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December 12th, 2019

Podcast 246: Where we die now

(No Ratings Yet)

For the first time in almost a century, Americans are dying at home more often than dying in hospitals.

This seems to mark a cultural change that will affect both how and where clinical medicine is practiced.

Dr. Haider Warraich’s letter to the editor of the NEJM presents the numbers, and he’s agreed to talk about their implications.

Links:

Cross and Warraich’s New England Journal of Medicine letter (Dec. 12 issue)

Warraich’s 2017 book “Modern Death”

“Near Death,” a Frederick Wiseman 6-hour documentary worth finding

Running time: 16 minutes

December 6th, 2019

Podcast 245: We revisit a 2018 episode on NPs’, PAs’, and MDs’ performance in the primary care of diabetes

(No Ratings Yet)

In November 2018 we interviewed two authors of an Annals of Internal Medicine study comparing the quality of diabetes care afforded by three provider types: nurse-practitioners, PAs, and MDs. They reported that there were no clinically significant differences in the intermediate outcomes — glycated hemoglobin, systolic pressure, or low-density lipoprotein cholesterol — among the groups.

We’re posting that interview again for two reasons: first, this week’s planned interviewee remained unreachable, no matter my pleadings; second, listeners reacted strongly (and positively)  the first time around, and I hope newer listeners will find it as interesting.

Links:

URL of the original podcast

Annals of Internal Medicine paper

Running time: 20 minutes

November 28th, 2019

Podcast 244: Colchicine after myocardial infarction

(No Ratings Yet)

The anti-inflammatory colchicine is powerful and cheap. It’s thought that, because cardiovascular problems often stem from inflammation, colchicine could help prevent secondary events after MI. That’s what Jean-Claude Tardif and an international group of colleagues set out to investigate.

The group reports in the NEJM that daily low-dose colchicine was associated with a lower rate of a composite endpoint than a placebo: death from cadiovascular causes, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization leading to coronary revascularization.

New England Journal of Medicine report

Editorial commentary in NEJM

Harlan Krumholz’s tweet on the report

Running time: 20 minutes

November 22nd, 2019

Podcast 243: Lowering high blood pressure lowers dementia risk

(3 votes, average: 3.33 out of 5)

Controlling hypertension lowers the relative risk for dementia and Alzheimer’s disease by roughly 15%.

Given that many people have poorly-controlled hypertension, the finding that all antihypertensives are effective in bringing about this result might get your patients to be more adherent.

We talk with Dr. Lenore Launer of the NIH’s Institute on Aging about her recent meta-analysis in The Lancet Neurology.

LINKS:

Launer’s paper in The Lancet Neurology

Lancet comment on the article

Running time: 16 minutes

November 15th, 2019

Podcast 242: Tranexamic acid saves lives after traumatic bleeds

(2 votes, average: 2.00 out of 5)

Tranexamic acid, which frustrates clot dissolution, has been shown to reduce death from intracranial bleeding in a large international placebo-controlled trial — “CRASH-3.”

Ali Raja and Joe Elia host a lively chat with Ian Roberts, the co-chair of the trial’s writing committee, who, in addition to chastising the hosts’ seeming fascination with P-values, recounts a story from early in his training that first stirred his devotion to preventing bleeding-related death after trauma.

NEJM Journal Watch Emergency Medicine summary of CRASH-3

CRASH-3 report in The Lancet

Ian Roberts explains CRASH-3 on YouTube to collaborators in Malaysia

Roberts presents CRASH-3 results at World Congress on Intensive Care on YouTube

Running time: 23 minutes

November 7th, 2019

Podcast 241: Talking about guns with patients

(4 votes, average: 3.25 out of 5)

Running time: 18 minutes

In California, Garen Wintemute and his group find evidence that people are willing to discuss gun safety with their clinicians, especially when there may be danger of harm present. That willingness extends across gun owners and non-owners. So why aren’t more clinicians doing it?

The findings appear in Health Affairs.

Links to the article & further resources:

Health Affairs article

Wintemute’s essay in Annals of Internal Medicine on gun violence

Another Annals article on preventing gun-related death and injury

 

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