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A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE HERE. This time, we look to New York for guidance on recognizing and treating monkeypox. Dr. Eric Meyerowitz of Montefiore and Dr. Stephen Baum of Einstein will lead you through the monkeypox thicket in a 17-minute chat. Included below is information for patients as well as links to some key articles of interest to clinicians. LINKS: For patients: Dr. Barry Zingman’s “Monkeypox — What you need to know” For clinicians: NEJM article on monkeypox in 16 countries NEJM Case Records of the Mass. General Hospital on the state’s first case Stephen Baum’s summary of a paper in Emerging Infectious Diseases describing viral persistence on fomites The post Podcast 301: Monkeypox — what to look for, how to treat first appeared on Clinical Conversations.

A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE HERE. We’re back with another interview from this year’s IASLC conference. This time, Christine Sadlowski and Dr. Julia Rotow interview Dr. Mariano Provencio about the survival outcomes from the NADIM II trial. In that trial, patients with resectable stage III AB non-small cell lung cancer received nivolumab plus chemotherapy versus chemotherapy alone. Overall survival at 5 years in these patients has been roughly 30%, according to Provencio. With the addition of chemo-immunotherapy, patients who showed a complete pathological response were all alive at the 3-year mark. These results, according to Rotow, are “really quite exciting.” INTERVIEW TRANSCRIPT Christine Sadlowski: This is part of the NEJM Group coverage of the IASLC’s 2022 World Conference on Lung Cancer. I’m Christine Sadlowski, and with me Dr. Julia Rotow, a clinical oncologist at Dana-Farber Cancer Institute in Boston. We’re here to interview Dr. Mariano Provencio, Chair of Medical Oncology at the

A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE HERE. Interim results on overall survival in phase 3 of the IMpower010 trial were presented at this year’s meeting of the International Assosciation for the Study of Lung Cancer (IASLC). As part of the NEJM Group’s coverage of the conference, Christine Sadlowski interviewed the presenter, Dr. Enriqueta Felip. In a 15-minute interview, she discusses the implications for different patient groups and the past, present, and future of the IMpower trial, which tests adjuvant atezolizumab following platinum-based chemotherapy in patients with resected early-stage non–small-cell lung cancer.  INTERVIEW TRANSCRIPT: Christine Sadlowski: This is coverage of the IASLC’s 2022 World Conference on Lung Cancer. I’m Christine Sadlowski of the NEJM Group. With me today is Dr. Enriqueta Felip, who is head of the thoracic cancer unit at the Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology in Barcelona, Spain. She is the presenting author for the overall survi

A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE AT THIS LINK. In treating most exacerbations of chronic obstructive pulmonary disease (COPD) the usual regimen consists of prednisone plus 5- to 7-days of antibiotics. But what if a shorter course of antibiotic therapy would do? That would be both convenient for patients and less likely to promote antibiotic resistance. A recent paper in Therapeutic Advances in Respiratory Disease describes just such a strategy: patients received prednisone plus either 2 or 7 days of levofloxacin. There was no substantive difference in clinical results between the groups. Summarized in NEJM Journal Watch General Medicine as “practice changing,” this research seems worth a closer look. To that end we’ve invited two of the researchers and the Journal Watch editor who wrote the summary to discuss the issues raised. Have a listen to this 14-minute Clinical Conversation. (A note of no great consequence: We’ve called this “Podcast 298” because, while numbering the titles, your host

A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE HERE. THE USUAL AUDIO FILE IS AVAILABLE BELOW Steven Cummings has co-written a take-no-prisoners editorial in the New England Journal of Medicine. The topic? Vitamin D supplements. The conclusion? “…providers should stop screening for 25-hydroxyvitamin D levels or recommending vitamin D supplements, and people should stop taking vitamin D supplements to prevent major diseases or extend life.” Dr. Cummings was commenting on research findings from the VITAL trial, also published in the journal, showing no fracture-lowering benefits of the supplements. Allan Brett interviews Cummings to get the details on his pronouncement, and it takes just 13 minutes to dismiss vitamin D (which, by the way, is not a vitamin at all). NEJM presentation of VITAL results Cummings and Rosen editorial The post Podcast 297: Forget about all that vitamin D testing!! first appeared on Clinical Conversations.

