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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

November 6th, 2017

Podcast 215: Has primary care been Amazon-ized?

(5 votes, average: 4.20 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

(2 votes, average: 4.50 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

Clinical Conversations

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