December 12th, 2019
Podcast 246: Where we die now
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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
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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:
Annals of Internal Medicine paper
Running time: 20 minutes
November 28th, 2019
Podcast 244: Colchicine after myocardial infarction
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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
Harlan Krumholz’s tweet on the report
Running time: 20 minutes
November 22nd, 2019
Podcast 243: Lowering high blood pressure lowers dementia risk
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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
Running time: 16 minutes
November 15th, 2019
Podcast 242: Tranexamic acid saves lives after traumatic bleeds
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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
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
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