You are a second-year resident working at the VA. On the first morning of Rounds, your medical student presents the following patient to you:

The patient is a 63-year-old white man who was admitted with an exacerbation of heart failure. He has a history of past myocardial infarction (MI) and an ejection fraction (EF) by Echo of 25%. He is very adherent and seldom, if ever, misses his medications. 

On admission, his medications were furosemide 40 mg po qd, enalapril 20 mg po bid, simvastatin 10 mg po qd and aspirin 325 mg po qd. He usually functions at a NYHA class II level, but he now has had two admissions for heart failure in the past four months. On this admission, he has already been ruled out for MI and remains in sinus rhythm. He has a normal renal function with a creatinine of 0.9. The patient is particularly concerned about staying out of the hospital because he lives alone and has no one to care for his pets or plants. He is very active in his community and is eager to get out of and stay out of the hospital.  

The medical student asks you whether the angiotensin receptor neprilysin inhibitor (ARNI) would help this man with his heart failure. The student was told by one of her prior residents that ARNI was a good choice for a patient with heart failure. A resident with whom you consulted states that angiotensin-converting enzyme (ACE) inhibitors, such as enalapril, are the gold standard, especially for a 63-year-old man. The medical student and resident both told you they consulted UpToDate, an evidence-based, point-of-care tool, but you believe that to find the best evidence, a search of the primary literature in PubMed is needed. They look to you for guidance.

Your patient, Sylvie, is a physically active 55-year-old, with type 2 diabetes. She has 25-year-old twin daughters, Andrea and Julia, who are also physically active, who spend much of their free time, when not working in their family’s landscaping business, bicycling and hiking in California’s national parks. While watching Dr. Oz last month, the guest speakers were debating the health benefits of coffee, and Dr. Oz presented data that associated coffee consumption with a reduced type 2 diabetes risk. Sylvie is intrigued, as she knows that type 2 diabetes can be hereditary. Both of her daughters are avid coffee drinkers, although one daughter, Julia, leans more toward decaffeinated coffee. She decides to do some further investigating on the web.  

Today, during your appointment with Sylvie, she asks you, her D.O. and primary care physician, if you have heard or read anything about an inverse association of coffee consumption with the risk of type 2 diabetes.  

She looks to you for any evidence of this.  Sylvie wants her daughters to maintain their health so they can continue to enjoy quality time with family and friends. You offer to search the literature for the best evidence possible, with the hope of finding a recent systematic review or meta-analysis on the topic.