Clinical Conversations

We talk with a Danish researcher, Emil Fosbøl, whose team estimated the risks of cardiovascular events caused by NSAID use in healthy people.
Your feedback is always welcomed and encouraged. Please drop me a note (jelia@jwatch.org) or call in a comment to 1-617-440-4374. I’m eager to act on your suggestions.
The interview-related link:
First Watch coverage of the NSAIDs article
News-related links:
Distracted driving
Valproic acid
The post Podcast 91: What risks do NSAIDs hold for healthy people? They’re not trivial. first appeared on Clinical Conversations.

Here’s a question wrapped in mist: How to prevent diabetes? Well, lifestyle changes for sure, but that’s hard. Drug therapy? Easier, but side effects can take away that advantage pretty quickly. Rosiglitazone offers some benefits, but its side effects — most notably increased risks for heart failure and death — have some people wondering whether it should stay on the market.
Canadian researchers took the approach of using low doses of rosiglitazone and metformin in combination. They compared that treatment with placebo in a small group of 200 patients with impaired glucose tolerance. Those receiving treatment had a much lower risk of developing type 2 diabetes over the ensuing 4 years of follow-up.
The results aren’t anywhere near ready for allowing clinical use, but they at least move us a bit through the fog. Our conversation this week is with Bernard Zinman, the principal author of the study, just published in the Lancet.
News-related link: First Watch coverage of BMJ study on hormone-replacement therapy
The post Podcast 90: Preventing type 2 diabetes with low-dose metformin and rosiglitazone seems possible, but clinical use has to await results of another study. first appeared on Clinical Conversations.

Glasses — when did you start wearing them? They serve to help us do more than just read the newspaper, according to our conversational guest today. Prof. Stephen Lord of Sydney’s Prince of Wales Medical Research Institute and his coauthors write in BMJ this week about trying to encourage elderly wearers of multifocal lenses to use single-focus lenses when they walk outside, where the terrain is unfamiliar. The results are practical, and the discussion about them (Prof. Lord’s side of it, that is) enlightening.
Give us a call at 617-440-4374.
This week’s conversation-related link:
Physician’s First Watch coverage of the BMJ study
This week’s news-related links:
AAP statement on pool and swimming safety
Beta-blockers and COPD
CREST: carotid endarterectomy vs. stenting
HIV-1 transmission drops after start of antiretroviral therapy
The post Podcast 89: Glasses aren’t just for reading any more. Listen in to how they can help the elderly avoid falls. first appeared on Clinical Conversations.

The New England Journal of Medicine carries several studies comparing the long-term outcomes of endovascular versus open repair of abdominal aortic aneurysms. Tying all those studies together is an editorial by Dr. K. Craig Kent of the University of Wisconsin. We’ve got him as our guest this week. Have a listen.
Interview-related links:
K. Craig Kent’s editorial
EVAR trial abstract
DREAM study abstract
News-related links
Swapping in a reassembled-from-scratch genome
Dengue now originates in Florida
Antibiotic use has consequences
The post Podcast 88: Weighing the benefits of endovascular versus open repair in abdominal aortic aneurysm. first appeared on Clinical Conversations.

Dr. Robert Centor of the University of Alabama at Birmingham believes that the paradigm for treating pharyngitis in adolescents and young adults must change. Listen to our conversation and hear why.
Here are this week’s links:
Interview-related links:
Commentary Urges ‘Expanding the Diagnostic Paradigm of Pharyngitis’ in Young People
Robert Centor’s blog — “Medrants”
News-related links:
PPI article in Archives of Internal Medicine
FDA’s “Bad Ad” Program website
Annual doses of vitamin D lead to increased falls
Cord-blood pH article from BMJ
The post Podcast 87: After this week’s news, we reprise an interview from last December on pharyngitis in adolescents and young adults. first appeared on Clinical Conversations.

