JAMA Clinical Reviews: Interviews about ideas & innovations in medicine, science & clinical practice. Listen & earn CME credit

By The JAMA Network

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Description

Author interviews that explore the latest clinical reviews.

Episode Date
Health Care Spending Gone Wild: Using Expensive Insulin Analogs With Few Clinical Advantages
27:07

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 23, 2018
A Goal Too Far: Rethinking HbA1c Targets for Diabetes Treatment
29:24

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 19, 2018
When Will It Stop? Clinicians Are Still Ordering Routine ECGs Despite Recommendations to the Contrary
22:12

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

 

Jun 12, 2018
Replacing the Trachea: An Exciting New Procedure; But How Do We Know It Really Works?
21:55

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 20, 2018
Update: New Recommendations for Prostate Cancer Screening
25:41

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

May 08, 2018
Peanut Allergy: The Recommendations Have Changed
19:11

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

Mar 06, 2018
What Is New in Acute Respiratory Disease Syndrome?
30:19

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 20, 2018
Medical Findings In U.S. Government Personnel Reporting Symptoms After Exposure To Sensory Phenomena in Havana, Cuba
29:37

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 14, 2018
The Health of Players of American Football
30:34

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-Related Concussion

 

Feb 01, 2018
Gastric Sleeve Resection for Obesity: How good Is It?
29:48

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

Anirban Gupta, MD
Washington Permanente Medical Group, Bellevue, WA

Read the article: Comparing the Outcomes of Sleeve Gastrectomy

Jan 16, 2018
Surveillance for Thyroid Cancer
16:37

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

Jan 02, 2018
Diagnosis and First-Line Treatment of Chronic Sinusitis
30:23

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 19, 2017
Managing Hypertension: Understanding the New AHA/ACC Hypertension Guideline, Part II
10:37

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 12, 2017
Matching Drugs to Genetic Abnormalities to Precisely Treat Cystic Fibrosis
26:07

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

Dec 05, 2017
Managing Hypertension: Understanding the New AHA/ACC Hypertension Guideline
39:43

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 05, 2017
Mendelian Randomization: How the Natural Assortment of Genes Can Mimic Randomized Clinical Trials
29:43

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 21, 2017
Bacteriophage Treatment for Serious Infections Is Back!
37:28

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 bacteria discovered while trying to grow viruses. Although Twort did not identify bacteriophages in his experiment, he believed there was some toxic entity that killed bacteria present in his experiments.

An investigation on the nature of ultra-microscopic viruses1 by Twort FW, L.R.C.P. Lond., M.R.C.S.

Reprint and translation of d’Herelle’s original 1917 description of bacteriophages isolated from soldiers recovering from dysentery.

On an invisible microbe antagonistic to dysentery bacilli. Note by M. F. d’Herelle, presented by M. Roux. Comptes Rendus Academie des Sciences 1917; 165:373–5

Review of the non-English-language literature on bacteriophage therapy of infection

Bacteriophage Therapy Antimicrob Agents Chemother. 2001 Mar; 45(3): 649–659.

Review of the history bacteriophage research and its effect on scientific development and clinical medicine

The Murky Origin of Snow White and Her T-Even Dwarfs Genetics 155: 481–486 (June 2000)

News report from UC San Diego on treatment of the patient described in the podcast

Novel Phage Therapy Saves Patient with Multidrug-Resistant Bacterial Infection

2017 JAMA Medical News article on the use of bacteriophage to treat a patient with multidrug-resistant Acinetobacter infection

Phage Therapy’s Role in Combating Antibiotic-Resistant Pathogens

Nov 14, 2017
Incontinence in Women: How We Talk About It and What Can Be Done
33:42

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 24, 2017
Managing Transgender Patients: Endocrine Society Guideline Update 2017
25:43

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 17, 2017
Replacing Tissue Biopsies With a Blood Test: The Technique of Liquid Biopsy
26:31

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

 

Oct 03, 2017
Delirium: Prevention, Diagnosis, and Treatment
23:14

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 26, 2017
Breast Cancer Surgery: Less Is More
34:06

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 12, 2017
How Couples With Genetic Disease Can Have Healthy Offspring
15:48

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

 

Sep 05, 2017
Are they safe? Drugs and devices receiving accelerated approval by the FDA
27:51

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

Aug 15, 2017
How Studying Familial Hypercholesterolemia Resulted in the Discovery of Statins as an Effective Treatment for High Cholesterol
20:53

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 25, 2017
How to Diagnose and Manage Adult Asthma
33:30

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 18, 2017
Dual Antiplatelet Therapy: Balancing Ischemic and Bleeding Risk
28:04

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 11, 2017
Penicillin Allergy – It’s Less Common Than You Think
20:22

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.

Jul 03, 2017
High-Intensity Statin Therapy – The Controversy Continues
35:15

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.

Jun 27, 2017
Diagnosing Congenital and Intellectual Abnormalities With Chromosomal Microarray Analysis
18:27

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
Treating Depression in Older Patients
34:45

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 23, 2017
Genomic Sequencing for the Healthy Individual?: Think Smaller
17:14

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.

