December 20th, 2015
Podcast 193: Glioma survival lengthened
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We usually don’t venture into oncology here, but the approach taken to glioma treatment in a JAMA paper — maintenance therapy with chemotherapy plus alternating electrical fields delivered transdermally via transducers — seems worth reporting to all clinicians. It prolonged patients’ lives significantly, which, according to an editorialist, hasn’t occurred in this disease in at least a decade.
The first-author of the manufacturer-sponsored research, Dr. Roger Stupp, explains the approach and the implications it holds for patients with this rapidly progressing tumor.
Physician’s First Watch coverage (free)
JAMA paper (free)
JAMA editorial (subscription required)
December 10th, 2015
Podcast 192: Are we too sweet on HbA1c testing?
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Over half the patients with Type 2 diabetes have their HbA1c measured too frequently — i.e., at least three times a year. Why is that a bad thing? Dr. Rozalina McCoy, the lead author of a paper in The BMJ explains.
Using claims data, her group followed over 30,000 patients with stable HbA1c levels and found that only 40% had measurements taken within guideline-suggested limits — twice a year.
Links:
- BMJ study on overtesting of HbA1c
- Physician’s First Watch coverage of BMJ study
- A November 2015 interview on treatment “deintensification” (free)
November 21st, 2015
Podcast 191: The prostate screening conundrum
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[Running time: 13 minutes]
The 2008 and 2012 recommendations from the USPSTF regarding PSA-based prostate screening have been accompanied by drops in both the screening and detection rates of prostate cancer, two studies in JAMA find.
Our guest, Dr. David Penson, wrote an editorial accompanying those studies. It attempts to put these new findings into perspective and to help the patients and physicians caught in the middle of a continuing debate on the wisdom of screening.
Physician’s First Watch coverage of the JAMA studies and editorial (free)
November 19th, 2015
Podcast 190: Last line of antibiotic defense breached
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The Lancet Infectious Diseases has just published a worrying account from China about a dangerous antibiotic resistance factor carried on plasmids. The factor, called MCR-1, confers resistance to colistin — a last line of defense against multi-resistant Gram-negative bacilli.
The co-author of a helpful commentary in that journal, Dr. David L. Paterson of the University of Queensland in Brisbane, is our guest.
Lancet Infectious Diseases article (free abstract)
Lancet Infectious Diseases commentary (free abstract)
November 9th, 2015
Podcast 189: Blood Pressure Target Should Be 120, SPRINT Data Show
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The SPRINT study, suggesting that we aim for a systolic BP target of 120 mm Hg in high-risk hypertensive patients, has been published with much fanfare.
Dr. Paul Whelton — one of the SPRINT investigators — is our guest. He warns against setting 120 as a performance measure, observing that roughly half the patients in the aggressively treated group had levels above that.
Links:
NEJM article (free)
November 1st, 2015
Podcast 188: Should “deintensification” be a quality-of-care measure?
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The ACCORD trial found dangers in too-strict control of blood pressure and glucose in diabetes. Our guest has just published a study in JAMA Internal Medicine measuring the scope of the problem. Using Veterans Affairs data, his group found that “deintensification” of therapy after targets were met or exceeded was disappointingly rare.
JAMA Internal Medicine study (free abstract)
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