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(Running time: 15 minutes) A study in the Lancet Oncology gathered information from dozens of epidemiological studies to estimate that over 200,000 cases of endometrial cancer have been prevented in the past 10 years as a result of oral contraceptive use. A commentary in the journal offers a remarkable look at weighing the benefits and harms of OCs. We talk with a co-author of that commentary, Dr. Nicolas Wentzensen of the National Cancer Institute. Lancet Oncology study Lancet Oncology comment The post Podcast 181: Oral Contraceptives’ Role in Reducing Endometrial Cancers first appeared on Clinical Conversations.

How Webster defined it 90 years ago. The CDC’s Seema Jain is our guest, talking about a study she did with her team to characterize the causes of community-acquired pneumonia in U.S. adults. (They don’t mention finding Webster’s Micrococcus lanceolatus.) Medicine has come a long way since 1925, but Dr. Jain says that clinicians still need better diagnostic tools to pinpoint the causes of CAP in individual patients. Using five hospitals in Chicago and Nashville, Jain’s team surveyed over 2000 adult patients admitted with radiographic evidence of CAP during a 30-month period. Also included is discussion of her February paper that sought to characterize CAP in children. NEJM abstract of study in adults NEJM abstract of study in children The post Podcast 180: A sketch of community-acquired pneumonia first appeared on Clinical Conversations.

Running time: 20 minutes The anticoagulant dabigatran, marketed in the U.S. as Pradaxa, has always had the problem that, although it’s more convenient to use, there’s no sure way to stop its effect if the patient has a major bleed. Now, a monoclonal antibody fragment called idarucizumab (pronounced i-DARE-you-scis-ooh-mab) shows promise as a reversal agent. In an interim analysis of the first 90 of a planned 300 patients, the fragment was quite effective in stopping bleeds. The analysis was published in the New England Journal of Medicine, and we talk with the paper’s first author, Charles V. Pollack, Jr. Link to NEJM article (free) The post Podcast 179: Pradaxa (dabigatran) reversal near? first appeared on Clinical Conversations.

Dr. Scott Allen of Physicians for Human Rights talks about the lessons evident in the complicity of clinicians — physicians, PAs, and psychologists at the very least — in the torture of prisoners. His group published an analysis under the title “Doing Harm: Health professionals’ central role in the CIA torture program,” and that’s the focus of this discussion. Allen says that the lesson for all clinicians is to remember the importance of their professions’ commitments to patients, which were badly eroded in these episodes. Running time: 20 minutes Doing Harm report from PHR The post Podcast 178: Why Should Clinicians’ Complicity in CIA Torture Matter to You? first appeared on Clinical Conversations.

Neel Shah wrote a Perspective essay in the New England Journal of Medicine earlier this month on the U.K.’s NICE recommendation that encourages wider acceptance of home delivery and midwifery. The question is, could it work in the U.S.? For the audio-oriented Clin Con audience we’ve adapted a video conversation that took place on Medstro (https://medstro.com/groups/nejm-group-open-forum/discussions/112). There, Dr. Shah and other clinicians discuss the problems U.S. obstetricians and U.S. mothers-to-be face. The Medstro forum is now finished, but the discussions back and forth over the course of its 10-day run are still available at the URL above. Running time: 32 minutes The post Clinical Conversation 177: Can We Deliver NICEly? first appeared on Clinical Conversations.

Running time: 19 minutes We talk with Dr. Cosette Wheeler about a new Lancet Oncology paper that offers follow-up on two major trials of HPV-16/18 vaccines. The analysis adds more data to the suspicion that although three doses of vaccine are optimal, two or even one may offer substantial protection. Wheeler is very cautious on this point, however, and insists that the goal must be to deliver three doses to every recipient. In the U.S., HPV vaccine courses are completed less than half the time. Lancet Oncology abstract The post Podcast 176: HPV Vaccine — How many doses are needed to confer protection? first appeared on Clinical Conversations.

