Clinical Conversations

We talk with Susan Mitchell, a Harvard researcher who set out to characterize the final clinical stages of advanced dementia. There are some surprises — namely, the benefit of clear communications with patients and their families (which, come to think of it, shouldn’t come as much of a surprise at all).
Talk with us at 1-617-440-4374 or write to jelia@nejm.org.
This week’s links:
Interview:
Advanced Dementia’s Course
News summaries:
Prophylactic Acetaminophen Reduces Immunogenicity of Childhood Vaccines
Nursing Home Residents See Marked Declines in Functional Status After Starting Dialysis
Minimally Invasive vs. Open Radical Prostatectomy
The post Podcast 61: A conversation about end-stage dementia. first appeared on Clinical Conversations.

It’s been treated as fact for a long time, but now there are data to prove it: weight loss in type 2 diabetes does ameliorate obstructive sleep apnea. Gary Foster of Temple University has an ongoing study of some 250 patients, and he’s just presented data on the first year of an anticipated 4-year follow-up. Listen in.
The gift deadline for our survey has been extended. The analysts want more data (don’t they always?), and so if you take the survey you’ll get a $5 gift certificate from Amazon. See the notice just above (or below) this text on the website for information. I don’t imagine they will extend the deadline much past the end of October, so please unload all your opinions upon us soonest.
If you’d rather do that informally and directly, you can always dial 1-617-440-4374 or contact me at jelia@nejm.org.
This week’s links:
Interview — Beneficial Effect of Weight Loss on Obstructive Sleep Apnea in Patients with Diabetes
News — H1N1 Update: CDC Releases 2009 H1N1 Vaccine Schedules
A Third of Patients with Chronic Back Pain Recover Within a Year
FDA Approves Intrauterine Device for Heavy Menstrual Bleeding
The post Podcast 60: Weight loss in type 2 diabetes benefits obstructive sleep apnea — a conversation with Prof. Gary Foster first appeared on Clinical Conversations.

Early in the 2009 H1N1 pandemic, it was thought that bacterial coinfection was rare, but now that’s been shown to be untrue. Dr. Dianna Blau, one of the principal contributors to a study of coinfections in 77 fatal cases of 2009 H1N, is our guest.
This week’s interview links:
H1N1 Update: Bacterial Coinfection in H1N1-Related Deaths
CDC guidance on use of pneumococcal vaccine in H1N1 pandemic
IDSA/ATS guidelines
This week’s news links:
Benefits of Treating Mild Gestational Diabetes
Maternal Smoking During Pregnancy Linked to Psychotic Symptoms in Children Years Later
Beneficial Effect of Weight Loss on Obstructive Sleep Apnea in Patients with Diabetes
The post Podcast 59: A conversation about bacterial coinfection in 2009 H1N1 flu deaths with Dianna Blau of the CDC first appeared on Clinical Conversations.

Pregnant women are at greater risk for flu complications. This week, we repeat a conversation with a CDC researcher who’d just published a paper in Lancet urging prompt treatment with antivirals, even in the face of pending lab results. Contact us at 1-617-440-4374. This week’s links:
In Pregnancy, Treat Suspected H1N1 Promptly Without Awaiting Test Results
Maternal Use of Sertaline, Citalopram Linked to Septal Heart Defects in Offspring
HIV Vaccine Shows Unexpected, if Limited, Success
Prostate-Specific Antigen Doesn’t Measure Up as a Screening Test
The post Podcast 58: A repeat of the July 31 interview with the CDC’s Denise Jamieson on treating pregnant women who have suspected 2009 H1N1. first appeared on Clinical Conversations.

When treated according to 2007 IDSA/ATS guidelines, community-acquired pneumonia is a less dangerous disease. You need to administer only 10 guideline-compliant treatments to elderly people, according to one estimate, in order to save a life. A good deal, no? We have the authors of two papers on the benefits of compliance as our guests this week. Their studies were published in the September 14 edition of Archives of Internal Medicine.
(A reminder to take the survey, please, if you haven’t already.)
This week’s interview links:
Community-Acquired Pneumonia: Guideline-Compliant Treatment Is Better
IDSA/ATS guidelines
This week’s news links:
Haemophilus Influenzae B Vaccine Recommendations
FDA Calls for Boxed Warning on Promethazine Hydrochloride Injection
The post Podcast 57: Treating community-acquired pneumonia according to the guidelines first appeared on Clinical Conversations.

