geoffrey modest medical blogs

  The Am College of Physicians and Am Acad of Family Physicians just released their joint clinical guidelines on the non-pharmacologic and pharmacologic treatment of acute non-low back injuries in adults (se e  pain guidelines acute non-low back AIM2020  in dropbox, or doi:10.7326/M19-3602). Details: --they used a network meta-analysis to compare the effectiveness of different therapies, including 207 trials with 32,959 patients, evaluating:     --pain relief at <2hrs and at 1-7 days     --physical function     --symptom relief, typically defined as reaching full resolution of symptoms, or >50% reduction in pain score (differed in studies)     --treatment satisfaction (varied in the different studies, but typically the patient's overall assessment of treatment satisfaction or efficacy)     --GI tract, dermatologic, and neurologic adverse effects --causes of acute pain varied in the studies: 48% had mix of muscul...

  i mentioned the CDC report of the increased psych and substance use problems currently in my last blog (see  http://gmodestmedblogs.blogspot.com/2020/08/covid-transmission-and-distancing.html  ), but given how striking the effects of Covid-19 are on the general population, i thought it would be important to review this report in more detail. see  https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm  or   https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6932a1-H.pdf  for the CDC report Details: --survey done june 24-30, 2020 --5470 respondents: 51% female, 13% 18-24yo/35% 25-44yo/35% 45-64yo/17% >65yo, 63% white/12% black/5% asian/16% hispanic, household income mostly $25-200K, education mostly high school to professional degree, 63% employed with 33% of them essential workers, 89% urban, 20% knew someone with covid-19/8% knew someone dying from covid-19 --prior depression 10%, prior anxiety 10%, prior PTSD 5% Results: --41% of US adults reported strug...

  There is continuing discussion on appropriate social distancing, with recent arguments that in schools it is fine to reduce the distancing from 6 feet to 3 feet. However, the guidelines on appropriate social distancing are not based on much evidence. In this light, a review of the existing studies   suggests that the even the 6 foot distance may well be inadequate (see  covid droplet distance greater than 6 feet JID2020  in dropbox, or DOI: 10.1093/infdis/jiaa189)    Details: --a systematic review assessed the horizontal distance traveled by respiratory droplets --this reviewed included 10 studies from both the medical and science/engineering journals   Results: --these studies used differing methodologies in determining the spread of virus, with 7 of the 10 using modeling --5 of the studies did experiments on human subjects, 4 of which did not use any artificial fluids or powders to induce sneezes or coughs. --8 of the 10 studies found that droplets...