Author in the Room™ Interviews

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Episodios

JAMA: 2013-02-27, Vol. 309, No. 8, Author in the Room™ Audio Interview

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Interview with Justin B. Dimick, MD, MPH, author of Bariatric Surgery Complications Before vs After Implementation of a National Policy Restricting Coverage to Centers of Excellence. Summary Points:

  • Bariatric surgery has become much safer over the past decade, likely due to better techniques, training in advanced laparoscopy, and tighter credentialing of surgeons.
  • The CMS policy of restricting care to Centers of Excellence has not improved outcomes, but may have had the unintended consequence of reducing access to care.
  • Referring patients to Centers of Excellence for bariatric surgery will not lower the risk of adverse outcomes and decisions should be based on other factors, such as a surgeon’s training, experience, and outcomes.

JAMA: 2013-03-20, Vol. 309, No. 11, Author in the Room™ Audio Interview

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Interview with Phillip M. Boiselle, MD, author of Computed Tomography Screening for Lung Cancer. Summary Points:

  • CT screening reduced lung cancer-specific mortality by 20% in a large randomized trial of a high-risk population.
  • CT is associated with a high false-positive rate, with associated risks and costs associated with follow-up CT and the potential for more invasive diagnostic procedures.
  • Physicians should consider discussing CT screening with their high-risk patients who meet criteria in published guidelines.

JAMA: 2013-02-20, Vol. 309, No. 7, Author in the Room™ Audio Interview

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Interview with Daniel J. Buysse, MD, author of Insomnia. Summary Points:

  • Insomnia is a frequent comorbid condition that increases costs and worsens outcomes.
  • Insomnia is a chronic condition for which there are effective and widely available acute treatments (medications) and effective but hard-to-find long-term treatments (behavioral).
  • Need to consider other health professionals such as nurses, physician assistants, and behavioral health managers (smoking, obesity, diet, exercise, sleep/insomnia).

JAMA: 2013-01-16, Vol. 309, No. 3, Author in the Room™ Audio Interview

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Interview with Daniel S. Chertow, MD, MPH, author of Bacterial Coinfection in Influenza: A Grand Rounds Review. Summary Points:

  • Influenza vaccine remains the best available tool for prevention of severe influenza illness commonly associated with bacterial coinfection.
  • Early empirical antiviral and antibiotic therapy should be administered to all individuals with suspected coinfection.
  • Vancomycin or linezolid should be administered in addition to standard therapy for community-acquired pneumonia to patients with severe or necrotizing pneumonia and/or evidence of sepsis.

JAMA: 2012-11-28, Vol. 308, No. 20, Author in the Room™ Audio Interview

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Interview with Robert H. Shmerling, MD, author of Management of Gout: A 57-Year-Old Man With a History of Podagra, Hyperuricemia, and Mild Renal Insufficiency. Summary Points:

  • Risk factor modification: alcohol intake, excess weight, diet, medications (although overall impact on gout uncertain).
  • Acute gout can be treated with NSAIDs, colchicine, corticosteroids, or a combination of these.
  • Urate-lowering treatment to prevent attacks and tophi is appropriate for certain patients with gout. (In my opinion, allopurinol is the best initial choice to suppress uric acid.)
  • Urate-lowering treatment should suppress uric acid to 6.0 mg/dL or less; allopurinol should start no higher than 100 mg/d but titrate up based on uric acid levels; it is common to require more than 300 mg/d.
  • Concomitant prophylaxis (eg, low-dose colchicine, 0.6 mg/d) is appropriate for 6-9 months or longer.

Take home message:
We now have new therapies and guidelines for the treatment of gout. Appropriate use of therapeutics for gout—both new and old—will provide optimal outcomes for the increasing number of patients with this common disease.

JAMA: 2012-11-21, Vol. 308, No. 19, Author in the Room™ Audio Interview

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Interview with Laura N. Gitlin, PhD, author of Nonpharmacologic Management of Behavioral Symptoms in Dementia. Summary Points:

  • Attending to behavioral symptoms is part of comprehensive dementia care and requires ongoing long-term management.
  • Use 6 steps to systematically prevent, assess, manage, eliminate or reduce behavioral symptoms.
  • Use combination of nonpharmacologic approaches.
  • Keep trying—nonpharmacologic approaches are relatively adverse free.
  • Create a health professional team to offset time needed for provision of nonpharmacologic approaches.

JAMA: 2012-10-17, Vol. 308, No. 15, Author in the Room™ Audio Interview

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Interview with Nancy A. Rigotti, MD, author of Strategies to Help a Smoker Who Is Struggling to Quit. Summary Points:

  • Treat tobacco use like the chronic disease that it is. Don't give up if your first few efforts do not succeed.
  • Medications and brief counseling are each effective, but combining the two is most effective.
  • Link your smokers to free national resources like the tobacco quit lines (1-800-QUIT-NOW). New noncombustible tobacco products are coming.

JAMA: 2012-10-03, Vol. 308, No. 13, Author in the Room™ Audio Interview

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Interview with Robert W. Haley, MD, author of Controlling Urban Epidemics of West Nile Virus Infection. Summary Points:

  • Epidemics of West Nile neuroinvasive disease have become a serious medical and public health challenge that will be with us for the foreseeable future.
  • Ultra low-volume aerial spraying of urban areas, guided by surveillance of mosquito trap positivity and human cases, is necessary and cost-effective to prevent chronic neurologic disability and death.
  • Complete, accurate, and timely diagnosis of West Nile viral disease in an epidemic is vitally important to spare patients needless prolonged antimicrobial therapy and build support for public health control measures.

JAMA: 2012-08-22, Vol. 308, No. 8, Author in the Room™ Audio Interview

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Interview with Philip Greenland, MD, author of Comparison of Novel Risk Markers for Improvement in Cardiovascular Risk Assessment in Intermediate-Risk Individuals. Summary Points:

  • In comparison with other competing biomarkers and risk factors, coronary artery calcium (CAC) is currently the most potent risk marker of subclinical coronary heart disease (CHD).
  • CAC was shown in several observational studies to improve the prediction of risk beyond traditional risk factors.
  • In this JAMA paper, CAC outperformed various competing risk assessment markers among asymptomatic people at intermediate risk for CHD. Whether CAC should be used in routine clinical practice, however, is still a matter of personal opinion or further research.

Antiretroviral Treatment of Adult HIV Infection 2012 Recommendations of the International Antiviral Society-USA Panel

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Interview with Melanie A. Thompson, MD, and Paul A. Volberding, MD, authors of Antiretroviral Treatment of Adult HIV Infection 2012 Recommendations of the International Antiviral Society-USA Panel. Summary Points:

  • Antiretroviral treatment is recommended and should be offered to all persons with HIV, regardless of CD4 cell count.
  • Particular attention should be paid to the design of an antiretroviral regimen for persons with concurrent conditions, such as viral hepatitis, opportunistic infections, and other medical diseases, because of the potential for drug interactions.
  • Monitoring of entry into and retention in HIV care, adherence to antiretroviral therapy, and quality of care indicators are recommended and should be used to increase care engagement and quality.

JAMA: 2012-06-13, Vol. 307, No. 22, Author in the Room™ Audio Interview

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Interview with Peter B. Bach, MD, MAPP, author of Benefits and Harms of CT Screening for Lung Cancer: A Systematic Review; and George T. O’Connor, MD, MS, author of Lung Cancer Screening, Radiation, Risks, Benefits, and Uncertainty. Summary Points:

  • Three randomized trials examined computed tomography (CT) screening for lung cancer’s effect on lung cancer mortality—one showed a benefit, the other 2 did not but were smaller studies.
  • CT screening does not appear to reduce mortality from causes other than lung cancer.
  • There are still a lot of uncertainties regarding the risks and how to mitigate them.

JAMA: 2012-05-02, Vol. 307, No. 17, Author in the Room™ Audio Interview

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Interview with Mary A. Whooley, MD, author of Diagnosis and Treatment of Depression in Adults With Comorbid Medical Conditions: A 52-Year-Old Man With Depression. Summary Points:

  • Depression screening has no benefit unless it is combined with team-based management
  • Self-management strategies (behavioral activation and exercise) improve depression
  • "TEAMcare" can improve both depression and chronic medical conditions

    JAMA: 2012-04-11, Vol. 307, No. 14, Author in the Room™ Audio Interview

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    Interview with Rita F. Redberg, MD, author of Healthy Men Should Not Take Statins; and Michael J. Blaha, MD, MPH, author of Statin Therapy for Healthy Men Identified as "Increased Risk". Dr Redberg's Summary Points: 1. Drugs given to asymptomatic persons should either help them to feel better or live longer. 2. Statins do not meet these criterion. 3. Lifestyle is cornerstone of primary prevention. Dr Blaha's Summary Points: 1. High-quality literature supports statins for reduction of first heart attack and stroke, in addition to a mild decrease in all-cause mortality over 3 to 5 years. 2. The key to efficient use of statins in primary prevention is risk stratification. 3. We must demand high-quality evidence for benefit and for harm in a potentially beneficial medication class such as statins. 4. Physicians should adhere to national guidelines to guide statin use in primary prevention.

