Doc my heart is racing— Stop drinking—or so says this article in NEJM that found when they took 140 pts who severed from paroxysmal afib and who drank 17 drinks a week that when randomized to complete alcohol abstinence for 6 months there was significant reduction in afib recurrence.. how much of a difference?? 20% ABSOLUTE DIFFERENCE….. I have a rule of thumb that anytime someone says the improvement is any percent over 10% I almost always assume they are talking relative risk reduction, but this was 20% ABSOLUTE risk reduction. That is a NNT of 5. So when your patient says my heart goes piter pat pitter piter pat pat pat pitter what should I do, the answer is to stop drinking. Now let me grab a sip of bourbon and onto the next article. DOC there is a puddle on the floor.. https://journals.lww.com/optvissci/Fulltext/2020/07000/Validation_of_a_More_Reliable_Method_of_Eye_Drop.7.aspx Tell them to close their eyes or so say this article in optometry and vision science that had 30 pts and on one visit, eye drop were placed by a trained clinician, and on the other, patient placed eye drops. The Intraocular pressure was measured before drop instillation and 2 hours after drop instillation. I know this doenst sound like a big deal but the clinician eye drop test was exactly as it sounds- open your eye and let me drop in the eye drop. The patient drop was different and awesome for patient self-administration of an eye drop, one in which the lids of the eye that is receiving the drop are closed at the time of administration. An eye drop placed anywhere over the medial area of a gently closed eyelid with the theory being that the eye drop will fall into the naturally occurring anatomical funnel and right into the eye. Basically the most midline part of the the eye, the part right next to the nose has a little opening and the eye drop should just funnel right in there or at least that was the theory THE RESULTS An average reduction in intraocular pressure was 3.75 ± 2.36 mmHg was found with clinician administration, and an average reduction of 3.32 ± 2.31 mmHg for closed eyed patient administration. THERE WAS NO DIFFERENCE intraocular pressure!!! AMAZING!! THIS IS BRILLIANT—larger trials are needed but for me this is all the evidence I NEED. I hate hate hate hate trying to put I drop in my eye. I feel like I waste the whole bottle In a recent report, a glaucoma specialist reviewed videotapes of 300 patients trying to self-administer eye drops using the traditionally taught method. It was concluded that patients released an average of seven drops before they felt confident that one had hit the eye So when your pt says there is a puddle on the floor, its from their eye drops, just have them close their eyes Doc I have pain--- Take turmeric. Or at least says this trial annals of internal medicine that took 70 adults with painful knee OA and randomized them to turmeric 1000mg daily or placebo for 12 weeks. The primary outcomes was change in knee pain on a 100 point visual analog scale. Those randomized to turmeric saw a 24 point reduction while those in the placebo saw a 15 point reduction. The difference between a 24point reduction on a 100 point scale and a 15 point reduction on a 100 point scale is statistically significant. And if you listen to questioning medicine at all you might expect me to say this is not clinically significant and the real difference between the active arm and the control arm is the difference between 24-15= 9. BUT this is game changing or at least I think it should be because the harms of 500mg of turmeric twice a day is almost nothing that I think it is worth prescribing for a 2 and a half point change on a 10 point scale. If you can get a pt with a pain score of 7 down to 4.5 just by prescribing turmeric that is a win and while it is not much better than placebo, sadly we am not allowed to write for placebo and have an pharmacist fill (continued)