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JAMA Clinical Reviews
Author interviews that explore the latest clinical reviews.
4 days ago
Diagnosis and Management of Headache, Part 2
Headache disorders are one of the most common reasons patients visit emergency rooms and medical offices. Matthew S. Robbins, MD, associate professor of neurology and neurology residency program director at Weill Cornell and New York Presbyterian Hospital, discusses effective migraine treatment approaches. Related Content: Diagnosis and Management of Headache
6 days ago
Diagnosis and Management of Headache, Part 1
Headache is one of the most common reasons patients visit emergency rooms and medical offices. Matthew S. Robbins, MD, associate professor of neurology and neurology residency program director at Weill Cornell and New York Presbyterian Hospital, discusses the diagnostic approach to headache with a focus on distinguishing migraine from other primary headache disorders. Related Content: Diagnosis and Management of Headache
May 4, 2021
Chronic Stable Angina—Diagnosis and Treatment
Chronic stable angina reduces quality of life and only rarely leads to acute coronary syndrome (ACS). Treatment is lifestyle modification to manage atherosclerotic risk factors, with revascularization (eg, PCI or CABG) indicated to reduce symptoms and improve quality of life only once medical therapy is maximized. James De Lemos, MD, professor of medicine in the division of cardiology at UT Southwestern Medical Center, summarizes these and other aspects of chronic stable angina management. Related Content: Diagnosis and Management of Stable Angina
Apr 27, 2021
USPSTF Recommendation: Screening for Hypertension in Adults
Interview with John B. Wong, MD, USPSTF member and coauthor of USPSTF Recommendation: Screening for Hypertension in Adults Related Content: * Screening for Hypertension in Adults * The 2021 USPSTF Recommendation on Blood Pressure Screening * USPSTF Recommendation: Screening for Hypertension in Adults * USPSTF Recommendation Statement on Hypertension Screening in Adults * Hypertension Screening Recommendation and Racial/Ethnic Disparities in Blood Pressure Control * USPSTF Recommendations for Screening for Hypertension in Adults * Patient Information: Screening for Hypertension in Adults * The Surgeon General's Call to Action to Control Hypertension * Hypertension, Obesity, and COVID-19
Apr 20, 2021
Dual Antiplatelet Therapy After Acute Coronary Syndrome
Dual antiplatelet therapy, typically aspirin and an oral P2Y12 receptor inhibitor (clopidogrel, prasugrel, ticagrelor, cangrelor), reduces adverse events after acute coronary syndrome (ACS) but choice of agent and optimal duration may be patient-specific. Umair Khalid, MD, a cardiologist at the Baylor School of Medicine in Houston, discusses how to use these agents in management of ACS. Related Article(s): Oral Antiplatelet Therapy After Acute Coronary Syndrome
Apr 13, 2021
Space Travel and Human Health, Part 2
Interest in space travel has increased since SpaceX’s first commercial launch to the International Space Station (ISS) in May 2020 and with efforts to send humans to Mars. Serena Auñón-Chancellor, MD, MPH, a physician-astronaut who completed a 6-month mission to the ISS in 2018 and is associate professor of clinical medicine at LSU Health Sciences Center in Baton Rouge and associate program director for the Aerospace Medicine Residency Program at University of Texas Medical Branch (UTMB) in Galveston, discusses how the human body and mind adapt to life in space. Related Content: Do Apollo Astronaut Deaths Shine a Light on Deep Space Radiation and Cardiovascular Disease?
Apr 6, 2021
Space Travel and Human Health, Part 1
Interest in space travel has increased since SpaceX’s first commercial launch to the International Space Station in May 2020 and with efforts to send humans to Mars. Jim Bagian, MD, a physician-astronaut who logged 337 hours in space between 1989 and 1991, is director of the Center for Healthcare Engineering and Patient Safety at the University of Michigan and discusses the effects of space travel on the human body and physiologic readjustments on return to earth. Related Content: Do Apollo Astronaut Deaths Shine a Light on Deep Space Radiation and Cardiovascular Disease?
Apr 1, 2021
Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke
Shyam Prabhakaran, MD, chairman of neurology at the University of Chicago, discusses the diagnosis and evaluation of patients who present with transient ischemic attack (TIA) and stroke. Related Article: Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke
Mar 23, 2021
Semaglutide for Weight Loss
Semaglutide has recently been shown to induce clinically significant weight loss in patients with obesity that is sustained for as long as the drug is given. Tom Wadden, PhD, from the University of Pennsylvania, discusses results from the series of recent STEP trials and how they compare to the effects of other medications used to treat obesity. Related Articles: Effect of Subcutaneous Semaglutide vs Placebo as an Adjunct to Intensive Behavioral Therapy on Body Weight in Adults With Overweight or Obesity Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity
Mar 9, 2021
A Simple Way to Understand Statistical Multiple Comparison Procedures
Performing repeated statistical comparisons on data can result in false-positive findings. Jing Cao, PhD, associate professor of statistics at Southern Methodist University, explains problems that can arise from multiple testing procedures and how to avoid making false conclusions. Related Article: Multiple Comparison Procedures
Mar 2, 2021
Irritable Bowel Syndrome—Diagnosis and Treatment
Irritable bowel syndrome (IBS) is a clinical syndrome of vague abdominal pain and cramping associated with diarrhea or constipation. IBS is a diagnosis of exclusion, and a variety of treatments can improve its symptoms. Michael Camilleri, MD, professor of medicine at the Mayo Clinic, discusses recent advances in the diagnosis and management of IBS. Related Content: Diagnosis and Treatment of Irritable Bowel Syndrome
Feb 26, 2021
Advance directives (ADs) allow patients to express their medical treatment preferences. Patients with ADs are more likely to receive medical care concordant with their wishes and are less likely to die in the hospital than patients without them, but use remains low in the US. Maria Silvera, MD, a palliative care physician and associate professor of medicine at the University of Michigan, and Catherine Auriemma, MD, a fellow in pulmonary/critical care medicine at the University of Pennsylvania, discuss the importance of ADs and strategies to increase their uptake. Related Article: Completion of Advance Directives and Documented Care Preferences During the Coronavirus Disease 2019 (COVID-19) Pandemic
Feb 26, 2021
Coronavirus Vaccines—An Overview
The Pfizer-BioNTech and Moderna COVID-19 mRNA vaccines are the first of many being tested for widespread use. Buddy Creech, MD, MPH, director of the Vanderbilt Vaccine Research Program, reviews these and other vaccines likely to become available, including products that use inactivated, protein subunit, and viral vector immunization strategies. Related Content: SARS-CoV-2 Vaccines
Feb 24, 2021
Vaccinating Nursing Home and Long-term Care Facility Residents for Coronavirus
The CDC coordinated a massive effort to immunize nearly all nursing home and long-term care facility residents in the US against COVID-19 infection in the month after vaccine approval. Ruth Link-Gelles, PhD, MPH, CDC staff epidemiologist and Lieutenant Commander of the US Public Health Service Commissioned Corps, describes how. Related Article(s): * First-Dose COVID-19 Vaccination Coverage Among Skilled Nursing Facility Residents and Staff * Nursing Homes’ Next Test—Vaccinating Workers Against COVID-19
Feb 23, 2021
Diagnosis and Treatment of Multiple Sclerosis—A Review
Highly effective B-cell therapies like rituximab and ofatumumab have changed the outlook for patients with multiple sclerosis (MS). Alexander Rae-Grant, MD, emeritus professor of neurology at the Cleveland Clinic Lerner College of Medicine, discusses recent advances in the diagnosis and treatment of MS. Related Article(s): * Diagnosis and Treatment of Multiple Sclerosis * Progress in Multiple Sclerosis Research
Feb 23, 2021
Structural Racism for Doctors—What Is It?
This is Dr Howard Bauchner, Editor in Chief of JAMA and the JAMA Network. The podcast on structural racism based on the discussion between Dr Ed Livingston and Dr Mitch Katz has been withdrawn. Comments made in the podcast were inaccurate, offensive, hurtful, and inconsistent with the standards of JAMA. Racism and structural racism exist in the US and in health care. After careful consideration, I determined that the harms caused by the podcast outweighed any reason for the podcast to remain available on the JAMA Network. I once again apologize for the harms caused by this podcast and the tweet about the podcast. We are instituting changes that will address and prevent such failures from happening again.
