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A large-scale computer simulation based on NHANES data plotted the most cost-effective strategy, which turns out to be to start screening before middle age and to repeat every 3 to 5 years. We talk with the first author of a Lancet paper that details the findings. Interview-related link: Physician’s First Watch summary of the Lancet paper News-related links: 2009 H1N1 makes an unwelcome comeback Health care workers are undervaccinated against 2009 H1N1 Checklists lower hospitals’ mortality rates in U.K. Dutasteride doesn’t prevent high-grade prostate tumors Is it reasonable to spend $638,000 to prevent a single MI? The post Podcast 81: When should you start screening for type 2 diabetes? first appeared on Clinical Conversations.

We talk with three of the academic authors of a New England Journal of Medicine study that pooled data from a few studies in an attempt to examine the possible link between use of bisphosphonates and femoral-shaft fractures. Interview-related links: Physician’s First Watch coverage NEJM paper NEJM editorial FDA statement News-related links: Aspirin ineffective in preventing miscarriage BNP-guided therapy for heart failure Have kids at risk carry two epi-pens Rotarix contamination The post Podcast 80: Bisphosphonates and atypical hip fractures — how large is the risk? first appeared on Clinical Conversations.

Patients who consult urologists only are more likely to get radical prostatectomy, and those who consult both urologists and radiation oncologists are more likely to get radiation. Those who see internists are more likely to receive watchful waiting. What are all these facts trying to tell us? Our conversation is with the principal authors of a study of Medicare data that examines this issue. This weeks interview-related link: First Watch coverage of the prostate cancer study This week’s news-related links: What’s in that health-reform bill? High-chair hazard prompts recall ACCORD study summary NAVIGATOR study summary Rabies shots lowered to a total of five American Academy of Neurology recommendations on Parkinson’s The Journal Watch website The post Podcast 79: Prostate cancer, patients’ consultations, and the treatments they receive first appeared on Clinical Conversations.

This week, a conversation with Michael Hochman on his examination of what the major general journals publish in the way of comparative effectiveness studies. He talks about what they are and how to think about that reprint that the drug rep has just dropped off for you. Reach us at 617-440-4374, or write to jelia@jwatch.org. This week’s interview links: Michael Hochman’s JAMA study The accompanying editorial This week’s news links: Blood pressure variability and CVD risk Elective coronary angiography’s low yield Prostate cancer treatments after consultations The post Podcast 78: Just what are “comparative effectiveness” studies anyway? first appeared on Clinical Conversations.

Our attempts to get an interview with a researcher were unavailing, so we’ve  gone to plan B and repeat a useful look at treating community-acquired pneumonia according to guideline recommendations. Please leave comments and complaints at jelia@jwatch.org. You can call and voice these at 1-617-440-4374. Interview-related links: Community-Acquired Pneumonia: Guideline-Compliant Treatment Is Better IDSA/ATS guidelines News-related links: Evaluating long-term risk via glycated hemoglobin Usefulness of aspirin in lowering risk in patients with abnormal ankle-brachial ratios Carotid endarterectomy versus stenting in patients at high risk Kapidex changes its name to Dexilant The post Podcast 77: We revisit a conversation on treating community-acquired pneumonia according to the guidelines (and we’ve got current news). first appeared on Clinical Conversations.

A conversation with the authors of an Archives of Internal Medicine study that examines the best tactics for saying “No” to inappropriate requests. Contact me at 1-617-440-4374 or at jelia@jwatch.org. Interview-related links: Archives of Internal Medicine abstract Atul Gawande’s New Yorker article News-related links: The rosiglitazone (Avandia) controversy Advisory on thiazolidinediones Physicians’ work hours 13-valent pneumococcal vaccine Influenza-vaccination expansion Group CBT for low-back pain The post Podcast 76: On saying “No” to patients’ requests. first appeared on Clinical Conversations.

Patients with hypertension at risk for cardiovascular events have done better with an ACE inhibitor-calcium channel blocker combination than with the ACE inhibitor plus hydrochlorothiazide. The ACCOMPLISH investigators have now reported on their analysis of progression-of-nephropathy outcomes in their trial. We interview the first author of the analysis, Dr. George Bakris of the University of Chicago’s Pritzker School of Medicine. Interview-related links: NHLBI guidelines on managing hypertension Physician’s First Watch coverage of ACCOMPLISH analysis News-related links: FDA warning on long-acting beta agonists Pipe- and cigar-smoking and COPD risk Metformin’s sometimes-offputting aroma Health statistics on the U.S. The post Podcast 75: Which regimen for hypertension? first appeared on Clinical Conversations.

We talk with Dr. Catherine Kelly about her study in  BMJ showing serious interference of some SSRIs with tamoxifen therapy in breast cancer. The study was conducted using Canadian provincial databases. Reach us at 1-617-440-4374 or by email to jelia@jwatch.org. Interview article: BMJ study Physician’s First Watch coverage Medical news links: Back pain guidelines Inflammatory bowel disease and venous thromboembolism Automated calling systems The post Podcast 74: How two SSRIs apparently interfere with tamoxifen therapy. first appeared on Clinical Conversations.

