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August 20th, 2017

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

(1 votes, average: 5.00 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

(No Ratings Yet)

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.

June 10th, 2017

Podcast 208: How inequality kills — David Ansell talks with us about his new book

(1 votes, average: 4.00 out of 5)

Dr. David Ansell, a professor of medicine at Rush University Medical Center in Chicago, discusses his new book, “The Death Gap: How inequality kills.”

What’s the death gap? Look at it this way: you’re getting on the Chicago Transit Authority’s Blue Line at “The Loop” in downtown, where the average life expectancy is 85 yrs. Go 7 stops south, and you’ll end up in a place whose inhabitants have a life expectancy of 69 — lower than that in Bangladesh. That’s a “death gap” of 16 years.

It’s worse in rural America. Drive from Connecticut to rural Mississippi and see some 35 years’ life expectancy evaporate.

How did the United States get here? And what are we going to do about it?

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

May 12th, 2017

Podcast 207: Fecal transplants, the gut microbiome and future medical care

(5 votes, average: 3.80 out of 5)

All previous editions are available at podcasts.jwatch.org.

I overheard this week’s guest, Zain Kassam, discussing his work at OpenBiome a few weeks ago. All those microbes in our intestines seem destined to play an important role in the future of medical care. Right now, fecal transplants are used against Clostridium difficile infection.

Dr. Kassam kindly agreed to chat with us and describe where he thinks the field of microbiome-based therapy is headed. Among the research under way, he describes one project on ulcerative colitis and another on hepatic encephalopathy in which fecal transplants have brought surprising results.

He recommended two books during our interview, and I’ve linked to their slots on Amazon’s bookshelves below:

Missing Microbes by Martin Blaser

Let Them Eat Dirt by  B. Brett Finlay and Marie-Claire Arrieta

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

May 7th, 2017

Podcast 206: Gluten avoidance and cardiac risks

(2 votes, average: 5.00 out of 5)

All previous editions are available at podcasts.jwatch.org.

Have you prepared a dinner party recently and not heard the word “gluten” come up?
Using food-frequency questionnaires, researchers followed the dietary habits of two very large cohorts of clinicians for over 25 years. Their results, just published in The BMJ suggest that, unless you have celiac disease or gluten sensitivity, you’re better off not avoiding the stuff. Our conversation is with the senior author, Andrew T. Chan.

Clinical Conversations comes to you through the NEJM Group.
Executive producer, Kristin Kelley.
Next week: We visit with the chief medical officer of OpenBiome.
Clinical Conversations

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