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.