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We talk with Susan Mitchell, a Harvard researcher who set out to characterize the final clinical stages of advanced dementia. There are some surprises — namely, the benefit of clear communications with patients and their families (which, come to think of it, shouldn’t come as much of a surprise at all). Talk with us at 1-617-440-4374 or write to jelia@nejm.org. This week’s links: Interview: Advanced Dementia’s Course News summaries: Prophylactic Acetaminophen Reduces Immunogenicity of Childhood Vaccines Nursing Home Residents See Marked Declines in Functional Status After Starting Dialysis Minimally Invasive vs. Open Radical Prostatectomy The post Podcast 61: A conversation about end-stage dementia. first appeared on Clinical Conversations.

It’s been treated as fact for a long time, but now there are data to prove it: weight loss in type 2 diabetes does ameliorate obstructive sleep apnea. Gary Foster of Temple University has an ongoing study of some 250 patients, and he’s just presented data on the first year of an anticipated 4-year follow-up. Listen in. The gift deadline for our survey has been extended. The analysts want more data (don’t they always?), and so if you take the survey you’ll get a $5 gift certificate from Amazon. See the notice just above (or below) this text on the website for information. I don’t imagine they will extend the deadline much past the end of October, so please unload all your opinions upon us soonest. If you’d rather do that informally and directly, you can always dial 1-617-440-4374 or contact me at jelia@nejm.org. This week’s links: Interview — Beneficial Effect of Weight Loss on Obstructive Sleep Apnea in Patients with Diabetes News — H1N1 Update: CDC Releases 2009 H1N1 Vaccine Schedules A Third of Patients wi

Early in the 2009 H1N1 pandemic, it was thought that bacterial coinfection was rare, but now that’s been shown to be untrue. Dr. Dianna Blau, one of the principal contributors to a study of coinfections in 77 fatal cases of 2009 H1N, is our guest. This week’s interview links: H1N1 Update: Bacterial Coinfection in H1N1-Related Deaths CDC guidance on use of pneumococcal vaccine in H1N1 pandemic IDSA/ATS guidelines This week’s news links: Benefits of Treating Mild Gestational Diabetes Maternal Smoking During Pregnancy Linked to Psychotic Symptoms in Children Years Later Beneficial Effect of Weight Loss on Obstructive Sleep Apnea in Patients with Diabetes The post Podcast 59: A conversation about bacterial coinfection in 2009 H1N1 flu deaths with Dianna Blau of the CDC first appeared on Clinical Conversations.

Pregnant women are at greater risk for flu complications. This week, we repeat a conversation with a CDC researcher who’d just published a paper in Lancet urging prompt treatment with antivirals, even in the face of pending lab results. Contact us at 1-617-440-4374. This week’s links: In Pregnancy, Treat Suspected H1N1 Promptly Without Awaiting Test Results Maternal Use of Sertaline, Citalopram Linked to Septal Heart Defects in Offspring HIV Vaccine Shows Unexpected, if Limited, Success Prostate-Specific Antigen Doesn’t Measure Up as a Screening Test The post Podcast 58: A repeat of the July 31 interview with the CDC’s Denise Jamieson on treating pregnant women who have suspected 2009 H1N1. first appeared on Clinical Conversations.

When treated according to 2007 IDSA/ATS guidelines, community-acquired pneumonia is a less dangerous disease. You need to administer only 10 guideline-compliant treatments to elderly people, according to one estimate, in order to save a life. A good deal, no? We have the authors of two papers on the benefits of compliance as our guests this week. Their studies were published in the September 14 edition of Archives of Internal Medicine. (A reminder to take the survey, please, if you haven’t already.) This week’s interview links: Community-Acquired Pneumonia: Guideline-Compliant Treatment Is Better IDSA/ATS guidelines This week’s news links: Haemophilus Influenzae B Vaccine Recommendations FDA Calls for Boxed Warning on Promethazine Hydrochloride Injection The post Podcast 57: Treating community-acquired pneumonia according to the guidelines first appeared on Clinical Conversations.

