Interview with Tumaini Rucker Coker, MD, MBA, USPSTF member and coauthor of Screening for Speech and Language Delay and Disorders in Children: US Preventive Services Task Force Recommendation Statement. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Screening for Speech and Language Problems in Young Children Recommendations for Speech and Language Screenings Screening for Speech and Language Delay and Disorders in Children Screening for Speech and Language Delay and Disorders in Children 5 Years or Younger

The capabilities and risks of various types of artificial intelligence (AI) are markedly different. JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, interviews author Michael Howell, MD, MPH, chief clinical officer at Google, to discuss how AI has evolved and how to understand the problems and possibilities of each iteration. Related Content: AI and Clinical Practice—AI Gaslighting, AI Hallucinations, and GenAI Potential Three Epochs of Artificial Intelligence in Health Care

Age-related macular degeneration affects approximately 196 million people worldwide and is a leading cause of visual impairment. In this JAMA podcast, JAMA Deputy Editor Mary McGrae McDermott, MD, interviews author Usha Chakravarthy, MD, PhD, Queen’s University of Belfast, Northern Ireland, about the causes, diagnosis, and treatment of age-related macular degeneration. Related Content: Age-Related Macular Degeneration

JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, JAMA Executive Editor Gregory Curfman, MD, and JAMA Deputy Editor Linda Brubaker, MD, highlight their selections of top JAMA 2023 Clinical Reviews podcasts. Related Content: Management of Cirrhosis in 2023 Diagnosis and Treatment of Heart Failure with Preserved Ejection Fraction Worsening US Maternal Death Rates Diagnosis and Management of Cirrhosis and Its Complications Heart Failure With Preserved Ejection Fraction Trends in State-Level Maternal Mortality by Racial and Ethnic Group in the United States

Perinatal mental health conditions are a leading cause of overall and preventable maternal mortality. JAMA Deputy Editor Linda Brubaker, MD, MS, discusses postpartum depression with author Tiffany A. Moore Simas, MD, MPH, MEd, chair of the Department of Obstetrics and Gynecology at the University of Massachusetts. Related Content: A Fast-Acting Pill Received Approval for Postpartum Depression—Is It a Game Changer? Postpartum Depression—New Screening Recommendations and Treatments

Most people will experience a painful foot or ankle condition at some point in their lives. JAMA Associate Editor David Simel, MD, MHS, discusses diagnosis and treatment of Morton neuroma, plantar fasciitis, and Achilles tendinopathy with Minton Truitt Cooper, MD, of the University of Virginia, Charlottesville. Related Content: Common Painful Foot and Ankle Conditions Diabetic Foot Ulcers What Are Diabetic Foot Ulcers?

The incidence of gestational diabetes and type 2 diabetes in pregnancy is increasing and is associated with adverse pregnancy outcomes. Denice Feig, MD MSc, professor of medicine at the University of Toronto and Head of the Diabetes and Endocrine in Pregnancy Program at Mount Sinai Hospital, talks with JAMA Associate Editor Tracy A. Lieu, MD, MPH, about metformin for diabetes in pregnancy. Related Content: Metformin for Diabetes in Pregnancy

Deaths during pregnancy and in the early postpartum period have increased in the US over the past several years, and approximately 80% of these deaths are considered preventable. JAMA Senior Editor Kristin L. Walter, MD, MS, speaks with Sadiya S. Khan, MD, MSc, from Northwestern University about the importance of monitoring and improving cardiovascular health during the postpartum period. Related Content: Cardiovascular Health in the Postpartum Period

Obesity affects approximately 42% of adults in the US. Multiple strategies are available to treat obesity, including behavior therapies, GLP-1 receptor agonists, and bariatric surgery. Therapies vary in effectiveness and risks. JAMA Deputy Editor Mary McGrae McDermott, MD, discusses evidence-based obesity treatment with Melanie Jay, MD, MS, New York University Grossman School of Medicine. Related Content: Obesity Management in Adults As Semaglutide’s Popularity Soars, Rare but Serious Adverse Effects Are Emerging FDA Green-Lights Tirzepatide, Marketed as Zepbound, for Chronic Weight Management

Critical bleeding is associated with a high mortality rate in patients with trauma. JAMA Associate Editor Christopher W. Seymour, MD, MSc, discuses the results of the CRYOSTAT-2 trial with Nicola Curry, MD, Oxford University Hospitals, and Ross Davenport, PhD, Centre for Trauma Sciences, UK. Related Content: Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury

