2018 Podcast Archive - PodMed

PodMed TT – Friday, July 12, 2019

This week’s topics include antibiotics for pneumonia, CRP and COPD exacerbations, factors related to lower extremity amputation, and supplements.

0:44 Supplements and cardiovascular outcomes
1:45 Some reduced risk with some supplements
2:45 Relies on a healthy diet
3:16 Pneumonia treatment with antibiotics
4:16 Treated appropriately in hospital
5:15 Keep as short as possible
6:05 COPD, C-reactive protein and antibiotic use
7:05 No evidence of harm in not using antibiotics
8:05 Used clinical criteria in the past
9:03 Peripheral arterial disease and microvascular disease, and amputation
10:01 Amputation over nine years
11:01 How to identify
12:08 End

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PodMed TT – Friday, July 05, 2019

This week’s topics include reanimating the upper extremity after spinal cord injury, raising rates of vaccination in kidsl, obesity and genes, and a bacterium and metabolic syndrome.

0:45 Using a bacterium to change obesity
1:45 Can be pasteurized
2:48 Not transferring the microbiome
3:14 Increasing vaccination rates in kids
4:15 Parents need to submit proof of discussing risks
5:15 Editorialists recommend federal policy
6:10 Address on a national level
6:46 Genes and environment and obesity
7:45 Don’t understand all the genes
8:45 Can’t change genes but can change environment
9:00 Reanimating upper extremity in quadriplegia
10:03 Move the nerve from a less needed muscle
11:00 Full function takes a lot of time
12:40 End

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PodMed TT – Friday, June 28, 2019

This week’s topics include Medicare Advantage plans and readmissions, high sensitivity troponin as part of an assessment tool, adrenal incidentalomas, and dual antiplatelet therapy after stent placement.

0:40 High sensitivity troponin plus other factors in MI risk
1:45 MI or 30-day outcomes
2:40 Complexity of algorithm
3:18 Dual antiplatelet therapy after stent
4:17 Half switched to single therapy
5:17 Decreased risk of bleeding
5:27 Incidentaloma in adrenal gland
6:30 Greater risk for cardiovascular events
7:30 No increase in mortality
8:00 Medicare advantage
9:00 Maybe restrict care?
10:00 Excess 2,700 readmissions for heart attack
11:00 Don’t provide the reasons
11:44 End

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PodMed TT – Friday, June 21, 2019

This week’s topics include a new agent for sickle cell, two ways to assess blood flow in the heart, the dangers of cosmetics for kids, and predicting who will develop dementia.

1:00 ED visits for kids due to cosmetics exposures
2:00 Fifteen-year study period
3:00 Need to store in a locked location
3:11 A new drug for sickle cell disease
4:11 Also received hydroxyurea in 2/3
5:12 Addresses the protein
5:40 Blockage in arteries around the heart
6:40 Fractional flow reserve
7:40 Could place a stent?
8:42 Predicting dementia with three tests
9:43 Ranged in age from 67 to 83
10:43 Thinning of brain
11:41 Somehow identify earlier
12:52 End

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PodMed TT – Friday, June 14, 2019

This week’s topics include preventing Type 1 diabetes, diagnosing meningitis and encephalitis, white coat hypertension and CVD, and screening and prevention of HIV infection.

0:45 A correction
1:25 White coat hypertension and cardiovascular events
2:25 Treated rise in blood pressure
3:25 Increased risk by 36%
4:21 USPSTF recommendations for HIV prevention
5:21 Pre-exposure prophylaxis
6:21 Now will be covered by Medicaid
6:49 Prevention of Type 1 diabetes with an antibody
7:49 Transient drop in white blood cells
8:49 Delayed by two years
9:58 Diagnosing encephalitis and meningitis
11:00 Confirm with more specific tests
12:34 End

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PodMed TT – Friday, June 07, 2019

This week’s topics include treatment of chronic lymphocytic leukemia, the cost of physician burnout, the impact of OpenNotes, and long term follow up of abdominal aortic aneurysm repair.

