Recent Posts

RSS

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

November 6th, 2017

Podcast 215: Has primary care been Amazon-ized?

(4 votes, average: 4.25 out of 5)

Timothy Hoff thinks clinicians “must finally recognize that they are indeed ‘workers’ whose ability to control their daily fates has been reduced greatly.” He worries about the continuing erosion of the doctor-patient relationship, and he wonders why the profession is so reluctant to view its members as “put-upon workers struggling to gain favorable conditions for their work within corporatized health care settings.”

We talked with Prof. Hoff about his just-published book: “Next in Line: Lowered expectations in the age of retail- and value-based health.”

To the barricades!

“Next in Line” (link to Oxford University Press site)


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

Clinical Conversations

About the Podcast

To subscribe: Subscribe on iTunes

To have your comment included in a future podcast, call 617-440-4374. Please leave your name, number, and the podcast ID number.