    JAMA: 2012-03-21, Vol. 307, No. 11, Author in the Room™ Audio Interview

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    Interview with James T. Pacala, MD, MS, author of Hearing Deficits in the Older Patient: "I Didn't Notice Anything". Summary Points: 1. Age-related hearing loss is extremely common and underrecognized by most health care providers. 2. There are many effective methods of detection of hearing loss that are easy and efficient. 3. Although the main stay of treatment is amplification, there remain many challenges to effective hearing aid use.

    JAMA: 2012-02-01, Vol. 307, No. 5, Author in the Room™ Audio Interview

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    Interview with David S. Ludwig, MD, PhD, author of Weight Loss Strategies for Adolescents: A 14-Year-Old Struggling to Lose Weight. Summary Points: 1. Childhood obesity arises from a complex interplay of biology, behavior, and the environment.  Consequently, successful treatment requires targeting multiple determinants of body weight. 2. Family-based treatment offers the most immediate and effective approach for childhood obesity, with benefits for all family members. 3. Ultimately, the solution to the obesity epidemic will require a comprehensive public health strategy to make the social environment healthier for children and adults.

    JAMA: 2011-12-14, Vol. 306, No. 22, Author in the Room™ Audio Interview

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    Interview with Harold Sox, MD, author of New American Cancer Society Process for Creating Trustworthy Cancer Screening Guidelines. Summary Points: 1. Trustworthy guidelines require transparency about purpose, process, evidence, and rationale. 2. Trustworthy guidelines require a systematic review of the pertinent evidence. 3. Expertise in evaluating evidence and freedom from financial conflicts of interest are the main requirements for membership on a guidelines panel. If these are present, then clinical skills are important.

    JAMA: 2012-01-04, Vol. 307, No. 1, Author in the Room™ Audio Interview

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    Interview with George A. Bray, MD, author of Effect of Dietary Protein Content on Weight Gain, Energy Expenditure, and Body Composition During Overeating: A Randomized Controlled Trial. Summary Points: 1. Excess calories are stored as fat, independent of protein. 2. Protein increases metabolic rate and lean body mass. 3. Adherence to a diet is more important than the macronutrient composition of that diet.

    JAMA: 2011-10-12, Vol. 306, No. 14, Author in the Room™ Audio Interview

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    Interview with Daniel Leffler, MD, MS, author of Celiac Disease Diagnosis and Management: A 46-Year-Old Woman With Anemia. Summary points: 1. Celiac disease can present at any age with a wide variety of signs and symptoms and delay in diagnosis is common. 2. Testing for celiac disease with IgA tissue transglutaminase is accurate and cost-effective. 3. The only treatment for celiac disease is the gluten-free diet, but this is very burdensome and requires ongoing education and support.

    JAMA: 2011-10-05, Vol. 306, No. 13, Author in the Room™ Audio Interview

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    Interview with Steven C. Zweig, MD, MSPH, author of The Physician's Role in Patients' Nursing Home Care. Summary Points: 1. Prevalent, fragile population, cared for until the end of life. 2. Care must be interdisciplinary (Facility, staff, physicians; Residents, family members). 3. Understand and anticipate natural history of aging and decline in long-term care, including planning, assessment, continuing care, acute care, and end-of-life care.

    JAMA: 2011-08-09, Vol. 306, No. 10, Author in the Room™ Audio Interview

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    Interview with Michael Paasche-Orlow, MD, MA, MPH, author of Caring for Patients With Limited Health Literacy: A 76-Year-Old Man With Multiple Medical Problems. Summary Points: 1. Massively increase patient education. 2. Systematically reduce unneeded complexity and variability. 3. Universal precautions (not screening), flip the default, and confirm comprehension (T2G).

    JAMA: 2011-08-03, Vol. 306, No. 5, Author in the Room™ Audio Interview

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    Interview with Laura Mosqueda, MD, author of Elder Abuse and Self-neglect: "I Don't Care Anything About Going to the Doctor, to Be Honest..."

    JAMA: 2011-07-06, Vol. 306, No. 1, Author in the Room™ Audio Interview

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    Interview with Ross Zafonte, DO, author of Diagnosis and Management of Sports-Related Concussion: A 15-Year-Old Athlete With a Concussion. Summary Points: 1. Concussion does not require a loss of consciousness and is typically a transient and reversible neurologic dysfunction. 2. Those with sports-related concussion should not return to play the same day. 3. Initial treatment often begins with rest and subsequent gradual activation.

    JAMA: 2011-05-11, Vol. 305, No. 18, Author in the Room™ Audio Interview

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    Interview with Gordon D. Schiff, MD, author of Medical Error: A 60-Year-Old Man With Delayed Care for a Renal Mass. Summary Points: The goals of this Author in the Room teleconference are to: 1. Appreciate the frequency, faces, and challenges of test result follow-up management errors. 2. Understand selected reliability science concepts and the ways they apply to the problem of test result management. 3. Learn about some specific change ideas that can help to ensure more fail-safe test follow-up.

    JAMA: 2011-02-16, Vol. 305, No. 7, Author in the Room™ Audio Interview

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    Interview with Eric Widera, MD, author of Finances in the Older Patient With Cognitive Impairment: 'He Didn't Want Me to Take Over'. Summary Points: 1. Individuals with Alzheimer disease will have increasing difficulty with finances over time, and the very first signs of this difficulty will occur prior to the diagnosis of dementia, when they have only mild cognitive impairment. 2. Health care professionals, including physicians, should educate older adult patients and families about the need for advance financial planning and encourage the use of Durable Power of Attorney for Financial Matters. 3. Using objective information from performance-based financial tests can help decide whether, when, and in which financial areas families or caregivers need to assume proxy financial responsibility.

    JAMA: 2011-03-02, Vol. 305, No. 9, Author in the Room™ Audio Interview

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    Interview with Lydia A. Bazzano, MD, PhD, and Angela M. Thompson, authors of Antihypertensive Treatment and Secondary Prevention of Cardiovascular Disease Events Among Persons Without Hypertension: A Meta-analysis. Summary Points: 1. Cardiovascular disease (CVD) risk increases beginning at systolic blood pressure levels of 115 mm Hg and the use of antihypertensive medications among patients with a history of CVD or diabetes and without hypertension have been debated. 2. Among patients with clinical history of CVD but with blood pressure lower than 140/90 mm Hg, antihypertensive treatment was associated with decreased risk of stroke, congestive heart failure, composite CVD events, and all-cause mortality. 3. Additional randomized trial data are necessary to assess these outcomes in patients without CVD events.

    JAMA: 2011-02-09, Vol. 305, No. 6, Author in the Room™ Audio Interview

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    Interview with Monica Morrow, MD, author of Axillary Dissection vs No Axillary Dissection in Women With Invasive Breast Cancer and Sentinel Node Metastasis. Summary Points: 1. Axillary dissection is a major cause of morbidity after breast cancer surgery. 2. In women who have 3 or fewer sentinel nodes and are undergoing breast conserving surgery, removal of only the sentinel nodes produces local axillary control in 99% of cases. 3. Axillary dissection does not contribute to survival. 4. In women with T1 and T2 clinically node negative BRCA who are undergoing lumpectomy and whole breast radiation, removal of sentinel nodes only is an appropriate management strategy.

    JAMA: 2011-02-02, Vol. 305, No. 5, Author in the Room™ Audio Interview

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    Interview with Gabriela Schmajuk, MD, author of Receipt of Disease-Modifying Antirheumatic Drugs Among Patients With Rheumatoid Arthritis in Medicare Managed Care Plans. Summary Points: 1. One third of Medicare managed care patients diagnosed with rheumatoid arthritis are not receiving disease-modifying antirheumatic drugs. 2. There is variation in disease-modifying antirheumatic drug receipt based on "accidental factors": sociodemographics, geographic location, and health plan. 3. Because disease-modifying antirheumatic drug use is the main way to affect outcomes in rheumatoid arthritis, these patient groups and the physicians treating them are a reasonable target for quality improvement interventions.

    JAMA: 2011-01-12, Vol. 305, No. 2, Author in the Room™ Audio Interview

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    Interview with Steven J. Jacobsen, MD, PhD, author of Herpes Zoster Vaccine in Older Adults and the Risk of Subsequent Herpes Zoster Disease. Summary Points: 1. The findings suggest that the zoster vaccine is as effective in a community setting with its mixed population and routine clinical practices as was found in the controlled clinical trials. 2. To date, the uptake of the zoster vaccine has been modest due to a number of reasons, including weaknesses in the adult vaccine infrastructure, knowledge and beliefs of clinicians and patients, periodic supply shortfalls, as well as financial reasons. 3. Because zoster and its attendant neurologic complication of postherpetic neuralgia are common and serious among the elderly, it seems prudent to recommend zoster vaccine. The potential impact of vaccination on the burden of the disease in this population is significant.

