Podcasts about comparative effectiveness

Summary In this episode of the Future of Dermatology Podcast, Dr. Faranak Kamangar discusses the evolving landscape of dermatology with a focus on incretin medications, particularly GLP-1 agonists. This podcast explores the historical context of these medications, their role in weight management, and the implications for dermatological health. Dr. Kamangar addresses the side effects associated with these treatments, including the phenomenon known as 'Ozempic face,' and offers recommendations for maintaining healthy weight and skin health. Takeaways - Incretin medications include GLP-1 agonists and GIPs. - GLP-1 agonists have been used since 2005 for diabetes. - Weight loss medications can have significant side effects. - Rapid weight loss can lead to 'Ozempic face' due to fat loss. - Maintaining muscle mass is crucial during weight loss. - Long-term use of weight loss medications may be necessary. - Lifestyle changes are essential for sustainable weight management. - Dermatologists should be aware of the metabolic effects of these medications. - Natural fat in the face is important for youthful appearance. - Body contouring devices can help target specific fat areas. Chapters 00:00 - Introduction to Dermatometabolic Series 02:47 - Understanding Incretin Medications 06:02 - The Role of GLP-1 Agonists in Weight Management 09:10 - Exploring Side Effects and Safety Profiles 12:08 - Comparative Effectiveness of Semaglutide and Terzepatide 14:48 - Ozempic Face: Causes and Solutions 21:07 - Recommendations for Healthy Weight Management

Asad E. Patanwala, PharmD, MPH, and Brian L. Erstad, PharmD, join CHEST Journal Podcast Moderator Alice Gallo De Moraes, MD, FCCP, to discuss their research into the effect of albumin administration on the need for renal replacement therapy and mortality in patients with septic shock and renal impairment. DOI: 10.1016/j.chest.2024.10.012 Disclaimer: The purpose of this activity is to expand the reach of CHEST content through awareness, critique, and discussion. All articles have undergone peer review for methodologic rigor and audience relevance. Any views asserted are those of the speakers and are not endorsed by CHEST. Listeners should be aware that speakers' opinions may vary and are advised to read the full corresponding journal article(s) for complete context. This content should not be used as a basis for medical advice or treatment, nor should it substitute the judgment used by clinicians in the practice of evidence-based medicine.

Send us a Text Message (please include your email so we can respond!)We are LIVE at CHEST2024! Thank you to the organizers of the conference for inviting us do a live show and thank you to everyone who came out to listen! We talk about a few articles that were recently published in CHEST - "Prophylactic Minocycline for Delirium in Critically Ill Patients: A Randomized Controlled Trial" published by Dal-Pizzol et al and then "Comparative Effectiveness of Amiodarone and Lidocaine for the Treatment of In-Hospital Cardiac Arrest" by Wagner et al.We then touch briefly on some articles being presented later at the conference which we might cover soon (stay tuned)!Minocycline for Delirium (pubmed): https://pubmed.ncbi.nlm.nih.gov/38043911/Minocycline for Delirium (CHEST): https://journal.chestnet.org/article/S0012-3692(23)05833-6/abstractAmio vs Lido (pubmed): https://pubmed.ncbi.nlm.nih.gov/36332663/Amio vs lido (CHEST): https://journal.chestnet.org/article/S0012-3692(22)04039-9/abstractIf you enjoy the show be sure to like and subscribe, leave that 5 star review! Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!

In the September 3, 2024, JACC issue, a major study evaluates the cardiovascular outcomes of second-line antihyperglycemic agents in type 2 diabetes, comparing SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, and sulfonylureas. The research reveals that SGLT2 inhibitors and GLP-1 receptor agonists offer superior cardiovascular protection over the other agents, highlighting their importance for patients with cardiovascular conditions.

Host: Michael Lewiecki, MD, FACP, FACE Here to talk about current concepts in the management of osteoporosis like insurance coverage, therapy sequencing, and comparative effectiveness is Dr. Michael Lewiecki, who presented a session on this exact topic at the 2024 Congress of Clinical Rheumatology.

Millie Long, MD, on Comparative Effectiveness in Ulcerative Colitis by Gastroenterology Learning Network

Joe Paduda is the principal of Health Strategy Associates and the author of the thought-provoking Managed Care Matters blog. He is also the president of CompPharma, LLC, a research and consulting firm dedicated to improving pharmacy programs in workers' compensation. In 2012, Joe received IAIABC's President's Award for his efforts to address the opioid problem in workers' compensation. He currently participates in the “Comparative Effectiveness of Two State Payer Strategies to Prevent Unsafe Opioid Prescribing” research project funded by the U.S. Department of Health and Human Services' Patient Centered Outcomes Research Institute. Before starting his consulting business in 1997, Joe held executive positions with major insurers, including Travelers, United Healthcare, and Liberty Mutual, and earned a Master of Science degree in Health Management from American University. In today's episode of the In The Know podcast, Chris Hampshire and Joe dive into the current state of the workers' compensation space, positive changes that have already been made, and where the industry needs to go from here to remain relevant and successful.   Key Takeaways   Joe highlights his career path in the workers' comp sector. Appealing aspects of the workers' compensation space. The role of functionality is the efforts of workers' comp. Three primary sectors that turn to workers' comp and what they are looking for. Insights into the current positive state of the workers' compensation industry. The dangers of underinvesting in technology in insurance. Major post-pandemic changes to the workers' comp industry. The current climate of activity in the regulatory environment. Insights from the evolution of the Managed Care Matters blog. Joe's thoughts on the pros and cons of workers' comp conferences. The future of workers' compensation, according to Joe. Strategies for attracting quality talent to the insurance industry. A five-year look at the future of the industry. Joe's advice to his early-career self.   Quotes “Workers' comp is the only healthcare system that cares about functionality.” “In workers' comp, we care about the health part of healthcare.” “Good medical care drives positive outcomes.” “The more there is honest debate around a lot of topics, the better off we're going to be.” “I hope people will get more conversant with and invest more intellectually in what's driving the healthcare system.”

Rapha, Leticia e Lucca discutem 7 armadilhas na doença do refluxo gastroesofageana (DRGE)! Referências: 1. Fass, Ronnie. “Gastroesophageal Reflux Disease.” The New England journal of medicine vol. 387,13 (2022): 1207-1216. 2. Parmar, Malvinder S. “Gastroesophageal Reflux Disease.” The New England journal of medicine vol. 388,9 (2023): 863. 3. Jenkins, Danny, and Ines Modolell. “Proton pump inhibitors.” BMJ (Clinical research ed.) vol. 383 e070752. 13 Nov. 2023. 4. Katzka, David A, and Peter J Kahrilas. “Advances in the diagnosis and management of gastroesophageal reflux disease.” BMJ (Clinical research ed.) vol. 371 m3786. 23 Nov. 2020, 5. Barr J, Gulrajani NB, Hurst A, Pappas TN. Bottoms Up: A History of Rectal Nutrition From 1870 to 1920. Ann Surg Open. 2021;2(1):e039. Published 2021 Feb 10. 6.Fass, R et al. “Clinical trial: the effects of the proton pump inhibitor dexlansoprazole MR on daytime and nighttime heartburn in patients with non-erosive reflux disease.” Alimentary pharmacology & therapeutics vol. 29,12 (2009): 1261-72. 7. Lee, R. D., et al. "Clinical trial: the effect and timing of food on the pharmacokinetics and pharmacodynamics of dexlansoprazole MR, a novel dual delayed release formulation of a proton pump inhibitor–evidence for dosing flexibility." Alimentary pharmacology & therapeutics 29.8 (2009): 824-833. 8.Metz, D C et al. “Clinical trial: dexlansoprazole MR, a proton pump inhibitor with dual delayed-release technology, effectively controls symptoms and prevents relapse in patients with healed erosive oesophagitis.” Alimentary pharmacology & therapeutics vol. 29,7 (2009): 742-54. 9. Ip, Stanley, et al. Comparative Effectiveness of Management Strategies For Gastroesophageal Reflux Disease. Agency for Healthcare Research and Quality (US), December 2005. 10. Zhuang, Qianjun, et al. "Comparative efficacy of P-CABs versus proton pump inhibitors for Grade C/D esophagitis: A systematic review and network meta-analysis." Official journal of the American College of Gastroenterology| ACG (2022): 10-14309. 11. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/020839s078lbl.pdf 12. Iwakiri, Katsuhiko, et al. "Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2021." Journal of gastroenterology 57.4 (2022): 267-285. 13. Graham, David Y., and Aylin Tansel. "Interchangeable use of proton pump inhibitors based on relative potency." Clinical Gastroenterology and Hepatology 16.6 (2018): 800-808. 14. Hatlebakk, J G et al. “Nocturnal gastric acidity and acid breakthrough on different regimens of omeprazole 40 mg daily.” Alimentary pharmacology & therapeutics vol. 12,12 (1998): 1235-40. 15. Chen, Joan W., et al. "AGA clinical practice update on the diagnosis and management of extraesophageal gastroesophageal reflux disease: expert review." Clinical Gastroenterology and Hepatology (2023). 16. Gyawali, C. Prakash, et al. "Updates to the modern diagnosis of GERD: Lyon consensus 2.0." Gut 73.2 (2024): 361-371. 17. Katz, Philip O., et al. "ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease." Official journal of the American College of Gastroenterology| ACG 117.1 (2022): 27-56. 18. Hicks, Douglas M., et al. "The prevalence of hypopharynx findings associated with gastroesophageal reflux in normal volunteers." Journal of Voice 16.4 (2002): 564-579. 19. Blondeau, Kathleen, et al. "Improved diagnosis of gastro‐oesophageal reflux in patients with unexplained chronic cough." Alimentary pharmacology & therapeutics 25.6 (2007): 723-732.

The latest research has new strategies for how to improve sleep. There are also important findings on improving fatigue and mood. Tune in to hear research-backed methods to improve your health. If you have any additional questions you would like answered in the future, let me know in the comments!   Watch/Read Next… How to Improve Sleep Efficiency: https://drruscio.com/improve-sleep-efficiency/ The Missing Link Between Stress and Gut Health? Gut Bacteria: https://drruscio.com/stress-and-gut-health/ Can Stress Cause Bloating? https://drruscio.com/can-stress-cause-bloating/ Exercise for Depression: https://drruscio.com/exercise-for-depression/ Natural Mood Enhancers: How to Improve Anxiety Without Medication https://drruscio.com/natural-mood-enhancers/ Do You Have These Surprising High-Funcitoning Anxiety Symptoms? https://drruscio.com/high-functioning-anxiety-symptoms/    Featured Resources Quiet Your Mind and Get to Sleep Book: https://www.amazon.com/dp/1572246278?psc=1&ref=ppx_yo2ov_dt_b_product_details CBT for Insomnia: https://www.cbtforinsomnia.com/ Behavioral Sleep Medicine Memebers Directory: https://www.behavioralsleep.org/index.php/united-states-sbsm-members    Timestamps 00:00 Intro  01:23 Can exercise offset too little sleep?  03:26 How to improve post-infection fatigue 05:21 An effective strategy for insomnia 06:35 Does blue-light blocking actually help sleep?  09:42 The importance of caffeine timing  11:40 Supports for chronic fatigue   14:21 Ways to improve mood & stress Featured Studies    Joint association of physical activity and sleep duration with risk of all-cause and cause-specific mortality: a population-based cohort study using accelerometry: https://pubmed.ncbi.nlm.nih.gov/36990109/  Positive Effects of Probiotic Therapy in Patients with Post-Infectious Fatigue: https://pubmed.ncbi.nlm.nih.gov/37233680/   Comparative Effectiveness of Digital Cognitive Behavioral Therapy vs Medication Therapy Among Patients With Insomnia: https://pubmed.ncbi.nlm.nih.gov/37040111/   Blue-light filtering spectacle lenses for visual performance, sleep, and macular health in adults: https://pubmed.ncbi.nlm.nih.gov/37593770/   Restricting short-wavelength light in the evening to improve sleep in recreational athletes - A pilot study: https://pubmed.ncbi.nlm.nih.gov/30427265/  Awakening effects of blue-enriched morning light exposure on university students' physiological and subjective responses: https://pubmed.ncbi.nlm.nih.gov/30674951/  The effect of caffeine on subsequent sleep: A systematic review and meta-analysis: https://pubmed.ncbi.nlm.nih.gov/36870101/  Coenzyme Q10 + alpha lipoic acid for chronic COVID syndrome: https://pubmed.ncbi.nlm.nih.gov/35994177/  Effectiveness of physical activity interventions on reducing perceived fatigue among adults with chronic conditions: a systematic review and meta-analysis of randomised controlled trials: https://pubmed.ncbi.nlm.nih.gov/37666869/  The Effects of Dose, Practice Habits, and Objects of Focus on Digital Meditation Effectiveness and Adherence: https://pubmed.ncbi.nlm.nih.gov/37725801/  Mindfulness and emotion regulation--an fMRI study: https://pubmed.ncbi.nlm.nih.gov/23563850/     Get the Latest Updates Facebook - https://www.facebook.com/DrRusciodc Instagram - https://www.instagram.com/drrusciodc/ Pinterest - https://www.pinterest.com/drmichaelrusciodc    DISCLAIMER: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Music featured in this video: "Modern Technology" by Andrew G, https://audiojungle.net/user/andrew_g  *Full transcript available on YouTube by clicking the “Show transcript” button on the bottom right of the video.

