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JAMA Clinical Reviews
Author interviews that explore the latest clinical reviews.
2 days ago
Racial and Ethnic Disparities in COVID-19
Ethnic and racial minorities have been particularly hard hit with COVID-19 in some communities. Mitchell Katz, MD, president and chief executive officer of New York City Health + Hospitals, and former Los Angeles County health agency director, discusses this problem and what has been learned from COVID-19 that can help resolve the general problem of health care disparities. Related Article: Racial and Ethnic Health Disparities Related to COVID-19
2 days ago
Pharmacologic Management of Tobacco Cessation
Tobacco use is the leading cause of preventable disease and death in the world, but most attempts to quit are unsuccessful. Atul Jain, MD, assistant professor of medicine at Mayo College of Medicine, discusses new guidelines from the American Thoracic Society on pharmacologic management of tobacco cessation, including target population and deciding when to initiate. Related Article(s): Initiating Pharmacologic Treatment in Tobacco-Dependent Adults
Jan 15, 2021
The Winter COVID-19 Surge in New York and Los Angeles
Mitchell Katz, MD, president and chief executive officer of New York City Health + Hospitals, and former Los Angeles County health agency director, discusses causes, similarities, and differences between the spike of COVID-19 cases, hospitalizations, and deaths in the 2 cities. Related Article: Modernize Medical Licensing, and Credentialing, Too—Lessons From the COVID-19 Pandemic
Jan 12, 2021
Glaucoma Diagnosis and Treatment
Glaucoma is the most common cause of irreversible blindness in the world. Joshua Stein, MD, MS, associate professor of ophthalmology at the University of Michigan, reviews the diagnosis and treatment of glaucoma. Related Article: Glaucoma in Adults—Screening, Diagnosis, and Management
Jan 11, 2021
Oral Antibiotics for Appendicitis
A new trial reports that a third of emergency department patients presenting with appendicitis admitted for oral antibiotic treatment had outcomes no different from those admitted for intravenous antibiotic treatment. Paulina Salminen, MD, PhD, professor of surgery at the University of Turku in Finland, discusses the findings. Related Article(s): Effect of Oral Moxifloxacin vs Intravenous Ertapenem Plus Oral Levofloxacin for Treatment of Uncomplicated Acute Appendicitis
Jan 8, 2021
Understanding the New SARS-CoV-2 Mutation Found in England
Gregory Armstrong, MD, director of the Advanced Molecular Detection Program for the CDC, explains what is currently known about the new mutations of SARS-CoV-2. Related Article(s): Genetic Variants of SARS-CoV-2—What Do They Mean? Next-Generation Sequencing of Infectious Pathogens Next Generation Sequencing of Infectious Pathogens in Public Health and Clinical Practice Understanding SARS-CoV-2 Genetic Variants
Jan 6, 2021
Next Generation Sequencing of Infectious Pathogens in Public Health and Clinical Practice (Repost)
Next-generation sequencing is a catchall term for new, high-throughput technologies that allow rapid sequencing of a full genome. It can be used to sequence a patient’s DNA in diagnosing a genetic disorder or characterizing a cancer, but it can also be used to sequence the genome of a pathogenic bacteria, virus, fungi, or parasites. In this JAMA clinical review podcast, we talk with authors Marta Gwinn, MD, MPH, and Gregory L. Armstrong, MD, from the CDC, about how next-generation sequencing of infectious pathogens is being implemented in clinical practice and in public health surveillance for infectious disease. Related Article(s): Next-Generation Sequencing of Infectious Pathogens Podcast originally published 2/14/19.
Jan 6, 2021
COVID-19 Vaccine Safety–Anaphylaxis and Allergic Reactions
Tom Shimabukuro, MD, MPH, MBA, and Sara Mbaeyi, MD, MPH, from the CDC discuss rare allergic complications in patients who received the first dose of the Pfizer-BioNTech vaccine between December 14-23, 2020.
Jan 5, 2021
Patent Foramen Ovale and Secondary Stroke Prevention
Patent foramen ovale (PFO) is an often overlooked cause of acute ischemic stroke. JAMA Associate Editor Jeffrey Saver, MD, professor of neurology at UCLA, discusses new recommendations from a 2020 AAN Practice Advisory about use of mechanical PFO closure and anticoagulant vs antiplatelet therapy to prevent subsequent strokes in patients with a PFO and an initial event. Related Article: Management of Patients With a Patent Foramen Ovale With History of Stroke or TIA
Jan 5, 2021
Crohn Disease Management
New therapies have greatly improved outcomes for patients with Crohn disease. Peter Higgins, MD, from the University of Michigan, discusses advances in management and treatment protocols. Related Article: Management of Crohn Disease
Dec 31, 2020
Understanding SARS-CoV-2 Genetic Variants
Adam Lauring, MD, PhD, from the University of Michigan Division of Infectious Diseases, an expert on the evolutionary biology of RNA viruses, explains the new genetic variants recently found in SARS-CoV-2 and their importance. Related Article(s): Genetic Variants of SARS-CoV-2—What Do They Mean?
Dec 30, 2020
Nursing Homes and COVID-19
Elderly persons and residents of nursing homes have been the hardest hit in the COVID-19 pandemic. Harvard geriatrician Sharon Inouye, MD, discusses the effect COVID-19 has had on nursing homes and what should be done about it. Related Article: Association of Nursing Home Ratings on Health Inspections, Quality of Care, and Nurse Staffing With COVID-19 Cases
Dec 22, 2020
Managing Chronic Medical Conditions for Homeless Patients Presenting to the Emergency Department
Homeless patients with chronic medical conditions who need long-term care often repeatedly present to emergency departments to receive treatment. Following a performance improvement analysis, clinicians at UCSF developed an emergency department–based team who work with the community to provide care for this challenging population. Hemal Kanzaria, MD, and Jack Chase, MD, discuss how UCSF has addressed this clinical problem. Related Article(s): Caring for Emergency Department Patients With Complex Medical, Behavioral Health, and Social Needs
Dec 15, 2020
Parental Relationships with Children During COVID-19 Pandemic-Related Lockdowns
JAMA Fishbein Fellow Kristin Walter, MD, interviews Craig Garfield, MD and Richard Weissbourd, EdD, about parental relationships during the COVID-19 pandemic. Related Article(s): Considerations for Young Children and Those With Special Needs as COVID-19 Continues
Dec 10, 2020
Gyms, Restaurants, Mass Transit, and Community COVID-19 Exposures
Lockdowns resulting from COVID-19 have had a devastating effect on everyone’s personal lives and the economy. What factors in people’s daily lives are most associated with SARS-CoV-2 transmission between people? Manish Patel, MD, team lead of the CDC’s Influenza Prevention & Control Team, discusses a study they conducted examining what sorts of activities might be associated with COVID-19 disease transmission. Related Article(s): Community Outbreak Investigation of SARS-CoV-2 Transmission Among Bus Riders in Eastern China
Dec 8, 2020
The Effect of Cannabis Intoxication on Driving Ability
It is well known that alcohol use severely affects driving ability, but does cannabis? There are many fewer traffic crashes related to cannabis than alcohol intoxication. Johannes Ramaekers, PhD, of the University of Maastricht in the Netherlands, discusses his study examining the relationship between vaping THC and driving safety. Related Articles: Effect of Cannabidiol and Δ-Tetrahydrocannabinol on Driving Performance Driving Under the Influence of CBD or THC—Is There a Difference?
