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Your host is struggling with an overload of pollen and its attendant insults to his immune system. Or maybe it’s the dreaded swine flu. In any event, Dr. Anne Schuchat gave an interesting interview on childhood immunization levels in those halcyon pre-porcine-obsessed days of September 2008, and I’m repeating it for you this week. This week’s links: Institute of Medicine Calls for Steps to Limit Conflicts of Interest Among Physicians Guidelines Recommend Against Valproate and Other Antiepileptics in Pregnancy Flu Notes: CDC Offers Info for Patients, NYC Cluster Details – and a Name Change Resources mentioned in the interview with Dr. Schuchat: http://www.cdc.gov/vaccines/ http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5735a1.htm The post Podcast 41: A repeat of an interview with Dr. Anne Schuchat of the CDC on childhood immunization levels. first appeared on Clinical Conversations.

The Annals of Internal Medicine published an intriguing essay online last week about tight glycemic control in type 2 diabetes. Its authors argue that we’ve got it all wrong: imposing tight controls is only subjecting patients to stresses — related to the complexities and costs of treatment — that make control less likely to succeed. In addition, the supposed benefits of that control haven’t been confirmed by the available evidence. They advocate a backing-off of the current stern limits, which might make visits to clinicians feel less like a visit to the principal’s office. Listen in on a conversation with Dr. Victor Montori, one of the essay’s coauthors. As always, you are invited to weigh in with your own thoughts. Leave us a piece of your mind at 1-617-440-4374. This week’s links: A Skeptical Look at Tight Glycemic Control Resources mentioned by Dr. Montori in the interview Additional Swine Flu Cases Found, CDC Says FDA Allows OTC ‘Morning-After Pill’ for 17-Year-Olds The post Podcast 40: Tight contr

Neurologists have talked about these effects for a while, but now they’ve got evidence showing that valproate lowers IQ at age 3 by almost 10 points. Since only half the antiepileptics are used in epilepsy, the results will affect everyone caring for women of reproductive age. Kimford Meador of Emory University is here to talk with us about it. Let me have your reactions at 1-617-440-4370. I do like hearing from listeners, if only to guide me to better content. This week’s news and interview links: Valproate Use During Pregnancy Associated with Impaired Cognitive Function in Offspring Dementia Risk Increased with Earlier Episodes of Hypoglycemia Fewer Than Half of Young, Sexually Active Women Screened for Chlamydia Post-CAD Depression Linked to Higher Heart Failure Risk The post Podcast 39: A conversation with Kimford Meador about a new paper assessing the later cognitive effects of fetal exposure to antiepileptic drugs. first appeared on Clinical Conversations.

There are lots of people with poorly controlled asthma who are on PPIs, but don’t need to be. That’s the clear implication of research just published in the New England Journal of Medicine. We’ll talk with a member of the writing committee, Dr. Robert A. Wise. If you like what you hear, call 1-617-440-4374, and if you don’t, the number’s the same — call anyway. Here are the principal links for this week’s podcast: PPIs Don’t Improve Asthma Control Exercise Training Brings ‘Modest Results’ in Heart Failure Many Healthy Older Adults Not Being Screened for Colorectal Cancer ACC/AHA Release Consensus Document on Pulmonary Hypertension The post Podcast 38: A conversation about using PPIs in poorly controlled asthma — rather, not using them — with Robert A. Wise of Johns Hopkins. first appeared on Clinical Conversations.

This week we talk with Don Griesdale about his meta-analysis on glucose control during intensive care. The evidence is complex, but we hope the presentation is straightforward and useful. You’ll let us know if it isn’t, right? Just call us at 1-617-440-4374 and leave a message. This week’s links: Medicare Rehospitalization Data Highlight Importance of Postdischarge Care Poor Communication in Hospital Readmissions News from the American College of Cardiology meeting Meta-Analysis of Tight Glucose Control in the ICU Calls Guidelines into Question Intensive Glucose Control May Raise ICU Mortality The post Podcast 37: A conversation with Vancouver General Hospital and the University of British Columbia’s Donald Griesdale about a meta-analysis on tight glucose control in the ICU. first appeared on Clinical Conversations.

