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August 2nd, 2019

Podcast 227: Chronic kidney disease and anticoagulants

(1 votes, average: 4.00 out of 5)

Chronic kidney disease, being a “prothrombic state,” would seem to warrant use of anticoagulants, yet they aren’t often used — why? The problem seems to be a lack of data with which to evaluate their effectiveness and possible harms. Big drug trials seem to avoid recruiting these patients, especially those in the later stages of CKD, where, for example, the risk for thromboembolism is two- to three-fold greater than in patients with normal kidney function.

We talk with Dr. Sunil Badve, senior author of a meta-analysis in a recent Annals of Internal Medicine. His findings? Non-vitamin K oral anticoagulants (or “NOACs”) seem better suited for those with early-stage disease than vitamin K antagonists like warfarin. In later-stage CKD, there just isn’t enough data available yet, and so the choice of therapy — if any — must weigh benefits against harms carefully.

Links:

Annals of Internal Medicine meta-analysis

Physician’s First Watch coverage

June 11th, 2019

Podcast 226: What we need to talk about when we talk about health

(3 votes, average: 3.00 out of 5)

Length: 18 minutes

Sandro Galea, dean of Boston University’s School of Public Health, has written a new book. It’s called “Well: What we need to talk about when we talk about health,” and it’s the centerpiece of our discussion.

Dr. Galea, who trained as an emergency physician, believes that health is a public good and thus worthy of public investment in the things that will promote health in the future, like public education, breathable air, drinkable water, and the like.

Listen in.

The book is available through Amazon or your local bookseller. It’s published by Oxford University Press.

November 28th, 2018

Podcast 225: Managing diabetes in primary care — are there quality differences among NPs, PAs, and MDs?

(6 votes, average: 3.83 out of 5)

Does the diabetes care afforded by NPs and PAs match that of MDs? According to a careful analysis among Veterans Affairs patients there are no clinical differences in intermediate outcomes — hemoglobin A1c, systolic pressure, or LDL cholesterol.

The principal and senior authors of that analysis are our guests this time.

Links:

August 23rd, 2018

Podcast 224: What’s a “preprint server,” and how might it change how we think about journals?

(5 votes, average: 5.00 out of 5)

Rohan Khera wrote an editorial in The BMJ to accompany his own paper on guidelines for hypertension treatment. In it, he wrote, not about his research, but about the way biomedical articles are published now, and how preprint servers could change that. (In essence, pre-print servers are online repositories of rough drafts of research available for all to see; articles on such servers have not been subjected to peer review.)

Khera’s research article, it should be noted, originally appeared months earlier in draft form on BioRxiv, a biomedical preprint server.

Khera argues that the “official” journals are too slow. He fears their slowness. for instance, can prevent important data from reaching policymakers when it’s most needed — while they are making decisions based on new research languishing in the standard publication process.

Khera’s BMJ commentary

Khera et al.’s preprint on BioRxiv

Khera et al.’s resarch article as published in The BMJ

Conversation with Harlan Krumholz (from 2016): “Rethinking what medical journals do”

August 14th, 2018

Podcast 223: What are the implications of the BP guidelines?

(8 votes, average: 4.50 out of 5)

If adopted, last December’s ACC/AHA guidelines on what pressure levels signal hypertension would label almost two thirds of the U.S. population between ages 45 and 75 as having the condition. The number of people who would be candidates for treatment would almost double — from 8 million to about 15 million.

What are the implications of this for clinicians?

Harlan Krumholz, senior author of an analysis in The BMJ, talks about the problems and the opportunities for collaboration with patients.

BMJ article (free)

July 19th, 2018

Podcast 222: Growing prominence of NPs in primary care

(2 votes, average: 5.00 out of 5)

This time we talk with Dr. Hilary Barnes, first author of a Health Affairs paper: “Rural and Nonrural Primary Care Physician Practices Increasingly Rely on Nurse Practitioners.”

I thought listeners might want to know more about the dramatic change in the way primary care is acquiring, in Barnes’s words, an “increasing interdisciplinary character.”

Health Affairs abstract

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