In July 2023, the US Food and Drug Administration (FDA) approved the first oral contraceptive pill (Opill) that will be available without a prescription. JAMA Senior Editor Kristin Walter, MD, MS, spoke with JAMA Associate Editor Melissa A. Simon, MD, MPH, about the use, effectiveness, and potential side effects of Opill. Related Content: Over-the-Counter Progestin-Only Oral Contraceptives

Interview with John M. Ruiz, PhD, USPSTF member and coauthor of Screening and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years, and Screening and Preventive Interventions for Oral Health in Adults: US Preventive Services Task Force Recommendation Statements. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years Screening and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years Screening and Preventive Interventions for Oral Health in Adults A Call for More Oral Health Research in Primary Care Dental Caries in Adults, Adolescents, and Children Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Adults

Approximately 5% of all primary care visits are related to knee pain. Osteoarthritis (OA), patellofemoral pain syndrome, and meniscal tears are among the most common causes of knee pain. JAMA Senior Editor Karen Lasser, MD, MPH, speaks with David Hunter, MD, PhD, from the University of Sydney, about common causes and first-line treatment of knee pain. Related Content: Evaluation and Treatment of Knee Pain Clinical Examination for Diagnosing Meniscal Tears

Hyperthyroidism affects 2.5% of adults worldwide and, if untreated, is associated with osteoporosis, heart rhythm abnormalities, heart failure, and increased mortality. JAMA Associate Editor Anne Cappola, MD, speaks with Elizabeth N. Pearce, MD, MSc, of Boston University, about the most common causes, symptoms, and first-line treatments for hyperthyroidism. Related Content: Hyperthyroidism

Preexposure prophylaxis (PrEP) and postexposure prophylaxis have recently gotten attention as ways to prevent sexually transmitted infections. JAMA Deputy Editor Preeti Malani, MD, MSJ, discusses postexposure prophylaxis using doxycycline (doxyPEP), with Kenneth H. Mayer, MD, professor of medicine and global health at Harvard and medical research director at Fenway Health in Boston. Related Content: Doxycycline Postexposure Prophylaxis and Sexually Transmitted Infections

Vasomotor symptoms are common during menopause and may have substantial negative effects on quality of life. JAMA Senior Editor Linda Brubaker, MD, MS, discusses nonhormonal therapies for menopausal vasomotor symptoms with Susan D. Reed, MD, MPH, MS, professor emeritus at the University of Washington and president and CEO of The North American Menopause Society. Related Content: Nonhormonal Therapies for Menopausal Vasomotor Symptoms

Approximately 500 000 adults in the US have survived childhood cancer. JAMA Deputy Editor Mary McGrae McDermott, MD, speaks with Smita Bhatia, MD, MPH, University of Alabama, about common medical problems that occur in adults who have survived a childhood cancer and optimal approaches to medical care for these patients. Related Content: Clinical Care for People Who Survive Childhood Cancer

Interview with Esa M. Davis, MD, MPH, USPSTF member and coauthor of Screening for Hypertensive Disorders of Pregnancy: US Preventive Services Task Force Final Recommendation Statement. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Screening for Hypertensive Disorders of Pregnancy Screening for Hypertensive Disorders of Pregnancy Hypertension Screening in Pregnancy Screening for High Blood Pressure Disorders During Pregnancy

Ulcerative colitis (UC) is a chronic inflammatory condition of the colon. Individuals with UC have a lower life expectancy and are at increased risk for colectomy and colorectal cancer. However, many new treatments are available. JAMA Senior Editor Karen E. Lasser, MD, MPH, speaks to Gilaad Kaplan, MD, MPH, University of Calgary, about the latest information related to this condition. Related Content: Ulcerative Colitis in Adults

There are long-term cardiometabolic health risks for individuals with pregnancies complicated by gestational diabetes. JAMA Senior Editor Linda Brubaker, MD, MS, discusses these risks with Kartik K. Venkatesh, MD, PhD, high-risk pregnancy specialist at The Ohio State University. Related Content: Gestational Diabetes and Long-Term Cardiometabolic Health

Interview with John B. Wong, MD, USPSTF member and coauthor of Preexposure Prophylaxis to Prevent Acquisition of HIV: US Preventive Services Task Force Recommendation Statement. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Preexposure Prophylaxis for the Prevention of HIV New USPSTF Guidelines for HIV Preexposure Prophylaxis Preexposure Prophylaxis to Prevent Acquisition of HIV Preventing HIV With PrEP