Feb 10, 2021
Mask Wearing for COVID-19 Prevention—Summary of CDC Data
Natural experiments comparing coronavirus spread on ships and in hair salons with vs without face masks point to the importance of wearing masks for curbing SARS-CoV-2 spread. John T. Brooks, MD, chief medical officer of the CDC’s COVID-19 response team, reviews recently published epidemiologic data that reinforce the role of mask use for pandemic control. Related Article: Effectiveness of Mask Wearing to Control Community Spread of SARS-CoV-2
Feb 9, 2021
Osteoarthritis—Diagnosis and Treatment
Philip Cohen, MD, associate clinical professor of internal medicine at UCLA, a primary care internist who also specializes in sports medicine, discusses the primary care management of osteoarthritis. Related Articles: * Drugs for Osteoarthritis * Diagnosis and Treatment of Hip and Knee Osteoarthritis
Feb 2, 2021
Management of Immunotherapy-Related Toxicities
Immune checkpoint inhibitors have been a major breakthrough in cancer treatment but can have many serious adverse effects. Pankti Reid, MD, MPH, assistant professor of medicine in rheumatology at the University of Chicago, discusses the pathogenesis, diagnosis, and treatment of toxicities from immune checkpoint inhibitors as outlined by the 2019 NCCN guidelines. Related Article: Management of Immunotherapy-Related Toxicities in Patients Treated With Immune Checkpoint Inhibitor Therapy
Jan 26, 2021
Acute Pancreatitis Part 2 of 2: Treatment
Howard Reber, MD, emeritus professor of surgery at UCLA, discusses how to treat acute pancreatitis. Related Article(s): Acute Pancreatitis
Jan 26, 2021
Acute Pancreatitis Part 1 of 2: Diagnosis
Howard Reber, MD, emeritus professor of surgery at UCLA, discusses how to diagnose acute pancreatitis. Related Article(s): Acute Pancreatitis
Jan 22, 2021
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
Jan 19, 2021
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
Oct 22, 2019
Emerging Applications for Ketamine
Even though it gained notoriety for recreational uses, Ketamine is experiencing a resurgence in clinical settings given its versatility and potential applications, including for pain treatment and depression. David Juurlink, MD, from Sunnybrook Health Sciences Center and John Krystal, MD from Yale University discuss current and emerging applications of this drug.
Oct 8, 2019
Understanding Lipids and Cardiovascular Risk Through Mendelian Randomization
Mendelian randomization is a powerful technique that enables investigators to mimic randomized clinical trials by characterizing genetic differences between groups of people and studying their clinical outcomes. Brian A. Ference, MD, MPhil, from the University of Cambridge in England, is a leading expert on this topic and spoke with us about how mendelian randomization has facilitated a better understanding of lipid biology and how it relates to cardiovascular risk.
Oct 8, 2019
Pancreatic cancer is the third most common cause of cancer death in the United States. Timothy Donohue, MD, chief of surgical oncology at the University of California, Los Angeles, provides an overview of the disease. Read the articles: Screening for Pancreatic Cancer Pancreatic Cancer
Oct 7, 2019
Personal Protective Equipment for Health Care Infection Control
Personal protective equipment comprises gloves, gowns, masks, regular respirators, and powered air purifying respirators (PAPRs). In this Clinical Review podcast Trish Perl, MD, of UT Southwestern Medical Center reviews the indications for each and the results of the RESPECT trial, which reported no difference in incidence of laboratory-confirmed influenza among health care personnel randomized to wear N95 respiratory or medical masks. She’s interviewed by JAMA Fishbein fellow Angel Desai, MD.
Oct 6, 2019
Improving Uptake of Preexposure Prophylaxis (PrEP) for HIV in Primary Care
JAMA Fishbein Fellow Angel Desai, MD interviews Douglas S. Krakower, MD at the IDWeek 2019 conference in Washington, D.C. Related article: Rising PrEP Awareness
Oct 5, 2019
Update in Clinical Infectious Diseases 2019-2020
This Clinical Review podcast reviews some of the most important advances in clinical infectious diseases presented at IDWeek 2019 including data on rapid testing, new antimicrobial agents, and new strategies for using existing antibiotics to manage antimicrobial resistance. JAMA Fishbein Fellow Angel Desai, MD interviews Helen Boucher, MD of Tufts University.
Sep 10, 2019
A New Path for Gun Research Funding
Since the passage of the Dickey Amendment in 1996, federal funding for gun violence research has been withheld from the CDC and other federal agencies that should be tasked with figuring out the origins and solutions to this problem. But while the US government has been locked in a political stalemate, other entities are stepping up in a new model for getting the job done.
Sep 3, 2019
Bariatric Surgery and Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity
JAMA Deputy Editor Ed Livingston, MD, interviews Steven Nissen, MD, at the European Society of Cardiology's 2019 conference in Paris, France.
Sep 2, 2019
Management of Heart Failure in 2019-2020, Part 2
JAMA Deputy Editor Ed Livingston, MD, interviews James Januzzi, MD, at the European Society of Cardiology's 2019 conference in Paris, France.
Sep 2, 2019
Management of Heart Failure in 2019-2020, Part 1
JAMA Deputy Editor Ed Livingston, MD, interviews Akshay Desai, MD, at the European Society of Cardiology's 2019 conference in Paris, France.
Aug 20, 2019
The Influence of Obesity on Cancer
Jennifer A. Ligibel, MD, from the Dana-Farber Cancer Institute and Harvard Medical School, Boston, explains how obesity influences the risk of developing cancer and how it influences the prognosis of existing cancer.
Aug 6, 2019
Responsible Use of Opioids to Treat Cancer Pain
Dr. Eduardo Bruera, Chair of the Department of Palliative Care at MD Anderson, discusses how to responsibly manage cancer pain using opioids.
Jul 22, 2019
Menopause is inevitable for women. It symptoms are uncomfortable and distressing. For women to best cope with menopause, it is useful to firmly establish the onset so that appropriate counseling can follow. In this podcast, an expert in this field, Nanette Santoro, MD, from the University of Colorado, explains how to diagnose menopause. Read the article: Diagnosing the Onset of Menopause
Jul 16, 2019
Guns and Suicide
Using firearms to commit suicide is one of the most common causes of firearm related deaths. This can happen even in families where it seems highly unlikely to occur. In this podcast, we tell the story of a policeman’s daughter who got a hold of his gun and tried to kill herself.
Jul 9, 2019
Subclinical hypothyroidism is common, but it is not clear how best to treat it. Anne R. Cappola, MD, ScM, professor of medicine at the University of Pennsylvania, explains how to manage this important clinical condition. Read the article: Subclinical Hypothyroidism: A Review
Jul 2, 2019
The Clinical Ramifications of Dense Breasts
There are now 36 states and recent federal legislation that require that clinicians inform women about breast density results from mammography. Consequently, clinicians must be aware of the clinical ramifications of dense breasts and what to do about them when found. Karla Kerlikowske, MD, from UCSF explains the risks associated with dense breasts and how to manage patients who have them. CME will be available on July 2 when the print/online issue of JAMA is published.
Jul 2, 2019
California’s Attempt to Improve Measles Vaccination Rates
California enacted 3 aggressive laws between 2014 and 2016 in an effort to improve measles vaccination rates. To a large extent these laws were effective in increasing vaccination rates, but some of the improvements were offset by clinicians granting inappropriate medical exemptions for vaccinations. S. Cassandra Pingali, MPH, MS, and Saad B. Omer, MBBS, MPH, PhD, from the Department of Epidemiology at Emory University, Atlanta, Georgia, discuss measles and what happened in California when legislators tried to improve measles vaccination rates. CME will be available on July 2 when the print/online issue of JAMA is published.
Jun 25, 2019
Reducing the Intensity of Antiplatelet Therapy Following Coronary Stent Procedures
A conversation with Greg Curfman, MD, JAMA Deputy Editor and a cardiologist, who reviews 2 new studies showing that a short duration of dual antiplatelet therapy may not result in more myocardial ischemic events. Read the article: Effect of 1-Month Dual Antiplatelet Therapy Followed by Clopidogrel vs 12-Month Dual Antiplatelet Therapy on Cardiovascular and Bleeding Events in Patients Receiving PCI: The STOPDAPT-2 Randomized Clinical Trial
Jun 11, 2019
The Gabby Giffords Shooting
Over the span of less than a minute, a gunman with a history of mental health issues turned a Safeway parking lot into the scene of a mass shooting, killing 6 and wounding 13 in 20 seconds. In this inaugural episode of the In Our Lane podcast series, we hear the stories of the survivors who wrestled the gunman to the ground and treated the injured during the wait for first responders.
Jun 4, 2019
Abnormal Uterine Bleeding
Andrew M. Kaunitz, MD, from the Department of Obstetrics and Gynecology at the University of Florida, Jacksonville, explains how to diagnose and treat various patterns of abnormal uterine bleeding. Read the article: Abnormal Uterine Bleeding in Reproductive-Age Women
May 30, 2019
Menopausal Hormone Therapy
Jan L. Shifren, MD, from the department of obstetrics and gynecology, Massachusetts General Hospital, and Harvard Medical School discusses menopausal symptoms such as hot flashes and how they can be effectively treated by the administration of hormones when given appropriately. Read the article: Menopausal Hormone Therapy CME will be available on June 25 when this article appears in the print edition of JAMA.
May 28, 2019
Cervical Cancer Screening
George F. Sawaya, MD, professor of obstetrics and gynecology at the University of California, San Francisco, discusses cervical cancer screening in the modern era. Read the article: Cervical Cancer Screening: More Choices in 2019 Read the transcript
May 7, 2019
Treating Nonmetastatic Breast Cancer in 2019
Breast cancer outcomes continue to improve. Treatments for the disease are very effective and continually evolving. We spoke with Patricia A. Ganz, MD, from UCLA about what is new in breast cancer treatment. Read the article here.
May 7, 2019
JAMA Women's Health Series Introduction by Dr Carolyn Crandall
Dr Carolyn Crandall, professor of medicine at the David Geffen School of Medicine at UCLA and JAMA Associate Editor, introduces JAMA's new series of articles on women's health.