Dec 7, 2020
Air Handling Standards for Increasing the Safety of Indoor Spaces During the COVID-19 Pandemic
Closing businesses during the COVID-19 pandemic has had devastating consequences for individuals and the economy in general. Proper air handling combined with the use of masks and physical distancing can greatly improve the safety of indoor spaces. Joseph Allen, DSc, MPH, assistant professor of exposure assessment science at Harvard T.H. Chan School of Public Health, and Andrew Ibrahim, MD, assistant professor of surgery and architecture and urban planning at the University of Michigan, discuss air conditioning standards that can substantially reduce the risk of disease transmission in indoor spaces. Related Article(s): Turbulent Gas Clouds and Respiratory Pathogen Emissions
Dec 3, 2020
Understanding Permuted Blocks and Stratification in Randomized Clinical Trials
Roger J. Lewis, MD, PhD, discusses Randomization in Clinical Trials from the JAMA Guide to Statistics and Methods Related Article(s): Randomization in Clinical Trials
Dec 1, 2020
Hearing Loss in Children
Judith Lieu, MD, from the Department of Otolaryngology–Head & Neck Surgery at Washington University in St Louis, discusses the need for screening young children for hearing loss and the importance of treating hearing loss as early in life as is possible. Related Article: Hearing Loss in Children
Nov 24, 2020
Health Care Facility Certificate of Need Regulations—Laws That Have Outlived Their Usefulness
Certificates of Need are regulations required by some states before any construction or expansion of services at medical facilities are undertaken. Originally developed to prevent excessive construction of expensive health care facilities, these rules have distorted health care markets and probably should be repealed. Karl Bilimoria, MD, from Northwestern University, Tarik K Yuce, MD, and JAMA Associate Editor Karen Joynt Maddox, MD, from Washington University, discuss the current status of these regulations and their effect on health care markets. Related Article(s): Association of State Certificate of Need Regulation With Procedural Volume, Market Share, and Outcomes Among Medicare Beneficiaries
Nov 17, 2020
Hematuria and Bladder Cancer
Mark Litwin, MD, chair of Urology at the UCLA School of Medicine, discusses the evaluation of hematuria and also the presentation, diagnosis, and treatment of bladder cancer. Related Article(s): Bladder Cancer
Nov 10, 2020
Elevated Liver Function Tests Following Liver Transplant
There are hundreds of thousands of liver transplant patients, all of whom will be seen in general clinical practices. It is common for them to develop elevated liver enzymes--a potentially serious problem that may be a sign that the transplanted liver is failing. Traditionally, patients with these findings are sent to a liver transplant center for an inpatient workup. A new protocol facilitating management of most of these patients in routine outpatient clinics has been developed, greatly improving the efficiency of managing patients with this clinical problem. Fady Kaldas, MD, director of the Dumont-UCLA transplant center, discusses how to manage elevated liver function results in liver transplant patients on an outpatient basis. Related Article(s): Outpatient Management of Liver Function Test Abnormalities in Patients With a Liver Transplant
Nov 10, 2020
Using e-Cigarettes to Stop Smoking
Are e-cigarettes helpful or harmful as a tool to help people stop smoking? Mark J. Eisenberg, MD, MPH, from the Jewish General Hospital and McGill University in Montreal, Canada, discuss a recent clinical trial he reported in the November 10, 2020, issue of JAMA examining the efficacy of e-cigarettes as a smoking cessation aid. Related Article: Effect of e-Cigarettes Plus Counseling vs Counseling Alone on Smoking Cessation
Nov 6, 2020
New Recommendations for How Often to Repeat Colonoscopy Following Polypectomy
A new multisociety guideline was recently released suggesting that for many patients, the interval between colonoscopies following polyp resection is less than previously recommended. Cecelia Zhang, MD, Duke University, and Maylyn Martinez, MD, University of Chicago, discuss the new guideline. Related Article: Recommendations for Follow-up Colonoscopy After Polypectomy
Nov 2, 2020
The Effect of COVID-19 on the 2020-2021 Influenza Season
Tim Uyeki, MD, chief medical officer for the Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), discusses how the COVID-19 pandemic may affect the 2020-2021 influenza season. Related Article(s): Preparing for the 2020-2021 Influenza Season
Oct 27, 2020
Ticagrelor or Clopidogrel for Antiplatelet Therapy After Percutaneous Intervention for Acute Coronary Syndrome?
The Platelet Inhibition and Patient Outcomes (PLATO) trial showed that ticagrelor had better outcomes than clopidogrel for avoiding thrombotic complications following acute coronary syndrome. Subsequent trials suggested that the outcomes for the drugs were about the same. The effects of ticagrelor and clopidogrel were examined in a very large observational study performed by Harlan Krumholz, MD, and colleagues, published in the October 27, 2020, issue of JAMA. Dr Krumholz explains how his study was performed and what it showed. Related Article: Association of Ticagrelor vs Clopidogrel With Net Adverse Clinical Events in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention ohdsi.org
Oct 19, 2020
Can We Count on Herd Immunity to Control COVID-19?
