Clinical Conversations

I tried arranging an interview across a 13-hour time difference, with no luck. We revisit, instead, an October conversation about the late clinical course of dementia.
First a look at the news.
Comments to jelia@jwatch.org or to 1-617-440-4374.
Interview link:
Advanced Dementia’s Course
News links:
Massachusetts elects a U.S. Senator
Screening and treating children for overweight
Abnormal lipid profiles found in many U.S. adolescents
Quitting smoking after early-stage cancer diagnosis lengthens survival
The post Podcast 71: We revisit, after a look at current clinical news, a conversation on the late clinical course of dementia. first appeared on Clinical Conversations.

This is the podcast for January 15, 2010.
We have an interview on the impact of the USPSTF guidelines with two clinicians who study the best ways to communicate clearly with patients. I think you’ll like it.
You can reach me at jelia@jwatch.org or by calling 617-440-4374. If you like this podcast, there are many others in the archives, and they’re all free. I hope you find them useful.
News links:
Adult immunization schedule in MMWR
Ticagrelor versus clopidogrel
Platelet-rich plasma injections
Lack of evidence supporting rapid response teams
Inerview linki:
JAMA essays on USPSTF recommendation
The post Podcast 70: Considering the USPSTF breast-screening guidelines with your patients first appeared on Clinical Conversations.

I’ve been on vacation, and I hope that you’ve managed to sneak some time away as well.
In December, JAMA published an article associating increased survival after breast cancer with eating even modest amounts of soy food regularly. The work was done using a cohort in Shanghai, and the study’s first author agreed to an interview.
If you have comments (and there seems to have been more over the holidays, for some reason) please feel free to chime in. I’ll be better about evaluating them promptly for appropriateness.
You can also leave voice mail at 1-617-440-4374 and email me at jelia@jwatch.org.
Here are the week’s links:
Interview-related–
JAMA abstract
News-related–
Atypical antipsychotics
Presurgical prep
High-test flu shot for elders
Contaminated cocaine and agranulocytosis
The post Podcast 69: Eating soy foods and survival after breast cancer 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:
Commentary Urges ‘Expanding the Diagnostic Paradigm of Pharyngitis’ in Young People
Robert Centor’s blog — “Medrants”
News stories:
Chronic Pain Linked to Greater Risk for Falls in the Elderly
Even Very Low Levels of Cardiac Troponin T Linked to Heart Failure, Cardiovascular Death
Length of ICU Stay Closely Linked to Infection Rate, International Survey Shows
Norpramin Label Updated to Warn of Use in Patients with Family Histories of Sudden Death, Cardiac Dysrhythmias
Postoperative VTE Risk in Women Remains Substantially Elevated for 12 Weeks
The post Podcast 68: Change your approach to pharyngitis in adolescents and young adults. first appeared on Clinical Conversations.

This week’s Archives of Internal Medicine investigates what happens when you analyze the outcome of all those pulmonary angiographic CTs ordered in the emergency department to rule out pulmonary embolism.
We talk things over with Dr. Shannon Carson and Dr. William Hall, two of the paper’s principal authors.
It’s Thanksgiving Week here in the U.S., and so there won’t be a news section in this edition. I’ll catch you up next week on what’s happened.
I hope your holiday is pleasant, if you get one, and your workload reasonable, if you don’t.
Interview link:
CT Testing for Pulmonary Embolism Is More Likely to Yield Burdensome ‘Incidental Findings’
The post Podcast 67: Unexpected “incidental” findings on pulmonary CT angiography present problems of pursuit and follow-up. first appeared on Clinical Conversations.

One of the more intriguing pieces of research presented at the American Heart Association this week (and simultaneously released online in the New England Journal of Medicine) shows that extended-release niacin outperforms ezetimibe in high-risk patients. We talk with Dr. Allen J. Taylor, the study’s first author.
Contact us at 1-617-440-4374 or write jelia@jwatch.org.
This edition’s links:
Interview Link:
Extended-Release Niacin Outperforms Ezetimibe in Lowering Cardiovascular Risk
News Links:
USPSTF Recommends Against Routine Mammography for Women in Their 40s
ACOG Releases New Cervical Screening Guidelines into Politically Charged Environment
FDA Approves New Treatment for Shingles-Related Pain
The post Podcast 66: Niacin versus ezetimibe in the face of high cardiovascular risk — a conversation with the ARBITER 6-HALTS trialist Allen Taylor first appeared on Clinical Conversations.