    JAMA: 2010-12-21, Vol. 304, No. 21, Author in the Room™ Audio Interview

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    Interview with Julia Howell Hayes, MD, author of Active Surveillance Compared With Initial Treatment for Men With Low-Risk Prostate Cancer: A Decision Analysis. Summary Points: 1. Active surveillance is a reasonable approach to consider for carefully selected 65-year-old men with low-risk clinically localized prostate cancer, providing improved quality of life even if associated with an increased risk of prostate cancer–specific death. 2. The results depend on patient preferences. 3. It is crucial that individual patients make this decision in conjunction with their physicians.

    JAMA: 2010-10-20, Vol. 304, No. 15, Author in the Room™ Audio Interview

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    Interview with Julia Neily, RN, MS, MPH, author of Association Between Implementation of a Medical Team Training Program and Surgical Mortality. Summary Points: 1. Improved communication is associated with decreased surgical mortality. 2. Since there was a dose response relationship, this indicates that continuing follow up was related to better results. 3. Briefings and debriefings is more than a checklist, it is about the conversation.

    JAMA: 2010-10-13, Vol. 304, No. 14, Author in the Room™ Audio Interview

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    Interview with Michael A. Steinman, MD, author of Managing Medications in Clinically Complex Elders. Summary Points: 1. First, a systematic approach to approaching prescribing is essential. 2. Second, an essential first step is to know what the patient is actually taking right now, and to clarify what goals you are trying to achieve by prescribing drugs. 3. Third, it is critical to individualize care based on what benefits and harms a patient is actually experiencing from their drugs.

    JAMA: 2010-08-25, Vol. 304, No. 8, Author in the Room™ Audio Interview

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    Interview with Ralph Gonzales, MD, MSPH, author of Does This Coughing Adolescent or Adult Patient Have Pertussis? Summary Points: 1. When evaluating adolescents and adults with persistent cough illness, the presence of classic symptoms of pertussis (paroxysmal cough, whooping cough, post-tussive emesis) modestly increase the likelihood of pertussis, and their absence modestly decreases the likelihood of pertussis; but they are not strong enough to rule-in or rule-out disease. 2. Most patients in whom pertussis is suspected will not derive symptomatic benefit from antibiotic treatment because their illness duration is usually greater than 10 days. 3. Vigilant testing and treatment should be provided to adolescents and adults who have been exposed to a known case of pertussis, or have contact with individuals at high risk for serious complications of pertussis, ie, child care providers and teachers, health care workers, and patients who live or work with infants less than 6 months of age; unvaccinated children; or immunosuppressed individuals.

    JAMA: 2010-07-14, Vol. 304, No. 2, Author in the Room™ Audio Interview

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    Interview with Matthew K. Wynia, MD, MPH, author of The Role of Professionalism and Self-regulation in Detecting Impaired or Incompetent Physicians. Summary Points: At the conclusion of this activity, participants will be able to: 1. Describe the frequency with which physicians report encountering other physician who may be impaired or incompetent. 2. Explain the 3 basic options available to policy-makers for regulating and ensuring the quality of medical practitioners. 3. Name at least 3 newer mechanisms by which the profession of medicine is enhancing its ability to self-regulate and detect physicians who are not providing high quality care.

    JAMA: 2010-06-02, Vol. 303, No. 21, Author in the Room™ Audio Interview

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    Interview with Patricia S. Goode, MSN, MD, author of Incontinence in Older Women. Summary Points: 1. UI is very common in older women and should be in Review of System for ALL older women. 2. Initial behavioral therapy (pelvic floor muscle exercises, urge and stress strategies, caffeine avoidance) is easy to do and should be FIRST line treatment for older women with urge and stress urinary incontinence. 3. Modifiable Contributing Factors for urinary incontinence should be addressed before prescribing antimuscarinic medications and include: urinary tract infection, constipation, diabetes control, mobility impairment, sleep apnea, caffeine, timing of diuretics, over-sedation.

    JAMA: 2010-05-26, Vol. 303, No. 20, Author in the Room™ Audio Interview

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    Interview with Kenneth J. Mukamal, MD, MPH, MA, author of A 42-Year-Old Man Considering Whether to Drink Alcohol for His Health. Summary Points:1. Careful alcohol histories are needed for all patients, particularly to identify binge drinking, which is frequent among moderate and especially younger drinkers. 2. Even moderate alcohol consumption has important and plausible health effects based on short-term trials and observational studies, including lower risk of heart disease presumably via higher HDL-cholesterol and higher risk of breast cancer (presumably via higher levels of estrone and DHEA sulfates). 3. Given these points, even controlled alcohol consumption is unlikely to benefit younger drinkers, but is a reasonable point of discussion for middle-aged and older adults, especially as a launching point for education about problem drinking and the potential risks and benefits of including alcohol as part of a healthy diet in older age.

    JAMA: 2010-04-28, Vol. 303, No. 16, Author in the Room™ Audio Interview

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    Interview with David B. Carr, MD, author of The Older Adult Driver With Cognitive Impairment. Summary Points: 1. Know how to assess a cognitively impaired older driver in the office setting. 2. Know how and where to refer at-risk cognitively impaired older drivers. 3. Know how to counsel cognitively impaired older drivers in regards to driving retirement.

    JAMA: 2010-04-07, Vol. 303, No. 13, Author in the Room™ Audio Interview

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    Interview with Roger Chou, MD, author of Will This Patient Develop Persistent Disabling Low Back Pain? Summary Points: 1. A small proportion of patients with acute LBP go on to develop chronic LBP, these patients account for a very high proportion of costs, services, and suffering. 2. The most helpful items to predict persistent disabling low back pain are presence of maladaptive pain coping behaviors, nonorganic signs, functional impairment, general health status, and presence of psychiatric comorbidities. 3. Early identification of patients with these risk factors could help guide early use of psychological therapies and exercise therapy to reduce the likelihood that they will go on to develop chronic disabling low back pain.

    JAMA: 2010-01-20, Vol. 303, No. 3, Author in the Room™ Audio Interview

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    Interview with Mary E. Tinetti, MD, author of The Patient Who Falls. Summary Points: 1. Falls are common health events that cause discomfort and disability for older adults and stress for caregivers. Previous falls; strength, gait and balance impairments; and medications are the strongest risk factors for falling. 2. The most effective strategy for reducing the rate of falling in community-living older adults may be intervening on multiple risk factors including strengthening and balance exercises through physical therapy, medication reduction, environmental modifications to reduce fall hazards, cataract surgery. Vitamin D has strong evidence of benefit for preventing fractures among older men at risk and probably of preventing falls in all at risk older adults. 3. While challenges and barriers exist, fall prevention strategies can be incorporated into clinical practice.

    JAMA: 2009-12-16, Vol. 302, No. 23, Author in the Room™ Audio Interview

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    Interview with Frank Davidoff, MD, author of Heterogeneity Is Not Always Noise. Summary Points: 1. A clinical trial is a powerful tool for showing whether an intervention works, but the heterogeneity of trial participants means it may be a mistake to assume that the overall (or group) benefit of an intervention found in such a trial is the same for every participant. 2. The absolute benefit of an intervention is greater for trial participants-and for patients generally-whose baseline risk for a bad outcome is high than it is for those whose baseline risk is low. 3. A quality improvement program in any one organization is like an individual patient in the sense that it is highly complex, it is unstable (ie, changes over time), and its local circumstances are unique. It is thus hard-although not impossible-to judge whether a quality improvement program in any particular setting actually works and to know whether it would work elsewhere.

    JAMA: 2009-12-23, Vol. 302, No. 24, Author in the Room™ Audio Interview

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    Interview with David Reuben, MD, author of Medical Care for the Final Years of Life. Summary Points: 1. When caring for older patients, the conventional evidence-based approach is modified by 3 important caveats: prognosis, insufficient evidence, and patient goals and preferences. 2. Conceptually, the care of older persons can be divided into 3 time frames: short term, which focuses on remediating the current problems; mid-range, focusing on preventive and foreseeable problems; and long-range, which focus on eventual decline and living arrangements. 3. Individual clinicians need to structure their practices to efficiently and comprehensively accommodate the diverse needs of elderly patients.

    JAMA: 2009-11-25, Vol. 302, No. 20, Author in the Room™ Audio Interview

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    Interview with Hussein Hollands, MD, MSc, author of Acute-Onset Floaters and Flashes: Is This Patient at Risk for Retinal Detachment? Summary Points: 1. The most likely cause of acute onset monocular floaters or flashes is posterior vitreous detachment. If left untreated, vitreous detachment complicated by retinal tear can progress to vision-threatening retinal detachment. 2. A minimum approach to evaluating a patient with suspected posterior vitreous detachment should include a history of change in vision or curtain of darkness, measurement of visual acuity, and assessment of confrontational visual fields. 3. High-risk features for retinal tear in the setting of acute posterior vitreous detachment are subjective or objective visual acuity loss, monocular visual field loss (or curtain of darkness), and vitreous pigment or hemorrhage on slit-lamp examination. Patients with any of these clinical findings should be referred for same day ophthalmology assessment.