Many people are hoping that enough people develop resistance to COVID-19, either from being exposed to the disease or from vaccination, to develop herd immunity that will enable society to return to normal. But will that happen? Saad Omer, MD, from the Yale Institute for Global Health, discusses his JAMA article on herd immunity and how much we can count on having it to return society to normal from this COVID-19 pandemic. Related Article(s): Herd Immunity and Implications for SARS-CoV-2 Control
Oct 13, 2020
Ten Things Every New Doctor Should Know About Drug Reactions
David Juurlink, MD, PhD, a clinical pharmacologist and professor of internal medicine at Sunnybrook Health Sciences Centre and professor of medicine at the University of Toronto, discusses 10 things new doctors should know about drugs and thir complications as they start practicing medications in the the fourth and final episode of this series.
Oct 6, 2020
Coping With Death
One of the most important things clinicians can do is help patients and their families deal with impending death. Despite its importance, this part of medical care is hardly covered in medical training. Clinicians have to learn this on their own. One of the most powerful ways to find out what it’s like is to go through it yourself. Martin F. Shapiro, MD, professor of medicine at the Weill Cornell School of Medicine, describes along with his sister, Lori Shapiro, what they went through in dealing with their mother’s death. Dr Shapiro relates what he learned to more effectively manage his patients and their families in coping with the end of life. Related Article(s): The Last Breath—Enriching End-of-Life Moments
Oct 2, 2020
Sweden and COVID-19
Sweden’s response to the COVID-19 pandemic differed from its neighbors in Europe. Lockdowns were minimized with the belief that they would be more damaging than the virus itself. Much criticism was levied at the country regarding these policies. Anders Tegnell, MD, is the head of the Department of Public Health Analysis and Data Management, Deputy Director General at the Public Health Agency of Sweden, and had been Sweden's state epidemiologist since 2013. He discusses what Sweden did in response to COVID-19 and what their outcomes were. Related Article: COVID-19 and Health Equity—A New Kind of “Herd Immunity”
Oct 1, 2020
Updated Guidelines for the Treatment of Community-Acquired Pneumonia
In the 13 years since the American Thoracic Society and Infectious Diseases Society of America have issued guidelines for the treatment of community-acquired pneumonia much has changed, resulting in a new guideline with 16 major recommendations. These are reviewed by Maylyn Martinez, MD, from the Department of Medicine at the University of Chicago and JAMA Network Open Associate Editor Angel Desai, MD, from the Department of Medicine at the University of California at Davis. Related Article: Diagnosis and Treatment of Adults With Community-Acquired Pneumonia
Sep 22, 2020
Intimate Partner Violence
Intimate partner violence--also known as domestic abuse--may affect as many as 1 in 3 women. It’s often underreported but that shouldn’t be the case. Harriet L. MacMillan, MD, from the Departments of Psychiatry & Behavioral Neurosciences and Pediatrics at McMaster University, discusses how to identify and intervene in intimate partner violence. Related Article(s): Intimate Partner Violence
Sep 15, 2020
Failing the Boards—What Happens When the Board Fails Itself?
When trying to administer its qualifying examination during the COVID-19 shutdowns, the American Board of Surgery failed. Jo Buyske, MD, president and chief executive officer of the American Board of Surgery, discusses what went wrong and what they are doing to fix it. Related Article: Association Between Resident Physician Training Experience and Program-Level Performance on Board Examinations
Sep 4, 2020
Treating Obstructive Sleep Apnea
A new clinical trial suggests that obstructive sleep apnea (in patients unable to tolerate treatment with CPAP or other devices) can be treated with airway surgery. The author of the study published in JAMA, Stuart MacKay, MBBS, from the University of Wollongong, Australia, discusses the study and treatments for obstructive sleep apnea. Related Article: Effect of Multilevel Upper Airway Surgery vs Medical Management on the Apnea-Hypopnea Index and Patient-Reported Daytime Sleepiness Among Patients With Moderate or Severe Obstructive Sleep Apnea
Sep 3, 2020
Understanding Stepped-Wedge Clinical Trials
Cluster randomized trials are performed when an intervention must be delivered to a group of patients like when testing new nursing protocols on award or different means for cleaning beds on a ward. One type of cluster trials is called a stepped-wedge where every cluster in the study ultimately undergoes the intervention. How this works it is explained by Susan Ellenberg, PhD, from the Department of Biostatistics, Epidemiology, and Informatics at the University of Pennsylvania School of Medicine. Related Article: The Stepped-Wedge Clinical Trial
Sep 1, 2020
What Is It Like to Have COVID-19?
