202520min

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