0:52 Treating chronic lymphocytic leukemia
1:52 Patients were high risk
2:52 No new toxicities
3:15 Abdominal aortic aneurysm repair
4:15 27% of endovascular had a second procedure
5:00 OpenNotes and medication adherence
6:00 Patients remember about half of the information in a visit
7:01 Patients entitled to this information
8:01 Encouraging patients to take a look
8:40 Cost of physician burnout
9:40 $7,600 per physician per year
10:40 Addressing electronic medical records
11:30 I do think it’s worse now
12:21 End

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PodMed TT – Friday, May 31, 2019

This week’s topics include mindfulness for surgeon burnout, cholesterol guidelines, causes of death around pregnancy, and mortality among football and baseball players.

0:38 Mindfulness for surgical trainees
1:38 Conscious awareness of cognitive control
2:29 Feasible and acceptable
3:30 Brain imaging to support
3:50 Cholesterol management
4:51 Consider adding another agent if doesn’t go down enough
5:52 Lowering cholesterol improves survival
6:05 Pregnancy-related mortality
7:06 Preventable in 60%
8:04 Death among NFL and MLB athletes
9:25 Chose other athletes as comparison
10:49 End

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PodMed TT – Friday, May 24, 2019

This week’s topics include best management of mild asthma, suicide data, bariatric surgery in adults and adolescents, and AI and lung cancer screening.

0:45 An AI model to improve lung cancer screening
1:47 Improve model’s predictive value
2:47 Had 42,000 CT scans
3:37 Management of mild asthma
4:38 Eosinophils in their sputum
5:37 Rise in suicides in 10-14-year-old girls
6:40 Guns in 15-19-year-olds
7:40 Social media relationship?
8:40 Use of bariatric surgery in adults and adolescents
9:40 Adolescents more likely to experience remission of diabetes
10:30 Shared decision making
11:15 End

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PodMed TT – Friday, May 17, 2019

This week’s topics include dabigatran for cryptogenic stroke, predicting kidney rejection, obstructive sleep apnea and surgical outcomes, and glucosamine supplements and cardiovascular outcomes.

0:40 Glucosamine and cardiovascular outcomes
1:43 Over 10,000 cardiovascular events
2:45 Many other factors could improve outcome
3:40 Genetic makeup and kidney rejection
4:41 Recipients developed antibodies against it
5:42 Maybe mimic Rh incompatibility?
6:25 Unrecognized obstructive sleep apnea and surgical outcomes
7:30 Did not modify irrespective of strategy
8:30 Don’t know how to treat
9:06 Dabigatran in stroke prevention
10:06 Better than aspirin?
11:00 No use for dabigatran
11:37 End

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PodMed TT – Friday, May 10, 2019

This week’s topics include progesterone in threatened miscarriage, Apgar scores, Mohs surgery use, and late treatment of stroke.

0:35 Mohs surgery use
1:35 Compare one surgeon to another
2:35 How to deal with outlying physicians?
3:33 More money per excision
3:43 Thrombolysis up to 9 hours post stroke
4:45 Did a scan to assess living tissue
5:45 Increased risk for bleeding
6:10 Apgar scores in normal window
7:10 A score of 7, 8 or 9
8:10 Do carry prognostic information
9:00 Progesterone and bleeding in early pregnancy
10:00 Followed to end of pregnancy
10:53 End

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PodMed TT – Friday, May 03, 2019

This week’s topics include PT after knee arthroscopy, management of hypertension in people with diabetes, mammography in older women, and measles update.

0:48 Measles update
1:48 90% haven’t been vaccinated
2:50 Titres may not prove immunity
3:10 Mammography in older women
4:11 Understanding what is the best screening technique
5:15 Women should have screening
6:11 USPSTF says there isn’t as much evidence
6:49 Blood pressure in patients with T2D and heart disease
7:50 Almost 11,000 patients
8:53 Rehabilitation after knee replacement
9:53 No important difference in patient reported pain
10:50 Bundled payment
11:30 More motivated as inpatient?
12:19 End

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PodMed TT – Friday, April 26, 2019

This week’s topics include metformin for long-term weight loss, glucose control and fetal health, Medicaid expansion and pregnancy outcomes, and sedentary behavior in the U.S.