A panel of the American Heart Association, the American Cancer Society, and the American Urological Association issued a statement on androgen-deprivation therapy and cardiovascular risk. We’ve got an interview with the chair of the writing committee, Dr. Glenn Levine. Interview-related links: Physician’s First Watch coverage of the statement Link to the statement, as published in Circulation News-related links: Lancet retracts 1998 paper linking MMR vaccination and autism Use prefilled Sanofi Pasteur N1N1 vaccines before mid-February JAMA study on proteinuria If you’d like to contact Clinical Conversations, call 1-617-440-4374 or write to jelia@jwatch.org The post Podcast 73: How best to monitor patients on androgen-deprivation therapy for cardiovascular risks? first appeared on Clinical Conversations.

We’ve got Dr. William Carroll this week — we tried last week, but the 13-hour time difference between Boston and Perth just stymied me. Dr. Carroll speaks about his NEJM editorial concerning two new drugs for multiple sclerosis. Both are oral therapies that work to keep lymphocytes at bay in this disease. Interview-story link: MS Treatments Said to Offer ‘New Horizon’ News links: New York Times series on radiation safety Lancet study on glycated hemoglobin levels FDA approval of diabetes drug JNCI study on ovarian cancer symptoms The post Podcast 72: A conversation about two new drugs for multiple sclerosis. first appeared on Clinical Conversations.

I tried arranging an interview across a 13-hour time difference, with no luck. We revisit, instead, an October conversation about the late clinical course of dementia. First a look at the news. Comments to jelia@jwatch.org or to 1-617-440-4374. Interview link: Advanced Dementia’s Course News links: Massachusetts elects a U.S. Senator Screening and treating children for overweight Abnormal lipid profiles found in many U.S. adolescents Quitting smoking after early-stage cancer diagnosis lengthens survival The post Podcast 71: We revisit, after a look at current clinical news, a conversation on the late clinical course of dementia. first appeared on Clinical Conversations.

This is the podcast for January 15, 2010. We have an interview on the impact of the USPSTF guidelines with two clinicians who study the best ways to communicate clearly with patients. I think you’ll like it. You can reach me at jelia@jwatch.org or by calling 617-440-4374. If you like this podcast, there are many others in the archives, and they’re all free. I hope you find them useful. News links: Adult immunization schedule in MMWR Ticagrelor versus clopidogrel Platelet-rich plasma injections Lack of evidence supporting rapid response teams Inerview linki: JAMA essays on USPSTF recommendation The post Podcast 70: Considering the USPSTF breast-screening guidelines with your patients first appeared on Clinical Conversations.

I’ve been on vacation, and I hope that you’ve managed to sneak some time away as well. In December, JAMA published an article associating increased survival after breast cancer with eating even modest amounts of soy food regularly. The work was done using a cohort in Shanghai, and the study’s first author agreed to an interview. If you have comments (and there seems to have been more over the holidays, for some reason) please feel free to chime in. I’ll be better about evaluating them promptly for appropriateness. You can also leave voice mail at 1-617-440-4374 and email me at jelia@jwatch.org. Here are the week’s links: Interview-related– JAMA abstract News-related– Atypical antipsychotics Presurgical prep High-test flu shot for elders Contaminated cocaine and agranulocytosis The post Podcast 69: Eating soy foods and survival after breast cancer first appeared on Clinical Conversations.

Dr. Robert Centor of the University of Alabama at Birmingham believes that the paradigm for treating pharyngitis in adolescents and young adults must change. Listen to our conversation and hear why. Here are this week’s links: Interview: Commentary Urges ‘Expanding the Diagnostic Paradigm of Pharyngitis’ in Young People Robert Centor’s blog — “Medrants” News stories: Chronic Pain Linked to Greater Risk for Falls in the Elderly Even Very Low Levels of Cardiac Troponin T Linked to Heart Failure, Cardiovascular Death Length of ICU Stay Closely Linked to Infection Rate, International Survey Shows Norpramin Label Updated to Warn of Use in Patients with Family Histories of Sudden Death, Cardiac Dysrhythmias Postoperative VTE Risk in Women Remains Substantially Elevated for 12 Weeks The post Podcast 68: Change your approach to pharyngitis in adolescents and young adults. first appeared on Clinical Conversations.