COVID-19 continues to rapidly spread throughout the world. In the past few months, the population affected by the disease has shifted from older to younger patients. Public health officials are concerned that younger people seem not to be very compliant with recommendations regarding masking and social distancing. It is believed that younger people think that the adverse consequences of the disease occur in the elderly and not in them. Garrett Salzman, MD, is a resident physician at UCLA and contracted the disease. He is young and healthy, but he has had substantial disability from COVID-19. He tells a cautionary tale of his experience with COVID-19 that this is not a benign disease in young people, that they need to be careful. Related Article: Potential Implications of COVID-19 for the 2020-2021 Residency Application Cycle
Sep 1, 2020
Update on Bariatric Surgery—2020
Bariatric surgery is unequivocally the most effective means for inducing weight loss and managing diabetes for obese patients. There are numerous other benefits for these operations including improved long-term cardiovascular outcomes. David Arterburn, MD, MPH, a senior investigator from the Kaiser Permanente Washington Health Research Institute, discusses bariatric surgery outcomes. Related Article(s): Benefits and Risks of Bariatric Surgery in Adults
Aug 27, 2020
Update on Ulcerative Colitis—2020
The new American College of Gastroenterology guideline on ulcerative colitis is discussed by one of its authors, David T. Rubin, MD, from the Inflammatory Bowel Disease Center at the University of Chicago, and Maylyn Martinez, MD, also from the University of Chicago. Related Article(s): Ulcerative Colitis in Adults
Aug 25, 2020
Managing Acute Pancreatitis
Acute pancreatitis can be a devastating disease. Complications of pancreatitis can be minimized by appropriate early, initial management. Joe Hines, MD, and Raman Muthusamy, MD, from UCLA discuss the recent American Gastroenterological Association guideline on managing acute pancreatitis. Related Article(s): Initial Management of Acute Pancreatitis
Aug 18, 2020
A Physician Gets Cancer
Patients with serious disease fear the unknown. A physician with a serious disease knows the potential outcomes, making it far more difficult to cope. How does a physician react to developing cancer? Adam Stern, MD, an assistant professor of Psychiatry at Harvard Medical School, developed metastatic renal cell carcinoma when he was just 33 years old. He wrote about his experiences as a cancer patient in a Piece of My Mind article in the March 3, 2020, issue of JAMA and spoke about this to JAMA Clinical Reviews. Related Article(s): The Secret About Achieving Your Dreams
Aug 14, 2020
The Consequences of Not Vaccinating for Measles
Before COVID-19, even though most children got vaccinated for measles, too many did not, resulting in worsening outbreaks of measles. People forgot how bad a disease measles is and became lax about getting their children vaccinated. Now in the COVID-19 era everyone is aware of what an out-of-control infectious disease can do and we are all anxiously awaiting a COVID-19 vaccine. Will this experience help encourage parents to get their children vaccinated? We discussed the problems of an adequate measles vaccination with Dr. Saad Omer, PhD, from the Yale Institute for Global Health at Yale University in New Haven, Connecticut. Related Article(s): Vaccine Refusal and Measles Outbreaks in the US
Aug 14, 2020
The Intersection Between Flu and COVID-19
As the COVID-19 pandemic continues to spread throughout the world, flu season is almost upon us. This is concerning because there will be an overlap between flu and COVID-19 and patients could get both diseases. Daniel Solomon, MD, from the Division of Infectious Diseases at the Brigham and Women’s Hospital of the Harvard Medical School in Boston, discusses COVID-19 and how the flu might pan out this year. Related Article: Influenza in the COVID-19 Era
Aug 13, 2020
How to Reopen Schools in the COVID-19 Era
One of the most contentious issues relating to COVID-19 is when to reopen schools. This is a complicated matter because placing people in close quarters risks spread of the disease. Yet children being at home makes it difficult for their working parents to manage their affairs and can potentially affect the learning experience. JAMA Associate Editor Preeti Malani, MD, chief health officer for the University of Michigan, discusses school reopening and how the University of Michigan is addressing this problem. Related Article: Association Between Statewide School Closure and COVID-19 Incidence and Mortality in the US
Aug 13, 2020
Why Are We Still Talking About Hydroxychloroquine as a Treatment for COVID-19?
The use of hydroxychloroquine as a treatment for COVID-19 serves as an example of what is wrong with medical information being widely disseminated before it is thoroughly vetted by peer review. Preliminary studies of this treatment modality were spread widely, creating false hope that a treatment for COVID-19 existed. Several randomized trials have shown that hydroxychloroquine is not an effective therapy for COVID-19. David Juurlink, MD, PhD, from the University of Toronto summarizes the evidence base regarding hydroxychloroquine and COVID-19. Related Article(s): Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19)
Aug 11, 2020
A Patient’s Perspective on Nonoperative Treatment of Appendicitis
A major study recently published in JAMA showed that many children who have appendicitis do not need surgery and, if they undergo surgery, may have more disability than if they were treated with antibiotics alone. JAMA Clinical Reviews spoke with a patient in the study whose mother happens to be JAMA Associate Editor Preeti Malani, MD, JAMA’s infectious diseases editor and chief health officer for the University of Michigan. This patient initially was treated with antibiotics, later required appendectomy, and discussed the difficulties he experienced following laparoscopic appendectomy. Related Article: Association of Nonoperative Management Using Antibiotic Therapy vs Laparoscopic Appendectomy With Treatment Success and Disability Days in Children With Uncomplicated Appendicitis
Aug 11, 2020
Updated Pulmonary Embolism Guidelines
The European Society of Cardiology updated its guidelines for pulmonary embolism in 2019. Jonathan Paul, MD, from the University of Chicago discusses what is new in the management of pulmonary embolism based on his August 11, 2020, JAMA Guidelines Synopsis article. Related Article(s): Management of Acute Pulmonary Embolism
Aug 6, 2020
The Importance of Minimal Clinically Important Differences in Research Studies
Before a study is carried out, it is important to define what is an important difference between groups. This is often not done correctly. Anna McGlothlin, PhD, from Berry Consultants discusses how to assess the minimal clinically important difference in research studies.
Aug 5, 2020
Update on Dexamethasone for the Treatment of COVID-19
Few treatments have proven to be effective for treating COVID-19. Recently, a clinical trial reporting the results of dexamethasone for treating COVID-19 was published and has received a great deal of attention in the popular media. Greg Curfman, MD, JAMA Deputy Editor, reviews the study and discusses what the findings do or do not reveal about the efficacy of dexamethasone for treating COVID-19. Related Article(s): Missed Opportunities on Emergency Remdesivir Use
Aug 4, 2020
Update on Congestive Heart Failure
Congestive heart failure is common and can have devastating effects on patients' quality of life. Until recently few treatments were available, but that has changed. Congestive heart failure management has substantially improved. Hutter Family Professor of Medicine at Harvard Medical School James L. Januzzi Jr, MD, reviews the diagnosis and treatment of congestive heart failure. Related Article(s): Heart Failure With Reduced Ejection Fraction
Jul 27, 2020
Treating Pediatric Appendicitis Nonoperatively
Accumulating evidence in adults has shown that nonoperative treatment of appendicitis is an acceptable means for treatment. A recent prospective study published in JAMA has shown the same is true for children. Most children who are treated with antibiotics instead of surgery for appendicitis do just fine. The lead author for this study, Peter Minneci, MD, from the Nationwide Children’s Hospital of the Ohio State Medical School, discusses his work in investigating alternative ways to treat appendicitis. Related Article: Association of Nonoperative Management Using Antibiotic Therapy vs Laparoscopic Appendectomy With Treatment Success and Disability Days in Children With Uncomplicated Appendicitis
Jul 21, 2020
Perioperative Risk Assessment
Jeffrey Berger, MD, from the Center for the Prevention of Cardiovascular Disease at the New York University School of Medicine, explains the ins and outs of perioperative cardiovascular risk assessment and management for noncardiac surgery. Related Article(s): Perioperative Cardiovascular Risk Assessment and Management for Noncardiac Surgery
Jul 21, 2020
Drug Treatment for Primary Prevention of Breast Cancer
Some of the nearly 40 000 deaths each year in the US from breast cancer might be avoided through use of medications to prevent breast cancer in high-risk women. Patricia Ganz, MD, Distinguished Professor of Medicine and Public Health at UCLA, reviews the evidence underlying chemoprevention of breast cancer and which women might benefit from the drugs. Related Article(s): Medications for Primary Prevention of Breast Cancer Breast Cancer Risk Calculators: https://bcrisktool.cancer.gov/calculator.html https://tools.bcsc-scc.org/BC5yearRisk/intro.htm https://ibis.ikonopedia.com/
Jul 20, 2020
Remdesivir and Dexamethasone for the Treatment of COVID-19
Both remdesivir and dexamethasone have been promoted as effective treatments for COVID-19. JAMA Deputy Editor Greg Curfman, MD, and Professor Rachel Sachs, JD, from the Washington University School of Law discuss the science and health policy aspects of these COVID-19 treatments. Related Article(s): Missed Opportunities on Emergency Remdesivir Use
Jul 13, 2020
How Is COVID-19 Transmitted?
