Clinical Conversations

Dr. Danielle Scheurer and Joe Elia have a free-form discussion on what’s happened over the past year.
Links to those stories (and, sometimes, interviews) are attached here.
If you’d like to suggest another, or comment on our selection, drop us a note in the comments field.
Discussion-related links (they are all free links):
Rivaroxaban
Dabigatran
Screening for lung cancer with low-dose CT (National Cancer Institute announcement)
Clinical Conversations interview with a principal investigator on the lung-cancer screening trial
Annals of Internal Medicine study warning against false-positive findings with CT screening
Emphasizing chest compressions in CPR (Physician’s First Watch summary)
Guidelines for clinicians performing CPR (from Circulation)
Disparate views on PCI’s benefits between patients and their physicians — after informed consent
U.S. lags behind other developed countries in health measures (Commonwealth Fund report summary)
National Healthcare Quality Report 2009
The post Podcast 111: A look back on the year’s most clinically important developments. first appeared on Clinical Conversations.

This week’s guest, Dr. Sripal Bangalore, finds no evidence that use of the standard anti-hypertensive drugs increases risks for cancer. His meta-analysis did find, however, an indication that ARBs and ACE inhibitors, when used in combination, increase risks modestly. Even with the short follow-up, Bangalore says clinicians should find reassurance in the results.
Listen in.
Interview-related links:
Physician’s First Watch coverage of the Lancet Oncology meta-analysis
Lancet Oncology abstract
FDA MedWatch statement (July 2010) concerning ongoing investigation of ARBs and cancer risk
First Watch coverage of earlier Lancet Oncology meta-analysis (June 2010) raising concerns
The post Podcast 110: ARBs (and anti-hypertensives, generally) pose no measurable cancer risk, meta-analysis shows. first appeared on Clinical Conversations.

We’ve got Dr. Harlan Krumholz, editor of Journal Watch Cardiology and CardioExchange, to guide us through a week’s worth of the top research presented at the American Heart Association in Chicago.
Interview-related links (in the order we discuss them in the interview):
CardioExchange (worth checking out — it’s an experiment in the clinical use of social media)
The anacetrapib study
Kidney denervation
Comparing rivaroxaban versus warfarin
Adding cardiac resynch function to ICDs
Remote telemonitoring in heart failure
The post Podcast 109: An overview of the American Heart Association meeting, with cardiologist Harlan Krumholz first appeared on Clinical Conversations.

We talk with Dr. Denise Aberle, a principal investigator on the CT-for-lung-cancer-screening trial that the National Cancer Institute stopped last week. NCI stopped the trial when the trial’s monitoring committee found a 20% decrease in lung cancer deaths among those randomized to CT screening.
Listen in for a fascinating look at what happens when trials stop — and most especially for the implications of this one.
Please make your comments here on the website.
Interview-related links:
Radiology article describing the study
News release from the National Cancer Institute
The post Podcast 108: CT screening for lung cancer first appeared on Clinical Conversations.

Our conversation is with Dr. Patricia Dykes of Boston’s Partners HealthCare. She’s first author on a paper published in JAMA earlier this week. In her study of fall prevention in hospitals, she and her team randomized eight medical units in four Boston-area hospitals either to their usual standards of fall prevention or to use of the “fall-prevention toolkit” — an intervention customized for each patient. The results are encouraging.
Interview-related links:
First Watch coverage (free)
The study abstract in JAMA (free)
Dr. Dykes’ email address
News-related links:
Radiology article on CT screening for lung cancer (free)
National Cancer Institute’s news release on the CT study
Duloxetine approved for chronic musculoskeletal pain
BMJ article on vitamin E’s stroke hazards (free)
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QuantiaMD & Journal Watch National Case Challenge – $2500 Grand Prize
Entering is easy and takes about 15 minutes – simply provide basic information about your case using our one-page entry form.   Submissions are due by November 8, 2010.  Finalists will be chosen by the editorial boards of QuantiaMD and Journal Watch.  We will work with finalists to produce and publish a full 4 to 8 minute interactive case.  These cases and their presenters will be widely promoted and the grand prize winner shall be selected by popular vote.   We encourage all of you to participate in the contest by voting on these finalist cases and help chose the Grand Prize winner.
Click here to participate: http://quantiamd.com/qmdjwncc_ack
The post Podcast 107: Hospital falls and how to reduce them first appeared on Clinical Conversations.