    JAMA: 2009-10-21, Vol. 302, No. 15, Author in the Room™ Audio Interview

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    Interview with Laura Esserman, MD, MBA, author of Rethinking Screening for Breast Cancer and Prostate Cancer. Summary Points: 1. The effectiveness of screening depends on the underlying biology of cancer. Routine mammographic screening works best for slow to moderate growth tumors, most common in women 50-74 and explains why the Preventive Services guidelines actually make sense. 2. There are ways that we can improve screening today. Trained mammographers find the most cancers and have the fewest false positives. Offering follow-up as an option for low risk mammographic lesions will decrease false positives. Screening the populations who benefit most will also avoid false positives and overdiagnosis in those who benefit less from screening. The prostate cancer risk calculator is a good tool to use to determine whether to do a biopsy. 3. We can and must do better. Mammography and PSA testing can detect very low risk cancers, and these cancers can be less aggressively treated. Tools are available to distinguish these low risk cancers. The most aggressive cancers often present between normal screens, so women with new masses, regardless of a recent normal mammogram should be evaluated. Men and women at high risk to develop breast and prostate cancer should consider prevention interventions. Future screening should be developed to reduce mortality from the highest risk cancers.

    JAMA: 2009-09-23/30, Vol. 302, No. 12, Author in the Room™ Audio Interview

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    Interview with Michael S. Krasner, MD, author of Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians. Summary Points: 1. Burnout is prevalent among physicians, and has untoward effects not only on the physicians themselves but also on the quality of the care they provide to their patients. 2. Mindful Communication training among a group of primary care physicians resulted in not only improvements in burnout and measures of well-being, but also improvements in markers of relationship-centered care to their patients. 3. Mindful Communication should be considered among a menu of continuing medical education opportunities available for physicians to enhance well-being, meaning, and interpersonal relationships in the practice of medicine.

    JAMA: 2009-08-19, Vol. 302, No. 7, Author in the Room™ Audio Interview

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    Interview with John Iskander, MD, author of Postlicensure Safety Surveillance for Quadrivalent Human Papillomavirus Recombinant Vaccine. Summary Points: 1. Since quadrivalent HPV vaccine was licensed in June 2006, more than 23 million doses have been administered nationally. 2. There were a total of 12,424 reports to the Vaccine Adverse Event Reporting System (VAERS) of adverse events following HPV vaccination through December 2008. The vast majority (94%) of adverse events reported to VAERS after receiving this vaccine have not been considered serious. The findings of this first published post-licensure safety review were generally not different from what is seen in safety reviews of other vaccines recommended for 9 to 26 year olds. 3. The most common events reported were syncope, local reactions at the site of immunization (pain and redness), dizziness, nausea, and headache.

    JAMA: 2009-08-12, Vol. 302, No. 6, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Thomas H. Gallagher, MD, author of A 62-Year-Old Woman With Skin Cancer Who Experienced Wrong-Site Surgery. Summary Points: 1. Errors and adverse events are common, and disclosure of these events to patients is recommended but often does not take place. 2. Physician fear of litigation inhibits disclosure, but so does physicians' lack of confidence in their communication skills and concern that disclosure might be harmful to the patient. 3. Important future developments in the field include linking disclosure with offers of compensation, and using performance improvement tools to enhance the disclosure process.

    JAMA: 2009-07-22/29, Vol. 302, No. 4, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with John P. Forman, MD, MSc, author of Diet and Lifestyle Risk Factors Associated With Incident Hypertension in Women. Summary Points: 1. At an individual level, combining healthy lifestyle factors may substantially reduce the risk of developing hypertension; according to the findings of the study, women who followed 6 healthy factors had nearly an 80% reduction in risk. 2. At a population level, a large fraction of all new cases of hypertension could hypothetically be prevented if all individuals in the population followed combinations of healthy lifestyle factors; according to the findings of the study, this fraction may is 78%. 3. Given that hypertension is a leading cause of preventable death in the population, and given that the majority of hypertension may be preventable through lifestyle modification, efforts should be intensified to improve lifestyle as a means of improving public health.

    JAMA: 2009-05-20, Vol. 301, No. 19, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Charles M. Morin, PhD, author of Cognitive-Behavior Therapy, Singly and Combined with Medication, for Persistent Insomnia. Summary Points: 1. Cognitive Behavioral Therapy (CBT) is an effective treatment for chronic insomnia and can help reduce medication treatment for this condition. 2. Clinicians can be successfully trained in CBT. 3. CBT works well alone for insomnia and while medication treatment may help early in the course of this condition, it has not advantages for long term use.

    JAMA: 2009-05-06, Vol. 301, No. 17, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Peter H. Hwang, MD, author of A 51-Year-Old Woman With Acute Onset of Facial Pressure, Rhinorrhea, and Tooth Pain. Summary Points: 1. There are now published consensus guidelines for the diagnosis and treatment of acute rhinosinusitis. 2. Acute viral rhinosinusitis and acute bacterial rhinosinusitis can be difficult to distinguish in the first 10 days of symptoms. 3. Radiologic imaging is often "positive" in both viral and bacterial etiologies of acute sinusitis and therefore cannot be used to distinguish the two. 4. Oral antibiotics when prescribed appropriately confer a higher rate of partial or complete resolution of acute sinusitis symptoms compared to placebo. However, it should be noted that the spontaneous rate of resolution of acute bacterial rhinosinusitis may be as high as 40-60%. 5. Adjunctive therapies such as topical and oral decongestants may offer symptomatic relief but have not been proven to shorten the duration of illness.

    JAMA: 2009-03-25, Vol. 301, No. 12, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Lisa A. Cooper, MD, author of A 41-Year-Old African American Man With Poorly Controlled Hypertension. Summary Points: 1. Cardiovascular disease accounts for 35% of the excess mortality in African Americans, in large part because of hypertension. 2. Racial disparities in physicians' clinical decision-making and in quality of care for cardiovascular disease have been documented extensively; studies also show racial differences in patient-physician communication, particularly when the patient and physician come from different racial backgrounds, and unconscious racial biases among physicians. 3. A categorical approach that lumps patients of particular cultural backgrounds into groups and outlines their characteristics values, customs and beliefs may lead to over-simplication and stereotyping. Instead, an understanding of broad cultural concepts and skills that emphasize a patient-centered approach are preferred. This approach takes into account the individual patients' explanatory model, illness agenda and behaviors, and social context, and attitudes and skills with regard to negotiating treatment. It also includes participatory behaviors such as asking open-ended questions, using reflective listening, and avoiding arguments in which one tries to change the patient's views. 4. Systematic reviews of interventions to improve patient adherence to treatments for hypertension show that simplifying dosing regimens is most effective; using motivational strategies such as home monitoring, small-group training, counseling by a nurse or other professional, and reminder calls for patients are somewhat effective; and patient education alone is not effective. Quality improvement strategies for hypertension management show team change interventions that include assignment of some responsibilities to a health professional other than the patient's physician (such as a nurse or pharmacist) are associated with the largest reductions in blood pressure. Improvement in patient-physician communication is linked to improved outcomes for mental health; more studies are needed that examine how patient-physician communication may improve hypertension control and other physiologic measures.

    JAMA: 2009-03-18, Vol. 301, No. 11, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Michael K. Kearney, MD, author of Self-care of Physicians Caring for Patients at the End of Life. Summary Points: 1. Burnout and compassion fatigue are fundamentally different phenomena. Understanding the difference is helpful for effective intervention. 2. Investments in self-awareness and self-care are sound business strategies that can be expected to reduce staff turnover and increase patient satisfaction. 3. Mindfulness meditation and reflective writing have both been shown to increase self-awareness and self-care. They are among a number of strategies that can be built into clinical practice to prevent burnout and compassion fatigue.

    JAMA: 2009-02-04, Vol. 301, No. 5, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Steven A. Schroeder, MD, author of A 51-Year-Old Woman With Bipolar Disorder Who Wants to Quit Smoking. Summary Points: 1. Smoking is extremely common among persons with mental illness and exerts a huge toll in terms of morbidity and mortality. 2. We are now in the midst of a culture change. Formerly smoking was an integral part of the mental health culture and smoking cessation was not deemed pertinent. Now it is evolving into an important component of mental health and wellness. 3. Most smokers who have mental illness would like to quit. And many are able to do so, using the standard smoking cessation techniques used for the general population. There is still much more to know, but we know enough to encourage persons with mental illness to stop smoking and to provide them the tools to do so.

    JAMA: 2009-01-14, Vol. 301, No. 2, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Mary M. McDermott, MD, author of Treadmill Exercise and Resistance Training in Patients With Peripheral Arterial Disease With and Without Intermittent Claudication. Summary Points: 1. Supervised treadmill exercise improves walking performance for patients with peripheral arterial disease (PAD), whether or not the patient has classic symptoms of intermittent claudication. 2. Supervised lower extremity strength training improves quality of life, stair climbing ability, and treadmill walking performance for PAD patients with and without intermittent claudication. 3. Supervised treadmill walking exercise improves brachial arterial flow mediated dilation in patients with PAD, suggesting a global cardiovascular health benefit.