Here is the profile for Harvard Professor Robert (Bobby) Yeh. His most recent Circulation paper: Bringing the Credibility Revolution to Observational Research in Cardiology. We referenced a paper by Professor Miguel Hernan: The C-Word: Scientific Euphemisms Do Not Improve Causal Inference From Observational DataPaper referenced on left ventricular assist devices: Comparative Effectiveness of Percutaneous Microaxial Left Ventricular Assist Device vs Intra-Aortic Balloon Pump or No Mechanical Circulatory Support in Patients With Cardiogenic ShockSensible Medicine is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.I learned a lot from this conversation. One of the main lessons is that no matter how well the authors avoid causal language, the intent of an observational comparison study is causal. And if that is so, the main thrust of these efforts ought to be simulate, as close as possible, a randomized clinical trial. One of my favorite parts of our chat was Bobby's now famous explanation of immortal time bias using Cheetos. Let us know what you think. I hope to do more of these types of conversations. JMM This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

Die Anzahl effektiver, gezielter Pharmakotherapien im septischen Schock, einem Krankheitsbild mit einer Mortalität über 30%, ist immer noch limitiert. Die aktuellen Leitlinien der Surviving Sepsis Campaign geben eine schwache Empfehlung mit i.v.-Hydrocortison 200mg/d, basierend auf Evidenz von moderater Qualität. Die sogenannte HPA-Achse, also das System zur Regulation der Stresshormone, scheint aber bei differenzierter Betrachtung von größerer Bedeutung für die Immunmodulation in der Sepsis zu sein als bisher angenommen. Über neueste Studien sprechen wir mit Prof. Briegel von der LMU München. Diskutierte Studien zum Nachlesen:Bosch NA, Teja B, Law AC, Pang B, Jafarzadeh SR, Walkey AJ. Comparative Effectiveness of Fludrocortisone and Hydrocortisone vs Hydrocortisone Alone Among Patients With Septic Shock. JAMA Intern Med. 2023;183(5):451-459. doi:10.1001/jamainternmed.2023.0258Annane D, Renault A, Brun-Buisson C, et al. Hydrocortisone plus Fludrocortisone for Adults with Septic Shock. N Engl J Med. 2018;378(9):809-818. doi:10.1056/NEJMoa1705716Venkatesh B, Finfer S, Cohen J, et al. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock (ADRENAL). N Engl J Med. 2018;378(9):797-808. doi:10.1056/NEJMoa1705835Sprung CL, Annane D, Keh D, et al. Hydrocortisone therapy for patients with septic shock (CORTICUS). N Engl J Med. 2008;358(2):111-124. doi:10.1056/NEJMoa071366Briegel J, Möhnle P, Keh D, et al. Corticotropin-stimulated steroid profiles to predict shock development and mortality in sepsis: From the HYPRESS study. Crit Care. 2022;26(1):343. Published 2022 Nov 7. doi:10.1186/s13054-022-04224-5Dequin PF, Meziani F, Quenot JP, et al. Hydrocortisone in Severe Community-Acquired Pneumonia. N Engl J Med. 2023;388(21):1931-1941. doi:10.1056/NEJMoa2215145

Interview with Robert W. Yeh, MD, MSc, author of Comparative Effectiveness of Percutaneous Microaxial Left Ventricular Assist Device vs Intra-Aortic Balloon Pump or No Mechanical Circulatory Support in Patients With Cardiogenic Shock, and David J. Cohen, MD, MSc, and Manesh R. Patel, MD, authors of Evidence Generation for Novel Cardiovascular Devices—Putting the Horse Back in Front of the Cart. Hosted by Ajay J. Kirtane, MD, SM. Related Content: Comparative Effectiveness of Percutaneous Microaxial Left Ventricular Assist Device vs Intra-Aortic Balloon Pump or No Mechanical Circulatory Support in Patients With Cardiogenic Shock Evidence Generation for Novel Cardiovascular Devices—Putting the Horse Back in Front of the Cart

Interview with Robert W. Yeh, MD, MSc, author of Comparative Effectiveness of Percutaneous Microaxial Left Ventricular Assist Device vs Intra-Aortic Balloon Pump or No Mechanical Circulatory Support in Patients With Cardiogenic Shock, and David J. Cohen, MD, MSc, and Manesh R. Patel, MD, authors of Evidence Generation for Novel Cardiovascular Devices—Putting the Horse Back in Front of the Cart. Hosted by Ajay J. Kirtane, MD, SM. Related Content: Comparative Effectiveness of Percutaneous Microaxial Left Ventricular Assist Device vs Intra-Aortic Balloon Pump or No Mechanical Circulatory Support in Patients With Cardiogenic Shock Evidence Generation for Novel Cardiovascular Devices—Putting the Horse Back in Front of the Cart

The NACE Journal Club with Dr. Neil Skolnik, provides review and analysis of recently published journal articles important to the practice of primary care medicine. In this episode Dr. Skolnik and guests review the following publications:1. Comparative Effectiveness of Digital Cognitive Behavioral Therapy vs Medication Therapy Among Patients With Insomnia – JAMA Network Open Guest:Aaron Sutton Clinical Assistant Professor of Family and Community Medicine at Thomas Jefferson University and the Behavioral Health Faculty at the Family Medicine Residency program at Abington Jefferson Health Chief Wellness Officer for graduate medical education at Abington Jefferson Health, Abington, PA.2. Vitamin D and Risk for Type 2 Diabetes in People With Prediabetes: A Systematic Review and Meta- analysis of Individual Participant Data From 3 Randomized Clinical Trials Guest: Anastassios G Pittas, MD,  Professor of Internal MedicineTufts School of Medicine Boston, MA3. Comparison of seven popular structured dietary programmes and risk of mortality and major cardiovascular events in patients at increased cardiovascular risk: systematic review and network meta-analysis Guest: Gabriella Petrongolo, DO, Second Year ResidentFamily Medicine ResidencyJefferson Health-Abington, Abington, PA4. Dietary sugar consumption and health: umbrella review Guest: Richard Potter, MD, First Year Resident, Family Medicine ResidencyJefferson Health-Abington, PAMedical Director and Host, Neil Skolnik, MD, is an academic family physician who sees patients and teaches residents and medical students as professor of Family and Community Medicine at the Sidney Kimmel Medical College, Thomas Jefferson University and Associate Director, Family Medicine Residency Program at Abington Jefferson Health in Pennsylvania. Dr. Skolnik graduated from Emory University School of Medicine in Atlanta, Georgia, and did his residency training at Thomas Jefferson University Hospital in Philadelphia, PA. This Podcast Episode does not offer CME/CE Credit. Please visit http://naceonline.com to engage in more live and on demand CME/CE content.

The Journal of Rheumatology's Editor-in-Chief Earl Silverman discusses this month's selection of articles that are most relevant to the clinical rheumatologist. Comparative Effectiveness of BNT162b2 and mRNA-1273 Vaccines Against COVID-19 Infection Among Patients With Systemic Autoimmune Rheumatic Diseases on Immunomodulatory Medications - doi.org/10.3899/jrheum.220870 Validation of the Antineutrophil Cytoplasmic Antibody Renal Risk Score and Modification of the Score in a Chinese Cohort With a Majority of Myeloperoxidase-Positive Patients - doi.org/10.3899/jrheum.220818 Predicting Disease Activity in Rheumatoid Arthritis With the Fibromyalgia Survey Questionnaire: Does the Severity of Fibromyalgia Symptoms Matter? - doi.org/10.3899/jrheum.220507 Effect of Communicative and Critical Health Literacy on Trust in Physicians Among Patients With Systemic Lupus Erythematosus (SLE): The TRUMP2-SLE Project - doi.org/10.3899/jrheum.220678 Investigating Associations Between Access to Rheumatology Care, Treatment, Continuous Care, and Healthcare Utilization and Costs Among Older Individuals With Rheumatoid Arthritis - doi.org/10.3899/jrheum.220729

Episode 9! In this episode we step a little out of our comfort zone to talk about a couple of analyses which caught our interest recently: 1) "Comparative Effectiveness of Fludrocortisone and Hydrocortisone vs Hydrocortisone Alone Among Patients With Septic Shock" published  by Bosch et al March 2023 in JAMA Internal Medicine2) "Osmotic Demyelination Syndrome in Patients Hospitalized with Hyponatremia" published by MacMillan et al March 2023 in NEJM EvidenceFludrocortisone: https://pubmed.ncbi.nlm.nih.gov/36972033/COIITSS: https://pubmed.ncbi.nlm.nih.gov/20103758/ODM: https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200215ODM Editorial: https://evidence.nejm.org/doi/full/10.1056/EVIDe2300014If you enjoy the podcast please share on social media or by word of mouth! Thank you!Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!

Interview with Nicholas A. Bosch, MD, MSc, author of Comparative Effectiveness of Fludrocortisone and Hydrocortisone vs Hydrocortisone Alone Among Patients With Septic Shock, and Michael A. Matthay, MD, author of Should We Add Fludrocortisone to Hydrocortisone for Treatment of Septic Shock? Hosted by Deborah Grady, MD, MPH. Related Content: Comparative Effectiveness of Fludrocortisone and Hydrocortisone vs Hydrocortisone Alone Among Patients With Septic Shock Should We Add Fludrocortisone to Hydrocortisone for Treatment of Septic Shock?

Interview with Nicholas A. Bosch, MD, MSc, author of Comparative Effectiveness of Fludrocortisone and Hydrocortisone vs Hydrocortisone Alone Among Patients With Septic Shock, and Michael A. Matthay, MD, author of Should We Add Fludrocortisone to Hydrocortisone for Treatment of Septic Shock? Hosted by Deborah Grady, MD, MPH. Related Content: Comparative Effectiveness of Fludrocortisone and Hydrocortisone vs Hydrocortisone Alone Among Patients With Septic Shock Should We Add Fludrocortisone to Hydrocortisone for Treatment of Septic Shock?

