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September 26th, 2019

Podcast 235: Forced sexual initiation and its clinical aftermath

(1 votes, average: 5.00 out of 5)

Running time: 18 min.

Laura Hawks and colleagues undertook a study of forced sexual initiation — that is, a woman’s first episode of vaginal intercourse (and it’s forced when it wasn’t voluntary on her part).

Using government survey data on some 13,000 women of reproductive age, Hawks compared the women whose sexual initiation was voluntary with those whose wasn’t. It turns out that there were longer-term medical consequences apparently associated with the circumstance. Listen in.

Links:

JAMA Internal Medicine article

JAMA Internal Medicine editorial

September 19th, 2019

Podcast 234: Pay for women pediatricians lags

(2 votes, average: 4.50 out of 5)

Running time: 21 minutes

A national sample of early- to midcareer pediatricians shows that women are lagging behind men in compensation, and another study from the sample shows that they’re not getting much help with the housework, either.

We talk with two of the authors of these studies and get their advice on what to do next — besides emptying the dishwasher and folding some laundry, gentlemen.

Links:

Pediatrics article on earnings

Pediatrics article on housework help

Pediatrics editorial on the two articles

September 11th, 2019

Podcast 233: Antipsychotics are no solution to delirium during hospitalization

(2 votes, average: 3.50 out of 5)

Using “Vitamin H” (haloperidol) or newer antipsychotics to treat delirium in hospitalized patients should be off the menu, writes Edward Marcantonio in an Annals of Internal Medicine editorial.

Dr. Marcantonio agrees with the authors of a systematic review who conclude that “current evidence does not support routine use of haloperidol or second-generation antipsychotics to treat delirium in adult inpatients.” In his commentary entitled “Old Habits Die Hard,” he writes “the findings presented are sufficient to stop this clinical practice.”

Links:

Annals of Internal Medicine editorial

Marcantonio’s “Clinical Practice” article in NEJM in 2017

September 6th, 2019

Podcast 232: Basic organic chem and drug pricing

(1 votes, average: 4.00 out of 5)

You surely remember “O-chem” — those late-night undergraduate hours spent grappling with benzene rings and alkanes and all the rest. Well, it turns out that drug makers were paying close attention to things like racemic mixtures and enantiomers. The manufacturers usually release their products as racemic mixtures and then, when patents are about to expire, an enantiomer appears. Voila! New drug, new price!

Dr. Joseph Ross and his crew looked at the implications to Medicare spending of all this. They published an interesting letter in the Annals of Internal Medicine detailing how much money the system could save if we stuck with the racemic mixtures. How much? Well, on the order of $15 billion over 5 to 6 years.

Links:

Annals of Internal Medicine letter

NEJM Journal Watch Pediatrics and Adolescent Medicine coverage of albuterol vs. levalbuterol

 

August 30th, 2019

Podcast 231 — The evidence behind VA’s suicide-prevention guidelines

(1 votes, average: 5.00 out of 5)

Dr. Eric Caine’s editorial in the Annals of Internal Medicine offers a skeptical, yet respectful, take on the evidence supporting the recent suicide-prevention guidelines from the U.S. Department of Veterans Affairs.

What are other countries doing to address suicide? It has increased in the U.S. from about 10.4 per 100,000 residents in the year 2000 to about 14.5 in 2017. Do firearm restrictions help? Better household safety? And how does the U.S. rate compare internationally?

Links:

Annals of Internal Medicine editorial

VA guidelines as published in the Annals

OECD stats on international suicide rates

August 23rd, 2019

Podcast 230 — Hospital-readmissions gaming?

(3 votes, average: 4.33 out of 5)

The Hospital Readmissions Reduction Program (HRRP for short) seems to be reducing 30-day readmissions — but what about revisits to facilities within those 30 days?

Rishi Wadhera and his co-authors measured readmissions, plus treat-and-discharge ER visits, plus stays in observation units among some 3 million Medicare discharges of a near-4-year span. They found that broadening the definition of readmissions to include not only formal returns to the hospital for a standard stay but also those ER and observation-unit encounters tells a different story. It’s a story that should make HRRP’s administrators rethink what should be measured and how expanding the definition of readmissions could benefit patients by truly promoting better quality-of-care.

Links:

Article in The BMJ on readmissions

Earlier article in JAMA on readmissions for heart failure

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