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 credential…

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 pote…

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 cons…

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 in…

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, cor…

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 combinat…

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 n…

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 mos…

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 disea…

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 attentio…

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 …

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 "TE…

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. …

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 sta…

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-base…

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…

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…

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.…

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 l…

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 confir…

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..."

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 sa…

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 way…

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 …

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 …

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, re…

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…

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. …

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 qua…

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 re…

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 …

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…

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.…

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 fo…

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 …

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 reti…

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 …

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…

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…

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 tim…

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-threat…

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…

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 …

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 Repor…

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…

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 ha…

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. …

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…

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 …

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 tha…