Whether the SARS-CoV-2 virus is transmitted by droplets or aerosol influences which public health interventions might slow its spread. Michael Klompas, MD, professor of medicine at Harvard Medical School, explains evidence to date about mechanisms of coronavirus transmission and implications for pandemic containment and mitigation efforts. Related: Airborne Transmission of SARS-CoV-2: Theoretical Considerations and Available Evidence
Jul 10, 2020
Complications From SSRIs
SSRIs are a commonly used medication. Although complications from them are not common because so many people take these medications, physicians will inevitably see problems such as dependence and withdrawal, hyponatremia, bleeding disorders, and even the uncommon but severe SSRI syndrome. To learn about these potential complications, we spoke with David Juurlink, MD, PhD, an internist and clinical pharmacologist at the University of Toronto.
Jul 8, 2020
Acute Kidney Injury Caused by Proton Pump Inhibitors
Proton pump inhibitors are among the most commonly used medicines by patients. They’re generally safe, but they can cause acute kidney injury, and it’s important for clinicians to be aware of this potential complication. David Juurlink, MD, PhD, internist and clinical pharmacologist from the University of Toronto, discusses this important potential complication. Related Article: An Evidence-Based Approach to the Treatment of Gastroesophageal Reflux Disease
Jul 7, 2020
Diagnosis and Management of Amyloidosis
Although there are only about 4000 new cases of amyloidosis in the US per year, it can cause preserved ejection fraction heart failure, kidney and liver failure, and neuropathy. Amyloidosis is easily diagnosed and treatable, and it should be considered in the differential diagnosis for these diseases. Morie A. Gertz, MD, from the Mayo Clinic in Rochester, Minnesota, talks with JAMA Clinical Reviews about amyloidosis. Related: Systemic Amyloidosis Recognition, Prognosis, and Therapy
Jul 6, 2020
A Clinical Pharmacologist's Perspective on Penicillin Allergy
Although frequently reported, penicillin allergy is actually uncommon. Penicillins are very effective against a wide variety of infections, and when they can't be used, problems arise. We discussed the problem of penicillin allergy with David Juurlink, MD, PhD, internist and clinical pharmacologist from the University of Toronto. Related Article(s): Evaluation and Management of Penicillin Allergy
Jul 2, 2020
Sample Size Calculation for a Hypothesis Test
One of the most common causes for problems we see in manuscripts at JAMA is an inappropriately calculated study sample size. This seemingly mysterious process is explained by Lynne Stokes, PhD, professor of Statistical Science at Southern Methodist University in Dallas, Texas.
Jun 25, 2020
Understanding Pragmatic Trials
Generalizability of randomized trials is always limited because of the super-selectivity of the patients enrolled in these trials and the very controlled conditions in which clinical care is delivered. Pragmatic trials are performed in order to provide guidance for how to best deliver clinical care in situations that more closely resemble actual clinical scenarios. Hal Sox, MD, director of peer review for the Patient-Centered Outcomes Research Institute (PCORI), explains how these trials work and what clinical questions they answer. Related: Pragmatic Trials: Practical Answers to “Real-world” Questions
Jun 2, 2020
Overview of Depression
Nearly 10% of all patients seen in primary care have depression. Although usually mild, when depression is severe the consequences can be serious. Tom Garrick, MD, professor of Psychiatry at the University of Southern California, discusses the diagnosis and treatment of depression. Related: Drugs for Depression
May 19, 2020
The Effect of Hearing Loss on Cognitive Decline
Even limited hearing loss might be associated with cognitive decline. If true, early intervention with hearing aids might help people have better cognitive performance. Michael Johns III, MD, online editor for JAMA Otolaryngology, speaks with Justin Golub, MD, assistant professor of otolaryngology at Columbia University, whose research has shown that very mild hearing loss can be associated with cognitive disability. Related Article
May 5, 2020
My Father Was Murdered by Terrorists: Recollections of a Trauma Surgeon
When she was a teenager Melissa Red Hoffman's father was killed by terrorists. Dr Hoffman recalls her father's death and how that has influenced her career and how she can identify with patients and their families at the most difficult moments. Read the story: The Sound of Silence—When There Are No Words
Apr 24, 2020
Coronavirus (COVID-19) Update: Ventilatory Management for COVID-Related Respiratory Failure
Management of COVID-19-related respiratory failure differs from what is necessary for ARDS. Rather than having alveolar edema, COVID-19 patients have pulmonary vascular dysregulation. Gas exchange is severely compromised with little reduction in lung compliance. Ventilatory support for COVID-19 patients requires higher than normal tidal volumes with minimal PEEP and allowance for higher than usual serum CO2 levels. How the unique pathophysiology of respiratory failure should be treated is discussed by John J. Marini, MD, professor of medicine at the University of Minnesota.
