A VIDEO RECORDING OF THIS INTERVIEW WILL BE AVAILABLE WITHIN A FEW DAYS. [display podcast] In treating most exacerbations of chronic obstructive pulmonary disease (COPD) the usual regimen consists of prednisone plus 5- to 7-days of antibiotics. But what if a shorter course of antibiotic therapy would do? That would be both convenient for patients and less likely to promote antibiotic resistance. A recent paper in Therapeutic Advances in Respiratory Disease describes just such a strategy: patients received prednisone plus either 2 or 7 days of levofloxacin. There was no substanti ..read more

A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE HERE. This time, we look to New York for guidance on recognizing and treating monkeypox. Dr. Eric Meyerowitz of Montefiore and Dr. Stephen Baum of Einstein will lead you through the monkeypox thicket in a 17-minute chat. Included below is information for patients as well as links to some key articles of interest to clinicians. LINKS: For patients: Dr. Barry Zingman’s “Monkeypox — What you need to know” For clinicians: NEJM article on monkeypox in 16 countries NEJM Case Records of the Mass. General Hospital on the s ..read more

A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE HERE. We’re back with another interview from this year’s IASLC conference. This time, Christine Sadlowski and Dr. Julia Rotow interview Dr. Mariano Provencio about the survival outcomes from the NADIM II trial. In that trial, patients with resectable stage III AB non-small cell lung cancer received nivolumab plus chemotherapy versus chemotherapy alone. Overall survival at 5 years in these patients has been roughly 30%, according to Provencio. With the addition of chemo-immunotherapy, patients who showed a complete pathological res ..read more

A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE HERE. Interim results on overall survival in phase 3 of the IMpower010 trial were presented at this year’s meeting of the International Assosciation for the Study of Lung Cancer (IASLC). As part of the NEJM Group’s coverage of the conference, Christine Sadlowski interviewed the presenter, Dr. Enriqueta Felip. In a 15-minute interview, she discusses the implications for different patient groups and the past, present, and future of the IMpower trial, which tests adjuvant atezolizumab following platinum-based chemotherapy in patients with rese ..read more

A VIDEO RECORDING OF THIS INTERVIEW WILL BE AVAILABLE HERE SHORTLY. THE USUAL AUDIO FILE IS AVAILABLE BELOW Steven Cummings has co-written a take-no-prisoners editorial in the New England Journal of Medicine. The topic? Vitamin D supplements. The conclusion? “…providers should stop screening for 25-hydroxyvitamin D levels or recommending vitamin D supplements, and people should stop taking vitamin D supplements to prevent major diseases or extend life.” Dr. Cummings was commenting on research findings from the VITAL trial, also published in the journal, showing no fracture-lower ..read more

A VIDEO RECORDING OF THIS ROUNDTABLE IS AVAILABLE HERE. Your host is old enough to remember when hospital corridors featured physicians with little black bags, scurrying around to see their patients. That’s no longer true, of course. Most of the physicians seen in those corridors these days are white-coated employees. The Annals of Internal Medicine reported a few months ago that “By 2018, 71% of newly certified general internists practiced as hospitalists, compared with only 8% practicing as outpatient-only physicians.”  In addition, between 2008 and 2018 mixed-practice ph ..read more

CREST-2’s results are probably more than a year away. In the meantime, what to do about diagnosed severe (but asymptomatic) carotid stenosis? Recent results suggest that medical management compares favorably with the surgical approach. In this edition, we address the question with a conversation between Dr. Allan Brett, NEJM Journal Watch‘s editor-in-chief, and Dr. Seemant Chaturvedi, a University of Maryland neurologist who serves on CREST-2’s executive committee. [Running time: 16 minutes] NEJM Journal Watch coverage of a recent JAMA paper on the topic. The post Podcast ..read more

Locally advanced rectal cancer usually receives a three-part treatment: chemotherapy followed by radiotherapy and then surgery. In a small-cohort study presented at this year’s ASCO conference researchers used a PD-1 inhibitor — dostarlimab — every three weeks for 6 months against the disease. All patients had mismatch repair deficient tumors. No other treatments were needed however, since the 12 patients all attained complete response if they completed the regimen. As part of the NEJM Group’s coverage of ASCO, Christine Sadlowski interviewed the study’s first author, Dr. Andrea Cerc ..read more

Patients with metastatic breast cancer whose tumors express low levels of HER2 are generally classified and treated as having HER2-negative disease. However, Dr. Shanu Modi of the Memorial Sloan Kettering Cancer Center and a group of international collaborators explored the use of a monoclonal antibody–drug conjugate (trastuzumab–deruxtecan) in patients with disease they classify as HER2-“low.” Compared with “low” patients treated with one of several standard-of-care regimens, those receiving the conjugate therapy had greater median progression-free survival (roughly 10 months versus 5) a ..read more

Apnea testing is part of the protocol used to determine whether a patient is dead according to neurologic criteria. The question is, do clinicians need to obtain consent to proceed? In a fascinating 15-minute chat, two intensivists, Drs. Patricia Kritek and Robert Truog, discuss that question and another, larger one: what is death, anyway? Their back-and-forth was prompted by a recent debate, published in Chest, between two others —  a clinician and a law professor. Have a listen, and please leave a comment to help guide future editions. The Chest article The post Pod ..read more