Recent Posts

July 6th, 2022

Podcast 295: How should clinicians manage severe (but asymptomatic) carotid artery stenosis while awaiting CREST-2’s results?

CREST-2’s results are probably more than a year away. In the meantime, what to do about diagnosed severe (but asymptomatic) carotid stenosis? Recent results suggest that medical management compares favorably with the surgical approach.

In this edition, we address the question with a conversation between Dr. Allan Brett, NEJM Journal Watch‘s editor-in-chief, and Dr. Seemant Chaturvedi, a University of Maryland neurologist who serves on CREST-2’s executive committee.

[Running time: 16 minutes]

NEJM Journal Watch coverage of a recent JAMA paper on the topic.

June 29th, 2022

Podcast 294: PD-1 blockade in locally advanced rectal cancer

Locally advanced rectal cancer usually receives a three-part treatment: chemotherapy followed by radiotherapy and then surgery.

In a small-cohort study presented at this year’s ASCO conference researchers used a PD-1 inhibitor — dostarlimab — every three weeks for 6 months against the disease. All patients had mismatch repair deficient tumors. No other treatments were needed however, since the 12 patients all attained complete response if they completed the regimen.

As part of the NEJM Group’s coverage of ASCO, Christine Sadlowski interviewed the study’s first author, Dr. Andrea Cercek of Memorial Sloan Kettering Cancer Centern about the study and its implications.

The study as published in the New England Journal of Medicine

June 27th, 2022

Podcast 293: HER2-“low” breast cancer and its reponse to an antibody-drug conjugate

Patients with metastatic breast cancer whose tumors express low levels of HER2 are generally classified and treated as having HER2-negative disease.

However, Dr. Shanu Modi of the Memorial Sloan Kettering Cancer Center and a group of international collaborators explored the use of a monoclonal antibody–drug conjugate (trastuzumab–deruxtecan) in patients with disease they classify as HER2-“low.” Compared with “low” patients treated with one of several standard-of-care regimens, those receiving the conjugate therapy had greater median progression-free survival (roughly 10 months versus 5) and a longer overall survival (roughly 24 versus 18 months).

Christine Sadlowski of the NEJM Group interviewed Dr. Modi during the Group’s coverage of this year’s ASCO meeting, where Modi presented her results.

Have a listen.

Modi et al. as published in the New England Journal of Medicine.

June 17th, 2022

Podcast 292: Informed consent and apnea testing for death — or — What is death, anyway?

Apnea testing is part of the protocol used to determine whether a patient is dead according to neurologic criteria. The question is, do clinicians need to obtain consent to proceed?

In a fascinating 15-minute chat, two intensivists, Drs. Patricia Kritek and Robert Truog, discuss that question and another, larger one: what is death, anyway? Their back-and-forth was prompted by a recent debate, published in Chest, between two others —  a clinician and a law professor.

Have a listen, and please leave a comment to help guide future editions.

The Chest article

The New Yorker article mentioned by Dr. Truog

May 24th, 2022

Podcast 291: Unionized nursing homes had lower mortality during Covid-19

In the early waves of the Covid-19 pandemic why did patients in unionized nursing homes, have a roughly 10% lower rate of mortality than those in non-unionized ones? A report in Health Affairs tries to sort out the possible reasons.

Listen to our 13-minute interview, which raises the question: Should you send your patients to non-unionized facilities?

Health Affairs article

May 8th, 2022

Podcast 290: USPSTF’s new take on aspirin and primary prevention of CVD

The U.S. Preventive Services Task Force recently issued its sixth set of guidelines on using daily aspirin to prevent cardiovascular disease. The guidelines appeared in JAMA — whose editors asked our guest, Dr. Allan Brett, to write an editorial evaluation.

This edition carries Brett’s advice on using the new guidelines in daily clinical practice.

Brett’s JAMA editorial

USPSTF recommendations in JAMA

[Running time: 15 minutes]

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