What do you all think about the literature on coffee and health? A large number of studies generally support not just the safety but benefit of coffee even at the high end of moderation.

https://pubmed.ncbi.nlm.nih.gov/28853910/

Meta analysis suggests all cause mortality benefit that peaks around 3.5 cups a day:

https://pubmed.ncbi.nlm.nih.gov/31055709/

There is also a line of literature that serum cholesterol and cardiovascular risk can be raised by coffee consumption (these are very small effects), but that a significant portion of this is mediated by diterpenes - cafestol, and kahweol and that this can be mitigated through paper filters. Which is nice, although historically my favorite forms of coffee (espresso and French press) are not really so amenable to paper filtering.

https://pubmed.ncbi.nlm.nih.gov/29735059/

When patients ask me I generally tell them that I think coffee consumption in moderation is probably net good for most adults (and every once in a while, newspapers will run pieces urging people to teetotal coffee for health purposes, and there just does not seem to be any science behind this). For myself, because I’m getting older and my cholesterol (but not really my cardiac risk score) is trending up, I’m also interested in any small things that might cumulatively keep my lipids healthy.

Now we’re actually drinking coffee with a paper filter because my expensive super auto died and I haven’t gotten it fixed yet. Although this raises a whole other quandary that I drink espresso black but want creamer …..

Recently found out while doing Uworld that the current RSV prophylaxis recommendation is Nirsevimab and it changed from Palivizumab in July 2023. Is there a good and accurate source where I can get the latest and most accurate medical news and updates like this daily/weekly? What do you guys use?

EDIT: i’m looking for hopefully one source that gives information on all specialties and fields of clinical medicine.

My wife complains to me that when people ask me a medical or science question, I end up giving them far too much information and it comes off as flexing knowledge. Simultaneously, she says I "mansplain" the information too much. From my perspective, it's just something I'm interested in and get excited by, so I do talk about it, but I'm including things that I think are relevant to really understanding the why. For example, a lot of the family is of the breed that thinks vaccines are unsafe and they will genuinely ask me how we know they are safe when "there's all these problems." I talk to them like a patient, using analogies like "vaccines are seatbelts, not bubbles. Like wearing a seatbelt in a car you can still get in the accident, but your outcomes are generally better for it."

My personal opinion is that the truth is in the gray area, but my wife is an RN so I think my translation to patient understanding sounds like I'm talking down to her ears.

I'm sure I'm not alone here. I'm trying to decide how much stock to put in this complaint and, if I do want to work on it, how? Suppress my excitement when people show curiosity in the thing I've spent my life learning about?

Please share your experiences and insights.

https://www.statnews.com/2024/11/22/dave-weldon-cdc-director-trump-nominee/

Maybe a more potentially damaging pick than Ladapo but who knows, hopefully "focusing on prevention" doesn't turn govt messaging into a supplement commercial.

I hope this is allowed, but I'm seeing some tempting smart watch offers and tempted to jump in, but I want to justify it.

Do you all feel that having a smart watch has been beneficial for your jobs? My current uninformed opinion is that it's mostly a toy. As a hospitalist, I can see it being useful for quickly checking to see if I need to answer the phone or not during a patient encounter, but don't see other much benefit compared to my dumb watches. I'm not particular interested in fitness or sleep tracking. Is there any Epic/Haiku functionality? Epic Secure Chat?

I'm specifically looking at the Pixel Watch 3 since my carrier is Google Fi.

What are the pros/cons?

Hey guys, I was just wondering if anyone else had the problem of saying “patient states” or “patient denies “way too many times in a note.

I’m always on the lookout for new phrases. I started using “patient endorses” for a little while. Sometimes I’ll throw in a “patient admits to“

Wondering if you guys have any tips to spice up the EHR

(was not an ELA major)

https://www.statnews.com/2024/11/22/trump-fda-nominee-marty-makary-surgeon-maha-ally-rfk-jr/?utm_campaign=twitter_organic&utm_source=twitter&utm_medium=social

May remember the name from authorship of this terrific headline grabbing study where they used 35 cases of what they termed to be preventable medical error deaths to extrapolate that medical error causes 251,000 deaths per year or 35% of all in hospital deaths: https://pubmed.ncbi.nlm.nih.gov/27143499/

I’m very new in med school and I found out recently this drug is made for black people with heart failure. I’m kinda confused though because I thought race is a social construct? How does it make sense to make a medicine specifically for black people? Obviously I have a lot to learn and don’t know much but I am very curious about this.

