Primary Care Corner with Geoffrey Modest MD: Should we delay giving flu vaccine??

The intraseason waning of influenza vaccine protection: Evidence from the US Influenza Vaccine Effectiveness Network, 2011-12 through 2014-15. Geoffrey Modest The US Influenza Vaccine Effectiveness Network compiled data on adults and children seeking outpatient care for acute respiratory illnesses at five different locations scattered through the US after influenza was confirmed in those communities. Eligible patients had […]

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Primary Care Corner with Geoffrey Modest MD: Coffee and decreased mortality

by Dr Geoffrey Modest Two articles just came out finding that coffee drinkers had decreased all-cause mortality. One study was from 10 European countries (see doi:10.7326/M16-2945). Details: 521,333 people enrolled in EPIC (European Prospective Investigation into Cancer and Nutrition) from 10 European countries, followed 16.4 years. 41,693 deaths occurred (18,003 were from cancer, 9106 were from […]

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Primary Care Corner with Geoffrey Modest MD: Changing diet changes lifespan

by Geoffrey Modest MD A recent review of the data from the Nurses’ Health Study and the Health Professionals Follow-up Study from 1998 to 2010 found that mortality tracks with changes in diet (see DOI: 10.1056/NEJMoa1613502). Details: — 47,994 women in the Nurses’ Health Study and 25,745 men in the Health Professionals Follow-up Study were assessed, correlating […]

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Primary Care Corner: Initial orthostatic hypotension and adverse outcomes

by Geoffrey Modest MD Yet another article came out indicating that initial orthostatic hypotension, measured immediately after standing, had a strong association with dizziness as well as long-term adverse outcomes measurement (see doi:10.1001/jamainternmed.2017.2937).   Details: — cohort study of 11,429 participants in the Atherosclerosis Risk in Communities Study (1987-1989) — mean age 54, 54% women, […]

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Primary Care Corner: A new atherosclerosis risk calculator – QRISK3

by Dr Geoffrey Modest In prior blogs I commented in a not particularly quantitative fashion that it made sense to have a gestalt about how aggressive to be in coronary artery disease prevention (see http://blogs.bmj.com/bmjebmspotlight/2014/05/09/primary-care-corner-with-geoffrey-modest-md-aha-lipid-guidelines-again/ or http://blogs.bmj.com/bmjebmspotlight/2016/07/01/primary-care-corner-with-geoffrey-modest-md-migraine-and-heart-disease-in-women/ for example). The point was that the available atherosclerotic risk calculators did not include many conditions that confer increased risk, including such things as peripheral artery disease, chronic […]

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Primary Care Corner with Geoffrey Modest MD: Prostatectomy not help for localised CA

by Dr Geoffrey Modest The 19.5 year follow-up of the PIVOT study (Prostate Cancer Intervention vs Observation Trial) confirmed their prior observations at the 12-year mark, showing that for men with localized prostate cancer, surgery was not significantly associated with decreases in all-cause or prostate cancer specific mortality (see Wilt TJ. N Engl J Med 2017;377:132).   Details: — From […]

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Primary Care Corner with Geoffrey Modest MD: Take the full course of antibiotics???

A recent BMJ analysis article argued that taking the “full course of antibiotics” is often likely counterproductive (see doi: 10.1136/bmj.j3418 )​. Details: –international health organizations and the WHO have pushed for completing antibiotic regimens: a 2016 WHO advisory to patients stated “always complete the full prescription, even if you feel better, because stopping treatment early promotes the growth of […]

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Primary Care Corner with Geoffrey Modest MD: PPIs and increased mortality

A large longitudinal study of US veterans found a 25% increased risk of death associated with proton pump inhibitor (PPI) usage (see doi.org/ 10.1136/ bmjopen-2016-015735)​. Details: — the researchers assessed three cohorts of patients, with 5.7 years of follow-up after the first acid suppression therapy prescription was written, and all patients had at least one outpatient serum creatinine […]

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Primary Care Corner with Geoffrey Modest MD: Decreasing opiate prescriptions

by Dr Geoffrey Modest   Some (likely) good news about prescription opioids from the CDC (see https://www.cdc.gov/mmwr/volumes/66/wr/mm6626a4.htm?s_cid=mm6626a4_w ).   — Opioid prescribing in the United States between 2006 and 2015 peaked in 2010 at 782 morphine milligrams equivalents (MME) per capita then decreased annually to 640 MME per capita in 2015 — there was pretty striking variation by US county, from […]

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Primary Care Corner with Geoffrey Modest MD: Dyspepsia guidelines

by Dr Geoffrey Modest ​​The American College Of Gastroenterology and the Canadian Association of Gastroenterology updated their guidelines on the management of dyspepsia (see doi: 10.1038/ajg.2017.154​)   Recommendations (note: the recommendation is much weaker when they use the word “suggest” vs “recommend”): — they suggest endoscopy for dyspepsia patients greater than 60 years old: conditional recommendation/very low-quality evidence. […]

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