Sidney Wolfe writes in the BMJ - AllTrials - Selective clinical trial
reporting: betraying trial participants, harming patients
Reporting biases found in trials of cardiovascular devicesReporting biases in published trials were first identified in 1986.1 Published randomized studies of combination chemotherapy compared with treatment with an alkylating agent as first line treatment for ovarian cancer showed a significant survival advantage for combination chemotherapy. Unpublished cancer trial registry data from the same studies, however, showed no such advantage.2 Similarly, in the treatment of multiple myeloma, registry data suggested a smaller survival advantage for combination chemotherapy (over prednisone and an alkylating agent) tha...
Source: PharmaGossip - June 11, 2015 Category: Pharmaceuticals Authors: insider Source Type: blogs
Sidney Wolfe writes in the BMJ - AllTrials - Selective clinical trial reporting: betraying trial participants, harming patients
Reporting biases found in trials of cardiovascular devicesReporting biases in published trials were first identified in 1986.1 Published randomized studies of combination chemotherapy compared with treatment with an alkylating agent as first line treatment for ovarian cancer showed a significant survival advantage for combination chemotherapy. Unpublished cancer trial registry data from the same studies, however, showed no such advantage.2 Similarly, in the treatment of multiple myeloma, registry data suggested a smaller survival advantage for combination chemotherapy (over prednisone and an alkylating agent) tha...
Source: PharmaGossip - June 11, 2015 Category: Pharmaceuticals Authors: insider Source Type: blogs
Sidney Wolfe writes in the BMJ - AllTrials - Selective clinical trial
reporting: betraying trial participants, harming patients
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Source: PharmaGossip - June 10, 2015 Category: Pharmaceuticals Authors: insider Source Type: blogs
Sidney Wolfe writes in the BMJ - AllTrials - Selective clinical trial
reporting: betraying trial participants, harming patients
Reporting biases found in trials of cardiovascular devicesReporting biases in published trials were first identified in 1986.1 Published randomized studies of combination chemotherapy compared with treatment with an alkylating agent as first line treatment for ovarian cancer showed a significant survival advantage for combination chemotherapy. Unpublished cancer trial registry data from the same studies, however, showed no such advantage.2 Similarly, in the treatment of multiple myeloma, registry data suggested a smaller survival advantage for combination chemotherapy (over prednisone and an alkylating agent) tha...
Source: PharmaGossip - June 10, 2015 Category: Pharmaceuticals Authors: insider Source Type: blogs
I lost the wheat, but didn’t lose the weight: Updated version
Yes, it happens: Rid your life of all things wheat and you get relief from acid reflux, joint pain, and high blood sugars . . . but not weight loss.
While most people enjoy rapid and dramatic weight loss with wheat elimination due to the loss of the appetite-stimulating effect of gliadin-derived opiates, the loss of repetitive glucose-insulin provocation of amylopectin A, the reduction of inflammation from the combined effects of gliadin/wheat germ agglutinin/amylopectin A, and reversal of the leptin-blocking effect of wheat germ agglutinin, this doesn’t happen to everybody. Or you lose, say, 20 pounds, only to have...
Source: Wheat Belly Blog - May 7, 2015 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle carbohydrates gluten grains insulin low-carb Thyroid Weight Loss whey Source Type: blogs
Heather’s impressive Wheat Belly experience
Heather is catching on: the Wheat Belly wheat/grain-free lifestyle impressively reverses inflammation body-wide, evident in photographs of the face. While the coloring of Heather’s photos prevent us from seeing any reversal of facial redness, there has been an obvious reduction in facial puffiness/edema over and above that achieved with weight loss . . . though weight loss has also been quite impressive.
“Six weeks into Wheat Belly and 22lbs down! Inflammation is WAY down as you can see, energy is up, and the weight is melting away. Thank you!”
The conventional approach to “treating” inflamma...
Source: Wheat Belly Blog - April 21, 2015 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Success Stories facial changes gluten grains Inflammation Weight Loss Source Type: blogs
What the heck happened – the acid-base solved
Apologies for my delay in providing the answer – I’ve been too busy answering MOC tweets (db has a sly grin and declares BS on himself)
49-year-old man with DM type I diagnosed 25 years ago progressed to ESRD s/p renal transplant x 2, second 3 years ago, and gastroparesis with worsening post-prandial N&V * 3 months with abnormal labs.
Medications:
Insulin
Mycophenolic acid
PPI
Prednisone
Tacrolimus
134
106
47
241
4.7
9
3.4
albumin 4.4
Your questions:
1. What is the likely acid-base disorder – i.e., predict that ABG?
ABG: 7.25 / 20.9 / 123.0 / 8.8 on RA (A-a gradient = 1...
Source: DB's Medical Rants - March 19, 2015 Category: Internal Medicine Authors: rcentor Tags: Acid-Base & Lytes Source Type: blogs
MKSAP: 23-year-old woman with stiffness and achiness of the hands
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 23-year-old woman is evaluated for a 1-year history of morning stiffness and achiness of the hands as well as Raynaud phenomenon. Two months ago, she experienced a sun-induced rash on the chest and back and patches of discoloration on the hands.