This week, please join author Xuerong Wen, Associate Editor Sandeep Das, and Guest Host Mercedes Carnethon as they discuss the article "Comparative Effectiveness and Safety of Direct Oral Anticoagulants and Warfarin in Patients With Atrial Fibrillation and Chronic Liver Disease: A Nationwide Cohort Study." Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass of the journal and its editors. We're your co-hosts. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, associate editor, Director of the Poly Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Greg, I'm so excited about today's feature paper. It deals with the important condition where atrial fibrillation exists in patients with chronic liver disease and what do we do for anticoagulation in these patients. It's a comparative effectiveness and safety study of direct oral anticoagulants compared with warfarin in these patients. A huge, wonderful, important study that we're going to discuss. But before we get there, I'd like to tell you about some papers in this issue and I'd like you to tell me about some too. You got your coffee? Dr. Greg Hundley: Absolutely. Dr. Carolyn Lam: All right. I'll go first In this paper that describes a quantitative prognostic tool for the mitral valve prolapse spectrum and it's derived from the new mitral regurgitation international database quantitative or MIDA-Q registry, which enrolled more than 8,000 consecutive patients from North America, Europe, Middle East. And these were patients all diagnosed with isolated mitral valve prolapse or MVP in routine clinical practice of academic centers, all of which also did prospective degenerative mitral regurgitation quantification. The MIDA-Q score was calculated based on characteristics collected in routine practice combining the established MIDA score, which integrated guideline based markers of outcomes like age, New York Heart Association status, atrial fibrillation, LA size, pulmonary artery pressure left ventricular and systolic, I mentioned, and ejection fraction. Integrating that with scoring points based on the degenerative mitral regurgitation quantitation that is measuring effective regurgitant orifice and volume. Dr. Greg Hundley: Very interesting Carolyn. So a scoring system that combines clinical information with what we might assess with echocardiography like regurgitant volume or regurgitant orifice area. So how well did this mortality risk score perform? Dr. Carolyn Lam: So the new score was associated with an extreme range of predicted survival under medical management and that ranged from 97% to 5% at five years for the extreme score ranges. And it was strongly, independently and incrementally associated with long-term survival over all the markers of outcomes. So the authors concluded, and these by the way were authors led by Dr. Maurice Serrano from Mayo Clinic, Rochester, Minnesota. These authors concluded that the score should allow integrated risk assessment of patients with mitral valve prolapse to refine clinical decision making in routine practice and ultimately reduce degenerative mitral regurgitation under treatment. Dr. Greg Hundley: Wonderful description Carolyn. Well I'm going to switch to the world of electrophysiology, Carolyn. And so as you know, the Brugada syndrome is an inherited arrhythmia syndrome caused by loss of function variants in the cardiac sodium channel gene SCN5A and that occurs in about 20% of subjects. And these authors led by Dr. Dan Roden at Vanderbilt University School of Medicine identified a family with four individuals diagnosed with Brugada syndrome, harboring a rare missense variant in the cardiac transcription factor, TBX5, but no SCN5A variant. And upon identifying these individuals, their objective was to establish TBX5 as a causative gene in Brugada syndrome and to define the underlying mechanisms by which it would be operative. Dr. Carolyn Lam: Oh wow. So a new gene variant. So what was the relationship? Dr. Greg Hundley: Right Carolyn? So using induced pluripotent stem cell derived cardiomyocytes from members of the affected family, multiple electrophysiologic abnormalities were detected in these cardiomyocytes including decreased peak and enhanced late cardiac sodium current. In these cells these abnormalities were entirely corrected by CRISPR/Cas9 mediated editing of that TBX5 variant and transcriptional profiling and functional assays in unedited and edited pluripotent stem cell derived cardiomyocytes showed direct SCN5A down regulation caused decreased peak sodium current and that reduced PDGF receptor expression and blunted signal transduction to phosphoinositide-3-kinase. And interestingly, PDGF receptor blockade markedly prolonged normal induced pluripotent stem cell derived cardiomyocyte action potentials. And also Carolyn interestingly in this study they did a separate analysis. It reviewed plasma levels of PDGF in the Framingham Heart Study and they found that they were inversely correlated with the QT corrected interval. And so Carolyn, these results established decrease SCN5A transcription by the TBX5 variant as a cause of Brugada syndrome and also reveal a new general transcriptional mechanism of arrhythmogenesis of enhanced late sodium current caused by reduced PDGF receptor mediated phosphoinositide-3-kinase signaling. Dr. Carolyn Lam: Wow. Wow, that's significant. Thanks Greg. So this next paper is also really important and could change the practice in the field of cardiac resynchronization therapy or CRT. You see, it suggests that the practice of what we do now, which is combining right bundle branch block with intraventricular conduction delay patients into a single non-left bundle branch block category when we select patients for CRT, that this may not be the way to go. So let's go back a bit and remember that benefit from CRT varies with QRS characteristics and individual trials are actually underpowered to assess the benefit for relatively small subgroups. So the current authors led by Dr. Friedman from Duke University Hospital and colleagues, therefore performed a patient level meta-analysis of randomized trials of CRT to assess the relationship between QRS duration and morphology with outcomes. Dr. Greg Hundley: Very interesting Carolyn. So another wonderful paper from the world of electrophysiology in trying to understand optimal mechanisms to resynchronize the ventricle in patients with differing bundle branch blocks or intraventricular conduction delays. So what did they find? Dr. Carolyn Lam: They found that patients with intraventricular conduction delays and a QRS duration of 150 milliseconds or more, CRT was associated with lower rates of heart failure hospitalizations and all cause mortality. The magnitude of CRT benefit among these patients with the interventricular conduction delay of 150 milliseconds or more and those with the left bundle branch block of 150 milliseconds or more were similar. In contrast, there was no clear CRT benefit for patients with a right bundle branch block of any QRS duration, although the authors could not rule out the potential for benefit at a markedly prolonged QRS duration. So they concluded that the practice of combining right bundle branch block with intraventricular conduction delay patients into a single non-left bundle branch block category when we make patient selections for CRT is not supported by the current data. And in fact, patients with an intraventricular conduction delay of 150 milliseconds or more should be offered CRT as is done for patients with a left bundle branch block of 150 milliseconds or more. Dr. Greg Hundley: Wow, Carolyn, so really interesting point. No clear CRT benefit for patients with right bundle branch block regardless of the QRS duration. Well we've got some other articles in the issue. I'll describe a couple from the mail bag. There's a Research Letter from Professor Lassen entitled "Risk of Incident Thromboembolic and Ischemic Events Following COVID-19 Vaccination Compared with SARS-COV2 Infection." Also Bridget Kuhn has a wonderful Cardiology News piece entitled "Collaborative Care Model Helps Heart Failure Patients Meet End-of-Life Goals." Dr. Carolyn Lam: There's an exchange of letters between Doctors Donzelli and Hippisley-Cox regarding that risk of myocarditis after sequential doses of COVID-19 vaccine, there's an AHA Update by Dr. Churchwell on continuous Medicaid eligibility, the lessons from the pandemic. There's an On My Mind paper by Dr. Parkhomenko on Russia's war in Ukraine and cardiovascular healthcare. Wow, what an issue. Thanks so much, Greg. Shall we go on to the feature discussion? Dr. Greg Hundley: You bet. Dr. Mercedes Carnethon: Well welcome to this episode of Circulation on the Run podcast. I'm Mercedes Carnethon, associate editor of the journal Circulation and Professor and Vice Chair of Preventive Medicine at the Northwestern University Feinberg School of Medicine. I'm very excited to be here today with Xuerong Wen and Sandeep Das, my fellow associate editor here at Circulation to talk about a wonderful piece by Dr. Wen and colleagues from the University of Rhode Island. So welcome this morning Xuerong and thank you so much for sharing your important work with us. Dr. Xuerong Wen: Thank you Dr. Carnethon. It was great meeting you all and I'm the Associate Professor of Pharmacoepidemiology and Health Outcomes at the University of Rhode Island. I'm happy to introduce my study to everyone. Dr. Mercedes Carnethon: Well thank you so much and thank you as well Sandeep for identifying this fantastic article and bringing it forth. Dr. Sandeep Das: Thanks Mercedes. It's great to be with you. Dr. Mercedes Carnethon: Great. Well let's go ahead and get into it. There's so much here to talk about. So Dr. Wen and colleagues studied the comparative effectiveness and safety of direct oral anticoagulants or DOACs and warfarin in patients with atrial fibrillation and chronic liver disease. So this is such an important topic. Can you tell us a little bit about what your study found? Dr. Xuerong Wen: So our study is a comparative effectiveness and the safety analysis using a national health administrative data from private health plans. So we compared the risk of hospitalized ischemic stroke, systemic embolism and major bleeding between DOACs and warfarin in patients with atrial fibrillation and chronic liver disease. So we also had to had compare to these primary outcomes between apixaban and rivaroxaban in the study population. So our studies show that among patients with atrial fibrillation and chronic liver disease, DOACs as a class was associated with lower risk of hospitalization of ischemic stroke and systemic embolism and major bleeding, compared with warfarin. And when compared risk outcomes between individuals apixaban has lower risks as compared to rivaroxaban. So that's our study results. Dr. Mercedes Carnethon: Well thank you so much. This seems like such an important question. We hear a lot about DOACs and some of their risks as well as their considerable benefits. I think what leaves me the most curious is why did you choose to pursue this question and in particular in patients with both atrial fibrillation and liver disease. So why was the intersection of these two particular conditions of interest to your study team? Dr. Xuerong Wen: That's a great question. So the liver actually plays a central role in both the synthesis of coagulation factors and the metabolism of anticoagulant drugs. And the clearance of the anticoagulants in liver ranges from 20% to 100% for DOACs and warfarin. So in clinical practice anticoagulation abnormalities and elevated risk of spontaneous or unprovoked venous thrombotic complications have been reported in patients with liver disease. While these patients with cirrhosis were excluded from the clinical trials of DOACs and also population based, the real world experience is very limited. So that is why we initiated this retrospective cohort study and based on the real world data in this specific population. Dr. Mercedes Carnethon: Oh, thank you so much for explaining that. I definitely learned a lot and really enjoyed reading the piece. I think it was very well organized and well written and I know that our readership will appreciate it. It obviously stood out to you as well, Sandeep. Can you tell me a little bit about why you thought that this would be an excellent piece for circulation? Dr. Sandeep Das: Yeah, absolutely. Thanks for the question. So in the broad field of what we call observational comparative effectiveness research, so basically that's using large observational data sets to try to answer important clinical questions and it's a really challenging thing to do. I mean we're all very familiar with the idea of using randomized trials to assess important clinical questions because of the structure of that design allows you to mitigate some of the effects of confounding. Here, it has to be done analytically. So what's the important factor that really drives you towards a great observational comparative effectiveness piece? So first the clinical importance. I feel a little guilty because I'm old enough to remember when warfarin was the only option available, but really as a clinician, or every patient, I really prefer DOACs over warfarin just for ease of use and lifestyle. So there's a huge sort of importance to the question. Second, the patients with chronic liver disease were excluded from the larger RCTs and the DOAC trials. So really we don't have the answer to the question already. It's an important question. Obviously the bleeding risk is tied up with the liver, warfarin directly antagonizes vitamin K, so there's real questions about safety and so this is the perfect storm and then on top of it was a really well done and well executed study. So when this came across my desk, the very first thing I thought was not, "Is this something that we're interested?" But rather, "How do we make it better? How do we make it more useful to the reader?" This had me from hello. Dr. Mercedes Carnethon: Well thanks so much. We rarely have the opportunity when we read an article to be able to ask the authors questions. So Sandeep, I know that you had mentioned that you had some follow up questions as well. Dr. Sandeep Das: Yeah. So the real thought that I have then is would you argue based on this that we know enough that we should change our practice? And that do you feel comfortable advocating that people now prescribe DOACs to these patients? Dr. Xuerong Wen: I would say yes. Okay. Although this is not a clinical trial, but our study is actually systematically compare the effectiveness and safety between DOAC users and also the warfarin users. And if you look at our table one, we compare with so many variables between these two users and we use the propensity score adjustment and we after propensity score weighting and the two control group almost balanced. And I know right now FDA actually suggested that emulate the trial using the large real world data to do the emulated trial. So our study actually conducted is based on the large population using large data and we use the propensity score weighting to control all this potential compounding factors. Although there are still some limitations in this study. I think we mentioned that in the discussion section and we discussed all potential compounding factors that still may exist. And also there are some misclassifications and out of all this limitations and we still found the two drugs performed differently in this specific population. So we feel that comfortable to say that a DOAC drug performs better than warfarin. And also I think based on other studies that based on the clinical trial in the general population, DOAC drug is performs much better than warfarin and considering that the clearance in liver for DOAC is less than warfarin. So plus all this information together, I think DOAC may be safer than wafarin in the patients with AF and chronic liver disease. Dr. Sandeep Das: Yeah, I would say that I agree that these data, even if you're skeptical about observational CT generally, which I admit that I tend to be, these are really reassuring data that at least the DOACs are... There's absolutely nothing that suggests that they're any worse than warfarin and all of the sort of soft indications for ease of use and patient happiness really would seem to favor DOACs. So I think this is the sort of rare observational CT paper that may actually change my practice. Dr. Mercedes Carnethon: I have a follow-up question, Xuerong, related to the design and as well your strategy to address differences between the groups. So inverse probability weighting is certainly a standard in the field to be able to manage differences between groups when you have a situation where can't, where it's not a randomized trial. Do you as well, and educate me, I admit I'm an epidemiologist whose methodological skills are sometimes challenged. Do you have the opportunity using this design and with inverse probability weighting to evaluate subgroup effects? So my specific question is were you able to determine whether or not these associations were similar based on age and gender in particular? Dr. Xuerong Wen: That's a great question. We did conducted a lot of subgroup study but not by age or gender. We conducted I think this study in a lot of subgroups using the propensity score weighting, but the subgroup that I think we did a subgroup like a patient with a different chronic liver disease. So that's what we did. And we also tested different methods inverse probability score weighting. So we did trimming and we used a different percentage of trimming and to see how that affect the study results. So we have done a lot of subgroup studies. We did not check the age and the gender, but that's a very good point. Maybe later, well I'll ask my student to do that. Dr. Mercedes Carnethon: Well, you're a good mentor. So I think that is a really certainly an appropriate approach. Sandeep, did you have additional questions? Dr. Sandeep Das: No, I wish I had thought of yours before you did. I think exactly the older age, women, racial ethnic groups that are underrepresented historically in trials. I think that that's really, again, the sweet spot of this observational research. We definitely, and NH definitely working on trying to increase enrollment of all these groups in our CTs. However, while we wait for that, I think that's exactly what we should be doing. Dr. Mercedes Carnethon: Well that's great. And Xuerong, you really alluded to really, I think what is one of my final questions related to what do you think based on what you have observed in this study, what do you see as the next steps in the research field for your team, your students, or other people who are carrying out this type of work? Dr. Xuerong Wen: Well, that's a great question. We currently have a couple of more manuscripts ongoing in this field, and we will continue conducting the comparative effectiveness and analysis to compare drugs head to head as well as developing and implementing new methodologies to this field. And we hope our study provides real world evidence for clinical decision making, prescribing anticoagulants to patients with atrial fibrillation and chronic liver disease. We also expect the physicians and researchers more and more value the real world data studies, especially when clinical trials are not feasible or ethical. Dr. Mercedes Carnethon: Well, thank you so much. That was such an excellent vision that you provided us with and we're just very grateful that you submitted this fantastic work to the journal Circulation. I know that our readers will enjoy really digging in. The podcast is meant as a teaser to bring you to the journal so that you can read about this wonderful work by Dr. Wen and colleagues. So again, thank you. I'm Mercedes Carnethon, joined with my associate editor partner here, Dr. Sandeep Das. And thank you very much for spending your time with us today, Dr. Wen. Dr. Xuerong Wen: Thanks for this great opportunity to disseminate my study with us, thank you. Dr. Sandeep Das: Thanks Mercedes. Dr. Mercedes Carnethon: Thank you for joining us for this episode of Circulation on the Run. Dr. Greg Hundley: This program is copyright of the American Heart Association 2023. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, please visit ahajournals.org.