Investigators have suspected that there isn’t much advantage to renovascular angioplasty and stenting in atherosclerosis, but their studies haven’t had the statistical power to prove that point. A new bit of research in this week’s New England Journal of Medicine may have hit the mark. We’ve got an interview with two of the principals of the ASTRAL study (that’s their acronym for Angioplasty and Stenting for Renal Artery Lesions). Dr. Philip Kalra, the nephrology lead, and Dr. Jonathan Moss, the radiology lead, kindly agreed to the conversation, which I think you’ll find of interest.
Reach us with your comments and suggestions at jelia@jwatch.org, or call 1-617-440-4374.
This edition’s links:
Interview link–
No Clinical Benefits of Revascularization in Atherosclerotic Renal Arteries
News links–
H1N1 Update: Estimates of Flu’s Toll; Seasonal Vaccine Not Effective Against 2009 H1N1
Prone Position for Acute Respiratory Distress Syndrome Doesn’t Boost Survival
The post Podcast 65: A conversation about the utility of renovascular angioplasty in the face of atherosclerosis first appeared on Clinical Conversations.

Avoiding use of the heart-lung machine during coronary artery bypass grafting was supposed to lower neurocognitive problems and other complications after the procedure. A large randomized trial finds otherwise. We’ve got a conversation with one of the investigators, Frederick Grover.
To contact us, call 1-617-440-4374. You can write to me at jelia@jwatch.org.
This week’s links:
News links:
Primary Care Visit Length Increasing
H1N1 Update: CDC Releases ‘Quick Facts’ for Providers on Antiviral Drug Use
Aspirin for Primary Prevention ‘Should Not Be Routinely Initiated’
Interview links:
Coronary Artery Bypass Grafting: On Pump or Off Pump?
The post Podcast 64: A conversation regarding on-pump versus off-pump CABG with Frederick Grover. first appeared on Clinical Conversations.

There are consequences of even short-term use of some drugs. Take the second-generation antipsychotics. A 3-month course can cause weight gain of almost 20 pounds in young people, according to a JAMA study. We interview Dr. Christoph Correll about the implications.
To reach Clinical Conversations, you can call 1-617-440-4374 or email me at jelia@jwatch.org.
This weeks news and interview links:
News:
Diabetes Prevention Interventions Have Long-Lasting Effects
Antibiotic Prophylaxis Lowers Risk for UTIs in Predisposed Kids
(Some of) You Are Feeling Very Sleepy…
Interview:
Atypical Antipsychotics Associated with Weight Gain and Other Adverse Metabolic Effects in Kids
The post Podcast 63: A conversation about the adverse cardiometabolic effects of second-generation antipsychotic drugs in young patients with Christoph Correll first appeared on Clinical Conversations.

The FDA seems set to announce a decision about vaccinating women past age 25 for HPV. A paper in the Annals of Internal Medicine this week indicates that such a strategy wouldn’t be cost-effective.
Don’t be put off by “cost-effectiveness” or by the fact that we actually discuss “QALY”s. It’s all good. We’ve got Harvard School of Public Health’s Jane Kim to guide your interviewer through the QALY thicket, and she’s a great guide.
Contact us at 1-617-440-4374 or write to jelia@nejm.org.
This week’s links:
NEWS:
Aldosterone Antagonists Underused in Heart Failure
ACP Issues Guidelines on Hormonal Testing and Pharmacologic Management of Erectile Dysfunction
Ketorolac for Injection Recalled
Intensified BP Control Benefits Kids with Chronic Kidney Disease
INTERVIEW:
Adding HPV Vaccination to U.S. Cervical Screening Isn’t Cost-Effective After Age 30
The post Podcast 62: A conversation with Jane Kim about cost-effectiveness of vaccinating women with HPV vaccine after age 30. first appeared on Clinical Conversations.