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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.

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.

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.

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.

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.

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.

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.

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.

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.