Efficacy and Safety of Intensive Versus Nonintensive Supplemental Insulin With a Basal-Bolus Insulin Regimen in Hospitalized Patients With Type 2 Diabetes: A Randomized Clinical Study | Diabetes Care | American Diabetes Association (diabetesjournals.org)   randomized noninferiority study from Emory University, 224 hospitalized patients with longstanding type 2 diabetes  Both groups received basal/bolus insulin; both the starting dose and subsequent changes were specified by the study protocol. Additional premeal SSI was added to scheduled premeal bolus doses.randomized to either intensive SSI (at BG >140 mg/dL) or nonintensive SSI (at BG >260 mg/dL) before meals and at bedtime.  Mean baseline glycosylated hemoglobin (HbA1c) was 9%, and 60% of patients were using insulin at home. Patients with a presenting glucose level of >400 mg/dL or diabetic ketoacidosis were excluded.  Outcome---Mean daily BG level, hypoglycemia, severe hyperglycemia, percent of BGs in the target range (70–180 mg/dL), and the amount of total, basal, or prandial insulin used did not differ between groups. However, significantly fewer patients in the nonintensive group than in the intensive group received SSI (34% vs. 91%).   COMMENTAlthough this is a single-center study, its results are persuasive and suggest that a less-intense SSI regimen can achieve similar glucose outcomes in hospitalized patients with type 2 diabetes who are receiving basal/bolus insulin. It also could decrease nursing treatment burden. As we move slowly toward more continuous glucose monitoring in hospitals, reducing use of SSI is another opportunity to achieve similar results with less staff burden and more patient comfort.  Comparative Effectiveness and Safety Between Apixaban, Dabigatran, Edoxaban, and Rivaroxaban Among Patients With Atrial Fibrillation: A Multinational Population-Based Cohort Study: Annals of Internal Medicine: Vol 175, No 11 (acpjournals.org) In a retrospective study, investigators accessed five electronic health databases from Europe and the U.S. to compare >500,000 new DOAC users with newly diagnosed atrial fibrillation. Follow up varied from 1.5 to 4.5 years.   In propensity score–adjusted analyses, patients who received apixaban had significantly less gastrointestinal (GI) bleeding did those who received any of the other three drugs (hazard ratios, 0.7–0.8). This result was consistent among older patients and those with chronic kidney disease (CKD). Risk for stroke or other systemic embolism, intracranial hemorrhage, and all-cause mortality did not differ significantly among DOACs.    COMMENTThis is the largest comparison of individual DOACs, and it demonstrates similar efficacy among all agents. Although apixaban was associated with less GI bleeding, absolute percentages of GI bleeds ranged from ≈2% to ≈3.5% for all DOACs; therefore, apixaban's statistically significant safety benefit might amount to marginal clinical benefit for any individual patient. I might turn to apixaban for patients at high risk for GI bleeding (and those with CKD), but all DOACs remain reasonable options for preventing thromboembolism in most patients with atrial fibrillation. Ellenbogen MI et al. Safety and effectiveness of apixaban versus warfarin for acute venous thromboembolism in patients with end-stage kidney disease: A national cohort study. J Hosp Med 2022 Oct; 17:809. (https://doi.org/10.1002/jhm.12926. opens in new tab)  . In an industry-funded retrospective study, investigators used a national database (years, 2014–2018) and propensity score–adjusted analysis to compare outcomes among >11,500 patients with ESRD and newly diagnosed VTE who received either apixaban or warfarin.Only 2% of patients received apixaban in 2014, but 47% received apixaban in 2018.during the 6 months following initiation of therapy, apixaban — compared with warfarin  associated with significantly lower incidence of major bleeding (10% vs. 14%), including intracranial bleeding (1.8% vs. 2.5%) and gastrointestinal bleeding (8.6% vs. 10.4%). Recurrent VTE and all-cause mortality were similar in the two groups.   VTE and creatine clearence less than 30 then I think apixaban is the drug of choice—I would like to see this study don't with afib and done with exclusively

Fonte: Oh, W.; An, Y.; Min, S.; Park, C. Comparative Effectiveness of Artificial Intelligence-Based Interactive Home Exercise Applications in Adolescents with Obesity. Sensors 2022, 22, 7352 - Siga no Instagram: @fabiodominski https://www.instagram.com/fabiodominski/ Gostou do podcast? Você vai gostar mais ainda desse livro! - Livro Exercício Físico e Ciência: Fatos e mitos de Fábio Dominski https://www.amazon.com.br/dp/6586363187?ref=myi_title_dp --- Support this podcast: https://podcasters.spotify.com/pod/show/fabiodominski/support

Drs Sumanta Pal and Martin Voss discuss second-line treatment of renal cell carcinoma, including current studies and agents used in the refractory setting. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/968745). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Renal Cell Carcinoma Treatment & Management https://emedicine.medscape.com/article/281340-treatment Comparative Effectiveness of Axitinib Versus Sorafenib in Advanced Renal Cell Carcinoma (AXIS): A Randomised Phase 3 Trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61613-9/fulltext Cabozantinib Versus Everolimus in Advanced Renal-Cell Carcinoma https://www.nejm.org/doi/full/10.1056/NEJMoa1510016 CANTATA: Primary Analysis of a Global, Randomized, Placebo (Pbo)-Controlled, Double-Blind Trial of Telaglenastat (CB-839) + Cabozantinib Versus Pbo + Cabozantinib in Advanced/Metastatic Renal Cell Carcinoma (mRCC) Patients (pts) Who Progressed on Immune Checkpoint Inhibitor (ICI) or Anti-Angiogenic Therapies. https://ascopubs.org/doi/abs/10.1200/JCO.2021.39.15_suppl.4501 FDA Approves Tivozanib for Relapsed or Refractory Advanced Renal Cell Carcinoma https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-tivozanib-relapsed-or-refractory-advanced-renal-cell-carcinoma Tivozanib Versus Sorafenib in Patients With Advanced Renal Cell Carcinoma (TIVO-3): A Phase 3, Multicentre, Randomised, Controlled, Open-Label Study https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(19)30735-1/fulltext Lenvatinib, Everolimus, and the Combination in Patients With Metastatic Renal Cell Carcinoma: A Randomised, Phase 2, Open-Label, Multicentre Trial https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00290-9/fulltext A Study of Atezolizumab in Combination With Cabozantinib Compared to Cabozantinib Alone in Participants With Advanced Renal Cell Carcinoma After Immune Checkpoint Inhibitor Treatment (CONTACT-03) https://clinicaltrials.gov/ct2/show/NCT04338269 TiNivo: Safety and Efficacy of Tivozanib-Nivolumab Combination Therapy in Patients With Metastatic Renal Cell Carcinoma https://linkinghub.elsevier.com/retrieve/pii/S0923-7534(20)42472-X Kidney Cancer Research Summit https://kcrs.kidneycan.org/

Theme: Critical Care.Participants: Dr Alex Yartsev (intensivist at Westmead Hospital), Dr Mark Salter (emergency physician at Westmead Hospital), Maddy Jegatheeswaran (intensive care Fellow at Westmead Hospital), Gladis Kabil (registered nurse at Westmead Hospital), Kristian Adams, Pramod Chandru, Caroline Tyers, Amanda De Silva, Shreyas Iyer, and Samoda Wilegoda. Discussion:Sud, S., Friedrich, J. O., Adhikari, N. K. J., Fan, E., Ferguson, N. D., Guyatt, G., & Meade, M. O. (2021). Comparative Effectiveness of Protective Ventilation Strategies for Moderate and Severe Acute Respiratory Distress Syndrome. A Network Meta-Analysis. American journal of respiratory and critical care medicine, 203(11), 1366–1377. https://doi.org/10.1164/rccm.202008-3039OC. Presenter: Maddy Jegatheeswaran intensive care Fellow at Westmead Hospital.Music/Sound Effects: Blue Sweater by RYYZN | https://soundcloud.com/ryyzn, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Good Day by Ikson | https://youtube.com/ikson, Music promoted by https://www.free-stock-music.com. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

In episode 8 we discuss the article about opioid tapering and discontinuation, and the risks of suicide and overdose.Larochelle MR, Lodi S, Yan S, Clothier BA, Goldsmith ES, Bohnert ASB. Comparative Effectiveness of Opioid Tapering or Abrupt Discontinuation vs No Dosage Change for Opioid Overdose or Suicide for Patients Receiving Stable Long-term Opioid Therapy. JAMA Netw Open. 2022;5(8):e2226523. doi:10.1001/jamanetworkopen.2022.26523We also discuss the recent Ruan vs. United States supreme court decision about pill mills.This is Addiction Medicine Journal Club with Dr. Sonya Del Tredici and Dr. John Keenan. We practice addiction medicine and primary care, and we believe that addiction is a disease that can be treated. This podcast reviews current articles to help you stay up to date with research that you can use in your addiction medicine practice. The best part of any journal club is the conversation, and we want to hear what you have to say. To have your opinions about the articles included in a future episode, send us your comments on Twitter or email, or join our Facebook group to continue the discussion.Email: addictionmedicinejournalclub@gmail.com Twitter: @AddictionMedJC Facebook: @AddictionMedJCCredits:Original theme music: Composed and performed by Benjamin KennedyAudio production: Angela OhlfestAddiction Medicine Journal Club is intended for educational purposes only, and should not be considered medical advice. The views expressed here are our own, and do not necessarily reflect those of our employers or the authors of the articles we review. All patient information has been modified to protect their identities.

What are some of the major differences between intravenous or IV ketamine and intranasal esketamine? How are you building on these research findings and what associated avenues have been explored? In this episode, we interview the poster winner from last year's NEI Congress, Dr. Balwinder Singh on his research comparing intravenous ketamine and intranasal esketamine. The study, conducted at Mayo Clinic rendered interesting findings that may be important for clinicians. Dr. Balwinder Singh is a Consultant and Assistant professor in the Department of Psychiatry at Mayo Clinic in Rochester, Minnesota. He is a psychiatrist specializing in mood disorders, and his research is focused on novel treatments for treatment-resistant depression and identifying biomarkers for ketamine response.  He is also involved in the ketamine and esketamine clinic practice at the Mayo Clinic Depression Center.   This is one of the first studies to highlight a faster response to intravenous ketamine as compared to intranasal esketamine in an observational study.

