Clinical Conversations

It’s simple: pregnant women (for un-simple reasons) are at greater risk for flu complications. It’s true even among hitherto apparently healthy patients. We’ve got a conversation with a CDC researcher who’s just published a paper in Lancet that urges prompt treatment, even in the face of pending lab results, with antivirals. Contact us at 1-617-440-4374.
This week’s links:
ACIP Recommends Five Groups as Priority Targets for H1N1 Vaccination
In Pregnancy, Treat Suspected H1N1 Promptly Without Awaiting Test Results
CDC “Full-Out” Recommends Seasonal Flu Vaccination for Children Over 6 Months
Expensive Tests to Evaluate Syncope Don’t Yield as Much as Simple Postural BP
ACOG Revises Labor Induction Guidelines
The post Podcast 51: In pregnant women with suspected H1N1, treat promptly! A conversation with Denise Jamieson of the CDC. first appeared on Clinical Conversations.

This week the FDA approved a form of fentanyl that can be administered through the buccal mucosa — but its label carries boxed warnings. And two weeks ago, the opioid propoxyphene got boxed warnings on its Darvon and Darvocet formulations. The FDA is trying to regulate the opioids more closely, reminding prescribers and users of the dangers they pose. In February, after another FDA announcement on opioid control, we interviewed Dr. Roger Chou of Oregon Health Sciences University on this topic.
Since it’s summer and the news is relatively scant, I’m reprising the interview and skipping the news summary.
Enough said!
This week’s links:
Darvon, Darvocet to Get Stronger Warnings on Fatal Overdose Risk
FDA Approves Fentanyl Buccal Soluble Film
Older links:
FDA to Tighten Opioid Restrictions
Guidelines on Opioids in Noncancer Pain Issued
The post Podcast 50: A re-podcast of an interview from February regarding the FDA’s plans for tightening regulations on opioid use. first appeared on Clinical Conversations.

We talk with Drs. Michael Mauer, Ronald Klein, and Bernard Zinman about their paper in the July 2 New England Journal of Medicine reporting on the RASS study (Renin-Angiotensin System Study). They found that blockade of the renin-angiotensin system was not effective in the primary prevention of diabetic nephropathy in Type 1 diabetes.
This week’s news links:
Darvon, Darvocet to Get Stronger Warnings on Fatal Overdose Risk
Famotidine Associated with Fewer GI Complications from Low-Dose Aspirin
Dronedarone Approved for Maintenance Therapy in Atrial Fibrillation and Atrial Flutter
The week’s interview links:
Renal and Retinal Effects of Enalapril and Losartan in Type 1 Diabetes
The post Podcast 49: Three RASS Study researchers discuss their findings on the lack of benefit of renin-angiotensin blockade in the primary prevention of diabetic nephropathy in Type 1 diabetes. first appeared on Clinical Conversations.

Scanning patients on bisphosphonates within the first 3 years of therapy is just wasted effort, and may even be misleading clinically. That’s what researchers conclude after reanalysis of FIT trial data on some 6500 women taking either alendronate or placebo. Prof. Les Irwig of the University of Sydney talks about his team’s findings and what they mean for clinicians used to doing densitometric studies to reassure patients about the progress of their therapy.
This week’s news links:
Diabetic Retinopathy, But Not Nephropathy, Benefits from Renin-Angiotensin Blockade
FDA Panel Votes to Ban Vicodin, Percocet
Value of CRP and Other Cardiovascular-Risk Biomarkers Questioned
Insulin Glargine Associated with Cancer Risk; ADA Calls Findings “Conflicting and Confusing”
This week’s Interview links:
Bone-Density Monitoring After Starting Bisphosphonates ‘Cannot Be Justified’
BMJ article
The post Podcast 48: A conversation with Les Irwig, which your bone scanner won’t like to hear. first appeared on Clinical Conversations.

Who knew that discussing QALYs could be so enjoyable? Dr. Elena Losina guides the interviewer through the thicket of cost-effectiveness and points to resources that keep track of the cost-effectiveness of most procedures. This is all done in the context of discussing her paper in Archives of Internal Medicine on total knee arthroplasty.
This week’s links:
Offer High School Students HIV Testing, CDC Reiterates
Fibrinolysis for STEMI Should Be Followed by Transfer and PCI
Bone-Density Monitoring After Starting Bisphosphonates ‘Cannot Be Justified’
Providers Often Fail to Inform Patients of Abnormal Test Results
Interview links:
Total Knee Replacement Found Cost-Effective Across Risk Categories
Peter Neumann’s registry of cost-effectiveness studies
World Health Organization site on cost-effectiveness
The post Podcast 47: Total knee arthroplasty’s cost-effectiveness — a conversation with Elena Losina first appeared on Clinical Conversations.