We’ve got an interview with the first author of JAMA‘s final installment in its series on end-of-life care. The last paper focuses on the (necessary) self-care of clinicians who care for the dying. It’s an interesting discussion. Please call 1-617-440-4374 if you have any comments. I’ll toss them into the mix. This week’s links: Intensive Glucose Control May Raise ICU Mortality Meta-Analysis of Tight Glucose Control in the ICU Calls Guidelines into Question Joint statement from ADA and AACE ACCF/AHA Guidelines on Diagnosing and Treating Heart Failure Stopping Smoking in Early Pregnancy Can Reverse Its Adverse Effects Center for Practitioner Renewal Self-test for measuring burnout and compassion fatigue Center for Mindfulness in Medicine The post Podcast 36: Michael K. Kearney is our guest. He talks about the self-care of clinicians engaged in end-of-life care. first appeared on Clinical Conversations.

Clinical Conversations, the podcast formerly known as Admitting Diagnosis, offers this week a reprise interview from last summer: Mary Tinetti talks about preventing falls in the elderly. Call 1-617-440-4374 to leave a suggestion. Let’s hear from you. Links: Prostate Cancer Screening Controversy Not Dead Yet Diabetics and Patients over 65 Show Bigger Survival Benefit from CABG than PCI USPSTF Updates Recommendations on Aspirin for CVD Prophylaxis Dr. Tinetti interview http://content.nejm.org/cgi/content/short/359/3/252 http://www.fallprevention.org/ http://nihseniorhealth.gov/ The post Podcast 35: Clinical Conversations reprises an interview with Mary Tinetti about falls in the elderly. first appeared on Clinical Conversations.

BMJ‘s paper on the possible association of migraine during pregnancy and stroke (and other vascular problems) is the focus of this week’s interview. We speak with first-author Dr. Cheryl Bushnell. And then there’s the week’s news, plus a message from a listener! It could have been you, if only you’d called 1-617-440-4374 and made a comment. Maybe you could get yourself to a phone and give it a shot this week? Relevant links: Errors in Administering ICU Parenteral Drugs Detailed BP-Lowering Therapy of Substantial Benefit to Patients with Diabetes and Afib Risk Factors plus Breast Density: ‘Best Approach’ to Estimating Breast Cancer Risk Migraines in Pregnancy Associated with Increased Stroke and Vascular Risks The post Podcast 34: An interview with Cheryl Bushnell of Wake Forest about her paper in BMJ concerning migraines during pregnancy and the possibility of their relation to strokes and other vascular problems. first appeared on Clinical Conversations.

This week’s podcast includes an interview from September 2008 with Stephen Hetz, co-editor of “War Surgery in Afghanistan and Iraq,” published last summer by the Surgeon General. We’re going to change our name to “Clinical Conversations.” which, come to think of it, makes more sense than “Admitting Diagnosis,” but doesn’t have the mystery and the possibilities. We heard that the old name smacked too much of the classroom, etc. So, let me know how you feel about the series so far. Call 1 617 440 4374 and leave me a message. Thanks! Links: Vitamin K Not Associated with Fewer Bleeding Events in Patients Taking Warfarin Using PPIs with Clopidogrel Associated with Adverse Outcomes After ACS Transdermal Patches Dangerous During MRI Ordering “War Surgery” through the Government Printing Office The post Podcast 33: We repeat, after the principal news of the week, an interview with Stephen Hetz, co-editor of “War Surgery in Afghanistan and Iraq” first appeared on Clinical Conversations.

We’ve run into a scheduling problem with the person we wanted to talk with. We’ll try again next week, because his views are intriguing and I’m guessing you’d rather have intriguing than ho-hum. However, so that you won’t have wasted your time downloading the podcast, I’ve reprised an interview from last June, when few of you were listening. It deals with the problem of patients’ false sense of optimism about their life expectancy. Intriguing for sure. Let me know what you think. Call 1 617 440 4374 and leave a message. NEWS LINKS: FDA Calls for Boxed Warning on Gastrointestinal Drug ‘Framingham Score’ Proposed for Atrial Fibrillation Risk Four Different Diets – Four Similar Results Moderate Alcohol Consumption Linked to Higher Cancer Risk in Women INTERVIEW LINKS Seattle Heart Failure Model JAMA article Journal Watch Cardiology coverage Physician’s First Watch coverage The post Podcast 32: Reprise of a June 2008 interview with Larry Allen from Duke, in which he talks about patients’ estimates of their l