    JAMA: 2008-12-17, Vol. 300, No. 23, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with David J.A. Jenkins, MD, PhD, author of Effect of a Low Glycemic Index or a High Cereal Fiber Diet on Type 2 Diabetes: A Randomized Trial. Summary Points: 1. Drugs such as the a–glucosidase inhibitor acarbose, which reduces the rate of digestion and absorption of carbohydrate and so flattens the post prandial glycemic response, have been shown to improve diabetes control, reduce the risk of developing hypertension, and lower the risk for cardiovascular disease. 2. Can a selection of more slowly digested carbohydrate foods achieve qualitatively similar benefits to drugs? Current data suggest that selection of diets containing low–glycemic intake foods have modest benefits in reducing glycated hemoglobin A1c even in patients with type 2 diabetes treated with 1 to 3 antihyperglycemic medications. 3. Foods with a low glycemic index include many traditional study foods such as dried peas, beans, lentils, intact-grain breads, pasta, oats, barley, parboiled rice, and temperate-climate fruits and berries. Low–glycemic index starchy foods are digested less readily in vitro. 4. Other effects include a tendency for higher high-density lipoprotein cholesterol levels, lower C-reactive protein values, and greater weight loss in the per-protocol completers, ie, those who completed the study with no change in medications.

    JAMA: 2008-11-12, Vol. 300, No. 18, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Brett D. Thombs, PhD, and Roy Ziegelstein, MD, authors of Depression Screening for Patients with Cardiovascular Disease. Summary Points: 1. Depression is a common and serious condition in patients with heart disease; therefore health care workers should inquire about symptoms of depression in their heart disease patients. 2. Our recent systematic review shows that there is not sufficient evidence at this time to call for routine screening for depression in patients with heart disease. 3. Additional research is needed to determine the optimal model(s) of care that will allow depression to be appropriately diagnosed and treated in patients with heart disease, particularly at times when these patients are being cared for primarily by heart disease experts rather than by experts in depression diagnosis and treatment.

    JAMA: 2008-10-15, Vol. 300, No. 15, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Rita Redberg, MD, MSc, author of Stress Testing to Document Ischemia Prior to Elective PCI. Summary Points: 1. A majority (55.5% ) of Medicare patients with stable coronary artery disease who underwent an elective percutaneous coronary intervention (PCI) did not have a recommended stress test performed to document ischemia. 2. The rate of stress testing before elective PCI shows significant geographic variation, from a low of 22% in Fresno, CA to a high of 71% in Rochester, MN. 3. Patient characteristics (female sex, age of 85 years or older, and having co-existing illnesses) and physician characteristics (physicians who performed a higher volume of PCI procedures) were associated with lower rates of stress testing.

    JAMA: 2008-09-17, Vol. 300, No. 11, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Ingrid E. Nygaard, MD, MS, author of Symptomatic Pelvic Floor Disorders in Women. Summary Points: 1. The three primary pelvic floor disorders include urinary and fecal incontinence, and pelvic organ prolapse. 2. In a national population-based sample, nearly one-quarter of U.S. women reported at least one symptomatic pelvic floor disorder: overall, 15.7 percent experienced moderate to severe urinary incontinence, 9.0 percent experienced fecal incontinence at least monthly and 2.9 percent experienced symptomatic pelvic organ prolapse (a bulge in the vagina they could see or feel). 3. Older women, overweight and obese women and multiparous women were more likely to report a pelvic floor disorder.

    JAMA: 2008-07-23, Vol. 300, No. 4, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with H. George Nurnberg, MD, author of Sildenafil Treatment of Women With Antidepressant-Associated Sexual Dysfunction: A Randomized Controlled Trial. Summary Points: 1. Emergent sexual dysfunction (SD) is a principal reason for a three-fold increased risk of non-adherence that leads to increased relapse, recurrence, and poor disease management outcomes. 2. Selective phosphodiesterase-type 5 inhibitors (PDE5Is), limited to studies in men, have demonstrated evidence based data to support broad based and clinically meaningful treatment efficacy. 3. In an intention-to-treat analysis, women treated with sildenafil showed significant improvement in adverse sexual effects compared with those taking placebo. 4. Evidence shows that selective phosphodiesterase type 5 inhibitors are effective in both sexes for patients who have been effectively treated for depression but need to continue on their medication to avoid relapse or recurrence.

    JAMA: 2008-06-25, Vol. 299, No. 24, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Beverly Beth Green, MD, MPH, author of Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: The e-BP Randomized Controlled Trial. Summary Points: 1. If blood pressure (BP) control could be improved, many deaths from cardiovascular and renal disease could be prevented. 2. The Chronic Care Model was used to design an intervention that empowered patients to be more involved in their own care using home BP monitoring, a patient shared electronic medical record, and Web-based pharmacist assistance. 3. The group of patients that received BP monitors and training to use an existing patient website (with encouragement to send their BP numbers to their physician) had a modest decrease in systolic blood pressure, but BP control did not significantly improve. The group that received BP monitors, web training, and web-based pharmacy assistance had greater decreases in BP and were almost two times as likely to have controlled BP.

    JAMA: 2008-06-18, Vol. 299, No. 23, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Sherita Hill Golden, MD, MHS, author of Examining a Bidirectional Association Between Depressive Symptoms and Diabetes. Summary Points: 1. People with symptoms of depression are more likely to engage in diabetes-producing health behaviors, including eating more, exercising less, and smoking more. As a consequence, they were more obese. 2. People with elevated symptoms of depression had a 42 percent increased risk of developing Type 2 diabetes over 3 years. This was partially explained by unhealthy behaviors. 3. People with treated Type 2 diabetes had a 52 percent increased risk of developing depressive symptoms over 3 years. This suggests that individuals with diabetes should be monitored for development of depression.

    JAMA: 2008-04-09, Vol. 299, No. 14, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Barbara V. Howard, PhD, author of Effect of Lower Targets for Blood Pressure and LDL Cholesterol on Atherosclerosis in Diabetes: The SANDS Randomized Trial. Summary Points: 1. Both standard and aggressive targets for blood pressure and LDL cholesterol in individuals with diabetes can be achieved and are safe. 2. Aggressive targets were associated with regression in IMT and greater decrease in LV mass, but long term data are needed to determine if they will result in improvement in clinical events. 3. Aggressive targets for blood pressure and LDL cholesterol may be considered on an individual basis.

    JAMA: 2008-05-14, Vol. 299, No. 18, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Wendie A. Berg, MD, PhD, author of Combined Screening With Ultrasound and Mammography vs Mammography Alone in Women at Elevated Risk of Breast Cancer. Summary Points: 1. Adding a single screening ultrasound examination to screening mammography in women at increased risk of breast cancer with at least heterogeneously dense breasts increases the cancer detection rate from 50% to 78%. 2. The risk of a biopsy for a benign lesion in our series was 1 in 40 for women undergoing mammography versus 1 in 10 for women undergoing mammography combined with ultrasound screening. 3. Using the standardized technique and interpretive criteria developed for this study, other radiologists and facilities with similar equipment and experience should expect similar results.

    JAMA: 2008-03-12, Vol. 299, No. 10, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Laura P. Svetky, MD, MHS, author of Comparison of Strategies for Sustaining Weight Loss: The Weight Loss Maintenance Randomized Controlled Trial. Summary Points: 1. Weight loss is feasible and long term weight loss is possible. 2. Ongoing personal contact and technology based interventions were effective but the overall benefits were small. 3. The role of clinicians is to reinforce the message that weight loss can prevent and treat multiple chronic conditions. Even small amounts of weight loss can lead to significant health benefits. 4. Our focus should be on long term healthy life style changes rather than dieting, which is by its very nature short term.

    JAMA: 2008-03-12, Vol. 299, No. 10, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Laura P. Svetky, MD, MHS, author of Comparison of Strategies for Sustaining Weight Loss: The Weight Loss Maintenance Randomized Controlled Trial. Summary Points: 1. Weight loss is feasible and long term weight loss is possible. 2. Ongoing personal contact and technology based interventions were effective but the overall benefits were small. 3. The role of clinicians is to reinforce the message that weight loss can prevent and treat multiple chronic conditions. Even small amounts of weight loss can lead to significant health benefits. 4. Our focus should be on long term healthy life style changes rather than dieting, which is by its very nature short term.

    JAMA: 2008-01-30, Vol. 299, No. 4, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Stephen M. Shortell, PhD, MBA, MPH, author of Improving Patient Safety by Taking Systems Seriously. Summary Points: 1. To make real progress in patient safety will require redesigning the underlying system of care such that healthcare professionals and institutions providing a continuum of services from prevention to hospice can address multiple conditions and episodes over time. A "culture of systems" must be established. 2. Competing priorities, professional autonomy, solo and small physician practices, disciplinary silos, miss-aligned financial incentives, and inadequate feedback about performance all undermine efforts to create safe healthcare systems. 3. A number of strategic, cultural, technical, and structural barriers need to be addressed to assure safer care. This includes the need for patient safety organizations to gather information across the continuum of care and provide both rapid feedback to practitioners and analyze trends over time.