A VIDEO RECORDING OF THIS ROUNDTABLE IS AVAILABLE CLICK HERE. THE USUAL AUDIO FILE IS AVAILABLE BELOW Your host is old enough to remember when hospital corridors featured physicians with little black bags, scurrying around to see their patients. That’s no longer true, of course. Most of the physicians seen in those corridors these days are white-coated employees. The Annals of Internal Medicine reported a few months ago that “By 2018, 71% of newly certified general internists practiced as hospitalists, compared with only 8% practicing as outpatient-only physicians.”  In addition, between 2008 and 2018 mixed-practice physicians — those black-bag-carrying types — declined by over 50%. To investigate this shift, we gathered five young internists for a roundtable discussion on the attractions of the hospitalist specialty. Running time: 30 minutes Annals of Internal Medicine article The post Podcast 296: A roundtable on the question, Why are young internists flocking to the hospitalist practice style? first appe

CREST-2’s results are probably more than a year away. In the meantime, what to do about diagnosed severe (but asymptomatic) carotid stenosis? Recent results suggest that medical management compares favorably with the surgical approach. In this edition, we address the question with a conversation between Dr. Allan Brett, NEJM Journal Watch‘s editor-in-chief, and Dr. Seemant Chaturvedi, a University of Maryland neurologist who serves on CREST-2’s executive committee. [Running time: 16 minutes] NEJM Journal Watch coverage of a recent JAMA paper on the topic. The post Podcast 295: How should clinicians manage severe (but asymptomatic) carotid artery stenosis while awaiting CREST-2’s results? first appeared on Clinical Conversations.

Locally advanced rectal cancer usually receives a three-part treatment: chemotherapy followed by radiotherapy and then surgery. In a small-cohort study presented at this year’s ASCO conference researchers used a PD-1 inhibitor — dostarlimab — every three weeks for 6 months against the disease. All patients had mismatch repair deficient tumors. No other treatments were needed however, since the 12 patients all attained complete response if they completed the regimen. As part of the NEJM Group’s coverage of ASCO, Christine Sadlowski interviewed the study’s first author, Dr. Andrea Cercek of Memorial Sloan Kettering Cancer Centern about the study and its implications. The study as published in the New England Journal of Medicine The post Podcast 294: PD-1 blockade in locally advanced rectal cancer first appeared on Clinical Conversations.

Patients with metastatic breast cancer whose tumors express low levels of HER2 are generally classified and treated as having HER2-negative disease. However, Dr. Shanu Modi of the Memorial Sloan Kettering Cancer Center and a group of international collaborators explored the use of a monoclonal antibody–drug conjugate (trastuzumab–deruxtecan) in patients with disease they classify as HER2-“low.” Compared with “low” patients treated with one of several standard-of-care regimens, those receiving the conjugate therapy had greater median progression-free survival (roughly 10 months versus 5) and a longer overall survival (roughly 24 versus 18 months). Christine Sadlowski of the NEJM Group interviewed Dr. Modi during the Group’s coverage of this year’s ASCO meeting, where Modi presented her results. Have a listen. Modi et al. as published in the New England Journal of Medicine. The post Podcast 293: HER2-“low” breast cancer and its reponse to an antibody-drug conjugate first appeared on Clinical Conversations.

Apnea testing is part of the protocol used to determine whether a patient is dead according to neurologic criteria. The question is, do clinicians need to obtain consent to proceed? In a fascinating 15-minute chat, two intensivists, Drs. Patricia Kritek and Robert Truog, discuss that question and another, larger one: what is death, anyway? Their back-and-forth was prompted by a recent debate, published in Chest, between two others —  a clinician and a law professor. Have a listen, and please leave a comment to help guide future editions. The Chest article The New Yorker article mentioned by Dr. Truog The post Podcast 292: Informed consent and apnea testing for death — or — What is death, anyway? first appeared on Clinical Conversations.

In the early waves of the Covid-19 pandemic why did patients in unionized nursing homes, have a roughly 10% lower rate of mortality than those in non-unionized ones? A report in Health Affairs tries to sort out the possible reasons. Listen to our 13-minute interview, which raises the question: Should you send your patients to non-unionized facilities? Health Affairs article The post Podcast 291: Unionized nursing homes had lower mortality during Covid-19 first appeared on Clinical Conversations.

The U.S. Preventive Services Task Force recently issued its sixth set of guidelines on using daily aspirin to prevent cardiovascular disease. The guidelines appeared in JAMA — whose editors asked our guest, Dr. Allan Brett, to write an editorial evaluation. This edition carries Brett’s advice on using the new guidelines in daily clinical practice. Brett’s JAMA editorial USPSTF recommendations in JAMA [Running time: 15 minutes] The post Podcast 290: USPSTF’s new take on aspirin and primary prevention of CVD first appeared on Clinical Conversations.

Saline or balanced crystalloids? The question of which resuscitation fluid to use in clinical practice seems to have been settled by recent research findings — or at least settled in favor of balanced crystalloids. But wait, our guests see slight differences that may affect your choice. Patricia Kritek practices critical care medicine at the University of Washington. In this edition, she pilots a discussion with Todd Rice of Vanderbilt. He has studied the problem carefully, having published two studies in the New England Journal of Medicine in 2018; more recently, he’s written a meta-analysis of the problem in NEJM Evidence. Listen in on a truly clinical conversation. [Running time: 16 minutes] The post Podcast 289: Saline versus balanced crystalloids — what to choose first appeared on Clinical Conversations.