We’ve seen research into this area before — 18 months ago, in fact. (We interviewed Joseph Ross back then in Podcast #2.) This time we interview Joseph Wislar, a survey-research specialist at JAMA, and Annette Flanagin, its managing deputy editor. They’ve just presented the abstracted results of a survey on ghost and honorary authorship that encompasses hundreds of articles from the principal medical journals. If you would like to comment, give us a call and leave a message at 1-617-440-4374 or drop me a note at jelia@nejm.org. This week’s links: Barack Obama speech transcript H1N1 Update: Early Results on Vaccine Indicate One Dose May Be Sufficient for Most Groups FDA Advisers: HPV Vaccine Should Be Approved for Use in Boys, Young Men New York Times story on “ghostwriting” in the principal medical journals Link to last year’s interview with Joseph Ross Physician’s First Watch coverage The post Podcast 56: A conversation with two JAMA staffers on their research into “ghost” authorship and “honorary” author

French researchers find that in non-ST-elevation acute coronary syndrome, delaying intervention until the next day does not affect the occurrence of death, MI, or the need for urgent revascularization by the one-month mark. We caught up with the study’s first author in Paris. If you want access to earlier podcasts, you’ve come to the right place if you’re reading this at http://podcasts.jwatch.org. If you’d like to leave a note of delight or dismay, 1-617-440-4374 is the place to do so — or via email to me at jelia@nejm.org. This week’s news and interview links: Immediate vs. Delayed Intervention in Non-ST-Segment Elevation ACS 2009 H1N1 Update: Childhood Deaths; Two-Dose Vaccine Likely; N95 Respirators Nonsurgical Treatment for Dupuytren Contracture with Collagenase Dabigatran at Least as Effective as Warfarin in Patients with Afib Ticagrelor Superior to Clopidogrel in Patients with Acute Coronary Syndromes The post Podcast 55: A conversation with Prof. Gilles Montalescot about his JAMA paper on immediate

Well, the headline says it all. UCSF’s Aaron Caughey has just published a meta-analysis in Annals of Internal Medicine that shatters the dogma of elective induction’s being associated with cesarean delivery. I hope you’ll enjoy the conversation. There won’t be a Clinical Conversation next week — I’m taking a week off — but the chit-chat returns in two weeks. Older conversations are all archived here at podcasts.jwatch.org, and you can leave me a note at 1-617-440-4374 or at jelia@nejm.org. This week’s links: Supervised Heroin Treatment Outperforms Methadone in Refractory Users FDA Approves Hiberix as Haemophilus Vaccine Booster Dose HPV Vaccine About as Safe as Other Vaccines, Researchers Report Chinese Herb Appears Better Than Standard Treatment for Rheumatoid Arthritis The Interview’s story link: Elective Labor Induction Associated with Lower Cesarean Delivery Rates The post Podcast 54: A conversation with Aaron Caughey, whose analysis of the literature shows that elective induction of labor does not,

Dr. Miquel Ferrer of the University of Barcelona took some time away from his holiday to talk with us about an article he’s just published in Lancet. His research shows that in a subgroup of patients with chronic respiratory diseases (mostly COPD) who are undergoing extubation but who remain in hypercapnia, noninvasive ventilation support is the way to go. This week’s links: Aspirin Use After Colorectal Cancer Diagnosis Linked to Lower Mortality Risk H1N1 Update: CDC Issues Guidance for School Districts for Upcoming Academic Year Using Noninvasive Ventilation after Extubation Associated with Better Outcomes in Some Patients with Chronic Respiratory Disease The post Podcast 53: Patients extubated with hypercapnia can be managed better with noninvasive ventilation, a new study shows. first appeared on Clinical Conversations.

We talk with two authors of a JAMA study that indicates that such screening doesn’t accomplish the ultimate goal: protecting the patient from further abuse. Our guests have some advice. This week’s news links: Vertebroplasty No Better Than Sham Procedure in Osteoporotic Fractures Researchers Advise Labor Induction for Women with Mild Hypertensive Disease Late in Pregnancy TNF-Blockers to Carry New Cancer Warnings Interview links: JAMA article Physician’s First Watch summary BMJ review article mentioned in the interview The post Podcast 52: Screening for intimate-partner violence doesn’t seem productive or very protective. What’s a concerned clinician to do? first appeared on Clinical Conversations.