Apr 9, 2019
Beyond the Rhetoric: Gun Control That Works, Part 3
Congressman Mike Thompson chairs the US House Gun Violence Prevention Taskforce. He spoke with us about what the House has done to address gun violence and what you can do to help them see necessary legislation make it into law. We also talk with Joshua Sharfstein, MD, about strategies that can be undertaken by the physician community to reduce gun violence.
Apr 2, 2019
How to Reduce Maternal Mortality Rates in the United States
Maternal mortality rates in most of the United States are high. These rates were successfully lowered in the United Kingdom and also in California. Many of these deaths are preventable. In this podcast we interview Elizabeth A. Howell, MD, MPP, from the Icahn School of Medicine at Mt Sinai in New York, who explains the relatively simple ways to address this problem. See related article.
Mar 26, 2019
Beyond the Rhetoric: Gun Control That Works, Part 2
Almost nothing is more controversial than gun control in the United States. Yet while passions flare and legislators posture but do little, deaths from gun violence are all too common. Almost every proposal put forward to address gun violence eventually fails. Seemingly, the Second Amendment stops any attempt to control guns. Despite this, there have been commonsense approaches to reducing gun violence that have been very effective in some communities. How gun violence has been managed in these communities is reviewed in this podcast with JAMA author April M. Zeoli, PhD, MPH, from the School of Criminal Justice at Michigan State University, Lansing. Part 2 of 3.
Mar 15, 2019
Update on Atrial Fibrillation: Review of the New AHA/ACC/HRS Treatment Guidelines
Cardiologist and JAMA Deputy Editor Greg Curfman, MD, discusses the many changes in the new AHA/ACC/HRS atrial fibrillation guidelines with University of Chicago cardiologists Gaurav Upadhyay, MD, and Francis Alenghat, MD, PhD. Major changes include recommendations for the use of various agents for anticoagulation, catheter ablation, and left atrial appendage occlusion. Read the article: Management of Patients With Atrial Fibrillation Index of content: 2:19 Summary of the new ACC/AHA Atrial Fibrillation Guideline 8:04 Cost and efficacy of NOACs used to treat atrial fibrillation 11:42 Preference for specific NOACs 14:00 Rate vs rhythm control 20:00 How catheter ablation is performed 26:20 Anticoagulation requirements following ablation 31:23 How to achieve rate control 32:25 Left atrial appendage occlusion devices 36:29 New lifestyle recommendation 37:44 More about rate vs rhythm control
Mar 12, 2019
Beyond the Rhetoric: Gun Control That Works, Part 1
Almost nothing is more controversial than gun control in the United States. Yet while passions flare and legislators posture but do little, deaths from gun violence are all too common. Almost every proposal put forward to address gun violence eventually fails. Seemingly, the Second Amendment stops any attempt to control guns. Despite this, there have been commonsense approaches to reducing gun violence that have been very effective in some communities. How gun violence has been managed in these communities is reviewed in this podcast with JAMA author April M. Zeoli, PhD, MPH, from the School of Criminal Justice at Michigan State University, Lansing.
Feb 26, 2019
Is It Safe? What Happens When Your Surgeon Is Not Actually Doing Some of Your Operation?
Great controversy exists regarding the safety of surgery when the attending surgeon allows someone else to perform parts of the operation. These practices are necessary components of surgical training, but how safe this is for patients remains unknown. In this podcast we discuss the risks and benefits associated with overlapping and concurrent surgery with a recognized expert in this topic, Michelle M. Mello, JD, PhD, a professor of law at Stanford University and the Department of Health Research and Policy, Stanford University School of Medicine, California.
Feb 26, 2019
COPD: All You Need to Know in 20 Minutes
COPD is common enough that it is responsible for 3% of all clinic visits in the United States. Clinicians will undoubtedly deal with this disease in their practice. How to diagnose and manage it is reviewed by Frank C. Sciurba, MD, a professor of medicine from the University of Pittsburgh, Pennsylvania.
Feb 14, 2019
Next Generation Sequencing of Infectious Pathogens in Public Health and Clinical Practice
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 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.
Feb 12, 2019
Can I Believe the Results From Observational Studies? Using E-Values That Anyone Can Calculate for Evaluating the Risk of Confounding
E-values are a new tool that enables investigators to estimate the likelihood that some unmeasured confounder might overcome seemingly positive results. They are very easy to calculate and any reader of the medical literature can do this calculation to get a sense for how likely it is that there is some unmeasured factor in an observational study that might negate otherwise seemingly positive findings. Read the article: Using the E-Value to Assess the Potential Effect of Unmeasured Confounding in Observational Studies E-Value Calculator
Jan 29, 2019
Finding a Serious Arrhythmia Using a Watch
Saved by a Fitbit. Technology is developing at a pace far exceeding its application in medical care. An exception is in consumer devices, which as long as they do not hold themselves out as diagnostic tools, can apply as many technologies to wearable devices as companies want to put into them. In this episode we discuss how a clinician used a wearable device to diagnose his father's rapid heart rates consistent with dangerous cardiac arrhythmias. Read the article: Wearable Devices for Cardiac Rhythm Diagnosis and Management
Jan 22, 2019
Screening for Breast Cancer: Is It Worth It?
Breast cancer screening is debated passionately among those who advocate for very aggressive screening and other experts who believe that screening can be harmful. The arguments for all sides of the debate are best understood by knowing the numbers of women who will benefit or be harmed by breast cancer screening. Both sides of the debate are explained in this podcast by Nancy Keating, MD, and Lydia Pace, MD, both from the Brigham and Women's Hospital and Harvard Medical School in Boston.
Jan 15, 2019
Major Societies Agree – A New Approach to Penicillin Allergy Is Needed
Very few people who think they are allergic to penicillin actually are. Yet, even if someone reports a remote and vague history of penicillin allergy, these very useful medications will not be given. This forces many patients to use antibiotics that may be too broad spectrum, not very effective, or expensive. Three major societies have come together to agree on an approach for assessing if penicillin allergy is really present when a patient reports an allergy to these medications. Erica S. Shenoy, MD, PhD, from Massachusetts General Hospital in Boston, author of a JAMA review on the topic, discusses this very important problem. Read the article: Evaluation and Management of Penicillin Allergy: A Review
Dec 21, 2018
Medical Emergencies While Flying
When flying and they call "Is there a licensed medical professional on board," should physicians respond? If so, what should they do? Are they liable if things go wrong? We interview Christian Martin-Gill, MD, MPH, Department of Emergency Medicine, University of Pittsburgh, who is an expert on in-flight emergencies and authored a JAMA review on the topic.
Dec 11, 2018
Bayes for Clinicians Who Need to Know but Don’t Like Math
The statistical concept of Bayes comes up in clinical medicine all the time. It simply means that what you know about something factors into how you analyze it. This contrasts with the commonly used statistical approach called frequentist analysis of hypothesis testing, in which it is assumed that every situation is unique and not influenced by the past. Bayesian analysis accounts for how prior information gets factored into decision making and is important to understand when applying clinical research findings to the delivery of medical care. In this interview Anna E. McGlothlin, PhD, senior statistical scientist at Berry Consultants in Austin, Texas, explains these concepts for clinicians. Read the article: Bayesian Hierarchical Models
Nov 20, 2018
Battle of the Heart Societies, Part 2: Who Is Right – the US or Europe Regarding How to Manage Hypertension? Their Differences
Within the last 2 years, major guidelines have been issued from US-based and European organizations that differ in their recommendations for the diagnosis and treatment of hypertension. Experts from both sides of the Atlantic--Paul Whelton, MD, from the United States and Bryan Williams, MD, from Europe--discuss the similarities and differences in these guidelines and the basis for the differences. They were interviewed by JAMA editors Greg Curfman, MD, and Ed Livingston, MD. Part 1 [LINK] of this 2-part series, reviewed the similarities between the 2 guidelines and discussed issues regarding how to best treat hypertension in elderly individuals. In this Part 2 episode, the differences between the guidelines are reviewed and how clinicians should use this information to treat patients is presented. See also the JAMA website on hypertension guidelines at https://sites.jamanetwork.com/jnc8/.
Nov 13, 2018
A Family’s Struggle With Alcoholism
What is it like to go through alcohol withdrawal at home? What is it like for a mother to sit by her son's side while he goes through withdrawal and supporting him? Why does someone who doesn't have any particular reason to drink misuse alcohol? The answers to these questions can be found by listening to a narrative from one patient and his mother about his descent into alcohol misuse, his experiences with withdrawal, and his eventual overcoming of a dreadful alcohol addiction. Read the article: Will This Hospitalized Patient Develop Severe Alcohol Withdrawal Syndrome?: The Rational Clinical Examination Systematic Review
Nov 6, 2018
Battle of the Heart Societies: Who Is Right – the US or Europe Regarding How to Manage Hypertension?
Within the last 2 years, major guidelines have been issued from US-based and European organizations that differ in their recommendations for the diagnosis and treatment of hypertension. Experts from both sides of the Atlantic—Paul Whelton, MD, from the United States (Tulane University, New Orleans, Louisiana) and Bryan Williams, MD, from Europe (University College London in England)—discuss the similarities and differences in these guidelines and the basis for the differences. They were interviewed by JAMA editors Greg Curfman, MD, and Ed Livingston, MD.