Running time: 26 minutes “Understanding Value-Based Healthcare,” published in April by McGraw-Hill is today’s focus. Drs. Christopher Moriates, of the University of California, San Francisco; Vineet Arora, of the University of Chicago; and Neel Shah of Harvard Medical — the book’s authors — discuss its straightforward approach to valuing patient outcomes foremost. The discussion ranges over their reasons for writing the book, their attempt to reach the broader audience concerned with healthcare costs, and their recommendations for taking action locally. Here’s a link to the authors’ Costs-of-Care website, where you will find information on ordering the book. The post Podcast 175: “Understanding Value-Based Healthcare” — A Discussion with the Authors of an Important New Book first appeared on Clinical Conversations.

The PARADIGM-HF trial of LCZ696 — a novel compound that both blocks the renin-angiotensin system with an ARB component and blocks neprilysin’s degradation of natriuretic peptides — increased survival in heart failure by some 20% relative to enalapril. It seems to be a big deal, and the trial’s two principal authors have agreed to talk about their work and its larger meaning. Running time: 15 minutes Other links: The study in the New England Journal of Medicine (free) NEJM Journal Watch coverage of the study (free) The post Podcast 174: PARADIGM and Heart Failure first appeared on Clinical Conversations.

Running time: 9 minutes In the light of the New England Journal of Medicine‘s recent publication three papers on sodium intake and its implications for cardiovascular disease, blood pressure, and excess mortality, we thought we’d speak again with Dr. Jan Staessen, who surprised a lot of people 3 years ago with a paper in JAMA warning against population-wide sodium reductions. His research showed that cutting sodium intakes to levels recommended by the U.S. Dept. of Agriculture was associated in his cohort with an increase in cardiovascular risk. Dr. Staessen kindly agreed to serve as our guide through the new NEJM research. LINKS: The 2011 Staessen interview Physician’s First Watch coverage of the new NEJM studies The post Podcast 173: Sensible Sodium Levels in View at Last first appeared on Clinical Conversations.

Running time: 15 minutes Dr. Danielle Ofri, author and internist (as well as an aspiring cellist), is writing a book about how patients and clinicians hear each other. Our discussion centers on that, and on her request that you contact her if you can put her in touch with great diagnosticians (and maybe even their patients). If you have any suggestions about this or other matters, please contact me here: jelia@nejm.org. Dr. Ofri may be contacted at her website: http://danielleofri.com  Here’s a link to our 2009 interview with Ofri. The post Podcast 172: Listening for the Diagnosis, a Conversation with Danielle Ofri first appeared on Clinical Conversations.

Running time: 10 minutes The Institute of Medicine’s report on treatment for post-traumatic stress disorder finds that active military and veterans with PTSD aren’t always getting evidence-based treatments. And when those treatments are used, they’re too often not used according to protocols and the results aren’t measured. The upshot? The agencies with responsibility for treating PTSD don’t know whether they’re doing their patients any good. Institute of Medicine report on PTSD (free) The post Podcast 171: PTSD Treatment Effects Remain Largely Unmeasured By the Military and the VA first appeared on Clinical Conversations.

Dr. Charlotte Yeh was crossing the street in Washington, D.C., on her way to dinner when a car hit her. She ended up in a Level I trauma center, and the experience was sobering for its reminder that in our drive to measure quality indicators, the patient may end up ignored or forgotten. Running Time: 10 minutes A link to her essay in Health Affairs The post Podcast 170 — An Emergency Physician Has the Tables Turned On Her and Returns with Lessons for All Clinicians first appeared on Clinical Conversations.

 Running time: 11 minutes The American Heart Association/American College of Cardiology have released four sets of guidelines — all aimed at the lowering of risk for atherosclerotic cardiovascular disease. For perspective, we’ve asked Harlan Krumholz, editor-in-chief of NEJM Journal Watch Cardiology and CardioExchange to chat. Links: Risk calculator (free) CardioExchange (free) Circulation homepage New York Times piece by Krumholz on the guidelines (free) The post Podcast 169: New guidelines on cardiovascular disease prevention first appeared on Clinical Conversations.

