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.
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
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.
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
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.
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.
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
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.
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
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.
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
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.
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.
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.
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.
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
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.
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.
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.
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
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
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.
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
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.
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
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/.
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
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.
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.
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.
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
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
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.
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.
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
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
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.
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.
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.
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.
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
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
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.
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
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
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
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.