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October 10th, 2017

Podcast 214: Drug-drug interactions and bleeding risks with NOACs

(1 votes, average: 5.00 out of 5)

The non-vitamin-K oral anticoagulants (known familiarly as NOACs or DOACs) share metabolic pathways with other drugs, which can potentiate NOACs’ anticoagulant actions dangerously. Dr. Shang-Hung Chang and his group studied Taiwan’s national health insurance database, which records data on virtually all that nation’s citizens, to measure the actual risks of some of these drug – drug interactions. Their findings were published earlier this month in JAMA.

Links:

JAMA article (abstract)

Physician’s First Watch coverage

September 22nd, 2017

Podcast 213: Continuous glucose monitoring in pregnancies with type 1 diabetes

(3 votes, average: 5.00 out of 5)

Pregnant women with type 1 diabetes can realize more than better control with continuous glucose monitoring: their babies are less likely to be large for gestational age and less likely to spend time in neonatal ICUs. Dr. Denice Feig, who authored a recent international study in The Lancet, talks about her findings and makes recommendations for the future.

Links:

Lancet study

Physician’s First Watch summary

September 14th, 2017

Podcast 212: BP in CKD — Where’s the Sweet Spot?

(1 votes, average: 5.00 out of 5)

There was an excellent commentary accompanying a recent JAMA Internal Medicine meta-analysis: “The Ideal Blood Pressure Target for Patients with Chronic Kidney Disease — Searching for the Sweet Spot” by Csaba Kovesdy. He offers a nice perspective on the problem and kindly agreed to talk with us.

Links:

August 20th, 2017

Podcast 211: On (not) staying the (antibiotic) course

(5 votes, average: 4.80 out of 5)

Sometimes — but not all the time — patients can be advised to stop a course of antibiotics if they feel better. Traditionally, the advice has been to complete the entire course, regardless. Why? Because it was thought that stopping early might lead to more antibiotic resistance. That’s changing now, as the WHO and the CDC advise that courses be taken as directed by (and in consultation with) the prescriber.

Prof. Martin Llewelyn and his colleagues wrote an intriguing analysis in The BMJ of the idea of stopping treatment under certain circumstances. They point out that it’s the longer duration of treatment (and thus longer exposure of commensals to antibiotics) that’s almost certainly causing most cases of resistance.

Links:

Article in The BMJ

NEJM Group Open Forum starting Wednesday, Aug. 23

August 16th, 2017

Podcast 210: Jerome Kassirer — an editor looks back

(1 votes, average: 4.00 out of 5)

Dr. Jerome P. Kassirer served as editor-in-chief of the New England Journal of Medicine from 1991 to 1999.

Almost 20 years later, Kassirer looks back on his life and his time as editor in a new autobiography, titled “Unanticipated Outcomes” — and in a conversation with us.

Links:

Kassirer editorial on managed care.

Kassirer on the digital transformation of medicine.

July 9th, 2017

Podcast 209: “The guidelines need to be rewritten” to encourage antibiotic use after incision and drainage of small skin abscesses

(2 votes, average: 5.00 out of 5)

The senior author of a paper examining the role of systemic antibiotics after incision-and-drainage in treating small skin abscesses says the results should prompt a rewriting of current guidelines.

Henry Chambers of UCSF found a 15-percentage-point advantage in short-term cure rates for antibiotics over placebo. The guidelines don’t encourage systemic antibiotics in these circumstances, but Chambers’ group found the advantage held both in the intention-to-treat results and among those patients who were full adherent to their regimens.

Clinical Conversations comes to you through the NEJM Group.
Executive producer, Kristin Kelley.
Clinical Conversations

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