It’s simple: pregnant women (for un-simple reasons) are at greater risk for flu complications. It’s true even among hitherto apparently healthy patients. We’ve got a conversation with a CDC researcher who’s just published a paper in Lancet that urges prompt treatment, even in the face of pending lab results, with antivirals. Contact us at 1-617-440-4374. This week’s links: ACIP Recommends Five Groups as Priority Targets for H1N1 Vaccination In Pregnancy, Treat Suspected H1N1 Promptly Without Awaiting Test Results CDC “Full-Out” Recommends Seasonal Flu Vaccination for Children Over 6 Months Expensive Tests to Evaluate Syncope Don’t Yield as Much as Simple Postural BP ACOG Revises Labor Induction Guidelines The post Podcast 51: In pregnant women with suspected H1N1, treat promptly! A conversation with Denise Jamieson of the CDC. first appeared on Clinical Conversations.

This week the FDA approved a form of fentanyl that can be administered through the buccal mucosa — but its label carries boxed warnings. And two weeks ago, the opioid propoxyphene got boxed warnings on its Darvon and Darvocet formulations. The FDA is trying to regulate the opioids more closely, reminding prescribers and users of the dangers they pose. In February, after another FDA announcement on opioid control, we interviewed Dr. Roger Chou of Oregon Health Sciences University on this topic. Since it’s summer and the news is relatively scant, I’m reprising the interview and skipping the news summary. Enough said! This week’s links: Darvon, Darvocet to Get Stronger Warnings on Fatal Overdose Risk FDA Approves Fentanyl Buccal Soluble Film Older links: FDA to Tighten Opioid Restrictions Guidelines on Opioids in Noncancer Pain Issued The post Podcast 50: A re-podcast of an interview from February regarding the FDA’s plans for tightening regulations on opioid use. first appeared on Clinical Conversations.

We talk with Drs. Michael Mauer, Ronald Klein, and Bernard Zinman about their paper in the July 2 New England Journal of Medicine reporting on the RASS study (Renin-Angiotensin System Study). They found that blockade of the renin-angiotensin system was not effective in the primary prevention of diabetic nephropathy in Type 1 diabetes. This week’s news links: Darvon, Darvocet to Get Stronger Warnings on Fatal Overdose Risk Famotidine Associated with Fewer GI Complications from Low-Dose Aspirin Dronedarone Approved for Maintenance Therapy in Atrial Fibrillation and Atrial Flutter The week’s interview links: Renal and Retinal Effects of Enalapril and Losartan in Type 1 Diabetes The post Podcast 49: Three RASS Study researchers discuss their findings on the lack of benefit of renin-angiotensin blockade in the primary prevention of diabetic nephropathy in Type 1 diabetes. first appeared on Clinical Conversations.

Scanning patients on bisphosphonates within the first 3 years of therapy is just wasted effort, and may even be misleading clinically. That’s what researchers conclude after reanalysis of FIT trial data on some 6500 women taking either alendronate or placebo. Prof. Les Irwig of the University of Sydney talks about his team’s findings and what they mean for clinicians used to doing densitometric studies to reassure patients about the progress of their therapy. This week’s news links: Diabetic Retinopathy, But Not Nephropathy, Benefits from Renin-Angiotensin Blockade FDA Panel Votes to Ban Vicodin, Percocet Value of CRP and Other Cardiovascular-Risk Biomarkers Questioned Insulin Glargine Associated with Cancer Risk; ADA Calls Findings “Conflicting and Confusing” This week’s Interview links: Bone-Density Monitoring After Starting Bisphosphonates ‘Cannot Be Justified’ BMJ article The post Podcast 48: A conversation with Les Irwig, which your bone scanner won’t like to hear. first appeared on Clinical Convers

Who knew that discussing QALYs could be so enjoyable? Dr. Elena Losina guides the interviewer through the thicket of cost-effectiveness and points to resources that keep track of the cost-effectiveness of most procedures. This is all done in the context of discussing her paper in Archives of Internal Medicine on total knee arthroplasty. This week’s links: Offer High School Students HIV Testing, CDC Reiterates Fibrinolysis for STEMI Should Be Followed by Transfer and PCI Bone-Density Monitoring After Starting Bisphosphonates ‘Cannot Be Justified’ Providers Often Fail to Inform Patients of Abnormal Test Results Interview links: Total Knee Replacement Found Cost-Effective Across Risk Categories Peter Neumann’s registry of cost-effectiveness studies World Health Organization site on cost-effectiveness The post Podcast 47: Total knee arthroplasty’s cost-effectiveness — a conversation with Elena Losina first appeared on Clinical Conversations.