Apr 14, 2020
Parkinson Disease Information for Patients
More than 6 million people worldwide have Parkinson disease. Even though it is classically associated with tremors, the disease has many manifestations and is very treatable for most patients. Michael S. Okun, MD, from the Department of Neurology at the University of Florida, Gainesville, discusses the pathophysiology, clinical presentation, diagnosis, and treatment of Parkinson disease. Related: Choosing a Parkinson Disease Treatment
Apr 8, 2020
Coronavirus (COVID-19) Update: Reusing Face Masks and N95 Respirators
Shortages of face masks and N95 respirators have forced clinicians and hospitals to reuse these normally disposable items. Ron Shaffer, PhD, former CDC PPE Research Branch Chief, discusses effective sterilization techniques and how to test that the equipment stays protective after sterilization.
Apr 7, 2020
Treating Pediatric Eczema
Eczema is extremely common in children. Most the time it is easily treated with topical steroids but on occasion it requires systemic therapies. JAMA Pediatrics Editor Dimitri Christakis, MD, MPH, and JAMA Network Open Editor Frederick Rivara, MD, MPH, discuss the results of a clinical trial of a new monoclonal antibody intended to improve eczema in children that was published in the January 2020 issue of JAMA Pediatrics. Related: Are Bacteria Transplants the Future of Eczema Therapy? Effect of an Intervention to Promote Breastfeeding on Asthma, Lung Function, and Atopic Eczema at Age 16 Years: Follow-up of the PROBIT Randomized Trial Persistence of Childhood Eczema Into Adulthood Association Between Eczema and Stature in 9 US Population-Based Studies Healthcare Utilization, Patient Costs, and Access to Care in US Adults With Eczema: A Population-Based Study Management of Atopic Dermatitis Anti-IgE Medication Lessens Pediatric Atopic Dermatitis Severity Atopic Eczema
Apr 3, 2020
Coronavirus (COVID-19) Update: Safe Shopping at Stores and Pharmacies
Food and medicine shopping is essential during the COVID-19 pandemic, but requires getting out and standing close to strangers at a time when social distancing and sheltering-in-place are recommended to slow spread of disease. David Aronoff, MD, director of the Division of Infectious Diseases at Vanderbilt University in Nashville, explains how to minimize COVID-19 risk while shopping.
Mar 27, 2020
Coronavirus Disease 2019 (COVID-19) Update: PCR Testing and Shortages
The lack of availability of COVID-19 testing has interfered with the ability to contain the spread of disease. Omai Garner, PhD, laboratory director for Clinical Microbiology in the UCLA health system, explains how PCR testing for COVID-19 works and why testing is in short supply.
Mar 25, 2020
Coronavirus (COVID-19) Update: Lessons Learned From The 2003 SARS Outbreak
In 2003, Toronto was the North American center for Severe Acute Respiratory Syndrome (SARS). The disease spread through the city’s hospitals before anyone knew what was happening. Dr Allison McGeer was a clinician caring for SARS patients and ultimately was infected herself. She describes her experience as a patient and provider and reviews lessons learned that might help others manage their regional COVID-19 outbreaks. Related: Supporting the Health Care Workforce During the COVID-19 Global Epidemic
Mar 25, 2020
Coronavirus Disease 2019 (COVID-19) Update: How the VA Is Preparing
As COVID-19 spreads, clinicians and health systems are struggling to prepare for a surge of patients. Richard Stone, MD, the US Veterans Health Administration's Executive in Charge, spoke with JAMA about how the VA health system is preparing for this public health emergency.
Mar 24, 2020
Coronavirus (COVID-19) Update: Chloroquine/Hydroxychloroquine and Azithromycin
Chloroquine was shown in 2004 to be active in vitro against SARS coronavirus but is of unproven efficacy and safety in patients infected with SARS-CoV-2. The drug's potential benefits and risks for COVID-19 patients, without and with azithromycin, is discussed by Dr. David Juurlink, head of the Division of Clinical Pharmacology and Toxicology at Sunnybrook Health Sciences Centre in Toronto.
Mar 24, 2020
Nonalcoholic Steatohepatitis: The Primary Care Perspective
Nonalcoholic steatohepatitis (NASH) is becoming more frequent as the population becomes more obese. This is not a benign problem, and NASH can ultimately lead to cirrhosis and liver failure. It is thought that NASH will ultimately become the most common cause for liver transplant. NASH is usually diagnosed as an incidental finding, but once found requires careful monitoring and patient counseling. Lisa N. Kransdorf, MD, MPH, from UCLA Health in California, discusses the diagnosis and management of NASH from a primary care clinician's perspective.
Mar 24, 2020
The Diagnosis and Management of Primary Hyperparathyroidism
Hyperparathyroidism is a fairly common disease that causes elevated calcium levels and bone depletion, resulting in fractures and kidney problems. There are medications that can effectively manage hyperparathyroidism, and in some cases surgery is indicated. Michael Yeh, MD, professor and chief of endocrine surgery at UCLA, discusses the management of hyperparathyroidism.
Mar 20, 2020
Coronavirus (COVID-19) Update: Early Safety Signals Around Ibuprofen and Renin-Angiotensin Inhibitors
Emerging information about how SARS-CoV-2 virus infects cells has led to speculation that NSAIDs and ACE inhibitors/angiotensin receptor blockers (ARBs) may worsen clinical disease. Infectious disease physician Carlos del Rio, MD, of Emory University explains the concerns and their clinical implications.
Mar 17, 2020
Nathan Pritikin and His Diet
Nathan Pritikin was a college dropout who became an entrepreneur. While doing research for the government during World War II, he observed that populations that had extremely limited food availability because of the war had substantially reduced mortality from cardiovascular disease—something unexpected at a time when cardiovascular disease was thought to be due to stress. After the war when food became more available CVD death rates went back up, resulting in Pritikin concluding that CVD was related to diet. Pritikin devised his own very low-fat diet that bears his name and the diet is still in use 65 years later. Related: The Pritikin Diet The Lost Lectures from Nathan Pritikin (drmcdougall.com)
Mar 17, 2020
Who Was Nathan Pritikin and Why Is There a Diet Named After Him?