"The people that you interact with emergently—critical care doctors, the transplant doctors, the trauma doctors—they can speak for you. And I think sometimes using our allies to speak for us in places where our voices may not be heard as much can be very powerful." —Janice Newsome, MD, FSIRHost Barbara Nickel Hamilton, MD, speaks with interventional radiologist Janice Newsome, MD, FSIR, about her efforts to build postpartum hemorrhage response teams and their potential to save lives. Related resources:Read "Utilization and Comparative Effectiveness of Uterine Artery Embolization versus Hysterectomy for Severe Postpartum Hemorrhage: A National Inpatient Sample Study," by  Linzi A. Webster, MBA, Janice Newsome, MD,  Mian Guo, MS et al. (Journal of Vascular and Interventional Radiology, April 2022) Read "The future of maternal care," by Janice Newsome, MD, FSIR (IR Quarterly, Summer 2021)Note: This episode was recorded on  May 10, 2022.Contact us with your ideas and questions, or read more about about interventional radiology in IR Quarterly magazine or SIR's Patient Center.(c) Society of Interventional Radiology.Support the show

Comparative Effectiveness Associated With Buprenorphine and Naltrexone in Opioid Use Disorder and Cooccurring Polysubstance Use 

Join Dr. Steve Gard, editor-and-chief for the Journal of Prosthetics and Orthotics, as he chats with Brian Kaluf about his research surrounding hydraulic- and microprocessor-controlled ankle-foot prostheses for limited community ambulators with unilateral transtibial amputation. The two discuss the experimental protocol of the research, data collection, primary findings, unanticipated surprises, and clinical takeaways.    Show Notes JPO article: Hydraulic- and Microprocessor-Controlled Ankle-Foot Prostheses for Limited Community Ambulators with Unilateral Transtibial Amputation: Pilot Study   Dr. Gard and Mr. Kaluf alludes to the body of evidence regarding microprocessor-controlled knees and transfemoral amputees with a K2 functional level classification. Here's the full article: The effect of microprocessor controlled exo-prosthetic knees on limited community ambulators: systematic review and meta-analysis (tandfonline.com)     Mr. Kaluf mentions a previous study he conducted with a similar protocol with transtibial amputees in the K3 and K4 functional levels: Comparative Effectiveness of Microprocessor-Controlled and Carbon-Fiber Energy-Storing-and-Returning Prosthetic Feet in Persons with Unilateral Transtibial Amputation: Patient-Reported Outcome Measures     Mr. Kaluf speaks about a systematic review that was published around the time of the design of the study described in the podcast. That review was performed by AHRQ and one of the aims was "comparison of component effects by subgroups": Lower Limb Prostheses: Measurement Instruments, Comparison of Component Effects by Subgroups, and Long-Term Outcomes | Effective Health Care (EHC) Program (ahrq.gov)

The Journal RETINA is devoted exclusively to diseases of the retina and vitreous. These podcasts are intended to bring to its listeners summaries of selected articles published in the current issue of this internationally acclaimed journal.

In this episode from ACEP E-QUAL, Dr. Elizabeth Samuels discusses a social emergency medicine approach to opioid use disorder. Guest: Elizabeth A. Samuels, MD MPH MHS, Brown Emergency Medicine Host: Jason Woods MD   Select references: Weiner SG, Baker O, Bernson D, Schuur JD. One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose. Ann Emerg Med. 2020 Jan;75(1):13-17. doi: 10.1016/j.annemergmed.2019.04.020. Epub 2019 Jun 20. PMID: 31229387; PMCID: PMC6920606. Wakeman SE, Larochelle MR, Ameli O, et al. Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder. JAMA Netw Open. 2020;3(2):e1920622. doi:10.1001/jamanetworkopen.2019.20622 Larochelle MR, Bernson D, Land T, Stopka TJ, Wang N, Xuan Z, Bagley SM, Liebschutz JM, Walley AY. Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study. Ann Intern Med. 2018 Aug 7;169(3):137-145. doi: 10.7326/M17-3107. Epub 2018 Jun 19. PMID: 29913516; PMCID: PMC6387681. Kilaru AS, Xiong A, Lowenstein M, et al. Incidence of Treatment for Opioid Use Disorder Following Nonfatal Overdose in Commercially Insured Patients. JAMA Netw Open. 2020;3(5):e205852. Published 2020 May 1. doi:10.1001/jamanetworkopen.2020.5852 D'Onofrio G, O'Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, Bernstein SL, Fiellin DA. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015 Apr 28;313(16):1636-44. doi: 10.1001/jama.2015.3474. PMID: 25919527; PMCID: PMC4527523. Hawk KF, D'Onofrio G, Chawarski MC, et al. Barriers and Facilitators to Clinician Readiness to Provide Emergency Department–Initiated Buprenorphine. JAMA Netw Open. 2020;3(5):e204561. doi:10.1001/jamanetworkopen.2020.4561

Brought to you by CSMi – https://www.humacnorm.com/ptinquest Learn more about/Buy Erik's courses – The Science PT Support us on the Patreons! Comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis. Winters M, Holden S, Lura CB, et al. Br J Sports Med. 2021;55:369-377. doi:10.1136/bjsports-2020-102819 Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: “The Science of Selling Yourself Short” by Less Than Jake Used by Permission Other Music by Kevin MacLeod – incompetech.com: MidRoll Promo – Mining by Moonlight

The recently published ADAPTABLE study seeks to answer, definitively, a long held question: What is the correct dose of aspirin to improve outcomes in secondary prevention of cardiovascular disease? Also, more information about PCORnet, which is referenced in the article and during the episode, may be found here: https://pcornet.org/Redeem your CPE or CME credit here!We want your feedback! Share your feedback and experience with GameChangers! https://www.jotform.com/build/90155144694964References and resources:Jones WS, Mulder H, Wruck LM, et al. Comparative Effectiveness of Aspirin Dosing in Cardiovascular Disease. N Engl J Med. 2021 May 15. doi: 10.1056/NEJMoa2102137. Epub ahead of print. PMID: 33999548.Continuing Education Information:Learning Objectives: 1. Describe the outcomes and design of the ADAPTABLE study 2. Discuss some of the limitations of this trial in its application to specific patients0.05 CEU | 0.5 HrsACPE UAN: 0107-0000-21-229-H01-P0.50 AMA PRA Category 1 Credits™Initial release date: 7/6/21Expiration date: 7/6/22Complete CPE & CME details can be found here.

Article discussed in today's episode:Comparative Effectiveness of Protective Ventilation Strategies for Moderate and Severe Acute Respiratory Distress Syndrome. A Network Meta-Analysis

John Mandrola, MD, presents an ACC 2021 recap. https://www.medscape.com/twic ACC 2021 Reveiw I -- Left Atrial Appendage Closure LAAOS III: Surgical LAA Closure Cuts AF Stroke Risk by One Third https://www.medscape.com/viewarticle/951232 - Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke https://www.nejm.org/doi/full/10.1056/NEJMoa2101897 Watchman Registry: 1-Year Stroke Estimates Reassuringly Low https://www.medscape.com/viewarticle/951235 II - Angiotensin-Neprilysin Inhibition PARADISE-MI: Sacubitril/Valsartan Can't Beat Ramipril in Patients With Acute MI https://www.medscape.com/viewarticle/951236 Life Trial Rationale Paper: https://doi.org/10.1016/j.jchf.2020.05.005 III - Renal Denervation Ultrasound Renal Denervation Drops BP in Patients on Triple Therapy https://www.medscape.com/viewarticle/951248 IV -- Clopidogrel vs ASA post Stent HOST-EXAM: Clopidogrel Beats Aspirin as Monotherapy After Stenting https://www.medscape.com/viewarticle/951294 - Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial https://doi.org/10.1016/S0140-6736(21)01063-1 V -- AF Ablation in HF RAFT-AF, Despite Itself, Hints at Advantage for Ablation Rhythm Control in Heart Failure With AF. https://www.medscape.com/viewarticle/951326 VI -- Rivaroxaban in COVID-19 – ACTION Trial Therapeutic Rivaroxaban Dose: Risk Outweighs Benefit in Stable COVID https://www.medscape.com/viewarticle/951475 VII -- REHAB-HF Trial Novel Rehab Program Fights Frailty, Boosts Capacity in Advanced HF https://www.medscape.com/viewarticle/951244 - Physical Rehabilitation for Older Patients Hospitalized for Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMoa2026141 VIII – ASA 81 vs 325 – ADAPTABLE Trial ADAPTABLE: Low-Dose Aspirin as Good as High-Dose in CHD? https://www.medscape.com/viewarticle/951230 - Comparative Effectiveness of Aspirin Dosing in Cardiovascular Disease https://www.nejm.org/doi/full/10.1056/NEJMoa2102137 Perspectives: Eight Things to Know About the Surgical Left Atrial Appendage Occlusion (LAAOS III) Trial https://www.medscape.com/viewarticle/951229 PARADISE-MI Makes Me Question the Benefits of Sacubitril/Valsartan https://www.medscape.com/viewarticle/951239 Sacubitril/Valsartan: Trending Toward PARADISE Post MI https://www.medscape.com/viewarticle/950300 Renal Denervation for Resistant Hypertension Is Not Back on Track https://www.medscape.com/viewarticle/951497 Acute Alcohol Consumption Raises Risk for Atrial Fibrillation https://www.medscape.com/viewarticle/950938 Does ADAPTABLE Inform Aspirin Dosing for Secondary Prevention? https://www.medscape.com/viewarticle/950969 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

FDA 批准降钙素基因相关肽单抗用于预防偏头痛和丛集性头痛的发作JAMA Neurology 妊娠与临床孤立综合征发病的关系J Am Coll Cardiol 复杂的颈动脉斑块是引起隐源性卒中的一个原因Nature子刊 颅内恶性肿瘤的无创检测Nature子刊 合成纳米颗粒治疗胶质母细胞瘤加那珠单抗（galcanezumab）降钙素基因相关肽（CGRP）受体位于疼痛信号通路、颅内动脉和肥大细胞中，其活化被认为在偏头痛的病理生理学中起着因果作用。加那珠单抗（galcanezumab）是一种CGRP单克隆抗体。和此前在《神经科星期四 Episode 4》中介绍的治疗急性偏头痛的CGRP受体拮抗剂包括：瑞美吉泮（rimegepant）和乌布吉泮（ubrogepant）；以及《神经科星期四 Episode 14》中介绍的预防偏头痛发作的依替尼单抗（eptinezumab）属于一类药物。2018年9月，FDA批准加那珠单抗用于预防偏头痛发作；2019年6月，FDA批准加那珠单抗用于预防丛集性头痛发作。《CONQUER研究：加那珠单抗预防偏头痛的安全性和有效性的3b期临床研究》Lancet Neurology，2020年10月 (1)这项多中心、随机、双盲、安慰剂对照的3b期研究，纳入2到4类偏头痛预防药物无效的患者655例，患者年龄在18-75岁之间，有发作性或慢性偏头痛，在50岁之前发生偏头痛，入组后随机接受安慰剂或加那珠单抗（120mg q1m * 3m）。在1-3个月期间，加那珠单抗治疗的患者偏头痛发作天数比安慰剂显著减少。与基线相比，加那珠单抗组每月平均少4·1天，而安慰剂组每月平均少1·0天（p < 0·0001）。加那珠单抗和安慰剂之间治疗紧急不良事件的类型和数量相似。结论：加那珠单抗在偏头痛的预防治疗方面优于安慰剂，并且在以前的多个标准预防治疗失败的患者中有良好的耐受性。 《加那珠单抗预防发作性丛集性头痛的临床研究》New England Journal of Medicine，2019年7月(2)阵发性丛集性头痛是一种神经功能障碍，其特征是每天头痛发作，持续数周或数月。共招募患者106人，随机分配接受加那珠单抗（300mg）或安慰剂组。基线期每周丛集性头痛的平均发作次数，加那珠单抗组为17.8，安慰剂组为17.3。在第1至3周中，加那珠单抗组每周平均减少为8.7次，而安慰剂组为5.2次（P =0.04）。在第3周，头痛频率降低≥50%的患者，加那珠单抗组为71%，安慰剂组为53%。除了加那珠单抗组8%的患者有注射部位疼痛外，不良事件发生率在组间没有实质性差异。结论：与安慰剂相比，在首次注射后的1-3周内，加那珠单抗300mg ip降低了偶发性丛集性头痛的发作频率。多发性硬化多发性硬化（multiple sclerosis，MS）是以中枢神经系统白质炎性脱髓鞘病变为主要特点的自身免疫病。本病最常累及的部位为脑室周围白质、视神经、脊髓、脑干和小脑，主要临床特点为中枢神经系统白质散在分布的多病灶与病程中呈现的缓解复发，症状和体征的空间多发性和病程的时间多发性。 多发性硬化症主要的模式和病程可以分为以下几种临床亚型：临床孤立综合征（CIS）、复发缓解型（RR）、继发进展型（SP）、和原发进展型（PP）。 《前瞻性队列研究：妊娠与临床孤立综合征发病的关系》JAMA Neurology，2020年12月 (3)多发性硬化症常诊断于育龄妇女，但妊娠是否能延迟脱髓鞘或临床孤立综合征（CIS）的首次发作尚无共识。研究的目的是探讨妊娠与CIS发病时间的关系。这个国际、多中心、前瞻性研究纳入2557名女性，CIS发病的平均年龄为31岁，发病前46%至少有1次怀孕，43%至少有1次分娩。首次怀孕的平均年龄为23.3岁，首次分娩的平均年龄为23.8岁。与从未怀孕过的女性相比，有过怀孕和分娩经历的女性发生CIS的时间较晚，延迟3.3年（P < 0.001）。与从未分娩过的女性相比，分娩过的女性发病年龄也较晚，延迟3.4年（P < 0.001）。孕产次数与发病延迟无关。结论：发病前怀孕和分娩与CIS发病时间之间存在关联，但与次数无关。需要进一步的研究来帮助解释怀孕和多发性硬化症发病之间关联的机制。《前瞻性观察性队列研究：持续免疫治疗与活动性继发进展性多发性硬化症患者残疾结果的相关性》JAMA Neurology，2020年11月 (4)研究旨在评价继发进展性多发性硬化的患者中残疾累计发生率，及是否能够通过治疗延缓残疾累积的进展。这项观察性队列研究中， 招募53680例多发性硬化的患者，其中4997例继发进展型，在1621例符合纳入条件的患者中，女性患者68.0%，发病时的平均年龄为33.9岁。共有661例（40.8%）患者在继发进展性多发性硬化期间经历了叠加性复发。早期治疗方案和残疾累计发生无关。继发进展期的高复发率与轮椅依赖的残疾风险增加有关（P = 0.009）。在继发进展性多发性硬化期间经历反复复发的患者中，抑制疾病进展的治疗与残疾进展率的降低和轮椅依赖风险的降低显著相关。结论： 继发进展型多发性硬化症患者中，残疾进展率与早期病程和治疗方案无关，但是与疾病复发相关。多发性硬化的治疗多发性硬化治疗的主要目的是抑制炎性脱髓鞘病变进展，防止急性期病变恶化及缓解期复发，晚期采取对症和支持疗法，减轻神经功能障碍带来的痛苦。疾病修正治疗（disease-modifying therapy，DMT）主要包括：抗整合素α-4单抗（那他珠单抗 natalizumab），抗CD20单抗（奥瑞珠单抗 ocrelizumab、奥法木单抗 ofatumumab、利妥昔单抗 rituximab），抗CD52单抗（阿伦单抗 alemtuzumab）、干扰素（干扰素β-1a、干扰素β1-b）、富马酸类（富马酸二甲酯 dimethyl fumarate、富马酸单甲酯 monomethyl fumarate）、鞘氨醇调节剂（芬戈莫德 fingolimod、西尼莫德 siponimod、奥扎莫德 ozanimod）、免疫抑制剂（克拉屈滨 cladribine），还可使用其他免疫抑制剂如特立氟胺（teriflunomide）、硫唑嘌呤、环磷酰胺、米托蒽醌等。《OPERA I和OPERA II研究：复发相关的恶化与复发无关的进展对典型复发性多发性硬化症总体确认残疾积累的贡献》JAMA Neurology，2020年9月 (5)奥瑞珠单抗（ocrelizumab）是一种靶向CD20+B细胞的单克隆抗体，于2017年被批准用于多发性硬化的治疗。研究旨在评价复发相关的恶化（relapse-associated worsening，RAW）和复发无关的进展（progression independent of relapse，PIRA）对证实的残疾累积（confirmed disability accumulation，CDA）的影响，并评估两种治疗方法对预后的影响。这2个相同的、3期、多中心、双盲随机临床试验中，1656人纳入分析，两组平均年龄37.2-37.1岁，随机奥瑞珠单抗组（奥瑞珠单抗 600mg ivgtt q24w）或干扰素组（干扰素 ip q3w）共96周。12周后，干扰素组和奥瑞珠单抗组的残疾累积事件发生率分别为29.6%和21.1%；24周发生率分别为22.7%和16.2%。复发无关的进展事件是12周和24周复合残疾累积事件的主要影响因素，分别占干扰素组的78.0%和80.6%，占奥瑞珠单抗组的88.0%和89.1%。结论：大部分的残疾积累事件与明显的疾病复发无关，这挑战了目前多发性硬化复发和进展形式的临床区别。《ORATORIO研究的事后分析：奥瑞珠单抗治疗原发性进行性多发性硬化症的长期随访》Lancet Neurology，2020年12月 (6)ORATORIO研究是一项国际、多中心、双盲、随机对照的3期试验，招募年龄18-55岁的、原发性进行性多发性硬化症患者，随机分配奥瑞珠单抗（600mg ivgtt q24w）或安慰剂，至少120周，之后可以选择进入开放标签阶段。共451人进入完成6.5年的随访。在早期使用奥瑞珠单抗的患者，残疾进展比例较低（51.7% vs 64.8%，P=0.0018），复合进展率较低（73.2% vs 83.3%；p = 0.0023）；需要轮椅的比例较低（11.5% vs 18.9%；p = 0.0274）。在研究结束时，奥瑞珠单抗组患者T2病变体积更小（0.45% vs 13.00%， p