On physical examination, temperature is 36.4 °C (97.5 °F), blood pressure is 106/66 mm Hg, pulse rate is 60/min, and respiration rate is 16/min. The lungs are clear. Erythematous, violaceous, clumped papules over the extensor surfaces of the elbows, metacarpophalange...
Source: Kevin, M.D. - Medical Weblog - February 28, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Rheumatology Source Type: blogs
Back to acid-base – what the heck is going on?
I have had several requests to provide some acid-base questions (seemingly a favorite topic). We discussed this patient at morning report recently.
49-year-old man with DM type I diagnosed 25 years ago progressed to ESRD s/p renal transplant x 2, second 3 years ago, and gastroparesis with worsening post-prandial N&V * 3 months with abnormal labs.
Medications:
Insulin
Mycophenolic acid
PPI
Prednisone
Tacrolimus
134
106
47
241
4.7
9
3.4
albumin 4.4
Your questions:
1. What is the likely acid-base disorder – i.e., predict that ABG?
2. Explain the likely etiology.
(...
Source: DB's Medical Rants - February 25, 2015 Category: Internal Medicine Authors: rcentor Tags: Acid-Base & Lytes Source Type: blogs
Drugs that block weight loss
Following the Wheat Belly lifestyle of wheat and grain elimination results in weight loss in the majority of people in short order.
But there are exceptions. The exceptions should not be interpreted to mean that this lifestyle does not work; it should initiate a search for why the weight loss effect of wheat and grain elimination is being blocked. Iodine deficiency, for example, is a common cause for failed weight loss, no matter how perfect your diet and how much you exercise.
Another common cause for failed weight loss are prescription drugs and a few over-the-counter drugs. Among the common drugs that will block your...
Source: Wheat Belly Blog - February 15, 2015 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle gluten grains prescription drugs Weight Loss Source Type: blogs
MKSAP: 72-year-old man with dyspnea at rest
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old man is evaluated for dyspnea at rest. He has end-stage COPD and is on a home hospice program. He has weight loss, reduced functional capacity, and muscle atrophy. His medications are ipratropium, salmeterol, fluticasone, albuterol as needed, and prednisone. He is uncomfortable, with chronic air hunger that has gradually increased over the past 2 weeks. Otherwise, his symptoms have been stable without change in cough, sputum production, or fever. Following a physical exam, what is the most appropria...
Source: Kevin, M.D. - Medical Weblog - February 7, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Pulmonology Source Type: blogs
Research and Reviews in the Fastlane 069
This study is an interesting step in analyzing the value of conference tweeting and, perhaps, ways in which Twitter can: (1)Provide feedback to speakers about how to present their messages clearly (2)Engage speakers to clarify or interact with twitter (3)Potentially disseminate messages more widely.Recommended by: Lauren WestaferRead more: Taking Conference Tweeting to the Next Level: From the Speaker’s Perspective (Emergency Medicine PharmD)Emergency MedicineShah K et al. Magnitude of D-dimer matters for diagnosing pulmonary embolus. Am J Emerg Med 2013; 31(6):942-5. PMID: 23685058We work up too many patients for...
Source: Life in the Fast Lane - February 5, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Education Emergency Medicine LITFL Pediatrics R&R in the FASTLANE Respiratory Social Media critical care examination Intensive Care research and reviews Source Type: blogs
MKSAP: 72-year-old woman with severe COPD
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old woman is evaluated during a routine examination. She has very severe COPD with multiple exacerbations. She has dyspnea at all times with decreased exercise capacity. She does not have cough or any change in baseline sputum production. She is adherent to her medication regimen, and she completed pulmonary rehabilitation 1 year ago. She quit smoking 1 year ago. Her medications are a budesonide/formoterol inhaler, tiotropium, and an albuterol inhaler as needed.
On physical examination, pulse rate is 9...
Source: Kevin, M.D. - Medical Weblog - November 1, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Pulmonology Source Type: blogs
MKSAP: 48-year-old man with urinary frequency
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 48-year-old man is evaluated during a follow-up visit for urinary frequency. He reports no hesitancy, urgency, dysuria, or change in urine color. He has not experienced fevers, chills, sweats, nausea, vomiting, diarrhea, or other gastrointestinal symptoms. He feels thirsty very often; drinking water and using lemon drops seem to help. He has a 33-pack-year history of smoking. He has hypertension, chronic kidney disease, and bipolar disorder. Medications are amlodipine, lisinopril, and lithium. He has tried oth...
Source: Kevin, M.D. - Medical Weblog - October 11, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Medications Nephrology Source Type: blogs
Research and Reviews in the Fastlane 050
This study compared bedside US by EPs vs radiology US vs CT as the INITIAL test in patients expected with nephrolithiasis. It found there was no difference in serious outcomes between the groups, but the rate of serious outcomes was overall very low.
Obviously patients that got only an US had lower radiation exposure and lengths of stay. But what is interesting is that 40% of patients with an initial ED US went on to get a CT also.
This study does not state that patients should ONLY undergo US, just that it should be the INITIAL test. If it cuts down on our CT ordering, it sounds like a good start. (Zack Repanshek)
Recomme...
Source: Life in the Fast Lane - September 29, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Clinical Research Emergency Medicine Infectious Disease R&R in the FASTLANE Radiology Resuscitation critical care Education Intensive Care literature recommendations Research and Review Source Type: blogs