Oct 23, 2018
Observations From ICU Patients We Thought Were Asleep, but Were Not
What if the patient you are managing in the ICU is not asleep when you thought they were? Patients relate their very disturbing stories about what they experienced while in an ICU and their treating clinicians thought they were asleep.
Oct 16, 2018
An Update on the Diagnosis and Treatment of Venous Thromboembolic Disease
Venous thromboembolic disease is common. There are many steps necessary to establish a diagnosis or treat this disease. These are summarized in this JAMA Clinical Reviews podcast and interview with Philip S. Wells, MD, from the Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada, and author of a recent JAMA review on the topic.
Oct 2, 2018
Alcohol Withdrawal Syndrome
Alcohol withdrawal is a serious problem that can lead to mortality. How to predict if it will occur when a patient who is misusing alcohol is admitted to the hospital is challenging. This Rational Clinical Examination article reports results of a systematic review of the literature to determine the best way to predict the occurrence of alcohol withdrawal. Read the article: Will This Hospitalized Patient Develop Severe Alcohol Withdrawal Syndrome?: The Rational Clinical Examination Systematic Review
Sep 25, 2018
Treating Appendicitis Without Surgery – 5-Year Follow-up From a Randomized Clinical Trial of Antibiotic Treatment
In 2015, JAMA published results of a randomized clinical trial showing that antibiotic treatment for acute appendicitis was feasible. Doubters of the efficacy of antibiotics for treating appendicitis were concerned about what the long-term recurrence rate would be for those patients treated without surgery. The 5-year results of the study are now presented, showing that only about 40% of patients treated with antibiotics ultimately go on to have an appendectomy. Read the article: Five-Year Follow-up of Antibiotic Therapy for Uncomplicated Acute Appendicitis in the APPAC Randomized Clinical Trial
Sep 18, 2018
Treating Lyme Disease in 2018, Part 2
There are new findings about another form of Borrelia: Borrelia miyamotoi. This form of Borrelia causes a relapsing fever but is spread in the same way that Lyme disease is. To help understand these new findings we spoke with Eugene Shapiro, MD, from the Department of Pediatrics and Department of Epidemiology of Microbial Diseases at Yale.
Sep 11, 2018
Treating Lyme Disease in 2018, Part 1
In this JAMA Clinical Reviews podcast, we talk to Eugene D. Shapiro, MD, from Yale University School of Medicine for an update on Lyme disease, including new ideas about its diagnosis and treatment.
Sep 4, 2018
What you need to know about syphilis in 2018
Syphilis is on the rise despite prior successful efforts to control it. Why is it coming back and what needs to be done about it? Dr Charles Hicks from UC San Diego explains. This podcast coincides with updated syphilis screening recommendations from the USPSTF that were published in the September 4, 2018 issue of JAMA.
Aug 28, 2018
Treating Alcohol Use Disorder
Up to 7% of the entire US population has alcohol use disorder. It’s important for every clinician to understand how to approach patients to question them about their use of alcohol and to establish a diagnosis when alcohol use disorder is present. Dr Henry Kranzler, from the University of Pennsylvania, is an authority on managing alcohol use disorder and discusses its diagnosis and treatment in this JAMA clinical reviews podcast. Read the article: Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A Review
Aug 14, 2018
Saving Lives by Stopping Bleeding
Bleeding is one of the most common preventable causes of death. It is common, yet most people don't know what to do about it when they see it. The Stop the Bleed campaign is an effort to educate the public should they encounter people who are bleeding. Simple maneuvers can have a great beneficial effect. In this JAMA Clinical Reviews podcast, we hear from people with substantial experience in managing bleeding in the field and what they recommend for managing this otherwise deadly problem. Read the article: Stop the Bleeding: Educating the Public
Aug 1, 2018
Working on the Precipice: On the Frontlines of the AIDS Epidemic at the CDC, Part II
As the AIDS crisis unfolded, each discovery seemed to lead to a new mystery. Who was at risk? Why was this disease of immune activation so hard for the body to fight? Most important, what could be done to stop it? In the conclusion of this JAMA Clinical Reviews series, we'll continue the story of the small team of CDC clinicians on the frontlines of the AIDS epidemic as they worked to stem the flow of this devastating disease.
Jul 24, 2018
Working on the Precipice: On the Frontlines of the AIDS Epidemic at the CDC, Part I
When AIDS first appeared in the gay community in 1981, it was terrifying for patients and clinicians alike. Nobody knew exactly what was going on. But using basic epidemiologic methods, a small team of public servants at the CDC raced against the clock to unravel the mystery, doing their best to minimize the damage of this rapidly spreading disease.
Jul 6, 2018
Return of the IUD: Long-acting Reversible Contraception Is Safe and Effective
Misplaced fears about IUDs have caused them to be avoided by many women, despite the fact that they are very safe and among the most effective means for contraception. In this JAMA Clinical Reviews podcast, we review long-acting reversible contraception (LARC) and how contraceptive practices were affected by the Dalkon Shield tragedy.
Jun 23, 2018
Health Care Spending Gone Wild: Using Expensive Insulin Analogs With Few Clinical Advantages
Health care spending in the United States is out of control. The most significant aspect of medical care driving this spending is pharmaceuticals; within pharmaceuticals the greatest increases have been in spending for diabetes medications. The cost of insulin analogs has increased 5- to 6-fold in the last 10 years for no particular reason. More than 90% of US patients who use insulin use these analogs, despite the fact that they have few if any clinical benefits relative to regular or NPH insulin, which cost 1/10 as much. Aside from the cost of insulin, diabetes is probably treated far more aggressively than necessary since clinical trials demonstrating the benefits of aggressive glucose control for type 2 diabetes demonstrated vanishingly small benefits of this form of treatment. In this podcast we discuss the perplexing case of spending too much money on diabetes treatment.
Jun 19, 2018
A Goal Too Far: Rethinking HbA1c Targets for Diabetes Treatment
The American College of Physicians just changed its guidance for how aggressively to treat type 2 diabetes, relaxing the HbA1c goal to something below 8 rather than 6.5 or 7 as other organizations recommend. This has stirred up substantial controversy. The rationale behind this decision is presented in this podcast. Related article
Jun 12, 2018
When Will It Stop? Clinicians Are Still Ordering Routine ECGs Despite Recommendations to the Contrary
For many years guidelines have recommended against obtaining ECGs for low-risk patients undergoing routine health examinations. Yet about a fifth of all patients having these exams get an ECG. Why? Are clinicians just stubborn or uninformed or are the guidelines missing something clinicians are concerned about? Read the article: The Screening ECG and Cardiac Risks
May 20, 2018
Replacing the Trachea: An Exciting New Procedure; But How Do We Know It Really Works?
Many attempts to replace the trachea have failed in the past. The most spectacular failure was fraudulent research done in Europe by a high-profile surgeon who was eventually charged with scientific misconduct. JAMA now reports a clinical series of successful tracheal transplants done in France. How do we know the procedures described in JAMA really worked? The answer is provided in this podcast.
May 8, 2018
Update: New Recommendations for Prostate Cancer Screening
The controversy continues about the efficacy of PSA screening for prostate cancer. New recommendations were just issued from the USPSTF about who should be screened for prostate cancer and when. But not everyone agrees with these recommendations. Ballentine Carter, MD, from the Department of Urology at the Johns Hopkins School of Medicine, discusses the new recommendations and provides an expert urologist's perspective on PSA screening for prostate cancer. Related article
Mar 6, 2018
Peanut Allergy: The Recommendations Have Changed
Peanut allergy is common. But it is more common in countries that delay the introduction of peanuts into the diets of infants. Guidelines in the United States previously recommended delayed introduction of peanuts for infants, which resulted in an increased prevalence of peanut allergy. New recommendations now recommend early introduction of peanuts into infants’ diets to minimize the risk of developing peanut allergy. Read the article: Peanut Allergy Prevention
Feb 20, 2018
What Is New in Acute Respiratory Disease Syndrome?
Acute respiratory disease syndrome is characterized by respiratory failure that occurs after someone is acutely ill, usually from a disease that does not primarily involve the lungs. Its cause, diagnosis, and treatment are reviewed in this JAMA Clinical Reviews Podcast for the February 20, 2018 issue
Feb 14, 2018
Medical Findings In U.S. Government Personnel Reporting Symptoms After Exposure To Sensory Phenomena in Havana, Cuba
Douglas H. Smith, MD, of the University of Pennsylvania's Department of Neurosurgery and Center for Brain Injury and Repair, and Randel Swanson II, DO, PhD, of the University of Pennsylvania's Physical Medicine and Rehabilitation department, summarize findings from a clinical evaluation of US government personnel reporting neurologic symptoms after exposure to directional auditory and sensory phenomena during their official postings in Havana, Cuba.
