Clinical Conversations

Latest Episodes:

Podcast 91: What risks do NSAIDs hold for healthy people? They’re not trivial. Jun 11, 2010

Show notes

We talk with a Danish researcher, Emil Fosbøl, whose team estimated the risks of cardiovascular events caused by NSAID use in healthy people.

Your feedback is always welcomed and encouraged. Please drop me a note (jelia@jwatch.org) or call in a comment to 1-617-440-4374. I’m eager to act on your suggestions.

The interview-related link:

First Watch coverage of the NSAIDs article

News-related links:

Distracted driving

Valproic acid

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Podcast 90: Preventing type 2 diabetes with low-dose metformin and rosiglitazone seems possible, but clinical use has to await results of another stud... Jun 05, 2010

Show notes

Here’s a question wrapped in mist: How to prevent diabetes? Well, lifestyle changes for sure, but that’s hard. Drug therapy? Easier, but side effects can take away that advantage pretty quickly. Rosiglitazone offers some benefits, but its side effects — most notably increased risks for heart failure and death — have some people wondering whether it should stay on the market.

Canadian researchers took the approach of using low doses of rosiglitazone and metformin in combination. They compared that treatment with placebo in a small group of 200 patients with impaired glucose tolerance. Those receiving treatment had a much lower risk of developing type 2 diabetes over the ensuing 4 years of follow-up.

The results aren’t anywhere near ready for allowing clinical use, but they at least move us a bit through the fog. Our conversation this week is with Bernard Zinman, the principal author of the study, just published in the Lancet.

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Podcast 89: Glasses aren’t just for reading any more. Listen in to how they can help the elderly avoid falls. May 28, 2010

Show notes

Glasses — when did you start wearing them? They serve to help us do more than just read the newspaper, according to our conversational guest today. Prof. Stephen Lord of Sydney’s Prince of Wales Medical Research Institute and his coauthors write in BMJ this week about trying to encourage elderly wearers of multifocal lenses to use single-focus lenses when they walk outside, where the terrain is unfamiliar. The results are practical, and the discussion about them (Prof. Lord’s side of it, that is) enlightening.

Give us a call at 617-440-4374.

This week’s conversation-related link:

Physician’s First Watch coverage of the BMJ study

This week’s news-related links:

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Podcast 88: Weighing the benefits of endovascular versus open repair in abdominal aortic aneurysm. May 21, 2010

Show notes

The New England Journal of Medicine carries several studies comparing the long-term outcomes of endovascular versus open repair of abdominal aortic aneurysms. Tying all those studies together is an editorial by Dr. K. Craig Kent of the University of Wisconsin. We’ve got him as our guest this week. Have a listen.

Interview-related links:

News-related links

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Podcast 87: After this week’s news, we reprise an interview from last December on pharyngitis in adolescents and young adults. May 16, 2010

Show notes

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-related links:

News-related links:

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Podcast 86: Prompt follow-up after discharge for heart failure reduces early-readmission rates. May 07, 2010

Show notes

Why wouldn’t you want your hospital to lower its rate of early readmissions for heart failure by 15%? We talk with Dr. Adrian Hernandez about his examination of Medicare data from over 200 hospitals, how the hospitals vary widely in the rates at which their patients are followed up within a week of discharge for heart failure, and what that means for readmission rates. Hint: hospitals with more efficient follow-up have lower readmission rates. Listen in to our conversation.

Interview-related link:

Physician’s First Watch summary of Hernandez’s JAMA article

News-related links:

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Podcast 85: B vitamins lower homocysteine levels, so why don’t they retard the progression of diabetic nephropathy? May 02, 2010

Show notes

A surprise finding: homocysteine is supposed to be a factor in vascular inflammation, but lowering hyperhomocysteinemia in patients with diabetic nephropathy actually accelerated the decline of their GFRs. What gives?

We have a conversation with Dr. J. David Spence, whose results were just published in JAMA.

Interview-related link:

JAMA paper on the effect of B vitamins on diabetic nephropathy

News-related links:

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Podcast 84: One year later, what have we learned from 2009 H1N1? A conversation with Richard Wenzel. Apr 23, 2010

Show notes

I’d forgotten that it’s only been a year since 2009 H1N1 (remember when we called it “swine flu”?) struck, but then I saw Richard Wenzel’s op-ed essay in the New York Times. Dr. Wenzel kindly agreed to a conversation, and that’s our offering this week.

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If you’d like to leave a comment, we’d love to have it. Give voice to more expressive messages at 1-617-440-4374.

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Podcast 83: An interview by CardioExchange’s editors on the COURAGE study Apr 16, 2010

Show notes

This week’s conversation introduces you to CardioExchange, a joint effort by Journal Watch and the New England Journal of Medicine to create an online community of clinicians interested in cardiovascular diseases.

Two of CardioExchange’s editors, Dr. Richard Lange and Dr. L. David Hillis, interview Dr. William Boden of the COURAGE study, and Dr. Gregg Stone, an interventionalist. The exchange of views is interesting.

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Podcast 82: Checklists save lives — lots of lives. Becoming a clinical automaton. Apr 09, 2010

Show notes

Repetitive tasks, like making sure to wash your hands after seeing each patient, may seem like drudgery, but they save patients’ lives.

This week we talk with Prof. Elizabeth Robb and Sir Brian Jarman about their success at chopping hospital mortality rates with simple checklists. Sir Brian has offered to monitor your hospital’s stats for free. So give a listen.

Comments to 1-617-440-4374 or to jelia@jwatch.org.

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