You’d think that a widely-ordered test would play a part in management and outcome, but two clotting mutations seem exceptions to that rule. Although often requested, the FDA-approved tests for Factor V Leiden and G20210A mutations don’t seem to figure greatly in case management of venous thromboembolism, at least according to the published literature. Dr. Jodi Segal and her team published a meta-analysis in JAMA this week, and she’s here to discuss the results.
This week’s links:
News–
CDC Counsels Infection-Control Vigilance to Prevent H1N1 in Health Workers
Zicam Nasal Cold Remedies Linked to Loss of Sense of Smell
Stents Not Associated with Improved Function in Renal Artery Stenosis
Leukotriene Modifiers for Asthma Associated with Neuropsychiatric Adverse Events
Interview links–
Does Testing for Clotting Mutations Improve Outcomes in VTE?
Agency for Healthcare Research and Quality (AHRQ)
The post Podcast 46: Does Genetic Testing for Clotting Mutations Matter? An interview with Jodi Segal of Johns Hopkins first appeared on Clinical Conversations.

Compression stockings, widely used to prevent DVT in patients after stroke, don’t work, according to new research published in Lancet. We’ve got the principal investigator, Martin Dennis of the University of Edinburgh, to talk with about this.
For your part, if you have someone you’d enjoy hearing talk about a bit of research or anything else bordering on the medical, let me know at 1-617-440-4374 or drop me a note at jelia@nejm.org.
This week’s links:
Pressure Stockings ‘Should Not Be Used’ to Prevent DVT After Stroke, Lancet Commentators Say
Weighing the Benefits and Risks of Aspirin for Primary Prevention of Vascular Disease
Radiofrequency Ablation Eliminates Metaplasia in Dysplastic Barrett Esophagus
Tolvaptan Approved for Use in Hyponatremia
The post Podcast 45: Prof. Martin Dennis discusses new findings discouraging the use of compression stockings after stroke first appeared on Clinical Conversations.

This week we talk with Harlan Krumholz about his paper in BMJ. His team finds that the door-to-balloon-time recommendation of 90 minutes is too long and that many more lives could be saved by shortening that time. Listen to his thoughts on this.
And I’d like to listen to your thoughts, which you may send along to jelia@nejm.org or voice at 1-617-440-4374.
This week’s links:
Early and Delayed Interventions Effective in Non-ST-Segment-Elevation ACS
Costs of Reducing Residents’ Workloads Could Exceed $1 Billion Annually
Flomax Associated with Complications After Ophthalmologic Surgery
Hospitals Should Aim for ‘As Soon As Possible’ Standard for Door-to-Balloon Time
The post Podcast 44: Harlan Krumholz on new door-to-balloon-time findings. first appeared on Clinical Conversations.

Northwestern’s Martha Gulati has just published a paper in Archives of Internal Medicine about the hazards of treating symptomatic women with normal angiograms as if they had a benign prognosis.
We’ll talk with her after a look at the news, and a reminder that you can really help Clinical Conversations with your feedback. The place to call with suggestions is 1-617-440-4374.
This week’s links:
Low-Back-Pain Interventional Guidelines Issued by American Pain Society
Geriatrics Society Changes Its Pain Management Guidelines
Clinical Prediction Tool Identifies Older Adults at Risk for Dementia
H1N1 Notes: Some Cases Without Fever; Postexposure Prophylaxis in Pregnancy
Interview link:
Elevated Risk for Adverse Outcomes in Women with CAD Symptoms and Normal Arteries
The post Podcast 43: An interview with Martha Gulati on her research into the cardiovascular risks faced by symptomatic women who have normal angiograms. first appeared on Clinical Conversations.

We talk about writing with Danielle Ofri, editor of the Bellevue Literary Review, author of “Singular Intimacies: Becoming a Doctor at Bellevue” and “Incidental Findings: Lessons from My Patients in the Art of Medicine,” and an attending physician at Bellevue.
I figured you could do with less information about influenza. If you’ve got a reaction, call us at 1-617-440-4374 and share it.
This week’s links:
CDC news briefing
Drug-Eluting Stents Have Similar Safety Profile to Bare-Metal Stents
Singular Intimacies — Amazon link
The post Podcast 42: An interview with Danielle Ofri — author, editor, clinician. first appeared on Clinical Conversations.