Clinical Conversations

Your host is struggling with an overload of pollen and its attendant insults to his immune system. Or maybe it’s the dreaded swine flu. In any event, Dr. Anne Schuchat gave an interesting interview on childhood immunization levels in those halcyon pre-porcine-obsessed days of September 2008, and I’m repeating it for you this week.
This week’s links:
Institute of Medicine Calls for Steps to Limit Conflicts of Interest Among Physicians
Guidelines Recommend Against Valproate and Other Antiepileptics in Pregnancy
Flu Notes: CDC Offers Info for Patients, NYC Cluster Details – and a Name Change
Resources mentioned in the interview with Dr. Schuchat:
http://www.cdc.gov/vaccines/
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5735a1.htm
The post Podcast 41: A repeat of an interview with Dr. Anne Schuchat of the CDC on childhood immunization levels. first appeared on Clinical Conversations.

The Annals of Internal Medicine published an intriguing essay online last week about tight glycemic control in type 2 diabetes. Its authors argue that we’ve got it all wrong: imposing tight controls is only subjecting patients to stresses — related to the complexities and costs of treatment — that make control less likely to succeed. In addition, the supposed benefits of that control haven’t been confirmed by the available evidence. They advocate a backing-off of the current stern limits, which might make visits to clinicians feel less like a visit to the principal’s office. Listen in on a conversation with Dr. Victor Montori, one of the essay’s coauthors.
As always, you are invited to weigh in with your own thoughts. Leave us a piece of your mind at 1-617-440-4374.
This week’s links:
A Skeptical Look at Tight Glycemic Control
Resources mentioned by Dr. Montori in the interview
Additional Swine Flu Cases Found, CDC Says
FDA Allows OTC ‘Morning-After Pill’ for 17-Year-Olds
The post Podcast 40: Tight control in type 2 diabetes — time to loosen up? A conversation with Mayo’s Victor Montori. first appeared on Clinical Conversations.

Neurologists have talked about these effects for a while, but now they’ve got evidence showing that valproate lowers IQ at age 3 by almost 10 points. Since only half the antiepileptics are used in epilepsy, the results will affect everyone caring for women of reproductive age. Kimford Meador of Emory University is here to talk with us about it.
Let me have your reactions at 1-617-440-4370. I do like hearing from listeners, if only to guide me to better content.
This week’s news and interview links:
Valproate Use During Pregnancy Associated with Impaired Cognitive Function in Offspring
Dementia Risk Increased with Earlier Episodes of Hypoglycemia
Fewer Than Half of Young, Sexually Active Women Screened for Chlamydia
Post-CAD Depression Linked to Higher Heart Failure Risk
The post Podcast 39: A conversation with Kimford Meador about a new paper assessing the later cognitive effects of fetal exposure to antiepileptic drugs. first appeared on Clinical Conversations.

There are lots of people with poorly controlled asthma who are on PPIs, but don’t need to be. That’s the clear implication of research just published in the New England Journal of Medicine. We’ll talk with a member of the writing committee, Dr. Robert A. Wise.
If you like what you hear, call 1-617-440-4374, and if you don’t, the number’s the same — call anyway.
Here are the principal links for this week’s podcast:
PPIs Don’t Improve Asthma Control
Exercise Training Brings ‘Modest Results’ in Heart Failure
Many Healthy Older Adults Not Being Screened for Colorectal Cancer
ACC/AHA Release Consensus Document on Pulmonary Hypertension
The post Podcast 38: A conversation about using PPIs in poorly controlled asthma — rather, not using them — with Robert A. Wise of Johns Hopkins. first appeared on Clinical Conversations.

This week we talk with Don Griesdale about his meta-analysis on glucose control during intensive care. The evidence is complex, but we hope the presentation is straightforward and useful.
You’ll let us know if it isn’t, right? Just call us at 1-617-440-4374 and leave a message.
This week’s links:
Medicare Rehospitalization Data Highlight Importance of Postdischarge Care
Poor Communication in Hospital Readmissions
News from the American College of Cardiology meeting
Meta-Analysis of Tight Glucose Control in the ICU Calls Guidelines into Question
Intensive Glucose Control May Raise ICU Mortality
The post Podcast 37: A conversation with Vancouver General Hospital and the University of British Columbia’s Donald Griesdale about a meta-analysis on tight glucose control in the ICU. first appeared on Clinical Conversations.