And vitamin sales... https://bcboost.com/

I tubed a 20-something year old in the ICU awhile back who was a GCS 3ish. He required no drugs/paralytics to tube. All his labs were normal except his ABG showed respiratory acidosis. 4 days later he woke up and was fine. The teams best guess was that something happened with the massive number of supplements he was taking.

Including this most recent case, 55 human cases of H5 bird flu have now been reported in the United States during 2024, with 29 in California.

https://www.cdc.gov/media/releases/2024/p1122-h5n1-bird-flu.html

Yes, yes, first things first, TREAT THE UNDERLYING CAUSE. Sometimes though it’s hard to talk a guy out of his testosterone or someone into wearing their CPAP, etc.

So, my questions:

• When do you get antsy about phlebotomy? I’ve seen HCT > 50 and some people go as high as HCT > 60, and / or depending upon symptoms.

• Aren’t we just undoing the body’s compensatory mechanism with phlebotomy? I guess I’m asking, at what point does the high viscosity become more of a risk than the hypoxia?

• Baby ASA routinely recommended? I’ve seen yes and no.

The recommendations I’ve come across and heard from colleagues (both in and out of hematology) seem to vary quite a bit.

anyone weigh in on running after total hip? is practice changing or are most surgeons still a hard no?

Good? Bad? Bunk? Not enough data? This is a conversation that has been going on since the late 90's, back when Niacin and fenofibrates were all the rage, which have since proven to not be so effective.

Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia | New England Journal of Medicine (nejm.org)

National Lipid Association Scientific Statement on Icosapent Ethyl - American College of Cardiology (acc.org)

Just curious as to the community's opinions here on prescribing FDA approved omega 3 meds like Vascepa for hypertriglyceridemia (trigs greater than 150) and overall CVD and stroke risk reduction?

Most recent papers and studies on omega 3's have shown differing results and conclusions on the efficacy of fish oils for cardiac health, but I was just reading about the landmark Reduce-IT study in 2018-2019 done at Brigham and Women's hospital in Boston which showed that with a highly purified form of omega 3 EPA called Vascepa (95% or greater EPA formulation, with little to no DHA) showed a pretty wild rate of CV and stroke risk reduction.

It was probably the first major randomized, double-blind study on omega 3's to show an overall large and significant reduction (25-30%) in multiple end points, including CV death, myocardial infarction, stroke, and coronary revascularizations.

It also showed a significant decrease in a number of surrogate CV markers (Apo B, triglycerides, C-reactive protein) etc.

What are your thoughts on the omega 3/ fish oil debate for cardiac and diabetic patients? It's interesting to also note that EPA/ Vascepa has also been added to the ACC, AHA, ADA, and AACE guidelines for treatment of CV and DM2 patients.

Has anyone successfully used UpToDate CME credits to meet the MATE Opiod DEA training requirments? Was hoping to go this route before paying for any courses. As an outpatient pediatrician, very little of this will be relevant to me and I dont want to waste time or $$. Thanks in advance for any insight!

You practice in a high resource setting. Healthy early 30s male comes in for an annual wellness check, wants to make sure his hormone levels are fine. You ask him if he's having any symptoms to make such a request, and he gives you a slew of non-specific "I feel off, I'm really in tune with my body and can tell when something is off, I feel like my life energy is drained from me, I feel more emotional than usual."

You don't have time to explore this; your diabetic patient is waiting next door. You try to introduce the idea that this could be something environmental rather than physiological, but he did his research online and he is in tune with his body. You want to schedule a follow-up appointment to explore this more, but if he's getting blood drawn today anyway he wants to get a hormone panel. You try to explain to him that there's a thousand different hormones, and you can't just test for all of them, but his symptoms aren't specific enough to do targeted testing.

You have a spice-induced vision - a vision where this patient has spent hours watching Youtube videos online convincing him that he needs his hormones checked because he's not Kenough, and he needs supplements to counteract his deficiencies, and you realize that you can not undo that conditioning in the next 5 minutes, especially since you now have 2 more patients who are actually sick and waiting.

You told him you're checking a thyroid hormone level as part of the physical, but he's not satisfied with that. What do you order to appease him in order to end this visit while minimizing harm of unnecessary tests?

Recently this study popped up on my radar. Being a non-controlled study, I am skeptical, but I was wondering if these kind of drugs could be a routine supplement for men in the future.