Feb 1, 2018
The Health of Players of American Football
The health risks associated with participation in American football have garnered increasing attention over the past several years. Particular focus has been on concussion and the association of repeated head trauma with chronic traumatic encephalopathy (CTE). However, other factors related to participation in professional football might be associated with better or worse health throughout life. Dr Ann McKee discusses the occurrence of CTE in a case series of deceased football players who donated their brains for research. Former National Football League (NFL) player Mike Adamle shares his story including his symptoms and suspected diagnosis of CTE. Dr Atheendar Venkataramani discusses a recent study about the association between playing in the NFL and all-cause mortality. Read the articles: Association Between American Football in the NFL and Long-term Mortality in Retirement Evaluation of Chronic Traumatic Encephalopathy in American Football Players JAMA Patient Page: Sport-Re…
Jan 16, 2018
Gastric Sleeve Resection for Obesity: How good Is It?
Why is two-thirds of the US population overweight or obese? Obesity began to increase in 1980, and its incidence is still rising. One reason for this might be that the population has become tolerant of obesity and accepted it as the normal state. On the other end of the spectrum, some people desire to lose weight but, in general, diets and medications are not very effective. The most effective way to lose weight is with bariatric surgery. A relatively new procedure, the gastric sleeve resection, has been introduced. However, most new bariatric operations fail; think of the jejunoileal bypass, vertical banded gastroplasty, and laparoscopic adjustable gastric banding procedures. Has the gastric sleeve resection been successful? A series of articles providing definitive outcomes for these procedures have been published in JAMA and their results are summarized in this podcast. Interviewees: David E. Arterburn, MD, MPH Kaiser Permanente Washington Health Research Institute, Seattle, WA…
Jan 2, 2018
Surveillance for Thyroid Cancer
The incidence of thyroid cancer is increasing. Like so many cancers, it is being diagnosed at earlier stages because of more aggressive screening and diagnostic testing. The aggressiveness of very early stage thyroid cancer is unknown and some of these tumors may be managed by active surveillance instead of surgery. In this podcast, Dr Sally Carty, Professor of Surgery at the University of Pittsburgh, reviews how to manage thyroid cancer. Natural History and Tumor Volume Kinetics of Papillary Thyroid Cancers Patient-Guided Decision Making in Papillary Thyroid Cancer Active Surveillance for Thyroid Cancer
Dec 19, 2017
Diagnosis and First-Line Treatment of Chronic Sinusitis
Sinusitis is one of the most common conditions seen by clinicians. Despite its frequency, it is often misdiagnosed. In this podcast, we review the proper way to establish a diagnosis and treat both acute and chronic sinusitis. Related article
Dec 12, 2017
Managing Hypertension: Understanding the New AHA/ACC Hypertension Guideline, Part II
In November 2017, new guidelines were issued for hypertension treatment. They are a comprehensive overhaul of recommendations for both the diagnosis and treatment of hypertension. Last week, we discussed the guidelines' specific recommendations with Dr Paul Whelton, professor of medicine at Tulane University, who chaired the guidelines-writing committee. We also spoke to Dr Phil Greenland from Northwestern University, who is one of the cardiology editors for JAMA. This week, in part 2 of this podcast, we discuss the controversies associated with the new hypertension guidelines. Related articles: The 2017 Clinical Practice Guideline for High Blood Pressure Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults The New 2017 ACC/AHA Guidelines “Up the Pressure” on Diagnosis and Treatment of Hypertension
Dec 5, 2017
Managing Hypertension: Understanding the New AHA/ACC Hypertension Guideline
In November 2017, new guidelines were issued for hypertension treatment. The new guideline is a comprehensive overhaul of recommendations for both the diagnosis and treatment of hypertension. Based on years of work by dozens of individuals who generated 106 recommendations, the guideline is complicated. Dr Paul Whelton, an author of the guideline, and Dr Phil Greenland, Professor of Medicine at Northwestern University and one of our cardiology editors here at JAMA, explain the major recommendations presented in the new hypertension guidelines. Related articles: The 2017 Clinical Practice Guideline for High Blood Pressure Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults The New 2017 ACC/AHA Guidelines “Up the Pressure” on Diagnosis and Treatment of Hypertension
Dec 5, 2017
Matching Drugs to Genetic Abnormalities to Precisely Treat Cystic Fibrosis
Cystic fibrosis is a common autosomal recessive disease. It is caused by any one of many discrete genetic abnormalities that affect chloride transport. Identification of specific genetic abnormalities enables clinicians to identify drugs that counteract the effects of the abnormal genes. In this podcast we review how genetic defects that cause cystic fibrosis are identified and how drugs that are likely to successfully treat the disease are matched to those genetic abnormalities. Related article
Nov 21, 2017
Mendelian Randomization: How the Natural Assortment of Genes Can Mimic Randomized Clinical Trials
The best evidence for proving cause-and-effect comes from randomized clinical trials. However, they are expensive and difficult to perform. The natural assortment of gene variants at birth can mimic randomization in some circumstances and yield important clinical information that can help physicians better care for their patients. Read the article: Mendelian Randomization
Nov 14, 2017
Bacteriophage Treatment for Serious Infections Is Back!
Bacteriophages are viruses that infect and kill bacteria. When they were first discovered in the early part of the 20th century, there was great enthusiasm for their potential use to treat all sorts of bacterial infections. They were supplanted by antibiotics and although they remained critically important in research that led to the understanding of DNA and how it works, bacteriophages never really made it in the therapeutic world. Now that multiple-drug-resistant bacteria are becoming increasingly common, there is renewed interest in using bacteriophages to treat bacterial infection. Links: YouTube video summarizing the career and science of Félix d'Hérelle-one of the discoverers of bacteriophages Dr. Felix d'Herelle Canadian Medical Hall of Fame Laureate 2007 Detailed history of the development of bacteriophage research in Georgia A Stalinist Antibiotic Alternative from New York Times Magazine, February 6, 2000 Reprint of Twort’s initial description of a substance killing…
Oct 24, 2017
Incontinence in Women: How We Talk About It and What Can Be Done
Urinary incontinence in women is common but not often discussed. Linda Brubaker, MD, and Emily S. Lukacz, MD, review the evaluation and management of incontinence in women, including how to broach the topic with patients and when to use treatments ranging from behavioral interventions and pelvic floor muscle exercises to vaginal devices, medications, and office-based procedures or surgery.
Oct 17, 2017
Managing Transgender Patients: Endocrine Society Guideline Update 2017
An increasing number of transgender patients are being seen in all care settings. Their medical needs are not too different from those for any primary care patient. New guidelines issued by the Endocrine Society in September 2017 are summarized in this podcast.
Oct 3, 2017
Replacing Tissue Biopsies With a Blood Test: The Technique of Liquid Biopsy
Powerful new genetic technologies enable clinicians to detect and sequence tiny amounts of free DNA circulating in blood. DNA gets into blood when cells fall apart. Abnormal DNA from diseased cells can be detected, enabling clinicians to detect cancer or monitor tumor growth by liquid biopsy. In this JAMA Clinical Reviews podcast, we talked with Victor E. Velculescu, MD, PhD, from the Johns Hopkins School of Medicine, and JAMA medical writer M.J. Friedrich about this new technology. Related articles: Cancer DNA in the Circulation: The Liquid Biopsy Going With the Flow: The Promise and Challenge of Liquid Biopsies Finding the Rare Pathogenic Variants in a Human Genome
Sep 26, 2017
Delirium: Prevention, Diagnosis, and Treatment
Delirium goes unrecognized in approximately 60% of cases. When it is recognized, it can be difficult to treat. Recognizing and treating, as well as preventing, delirium is important because delirium is associated with poor health outcomes and significant health care costs. Esther S. Oh, MD, PhD, Tammy T. Hshieh, MD, MPH, and Sharon K. Inouye, MD, MPH, discuss their review article about advances in diagnosis and treatment of delirium, and Dr Maria Duggan provides additional insights about diagnosis and management from her perspective as a clinician and researcher. Related article: Delirium in Older Persons: Advances in Diagnosis and Treatment
Sep 12, 2017
Breast Cancer Surgery: Less Is More
Every successive major clinical trial of less invasive breast cancer surgery seems to show that less is more--less because less surgery seems to not influence outcomes and more because with less surgery, there are fewer complications, resulting in a net benefit for women with breast cancer.
Sep 5, 2017
How Couples With Genetic Disease Can Have Healthy Offspring
Clinicians can now sample DNA from in vitro blastocysts to identify embryos with genetic abnormalities and avoid implanting them. This genetic screening allows couples who carry dangerous genetic diseases to avoid having children with those diseases. Interviewees: Siobhan M. Dolan, MD, Tamar H. Goldwaser, MD, and Sangita K. Jindal, PhD Links discussed in this episode: Preimplantation Genetic Diagnosis for Mendelian Conditions
Aug 15, 2017
Are they safe? Drugs and devices receiving accelerated approval by the FDA
Some drugs and devices receive accelerated approval from the FDA in order to provide potentially important treatments for patients when effective therapies may not be available. These drugs or devices are supposed to have postmarketing studies to definitively show their efficacy or safety, but sometimes this doesn't happen. Rita F. Redberg, MD, MSc, Aaron S. Kesselheim, MD, JD, MPH, and Robert M. Califf, MD, discuss their articles characterizing studies used for the approval of high-risk medical devices and accelerated approval of drugs by the FDA. Discussed in this podcast: FDA Online
Jul 25, 2017
How Studying Familial Hypercholesterolemia Resulted in the Discovery of Statins as an Effective Treatment for High Cholesterol
Scott Grundy, MD, PhD, is a professor of medicine at UT Southwestern in Dallas and is one of a small group of investigators who saved statins from being dumped as a potential drug class. Dr Grundy tells the story of how studying patients with familial hypercholesterolemia unraveled the mysteries of high cholesterol levels. This resulted in the development of very effective drugs to treat any patient with high cholesterol. Familial hypercholesterolemia is fairly common and when patients have very high cholesterol levels they and their families should undergo cascade screening. Interviewees: Scott M. Grundy, MD, PhD, and author Joshua W. Knowles, MD, PhD Links discussed in this episode: Cascade Screening for Familial Hypercholesterolemia and the Use of Genetic Testing Dietary Guidelines for Americans Interview with Karen DeSalvo, MD, MPH, MSc, author of Dietary Guidelines for Americans
Jul 18, 2017
How to Diagnose and Manage Adult Asthma
Asthma often develops in childhood but also affects a significant number of adults. It can present in various ways and with varying degrees of severity. William J. Calhoun, MD, of the University of Texas Medical Branch, Galveston, discusses the approach to diagnosis and provides tips for management of this common condition.
