Summary: Consolidate your knowledge and reinforce the learning you’ve done with us in 2016. Enjoy this holiday helping of knowledge food for your brain hole. The guys offer their best of recommendations for 2016 and recap key teaching points from the past year so you have the tools to dominate 2017. Recommend a guest or topic and give feedback at thecurbsiders@gmail.com   Clinical Pearls: SPRINT trial debate Bias effects results seen in this trial. e.g. stopped early Blood pressure (BP) control may have been overestimated based on how BP was measured leading to increased CV events (Stuart’s view). BP measurements in trial likely reflected out of office BP so results are useful (Paul’s view). Lower BP is probably safe, even in the elderly so be reluctant to back off on meds. HTN Urgency Verify BP reading and measurement technique Evaluate for pain, anxiety, volume overload, nonadherence, or noncompliance Treat high BP with long term goals in mind (i.e. go up on chronic/long-acting meds) Anticoagulation Avoid warfarin in patients with gastric bypass or Crohn’s with ileitis. Use SPARC tool to visually demonstrate risks and benefits of anticoagulation in Afib. Physicians commonly underestimate benefit of anticoagulation in older sicker patients and overestimate risk of bleeding. Fibromyalgia and chronic pain Recognize the constellation of fatigue, memory problems, sleep disturbance, and multifocal pain as fibromyalgia. Use the 2011 American College of Rheumatology criteria for diagnosis. No tender point exam required! Nonpharmacologic therapies and education are most effective (see video links below). Chronic painful conditions like rheumatoid arthritis, or lupus can lead to fibromyalgia. Functional Medicine At least 80% of your food should be whole foods. Use the Dirty Dozen and Clean 15 to guide organic food choices. Knowledge of pathophysiology and biochemistry can be used to treat disease e.g. treating small intestinal bacterial overgrowth can fix iron deficiency and indirectly treat iron deficiency. Lipids Lowering LDL is key. Some statin is better than none, so consider intermittent dosing (three times weekly) of atorvastatin or rosuvastatin. Statins have a 20 year safety record, are cheap, and will remain king for now. Check baseline LDL and monitor percent decrease on statin therapy to ensure desired effect (e.g. 50% drop in LDL for patient requiring high intensity). Withdrawal of statins at end of life is warranted and safe. Insomnia Nonpharmacologic therapy is as good or better than pharmacologic therapy. Benefits of nonpharmacologic therapy persist 1-2 years after discontinuation. Identify problem with sleep initiation versus maintenance, or both, then choose agent. Use long taper of sleep agent (several months) along with CBT for nightly problems with sleep. Intermittent dosing of sleep agent okay if only intermittent sleep trouble. Osteoporosis If secondary hyperparathyroidism present, then target normal PTH not just a Vit D level 30-50 ng/ml. After hip fracture, first normalize Vit D and/or PTH, then treat with bone conserving agent. Drug holiday stops when bone density falls, fracture occurs, or risk increases (e.g. steroid use). Patients may require multiple courses of bisphosphonates or other bone conserving drugs. In-flight emergencies Know contents of standard medical kit include: Be prepared to improvise. Lessons learned Failure is essential to learning and improving. Don’t fall victim to “fear of being left out”. Saying “No” protects you from being spread thin. Overcome the “curse of knowledge” by teaching the basics and gearing lesson to level of learner. Disclosures: The Curbsiders report no relevant financial disclosures, but hope to have a long list of them in the future. Time Stamps 00:00 Intro 02:54 Best of 2016 Articles 07:45 Best of 2016 Book recommendations 12:44 Best of 2016 Apps 15:49 SPRINT trial 24:34 Hypertensive urgency 27:05 Anticoagulation 33:00 Fibromyalgia and chronic pai