February 13th, 2012
Podcast 145: The Y chromosome and the possible role of a common variant in coronary disease in men.
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Haplogroups — who knew? Ancient variations in the Y chromosome form what’s known as haplogroups, and haplogroup I is common in Europe, particularly so in northern Europe. Researchers find that “I” is an independent risk factor for coronary artery disease in men, carried as it is on the male-only Y chromosome.
Listen in as we talk ancient genetics and what it all could mean for a range of immune-system-related diseases. There’s plenty of work to be done, but we thought you ought to know about this earlier rather than later.
Links:
- Physician’s First Watch coverage (free)
- Lancet abstract (free)
February 3rd, 2012
Podcast 144: Hip fractures, PPIs, and smoking history in postmenopausal women — increased risks
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PPIs are back on our radar, and this time it’s their regular use among postmenopausal women.
A BMJ article examines data from the Nurses’ Health Study to show a significantly increased risk for hip fracture among postmenopausal women with any smoking history. Never-smokers showed no statistically significant increase.
Now that proton pump inhibitors have been available over-the-counter for the better part of a decade, should clinicians be asking about their patients’ smoking history in concert with asking about how they handle heartburn?
Links:
BMJ article (free)
January 27th, 2012
Podcast 143: PPIs and asthma control — it doesn’t work in kids, either
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Controlling asthma by the use of proton pump inhibitors apparently doesn’t work any better in children than it does in adults. Yet the practice is widely used.
A study in JAMA and an accompanying fiery editorial seem to put the notion to rest. Listen in.
As always, suggestions are welcomed. You can reach me directly at 617-440-4374 — don’t be shy!
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January 20th, 2012
Podcast 142: Really, why are you ordering that test?
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The American College of Physicians wants to encourage high-value, cost-conscious care. And so they convened a consensus panel of physicians to list tests that they considered overused or inappropriately used in certain circumstances. One example would be the use of MRI for breast screening in normal-risk patients; another is the use of imaging studies in the diagnosis of nonspecific low-back pain.
The panel came up with about 40 such examples, and the ACP is inviting your reactions (and suggestions for further examples) on a survey available on its website, a link to which is in the list below.
Meanwhile, listen in on a 15-minute conversation with Dr. Amir Qaseem, the first author of the panel’s report, just published in the Annals of Internal Medicine. An editorial on the report cites a Congressional Budget Office study estimating that 5% of the nation’s GDP is misspent on medical tests and procedures that don’t help the patient. That’s fully 25% of all health expenditures! Houston, we have a problem….
Links:
Physician’s First Watch coverage (free)
Annals of Internal Medicine article (free abstract)
ACP survey form (free access)
January 13th, 2012
Podcast 141: Clinically apparent atrial fibrillation increases stroke risk; does subclinical afib do the same?
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Yes, it apparently does.
An international study in the New England Journal of Medicine monitored subclinical atrial fibrillation among some 2600 patients who’d just received an implanted pacemaker or cardioverter-defibrillator.
After 3 months of monitoring, about 10% of the group showed subclinical episodes of afib lasting at least 6 minutes.
Over an additional 2.5 years of follow-up the patients initially showing subclinical afib were found to have at least twice the risk for stroke or systemic thromboembolism compared with the rest of the group.
What does it all mean to clinicians? Should anticoagulation measures be taken in patients showing subclinical afib?
Dr. Stuart J. Connolly, one of the study’s principal authors, chatted with Clinical Conversations, offering some clinical guidance on what to do while the apparent magnitude of the effect is investigated further.
Links:
January 6th, 2012
Podcast 140: A new edition of the ACP’s manual on ethics for clinicians is available online
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The new edition of the American College of Physicians Ethics Manual has just been released, and at 30 pages, it’s well worth the reading time.
It’s available free online as a supplement to the Annals of Internal Medicine. New or updated topics include social media and online professionalism, interrogation of prisoners, and allocation of medical resources.
In discussing the relation of the physician to the government, the manual states unequivocally: “Under no circumstances is it ethical for a physician to be used as an instrument of government to weaken the physical or mental resistance of a human being….”
Listen in to our chat with two of the people on the committee that put the new edition of the manual together
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