You’d think that a widely-ordered test would play a part in management and outcome, but two clotting mutations seem exceptions to that rule. Although often requested, the FDA-approved tests for Factor V Leiden and G20210A mutations don’t seem to figure greatly in case management of venous thromboembolism, at least according to the published literature. Dr. Jodi Segal and her team published a meta-analysis in JAMA this week, and she’s here to discuss the results. This week’s links: News– CDC Counsels Infection-Control Vigilance to Prevent H1N1 in Health Workers Zicam Nasal Cold Remedies Linked to Loss of Sense of Smell Stents Not Associated with Improved Function in Renal Artery Stenosis Leukotriene Modifiers for Asthma Associated with Neuropsychiatric Adverse Events Interview links– Does Testing for Clotting Mutations Improve Outcomes in VTE? Agency for Healthcare Research and Quality (AHRQ) The post Podcast 46: Does Genetic Testing for Clotting Mutations Matter? An interview with Jodi Segal of Johns Hop

Compression stockings, widely used to prevent DVT in patients after stroke, don’t work, according to new research published in Lancet. We’ve got the principal investigator, Martin Dennis of the University of Edinburgh, to talk with about this. For your part, if you have someone you’d enjoy hearing talk about a bit of research or anything else bordering on the medical, let me know at 1-617-440-4374 or drop me a note at jelia@nejm.org. This week’s links: Pressure Stockings ‘Should Not Be Used’ to Prevent DVT After Stroke, Lancet Commentators Say Weighing the Benefits and Risks of Aspirin for Primary Prevention of Vascular Disease Radiofrequency Ablation Eliminates Metaplasia in Dysplastic Barrett Esophagus Tolvaptan Approved for Use in Hyponatremia The post Podcast 45: Prof. Martin Dennis discusses new findings discouraging the use of compression stockings after stroke first appeared on Clinical Conversations.

This week we talk with Harlan Krumholz about his paper in BMJ. His team finds that the door-to-balloon-time recommendation of 90 minutes is too long and that many more lives could be saved by shortening that time. Listen to his thoughts on this. And I’d like to listen to your thoughts, which you may send along to jelia@nejm.org or voice at 1-617-440-4374. This week’s links: Early and Delayed Interventions Effective in Non-ST-Segment-Elevation ACS Costs of Reducing Residents’ Workloads Could Exceed $1 Billion Annually Flomax Associated with Complications After Ophthalmologic Surgery Hospitals Should Aim for ‘As Soon As Possible’ Standard for Door-to-Balloon Time The post Podcast 44: Harlan Krumholz on new door-to-balloon-time findings. first appeared on Clinical Conversations.

Northwestern’s Martha Gulati has just published a paper in Archives of Internal Medicine about the hazards of treating symptomatic women with normal angiograms as if they had a benign prognosis. We’ll talk with her after a look at the news, and a reminder that you can really help Clinical Conversations with your feedback. The place to call with suggestions is 1-617-440-4374. This week’s links: Low-Back-Pain Interventional Guidelines Issued by American Pain Society Geriatrics Society Changes Its Pain Management Guidelines Clinical Prediction Tool Identifies Older Adults at Risk for Dementia H1N1 Notes: Some Cases Without Fever; Postexposure Prophylaxis in Pregnancy Interview link: Elevated Risk for Adverse Outcomes in Women with CAD Symptoms and Normal Arteries The post Podcast 43: An interview with Martha Gulati on her research into the cardiovascular risks faced by symptomatic women who have normal angiograms. first appeared on Clinical Conversations.

We talk about writing with Danielle Ofri, editor of the Bellevue Literary Review, author of “Singular Intimacies: Becoming a Doctor at Bellevue” and “Incidental Findings: Lessons from My Patients in the Art of Medicine,” and an attending physician at Bellevue. I figured you could do with less information about influenza. If you’ve got a reaction, call us at 1-617-440-4374 and share it. This week’s links: CDC news briefing Drug-Eluting Stents Have Similar Safety Profile to Bare-Metal Stents Singular Intimacies — Amazon link The post Podcast 42: An interview with Danielle Ofri — author, editor, clinician. first appeared on Clinical Conversations.