Clinical Conversations

Starting a patient on warfarin is nobody’s idea of a good time, but pharmacogenetic research can help. A study in this week’s NEJM shows the advantage of using genetic information (plus some clinical data) over the old “start at 5 mg a day and pray for success” approach. We talk with Julie Johnson of the University of Florida about the study.
We’ve shortened our news presentation, on the theory that you can’t assimilate too many details through your ears, so we give you the aural cartoon version and provide links for details at the website: podcasts.jwatch.org.
If you want to contact us with your suggestions, please call 1 617 440 4374.
Links for this edition:
Healthy Behaviors Associated with Halving of Stroke Risk
Patients’ Genetic Profiles Help Determine Appropriate Warfarin Dosing
Bypass Grafting Proves Superior to PCI in Severe Coronary Artery Disease
Less Than 1% of U.S. Adolescents Need Drug Treatment for Dyslipidemia
The post Podcast 31: Making your clinical life easier — with genetics. Dr. Julie Johnson talks about using a patient’s genetic profile to help set their initial warfarin dose more accurately. You got a problem with that? first appeared on Clinical Conversations.

The FDA announced an early-March meeting with manufacturers of opioids to discuss how problems with the drugs’ overuse and abuse might be addressed. We talk with an author of guidelines just published (and freely available) in the Journal of Pain that coincidentally address some of these concerns.
Then, of course, there’s the usual news roundup, and we finish off with a 200th birthday salute to Charles Darwin (no thanks to unevolved Americans).
To join the merriment or complain about the cake, call 617-440-4374 and leave a message.
To trace the evolution of “Admitting Diagnosis,” which we admit is horribly misnamed, go to podcasts.jwatch.org.
Links for this edition:
Severe Ankle Sprains Respond Best to Immobilization in the Short Term
Multivitamin Use Not Associated with Lower Risk for Cancer or CVD in Women
FDA to Tighten Opioid Restrictions
Guidelines on Opioids in Noncancer Pain Issued
The post Podcast 30: Dr. Roger Chou of Oregon Health Sciences University talks about recent guidelines for opioid use in non-cancer pain and reflects on the FDA’s recent announcement of tighter regulation on use of the drugs. first appeared on Clinical Conversations.

Millions of people are discharged each year from U.S. hospitals. How many find themselves on the street with no clear idea of what they’ve been treated for, what drugs they should take and when, and how to get in touch with a clinician if something goes wrong?
No surprise, many are readmitted — either directly or through the emergency room.
Brian Jack and colleagues embarked on Project RED to re-engineer hospital discharge procedures (which, by the way, are not currently standardized).
There’s news and links too. Plus, your chance to talk back by calling 617-440-4374.
Links for this issue:
A couple of position papers on type 2 diabetes
64-slice CT angiography is the equivalent of 600 chest x-rays
Routine lower-back imaging is a waste of time
Ending Hospitalizations Carefully Avoids Rehospitalizations
Project RED website
Project RED toolkit (example of an after-hospital care plan and the training manual)
The post Podcast 29: Dr. Brian Jack of Boston University sees RED (Re-Engineered Discharge) as a way to lower hospital readmissions. first appeared on Clinical Conversations.

There are a dozen new-generation antidpressants on the market now. How to sort them out? On what basis? We talk with two authors of an intriguing meta-analysis released online in Lancet this week.
And we offer the usual roundup of news and, speaking of roundups, a working name while we come up with something better than the rather staid “Admitting Diagnosis.”
Calls, comments, and complaints to 1-617-440-4374.
Links for this podcast:
First Watch coverage of the Lancet paper on antidepressants
Lancet‘s abstract
The meta-analysis design
Haemophilus influenzae type B cases from MMWR
Alcohol abuse review in Lancet
Kidney donation article in NEJM
The post Podcast 28: A discussion with Dr. Andrea Cipriani and Prof. John Geddes about their ranking of 12 antidepressants first appeared on Clinical Conversations.

The 6-year period 2001 – 2006 saw an increase from 12 to 28 in the percentage of S. aureus infections among head-and-neck infections in childen that were methicillin resistant. This 16-point jump is concerning, and we talk with an author of the paper documenting that increase.
Also, we’d like to know: should we be calling this thing here “Admitting Diagnosis” — or something else?
If you would like to comment or offer an idea for a future podcast, please call 617-440-4374.
Links for this podcast:
Steroids and wheezing children
Journal Watch Pediatrics & Adolescent Medicine summary
NEJM prednisolone abstract
NEJM fluticasone abstract
Journal Watch General Medicine coverage of benefits of antidepressants in fibromyalgia
JAMA fibromyalgia abstract from Pubmed
Physician’s First Watch coverage of MRSA study
Archives of Otolaryngology abstract
The post Podcast 27: Dr. Steven E. Sobol talks with us about his paper on trends in pediatric head-and-neck infections from S. aureus — an increasing percentage of which are MRSA. first appeared on Clinical Conversations.