This podcast explains the Pritikin diet to patients. Nathan Pritikin was a college dropout who became an entrepreneur. While doing research for the government during World War II, he observed that populations that had extremely limited food availability because of the war had substantially reduced mortality from cardiovascular disease—something unexpected at a time when cardiovascular disease was thought to be due to stress. After the war when food became more available CVD death rates went back up, resulting in Pritikin concluding that CVD was related to diet. Pritikin devised his own very low-fat diet that bears his name and the diet is still in use 65 years later. Related: The Pritikin Diet The Lost Lectures from Nathan Pritikin (drmcdougall.com)
Mar 15, 2020
COVID-19 in Seattle: Clinical Features and Managing the Outbreak
Seattle was one of the first US cities to have a COVID-19 outbreak, with a cluster of nursing home-related deaths. However, many people who tested positive for the novel coronavirus never became ill, and in some the clinical illness was indistinguishable from influenza. John Lynch, MD, MPH, an infectious disease physician and medical director for infection prevention and control at the Harborview Medical Center, summarizes his hospital’s experience managing the patients and outbreak.
Mar 13, 2020
The Effect of the COVID-19 Pandemic on Clinic Operations
Seattle has been a focal point for the US in the coronavirus pandemic. Doug Paauw, MD, professor of medicine at the University of Washington, in Seattle, describes the UW primary care clinic experience as this pandemic evolved. Major lessons learned included accommodating for significant numbers of staff not available to work in the clinic because of school closures, change in workflow because of shortages of personal protective equipment, physicians having to accommodate very large numbers of patient queries via telephone, email, or electronic health record, and the importance of the rapid development of local ability to test for SARS-CoV-2 independent of public health agencies.
Mar 9, 2020
Update on Coronavirus: March 6, 2020, by NIAID’s Anthony Fauci, MD
Coronovirus (the virus SARS-CoV-2) continues to spread throughout the world. In recent weeks, there has been an increasing number of cases and deaths in the US. As concern about the virus increases, there is an increasing need for accurate information about the disease and how much concern we should have. Anthony Fauci, MD, is the director of the National Institute for Allergy and Infectious Diseases (NIAID) and has been the main spokesperson for the US government about coronavirus. Dr Fauci spoke with JAMA Editor in Chief Howard Bauchner, MD, about where we are as of today with the SARS-CoV-2 epidemic. JAMA Coronavirus Resource Center
Feb 25, 2020
Unprofessional Behavior Leads to Complications
Physicians who act out cause all sorts of problems. Fortunately, only a few clinicians have behavior problems and in the modern era, bad behaviors are not tolerated. Bad behaviors get reported these days and actions are taken against these sorts of clinicians. Clinicians who act out frequently say they are doing so to protect their patients. But are they? William Cooper, MD, MPH, and Gerald B. Hickson, MD, from Vanderbilt University Medical Center in Nashville, Tennessee, discuss a study they published in relating bad behaviors to having more complications of surgical care. Related article: Association of Coworker Reports About Unprofessional Behavior by Surgeons With Surgical Complications in Their Patients
Feb 18, 2020
The 2020 Influenza Epidemic—More Serious Than Coronavirus in the US
Although coronavirus disease 2019 (COVID-19) dominates the news in early 2020, it affects few people in the US. In contrast, at the same time the US is experiencing a severe influenza epidemic, which has caused an estimated 250 000 hospitalizations and 14 000 deaths. Timothy Uyeki, MD, lead for the CDC’s 2019 novel coronavirus response team and Chief Medical Officer of CDC’s influenza division, discusses influenza in the US, how it compares to coronavirus, and what both patients and clinicians should know about this year’s flu season. CDC's Influenza site CDC's Weekly U.S. Influenza Surveillance Report HealthMap Vaccine Finder
Feb 18, 2020
AIDS-Related Chronic Inflammation Leading to Chronic Disease
Great strides have been made in treating HIV, as Anthony Fauci, MD, discusses in this podcast episode. But even substantial viral suppression leaves some virus behind, causing chronic inflammation. Many chronic diseases, including atherosclerotic coronary vascular disease, are worsened by this chronic inflammatory state. Because HIV patients are now living very long lives, they are also developing chronic diseases at a more rapid rate than their non-HIV-infected peers because of this chronic inflammation.
Feb 11, 2020
More than 6 million people worldwide have Parkinson disease. Even though it is classically associated with tremors, the disease has many manifestations and is very treatable for most patients. Michael S. Okun, MD, from the Department of Neurology at the University of Florida, Gainesville, discusses the pathophysiology, clinical presentation, diagnosis, and treatment of Parkinson disease. Related article: Parkinson Disease AMA Manual of Style
Feb 11, 2020
Testing for Breast Cancer Susceptibility Genes
Breast cancer is a leading cause of death in women. Some women have a cancer susceptibility gene known as BRCA, and women should be tested for BRCA under some circumstances. Carol Mangione, MD, division chief of General Internal Medicine and Health Services Research at UCLA, discusses when testing is appropriate, and Ranjit Manchanda, MD, PhD, from Barts Cancer Institute in London, UK, discusses the cost-effectiveness of BRCA screening for women who have had breast cancer.
Feb 4, 2020
Management of Chronic Stable Angina in 2020
Controversy exists regarding how to best manage chronic stable angina. Intuitively, it seems that because it is usually caused by coronary artery lesions, addressing those lesions either via percutaneous coronary angiography or coronary artery bypass operations would be the best way to manage this problem. Several studies have suggested that this is not the case and that results of these interventions are no better than optimal medical management. Recently, a very large trial examining this clinical question has provided results suggesting that any approach works about the same. We interviewed Donald Lloyd-Jones, MD, chair of the department of preventive medicine at Northwestern University, during the recent American Heart Association meeting about this issue. Related articles: Baseline Characteristics and Risk Profiles of Participants in the ISCHEMIA Randomized Clinical Trial Does This Patient With Chest Pain Have Acute Coronary Syndrome?: The Rational Clinical Examination System…
Feb 4, 2020
Treating Conjunctivitis and Dry Eye Disease
Conjunctivitis and dry eye disease are some of the most common conditions patients present with. They are usually benign entities that respond well to conservative measures and usually don’t require medications. However, if medications are necessary, clinicians can find a comprehensive assessment of these drugs recently published in the December 2, 2019, issue of The Medical Letter. An excerpt from this article summarizing information about conjunctivitis and dry eye disease was published in the February 4, 2020 issue of JAMA. Kathryn Colby, MD, PhD, chair of the Department of Ophthalmology & Visual Science at the University of Chicago, explains in this podcast how to treat conjunctivitis and dry eye disease.