Why wouldn’t you want your hospital to lower its rate of early readmissions for heart failure by 15%? We talk with Dr. Adrian Hernandez about his examination of Medicare data from over 200 hospitals, how the hospitals vary widely in the rates at which their patients are followed up within a week of discharge for heart failure, and what that means for readmission rates. Hint: hospitals with more efficient follow-up have lower readmission rates. Listen in to our conversation.
Interview-related link:
Physician’s First Watch summary of Hernandez’s JAMA article
News-related links:
ACIP guidelines on MMRV vaccine
Herpes zoster vaccine underuse
Breast-cancer screening’s numbers for women just under 40
The post Podcast 86: Prompt follow-up after discharge for heart failure reduces early-readmission rates. first appeared on Clinical Conversations.

A surprise finding: homocysteine is supposed to be a factor in vascular inflammation, but lowering hyperhomocysteinemia in patients with diabetic nephropathy actually accelerated the decline of  their GFRs. What gives?
We have a conversation with Dr. J. David Spence, whose results were just published in JAMA.
Interview-related link:
JAMA paper on the effect of B vitamins on diabetic nephropathy
News-related links:
Clopidogrel suffers possible class-effect interference from PPIs
BMJ paper on hyperemesis gravidarum across generations
High-test flu vaccine guidance from ACIP
Brain games and the lack of data supporting their effectiveness
The post Podcast 85: B vitamins lower homocysteine levels, so why don’t they retard the progression of diabetic nephropathy? first appeared on Clinical Conversations.

I’d forgotten that it’s only been a year since 2009 H1N1 (remember when we called it “swine flu”?) struck, but then I saw Richard Wenzel’s op-ed essay in the New York Times. Dr. Wenzel kindly agreed to a conversation, and that’s our offering this week.
Interview-related links:
Wenzel’s op-ed piece in the New York Times
CDC’s estimates of flu-attributable illness
News-related links:
PTU gets a boxed warning
False-positives in screening for lung cancer
Hospitalizations for MI have declined
If you’d like to leave a comment, we’d love to have it. Give voice to more expressive messages at 1-617-440-4374.
The post Podcast 84: One year later, what have we learned from 2009 H1N1? A conversation with Richard Wenzel. first appeared on Clinical Conversations.

This week’s conversation introduces you to CardioExchange, a joint effort by Journal Watch and the New England Journal of Medicine to create an online community of clinicians interested in cardiovascular diseases.
Two of CardioExchange’s editors, Dr. Richard Lange and Dr. L. David Hillis, interview Dr. William Boden of the COURAGE study, and Dr. Gregg Stone, an interventionalist. The exchange of views is interesting.
Interview-related links:
The COURAGE study as it appeared in NEJM
The COURAGE “Nuclear Substudy” as it appeared in Circulation
Signing up for CardioExchange
News-related links:
White House orders change to hospital visitation policies
AHRQ’s report on the state of U.S. healthcare
Flu vaccines’ non-effect on vitamin-K antagonists
Driving with dementia
The post Podcast 83: An interview by CardioExchange’s editors on the COURAGE study first appeared on Clinical Conversations.

Repetitive tasks, like making sure to wash your hands after seeing each patient, may seem like drudgery, but they save patients’ lives.
This week we talk with Prof. Elizabeth Robb and Sir Brian Jarman about their success at chopping hospital mortality rates with simple checklists. Sir Brian has offered to monitor your hospital’s stats for free. So give a listen.
Comments to 1-617-440-4374 or to jelia@jwatch.org.
Interview-related links:
BMJ article
Links to the checklists used
Physician’s First Watch summary
Prof. Robb’s You-Tube video
Dr Foster Intelligence unit at Imperial College, London
News-related links:
Fruit-and-veggie intake
Chlamydia screening
Generic losartan (Cozaar)
Childhood cancer’s aftereffects
Back-surgery conflicts
The post Podcast 82: Checklists save lives — lots of lives. Becoming a clinical automaton. first appeared on Clinical Conversations.