We’ve got an interview with the first author of JAMA‘s final installment in its series on end-of-life care. The last paper focuses on the (necessary) self-care of clinicians who care for the dying. It’s an interesting discussion.
Please call 1-617-440-4374 if you have any comments. I’ll toss them into the mix.
This week’s links:
Intensive Glucose Control May Raise ICU Mortality
Meta-Analysis of Tight Glucose Control in the ICU Calls Guidelines into Question
Joint statement from ADA and AACE
ACCF/AHA Guidelines on Diagnosing and Treating Heart Failure
Stopping Smoking in Early Pregnancy Can Reverse Its Adverse Effects
Center for Practitioner Renewal
Self-test for measuring burnout and compassion fatigue
Center for Mindfulness in Medicine
The post Podcast 36: Michael K. Kearney is our guest. He talks about the self-care of clinicians engaged in end-of-life care. first appeared on Clinical Conversations.

Clinical Conversations, the podcast formerly known as Admitting Diagnosis, offers this week a reprise interview from last summer: Mary Tinetti talks about preventing falls in the elderly. Call 1-617-440-4374 to leave a suggestion. Let’s hear from you.
Links:
Prostate Cancer Screening Controversy Not Dead Yet
Diabetics and Patients over 65 Show Bigger Survival Benefit from CABG than PCI
USPSTF Updates Recommendations on Aspirin for CVD Prophylaxis
Dr. Tinetti interview
http://content.nejm.org/cgi/content/short/359/3/252
http://www.fallprevention.org/
http://nihseniorhealth.gov/
The post Podcast 35: Clinical Conversations reprises an interview with Mary Tinetti about falls in the elderly. first appeared on Clinical Conversations.

BMJ‘s paper on the possible association of migraine during pregnancy and stroke (and other vascular problems) is the focus of this week’s interview. We speak with first-author Dr. Cheryl Bushnell.
And then there’s the week’s news, plus a message from a listener!
It could have been you, if only you’d called 1-617-440-4374 and made a comment. Maybe you could get yourself to a phone and give it a shot this week?
Relevant links:
Errors in Administering ICU Parenteral Drugs Detailed
BP-Lowering Therapy of Substantial Benefit to Patients with Diabetes and Afib
Risk Factors plus Breast Density: ‘Best Approach’ to Estimating Breast Cancer Risk
Migraines in Pregnancy Associated with Increased Stroke and Vascular Risks
The post Podcast 34: An interview with Cheryl Bushnell of Wake Forest about her paper in BMJ concerning migraines during pregnancy and the possibility of their relation to strokes and other vascular problems. first appeared on Clinical Conversations.

This week’s podcast includes an interview from September 2008 with Stephen Hetz, co-editor of “War Surgery in Afghanistan and Iraq,” published last summer by the Surgeon General.
We’re going to change our name to “Clinical Conversations.” which, come to think of it, makes more sense than “Admitting Diagnosis,” but doesn’t have the mystery and the possibilities. We heard that the old name smacked too much of the classroom, etc.
So, let me know how you feel about the series so far. Call 1 617 440 4374 and leave me a message. Thanks!
Links:
Vitamin K Not Associated with Fewer Bleeding Events in Patients Taking Warfarin
Using PPIs with Clopidogrel Associated with Adverse Outcomes After ACS
Transdermal Patches Dangerous During MRI
Ordering “War Surgery” through the Government Printing Office
The post Podcast 33: We repeat, after the principal news of the week, an interview with Stephen Hetz, co-editor of “War Surgery in Afghanistan and Iraq” first appeared on Clinical Conversations.

We’ve run into a scheduling problem with the person we wanted to talk with. We’ll try again next week, because his views are intriguing and I’m guessing you’d rather have intriguing than ho-hum.
However, so that you won’t have wasted your time downloading the podcast, I’ve reprised an interview from last June, when few of you were listening. It deals with the problem of patients’ false sense of optimism about their life expectancy. Intriguing for sure.
Let me know what you think. Call 1 617 440 4374 and leave a message.
NEWS LINKS:
FDA Calls for Boxed Warning on Gastrointestinal Drug
‘Framingham Score’ Proposed for Atrial Fibrillation Risk
Four Different Diets – Four Similar Results
Moderate Alcohol Consumption Linked to Higher Cancer Risk in Women
INTERVIEW LINKS
Seattle Heart Failure Model
JAMA article
Journal Watch Cardiology coverage
Physician’s First Watch coverage
The post Podcast 32: Reprise of a June 2008 interview with Larry Allen from Duke, in which he talks about patients’ estimates of their life expectancy, compared with what disease models predict. first appeared on Clinical Conversations.