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January 16th, 2020

Podcast 248: “Hotspotting” didn’t work in its home town — why?

(No Ratings Yet)

The process of identifying super-users of healthcare and reducing the frequency of their hospitalizations — so-called “hotspotting” — was subjected to a randomized, controlled trial in Camden, NJ, the birthplace of the idea. It failed there.

Those in the intervention group had a readmission rate within 6 months that was statistically identical to those getting usual care.

True, the Camden patients had particularly complex social and medical problems, so that doesn’t mean that the program can’t work elsewhere.

Listen to our chat with the report’s senior author, Prof. Joseph Doyle, and as well, listen to our interview with Dr. Jeffrey Brenner from 6 years ago — he’s the one who put “hotspotting” on the map. Despite the apparent failure of the trial, the Coalition still has a lot to offer.

Results of the randomized trial in NEJM

Interview with Dr. Jeffrey Brenner from 2013

Camden Coalition’s website

Running time: 15 minutes

December 20th, 2019

Podcast 247: Managing dyspepsia

(2 votes, average: 5.00 out of 5)

A “network meta-analysis” (we’ll explain that) finds that “test and treat” is the best way forward in managing this common condition.

Patients, paradoxically, prefer immediate endoscopy to test-and-treat, but unless the patient has “alarm symptoms” (such as dysphagia, weight loss, and anemia), endoscopy is likely to add complications and costs without adding further benefit.

Our guest is Prof. Alexander Ford of Leeds, senior author on the guideline-affirming study in The BMJ.

Links:

Article in The BMJ

Physician’s First Watch summary

NEJM Journal Watch Gastroenterology summary of 2017 joint U.S. – Canadian guideline

December 12th, 2019

Podcast 246: Where we die now

(3 votes, average: 3.67 out of 5)

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

(1 votes, average: 4.00 out of 5)

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

(1 votes, average: 5.00 out of 5)

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

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