FDA 批准降钙素基因相关肽单抗用于预防偏头痛和丛集性头痛的发作JAMA Neurology 妊娠与临床孤立综合征发病的关系J Am Coll Cardiol 复杂的颈动脉斑块是引起隐源性卒中的一个原因Nature子刊 颅内恶性肿瘤的无创检测Nature子刊 合成纳米颗粒治疗胶质母细胞瘤加那珠单抗（galcanezumab）降钙素基因相关肽（CGRP）受体位于疼痛信号通路、颅内动脉和肥大细胞中，其活化被认为在偏头痛的病理生理学中起着因果作用。加那珠单抗（galcanezumab）是一种CGRP单克隆抗体。和此前在《神经科星期四 Episode 4》中介绍的治疗急性偏头痛的CGRP受体拮抗剂包括：瑞美吉泮（rimegepant）和乌布吉泮（ubrogepant）；以及《神经科星期四 Episode 14》中介绍的预防偏头痛发作的依替尼单抗（eptinezumab）属于一类药物。2018年9月，FDA批准加那珠单抗用于预防偏头痛发作；2019年6月，FDA批准加那珠单抗用于预防丛集性头痛发作。《CONQUER研究：加那珠单抗预防偏头痛的安全性和有效性的3b期临床研究》Lancet Neurology，2020年10月 (1)这项多中心、随机、双盲、安慰剂对照的3b期研究，纳入2到4类偏头痛预防药物无效的患者655例，患者年龄在18-75岁之间，有发作性或慢性偏头痛，在50岁之前发生偏头痛，入组后随机接受安慰剂或加那珠单抗（120mg q1m * 3m）。在1-3个月期间，加那珠单抗治疗的患者偏头痛发作天数比安慰剂显著减少。与基线相比，加那珠单抗组每月平均少4·1天，而安慰剂组每月平均少1·0天（p < 0·0001）。加那珠单抗和安慰剂之间治疗紧急不良事件的类型和数量相似。结论：加那珠单抗在偏头痛的预防治疗方面优于安慰剂，并且在以前的多个标准预防治疗失败的患者中有良好的耐受性。 《加那珠单抗预防发作性丛集性头痛的临床研究》New England Journal of Medicine，2019年7月(2)阵发性丛集性头痛是一种神经功能障碍，其特征是每天头痛发作，持续数周或数月。共招募患者106人，随机分配接受加那珠单抗（300mg）或安慰剂组。基线期每周丛集性头痛的平均发作次数，加那珠单抗组为17.8，安慰剂组为17.3。在第1至3周中，加那珠单抗组每周平均减少为8.7次，而安慰剂组为5.2次（P =0.04）。在第3周，头痛频率降低≥50%的患者，加那珠单抗组为71%，安慰剂组为53%。除了加那珠单抗组8%的患者有注射部位疼痛外，不良事件发生率在组间没有实质性差异。结论：与安慰剂相比，在首次注射后的1-3周内，加那珠单抗300mg ip降低了偶发性丛集性头痛的发作频率。多发性硬化多发性硬化（multiple sclerosis，MS）是以中枢神经系统白质炎性脱髓鞘病变为主要特点的自身免疫病。本病最常累及的部位为脑室周围白质、视神经、脊髓、脑干和小脑，主要临床特点为中枢神经系统白质散在分布的多病灶与病程中呈现的缓解复发，症状和体征的空间多发性和病程的时间多发性。 多发性硬化症主要的模式和病程可以分为以下几种临床亚型：临床孤立综合征（CIS）、复发缓解型（RR）、继发进展型（SP）、和原发进展型（PP）。 《前瞻性队列研究：妊娠与临床孤立综合征发病的关系》JAMA Neurology，2020年12月 (3)多发性硬化症常诊断于育龄妇女，但妊娠是否能延迟脱髓鞘或临床孤立综合征（CIS）的首次发作尚无共识。研究的目的是探讨妊娠与CIS发病时间的关系。这个国际、多中心、前瞻性研究纳入2557名女性，CIS发病的平均年龄为31岁，发病前46%至少有1次怀孕，43%至少有1次分娩。首次怀孕的平均年龄为23.3岁，首次分娩的平均年龄为23.8岁。与从未怀孕过的女性相比，有过怀孕和分娩经历的女性发生CIS的时间较晚，延迟3.3年（P < 0.001）。与从未分娩过的女性相比，分娩过的女性发病年龄也较晚，延迟3.4年（P < 0.001）。孕产次数与发病延迟无关。结论：发病前怀孕和分娩与CIS发病时间之间存在关联，但与次数无关。需要进一步的研究来帮助解释怀孕和多发性硬化症发病之间关联的机制。《前瞻性观察性队列研究：持续免疫治疗与活动性继发进展性多发性硬化症患者残疾结果的相关性》JAMA Neurology，2020年11月 (4)研究旨在评价继发进展性多发性硬化的患者中残疾累计发生率，及是否能够通过治疗延缓残疾累积的进展。这项观察性队列研究中， 招募53680例多发性硬化的患者，其中4997例继发进展型，在1621例符合纳入条件的患者中，女性患者68.0%，发病时的平均年龄为33.9岁。共有661例（40.8%）患者在继发进展性多发性硬化期间经历了叠加性复发。早期治疗方案和残疾累计发生无关。继发进展期的高复发率与轮椅依赖的残疾风险增加有关（P = 0.009）。在继发进展性多发性硬化期间经历反复复发的患者中，抑制疾病进展的治疗与残疾进展率的降低和轮椅依赖风险的降低显著相关。结论： 继发进展型多发性硬化症患者中，残疾进展率与早期病程和治疗方案无关，但是与疾病复发相关。多发性硬化的治疗多发性硬化治疗的主要目的是抑制炎性脱髓鞘病变进展，防止急性期病变恶化及缓解期复发，晚期采取对症和支持疗法，减轻神经功能障碍带来的痛苦。疾病修正治疗（disease-modifying therapy，DMT）主要包括：抗整合素α-4单抗（那他珠单抗 natalizumab），抗CD20单抗（奥瑞珠单抗 ocrelizumab、奥法木单抗 ofatumumab、利妥昔单抗 rituximab），抗CD52单抗（阿伦单抗 alemtuzumab）、干扰素（干扰素β-1a、干扰素β1-b）、富马酸类（富马酸二甲酯 dimethyl fumarate、富马酸单甲酯 monomethyl fumarate）、鞘氨醇调节剂（芬戈莫德 fingolimod、西尼莫德 siponimod、奥扎莫德 ozanimod）、免疫抑制剂（克拉屈滨 cladribine），还可使用其他免疫抑制剂如特立氟胺（teriflunomide）、硫唑嘌呤、环磷酰胺、米托蒽醌等。《OPERA I和OPERA II研究：复发相关的恶化与复发无关的进展对典型复发性多发性硬化症总体确认残疾积累的贡献》JAMA Neurology，2020年9月 (5)奥瑞珠单抗（ocrelizumab）是一种靶向CD20+B细胞的单克隆抗体，于2017年被批准用于多发性硬化的治疗。研究旨在评价复发相关的恶化（relapse-associated worsening，RAW）和复发无关的进展（progression independent of relapse，PIRA）对证实的残疾累积（confirmed disability accumulation，CDA）的影响，并评估两种治疗方法对预后的影响。这2个相同的、3期、多中心、双盲随机临床试验中，1656人纳入分析，两组平均年龄37.2-37.1岁，随机奥瑞珠单抗组（奥瑞珠单抗 600mg ivgtt q24w）或干扰素组（干扰素 ip q3w）共96周。12周后，干扰素组和奥瑞珠单抗组的残疾累积事件发生率分别为29.6%和21.1%；24周发生率分别为22.7%和16.2%。复发无关的进展事件是12周和24周复合残疾累积事件的主要影响因素，分别占干扰素组的78.0%和80.6%，占奥瑞珠单抗组的88.0%和89.1%。结论：大部分的残疾积累事件与明显的疾病复发无关，这挑战了目前多发性硬化复发和进展形式的临床区别。《ORATORIO研究的事后分析：奥瑞珠单抗治疗原发性进行性多发性硬化症的长期随访》Lancet Neurology，2020年12月 (6)ORATORIO研究是一项国际、多中心、双盲、随机对照的3期试验，招募年龄18-55岁的、原发性进行性多发性硬化症患者，随机分配奥瑞珠单抗（600mg ivgtt q24w）或安慰剂，至少120周，之后可以选择进入开放标签阶段。共451人进入完成6.5年的随访。在早期使用奥瑞珠单抗的患者，残疾进展比例较低（51.7% vs 64.8%，P=0.0018），复合进展率较低（73.2% vs 83.3%；p = 0.0023）；需要轮椅的比例较低（11.5% vs 18.9%；p = 0.0274）。在研究结束时，奥瑞珠单抗组患者T2病变体积更小（0.45% vs 13.00%， p