This week’s Archives of Internal Medicine investigates what happens when you analyze the outcome of all those pulmonary angiographic CTs ordered in the emergency department to rule out pulmonary embolism. We talk things over with Dr. Shannon Carson and Dr. William Hall, two of the paper’s principal authors. It’s Thanksgiving Week here in the U.S., and so there won’t be a news section in this edition. I’ll catch you up next week on what’s happened. I hope your holiday is pleasant, if you get one, and your workload reasonable, if you don’t. Interview link: CT Testing for Pulmonary Embolism Is More Likely to Yield Burdensome ‘Incidental Findings’ The post Podcast 67: Unexpected “incidental” findings on pulmonary CT angiography present problems of pursuit and follow-up. first appeared on Clinical Conversations.

One of the more intriguing pieces of research presented at the American Heart Association this week (and simultaneously released online in the New England Journal of Medicine) shows that extended-release niacin outperforms ezetimibe in high-risk patients. We talk with Dr. Allen J. Taylor, the study’s first author. Contact us at 1-617-440-4374 or write jelia@jwatch.org. This edition’s links: Interview Link: Extended-Release Niacin Outperforms Ezetimibe in Lowering Cardiovascular Risk News Links: USPSTF Recommends Against Routine Mammography for Women in Their 40s ACOG Releases New Cervical Screening Guidelines into Politically Charged Environment FDA Approves New Treatment for Shingles-Related Pain The post Podcast 66: Niacin versus ezetimibe in the face of high cardiovascular risk — a conversation with the ARBITER 6-HALTS trialist Allen Taylor first appeared on Clinical Conversations.

Investigators have suspected that there isn’t much advantage to renovascular angioplasty and stenting in atherosclerosis, but their studies haven’t had the statistical power to prove that point. A new bit of research in this week’s New England Journal of Medicine may have hit the mark. We’ve got an interview with two of the principals of the ASTRAL study (that’s their acronym for Angioplasty and Stenting for Renal Artery Lesions). Dr. Philip Kalra, the nephrology lead, and Dr. Jonathan Moss, the radiology lead, kindly agreed to the conversation, which I think you’ll find of interest. Reach us with your comments and suggestions at jelia@jwatch.org, or call 1-617-440-4374. This edition’s links: Interview link– No Clinical Benefits of Revascularization in Atherosclerotic Renal Arteries News links– H1N1 Update: Estimates of Flu’s Toll; Seasonal Vaccine Not Effective Against 2009 H1N1 Prone Position for Acute Respiratory Distress Syndrome Doesn’t Boost Survival The post Podcast 65: A conversation about the ut

Avoiding use of the heart-lung machine during coronary artery bypass grafting was supposed to lower neurocognitive problems and other complications after the procedure. A large randomized trial finds otherwise. We’ve got a conversation with one of the investigators, Frederick Grover. To contact us, call 1-617-440-4374. You can write to me at jelia@jwatch.org. This week’s links: News links: Primary Care Visit Length Increasing H1N1 Update: CDC Releases ‘Quick Facts’ for Providers on Antiviral Drug Use Aspirin for Primary Prevention ‘Should Not Be Routinely Initiated’ Interview links: Coronary Artery Bypass Grafting: On Pump or Off Pump? The post Podcast 64: A conversation regarding on-pump versus off-pump CABG with Frederick Grover. first appeared on Clinical Conversations.

There are consequences of even short-term use of some drugs. Take the second-generation antipsychotics. A 3-month course can cause weight gain of almost 20 pounds in young people, according to a JAMA study. We interview Dr. Christoph Correll about the implications. To reach Clinical Conversations, you can call 1-617-440-4374 or email me at jelia@jwatch.org. This weeks news and interview links: News: Diabetes Prevention Interventions Have Long-Lasting Effects Antibiotic Prophylaxis Lowers Risk for UTIs in Predisposed Kids (Some of) You Are Feeling Very Sleepy… Interview: Atypical Antipsychotics Associated with Weight Gain and Other Adverse Metabolic Effects in Kids The post Podcast 63: A conversation about the adverse cardiometabolic effects of second-generation antipsychotic drugs in young patients with Christoph Correll first appeared on Clinical Conversations.

The FDA seems set to announce a decision about vaccinating women past age 25 for HPV. A paper in the Annals of Internal Medicine this week indicates that such a strategy wouldn’t be cost-effective. Don’t be put off by “cost-effectiveness” or by the fact that we actually discuss “QALY”s. It’s all good. We’ve got Harvard School of Public Health’s Jane Kim to guide your interviewer through the QALY thicket, and she’s a great guide. Contact us at 1-617-440-4374 or write to jelia@nejm.org. This week’s links: NEWS: Aldosterone Antagonists Underused in Heart Failure ACP Issues Guidelines on Hormonal Testing and Pharmacologic Management of Erectile Dysfunction Ketorolac for Injection Recalled Intensified BP Control Benefits Kids with Chronic Kidney Disease INTERVIEW: Adding HPV Vaccination to U.S. Cervical Screening Isn’t Cost-Effective After Age 30 The post Podcast 62: A conversation with Jane Kim about cost-effectiveness of vaccinating women with HPV vaccine after age 30. first appeared on Clinical Conve