Starting a patient on warfarin is nobody’s idea of a good time, but pharmacogenetic research can help. A study in this week’s NEJM shows the advantage of using genetic information (plus some clinical data) over the old “start at 5 mg a day and pray for success” approach. We talk with Julie Johnson of the University of Florida about the study. We’ve shortened our news presentation, on the theory that you can’t assimilate too many details through your ears, so we give you the aural cartoon version and provide links for details at the website: podcasts.jwatch.org. If you want to contact us with your suggestions, please call 1 617 440 4374. Links for this edition: Healthy Behaviors Associated with Halving of Stroke Risk Patients’ Genetic Profiles Help Determine Appropriate Warfarin Dosing Bypass Grafting Proves Superior to PCI in Severe Coronary Artery Disease Less Than 1% of U.S. Adolescents Need Drug Treatment for Dyslipidemia The post Podcast 31: Making your clinical life easier — with genetics. Dr. Julie

The FDA announced an early-March meeting with manufacturers of opioids to discuss how problems with the drugs’ overuse and abuse might be addressed. We talk with an author of guidelines just published (and freely available) in the Journal of Pain that coincidentally address some of these concerns. Then, of course, there’s the usual news roundup, and we finish off with a 200th birthday salute to Charles Darwin (no thanks to unevolved Americans). To join the merriment or complain about the cake, call 617-440-4374 and leave a message. To trace the evolution of “Admitting Diagnosis,” which we admit is horribly misnamed, go to podcasts.jwatch.org. Links for this edition: Severe Ankle Sprains Respond Best to Immobilization in the Short Term Multivitamin Use Not Associated with Lower Risk for Cancer or CVD in Women FDA to Tighten Opioid Restrictions Guidelines on Opioids in Noncancer Pain Issued The post Podcast 30: Dr. Roger Chou of Oregon Health Sciences University talks about recent guidelines for opioid use i

Millions of people are discharged each year from U.S. hospitals. How many find themselves on the street with no clear idea of what they’ve been treated for, what drugs they should take and when, and how to get in touch with a clinician if something goes wrong? No surprise, many are readmitted — either directly or through the emergency room. Brian Jack and colleagues embarked on Project RED to re-engineer hospital discharge procedures (which, by the way, are not currently standardized). There’s news and links too. Plus, your chance to talk back by calling 617-440-4374. Links for this issue: A couple of position papers on type 2 diabetes 64-slice CT angiography is the equivalent of 600 chest x-rays Routine lower-back imaging is a waste of time Ending Hospitalizations Carefully Avoids Rehospitalizations Project RED website Project RED toolkit (example of an after-hospital care plan and the training manual) The post Podcast 29: Dr. Brian Jack of Boston University sees RED (Re-Engineered Discharge) as a way to

There are a dozen new-generation antidpressants on the market now. How to sort them out? On what basis? We talk with two authors of an intriguing meta-analysis released online in Lancet this week. And we offer the usual roundup of news and, speaking of roundups, a working name while we come up with something better than the rather staid “Admitting Diagnosis.” Calls, comments, and complaints to 1-617-440-4374. Links for this podcast: First Watch coverage of the Lancet paper on antidepressants Lancet‘s abstract The meta-analysis design Haemophilus influenzae type B cases from MMWR Alcohol abuse review in Lancet Kidney donation article in NEJM The post Podcast 28: A discussion with Dr. Andrea Cipriani and Prof. John Geddes about their ranking of 12 antidepressants first appeared on Clinical Conversations.

The 6-year period 2001 – 2006 saw an increase from 12 to 28 in the percentage of S. aureus infections among head-and-neck infections in childen that were methicillin resistant. This 16-point jump is concerning, and we talk with an author of the paper documenting that increase. Also, we’d like to know: should we be calling this thing here “Admitting Diagnosis” — or something else? If you would like to comment or offer an idea for a future podcast, please call 617-440-4374. Links for this podcast: Steroids and wheezing children Journal Watch Pediatrics & Adolescent Medicine summary NEJM prednisolone abstract NEJM fluticasone abstract Journal Watch General Medicine coverage of benefits of antidepressants in fibromyalgia JAMA fibromyalgia abstract from Pubmed Physician’s First Watch coverage of MRSA study Archives of Otolaryngology abstract The post Podcast 27: Dr. Steven E. Sobol talks with us about his paper on trends in pediatric head-and-neck infections from S. aureus — an increasing percentage of wh