Spend 15 minutes with Dr. Natalia Shevchuk, whom we interviewed by candlelight last month. She is sheltering in the Odessa region now, having left the Donetsk area. This time, she relates how she lost a colleague in Russia’s attack on the Kramatorsk railway station and found another she’d feared lost in Mariupol. She told us that she’s impressed by her patients’ willingness to fight, despite their opioid dependence. The narrative can be confusing at times, and following closely will require having a map of Ukraine handy. A technical glitch or two complicated things, but you’ll get the main idea: Ukraine needs help. [Running time: 15 minutes] The post Podcast 288: Following up with a Ukrainian narcologist first appeared on Clinical Conversations.

During the American Academy of Neurology’s 2022 meeting in Seattle, Dr. Richard Lipton of Albert Einstein College of Medicine took questions from Dr. Teshamae Monteith (U. Miami) and Joe Elia. Lipton’s group sought to characterize the impact of patients’ monthly headache days on their quality of life, especially the role of depression, allodynia, and anxiety. (Read the conference’s abstract here.) [Listening time: 14 minutes] Please leave a comment below to suggest how we can improve these interviews. The post Podcast 287: Thinking about quality-of-life in migraine first appeared on Clinical Conversations.

Dr. Natalia Shevchuk (pictured above) treats substance use disorders in Ukraine’s Donetsk region. Her face is candlelit because her town is under curfew, and people aren’t allowed to put on their room lights (if they have electricity) in the hours of darkness, lest Russian bombardments use the lights as guides. She talked with Dr. Ali Raja and Joe Elia via Zoom about her work and her concerns for colleagues in Mariupol she’s not heard from for weeks. It’s wartime and nothing is running as usual. But let her tell you all about that. Here is a transcript. [Running time: 20 minutes] The post Podcast 286: Talking about addiction treatment by candlelight from Ukraine’s Donetsk region first appeared on Clinical Conversations.

Gastroesophageal reflux, or GERD, was the focus of a revised set of guidelines issued in January in the American Journal of Gastroenterology. Given the frequency of that condition in primary care clinics, internist and NEJM Journal Watch editor-in-chief Allan Brett proposed a discussion about the practical application of these guidelines with David Bjorkman. Dr. Bjorkman, a gastroenterologist, delivers much practical advice on the matter. [Listening time: 24 minutes] Journal Watch summary on the guidelines American Journal of Gastroenterology containing the guidelines Transcript of the discussion The post Podcast 285: GERD’s revised guidelines — an internist and a gastroenterologist discuss them. first appeared on Clinical Conversations.

Some 85 years ago Guernica was bombed, and after that came Dresden, Coventry, Hiroshima, Bach Mai, and the rest. This episode of Clinical Conversations asks how it might be possible to help clinicians under bombardment in Ukraine. As you will hear, one hospital in Chernihiv keeps all but essential staff away from its buildings when they are not on duty — for fear of losing them to Russian attacks. A neurologist in Chernihiv, Serhiy Kareta, and a Ukrainian American trauma surgeon based in Philadelphia, Roxolana Horbowyj, join the Mass. General’s Ali Raja and NEJM Group’s Joe Elia in a conversation about the clinical situation in Ukraine and what listeners can do to help. Here is a link to the Ukraine Ministry of Health’s humanitarian needs list Transcript of the interview [Running time: 20 minutes] The views and opinions expressed in these blogs are not necessarily those of NEJM Journal Watch or NEJM Group. The post Podcast 284: The clinical situation in Ukraine first appeared on Clinical Conversations.

You want more evidence that post-recovery vaccination against Covid-19 reinfection helps? Here is a careful study from the U.K. that followed some 35,000 health care workers — initially without symptoms — in over 100 institutions there. Starting in June 2020 the SIREN study tested these people regularly, with blood sampling every month and nasal swabs every 2 weeks during the period when the Delta variant was the greatest threat. Almost a third of the group, although asymptomatic, showed seropositivity by the time the vaccine was introduced to the U.K. in December 2020. Dr. Susan Hopkins, the senior author of the paper just published in the New England Journal of Medicine, explains SIREN’s results. The short version is that the vaccine was effective — up to 85% after the first dose — and its protection waned to about 50% some 6 months after a second dose. Among those who were seropositive before the arrival of the vaccine, vaccination showed a remarkable 90% effectiveness after the first dose, and that effect

Governments’ directives about how and when to vaccinate people who’ve recovered from Covid-19 vary widely. But, according to this episode’s guest, Dr. Ronen Arbel, they all say they don’t have enough evidence to set firm policy. So, Arbel and his colleagues set out to collect evidence from some 150,000 patients’ records in Israel who’d recovered from the earliest waves of the pandemic. About half the patients subsequently received at least one shot of the Pfizer-BioNTech vaccine, and all were followed over a period of some 9 months. Arbel’s group, using the patients’ health records, tracked how many became reinfected with Covid-19 — during that interval, the Delta variant was predominant. They found that reinfection was roughly fourfold higher among the unvaccinated; they also observed less benefit among patients aged 65 and older; in addition, the results from one or two shots were statistically the same. Listen in to what this means for practicing clinicians. [Running time: 15 minutes] New England Journal o