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2771041#:~:text=Conclusions%20and%20Relevance%20Initiation%20of,effective%20as%20brand%2Dname%20levothyroxine. Comparative Effectiveness of Generic vs Brand-Name Levothyroxine in Achieving Normal Thyrotropin Levels JAMA Netw Open. 2020;3(9):e2017645. doi:10.1001/jamanetworkopen.2020.17645 Quick history lesson- levothyroxine was cleared and approved for generic use in 2004 – until then Synthroid had enjoyed a huge market share. The only market share. They were it and there is soooo much money when you are the only drug on the market and the most prescribed drug on the market—in 2002 the revenue was estimated at 1 billion dollars. I was alive in 2002 and I can tell you back then 1 billion dollars was a lot of money. But then 2004 there is now competition, a generic drug.! What does the drug company do? Use some of their small fortune to trash the drug, pay of some doctors to write a paper and later in 2004 there was a paper released by The Endocrine Society released the paper citing concern for the generic drug and the bioavailability. https://www.endocrine.org/advocacy/position-statements/bioequivalence-of-sodium-levothyroxine as recent as 2014 the American Thyroid Association guideline specifically recommends “Switches between levothyroxine products could potentially result in variations in the administered dose and should generally be avoided for that reason” Meaning don’t have them on brand name synthroid and then switch them to generic. Stay constant! But todays study wanted to look at the comparative effectiveness of generic vs brand-name levothyroxine in patients initiating therapy for hypothyroidism 4570 patients initiating therapy with thyrotropin levels ranging from 4.5 to 19.9 mIU/L were 1:1 propensity–matched One group was started on generic levothyroxine and the other group was started on brand-name levothyroxine also known as Synthroid. As an outcome they looked at three different things the numbers of individuals who attained a normal thyrotropin level within 3 months, the clinically meaningful abnormal thyrotropin level within 3 months the number of people with stable thyrotropin level(s) 3 months AFTER having a normal thyrotropin level Among 4570 propensity score–matched patients those that received generic levothyroxine had a normal TSH 75.4% of the time and those that got brand-name levothyroxine had a normal TSH 76.9% And in both groups about 4% of the individuals had a markedly abnormal TSH level (94 [4.1%; 95% CI, 3.4%-5.0%] vs 88 [3.9%; 95% CI, 3.1%-4.7%]; P = .65). They then took the individuals who had a normal TSH at 3 months and propensity matched those individuals to 3 MORE months and the proportion maintaining normal TSH levels during the next 3 months was similar regardless if you received generic or brand name levothyroxine, 82% vs 83% respectively. (427 [82.6%] vs 433 [83.8%]; P = .62). Here is the kick in the pants- Per good RX Levothyroxine is $4 on good RX Synthroid is $45

In this episode, we explore how our healthcare system prepares itself for an ageing population, with guest Dr. Steven Albert. Host: Corina Paraschiv https://www.linkedin.com/in/corinamihaelaparaschiv/ https://atdesignresearch.com/ Guest Bio: Steven Albert is Chair of the Department of Behavioral and Community Health Sciences, University of Pittsburgh, Graduate School of Public Health. He holds the Hallen Chair of Community Health and Social Justice. He has nearly 30 years of research experience in public health, aging, neurologic disease, and health behavior. He served as principal investigator on three NIH R01 efforts (AG18234, Cognitive and Physical Basis of Disablement, 2001-06; MH62200, Depression and End of Life Care in Amyotrophic Lateral Sclerosis, 2000-07; and NR012459, End of Life in the Very Old, 2010-15). he currently directs or co-directs the Clinical and Population Outcomes Core of the University of Pittsburgh NIA Claude D. Pepper Older Americans Independence Center (P30 AG024827) and the U Pitt CDC Prevention Research Center (PRC U48 DP001918). He recently co-directed the HRSA Public Health Social Work Leadership training program (6G05HP7841) and U Pitt NIMH Advanced Center for Intervention Services Research for Late Life Depression Prevention (MH090333). He has also completed an extensive array of CDC-funded research, including an evaluation of the Pennsylvania Department of Aging’s statewide falls prevention program (SM Albert, PI, “Comparative Effectiveness of Community-Based Falls Prevention in Pennsylvania,” CDC ARRA U48 DP002657, 2010-13) that established the evidence base for the program. Our efforts led to important changes in these programs to support effectiveness and dissemination, as well as certification as an evidence-based program for Title-IIID ACL/AoA funding. He has also led the community health needs assessment (CHNA) for the University of Pittsburgh Medical Center’s 40-hospital network. He has mentored doctoral (15+), postdoctoral (10+), visiting fellows (4), and junior faculty (6) across a number of academic fields. Diving Further: Prohaska TR, Anderson L, Binstock RH. Public Health for an Aging Society, Johns Hopkins Press, 2012. Albert, SM & Freedman VA. Public Health and Aging, Springer Publishing Company, 2nd Edition, 2010.

JAMA Pediatrics Editors' Summary by Dimitri Christakis, MD, MPH, Editor in Chief, and Frederick Rivara, MD, MPH, Editor in Chief of JAMA Network Open for the April 6, 2020 issue

Sarah E. Wakeman, MD joins JAMA Network editors to discuss a comparative effectiveness research study examining associations between opioid use disorder treatment pathways and overdose and opioid-related acute care use as proxies for opioid use disorder recurrence. Read the article here: https://ja.ma/2uuVUtc. JNO Live is a weekly broadcast featuring conversations about the latest research being published in JAMA Network Open. Follow us on Facebook, Twitter and YouTube for details on the next broadcast.

06: Til and Whitney discuss considerations for hands-on work with tendinopathies and tendon issues. In this episode, What is a tendinopathy? Examples? Tendinitis vs.tendinosis; tenosynovitis; What are typical signs? What is known about causes? Inflammation or degeneration? Collagen, paretenon, fascicles, etc; Nerval arborization/sprouting; What’s manual therapy’s role? Approaches, debates, consensus; And much more...  Get the full transcript at Til or Whitney's sites! Resources discussed in this episode: Chen PC, Wu KT, Chou WY, et al. Comparative Effectiveness of Different Nonsurgical Treatments for Patellar Tendinopathy: A Systematic Review and Network Meta-analysis. Arthrosc - J Arthrosc Relat Surg. 2019;35(11):3117-3131.e2. doi:10.1016/j.arthro.2019.06.017  Cook JL, Purdam C. Is compressive load a factor in the development of tendinopathy? Br J Sports Med. 2012;46(3):163-168. doi:10.1136/bjsports-2011-090414,   Lederman E. The Science and Practice of Manual Therapy. 2n3 ed. Edinburgh: Elsevier; 2005.  Murtaugh B, Ihm JM. Eccentric training for the treatment of tendinopathies. Curr Sports Med Rep. 1987;12(3):175-182. doi:10.1249/JSR.0b013e3182933761,  Lipman K, Wang C, Ting K, Soo C, Zheng Z. Tendinopathy: Injury, repair, and current exploration. Drug Des Devel Ther. 2018;12:591-603. doi:10.2147/DDDT.S154660,  Witvrouw E, Mahieu N, Roosen P, McNair P. The role of stretching in tendon injuries. Br J Sport Med. 2007;41(4):224-226.  Van Der Vlist AC, Breda SJ, Oei EHG, Verhaar JAN, De Vos RJ. Clinical risk factors for Achilles tendinopathy: A systematic review. Br J Sports Med. 2019;53(21):1352-1361. doi:10.1136/bjsports-2018-099991  AcademyOfClinicalMassage.com  Advanced-Trainings.com  Sponsor Offers: Books of Discovery: save 15% by entering "thinking" at checkout on booksofdiscovery.com. ABMP: save $24 on new membership at abmp.com/thinking. Handspring Publishing: save 20% by entering “TTP” at checkout at handspringpublishing.com. About Whitney Lowe  |  About Til Luchau  |  Email Us (The Thinking Practitioner Podcast is intended for professional practitioners of manual and movement therapies: bodywork, massage therapy, structural integration, chiropractic, myofascial and myotherapy, orthopedic, sports massage, physical therapy, osteopathy, yoga, strength and conditioning, and similar professions. It is not medical or treatment advice.)

Editor's Summary by Howard Bauchner, MD, Editor in Chief of JAMA, the Journal of the American Medical Association, for the September 17, 2019 issue

In this episode, we discuss cervical and lumbar disc herniations,spinal manipulation, nerve root injections, neck pain, dizziness and chronic low back pain.

Dr. Mathias Buron discusses the takeaways from his paper the comparative effectiveness of teriflunomide and dimethyl fumarate.

In the first segment, Dr. Stacey Clardy talks with Dr. Mathias Buron about his paper addressing the comparative effectiveness of teriflunomide and dimethyl fumarate. In the second part of the podcast, Dr. Jason Crowell focuses his interview with Dr. Joanna Hellmuth on the rise of pseudomedicine for dementia and brain health.

To the extent that outcomes are mediated through negative perceptions of generics (the nocebo effect), observational studies comparing brand-name and generic drugs are susceptible to bias favoring the brand-name drugs. We used authorized generic (AG) products, which are identical in composition and appearance to brand-name products but are marketed as generics. Desai RJ et al. (2019) Comparative effectiveness of generic and brand-name medication use: A database study of US health insurance claims. PLoS Med. 16(3): e1002763. doi: 10.1371/journal.pmed.1002763.

This week, we're presenting a special two-part bonus episode featuring the stories from our June 2018 show at Caveat in New York City, as part of the Underground Science Festival. Rather than the speeches we typically hear on this topic, our storytellers -- who are both OB-GYNs and patients -- have shared firsthand experiences that cross both generations and borders, and are crucial to our understanding of women's health. You can find Part 1 of this special episode here.  Part 1: While working with Doctors Without Borders in a country where abortion is illegal, OB-GYN Veronica Ades is falsely accused of performing an abortion. Part 2: When Tracey Segarra tells her mother she had an abortion, she's shocked by the response. Veronica Ades, MD, MPH is a board-certified obstetrician-gynecologist. She completed her Doctor of Medicine degree at the State University of New York at Downstate in Brooklyn, NY, and a Master’s degree in Public Health with a concentration in Quantitative Methods at the Harvard School of Public Health. She completed residency training in obstetrics and gynecology at the Albert Einstein School of Medicine in the Bronx, NY, and a fellowship in Reproductive Infectious Disease at the University of California, San Francisco. Dr. Ades also completed a Certificate in Comparative Effectiveness at the NYU School of Medicine. Dr. Ades has worked with Médecins Sans Frontières/Doctors Without Borders on assignments in Aweil, South Sudan in 2012 and 2016 and in Irbid, Jordan in 2013. Dr. Ades is currently an Assistant Professor of Obstetrics and Gynecology and Director of Global Women’s Health at the New York University School of Medicine (NYUMC). Her clinical work is at the New York Harbor VA, Gouverneur Health, and Bellevue Hospital. She is the Founder and Director of the EMPOWER Clinic for Survivors of Sex Trafficking and Sexual Violence at Gouverneur Health on the Lower East Side. Dr. Ades conducts research on sexual- and gender-based violence and trauma, and runs the Empower Lab at NYU. Read her blog here. Tracey Segarra launched her career in NYC as a reporter and editor for local newspapers and national wire services, interviewing assorted politicians, celebrities and criminals. But now all she wants to do is tell stories to strangers about her own life. She has appeared on the Story Collider and Risk! live shows and podcasts, the Moth Radio Hour on NPR and is the host of her own storytelling show based on Long Island, "Now You're Talking!" Learn more about your ad choices. Visit megaphone.fm/adchoices

En el programa de hoy hablamos de cual seria el tratamiento antibiótico idea de la infección severa por S. aureus meticilino-susceptible: penicilina anti-stafilococcica o cefalosporina de primera generación.  Referencia: Jennifer S McDanels y colaboradores. Comparative Effectiveness of Cefazolin Versus Nafcillin or Oxacillin for Treatment of Methicillin-Susceptible Staphylococcus aureus Infections Complicated by Bacteremia: A Nationwide Cohort Study. Clin Infect Dis. March 2017. Marguerite L Monogue y colaboradores. Nafcilin versus cefazolin for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia. J Infect Public Health. March 2018   Sheryl A Zelenitsky y colaboradores. Limitations of ceftriaxone compared with cefazolin against MSSA: an integrated pharmacodynamic analysis. J Antimicrob Chemother. April 8, 2018.   J Alexander Viehman y colaboradores. Adverse events lead to drug discontinuation more commonly among patients who receive nafcillin compared to oxacillin. Antimicrob Agent Chemother 2016.    La Frase de la Semana La tomamos de Isaac Asimov (1920-1992): escritor estadounidense nacido en Rusia y profesor de bioquímica en la Universidad de Boston. Era conocido por sus obras de ciencia ficción y de divulgación científica.    “Tus suposiciones son ventanas en el mundo. Límpialas de vez en cuando, o la luz no entrará".  