    JAMA: 2008-01-30, Vol. 299, No. 4, Author in the Room™ Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Stephen M. Shortell, PhD, MBA, MPH, author of Improving Patient Safety by Taking Systems Seriously. Summary Points: 1. To make real progress in patient safety will require redesigning the underlying system of care such that healthcare professionals and institutions providing a continuum of services from prevention to hospice can address multiple conditions and episodes over time. A "culture of systems" must be established. 2. Competing priorities, professional autonomy, solo and small physician practices, disciplinary silos, miss-aligned financial incentives, and inadequate feedback about performance all undermine efforts to create safe healthcare systems. 3. A number of strategic, cultural, technical, and structural barriers need to be addressed to assure safer care. This includes the need for patient safety organizations to gather information across the continuum of care and provide both rapid feedback to practitioners and analyze trends over time.

    JAMA: 2008-01-02, Vol. 299, No. 1, Author in the Room Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Mark J. Pletcher, MD, MPH, author of Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments. Summary Points: 1. Doctors appear to prescribe opioids less often to blacks and Hispanics/Latinos than they do to whites in the emergency department. 2. These differences do not appear to be explained by differences in type or severity of pain. To address these disparities, we would recommend: 1. Educating patients to make sure non-white patients expect good pain control and know how/when to ask for it. 2. Educating physicians and nurses about the existing disparities and the need to eliminate them, specifically addressing fears of prescription opioid abuse and other reasons physicians may withhold opioids. 3. Creating systems that minimize barriers to prescribing and monitor resolution of pain. 4. Monitoring quality of care by measuring resolution of pain and collecting and analyzing data by race/ethnicity.

    JAMA: 2007-12-05, Vol. 298, No. 21, Author in the Room Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Ian G. Williamson, MD, author of Antibiotics and Topical Nasal Steroid for Treatment of Acute Maxillary Sinusitis. Summary Points: 1. Antibiotics are not so effective in the routine treatment of cases of acute sinusitis even when of probable bacterial origin, and should therefore be used more judiciously and with greater caution. 2. Expectations should not necessarily be for antibiotics but balanced risk assessments and symptom advice are still important. 3. Findings of lack of efficacy for antibiotics should drive a research agenda which aims to identify subgroups that might benefit from their use and/or other types of treatment.

    JAMA: 2007-11-21, Vol. 298, No. 19, Author in the Room Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Dena M. Bravata, MD, MS, author of Using Pedometers to Increase Physical Activity and Improve Users' Health. Summary Points: 1. Pedometer users increase their physical activity. They walked 2000 steps per day more than people who do not use a pedometer. 2000 steps is equivalent to about 1 mile per day or about 100 calories per day. 2. Having a daily step goal is important for increasing physical activity with a pedometer. Pedometer users with any goal plus or minus either 10,000 steps per day or an individualized step goal plus or minus increase their physical activity whereas those pedometer users without a goal do not. 3. Pedometer users lose weight and lower their blood pressure. 4. Pedometer interventions that take place in the workplace are less likely to result in improvements in physical activity than interventions that took place in non-workplace settings. This is because the people who chose to participate in workplace interventions already had relatively high baseline physical activity which suggests that workplace interventions should target sedentary employees.

    JAMA: 2007-10-17, Vol. 298, No. 15, Author in the Room Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with R. Monina Klevens, DDS, MPH, author of Invasive Methicillin-Resistant Staphylococcus aureus Infections in the United States. Summary Points: 1. The magnitude of MRSA infection is significant, demonstrating that it is a major healthcare and public health issue. 2. The majority of invasive MRSA infections are healthcare associated; hospitals and other healthcare facilities should make MRSA prevention a priority. 3. MRSA skin infections are common in the community and rarely become life threatening or invasive.

    JAMA: 2007-09-05, Vol. 298, No. 9, Author in the Room Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Romsai T. Boonyasai, MD, MPH, author of Effectiveness of Teaching Quality Improvement to Clinicians. Summary Points: 1. Quality Improvement (QI) curricula are often effective in improving learners plus or minus QI-related participation, attitudes, and knowledge. 2. QI curricula are less often associated with clinical improvements. 3. Clinical improvements occur more often when learners engage in multiple small cycles of change, and when they have individualized coaching in QI, access to their performance data, and access to pre-developed QI tools.

    JAMA: 2007-08-15, Vol. 298, No. 7, Author in the Room Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Douglas R. Lowy, MD, author of Effect of Human Papillomavirus 16/18 L1 Viruslike Particle Vaccine Among Young Women With Preexisting Infection. Summary Points: 1. The HPV vaccine has been shown to work very well in preventing new (incident) infection and disease caused by the HPV types targeted in the vaccine. 2. The JAMA study shows that HPV vaccination does not hasten clearance of existing (prevalent) infection with the HPV types targeted by the vaccine (HPV16 and 18). 3. It is most cost-effective to administer the vaccine before patients are exposed to HPV, because the vaccine is effective in preventing new infection but does not appear to be effective in treating established infection.

    JAMA: 2007-07-18, Vol. 298, No. 3, Author in the Room Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Roy C. Ziegelstein, MD, author of Acute Emotional Stress and Cardiac Arrhythmias. Summary Points: 1. Episodes of emotional stress, especially when sudden, severe, and unexpected, may have significant adverse effects on the heart. 2. Acute emotional stress can increase sympathetic stimulation of the heart and can alter brain activity in a way that makes the heart more susceptible to rhythm disturbances. 3. Since episodes of emotional stress are almost inevitable in life, part of a healthy lifestyle is learning how to deal effectively with stress.

    JAMA: 2007-06-06, Vol. 297, No. 21, Author in the Room Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Bernard Cole, PhD, and Robert S. Sandler, MD, authors of Folic Acid for Prevention of Colorectal Adenomas. Summary Points: 1. Folic acid supplementation is not useful for preventing colorectal adenomas. 2. Folic acid supplementation may be harmful through increasing colorectal adenomas. 3. Practitioners and patients should wait for strong evidence before initiating therapies given the potential for waste and unintended adverse consequences.

    JAMA: 2007-05-09, Vol. 297, No. 18, Author in the Room Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Steven R. Steinhubl, MD, author of Aspirin Dose for the Prevention of Cardiovascular Disease. Summary Points: 1. While aspirin is generally a safe drug and extremely effective, with more than 50 million US adults taking it every day for cardiovascular disease prevention, even a very small incidence of adverse effects can have major implications. Consistent with this, one study found that the most common medication leading to an adverse event requiring hospitalization was aspirin for cardiovascular disease prevention. 2. In terms of preventing heart attacks, strokes, or cardiovascular deaths, no clinical trial has identified an aspirin dose more efficacious than 75 to 81 mg daily. 3. Although there is no dose of aspirin that doesn't increase the risk of GI toxicity or bleeding, greater doses of aspirin are consistently associated with a greater risk. For example, in the United States alone, if everyone took 325 mg of aspirin daily instead of 81 mg, based on observational data, this could translate into nearly 1 million additional major bleeding complications a year.

    JAMA: 2007-04-04, Vol. 297, No. 13, Author in the Room Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Jan L. Brandes, MD, author of Sumatriptan-Naproxen for Acute Treatment of Migraine. Summary Points: 1. Evidence from two replicate randomized, double-blind, placebo-controlled trials showed sumatriptan-naproxen as a fixed dose combination was superior in treating an attack of migraine when compared with sumatriptan alone, naproxen alone, or placebo. 2. Most importantly, given that migraine attacks in adults are 4 to 72 hours in duration, the fixed-dose combination of sumatriptan-naproxen was significantly more effective than sumatriptan monotherapy or naproxen monotherapy in providing a 24-hour sustained pain-free response. 3. Patients using the fixed-dose combination therapy were less likely to use rescue medication or to have headache recurrence, and did not experience any increase in adverse effects using the combination.

    JAMA: 2007-05-09, Vol. 297, No. 18, Author in the Room Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Steven R. Steinhubl, MD, author of Aspirin Dose for the Prevention of Cardiovascular Disease. Summary Points: 1. While aspirin is generally a safe drug and extremely effective, with more than 50 million US adults taking it every day for cardiovascular disease prevention, even a very small incidence of adverse effects can have major implications. Consistent with this, one study found that the most common medication leading to an adverse event requiring hospitalization was aspirin for cardiovascular disease prevention. 2. In terms of preventing heart attacks, strokes, or cardiovascular deaths, no clinical trial has identified an aspirin dose more efficacious than 75 to 81 mg daily. 3. Although there is no dose of aspirin that doesn't increase the risk of GI toxicity or bleeding, greater doses of aspirin are consistently associated with a greater risk. For example, in the United States alone, if everyone took 325 mg of aspirin daily instead of 81 mg, based on observational data, this could translate into nearly 1 million additional major bleeding complications a year.