Jul 11, 2017
Dual Antiplatelet Therapy: Balancing Ischemic and Bleeding Risk
Following placement of cardiac stents, patients receive dual antiplatelet therapy (DAPT) to prevent stent thrombosis. Prevention of thrombosis is offset by a risk of bleeding. The optimal balance between thrombosis prevention and bleeding risk is not always known. How to go about optimizing DAPT therapy is discussed by Glen Levine, MD, professor of medicine at Baylor College of Medicine in Houston, Texas, and chair of the combined American College of Cardiology/American Heart Association Guideline Committees.
Jul 3, 2017
Penicillin Allergy – It’s Less Common Than You Think
Allergy to penicillin is one of the most commonly reported allergies by patients. In reality, true penicillin allergy is uncommon. Dr. Elizabeth Phillips from Vanderbilt University discusses her experience with testing for penicillin allergy in patients who thought they had this problem.
Jun 27, 2017
Diagnosing Congenital and Intellectual Abnormalities With Chromosomal Microarray Analysis
Chromosomal microarray technology (CMA) facilitates the genetic diagnosis of intellectual disabilities, autism spectrum disorder, and congenital abnormalities in children. Previously, G-band karyotyping was the test performed for this purpose but it could only identify very large chromosomal abnormalities and was not very sensitive. Being a molecular rather than microscopic technique, CMA is far more sensitive for identifying genetic abnormalities and is now the test of choice. We interview David H. Ledbetter, MD, and Christa Lese Martin, PhD, from Geisinger Health System, authors of this JAMA Insights article. Articles discussed in this episode: Chromosomal Microarray Testing for Children With Unexplained Neurodevelopmental Disorders New Approaches to Molecular Diagnosis
Jun 27, 2017
High-Intensity Statin Therapy – The Controversy Continues
Multiple guidelines have been issued regarding how aggressively cholesterol should be managed. These guidelines do not agree with one another and the most significant area of disagreement is in recommendations for high intensity statin therapy. In this podcast we discuss this issue with a number of experts in the field to help better understand how high-intensity statin therapy might be applied to patient care.
May 23, 2017
Treating Depression in Older Patients
Depression is very common in old age. Because it is associated with many issues related to aging such as having diabetes, hypertension, and other diseases and also the general ability to do less than when a person was younger, it is often assumed that depression is just part of the aging process. Inadequate treatment is often given for depression, frustrating patients and clinicians. However, aggressive depression treatment in elderly individuals can be very successful and greatly improve an older person’s quality of life. PHQ-9 USPSTF recs JAMA Patient Page on Screening for Depression
May 9, 2017
Genomic Sequencing for the Healthy Individual?: Think Smaller
Whole-genome sequencing is now easily done for very little cost. It is not known how to interpret the results of this testing. It is inadvisable for healthy individuals to undergo routine whole-genome sequencing but if someone has a reason to suspect a particular disease known to be associated with a unique gene, then targeted genetic sequencing is reasonable. Interviewee: James P. Evans, MD, PhD, from the University of North Carolina at Chapel Hill.
Apr 3, 2017
Diabetes in 2017: Focus Less On HbA1c and More On Cardiovascular Risk Reduction
Much has changed recently in diabetes management. The treatment goal has shifted from rigorous glucose control with HbA1c as the primary target to cardiovascular risk reduction. Risk reduction can be achieved in a variety of ways and does not necessarily depend on expensive new drugs that were shown to achieve this end point. Older, cheaper drugs may achieve the same goal but were never tested in this context. Interview with JoAnn E. Manson, MD, PhD, from Brigham and Women's Hospital in Boston and Jane Reusch, MD, from University of Colorado, Denver. Article: Reusch JEB, Manson JE. Management of type 2 diabetes in 2017: getting to goal. JAMA. 2017;317(10):1015-1016. doi:10.1001/jama.2017.0241
Mar 28, 2017
JAMA Performance Improvement: Retained Foreign Body From a Sheared Off Lumbar Drain
A resident is asked to remove a drain that was placed in the lumbar space during an operation. Having never seen this sort of drain before not having removed one, the resident proceeded to remove the catheter. Several days later, the patient complained of persistent drainage. An 11-cm segment of retained catheter was removed. This JAMA Performance Improvement article discusses how to avoid this sort of problem as well as how to ensure that resident physicians have sufficient skills to perform procedures on their own. We talk with Drs Cynthia Barnhard, John DeLancey, authors of Retained Lumbar Catheter Tip, and Dr Aaron Reynolds and Dr David Baker. Related article: Retained Lumbar Catheter Tip
Mar 20, 2017
Alzheimer Disease Overview and the Possibility That It’s Caused By Infections
Alzheimer disease causes progressive neurologic deterioration and is reasonably common in elderly patients. It is characterized by specific patterns of memory loss, which progressively worsens and for which there is no treatment. Recent drug trials have been disappointing in that promising medications have failed to affect the disease. Interesting new hypotheses have emerged from basic science research suggesting that the neurofibrillary tangles characteristic of Alzheimer brain lesions form in response to infection of the brain. Interview with Rudolph Tanzi, PhD, of Harvard University; Berislav Zlokovic, MD, PhD, of the University of Southern California; and Andy Josephson, MD, of the University of California San Francisco, and editor of JAMA Neurology. Related article: Alzheimer Outlook Far From Bleak
Mar 7, 2017
Why the New Sepsis Guideline Changed
Recent guidelines for how to best manage septic shock have changed. Gone are recommendations for central venous oxygen saturation monitoring and goal-directed therapy. In is the concept that septic shock be treated as an emergency with rapid administration of antibiotics and large amounts of fluids. Our discussants Derek C. Angus, MD, MPH, and Michael D. Howell, MD, MPH, discuss why these recommendations have changed. This is the second podcast in the Surviving Sepsis guideline series. The first podcast reviewed what recommendations are in the guideline itself. Article discussed in this episode: Management of Sepsis and Septic Shock Speakers: JAMA Associate Editor Derek C. Angus, MD, MPH, University of Pittsburgh, and Michael D. Howell, MD, MPH, University of Chicago.
Feb 28, 2017
Updated Guidelines for Sepsis Management
In 2017 the Society for Critical Care Medicine updated its guidelines for sepsis management. These new guidelines differ significantly from ones in the past in that they no longer recommend protocolized resuscitation and emphasize early and aggressive fluid resuscitation when patients present with septic shock. This is the first podcast in the Surviving Sepsis guideline series. The next episode discusses why the new sepsis guideline changed. Article discussed in this episode: Management of Sepsis and Septic Shock Speakers: Laura Evans, MD, MSc, of Bellevue Hospital and NYU Medical Center Andrew Rhodes, MBBS, MD, of St George’s University Hospitals NHS Trust and co-chair of the Surviving Sepsis guideline panel Mitchell M. Levy, MD, of the Alpert Medical School of Brown University and Rhode Island Hospital
Feb 16, 2017
JAMA Professionalism: What Should Students or Residents Do When Abused by Faculty
Approximately one-third of all medical school graduates report having been abused as students. Medical student and resident abuse has long been considered unacceptable behavior but still persists in the teaching environment. In this podcast we discuss how students and residents might respond to these events. We interview Geoffrey Young, MD, from the Association of American Medical Colleges and Thomas J. Nasca, MD, from the Accreditation Council for Graduate Medical Education, who discuss how they expect medical schools to respond to abusive behaviors and what resources are available to students and residents who have been abused to report those experiences without fearing retribution. Article discussed in this episode: Medical Student Mistreatment
Feb 9, 2017
Sarcopenia, Frailty and Risk Prediction in Geriatric Patients
As people age, loss of muscle mass is inevitable, resulting in sarcopenia. Muscle loss contributes to overall weakness, which causes frailty. Frailty, in turn, is the generalized susceptibility to disease and injury, all of which causes loss of autonomy. Because of the potential for progressive decline in physical function in very elderly patients, accurate tools are needed to predict mortality risk to individualize treatments intended to improve longevity such as chemotherapy, management of chronic diseases, and surgery. In this podcast, sarcopenia, frailty, and risk prediction are discussed in the context of major trials studying them being conducted in Europe.
