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March 4th, 2016

Podcast 197: A dissent on sepsis

(5 votes, average: 3.60 out of 5)

The authors of the new sepsis definitions encouraged “debate and discussion,” and an editorial in Chest was quick to provide it.

The editorialist, Dr. Steven Simpson, is worried about missing some cases if consideration of SIRS (the systemic inflammatory response syndrome) is tossed out of the definition.

Chest editorial (free PDF available if you scroll down that landing page)

Last week’s interview on the new defintions (free)

 

February 27th, 2016

Podcast 196: Sepsis redefined

(4 votes, average: 2.50 out of 5)

We have Edward Abraham, Dean of Wake Forest School of Medicine, with us to talk about the new definitions of sepsis and septic shock. He wrote an editorial in JAMA that puts the changed definitions into perspective for clinicians. Listen in.

Editorial in JAMA (free)

JAMA paper with new definitions (free)

NEJM Journal Watch coverage (free)

 

February 18th, 2016

Podcast 195: Pioglitazone for secondary prevention?

(3 votes, average: 4.00 out of 5)

Pioglitazone, long known to increase insulin sensitivity, has been “mostly relegated to use in unusual conditions such as lipodystrophies” after its drug class, the thiazolidinediones, “fell from grace” in the words of our guest.

Dr. Clay Semenkovich has just written an editorial comment on a study in the New England Journal of Medicine. That study showed a benefit from pioglitazone use in the secondary prevention of vascular events among patients with insulin resistance (but not diabetes) who’d had a recent ischemic stroke or TIA.

He discusses the implications of those findings and, given the drug’s side effects, cautions against a rush to prescribing pioglitazone without first discussing the trade-offs with patients.

NEJM editorial (free)

NEJM study (free)

Physician’s First Watch coverage (free)

February 3rd, 2016

Podcast 194: Rising middle-age mortality rates are worrying

(3 votes, average: 3.00 out of 5)

Ever since Anne Case and Angus Deaton published a paper in the Proceedings of the National Academy of Sciences last November there has been a spate of commentary over their major finding: mortality rates among middle-aged whites in the U.S. are rising while everyone else’s are improving.

The Commonwealth Fund has just published an “issue brief” on the topic, and we’ve got the authors — senior researcher David Squires and Fund president David Blumenthal — to talk things over with us.

Commonwealth Fund issue brief (free)

PNAS study (free)

December 20th, 2015

Podcast 193: Glioma survival lengthened

(2 votes, average: 2.50 out of 5)

We usually don’t venture into oncology here, but the approach taken to glioma treatment in a JAMA paper — maintenance therapy with chemotherapy plus alternating electrical fields delivered transdermally via transducers — seems worth reporting to all clinicians. It prolonged patients’ lives significantly, which, according to an editorialist, hasn’t occurred in this disease in at least a decade.

The first-author of the manufacturer-sponsored research, Dr. Roger Stupp, explains the approach and the implications it holds for patients with this rapidly progressing tumor.

Physician’s First Watch coverage (free)

JAMA paper (free)

JAMA editorial (subscription required)

December 10th, 2015

Podcast 192: Are we too sweet on HbA1c testing?

(3 votes, average: 2.33 out of 5)

Over half the patients with Type 2 diabetes have their HbA1c measured too frequently — i.e., at least three times a year. Why is that a bad thing? Dr. Rozalina McCoy, the lead author of a paper in The BMJ explains.

Using claims data, her group followed over 30,000 patients with stable HbA1c levels and found that only 40% had measurements taken within guideline-suggested limits — twice a year.

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