May 09, 2017
Diabetes in 2017: Focus Less On HbA1c and More On Cardiovascular Risk Reduction
29:47

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

Apr 03, 2017
JAMA Performance Improvement: Retained Foreign Body From a Sheared Off Lumbar Drain
19:33

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 28, 2017
Alzheimer Disease Overview and the Possibility That It’s Caused By Infections
27:37

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 20, 2017
Why the New Sepsis Guideline Changed
33:32

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.

Mar 07, 2017
Updated Guidelines for Sepsis Management
15:36

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 28, 2017
JAMA Professionalism: What Should Students or Residents Do When Abused by Faculty
30:41

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 16, 2017
Sarcopenia, Frailty and Risk Prediction in Geriatric Patients
18:02

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 09, 2017
Hypertension Management and Dealing With Polypharmacy in Elderly Patients—A Report From the 2016 European Union Geriatric Medical Society Meeting
28:41

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’Mahony from University College Cork, Ireland.

Links:

JAMA reviews on polypharmacy in the elderly: Evaluation and Treatment of Older Patients With Hypercholesterolemia (Sep 17, 2014)

Polypharmacy in the Aging Patient: Management of Hypertension (July 14, 2015)

Polypharmacy in the Aging Patient: Review of Glycemic Control in Older Adults With Type 2 Diabetes (DM article has polypharmacy podcast - Mar 8, 2016

SPRINT Trial of Hypertension Control in the Elderly: American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults or geriatricscareonline.org, click on the link for Clinical Guidelines & Recommendations–

The EU(7)-PIM list: Potentially Inappropriate Medications for Older People

STOPP/START Criteria for Potentially Inappropriate Prescribing in Older People

Feb 02, 2017
Managing Violent Patients in Health Care Settings
21:55

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

Jan 30, 2017
Systematic Approach to a New Onset Seizure
28:14

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

 

Dec 27, 2016
Using Medicare Star Ratings to Select Hospitals
26:54

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

 

Nov 01, 2016
Treatments for Hyperemesis and Nausea and Vomiting in Pregnancy
18:05

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

Oct 04, 2016
Fluid Resuscitation for Patients in Septic Shock
30:40

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?

 

Sep 27, 2016
The High Cost of Pharmaceuticals in the United States
32:46

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 26, 2016
Opioid Use Disorder
34:55

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: 

Aug 11, 2016
Treating Opioid Use Disorder Using Buprenorphine Implants
18:41
Jul 19, 2016
Review of Lyme Disease
38:26

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

Jul 12, 2016
Managing Persistent Diarrhea
37:25

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 28, 2016
The Discovery of Lyme Disease with Dr Allen Steere
23:03

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

Jun 14, 2016
GERD and Esophagitis
29:31

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 17, 2016
Treating ADHD in Adolescents
25:12

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:

May 10, 2016
Diagnosing Infectious Mononucleosis
33:33

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:

Apr 12, 2016
Opioid Prescribing: Rising to the Challenge
23:00

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:

Mar 15, 2016
Treating Geriatric Polypharmacy by Deintensifying Unnecessary Diabetes Treatment
27:28

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:

Mar 08, 2016
2015 Breast Cancer Screening Recommendations for Women at Average Risk
22:39

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 23, 2016
Antibiotic Therapy for Community-Acquired Pneumonia in Adults
18:42

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 09, 2016
New Dietary Guidelines
25:19

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 interview with Dr DeSalvo on the guidelines is also available within the Dietary Guidelines for Americans article.

Feb 02, 2016
Peripheral Neuropathy
26:43

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 19, 2016
Advances in Diagnosis and Treatment of Constipation
27:57

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:

Jan 12, 2016
Antibiotics vs Appendectomy for Uncomplicated Appendicitis Treatment
19:21

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 29, 2015
Head Trauma
25:35

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 22, 2015
Graves Disease
24:49

Edward H. Livingston, MD discusses Graves disease with David Cooper, MD, author of Management of Graves Disease: A Review

Dec 15, 2015
Prostate Cancer Screening
18:52

Edward H. Livingston MD, explores the topic of prostate cancer screening in author interviews with:

Nov 17, 2015
Ruling Out Acute Coronary Syndrome in Patients With Chest Pain
17:30

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 08, 2015
Using Likelihood Ratios to Understand How Chest Pain Predicts Acute Coronary Syndrome
14:58
Nov 08, 2015
Explaining the Improved Health of the US: Mortality Trends 1969-2013
19:02

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.

Oct 27, 2015
Treating Chronic Sinusitis in Adults
24:55

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.

Sep 01, 2015
Posttraumatic Stress Disorder
23:11

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.

Aug 04, 2015
Managing Atrial Fibrillation
22:30

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.

Jul 21, 2015
Medical Marijuana for Treatment of Chronic Pain and Other Problems
19:25

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?

Jun 23, 2015
Stroke Prevention in Atrial Fibrillation
18:41

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 19, 2015
Achalasia
19:26

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.

May 12, 2015