This week, we present two stories about identity, from a neuroscientist's encounters with racism to an OB-GYN's struggle with her feelings about motherhood. Part 1: After a thoughtless remark from a colleague, neuroscientist Devon Collins reflects on the way racism has impacted his life and science. Part 2: OB-GYN Veronica Ades tries to save a pregnant woman’s life in South Sudan, while struggling with her own feelings about motherhood. Devon Collins is a neuroscientist, podcaster, and educator from the Midwest. Currently a PhD candidate at the Rockefeller University, he studies how common genetic variation affects the brain’s responses to drugs and stress. He is one-third of the team behind Science Soapbox, a podcast about science and how it interacts with our personal and political lives. Passionate about making the future of STEM more diverse and inclusive, Devon also works as an educator in a STEM-focused after-school program for high school students from low-resource backgrounds. When he’s not doing science, talking science, or teaching science, you can find him baking, running, container gardening, or napping on his sofa with his cat and dog. Veronica Ades, MD, MPH is a board-certified obstetrician-gynecologist. She attended medical school at the State University of New York at Downstate in Brooklyn, NY, and obtained residency training in obstetrics and gynecology at the Albert Einstein School of Medicine in the Bronx, NY. After residency, she obtained a Master’s degree in Public Health with a concentration in Quantitative Methods at the Harvard School of Public Health. Dr. Ades then completed a three-year fellowship in Reproductive Infectious Disease at the University of California, San Francisco, in which she lived and worked in rural Uganda, and  conducted research on placental malaria in HIV-infected and –uninfected women. Dr. Ades also completed a Certificate in Comparative Effectiveness at the NYU School of Medicine. Dr. Ades has worked with Médecins Sans Frontières/Doctors Without Borders on assignments in Aweil, South Sudan in 2012 and 2016 and in Irbid, Jordan in 2013. Dr. Ades is currently an Assistant Professor of Obstetrics and Gynecology and Director of Global Women’s Health at the New York University School of Medicine (NYUMC). Her clinical work is at the New York Harbor VA and at Gouverneur Health. At NYUMC, Dr. Ades has created an educational and research partnership with Korle Bu Teaching Hospital in Accra, Ghana. She is also the Director of the EMPOWER Clinic for Survivors of Sex Trafficking and Sexual Violence at Gouverneur Health on the Lower East Side. Dr. Ades’ main research focus is on post-sexual trauma gynecologic care. She runs the Empower Lab at the College of Global Public Health at NYU, where she has active research projects on sexual and gender-based violence, intimate partner violence, military sexual trauma, and global women’s health. Learn more about your ad choices. Visit megaphone.fm/adchoices

Organifi Quah! In this episode of Quah, sponsored by Organifi (organifi.com, code "mindpump" for 20% off), Sal, Adam & Justin answer Pump Head questions about squatting too low, how basketball, tennis and vollyball's compares to treadmills & ellipticals, if it be better for women to eat and train according to their cycle and the lowdown about Breatharians, those people who eat and drink nothing but air. Justin the storyteller (3:25) Sal and Adam the Ramblers (7:10) The chemistry between all the guys Transparency Quah question #1 – Is there such a thing as squatting too low? (14:10) Don't go beyond your body's end range of motion Test from MAPS Prime Lose contact with PVC pipe What you train, you strengthen Quah question #2 – Do you think it would be better for women to eat and train differently around their cycle? (22:09) Eat more on the days you feel hungry Supplement with evening primrose oil Take multivitamin right around the time they were having their period General nutrient loss Focus on form and range of motion with training Slow things down Listen to your body overall Quah question #3 – Hates the treadmill, but loves doing activities outside with his wife. Does one have more carry over? (35:40) Do what you like Change modalities every couple weeks Body adapts Quah question #4 – Please talk about breatharians. People who only live off the energy of the earth and breathing. When bad things go viral Guys talk with Jordan Harbinger, from the Art of Charm Podcast, about recent episode with Tim Grover (46:35) Related Links/Products Mentioned 110 NFL Brains: A neuropathologist has examined the brains of 111 N.F.L. players — and 110 were found to have C.T.E., the degenerative disease linked to repeated blows to the head. (article) Organifi (website) Discount Code mindpump To get MAPS Prime (website) Evening primrose oil great to help cramps (study) Comparative Effectiveness of a Mindful Eating Intervention to a Diabetes Self-Management Intervention among Adults with Type 2 Diabetes: A Pilot Study Mindful eating can help weight loss, study shows (article) A couple claimed they learned to live without food, and news outlets ate it up (article) Relentless: From Good to Great to Unstoppable – Tim Grover (book) Get our newest program, MAPS Prime Pro, which shows you how to self assess and correct muscle recruitment patterns that cause pain and impede performance and gains. Get it at www.mindpumpmedia.com! Get MAPS Prime, MAPS Anywhere, MAPS Anabolic, MAPS Performance, MAPS Aesthetic, the Butt Builder Blueprint, the Sexy Athlete Mod AND KB4A (The MAPS Super Bundle) packaged together at a substantial DISCOUNT at www.mindpumpmedia.com. Make EVERY workout better with our newest program, MAPS Prime, the only pre-workout you need… it is now available at mindpumpmedia.com Have Sal, Adam & Justin personally train you via video instruction on our YouTube channel, Mind Pump TV. Be sure to Subscribe for updates. Please subscribe, rate and review this show! Each week our favorite reviewers are announced on the show and sent Mind Pump T-shirts! Have questions for Mind Pump? Each Monday on Instagram (@mindpumpradio) look for the QUAH post and input your question there. (Sal, Adam & Justin will answer as many questions as they can)

In this interview with Allison we discuss: *Intuitive Eating - what is it? how to do it? why is it important? *Dieting and Food Rules *Social media *Our own stories   So much more.    Website: allisonmossofitness.com    Instagram: https://www.instagram.com/allisonmossofitness/    Facebook: https://www.facebook.com/allisonmossofitness/   Youtube https://www.youtube.com/channel/UCrcMaDhPEujtM4l4KlqbU6Q   Studies:   Diabetes & Obesity Related Studies: Miller (2012) Comparative Effectiveness of a Mindful Eating Intervention to a Diabetes Self Management Intervention among Adults with Type 2 Diabetes : A Pilot Study  Wheeler (2016) Intuitive Eating is associated with Glycaemic Control in Adolescents with Type 1 Diabetes Mellitus  Ross et. al (2015) Changing the Endpoints for Determining Effective Obesity Management Studies on comparing different countries relaxed/community eating vs. ours: Rozin et. al (1999) Attitudes to Food and the Role of Food in Life in the U.S.A., Japan, Flemish Belgium and France: Possible Implications for the Diet-Health Debate    Support the podcast by heading over to PATREON and becoming a support - you can pledge any amount and it will go towards helping this podcast to keep and running.  If you're local to Minneapolis join us for weekend work outs, group personal training, 1-1 personal training, life coaching and so much more. Head over to the PARTICIPATE page to stay updated on all the happenings.    If you would enjoy the blog straight into your inbox every Tuesday as well as Friday Fun emails - sign up for the FREE newsletter. 

This week we review if the needle is mightier than the blade for Dupuytren's? Zhou C, Selles RW, Slijper HP, Feitz R, van Kooij Y, Moojen TM, Hovius SE. Comparative Effectiveness of Percutaneous Needle Aponeurotomy and Limited Fasciectomy for Dupuytren's Contracture: A Multicenter Observational Study. Plast Reconstr Surg. 2016 Oct;138(4):837-46

Dr. Jeffrey Drazen is the Editor-in-Chief of the Journal. Stephen Morrissey, the interviewer, is the Managing Editor of the Journal. J. Woodcock and Others. Clinical Trials Series. N Engl J Med 2016;374:2167.

This episode is our first audio journal club. We discuss 5 papers today with our guests, Dr Dan von Allmen, Dr George Whit Holcomb, and Dr Aaron Lipskar. Table of contents: 00:00 Introduction 00:55 Corticosteroids for biliary atresia 05:21 Dr von Allmen’s comments 10:54 Antiseptic agents and surgical site infection 14:15 Dr Holcomb’s comments 20:17 Non-operative management of non-perforated appendicitis 25:19 Dr Holcomb’s comments 30:41 Enteral autonomy after intestinal failure 33:37 Dr Lipskar’s comments 36:41 Anesthesia neurotoxicity 40:27 Dr Lipskar’s comments Use of Corticosteroids After Hepatoportoenterostomy for Bile Drainage in Infants With Biliary Atresia: the START randomized clinical trial Discussed by Dr Dan von Allmen Bezerra JA, et al. Use of Corticosteroids After Hepatoportoenterostomy for Bile Drainage in Infants With Biliary Atresia: the START randomized clinical trial. JAMA. 2014 May 7;311(17):1750–10. Dr von Allmen’s comments: • Dr von Allmen would not use corticosteroids after Kasai procedure. • The difference of bile drainage in the steroid group versus control (58.6% vs 48.6%) was not significant enough to continue use of corticosteroids. Comparative Effectiveness of Skin Antiseptic Agents in Reducing Surgical Site Infections: A Report from the Washington State Surgical Care and Outcomes Assessment Program Discussed by Dr George Whit Holcomb Hakkarainen TW, et al. Comparative Effectiveness of Skin Antiseptic Agents in Reducing Surgical Site Infections: A Report from the Washington State Surgical Care and Outcomes Assessment Program. J Am Coll Surg. 2014 Mar 1;218(3):336–44. Dr Holcomb’s comments: • This paper would not change his choice of antiseptic agent. Dr Holcomb feels that iodine based agents and chlorhexidine agents are equally appropriate based on these results. • Dr Holcomb uses chlorhexidine and isopropyl alcohol for skin preparation. Nonoperative Treatment With Antibiotics Versus Surgery for Acute Nonperforated Appendicitis in Children: a pilot randomized controlled trial Discussed by Dr George Whit Holcomb Svensson JF, et al. Nonoperative Treatment With Antibiotics Versus Surgery for Acute Nonperforated Appendicitis in Children: a pilot randomized controlled trial. Annals of Surgery. 2015 Jan;261(1):67–71. Dr Holcomb’s comments: • This is a well done pilot study that shows that a larger randomized trial is needed. • Long term follow-up is needed to determine the true risk of recurrent appendicitis after non-operative management. Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study Discussed by Dr Aaron Lipskar Khan FA, et al. Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study. J Pediatr. 2015 Jul;167(1):29–34.e1. Dr Lipskar’s comments: • It is counterintuitive that NEC is a protective factor for enteral autonomy. • It is difficult to make sense of the data as centers with transplant programs likely attract sicker patients. • This highlights the importance of intestinal failure patients being managed in a multidisciplinary intestinal failure program. Anesthetic neurotoxicity--clinical implications of animal models Discussed by Dr Aaron Lipskar Rappaport BA, et al. Anesthetic neurotoxicity--clinical implications of animal models. N Engl J Med. 2015 Feb 26;372(9):796–7. Dr Lipskar’s comments: • Until further trials in humans are conducted and provide more conclusive evidence, elective cases should be deferred until the age of 3. • It may be difficult to define what constitutes an elective procedure in pediatric surgery. Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: creativecommons.org/licenses/by/3.0/

Commentary by Dr. Valentin Fuster

Commentary by Dr. Valentin Fuster

Medical Grand Rounds with Jon Lurie, MD, MS

Host Dr. Barry Mennen welcomes Dr. Ryan Stidham, Assistant Professor of Internal Medicine at the Inflammatory Bowel Diseases Center of the University of Michigan Health System, to discuss the current therapeutic landscape for IBD based on recent comparative clinical trials.

Host Dr. Barry Mennen welcomes Dr. Ryan Stidham, Assistant Professor of Internal Medicine at the Inflammatory Bowel Diseases Center of the University of Michigan Health System, to discuss the current therapeutic landscape for IBD based on recent comparative clinical trials.

Wed, 2 Jul 2014 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/17155/ https://edoc.ub.uni-muenchen.de/17155/1/Bartmus_Thomas.pdf Bartmus, Thomas

Editor's Audio Summary by Howard Bauchner, MD, Editor in Chief of JAMA, the Journal of the American Medical Association, for the February 06, 2013 issue

Comparative Effectiveness is not that bad - until you add costs into the analysis.

Guest: Les Paul, MD Host: Bruce Japsen Comparative effectiveness is gaining momentum as a way to decide what drugs and devices should be used by doctors. But why was it part of the economic stimulus approved by Congress and pushed by President Obama? Dr. Les Paul, vice president of clinical and scientific affairs at the National Pharmaceutical Council, tells the Chicago Tribune's Bruce Japsen about how policymakers are looking at comparative effectiveness and how medical care providers and the healthcare industry should be involved.