Jan 30, 2020
2019 Novel Coronavirus: An Update From NIAID Director Anthony Fauci, MD
A new virus known as the 2019 novel coronavirus (2019-nCoV) is rapidly spreading through China. The rapid spread and severity of this illness are worrisome and the possibility that it develops into a pandemic is very real. Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, provides an update on this new disease.
Jan 29, 2020
Football Players and Erectile Dysfunction Associated With Repetitive Head Injury
American football is a dangerous sport and is characterized by violent contact between people that often leads to repetitive head injury. A multitude of health effects may result from this sort of head injury, but a new finding reported in the December issue of JAMA Neurology maintains that football players are at risk for developing low testosterone levels and erectile dysfunction. Rachel Grashow, PhD, from Harvard T.H. Chan School of Public Health and the Football Players Health Study at Harvard Medical School discusses the findings regarding the relationship between head injury and erectile dysfunction.
Jan 28, 2020
The Keto, Atkins, and Pritikin Diets
There are many named diets that receive a great deal of attention. But what are they and do they work? David Heber, MD, PhD, from the UCLA Center for Human Nutrition explains these diets. Related articles: Ketogenic Diets (Patient Page) Interest in the Ketogenic Diet Grows for Weight Loss and Type 2 Diabetes Comparison of Weight Loss Among Named Diet Programs in Overweight and Obese Adults: A Meta-analysis
Jan 28, 2020
The Keto Diet: Advice for Patients
The keto diet is very popular and involves eating very few carbohydrates, a fair amount of fat, and normal amounts of protein. It is one of many ways to lose weight. David Heber, MD, formerly the chair of Clinical Nutrition at UCLA, explains the keto diet. Related article: Ketogenic Diets
Jan 21, 2020
The American Heart Association Takes a Stance Against e-Cigarettes
e-Cigarettes are dangerous, but the public has been falsely led to believe that they are safe. Because of this misconception and the inherent dangers, the American Heart Association (AHA) has taken an aggressive stance to educate the public about e-cigarettes, especially their use by kids. Rose Marie Robertson, MD,deputy chief science and medical officer for the AHA, spoke to JAMA about e-cigarettes and the frightening increase in their use among kids. Read the article: The American Heart Association Takes on Vaping
Jan 14, 2020
An Inconvenient Tooth
Animal bites can be a cause of significant injury and on occasion, fatalities. In this episode, JAMA Fishbein Fellow Angel Desai, MD, MPH discusses the prevention, treatment, and epidemiological oddities of animal bites with Dr Sandra Nelson, Assistant Professor of Medicine at Massachusetts General, Dr Justin Hensley from Children’s Hospital of San Antonio, and others. Desai also talks prevention and risk of rabies acquisition with Dr Catherine Brown, state epidemiologist and public health veterinarian from the Massachusetts Department of Public Health.
Dec 19, 2019
NICE Guidelines for Heavy Menstrual Bleeding: What to Make of Them
The UK’s National Institute for Health and Care Excellence (NICE) recently issued guidelines for how to manage heavy menstrual bleeding. Guidelines only provide guidance and they must be interpreted for an individual patient's clinical context. Andrew Kauntiz, MD, professor and associate chair in the department of obstetrics and gynecology, University of Florida College of Medicine in Jacksonville, an expert in this topic, discusses these new NICE guidelines and how clinicians should use them. Read the article: Assessment and Management of Heavy Menstrual Bleeding
Dec 10, 2019
The Medical and Political Response to the 2019 Christchurch Mosque Mass Shooting
On March 15, 2019, a lone gunman walked into 2 mosques within minutes of each other in Christchurch, New Zealand, and opened fire with semiautomatic weapons, killing 51 and wounding many more. We spoke to Greg Robertson, MB ChB, the surgeon who coordinated the medical response to this mass casualty event. Robertson talks about what his hospital had to do to manage all these casualties and also how New Zealand quickly changed its laws to restrict the availability of weapons used for these sorts of attacks.
Nov 25, 2019
What Do I Need to Know About e-Cigarettes and If They Help People Stop Smoking?
Electronic cigarette (e-cigarette) use, otherwise known as “vaping,” has been increasing since 2010. This podcast reviews research on the epidemiology and possible adverse health effects of e-cigarette and nicotine use, and the pitfalls associated with using e-cigarettes as a method to stop smoking. These issues are discussed by Suchitra Krishnan-Sarin, PhD, a professor with the Department of Psychiatry at Yale University School of Medicine, and JAMA Associate Editor George O’Connor, a professor of medicine at Boston University. Related article: e-Cigarette Use Among Youth in the United States, 2019
Nov 18, 2019
The Underappreciated Problem of Cardiac Disease in Women
Barbra Streisand and Noel Bairey Merz, MD, director of the Streisand Women’s Heart Center at Cedars-Sinai in Los Angeles, California, discuss the problem of cardiovascular disease in women and especially coronary microvascular disease, which causes an unusual presentation of cardiac ischemic disease in women.
Nov 12, 2019
Review of Atrial Fibrillation Treatment
Atrial fibrillation is a very common problem that is treated with a variety of medications and interventions. Sandip Mukherjee, MD, a contributing editor to The Medical Letter, is the Medical Director of Physician Liaison Services with the Office of the Chief Medical Officer at Yale New Haven Hospital, and an associate professor of medicine at Yale. He summarizes the latest information published in The Medical Letter on treatments for atrial fibrillation.
Nov 6, 2019
Influenza Vaccination in 2019-2020
Winter is coming…and with it, the onset of flu season. In this episode, Jean-Marie Pflomm, PharmD, Editor in Chief of The Medical Letter, decodes flu vaccines: trivalent vs quadrivalent, live attenuated vs inactivated, and much more.
Nov 5, 2019
How Adolescent Boys’ Need for Friendship Affects Their Mental Health
Adolescent boys are notoriously difficult to deal with. However, some of their behaviors mask a need they have for developing intimate friendships. Being adolescent boys living in a macho culture, many deny that they need these relationships. Niobe Way, EdD, professor of Developmental Psychology at New York University, has spent her professional career studying adolescent boys’ relationships with each other and how they affect their behaviors. She explains how to intervene to help them better understand their needs for intimacy, which, in turn, helps them to better relate with people and avoid unpleasant behaviors. Related article: Loneliness Might Be a Killer, but What’s the Best Way to Protect Against It? CME Quiz The Listening Project