Each year approximately 100 000 people in the US are treated for cervical precancer, and about 4000 individuals die from cervical cancer. JAMA Senior Editor Melissa Simon, MD, MPH, and Rebecca B. Perkins, MD, MSc, Boston University School of Medicine, discuss the importance of HPV screening, genotyping and cytology testing, and HPV vaccination. Related Content: Cervical Cancer Screening

In this interview, dementia expert Gil D. Rabinovici, MD, discusses monoclonal antibodies that target beta-amyloid–-including a recent phase 3 trial of donanemab published in JAMA-–and reviews considerations for their use in patients with Alzheimer disease. Related Content: Amyloid-Targeting Monoclonal Antibodies for Alzheimer Disease Donanemab in Early Symptomatic Alzheimer Disease

Interview with Katrina E. Donahue, MD, MPH, USPSTF member and coauthor of Folic Acid Supplementation for the Prevention of Neural Tube Defects: US Preventive Services Task Force Reaffirmation Recommendation Statement. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Folic Acid Supplementation to Prevent Neural Tube Defects Folic Acid Supplementation to Prevent Neural Tube Defects Fully Effective Folic Acid Fortification Reaffirming Recommendations for Folic Acid Supplementation Folic Acid to Prevent Neural Tube Defects

JAMA Associate Editor David L. Simel, MD, MHS, discusses the latest European Society of Intensive Care Medicine (ESICM) Guidelines on Acute Respiratory Distress Syndrome, which were released in June 2023, with Derek C. Angus, MD, MPH, University of Pittsburgh. Related Content: Caring for Patients With Acute Respiratory Distress Syndrome

Interview with Li Li, MD, PhD, MPH, USPSTF member and coauthor of Screening for Lipid Disorders in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Screening for Lipid Disorders in Children and Adolescents Screening for Lipid Disorders in Children and Adolescents Still “on the Fence” About Universal Childhood Lipid Screening Screening for Lipid Disorders in Children and Adolescents

The incidence of Cushing syndrome due to endogenous overproduction of cortisol is 2 to 8 people per million annually. JAMA Deputy Editor Mary M. McDermott, MD, discusses diagnosis, management, and treatment of this condition with authors Martin Reincke, MD, from University of Munich, and Maria Fleseriu, MD, from Oregon Health and Science University. Related Content: Cushing Syndrome

The 2021 US maternal mortality rate is more than 10 times the rate of other high-income countries, according to a March 2023 CDC report. In this Q&A, JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, is joined by Monica McLemore, PhD, MPH, RN, University of Washington, Audra Meadows, MD, MPH, UC San Diego, and Joia Crear-Perry, MD, founder and president of the National Birth Equity Collaborative, to discuss these concerning numbers and why preventable death rates are worsening in the US. Related Content: Trends in State-Level Maternal Mortality by Racial and Ethnic Group in the United States Worsening US Maternal Death Rates US Maternal Mortality Is Unacceptably High, Unequal, and Getting Worse—What Can Be Done About It? Trends in Maternal Mortality and Severe Maternal Morbidity During Delivery-Related Hospitalizations in the United States, 2008 to 2021

Interview with Michael Silverstein, MD, MPH, USPSTF chair and coauthor of Screening for Depression and Suicide Risk in Adults, and Screening for Anxiety Disorders in Adults: US Preventive Services Task Force Recommendation Statements. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Anxiety Screening Depression and Suicide Risk Screening Screening for Depression and Suicide Risk in Adults Screening for Anxiety Disorders in Adults Screening for Depression and Suicide Risk in Adults Screening for Anxiety Disorders in Adults Are There Reasons to Fear Anxiety Screening? Reframing the Key Questions Regarding Screening for Suicide Risk

JAMA Senior Editor Kristin Walter, MD, MS, speaks with Fernando Zampieri, MD, PhD, assistant professor in the Department of Critical Care Medicine at the University of Alberta in Alberta, Canada, about fluid therapy in critically ill adults with sepsis. Related Content: Fluid Therapy for Critically Ill Adults With Sepsis

Transgender and gender diverse persons may desire gender-affirming medical and surgical treatment that can mitigate psychologic distress and reduce suicide risk. JAMA Associate Editor David L. Simel, MD, MHS, speaks with Andrew M. Davis, MD, MPH, University of Chicago, and Tonia Poteat, PhD, PA-C, MPH, University of North Carolina, Chapel Hill, about the Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 guidelines. Related Content: Standards of Care for Transgender and Gender Diverse People

Cirrhosis affects approximately 2.2 million adults in the US, and the annual age-adjusted mortality of cirrhosis has increased from 2010 to 2021. JAMA Senior Editor Karen E. Lasser, MD, MPH, and Elliot B. Tapper, MD, from the University of Michigan, discuss the diagnostic workup and evidence-based therapies for cirrhosis. Related Content: Diagnosis and Management of Cirrhosis and Its Complications