NEJM published a paper this week detailing the risks of sudden cardiac death in those taking both typical and atypical antipsychotic drugs. We talk with the paper’s first author Dr. Wayne A. Ray of Vanderbilt University School of Medicine. If you would like to comment or offer an idea for a future podcast, please call 617-440-4374. Links for this podcast: Simple Checklist Reduces Postoperative Complications NEJM article on checklists Surgical safety checklist Influenza A Treatment Recommendations Emphasized CDC recommendations Vicks VapoRub May Cause Respiratory Distress in Infants, Animal Study Suggests Chest article Measuring Fractional Flow Reserve During PCI Improves 1-Year Outcomes Journal Watch Cardiology summary NEJM article Antipsychotics Increase Risks for Sudden Cardiac Death NEJM article Poor Sleep Patterns May Increase Risk for the Common Cold Archives of Internal Medicine article The post Podcast 26: Dr. Wayne A. Ray talks about the dangers of sudden cardiac death from antipsychotic drugs fir

Hospitals don’t have many outbreaks of viral hepatitis, owing to a strong culture of infection control. However, health care is moving increasingly to nonhospital settings like outpatient clinics and longterm care facilities where infection control is less established. We talk with Nicola Thompson and Joseph Perz of the CDC about their paper detailing the causes of over 30 outbreaks in nonhospital healthcare settings over the past decade. If you would like to comment or offer an idea for a future podcast, please call 617-440-4374. Links for this podcast: FDA: Not Necessary to Stop Taking Vytorin or Other Lipid-Lowering Drugs Elective Cesareans Before 39 Weeks Associated with Adverse Neonatal Outcomes Parkinson Disease: Neurostimulation vs. Medical Therapy 2009 Pediatric Immunization Schedules Approved CDC’s Guidelines on Preventing Transmission of Infectious Agents in Healthcare Settings 2007 CDC’s Estimates of Healthcare Infections Journal Watch General Medicine top stories of 2008 Journal Watch Psychiatry

We talk with Douglas B. White about his paper in the Annals of Internal Medicine, entitled “Hope, Truth, and Preparing for Death: Perspectives of surrogate decision makers,” and we offer a roundup of the week’s news. A reminder, before we start, that Admitting Diagnosis is taking the next two weeks off. We hope you’ll find some time to enjoy the holdays as well. We’ll be back in the first full week of January. Meanwhile, if you’d like to comment on these interviews or offer an idea for a future podcast, please call 617-440-4374. We’re all ears. Links for this podcast– FDA Calls for Suicidality Warning on All Antiepileptic Drugs Intensive Glucose Control Fails to Reduce Cardiovascular Events Even Small HER2-Positive Tumors May Require Aggressive Treatment Patients’ Surrogates Want to Discuss Prognosis, Even at the Risk of Extinguishing Hope Pediatric and Adolescent Medicine Top Stories of 2008 Cardiology Top Stories of 2008 Oncology and Hematology Top Stories of 2008 The post Podcast 24: An interview with D

A week with just a few notable stories, one of which is about using supplements like vitamin C or selenium to prevent prostate cancer. We interview J. Michael Gaziano about two studies in JAMA on that topic. Have a listen, and if you want to react to any of this, call 1-617-440-4374. Links for this issue: FDA advisory panel vote to ban two asthma drugs Journal Watch General Medicine backgrounder on long-acting beta agonists Hemoglobin A1c and the risk of kidney disease in diabetics Archives of Internal Medicine abstract First Watch coverage Using dietary supplements to prevent prostate cancer JAMA Physicians’ health study II (free) JAMA SELECT trial (free) JAMA editorial (free) First Watch coverage The post Podcast 23: An interview with J. Michael Gaziano concerning two JAMA studies on the uselessness of dietary supplements in preventing prostate cancer first appeared on Clinical Conversations.

This week, in addition to the usual news roundup, we talk with Dr. Aaron Kesselheim about his JAMA paper on the equivalence between proprietary and generic cardiovascular drugs. The data and the editorials are often at odds on this question. Have a listen, and if you want to react to any of this, call 1-617-440-4374. Links for this issue: –Vitamin D American Academy of Dermatology guidelines Physician’s First Watch coverage –Controlling hypertension NEJM abstract Journal Watch Cardiology coverage Physician’s First Watch coverage — Work hours for residents Institute of Medicine recommendations Physician’s First Watch coverage –Depression in stable coronary disease Pubmed abstract Journal Watch Cardiology coverage –Generic versus proprietary cardiovascular drugs JAMA abstract Physician’s First Watch coverage The post Podcast 22: Interview with Aaron Kesselheim about his meta-analysis of the efficacy of proprietary versus generic cardiovascular drugs. first appeared on Clinical Conversations.