Running time: 10 minutes The Camden Coalition of Healthcare Providers formed about 10 years ago as a quarterly breakfast club of primary-care providers who were frustrated in their attempts to bring care to comprehensive care to their patients in Camden, N.J. The Coalition’s found and executive director, Dr. Jeffrey Brenner (himself a family physician) has just been awarded a MacArthur Foundation fellowship, and so we caught up with him for a quick chat. Link: The coalition’s website The post Podcast 168: The Camden Coalition’s work on alleviating the discontinuity of medical care first appeared on Clinical Conversations.

Running time: 7 min The recent JAMA article examining the effects of the “polypill” on adherence and clinical benefits in patients with (or at high risk for) cardiovascular disease, is our topic. The polypill in this trial contained fixed doses of four separate drugs: aspirin, a statin, lisinopril and one other blood-pressure-lowering drug — either atenolol or hydrochlorothiazide. Adherence among patients on the polypill was 20 percentage points higher than among those following regular multi-pill regimens. It was even higher — by some 40 percentage points — among those least adherent to their regimens at the start of the 15-month trial. Dr. Anthony Rodgers of the University of Sydney — the paper’s senior author — talks with us about the trial. Links: Physician’s First Watch coverage of the trial (free) JAMA article (free) The post Podcast 167 — The polypill: adherence at last? first appeared on Clinical Conversations.

Running time: 19:45 This week’s guest is Yoanna Skrobik, a Montreal intensivist and author of an intriguing commentary on a Lancet Respiratory Medicine paper on the (non)effect of haloperidol in influencing the incidence or length of delirium/coma in critically ill patients. Physician’s First Watch coverage of the Lancet articles Nurse-facilitated family participation Early physical/occupational therapy in mechanically ventilated patients The post Podcast 166: Delirium and intensive care first appeared on Clinical Conversations.

Running time: 14 minutes. A study in Diabetes Care shows that people at higher genetic risk for diabetes and cardiovascular complications had a relatively lower stroke risk when they adhered to a Mediterranean diet. Dr. Jose Ordovas, the study’s senior author, is our guest for this discussion about the interaction between genes and diet — and its implications even for those without risky genetics. Diabetes Care abstract (free) Physician’s First Watch summary (free) The post Podcast 165: The Mediterranean diet’s salutary interaction with risk-conferring genes first appeared on Clinical Conversations.

Running time: 11 minutes Last month John You and his colleagues published a guide to discussing advance care planning with patients at high risk of dying in the Canadian Medical Association Journal. It’s full of practical advice, and I thought it would be interesting to get a sense of You’s approach to this difficult issue that all clinicians confront sooner or later. Links: Physician’s First Watch coverage of the CMAJ paper. Link to the prognosis estimators. The post Podcast 164: Talking about death first appeared on Clinical Conversations.

Dr. Brien Barnewolt of Tufts Medical Center shares his thoughts on the aftermath of the April 15 bombings at the Boston Marathon. Simple things matter in these circumstances, like wearing your ID badge. Length: 9 minutes The post Podcast 163: Boston bombings – 4 first appeared on Clinical Conversations.

Andrew Ulrich, executive vice chair of Boston Medical Center’s emergency department and an associate professor of emergency medicine at Boston University School of Medicine talks about the day and its lessons. He was just starting his shift when victims began arriving. We’ll continue our explorations of the bombings, trying at least to salvage some lessons. If you have suggestions for the series — or thoughts on Clinical Conversations — please share them via the “add a comment” link below. Joe Elia Last week’s conversation with Alasdair Conn The post Podcast 162: Boston bombings lessons part 3 first appeared on Clinical Conversations.