0:41 Metformin and long term weight loss
1:43 At one year intensive lifestyle appeared best
2:43 Increased indications for metformin
3:32 One in 200 women with type 1 diabetes and preterm birth
4:30 The higher your sugar the more likely preterm birth
5:30 Affects both mother and fetus
5:40 Medicaid expansion and birth outcomes
6:40 Did not see a benefit except in racial disparity
7:44 What the causative factors might be?
8:10 Sedentary behavior in US population
9:20 Computer use increased
10:25 Do not offset deleterious impact of sitting
11:44 End

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PodMed TT – Friday, April 19, 2019

This week’s topics include testing pregnant women and children for lead, health benefits of FDA labeling on sugar in foods, outcomes for cancer surgery, and live kidney donation complications.

0:58 FDA sugar labeling of foods and health
1:52 Could save 350,000 people from cardiovascular disease
2:50 What if they reformulated beverages?
3:50 Long time for FDA implementation
4:27 Safety in top-ranked cancer hospitals and affiliates
5:28 As much as 100 percent higher
6:28 Experience of surgeon and team
7:10 Long term outcomes for live kidney donation
8:18 Most of the events not related to surgery
9:15 10,000 patients over a long period of time
10:00 Lead levels in children and pregnant women
11:15 Suggest that blood lead level in kids should be done?
12:31 Chelating agents associated with harms in kids
13:47 End

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PodMed TT – Friday, April 12, 2019

This week’s topics include best treatment after sudden cardiac death, getting more physicians involved in diagnosis, low-dose aspirin and lung cancer prevention, and reducing amyloid and Alzheimer’s disease.

0:44 More than one doctor to make the diagnosis
1:45 Collective intelligence associated with higher diagnostic accuracy
2:42 How do you make this happen?
3:43 More esoteric cases
4:30 Looking for heart disease in people with sudden cardiac death
5:35 Both groups about 2/3 survived
6:40 Low-dose aspirin and lung cancer prevention
7:40 Modest decreased risk of lung cancer
8:41 Dying of a higher rate of other reasons
9:30 Amyloid reduction and Alzheimer’s
10:30 People that have MCI but not dementia
11:30 May be a bystander
12:25 End

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PodMed TT – Friday, April 05, 2019

This week’s topics include treatment of patients lacking health insurance, transplant of HCV-infected organs, alcohol use and health impact, and how nutrition affects non-communicable diseases worldwide.

0:42 Transplant of HCV infected organs
1:42 Donors had high viral load
2:42 Longest followed for a year
3:30 Insurance status and access to hospital care
4:32 Target those seen for pulmonary issues
5:31 Weighs heavy on inner city hospitals
6:33 Alcohol and cigarette comparison
7:35 Run counter to a lot of studies on alcohol
8:33 Cancer just one of the conditions
9:27 Global burden of suboptimal diet
10:27 25% of deaths globally due to this
11:25 Transition to a Western diet
12:14 End

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PodMed TT – Friday, March 29, 2019

This week’s topics include stem cells for heart repair, the very preterm babies and outcomes, malpractice claims and physician behavior, and air pollution and psychosis.

0:44 Air pollution and psychotic experiences in adolescence
1:42 At 18 years of age privately interviewed
2:46 May explain about 60 percent of the association
3:35 Contribute to neurotoxicity
4:24 Physician malpractice and behavior
5:26 Increased odds of leaving practice
6:26 Do not move in response
6:45 Neonatal outcomes in Sweden
7:45 Necrotizing enterocolitis did not decrease
8:45 About 28 weeks still common limit
9:19 Stem cells for heart failure
10:19 Advanced heart failure on LVAD
11:10 Pretty disappointing
12:17 End

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PodMed TT – Friday, March 22, 2019

This week’s topics include best medicines for atrial fibrillation when a stent is used, the an envelope for cardiac devices to reduce infection risk, psychosis and ADHD medicines, and eggs and cardiovascular disease.