Feb 2, 2017
Hypertension Management and Dealing With Polypharmacy in Elderly Patients—A Report From the 2016 European Union Geriatric Medical Society Meeting
Managing hypertension in elderly patients is complicated. Recent studies have shown that elderly patients may benefit from aggressive hypertension management, but other studies have shown that some are harmed by overly aggressive hypertension management. These issues were discussed in detail at the 2016 European Union Geriatric Medicine Society meeting. In this podcast we discuss how to best manage hypertension in elderly patients with Athanase Benetos, MD, PhD, a professor of internal medicine from Nancy, France, and the academic director of the European Union Geriatric Medicine Society. Older patients tend to have multiple comorbid conditions requiring treatment with many medications. Managing polypharmacy is challenging. In this podcast we discuss 2 tools that help deal with this problem: The Beer’s list and the START/STOPP criteria. To help understand these tools we spoke with Michael Steinman, MD, a professor of medicine from University of California-San Francisco, and Denis O…
Jan 30, 2017
Managing Violent Patients in Health Care Settings
Workplace violence–related injuries occur disproportionately in health care settings. In this podcast, we discuss how individual clinicians should manage violent patients who might attack them. Article discussed in this episode: Ensuring Staff Safety When Treating Potentially Violent Patients
Dec 27, 2016
Systematic Approach to a New Onset Seizure
Between 8% and 10% of the population will have a seizure at one point in life. It's important to distinguish seizures from other entities that can look like them and, once a diagnosis of a seizure is established, know how to treat them. In this podcast we discuss seizures and epilepsy with Jay Gavvala, MD, author of New-Onset Seizure in Adults and Adolescents: A Review. Article discussed in this episode: New-Onset Seizure in Adults and Adolescents: A Review
Nov 1, 2016
Using Medicare Star Ratings to Select Hospitals
Medicare recently developed a star rating system to help consumers determine the quality of care delivered at various hospitals. This rating system was considered controversial by many. In this podcast we discuss the rating system with one of its critics, Karl Y. Bilimoria, MD, MS, and with Kate Goodrich, MD, the Director of the Center for Clinical Standards and Quality at Medicare. Article discussed in this episode: The New CMS Hospital Quality Star Ratings: The Stars Are Not Aligned
Oct 4, 2016
Treatments for Hyperemesis and Nausea and Vomiting in Pregnancy
Nearly all women experience some element of nausea and vomiting during their pregnancies. In this podcast we review the entire spectrum of disease all the way up to hyperemesis gravidarum and how to provide care for women experiencing these problems. Article discussed in this episode: Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy
Sep 27, 2016
Fluid Resuscitation for Patients in Septic Shock
When managing septic shock, passive leg raising is the best test to determine if a patient is likely to respond to a fluid bolus, better than CVP lines or even bedside ultrasound. Dr Najib Ayas, Associate professor of Critical Care Medicine at the University of British Columbia, discusses shock management from the context of his Rational Clinical examination article in the September 27, 2016 issue of JAMA, entitled “Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids?”
Aug 26, 2016
The High Cost of Pharmaceuticals in the United States
Drug prices continue to rise in the US. Many solutions have been proposed but few have been implemented. Drs. Janet Woodcock from the FDA and Aaron Kesselheim, author of The High Cost of Prescription Drugs in the United States from the Harvard Medical School discuss the role of brand name drugs and generics and how they influence the cost of pharmaceuticals. Also see The Cost of US Pharmaceutical Price Reductions: A Financial Simulation Model of R&D Decisions by Thomas A. Abbott and John A. Vernon.
Aug 11, 2016
Opioid Use Disorder
Edward H. Livingston, MD, discusses the British Columbia Ministry of Health’s 2015 guidelines on clinical management of opioid use disorder in adults with Keith Ahamad, MD, Evan Wood, MD, PhD, ABIM, FRCPC, Tony L. Yaksh, PhD, and Humayun J. Chaudhry, DO, MS, MACP, FACOI. Articles and resources discussed in this episode: * Opioid Use and Addiction Microsite * Clinical Management of Opioid Use Disorder (JAMA Clinical Guidelines Synopsis) * The Vancouver Opioid Use Disorder Guideline * Model Policy on DATA 2000 And Treatment of Opioid Addiction in the Medical Office
Jul 19, 2016
Treating Opioid Use Disorder Using Buprenorphine Implants
Richard N. Rosenthal, MD discusses a randomized clinical trial demonstrating the efficacy of an implantable buprenorphine-releasing device for treating opioid use disorder.
Jul 12, 2016
Review of Lyme Disease
Lyme disease is very common in certain regions of the country and is caused by the spirochete Borrelia bergdorferi. Lyme disease is transmitted by tick bites and in this podcast we review the discovery of Lyme disease, its major clinical features, and how to diagnose and treat it, as told by Dr Alan Steere, Dr Lyndon Hu, and Dr Paul Auerwerter. Related article: Review of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis
Jun 28, 2016
Managing Persistent Diarrhea
Persistent diarrhea is a poorly recognized syndrome in all populations that requires proper assessment and diagnosis to ensure that affected individuals receive the treatment needed to experience improvement of clinical symptoms. Listen to Drs Herbert DuPont and Annie Feagins discuss how to diagnose and treat diarrhea. Related article: Persistent Diarrhea
Jun 14, 2016
The Discovery of Lyme Disease with Dr Allen Steere
Dr Allen Steere discovered Lyme disease and discusses what he saw and did when confronted early in his career with a previously undescribed disease. Late stage disease, a form not commonly seen today, is discussed in detail since that is how the disease presented before its cause was determined. Related article: Review of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis
May 17, 2016
GERD and Esophagitis
Drs Stuart Spechler and Peter Kahrilis discuss GERD and esophagitis--how they occur and how they are treated. Dr Spechler also discusses a new hypothesis regarding how reflux esophagitis is caused that differs from the traditional teaching that acid and pepsin reflux into the esophagus and burn the mucosa layers. Related articles: Association of Acute Gastroesophageal Reflux Disease With Esophageal Histologic Changes Turning the Pathogenesis of Acute Peptic Esophagitis Inside Out
May 10, 2016
Treating ADHD in Adolescents
Attention-Deficit/Hyperactivity Disorder, or ADHD is a very common problem affecting about 10% of all adolescents. Children with ADHD have short attention spans, are hyperactive, talk a great deal, can be disruptive in the classroom etc.-features that are common in many adolescents. However, to have true ADHD, children must be significantly impaired by these problems. An array of medical and behavioral treatments can successfully help manage ADHD. These are reviewed in a series of articles appearing in the May 10, 2016, issue of JAMA. In this podcast, we discuss ADHD with the authors of some of those papers, Eugenia Chan, MD, MPH from Harvard and Philip Shaw, MD, PhD from the National Human Genome Research Institute. Articles discussed in this episode: * Treatment of Attention-Deficit/Hyperactivity Disorder in Adolescents : A Systematic Review * Quantifying the Benefits and Risks of Methylphenidate as Treatment for Childhood Attention-Deficit/Hyperactivity Disorder * Methylp…
Apr 12, 2016
Diagnosing Infectious Mononucleosis
Mononucleosis is a common disease of young adults manifested by lethargy, fever, pharyngitis, lymphadenopathy and splenomegaly. In this podcast, we review the clinical features of the disease and how good each of them is at establishing a diagnosis of mononucleosis. We also review how Epstein Barr virus was discovered as the cause of mononucleosis and talk to Mark H. Ebell, MD, MS, author of Does This Patient Have Infectious Mononucleosis? The Rational Clinical Examination Systematic Review. Articles discussed in this episode: * Does This Patient Have Infectious Mononucleosis? The Rational Clinical Examination Systematic Review (2016) * Acute Lymphatic Leukemia and Infectious Mononucleosis (1931) * Infectious Mononucleosis: Part I. Clinical Aspects (1935) * Infectious Mononucleosis: Clinical Manifestations in Relation to EB Virus Antibodies (1968)
Mar 15, 2016
Opioid Prescribing: Rising to the Challenge
An opioid abuse epidemic now plagues US healthcare. It was caused, in part, by overzealous advocacy for controlling chronic pain resulting in overuse of narcotics. There are now 2 million Americans addicted to opioids. The approach for treating chronic pain must change. In this podcast, we summarize recent CDC guidelines for the proper use of opioids for treating chronic pain. Articles discussed in this episode: * CDC Guideline for Prescribing Opioids for Chronic Pain— United States, 2016 * The CDC Guideline on Opioid Prescribing: Rising to the Challenge (Yngvild Olsen, MD, MPH) * The DSM-V definition for opioid use disorder and 11 point checklist
Mar 8, 2016
Treating Geriatric Polypharmacy by Deintensifying Unnecessary Diabetes Treatment
Polypharmacy is a rapidly worsening problem that hits elderly patients particularly hard. As patients grow older, they need more medications but at the same time become less capable of managing the complexity of drug treatments. In order to simplify treatment regimens for older patients, it is necessary to consider the evidence supporting treatment of various conditions and when the evidence is not particularly strong, reduce or eliminate medications accordingly. Diabetes management in the elderly is highlighted in this podcast with specific attention given to deintensifying diabetes treatment in the elderly. Articles discussed in this episode: * Polypharmacy in the Aging Patient: Glycemic Control in Older Adults With Type 2 Diabetes: A Review (Kasia J. Lipska, MD, MHS) * Evaluation and Treatment of Older Patients With Hypercholesterolemia: A Clinical Review (Timo E. Strandberg, MD, PhD) * Trends in Prescription Drug Use Among Adults in the United States From 1999-2012 (Eliz…
Feb 23, 2016
2015 Breast Cancer Screening Recommendations for Women at Average Risk
The American Cancer Society breast cancer screening guidelines have been changed to recommend annual screening for women older than 45 and every other year screening for women older than 55. Older women should only pursue screening if they have a more than 10 year life expectancy. These guidelines were somewhat controversial and were published in the October 15, 2015 issue of JAMA. JAMA Senior editor Mary McDermott interviews Nancy Keating, Evan Myers and Elizabeth Fontham to discuss these guidelines in detail.
