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April 10th, 2018

Podcast 221: Pertussis makes a comeback — kids have an outsize role

(2 votes, average: 4.00 out of 5)

What’s causing this resurgence, and what’s to be done? Pejman Rohani talks about his Science Translational Medicine study that used “gold standard” historical data to examine possible causes.

He and his colleagues conclude that, as with mumps, slowly waning vaccine protection is at play. However, they identify the “core transmission group” as schoolchildren, who have a greater frequency of contacts. Adults, they find, have “at most a minor role.”

LINKS:

April 4th, 2018

Podcast 220: Mumps outbreaks — blame waning protection, not new viruses or bad vaccines

(2 votes, average: 5.00 out of 5)

Mumps outbreaks keep happening, even among vaccinated groups. Why?

Our guest, Joseph Lewnard, and his coauthor, Yonstan Grad, probed studies of mumps vaccine efficacy carried out over five decades. They show that the fault, dear clinician, is not in our vaccines or new viral strains, but in ourselves. Our bodies slowly lose their immune response after vaccination, and about 25 years after the last vaccine dose, it’s gone.

Listen in.

Links:

Science Translational Medicine study

CDC recommends a third dose of MMR vaccine in an outbreak

March 28th, 2018

Podcast 219: Digital rectal exams shouldn’t be routine in primary care

(2 votes, average: 4.50 out of 5)

There simply isn’t enough evidence to sustain its continued use in asymptomatic men, argues our guest. Dr. Jason Profetto, senior author on an Annals of Family Medicine meta-analysis.

 

Links:

Annals of Family Medicine abstract

Physician’s First Watch coverage

March 14th, 2018

Podcast 218: Better integration of midwifery associated with better birth outcomes

(2 votes, average: 4.50 out of 5)

An analysis of the states’ integration of midwifery into their healthcare systems concludes that better integration led to better outcomes for mothers and babies.

We discuss this with Dr. Saraswathi Vedam, the study’s first author.

Links:

University of British Columbia’s Birth Place Lab

PLoS One article

First Watch coverage of the Lancet series on midwifery

March 9th, 2018

Podcast 217: Aspirin and rivaroxaban “comparably effective and safe” for prophylaxis after arthroplasty

(1 votes, average: 4.00 out of 5)

The EPCAT II trial examined whether aspirin and rivaroxaban were clinically equivalent in the extended prophylaxis of venous thromboembolism after hip or knee replacement. They proved “comparably effective and safe,” according to our guest, Dr. David Anderson, the study’s first author. An editorial in the New England Journal of Medicine, where the study appeared in February, calls the results practice-changing. One thing was sure from the outset — aspirin is cheaper than rivaroxaban by orders of magnitude.

A note to listeners: Dr. Anderson and I conducted the interview over several sessions, so the first-half audio sounds a bit rougher than the second. Your speakers don’t suddenly get better — my equipment does!

Links:

NEJM report

NEJM editorial

Journal Watch General Medicine summary

February 21st, 2018

Podcast 216: What role for MRI in breast cancer screening?

(No Ratings Yet)

A recent paper in JAMA Internal Medicine sought to examine what happens after breast cancer screening with magnetic resonance imaging. It reported that core and surgical biopsy rates doubled, compared with mammography, in women with a personal history of breast cancer; they rose fivefold among women with no personal breast cancer histories.

Dr. Diana Buist, the study’s principal author, helps sort out the implications of this study, done on some 2 million screenings.

Running time: 18 minutes

JAMA Internal Medicine paper

USPSTF guidelines on breast cancer screening for normal-risk women

American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline

American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography

National Comprehensive Cancer Network clinical practice guidelines on breast cancer

Clinical Conversations

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