0:54 Eggs and cardiovascular outcomes and death
1:53 Linear relationship with consumption
2:50 Egg consumption associated with other unhealthy behaviors in past
3:56 Tied more to cholesterol
4:34 Cardiac device envelope
5:35 Mesh material with antibiotics
6:36 ADHD medicines and psychosis
7:36 Twice as high in the amphetamine group
8:40 0.1 to 0.2% of patients
9:20 One in five people with a-fib need a stent
10:27 Safest anticlotting was apixiban
11:58 End

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PodMed TT – Friday, March 15, 2019

This week’s topics include vaccines and autism, the effects of low-dose aspirin after prostate cancer diagnosis, wearable technologies and surgery recovery, and a report of a patient cured of HIV infection.

0:47 Report of HIV remission in man who tested positive
1:49 After bone marrow transplant, no reported HIV infection
2:45 Autism spectrum disorders and vaccines
3:40 Relationship between vaccines and autism a resounding “no!”
4:20 Two-decade old controversial paper retracted
5:36 Unvaccinated individuals have caused measles outbreaks
6:41 Low-dose aspirin not associated with improvement in mortality
7:40 Wearable devices
8:30 Technology might result in benefit
9:17 Physicians not good at predicting ambulation
10:42 End

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PodMed TT – Friday, March 08, 2019

This week’s topics include testing for breast cancer mutations, peanut allergy treatment, aspirin use for prevention, and FIT testing for colorectal cancer screening.

0:45 Easily treat children for peanut allergy?
1:46 Was able to reduce the response by 21 percent
2:44 Didn’t appear as good as other methods
3:12 Fecal immunochemical test in colorectal cancer
4:15 If you’re not going to use colonoscopy do it annually
5:20 USPSTF recommendations for BRCA mutations
6:20 Autosomal dominant
7:20 Worry and anxiety increase with positive results
8:22 Bleeding risk with aspirin
9:22 Over 4,400 major bleeding events
10:22 Engage patient in decision
11:20 Use EHR to employ
12:19 End

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PodMed TT – Friday, March 01, 2019

This week’s topics include complications of shoulder surgery, induction of labor, sepsis and death and bag ventilation at intubation.

0:37 Induction of labor at 41 weeks
1:39 May be better to induce than to wait
2:40 Studies in pregnant women
3:16 Complications of shoulder surgery
4:16 Serious adverse events
5:21 Sepsis and death
6:24 Hospice qualifying condition on admission
7:24 Less than 5 percent preventable
8:03 Making intubation safer
9:15 Bag mask ventilation
10:10 1.5 million patients ventilated each year
11:15 End

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PodMed TT – Friday, February 22, 2019

This week’s topics include push-ups and mortality, primary care physicians and mortality, osteoporosis in men and early initiation of MS therapy.

0:41 Early use of treatments for MS
1:43 Disease modifying therapy complex
2:43 Several studies relative to MS
3:00 Primary care physician supply and outcomes
4:01 Change in population distribution
5:00 Address risk factors
5:35 Push-ups and mortality
6:35 Mean age almost 40 years
7:36 Cardio fitness was predictive
8:37 Any measure of cardiovascular fitness good
9:00 Osteoporosis in older men and women
10:00 Risk factors, DEXA scans and treatment
11:00 Oral steroids and other factors still didn’t predict screening
11:47 End

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PodMed TT – Friday, February 15, 2019

This week’s topics include decolonizing people with MRSA, perinatal depression guidelines, active surveillance for prostate cancer and reducing opioid use after hip surgery.

0:41 Active surveillance for low-risk prostate cancer
1:42 SEER database for prostate cancer
2:45 Personalized approach
3:13 Perinatal depression guidelines
4:14 CBT or interpersonal therapy helpful
5:17 Psychotherapy via telemedicine
5:50 Effect of acetaminophen and ibuprofen on morphine use
6:50 Combination reduced morphine use
7:51 Doesn’t increase adverse side effects
8:21 Reducing MRSA among carriers
9:23 Use cleansing techniques after discharge
10:24 All done at home
11:39 End

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PodMed TT – Friday, February 08, 2019

This week’s topics include a new tetracycline class antibiotic, a look at topical pain creams and gels, attempts to reduce delirium postoperatively and are you ever too old for statins?

