General Session keynote reviews practice-changing research from past year

Frank Domino, MD

Frank Domino, MD

Milk is good. Diet soda makes you fat. Daily exercise has no more benefits than exercising twice a week. Drinking 15 to 21 alcoholic beverages a week for men has better outcomes on all-cause and cardiovascular mortality than not drinking. Those surprising tidbits were just part of the dizzying array of research shared by Friday General Session keynote speaker Frank Domino, MD, in his talk "Top Ten Updates in Evidence-Based Medicine."

Domino, professor and pre-doctoral education director, Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, reviewed what he called “practicing-changing publications that have come out in the last year” in hopes of inspiring family physicians to make patient- benefiting changes to their practices.

"Of all my peers from college, my peers from medical school, I don’t know anybody that’s got as cool a job as we do as family physicians," he said.

Despite the coolness factor, though, he acknowledged a burnout factor also exists for physicians and offered suggestions for combating that fatigue.

“We are terribly independent as family physicians. We hate having other people help us. We have got to try to break that mold and set good limits,” he said. “Buy a bird feeder. Just seeing life outside your window is beneficial.”

Domino offered up a study from the United Kingdom, which showed people living in neighborhoods with higher levels of vegetation cover and afternoon bird populations had reduced degrees of depression, anxiety, and stress. He also shared results from a study on meditation showing it improved mindfulness and resiliency while also helping fight stress, anxiety, and burnout in hospital-based physicians. Other provocative research Domino shared included:

  • Improve the odds of collecting a urine sample in infants with the Quick Wee method: Cold-water stimulation on the suprapubic area.
  • Work on the family when you have a picky eater. Study shows selective eating is often indicative of family dysfunction. Use the opportunity to assess the home environment. Recommend milk drinking, even chocolate milk. “Chocolate milk is fine. If they eat other junk, at least you’ve got some good calories into them,” he said.
  • Milk is not bad for you. Domino provided research that showed high- and low-fat dairy intake continued to show no association with mortality, coronary heart disease, or cardiovascular disease.
  • No artificial drinks! Artificially sweetened drinks increase stroke risk and risk of all-cause dementia and Alzheimer’s disease. “The more you drank, the worse the outcomes were,” he said.
  • Exercising once or twice a week may provide the same risk-reduction benefits as more aggressive exercise pattern.
  • No alcohol was a worse outcome than heavy alcohol use. Data from the Health and Retirement Study on the influence of alcohol, tobacco, and obesity showed that drinking 15-21 drinks a week for men and nine to 14 drinks a week for women had the better outcomes than those who didn't drink at all. Additionally in a Danish cohort study, 14 drinks per week for men and nine per week for women correlated with the lowest risk for diabetes.
  • Broaden your perspective in type 2 diabetes. Studies continue to show self-glucose monitoring shows no significant different in quality of life scores or in adverse affects such as hypoglycemia, healthcare usage, or insulin usage. Another study indicates that an A1c score of between 6 and 9 is considered safe and healthy for a patient with type 2 diabetes. “Also, this is another practice changer, sulphonylureas are probably drugs of the past,” Domino said, citing a large study that said use of sulphonylureas increased all-cause mortality and increased cardiovascular mortality.
  • Rethink internal exams. Domino cited studies indicated that bimanual pelvic exams and digital rectal exams provide no benefit in reducing mortality, morbidity or increasing quality of life.
  • Rethink your use of statins. “There's a whole data set that shows non daily statin dosing has as much effect as regular dosing in patients without known heart disease,” he said.