Feb 9, 2016
Antibiotic Therapy for Community-Acquired Pneumonia in Adults
Community acquired pneumonia accounts for 600,000 hospital admissions a year. Many patients with this disease are quite ill and have a very high mortality. To save lives, the appropriate antibiotics should be given in a timely basis, but it is not clear what the best antibiotics are and how long they should be given. In this podcast we interview the author of a JAMA review on community acquired pneumonia, Dr Jonathan Lee, author of Antibiotic Therapy for Adults Hospitalized With Community-Acquired Pneumonia, who performed a systematic review of the literature to determine the best way to treat community acquired pneumonia.
Feb 2, 2016
New Dietary Guidelines
The 2015-2020 US Dietary Guidelines for Americans were recently released. They are intended to provide guidance for health policy officials and clinicians regarding healthy diets and establishing goals for improving nutrition. These are important since bad eating habits are the underlying cause for a great deal of disease in the US and that these guidelines influence the operations of programs such as school lunch assistance, meals on wheels etc. Because these guidelines influence policy, they have been criticized by various investigators and special interest groups. Karen DeSalvo, MD, Acting Assistant Secretary for Health at HHS and author of Dietary Guidelines for Americans responds to some of these criticisms and explains how the guideline was created and what it is intended to do. Implementation of the guidelines dietary advice may be challenging and Deborah Clegg, RD, PhD, Professor of Internal Medicine at UCLA discusses how the various recommendations can be followed. An earlier…
Jan 19, 2016
Peripheral neuropathy is a highly prevalent and morbid condition affecting 2% to 7% of the population. Patients frequently experience pain and are at risk of falls, ulcerations, and amputations. It is most commonly occurs in patients with diabetes. For most cases, the diagnosis and treatment of neuropathy can be made without complex testing or referral to specialists. Drs. Eva Feldman and Brian Callaghan from the University of Michigan Department of Neurology, authors of Distal Symmetric Polyneuropathy and Electrodiagnostic Tests in Polyneuropathy and Radiculopathy, explain how to manage neuropathy.
Jan 12, 2016
Advances in Diagnosis and Treatment of Constipation
Constipation is one of the most frequent problems clinicians are asked to deal with. Despite how common it is, constipation is frequently not treated adequately. In this podcast, Arnold Wald, MD, explains a stepwise approach to the management of constipation ranging from very simple measures to the most novel and complicated new medical therapies. Articles discussed in this episode: * JAMA Clinical Review: Constipation: Advances in Diagnosis and Treatment * JAMA Clinical Guidelines Synopsis: Evaluation and Treatment of Patients With Constipation * From The Medical Letter on Drugs and Therapeutics: Naloxegol (Movantik) for Opioid-Induced Constipation * JAMA Patient Page: Constipation
Dec 29, 2015
Antibiotics vs Appendectomy for Uncomplicated Appendicitis Treatment
Appendicitis is one of the most common reasons people undergo abdominal surgery. Lost in history are the reasons why appendectomy was performed in the first place, and in the hundred years since appendicitis was first described, many changes in patient management have occurred improving both the diagnosis and treatments for appendicits. A major trial, Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis, was recently published in JAMA showing that most patients with acute, uncomplicated appendicitis can be treated with antibiotics alone and avoid surgery.
Dec 22, 2015
Minor head trauma usually does not cause significant brain injury. To be safe, clinicians often obtain head CT scans to ensure no major injury is present. For minor head trauma (Glascow coma scale 13-15), the risk to benefit ratio for head CT is usually not in favor of getting CT scans. When the Canadian head CT rule or New Orleans Criteria are negative, there is a very small risk for missing a significant brain injury. Joshua Easter, MD from the Department of Emergency Medicine at the University of Virginia who authored a JAMA Rational Clinical Examination article on this topic is interviewed as is Frederick Rivara, from the Department of Pediatrics at the University of Washington who wrote an accompanying editorial. Michelle Mello, a Law Professor at Stanford, discusses the medical liability associated with not obtaining neuroimaging for minor head trauma.
Dec 15, 2015
Edward H. Livingston, MD discusses Graves disease with David Cooper, MD, author of Management of Graves Disease: A Review
Nov 17, 2015
Prostate Cancer Screening
Edward H. Livingston MD, explores the topic of prostate cancer screening in author interviews with: * Dan Merenstein about losing a malpractice case despite following evidence-based medicine guidelines (PSA Screening — I Finally Won!). * Otis Brawley about Prostate Cancer Incidence and PSA Testing Patterns in Relation to USPSTF Screening Recommendations. * David F. Penson about The Pendulum of Prostate Cancer Screening. * Victor M. Montori about The Connection Between Evidence-Based Medicine and Shared Decision Making.
Nov 8, 2015
Ruling Out Acute Coronary Syndrome in Patients With Chest Pain
ACS is a common and potentially lethal problem. However, only about 10% of patients who present to an emergency department with chest pain actually have ACS. In this JAMA Clinical Reviews podcast, we discuss which signs, symptoms and tests used to make the diagnosis of ACS are reliable. Edward H. Livingston MD, speaks with Alexander Fanaroff, MD, author of Does This Patient With Chest Pain Have Acute Coronary Syndrome? The Rational Clinical Examination Systematic Review as well as a patient who was diagnosed with myocardial infarction.
Nov 8, 2015
Using Likelihood Ratios to Understand How Chest Pain Predicts Acute Coronary Syndrome
Interview with David Simel, MD, author of Does This Patient With Chest Pain Have Acute Coronary Syndrome? The Rational Clinical Examination Systematic Review
Oct 27, 2015
Explaining the Improved Health of the US: Mortality Trends 1969-2013
Interview with Ahmedin Jemal, DVM, PhD, author of Temporal Trends in Mortality in the United States, 1969-2013, and J. Michael McGinnis, MD, MPP, author of Mortality Trends and Signs of Health Progress. Also in this episode is a conversation with Christopher J.L. Murray, MD, DPhil, a Professor of Global Health at the University of Washington and Institute Director of the Institute for Health Metrics and Evaluation. CME for this activity is available here.
Sep 1, 2015
Treating Chronic Sinusitis in Adults
Interview with Luke Rudmik, MD, MSc, author of Medical Therapies for Adult Chronic Sinusitis: A Systematic Review. This systematic review summarizes the evidence-based medical treatment of adult chronic sinusitis and proposes a treatment algorithm.
Aug 4, 2015
Posttraumatic Stress Disorder
Edward H. Livingston, MD, interviews a war veteran and discusses PTSD with Maria Steenkamp, PhD, author of Psychotherapy for Military-Related PTSD, and Michele Spoont, PhD, author of Rational Clinical Exam: Does This Patient Have Posttraumatic Stress Disorder? The article by Dr Steenkamp reports that many military personnel and veterans with posttraumatic stress disorder achieve clinically meaningful improvement with use of the first-line trauma-focused interventions cognitive processing therapy and prolonged exposure. The Rational Clinical Examination Systematic Review by Dr Spoont examines the utility of self-report screening instruments for posttraumatic stress disorder among primary care and high-risk populations.
Jul 21, 2015
Managing Atrial Fibrillation
Edward H. Livingston, MD discusses atrial fibrillation with Eric N. Prystowsky, MD, author of Treatment of Atrial Fibrillation, and talks about new technologies to facilitate screening for atrial fibrillation with Leslie Saxon, MD.
Jun 23, 2015
Medical Marijuana for Treatment of Chronic Pain and Other Problems
Interview with Kevin P. Hill, MD, MHS, author of Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems: A Clinical Review, and Deepak Cyril D'Souza, MBBS, MD, author of Medical Marijuana: Is the Cart Before the Horse?
May 19, 2015
Stroke Prevention in Atrial Fibrillation
Edward H. Livingston, MD discusses stroke prevention in atrial fibrillation with Gregory Lip, MD, author of Stroke Prevention in Atrial Fibrillation: A Systematic Review
May 12, 2015
Read the article and earn CME: bit.ly/1T3EpB1 Patient Page: bit.ly/1T3Exk0 Spanish Patient Page (Acalasia): bit.ly/1T3EHrr Understanding the swallowing disorders dysphagia and achalasia as explained by John Pandolfino, MD from Northwestern University. Dr Pandolfino describes how to examine patients with these disorders and how these diseases should be treated.