Interview with Gbenga Ogedegbe, MD, MPH, USPSTF member and coauthor of Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Screening for Latent Tuberculosis Infection in Adults Screening for Latent Tuberculosis Infection Among Non–US-Born Adults in the US Screening for Latent Tuberculosis Infection in Adults Screening for Latent Tuberculosis

Interview with Katrina E. Donahue, MD, MPH, USPSTF member and coauthor of Screening for Skin Cancer: US Preventive Services Task Force Recommendation Statement. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Skin Cancer Screening Screening and Prevention of Skin Cancer Screening for Skin Cancer What Is Mohs Surgery? Skin Cancer Screening

One in 3 adults in the US has prediabetes. JAMA Associate Editor David L. Simel, MD, interviews Samuel Dagogo-Jack, MD, who is the chief of the Division of Endocrinology, Diabetes, and Metabolism at the University of Tennessee, about the diagnosis, screening, complications, lifestyle interventions, and medications for prediabetes. Related Content: Diagnosis and Management of Prediabetes

Chronic lymphocytic leukemia (CLL) affects more than 200 000 people and is associated with >4000 deaths in the US annually. Many people have asymptomatic disease and can be monitored without treatment for long periods. In this podcast, author Mazyar Shadman, MD, MPH, from the University of Washington, Seattle, joins JAMA Deputy Editor Mary M. McDermott, MD, in a discussion about diagnosis and management of CLL. Related Content: Diagnosis and Treatment of Chronic Lymphocytic Leukemia

Approximately 3 million people in the US have heart failure with preserved ejection fraction (HFpEF). JAMA Executive Editor Gregory Curfman, MD, discusses diagnosis and treatment of HFpEF with authors Margaret Redfield, MD, and Barry Borlaug, MD, both from Mayo Foundation for Medical Education and Research Division of Cardiovascular Diseases. Related Content: Heart Failure With Preserved Ejection Fraction

More than 2 million individuals in the US are chronically infected with hepatitis C, and nearly 15 000 die every year. Antivirals are available but are not reaching the majority of infected individuals. In this Q&A, JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, and Francis S. Collins, MD, PhD, discuss a plan to eliminate hepatitis C included in the Biden-Harris 2024 budget proposal. Related Content: A National Hepatitis C Elimination Program in the United States Eliminating Hepatitis C in the United States Former NIH Director Francis S. Collins on the New White House Plan to Eliminate Hepatitis C Association of Direct-Acting Antiviral Therapy With Liver and Nonliver Complications and Long-term Mortality in Patients With Chronic Hepatitis C After 12 Years, NIH Director Francis S. Collins, MD, PhD, Seeks His Next Chapter After 12 Years, NIH Director Francis S. Collins Seeks His Next Chapter

In January 2023, the US Organ Procurement & Transplantation Network (OPTN) required transplant centers to modify transplant list wait times for Black patients. JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, and L. Ebony Boulware, MD, MPH, Dinushika Mohottige, MD, MPH, and Tanjala S. Purnell, PhD, MPH, discuss why the OPTN mandate is a valuable model for reforming race-based practices. Related Content: Race-Neutral Estimates of Kidney Function: Enhancing Equity Race-Based Equations Delayed Black Patients From Getting Onto Kidney Transplant Lists—An Unprecedented New Policy Seeks to Undo the Damage Redressing the Harms of Race-Based Kidney Function Estimation

Malignant primary brain tumors cause more than 15 000 deaths annually in the US. JAMA Fishbein Fellow Revital Marcus, MD, interviews Ingo Mellinghoff, MD, PhD, neuro-oncologist and chair of the department of neurology at Memorial Sloan Kettering Cancer Center in New York, about the epidemiology, diagnosis, and treatment of various primary malignant brain tumors in adults. Related Content: Glioblastoma and Other Primary Brain Malignancies in Adults

During the transition to menopause, approximately 50%-75% of individuals experience vasomotor or genitourinary symptoms. JAMA Senior Editor Linda Brubaker, MD, and Carolyn Crandall MD, MS, of the University of California, Los Angeles, discuss hormonal and nonhormonal therapy for treatment of menopausal symptoms. Related Content: Management of Menopausal Symptoms