We’ve seen research into this area before — 18 months ago, in fact. (We interviewed Joseph Ross back then in Podcast #2.) This time we interview Joseph Wislar, a survey-research specialist at JAMA, and Annette Flanagin, its managing deputy editor. They’ve just presented the abstracted results of a survey on ghost and honorary authorship that encompasses hundreds of articles from the principal medical journals.
If you would like to comment, give us a call and leave a message at 1-617-440-4374 or drop me a note at jelia@nejm.org.
This week’s links:
Barack Obama speech transcript
H1N1 Update: Early Results on Vaccine Indicate One Dose May Be Sufficient for Most Groups
FDA Advisers: HPV Vaccine Should Be Approved for Use in Boys, Young Men
New York Times story on “ghostwriting” in the principal medical journals
Link to last year’s interview with Joseph Ross
Physician’s First Watch coverage
The post Podcast 56: A conversation with two JAMA staffers on their research into “ghost” authorship and “honorary” authorship in the principal medical journals. first appeared on Clinical Conversations.

French researchers find that in non-ST-elevation acute coronary syndrome, delaying intervention until the next day does not affect the occurrence of death, MI, or the need for urgent revascularization by the one-month mark. We caught up with the study’s first author in Paris.
If you want access to earlier podcasts, you’ve come to the right place if you’re reading this at http://podcasts.jwatch.org. If you’d like to leave a note of delight or dismay, 1-617-440-4374 is the place to do so — or via email to me at jelia@nejm.org.
This week’s news and interview links:
Immediate vs. Delayed Intervention in Non-ST-Segment Elevation ACS
2009 H1N1 Update: Childhood Deaths; Two-Dose Vaccine Likely; N95 Respirators
Nonsurgical Treatment for Dupuytren Contracture with Collagenase
Dabigatran at Least as Effective as Warfarin in Patients with Afib
Ticagrelor Superior to Clopidogrel in Patients with Acute Coronary Syndromes
The post Podcast 55: A conversation with Prof. Gilles Montalescot about his JAMA paper on immediate versus delayed intervention in non-ST-segment elevation acute coronary syndrome first appeared on Clinical Conversations.

Well, the headline says it all. UCSF’s Aaron Caughey has just published a meta-analysis in Annals of Internal Medicine that shatters the dogma of elective induction’s being associated with cesarean delivery. I hope you’ll enjoy the conversation.
There won’t be a Clinical Conversation next week — I’m taking a week off — but the chit-chat returns in two weeks.
Older conversations are all archived here at podcasts.jwatch.org, and you can leave me a note at 1-617-440-4374 or at jelia@nejm.org.
This week’s links:
Supervised Heroin Treatment Outperforms Methadone in Refractory Users
FDA Approves Hiberix as Haemophilus Vaccine Booster Dose
HPV Vaccine About as Safe as Other Vaccines, Researchers Report
Chinese Herb Appears Better Than Standard Treatment for Rheumatoid Arthritis
The Interview’s story link:
Elective Labor Induction Associated with Lower Cesarean Delivery Rates
The post Podcast 54: A conversation with Aaron Caughey, whose analysis of the literature shows that elective induction of labor does not, contrary to dogma, increase the risk of cesarean delivery. first appeared on Clinical Conversations.

Dr. Miquel Ferrer of the University of Barcelona took some time away from his holiday to talk with us about an article he’s just published in Lancet. His research shows that in a subgroup of patients with chronic respiratory diseases (mostly COPD) who are undergoing extubation but who remain in hypercapnia, noninvasive ventilation support is the way to go.
This week’s links:
Aspirin Use After Colorectal Cancer Diagnosis Linked to Lower Mortality Risk
H1N1 Update: CDC Issues Guidance for School Districts for Upcoming Academic Year
Using Noninvasive Ventilation after Extubation Associated with Better Outcomes in Some Patients with Chronic Respiratory Disease
The post Podcast 53: Patients extubated with hypercapnia can be managed better with noninvasive ventilation, a new study shows. first appeared on Clinical Conversations.

We talk with two authors of a JAMA study that indicates that such screening doesn’t accomplish the ultimate goal: protecting the patient from further abuse. Our guests have some advice.
This week’s news links:
Vertebroplasty No Better Than Sham Procedure in Osteoporotic Fractures
Researchers Advise Labor Induction for Women with Mild Hypertensive Disease Late in Pregnancy
TNF-Blockers to Carry New Cancer Warnings
Interview links:
JAMA article
Physician’s First Watch summary
BMJ review article mentioned in the interview
The post Podcast 52: Screening for intimate-partner violence doesn’t seem productive or very protective. What’s a concerned clinician to do? first appeared on Clinical Conversations.