NEJM published a paper this week detailing the risks of sudden cardiac death in those taking both typical and atypical antipsychotic drugs. We talk with the paper’s first author Dr. Wayne A. Ray of Vanderbilt University School of Medicine.
If you would like to comment or offer an idea for a future podcast, please call 617-440-4374.
Links for this podcast:
Simple Checklist Reduces Postoperative Complications
NEJM article on checklists
Surgical safety checklist
Influenza A Treatment Recommendations Emphasized
CDC recommendations
Vicks VapoRub May Cause Respiratory Distress in Infants, Animal Study Suggests
Chest article
Measuring Fractional Flow Reserve During PCI Improves 1-Year Outcomes
Journal Watch Cardiology summary
NEJM article
Antipsychotics Increase Risks for Sudden Cardiac Death
NEJM article
Poor Sleep Patterns May Increase Risk for the Common Cold
Archives of Internal Medicine article
The post Podcast 26: Dr. Wayne A. Ray talks about the dangers of sudden cardiac death from antipsychotic drugs first appeared on Clinical Conversations.

Hospitals don’t have many outbreaks of viral hepatitis, owing to a strong culture of infection control. However, health care is moving increasingly to nonhospital settings like outpatient clinics and longterm care facilities where infection control is less established.
We talk with Nicola Thompson and Joseph Perz of the CDC about their paper detailing the causes of over 30 outbreaks in nonhospital healthcare settings over the past decade.
If you would like to comment or offer an idea for a future podcast, please call 617-440-4374.
Links for this podcast:
FDA: Not Necessary to Stop Taking Vytorin or Other Lipid-Lowering Drugs
Elective Cesareans Before 39 Weeks Associated with Adverse Neonatal Outcomes
Parkinson Disease: Neurostimulation vs. Medical Therapy
2009 Pediatric Immunization Schedules Approved
CDC’s Guidelines on Preventing Transmission of Infectious Agents in Healthcare Settings 2007
CDC’s Estimates of Healthcare Infections
Journal Watch General Medicine top stories of 2008
Journal Watch Psychiatry top stories of 2008
AIDS Clinical Care top HIV/AIDS stories of 2008
The post Podcast 25: Drs. Nicola Thompson and Joseph Perz talk about their Annals of Internal Medicine paper on the epidemiology of viral hepatitis outbreaks in nonhospital healthcare settings first appeared on Clinical Conversations.

We talk with Douglas B. White about his paper in the Annals of Internal Medicine, entitled “Hope, Truth, and Preparing for Death: Perspectives of surrogate decision makers,” and we offer a roundup of the week’s news.
A reminder, before we start, that Admitting Diagnosis is taking the next two weeks off. We hope you’ll find some time to enjoy the holdays as well. We’ll be back in the first full week of January.
Meanwhile, if you’d like to comment on these interviews or offer an idea for a future podcast, please call 617-440-4374. We’re all ears.
Links for this podcast–
FDA Calls for Suicidality Warning on All Antiepileptic Drugs
Intensive Glucose Control Fails to Reduce Cardiovascular Events
Even Small HER2-Positive Tumors May Require Aggressive Treatment
Patients’ Surrogates Want to Discuss Prognosis, Even at the Risk of Extinguishing Hope
Pediatric and Adolescent Medicine Top Stories of 2008
Cardiology Top Stories of 2008
Oncology and Hematology Top Stories of 2008
The post Podcast 24: An interview with Dr. Douglas B. White on the perspectives of surrogate decision makers regarding discussions about their loved one’s prognosis first appeared on Clinical Conversations.

A week with just a few notable stories, one of which is about using supplements like vitamin C or selenium to prevent prostate cancer. We interview J. Michael Gaziano about two studies in JAMA on that topic.
Have a listen, and if you want to react to any of this, call 1-617-440-4374.
Links for this issue:
FDA advisory panel vote to ban two asthma drugs
Journal Watch General Medicine backgrounder on long-acting beta agonists
Hemoglobin A1c and the risk of kidney disease in diabetics
Archives of Internal Medicine abstract
First Watch coverage
Using dietary supplements to prevent prostate cancer
JAMA Physicians’ health study II (free)
JAMA SELECT trial (free)
JAMA editorial (free)
First Watch coverage
The post Podcast 23: An interview with J. Michael Gaziano concerning two JAMA studies on the uselessness of dietary supplements in preventing prostate cancer first appeared on Clinical Conversations.

This week, in addition to the usual news roundup, we talk with Dr. Aaron Kesselheim about his JAMA paper on the equivalence between proprietary and generic cardiovascular drugs. The data and the editorials are often at odds on this question.
Have a listen, and if you want to react to any of this, call 1-617-440-4374.
Links for this issue:
–Vitamin D
American Academy of Dermatology guidelines
Physician’s First Watch coverage
–Controlling hypertension
NEJM abstract
Journal Watch Cardiology coverage
Physician’s First Watch coverage
— Work hours for residents
Institute of Medicine recommendations
Physician’s First Watch coverage
–Depression in stable coronary disease
Pubmed abstract
Journal Watch Cardiology coverage
–Generic versus proprietary cardiovascular drugs
JAMA abstract
Physician’s First Watch coverage
The post Podcast 22: Interview with Aaron Kesselheim about his meta-analysis of the efficacy of proprietary versus generic cardiovascular drugs. first appeared on Clinical Conversations.