0:36 Are you ever too old for statins?
1:37 Lowering risk of vascular events
2:32 Absolute benefit about the same
3:20 Topical compounded pain creams and gels
4:20 Avoid oral medications
5:23 A new antibiotic
6:23 Just as effective as older antibiotics
7:22 Part of the tetracycline class
7:44 Trying to reduce delirium postop
8:44 Titrate to minimize EEG disruption
9:43 National guidelines recommend and should reevaluate
10:44 Other strategies known to help
11:13 End

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PodMed TT – Friday, February 01, 2019

This week’s topics include antibiotic treatment for bone and joint infection, the benefits of breakfast, a heart failure prediction score and computer-aided decision-making for surrogates in the ICU.

0:41 Assisting surrogate decision-makers with a web-based tool
1:43 Explore options relative to decision-making
2:43 Beliefs more important that facts
3:43 A lot of experience
4:47 Make sure advance directives are in place
5:17 Antibiotic treatment for bone and joint infection
6:17 Treatment failures the same for IV or oral
7:13 Should you eat breakfast?
8:13 Ate more calories in a day
9:13 No support that breakfast helps weight loss
9:42 Acute heart failure risk score
10:41 Risk score very good at predicting 30-day mortality
11:43 Overall mortality about 8 percent
12:55 End

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PodMed TT – Friday, January 25, 2019

This week’s topics include harms related to medical treatment, when to start a common Parkinson’s disease drug, overprescription of antibiotics, and a diabetes drug and prevention of heart disease.

0:38 Using a diabetes drug to prevent heart disease
1:36 Midway change in the trial
2:26 Which diabetes drug is best?
3:20 Harms of medical treatment
4:20 Rate decreased over 21 percent
5:20 Help focus in on places to intervene
6:27 When to start medicine for Parkinson’s disease
7:27 No difference in when levodopa is started
8:25 Viral component?
9:00 Factors related to aging to 90
10:10 Men had a linear association with physical activity
11:54 End

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PodMed TT – Friday, January 18, 2019

This week’s topics include treatment of multiple sclerosis, malaria treatment, overprescription of antibiotics and fecal transplant for ulcerative colitis.

0:43 Overprescribing of antibiotics
1:45 13 percent appropriately prescribed
2:45 Antibiotic stewardship
3:32 Malaria treatment
4:30 Tafenoquine about 67 percent effective
5:30 Fecal transplant for ulcerative colitis
6:30 Primary outcome achieved in about a third
7:33 Better identify patients who would benefit
8:26 Treatments for multiple sclerosis
9:26 Stem cell therapy
10:30 From experienced centers
11:31 End

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PodMed TT – Friday, January 11, 2019

This week’s topics include paying people to take heart medicines, resecting the esophagus, economic impact of cardiovascular events and medical advertising.

0:41 Economic impact of cardiovascular events
1:43 Has societal consequences
2:45 Economic burden on people with cancer
3:40 Incentivizing people to take heart medicines
4:40 Gave half a copay voucher
5:42 Cost wasn’t the entire issue
6:05 Esophagus resection
7:02 Lower incidence of complications with less invasive procedure
8:02 Didn’t compromise survival
8:36 Medical advertising
9:35 $2.1 billion to $9.6 billion increase
10:36 This is a trust issue with patients
11:29 End

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PodMed TT – Friday, January 04, 2019

This week’s topics include incentivizing healthy behaviors, bundling hip and knee replacements, the cost of a new cholesterol med, and compliance with cancer screening and mortality.

0:48 Incentivizing healthy behaviors
1:48 May provide money to lower premiums
2:46 Patients didn’t understand well
3:36 Adherence to cancer screening and mortality
4:35 Mortality among nonadherents
5:32 Nonadherence identifies them at higher risk
6:35 In observational studies we pick healthier people
7:21 Antibody for cholesterol lowering PCSK9 inhibitor
8:21 Are they cost effective?
9:22 Price has to drop to $1,100 per year
10:00 Bundled knee and hip replacements and impact on cost
11:00 Didn’t discharge to post-procedure care facilities
12:00 Didn’t measure patient factors
13:23 End

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