    JAMA: 2007-03-07, Vol. 297, No. 9, Author in the Room Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Peter B. Bach, MD, author of Computed Tomography Screening and Lung Cancer Outcomes. Summary Points: 1. Screening and other prevention approaches involve subjecting very large numbers of people to an intervention, with the expectation that a few will benefit, but most will not (as they would have never developed the condition anyway). 2. In general, screening for diseases such as cancer will uncover some reservoir of abnormalities that appear to be precursors to clinical disease but are not yet causing disease. 3. We really have no evidence to support screening for lung cancer right now with any technology. 4. We really should be advocating for our patients to help them understand why they shouldn't have this test until we know that it is more likely to hurt them or help them.

    JAMA: 2007-02-14, Vol. 297, No. 6, Author in the Room Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Paul M. Ridker, MD, MPH, author of Development and Validation of Improved Algorithms for the Assessment of Global Cardiovascular Risk in Women: The Reynolds Risk Score. Summary Points: 1. Half of all heart attacks and strokes occur among those with normal cholesterol levels and 15-20% occur among those with no major risk factors at all. 2. The major breakthroughs in understanding cardiovascular disease over the past decade include insights about inflammation and genetics. Each of these can easily be ascertained with either a simple blood test (hsCRP for inflammation) or a simple question about parental history of myocardial infarction. 3. By incorporating these 2 new measures into how we think about risk, a new risk tool was derived known as the "Reynolds Risk Score." 4. This is a win-win for everyone as it allows us to better target therapies, avoid toxicity, and improve overall prevention strategies for heart disease.

    JAMA: 2007-01-03, Vol. 297, No. 1, Author in the Room Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with David Ganz, MD, MPH, author of The Rational Clinical Exam: Will My Patient Fall? Summary Points: 1. Screening for falls is as simple as asking the patient if she's fallen in the past year. For patients who have not fallen, ask about gait or balance problems (e.g. "Do you have a walking or balance problem?"). 2. Most older patients who have a history of falls in the past year, or a gait/balance problem, have at least a 50% chance of falling in the coming year. You may want to do a more thorough evaluation on these patients. 3. To make screening easy for new patients, add into your pre-visit questionnaire questions that ask about a history of falls and/or gait/balance problems. Or, have your office staff ask these questions routinely when patients are being checked in.

    JAMA: 2006-11-15, Vol. 296, No. 19, Author in the Room Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Louise Walter, MD, author of PSA Screening Among Elderly Men With Limited Life Expectancies. Summary Points: 1. Most cancer screening guidelines do not recommend screening elderly persons in poor health who have limited life expectancies because the harms of screening (which occur immediately) outweigh the potential benefits (which occur many years in the future). 2. PSA screening rates among elderly men with limited life expectancies should be much lower than current practice to avoid harming these men with unnecessary tests and procedures. 3. Guidelines should be more explicit about how life expectancy is defined and provide tools to help clinicians identify men with poor prognoses who are most likely to be harmed by PSA screening, considering both age and the presence of severe disease.

    JAMA: 2006-12-27, Vol. 296, No. 24, Author in the Room Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Dennis Black, PhD, author of The Effects of Continuing or Stopping Alendronate after Five Years of Treatment: Results from the Fracture Intervention Trial Long-term Extension. Summary Points: 1. The long-term use of alendronate for up to 10 years is safe. 2. Those who discontinued treatment at 5 years lost bone mass compared with those who continued but the bone loss was only moderate. Rates of fracture were similar among those who continued vs those who discontinued except for clinical vertebral fractures which, although relatively uncommon, were higher in those who discontinued treatment. 3. Results suggest that after 5 years of alendronate, many women may discontinue therapy for up to 5 years. However, those at high risk of clinical vertebral fracture may benefit by continuing.

    JAMA: 2006-10-18, Vol. 296, No. 15, Author in the Room Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with Dariush Mozaffarian, MD, DrPH, author of Fish Intake, Contaminants, and Human Health, published in the October 18 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. For the general population, the health benefits of fish intake far outweigh the risks. 2. Women of childbearing age, nursing mothers and young children should eat up to two servings of fish per week as the benefits of fish intake still outweigh the risks. 3. Given the magnitude of the benefits, physicians should regularly give dietary advice to patients for cardiovascular disease prevention.

    JAMA: 2006-09-13, Vol. 296, No. 10, Author in the Room Audio Interview

    por Copyright © 2019 American Medical Association. All Rights Reserved.

    Interview with David Mark Spiro, MD, MPH, author of Wait-and-See Prescription for the Treatment of Acute Otitis, published in the September 13 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Wait-and-See Prescription (WASP) is a viable approach to managing children with acute otitis media. Compared with the standard prescription group, the WASP group filled the antimicrobial prescription much less frequently and had equivalent clinical outcomes. 2. Within the WASP group, fever and ear pain were associated with filling the prescription demonstrating that parents are able to make appropriate care decisions when given clear guidance. 3. In the management of acute otitis media, important points for clinicians are first to make right diagnosis and then to provide sufficient analgesia. Adequate pain control allows parents to better manage their sick child and use antimicrobials judiciously while also reducing the risk of medical adverse effects and antibiotic resistance.

    JAMA: 2006-08-02, Vol. 296, No. 5, Author in the Room Audio Interview

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    Interview with Harriet L. MacMillan, MD, MSc, FRCP(C), author of Approaches to Screening for Intimate Partner Violence in Health Care Settings: A Randomized Trial, published in the August 8 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Even though we have long assumed that clinicians should ask patients directly about intimate partner violence, this study shows that self-complete methods for soliciting such information are preferred by women, and may be more efficient. 2. The prevalence rate for intimate partner violence differs by setting and population and varies significantly from approximately 4% to approximately 18%. 3. While this study provides evidence on the best methods to solicit information on intimate partner violence, it doesn't tell us if collecting this information improves outcomes for women exposed to such violence. A randomized controlled trial evaluating the effectiveness of screening women for intimate partner violence in health care settings is currently underway.

    JAMA: 2006-07-05, Vol. 296, No. 1, Author in the Room Audio Interview

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    Interview with David Gonzales, PhD, and Stephen Rennard, MD, authors of Helping Patients Stop Smoking: Varenicline vs Bupropion, published in the July 5 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. There is a new and novel pharmaceutical approach to treating nicotine addiction that helps smokers quit by specifically targeting nicotine receptors. 2. Efficacy for varenicline was three to four times that of placebo and twice that of bupropion at the end of 12 weeks of treatment, but abstinence rates in all groups declined after drug treatment ended. 3. The launch of a new smoking cessation medication will likely drive patient demand for smoking cessation services. Medical practices should be prepared to respond to this demand by having a clear, systematic approach to smoking cessation.

    JAMA: 2006-06-21, Vol. 295, No. 23, Author in the Room Audio Interview

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    Interview with Victor G. Vogel, MD, MHS, author of Effects of Tamoxifen vs Raloxifene on the Risk of Developing Invasive Breast Cancer and Other Disease Outcomes , published in the June 21 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Raloxifene is as effective in reducing the risk of invasive breast cancer in postmenopausal women who are at increased risk of the disease. 2. The safety profile of raloxifene is more favorable than tamoxifen with fewer hysterectomies, uterine malignancies, serious thrombotic events, and cataracts. 3. Both physicians and patients are familiar with raloxifene and its use for preventing and treating osteoporosis, and there is a long experience with its use in healthy women.

    JAMA: 2006-03-08, Vol. 295, No. 18, Author in the Room Audio Interview

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    Interview with Christopher M. Callahan, MD, author of Effectiveness of Collaborative Care for Older Adults With Alzheimer Disease in Primary Care: A Randomized Controlled Trial, published in the May 10 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Primary care practices have standard protocols to offer a patient with Alzheimer Disease and their caregivers. 2. The quality of care of many geriatric syndromes, including Alzheimer Disease, can be improved by implementing a collaborative care model. 3. Similarly to many geriatric syndromes, medication may be useful, but it is not enough. Medications are one part of a package of care.

    JAMA: 2006-03-08, Vol. 295, No. 10, Author in the Room Audio Interview

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    Interview with William Taylor, MD, author of A 71-Year-Old Woman Contemplating a Screening Colonoscopy, published in the March 8 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Embedded in experts’ recommendations for colorectal cancer screening are nearly impossible demands on primary care clinicians to discuss the pros and cons of various modalities for screening with each patient and to assess risk even to the detail of learning the pathology of the biopsy of relatives’ colonoscopies (e.g., adenomatous vs. hyperplastic polyps). 2. The complex set of components involved in the decision to screen (or not) for colon cancer includes input from both the doctor (e.g., data about what might happen and how likely the possibilities are) and the patient (e.g., how the patient weighs the relative desirability of the various possible outcomes that result from the possible decisions). 3. The decision to undertake a preventive maneuver involves weighing the risks, cost, and inconvenience of an intervention now for a potential benefit in the future.

