Tag Archives: New England Journal Of Medicine

Health: Lung Cancer Deaths Drop As Targeted Therapies Improve (NEJM)

August 14, 2020 boomersdaily Leave a comment

NEJM (Aug 13, 2020) – Population-level mortality from NSCLC in the United States fell sharply from 2013 to 2016, and survival after diagnosis improved substantially. Our analysis suggests that a reduction in incidence along with treatment advances — particularly approvals for and use of targeted therapies — is likely to explain the reduction in mortality observed during this period.

“The survival benefit for patients with non-small cell lung cancer treated with targeted therapies has been demonstrated in clinical trials, but this study highlights the impact of these treatments at the population level,” said Nadia Howlader, Ph.D., of NCI’s Division of Cancer Control and Population Sciences, who led the study. “We can now see the impact of advances in lung cancer treatment on survival.”

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Beverages, Health, Studies

Health: New Studies Find “Coffee & Caffeine” Lower Heart Disease, Cancer Risk

July 27, 2020 boomersdaily Leave a comment

NEW ENGLAND JOURNAL OF MEDICINE (JULY 23, 2020): A large body of evidence suggests that consumption of caffeinated coffee, the main source of caffeine intake in adults in the United States, does not increase the risk of cardiovascular diseases and cancers. In fact, consumption of 3 to 5 standard cups of coffee daily has been consistently associated with a reduced risk of several chronic diseases.

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Coffee and tea have been consumed for hundreds of years and have become an important part of cultural traditions and social life.⁵ In addition, people use coffee beverages to increase wakefulness and work productivity. The caffeine content of commonly used sources of caffeine is shown in Table 1. For a typical serving, the caffeine content is highest in coffee, energy drinks, and caffeine tablets; intermediate in tea; and lowest in soft drinks. In the United States, 85% of adults consume caffeine daily,⁶ and average caffeine intake is 135 mg per day, which is equivalent to about 1.5 standard cups of coffee (with a standard cup defined as 8 fluid oz [235 ml]).⁷ Coffee is the predominant source of caffeine ingested by adults, whereas soft drinks and tea are more important sources of caffeine ingested by adolescents,

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Health, Interviews, Medicine, Podcasts

Podcasts Interviews: The Diagnosis And Early Treatment Of Covid-19

Audio June 3, 2020 boomersdaily Leave a comment

In this audio interview conducted on June 3, 2020, the editors discuss two new studies: one comparing test swabs collected by health care workers with swabs collected by the patients themselves and one assessing hydroxychloroquine treatment in people who had been exposed to Covid-19 but weren’t yet ill.

The continuing spread of SARS-CoV-2 remains a Public Health Emergency of International Concern. What physicians need to know about transmission, diagnosis, and treatment of Covid-19 is the subject of ongoing updates from infectious disease experts at the Journal.

Eric Rubin is the Editor-in-Chief of the Journal. Lindsey Baden is a Deputy Editor of the Journal. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal.

Health, Interviews, Medicine, News, Podcasts

Podcasts: “Developing Covid-19 Vaccines At Pandemic Speed” (NEJM)

Audio May 22, 2020 boomersdaily Leave a comment

Interview with Dr. Nicole Lurie on rapid vaccine development, including new tools to facilitate vaccine testing and manufacturing and persistent challenges.

The need to rapidly develop a vaccine against SARS-CoV-2 comes at a time of explosion in basic scientific understanding, including in areas such as genomics and structural biology, that is supporting a new era in vaccine development. Over the past decade, the scientific community and the vaccine industry have been asked to respond urgently to epidemics of H1N1 influenza, Ebola, Zika, and now SARS-CoV-2. An H1N1 influenza vaccine was developed relatively rapidly, largely because influenza-vaccine technology was well developed and key regulators had previously decided that vaccines made using egg- and cell-based platforms could be licensed under the rules used for a strain change. Although a monovalent H1N1 vaccine was not available before the pandemic peaked in the Northern Hemisphere, it was available soon afterward as a stand-alone vaccine and was ultimately incorporated into commercially available seasonal influenza vaccines.

Nicole Lurie is a strategic advisor to the CEO of the Coalition for Epidemic Preparedness Innovations. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal.

Health, Medicine, News, Podcasts

New Medical Podcasts: E-Cigarette Deaths, Heart Disease And 10-Weeks To Crush The Curve (NEJM)

Audio April 22, 2020 boomersdaily Leave a comment

Featuring articles on deaths due to e-cigarette– or vaping-associated lung injury, apixaban for venous thromboembolism in cancer, the management of coronary disease in patients with advanced kidney disease, health-status outcomes in the ISCHEMIA-CKD trial, and ten weeks to crush the curve.

Additionally, renin–angiotensin–aldosterone system inhibitors in patients with Covid-19, and teasing the immune system to repair the heart; a review article on the care of patients with diabetic retinopathy; a case report of a man with high blood pressure, renal insufficiency, and hematuria; and Perspective articles on clinical and social risk adjustment, on prediction models, and on medical care during the pandemic.

