olanzapine

NNT of 21 over 18 months to prevent a composite of worsening heart failure or cardiovascular death

NNT for hospitalization = 27

NNT for Cardiovascular Death = 53

N Engl J Med 2019; 381:1995-2008

During average follow-up of in this study the incidence of prostate cancer was less than 1% — and not significantly different 
 Remember most of these pts had testosterone levels around 350 ish give or take so the safety of longer-duration treatment — or treatment resulting in higher blood levels of testosterone — remains unclear.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2813293

From a mean score of 45 points at baseline, mood improved by about 5 points in the placebo group and 6 points in the testosterone group — a statistically significant but small difference. I think you will be hard pressed to find anyone that thinks this is clinically significant except for maybe the authors of the paper when they write that it is beneficial in their conclusion

https://academic.oup.com/jcem/advance-article-abstract/doi/10.1210/clinem/dgae026/7516050?redirectedFrom=fulltext&login=true

Erectile disfunction should be treated with the appropriate medications like the PDE5 inhbitors—not testosterone—testosterone may make it so you flirt half a time more a day but that is not likely worth the harm that comes with even in the placebo small doses seen in the traverse trial

https://academic.oup.com/jcem/article-abstract/109/2/569/7244351?redirectedFrom=fulltext&login=true

even at very small some would argue barely even treating doses of testosterone patients had an increase rate of fractures with a NNH of 100—when you add this to the 1 risk of aki and 2 percent risk of arthymia the harms vs benefit conversation to use testosterone seems to be leaning heavy towards harms

https://www.nejm.org/doi/full/10.1056/NEJMoa2308836?query=recirc_curatedRelated_article

Risk of progression from prediabetes to diabetes did not differ significantly between testosterone and placebo groups- and they looked for a change at 6,12,24,36,48 months of follow up

Not to sound like a broken record but

Risk of progression from diabetes to not having diabetes did not differ significantly between testosterone and placebo groups- and they looked for a change at 6,12,24,36,48 months of follow up

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2814401?guestAccessKey=d63bbb99-4d14-4f17-a4ac-b208633827e2&utm_source=twitter&utm_medium=social_jamaim&utm_term=12573820072&utm_campaign=article_alert&linkId=310108953

Use the PE Severity Index. If low risk and that is the only reason for admission, then the patient is safe for discharge

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60824-6/abstract

https://www.acpjournals.org/doi/10.7326/M23-2442

american college of physicians says- 

No need to start colon cancer screening prior to 50. stop at age 75 or with 10 yrs of life left and FIT testing can be every other year and Cologuard is not recommended. 

https://www.acponline.org/acp-newsroom/acp-issues-updated-guidance-for-colorectal-cancer-screening-of-asymptomatic-adults

While weight loss may be beneficial for individuals with knee osteoarthritis, it does not see to have a protective or beneficial effect for those with hip osteoarthritis. 

https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18371

In patients with HIV and cv risk score of 4.5% there was a NNT of 106 at 5 yrs of follow up to prevent 1 MACE

https://www.acpjournals.org/doi/10.7326/M22-2643?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

During 28 months of follow-up, absolute risks for progression from CIN2 to CIN3 (or worse) were as follows:

• 23% among women vaccinated before age 15
• 32% among women vaccinated between ages 15 and 20
• 38% among women vaccinated after age 20
• 38% among unvaccinated women

Krog L et al. Risk of progression of cervical intraepithelial neoplasia grade 2 in human papillomavirus–vaccinated and unvaccinated women: A population-based cohort study. Am J Obstet Gynecol 2023 Dec 30; [e-pub]. (https://doi.org/10.1016/j.ajog.2023.11.1235. opens in new tab)

PDE5i are bad if your health if you have cardiovascular disease and a provider that didn't read the paper and only looked at the abstract. Go ahead and write for PDE5i for your patients that need it and do not change your practice based on this study. 

https://www.sciencedirect.com/science/article/pii/S0735109723080749?via%3Dihub#mmc1

Doxy 100mg BID x7days for chlamydia- and consider treating the partner unless you live in West Virginia. 

https://www.cdc.gov/std/treatment-guidelines/chlamydia.htm

Overall incidence of zoster (defined as the presence of the specific diagnostic code in the medical record, accompanied by a prescription for acyclovir) was lower among vaccine recipients, with vaccine protective efficacy estimated to be 64% after a single dose and 76% after two doses.



Zerbo O et al. Effectiveness of recombinant zoster vaccine against herpes zoster in a real-world setting. Ann Intern Med 2024 Jan 9; [e-pub]. (https://doi.org/10.7326/M23-2023. opens in new tab)

At 25yrs the odds of still having your appendix if you were initially managed nonoperatively was 60%.

https://jamanetwork.com/journals/jamasurgery/article-abstract/2808133

Although an observational trial, it appears lactated ringers is better than normal saline for those individuals with acute pancreatitis to prevent organ failure or local complications. 

https://journals.lww.com/ajg/fulltext/2023/12000/lactated_ringers_use_in_the_first_24_hours_of.29.aspx

Sleep restriction therapy led by nurses with only 4 hours of education significantly improved patients insomnia at 6 months.

More info HERE ___>
https://thrive.kaiserpermanente.org/care-near-you/northern-california/sanjose/wp-content/uploads/sites/7/2015/10/sleep-restriction-rev2_tcm28-557887.pdf

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00683-9/fulltext#:~:text=Results%20indicate%20superiority%20of%20nurse,at%20established%20cost%2Deffectiveness%20thresholds.

When taking Ferrous Fumarate a little bit of vitamin C or an 8 ounce glass of orange juice with an otherwise empty stomach will improve the absorption- this absorption is decreased with food and coffee.  

https://onlinelibrary.wiley.com/doi/10.1002/ajh.26987

Olanzapine 2.5mg for weight gain with advance cancer NNT of 50 for >5% weight gain


https://pubmed.ncbi.nlm.nih.gov/36977285/