    JAMA: 2006-03-08, Vol. 295, No. 10, Author in the Room Audio Interview

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    Interview with Thomas Nolan, PhD, and Donald M. Berwick, MD, MPP, author of All-or-None Measurement Raises the Bar on Performance, published in the March 8 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. All or none measurement more closely reflects the interests and likely desires of patients than other approaches to measurement such as composite or item-by-item. 2. All or none measurement forces a system perspective. 3. All or none measurement offers a more sensitive scale for assessing improvements.

    JAMA: 2006-02-15, Vol. 295, No. 7, Author in the Room Audio Interview

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    Interview with Anna Taddio, PhD, author of Intravenous Morphine and Topical Tetracaine for Treatment of Pain in Preterm Neonates Undergoing Central Line Placement, published in the February 15 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Infants feel pain during central line placement and this pain can be reduced with analgesics. 2. IV Morphine used alone or in combination with Tetracaine Gel is more effective than Tetracaine alone or no treatment. 3. IV Morphine and Tetracaine Gel are associated with expected side effects; IV Morphine causes mild respiratory depression and Tetracaine causes reddening discoloration of the skin.

    JAMA: 2006-01-18, Vol. 295, No. 3, Author in the Room Audio Interview

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    Interview with Olga Jonasson, MD, author of Watchful Waiting vs Repair of Inguinal Hernia in Minimally Symptomatic Men, published in the January 18 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Men, and men only, who have few if any symptoms from their inguinal hemia, can safely delay having it fixed. 2. When symptoms develop, especially if the symptoms worsen suddenly, they should visit a surgeon and request a repair. 3. If the hernia suddenly becomes incarcerated, painful, and signs of a bowel obstruction develop (vomiting, abdominal cramps), an operation should be done immediately. In 2006, even this emergency operation is safe and mortality rates are low.

    JAMA: 2005-12-21, Vol. 294, No. 23, Author in the Room Audio Interview

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    Interview with Sandra Dial, MD, MSc, author of Use of Gastric Acid Suppressive Agents and the Risk of Community Acquired Clostridium difficile Associated Disease, published in the December 21 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Acid suppressive therapy use was associated with an increased risk of CDAD, with PPIs appearing to be associated with a higher risk than h2blockers. These agents, particularly PPIs, are being prescribed with increasing frequency to patients, including situations where the benefits may be small. 2. Although the rate is lower than in the hospital, CDAD is occurring in the community and is being diagnosed more frequently. 3. Prior antibiotic exposure appears to be less frequent in patients diagnosed in the community as compared to patients diagnosed in hospital.

    Clinical Decision Support and Appropriateness of Antimicrobial Prescribing: A Randomized Trial

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    Interview with Matthew H. Samore, MD, author of Clinical Decision Support and Appropriateness of Antimicrobial Prescribing: A Randomized Trial, published in the November 9 issue of JAMA, the Journal of the American Medical Association. Summary points: 1. Repetitive use of a diagnostic and treatment algorithm to ingrain new prescribing habits was a valuable part of this practice change intervention. 2. Clinical decision support systems (CDSS) are feasibly implemented in practice settings that lack electronic medical records, including rural communities. 3. CDSS needs to be integrated with tools that save clinicians' time to be sustainable.

    JAMA: 2005-10-19, Vol. 294, No. 15, Author in the Room Audio Interview

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    Interview with David R. Flum, MD, MPH, author of Use of Early Mortality Among Medicare Beneficiaries Undergoing Bariatric Surgical Procedures, published in the October 19 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Patients 65 years or older have a much higher risk of early death than younger patients after bariatric (obesity) surgery. 2. Already a high risk population, Medicare medically disabled patients have a higher risk of early death after bariatric (obesity) surgery is performed than previously reported. 3. Older patients of more experienced bariatric surgeons had a much lower risk of death than those older patients whose surgeons had less experience performing the surgery.

    JAMA: 2005-09-28, Vol. 294, No. 12, Author in the Room Audio Interview

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    Interview with Charles N. Ford, MD, author of Evaluation and Management of Laryngopharyngeal Reflux, published in the September 28 issue of JAMA, the Journal of the American Medical Association. Summary points: 1. Differentiating between gastroesophageal reflux and laryngopharyngeal reflux. 2. Making and confirming laryngopharyngeal reflux diagnosis. 3. Resolution of laryngopharyngeal reflux findings may require aggressive and prolonged treatment.

    JAMA: 2005-08-17, Vol. 294, No. 7, Author in the Room Audio Interview

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    Interview with Fangjun Zhou, PhD, MS and Rafael Harpaz, MD, MPH, authors of Impact of Varicella Vaccination on Health Care Utilization, published in the August 17 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Varicella can be severe and at times life threatening, however, since the introduction of varicella vaccine in 1995, varicella hospitalizations have declined significantly, as have outpatient visits. 2. Herd immunity is protecting unvaccinated persons from varicella. Since varicella can be more severe in adults, it is particularly important that patients be screened for evidence of immunity to varicella and anyone susceptible be vaccinated, so that children and adolescents do not remain susceptible at adulthood. The federal government's Advisory Committee on Immunization Practices, or ACIP, provides new recommendations regarding screening patients for evidence of immunity to varicella and vaccinating those at risk of the disease. 3. The diagnosis of varicella has become challenging as rates have declined and since the disease is highly modified among those vaccinated. Laboratory testing will play an increasing role in diagnosis of varicella. 4. Providers should report varicella to the local health department so that public health authorities can act to control outbreaks and can monitor for development of problems in the vaccination program. Thanks to everyone who took part in Author in the Room on September 21. During the call, Dr. Rafael Harpaz mentioned that the CDC has some photo images of more attenuated forms of varicella. You can find these images at www.cdc.gov.

    Symptom Experience After Discontinuing Use of Estrogen Plus Progestin

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    Interview with Judith K. Ockene, PhD, MEd, author of Symptom Experience After Discontinuing Use of Estrogen Plus Progestin, published in the July 13 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Of the women who stopped E plus P, 21.2% had menopausal symptoms (hot flashes or night sweats) after stopping study medication compared to 4.8% of women who were on placebo. 2. Of the women who had menopausal symptoms when they started the study (about 12%) and were in the active hormone group, over 50% had a recurrence of symptoms after they stopped MHT compared to 21% of placebo users who had a recurrence of symptoms. 3. Women in the E plus P group reported higher rates of pain or stiffness (36.8%) after they stopped study medication compared to women who had been on placebo (22.2%). 4. Women who had symptoms after they stopped study medication reported using a wide range of strategies to manage symptoms and a large proportion found the strategies to be helpful.

    Combined Tetanus, Diphtheria, and 5-Component Pertussis Vaccine for Use in Adolescents and Adults

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    Interview with Michael E. Pichichero, MD, author of Combined Tetanus, Diphtheria, and 5-Component Pertussis Vaccine for Use in Adolescents and Adults, published in the June 22/29 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Need: The combined tetanus-diphtheria 5-component pertussis vaccine is needed; There has been a 300% increase of pertussis among US adolescents in the last three years. 2. Safety: The combined tetanus-diphtheria 5-component pertussis vaccine is safe, as the reactions are the same as the tetanus vaccine. 3. Universal: On June 30, 2005, the American Academy of Pediatrics (ASAP), America Academy of Family Physicians (AFAR), and the Advisory Committee on Immunization Practices (ACID) all recommended the universal use of the combined tetanus-diphtheria 5-component pertussis vaccine or its competitor vaccine for adolescents.

    Update on the Treatment of Tuberculosis and Latent Tuberculosis Infection

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    Interview with Henry M. Blumberg, MD, author of Update on the Treatment of Tuberculosis and Latent Tuberculosis Infection, published in the June 8 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Tuberculosis is a public health problem. The responsibility for prescribing an appropriate regimen and assuring that treatment is completed is assigned to the public health program or the treating physician, not the patient. 2. Directly observed therapy is recommended for all patients being treated for active TB, this will necessitate the need for greater collaboration between the treating physician and the public health department. 3. Initial therapy for newly diagnosed patients with tuberculosis consists of a 4-drug regimen including isoniazid, rifampin, pyrazinamide and ethambutol. 4. Testing for latent TB infection should be targeted at those who are at increased risk of progression to active TB. 5. Despite its limitations, the tuberculin skin test remains the most commonly used test for the diagnosis of latent TB infection; newer diagnostic tests for latent TB infection are on the horizon. 6. Active tuberculosis should be excluded before beginning treatment for latent tuberculosis infection. 7. Nine months of isoniazid is the preferred therapy for the treatment of latent TB infection.

    Follow-up Testing Among Children With Elevated Screening Blood Lead Levels

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    Interview with Alex R. Kemper, MD, MPH, MS, author of Follow-up Testing Among Children With Elevated Screening Blood Lead Levels, published in the May 11 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. About half the children (six years and younger) with elevated blood lead levels did not receive follow up testing. 2. Nonwhite children, and those living in urban as well as high-risk lead settings, were less likely to receive follow up testing compared to their counterparts. 3. Follow-up testing for children with high blood lead levels is essential for managing lead poisoning and for maximizing cognitive development. 4. Interventions are needed to overcome disparities in care.