Health, Medicine, Podcasts

Medical Podcasts: Are Cardiovascular Patients Avoiding Emergency Rooms During Covid-19?

Audio April 20, 2020 boomersdaily Leave a comment

Cardiovascular consults are way down. Is the threat of COVID-19 infection scaring people away from ED’s?

We caught up with Dr. Comilla Sasson, the American Heart Association’s VP for science and innovation. She’s an emergency physician who teaches at the University of Colorado. She’d traveled to New York City to “help with the response,” and she talked with us from a field hospital that had been set up on a tennis court in Central Park.

She had lots to say about what’s driving patients away from emergency departments these days and what’s likely to happen in medicine (hello, telemedicine!) once the pandemic abates.

Running time: 15 minutes

Exercise, Health, Medicine, Studies

Health Study: Physical Therapy Superior To Steroid Injection For Knee Osteoarthritis

April 14, 2020 boomersdaily 2 Comments

Patients with osteoarthritis of the knee who underwent physical therapy had less pain and functional disability at 1 year than patients who received an intraarticular glucocorticoid injection.

Osteoarthritis of the knee is a leading cause of disability.¹ Current management is typically limited to the treatment of symptoms until late stages of arthritis lead to knee replacement.² Intraarticular glucocorticoid injections are commonly used as a primary treatment for osteoarthritis of the knee,³ but there are conflicting reports regarding the extent and duration of the relief of symptoms with this therapy.^4-6 Complications from these injections occur infrequently but include joint infection,⁷ accelerated degradation of articular cartilage,⁸ and subchondral insufficiency fractures.⁹

PHYSICAL THERAPY

The physical therapy intervention, which is described in the protocol,²⁶ included instructions and images for exercises, joint mobilizations, and the clinical reasoning underlying the priorities, dosing, and progression of treatment. During a typical clinical session, the physical therapist would implement hands-on, manual techniques immediately before the patient performed reinforcing exercises to help the patient perform the movements with little or no pain. For example, if a patient could not fully extend or flex the knee, or those movements were painful, the physical therapist would use a hands-on, passive mobilizing technique to repeatedly move the knee to reduce stiffness while altering the mechanics of the technique to avoid pain. The patient would then perform repeated active knee movements in the same direction.

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Health, Interviews, Podcasts

Hospitals & Coronavirus: Emergency Room Doctor Discusses Preparing For Cases In Miami Area (NEJM)

Audio March 27, 2020 boomersdaily Leave a comment

NEJM talks with Dr. Julian Flores, who works in a Broward County, Florida, emergency room.

When he was interviewed, the count of Covid-19 cases stood at 412, less than 12 hours later, the new number was 505. He’s expecting the wave to hit hard there. Broward is home to Fort Lauderdale (think spring break) and Pompano Beach (think aging retirees). Couple those demographics with a lack of easy testing for the virus, and you’ve got a worrisome situation.

Finance, Health, Medicine, News, Podcasts

Medical Care: Federal Efforts To End “Surprise Billing” (NEJM Podcast)

Audio March 25, 2020 boomersdaily Leave a comment

Though U.S. legislation targeting the problem of surprise medical bills advanced out of key congressional committees in 2019 with support from leaders in both parties, Congress ultimately failed to pass a law to end such bills.

Erin Fuse Brown is an associate professor of law at Georgia State University. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal.

Health, Medicine, News, Technology

“Telemedicine” Is The Way To Treat “Coronavirus / Covid-19” Pandemic (NEJM)

March 11, 2020 boomersdaily Leave a comment

From a New England Journal of Medicine article (March 11, 2020):

A central strategy for health care surge control is “forward triage” — the sorting of patients before they arrive in the emergency department (ED). Direct-to-consumer (or on-demand) telemedicine, a 21st-century approach to forward triage that allows patients to be efficiently screened, is both patient-centered and conducive to self-quarantine, and it protects patients, clinicians, and the community from exposure.

It can allow physicians and patients to communicate 24/7, using smartphones or webcam-enabled computers. Respiratory symptoms — which may be early signs of Covid-19 — are among the conditions most commonly evaluated with this approach. Health care providers can easily obtain detailed travel and exposure histories. Automated screening algorithms can be built into the intake process, and local epidemiologic information can be used to standardize screening and practice patterns across providers.

More than 50 U.S. health systems already have such programs. Jefferson Health, Mount Sinai, Kaiser Permanente, Cleveland Clinic, and Providence, for example, all leverage telehealth technology to allow clinicians to see patients who are at home. Systems lacking such programs can outsource similar services to physicians and support staff provided by Teladoc Health or American Well. At present, the major barrier to large-scale telemedical screening for SARS-CoV-2, the novel coronavirus causing Covid-19, is coordination of testing. As the availability of testing sites expands, local systems that can test appropriate patients while minimizing exposure — using dedicated office space, tents, or in-car testing — will need to be developed and integrated into telemedicine workflows.

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