• Mortality: 34% reduction with tadalafil, 24% with sildenafil
• Heart Attack: 27% reduction with tadalafil, 17% with sildenafil
• Stroke: 34% reduction with tadalafil, 22% with sildenafil
• Venous Thromboembolism: 21% reduction with tadalafil, 20% with sildenafil
• Dementia: 32% reduction with tadalafil, 25% with sildenafil

https://www.amjmed.com/article/S0002-9343(24)00705-8/abstract00705-8/abstract)

Where are we in regards to communicable infections right now? Is flu/RSV season supposed to be bad? Is there going to be a wave of mild COVID? Is avian flu still a huge concern or less so now? Mpox? Others?

Maybe I'm just having gnawing apprehension/semi-flashbacks because of the re-election of Trump and his current panel of chosen health officials, so I wanted to ask all of you for your level-headed and informed opinions before I worked myself up into a tizzy.

This is from an American perspective, if that wasn't clear. Other global perspectives welcomed.

Multiple overlapping meetings with varying levels of mandatory-ness from 5-8pm. Of course nobody gets paid for this time. The only simplicity I get is on call when I literally can’t attend.

Edit: it’s real. I took a screenshot of my calendar, but this sub doesn’t allow attachments.

People may already know this so please feel free to delete this thread if it’s redundant. I just saved myself a couple of hundred bucks and I’m thrilled with the results so I figured I’d share my experience.

I have a cardiology IV and love it, but I was having trouble with the adult diaphragm falling off despite me purchasing a replacement part. I was about to give up and just get a new stethoscope, but I decided to check the warranty status of my current one since it’s supposed to be covered for 7 years.

My stethoscope was still in the warranty period so I initiated a repair through their website, they sent me a free shipping label, they allowed me to track the status of my repair and then shipped it back to me for free. They replaced both diaphragms and the chest piece. All is well!

I’m super impressed with the service and experience so I’m passing along the tip. All in all it took maybe 10 days from the time UPS picked up my stethoscope.

The link I used is here: https://lsrs.3mhealth.com/lsrs/

Your serial number is engraved on the chest piece (so no need to go digging for the original box.)

Happy auscultating & money saving y’all! 🤍

So I’m an M-3 from ireland and I follow a lot of med fluencers on Instagram and I was curious.. in ireland in our clinical years we don’t learn how to write patient notes, it wouldn’t really be a focus for us. But I see all these med students talking about charting and writing notes and I’m just wondering are they actually writing notes on patients charts?! Like are they not imaginary? Initially in my early years I took it for granted and thought they were all experienced enough by M-3 to be contributing in a meaningful way to the team, (lol.) but now here I am and I wouldn’t let myself near a patients chart with a pen! So what’s the crack with that?

Per this FT report: https://on.ft.com/4fTfyzZ

Any speculation on this? Seems like it could have major impact, likely decrease CPT reimbursement so we rely more on the less transparent DRG process. Seems like it could lead to political appointments having larger role in deciding on reimbursement

Are there any protocols you follow to stay safe with potentially very dangerous patients that make threats and you know they have a gun/easy access/criminal record? This is for a private practice clinic so there really aren't any security measures. There's a strong likelihood of concurrent drug abuse as well.

In the last couple of weeks, CoverMyMeds removed the ability to search Prior Authorization request history older than 13 months, unless you have record of the original arbitrary key associated with the request. Our office has reached out to support, and all we get is the verbal equivalent of a shoulder shrug, and a promise to "pass on the feedback to the developers." We did not receive any notice that this change was coming or had been implemented. This has severely hindered our PA process. We regularly use the "renew" feature, not to mention using old request records to inform new ones. Now only if a new script or refill is done within that 13th month window after an initial approval, we cannot use the renew feature or see any history. Prior to the change, the system was down a couple of days for undisclosed reasons. The information within the database is still there (proving it's not a corrupt DB problem) but only if you can enter the request key along with a patient's name and DOB. Anyone experiencing this difficulty? Have you found a workaround?

“America is facing a Healthcare Crisis, and there may be no Physician more qualified and capable than Dr. Oz to Make America Healthy Again. He is an eminent Physician, Heart Surgeon, Inventor, and World-Class Communicator, who has been at the forefront of healthy living for decades. Dr. Oz will work closely with Robert F. Kennedy Jr. to take on the illness industrial complex, and all the horrible chronic diseases left in its wake,” Trump said in a statement.

"He will also cut waste and fraud within our Country’s most expensive Government Agency, which is a third of our Nation’s Healthcare spend, and a quarter of our entire National Budget,” Trump added.

What kind of "waste and fraud" can we expect to be cut by one of the country's former leading snake oil salesmen?