OK, now what can be done to control hypertension among African American men? What about recruiting barbershops to put a shoulder to the wheel? They’re community centers, trusted sources of gossip and advice, and places of relaxation. In Texas, a group of researchers undertook a randomized trial in black-owned barbershops in which barbers took blood pressures and made referrals to clinicians when necessary. Listen in on how it went.
Interview-related link:
Physician’s First Watch coverage
News-related links:
ACIP recommends vaccination boosters in two areas
Asking after dad’s family history of breast and ovarian cancer
(advertisement)
QuantiaMD & Journal Watch National Case Challenge – $2500 Grand Prize
Entering is easy and takes about 15 minutes – simply provide basic information about your case using our one-page entry form.   Submissions are due by November 8, 2010.  Finalists will be chosen by the editorial boards of QuantiaMD and Journal Watch.  We will work with finalists to produce and publish a full 4 to 8 minute interactive case.  These cases and their presenters will be widely promoted and the grand prize winner shall be selected by popular vote.   We encourage all of you to participate in the contest by voting on these finalist cases and help chose the Grand Prize winner.
Click here to participate: http://quantiamd.com/qmdjwncc_ack
The post Podcast 106: The barbershop and hypertension — a little off the top first appeared on Clinical Conversations.

In the face of scheduling problems we’ve had to postpone this week’s interview and use, instead, one from early this summer. It’s on NSAIDs, and if you missed it, it’s worth a listen. If you didn’t miss it, then join us again next week, but give a listen to the news round-up before you head off to rake leaves….
The pace of suggestions and comments has quickened, and I’m grateful. Please keep them coming to jelia@jwatch.org.
Interview-related link:
First Watch coverage of the NSAIDs article from June 9, 2010
News-related links:
Stroke  guidelines as published in Stroke
First Watch summary of the guidelines plus links to hypertension & diabetes care standards
FDA alert on prostate cancer drugs used for androgen deprivation therapy
NEJM paper on dabigatran from August 2009
*  *  *
(advertisement)
QuantiaMD & Journal Watch National Case Challenge – $2500 Grand Prize
Entering is easy and takes about 15 minutes – simply provide basic information about your case using our one-page entry form.   Submissions are due by November 8, 2010.  Finalists will be chosen by the editorial boards of QuantiaMD and Journal Watch.  We will work with finalists to produce and publish a full 4 to 8 minute interactive case.  These cases and their presenters will be widely promoted and the grand prize winner shall be selected by popular vote.   We encourage all of you to participate in the contest by voting on these finalist cases and help chose the Grand Prize winner.
Click here to participate: http://quantiamd.com/qmdjwncc_ack
The post Podcast 105: NSAIDs revisited first appeared on Clinical Conversations.

We welcome Dr. Danielle Bowen Scheurer to our conversational team this week She’s a hospitalist at the Medical University of South Carolina and an associate editor of Physician’s First Watch.
Our guest is Dr. Deepak Bhatt, who has just published some reassuring results on omeprazole’s putative interaction with clopidogrel in the New England Journal of Medicine.
If you’d like to suggest topics or ways to improve this podcast, we’re all ears. Drop me a line at jelia@jwatch.org — thank you.
Interview-related link:
New England Journal of Medicine article (free)
News-related links:
Vaccine matchup looks good — MMWR article (free)
Low Apgar scores and cerebral palsy risk — BMJ article (free)
Screening survivors of childhood cancer — Annals abstract (free)
COG screening guidelines (free)
The post Podcast 104: Reassurance on clopidogrel and omeprazole. first appeared on Clinical Conversations.

Welcome back. We take a look this week at a study from Iceland that looks at whether estimated glomerular filtration rates have a role in estimating cardiovascular risk. Our interview is with Cambridge University’s Dr. Emanuele Di Angelantonio.
Your comments are welcome, both here and to my email address: jelia@jwatch.org.
Interview-related links:
BMJ study (free)
BMJ meta-analysis (free)
BMJ editorial (subscription needed)
News-related links:
ADHD story in Physician’s First Watch
Archives of Disease in Childhood (abstract)
MMWR (free)
Annals of Family Medicine (free full text)
The post Podcast 103: eGFR and cardiovascular risk assessment first appeared on Clinical Conversations.

Prof. Martin Dennis chats with us about his latest trial, comparing the utility of thigh- versus below-knee-length stockings for patients immobilized after stroke. The latest results show the superiority of thigh-length stockings, but at the further risk of skin breaks in these vulnerable patients. Taken together with the results of his earlier work, at the very least the use of below-knee-length compression stockings — now widely used in patients undergoing surgery — must be called into question.
Interview-related links:
Clinical Conversation’s earlier interview with Prof. Dennis.
Full text of the latest trial in Annals of Internal Medicine (free)
News-related links:
Avandia (rosiglitazone) restricted in Europe and the U.S.
Mammography’s modest contribution to lowering breast cancer mortality
New MS drug, fingolimod, approved by FDA
The post Podcast 102: Short compression stockings would seem to have no further role clinically. first appeared on Clinical Conversations.