Clinical Conversations

Latest Episodes:

Podcast 51: In pregnant women with suspected H1N1, treat promptly! A conversation with Denise Jamieson of the CDC. Jul 31, 2009

Show notes

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:

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Podcast 50: A re-podcast of an interview from February regarding the FDA’s plans for tightening regulations on opioid use. Jul 19, 2009

Show notes

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:

Older links:

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Podcast 49: Three RASS Study researchers discuss their findings on the lack of benefit of renin-angiotensin blockade in the primary prevention of diab... Jul 10, 2009

Show notes

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:

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.

Podcast 48: A conversation with Les Irwig, which your bone scanner won’t like to hear. Jul 02, 2009

Show notes

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:

This week’s Interview links:

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Podcast 47: Total knee arthroplasty’s cost-effectiveness — a conversation with Elena Losina Jun 29, 2009

Show notes

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:

Interview links:

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Podcast 46: Does Genetic Testing for Clotting Mutations Matter? An interview with Jodi Segal of Johns Hopkins Jun 19, 2009

Show notes

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–

Interview links–

The post Podcast 46: Does Genetic Testing for Clotting Mutations Matter? An interview with Jodi Segal of Johns Hopkins first appeared on Clinical Conversations.

Podcast 45: Prof. Martin Dennis discusses new findings discouraging the use of compression stockings after stroke May 29, 2009

Show notes

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:

The post Podcast 45: Prof. Martin Dennis discusses new findings discouraging the use of compression stockings after stroke first appeared on Clinical Conversations.

Podcast 44: Harlan Krumholz on new door-to-balloon-time findings. May 23, 2009

Show notes

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:

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Podcast 43: An interview with Martha Gulati on her research into the cardiovascular risks faced by symptomatic women who have normal angiograms. May 17, 2009

Show notes

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:

Interview link:

Elevated Risk for Adverse Outcomes in Women with CAD Symptoms and Normal Arteries

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Podcast 42: An interview with Danielle Ofri — author, editor, clinician. May 08, 2009

Show notes

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:

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