Interview with Vanessa Northington Gamble, MD, PhD, author of Dr Herman A. Barnett, Black Civil Rights Activists, and the Desegregation of The University of Texas Medical Branch in 1949: “We Ought to Go in Texas and I Don’t Mean to a Segregated Medical School.” Hosted by Robert Steinbrook, MD, and Raegan W. Durant, MD, MPH. Related Content: Dr Herman A. Barnett, Black Civil Rights Activists, and the Desegregation of The University of Texas Medical Branch in 1949

Deverick John Anderson, MD, MPH, professor of medicine at Duke University and director of the Duke Center for Antimicrobial Stewardship and Infection Prevention, discusses the evidence and appropriate strategies used in the prevention of surgical site infections with JAMA Associate Editor Anthony Charles, MD, MPH. Related Content: Surgical Site Infection Prevention

Anxiety disorders affect approximately a third of adults during their lifetime in the US and are associated with significant distress and impairment. JAMA Deputy Editor Mary M. McDermott, MD, discusses diagnosis and treatment of anxiety disorders with Naomi M. Simon, MD, MSc, professor of the Department of Psychiatry at NYU Grossman School of Medicine. Related Article(s): Anxiety Disorders

Bacterial meningitis is a worldwide health problem causing approximately 300 000 deaths annually. In this podcast, JAMA Fishbein Fellow Revital Marcus, MD, speaks with Rodrigo Hasbun, MD, MPH, infectious disease specialist and professor of medicine at the University of Texas Health Science Center in Houston, about the epidemiology, diagnosis, and treatment of bacterial meningitis. Related Content: Progress and Challenges in Bacterial Meningitis Bacterial Meningitis

Rajesh T. Gandhi, MD, director of Harvard University’s Center for AIDS Research, talks about recent advances in the treatment and prevention of HIV and discusses HIV in the context of COVID-19 and monkeypox infections. Hosted by JAMA Deputy Editor and Editorial Director for Equity Preeti Malani, MD, MSJ. Related Content: Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults Ending the HIV Epidemic Anthony Fauci, MD: Working to End HIV/AIDS

Phenome-wide association studies use large data sets to search for phenotypes associated with specific single-nucleotide variants, investigating whether specific genetic variations may be associated with multiple conditions and traits. In this podcast, JAMA Fishbein Fellow Revital Marcus, MD, discusses phenome-wide association studies with Dan M. Roden, MD, professor of medicine, pharmacology, and biomedical informatics at Vanderbilt University Medical Center, and Joshua C. Denny, MD, MS, chief executive officer of the National Institutes of Health's All of Us Research Program. Related Content: Phenome-Wide Association Studies

JAMA Interim Executive Editor Gregory Curfman, MD, interviews Robert M. Carey, MD, University of Virginia, about his review article on treatment of hypertension in the November 8, 2022, issue of JAMA. Their discussion addresses the clinical consequences of hypertension, as well as nonpharmacological and pharmacological approaches to management, including patients with resistant hypertension. Related Content: Treatment of Hypertension

Michele Bratcher Goodwin, JD (Center for Biotechnology and Global Health Policy, University of California, Irvine), Molly Meegan, JD (American College of Obstetricians and Gynecologists), and Lisa Harris, MD, PhD (University of Michigan) discuss how new abortion bans in the US are creating serious legal and ethical dilemmas for clinicians. Hosted by JAMA Legal and Global Health Correspondent Lawrence O. Gostin, JD (Georgetown University). Related Content: Legal Risks and Ethical Dilemmas for Clinicians in the Aftermath of Dobbs The Future of Ob-Gyn Training in the US Post-Dobbs Medical Indications for Abortion   Conflict of Interest Disclosures: Lawrence O. Gostin, JD, is the Legal and Global Health Correspondent for JAMA and Faculty Director of the O’Neill Institute for National and Global Health Law at Georgetown University.  No other disclosures were reported. Michele Bratcher Goodwin, JD, LLM, SJD is Director of the Center for Biotechnology and Global Health Policy at University of California, Irvine.  No other disclosures were reported.  Lisa Harris, MD, PhD, is the F. Wallace and Janet Jeffries Collegiate Professor of Reproductive Health, and Professor and Associate Chair in the Department of Obstetrics and Gynecology at University of Michigan. She is also a Professor in the Department of Women’s Studies.  No other disclosures reported.  Molly Meegan is the Chief Legal Officer and General Counsel for the American College of Obstetricians and Gynecologists (ACOG).  No other disclosures reported.

An estimated 45% of accredited US obstetrics and gynecology residency programs are located in states that currently ban or severely restrict abortions. JAMA Associate Editor Linda Brubaker, MD, and JAMA Internal Medicine Deputy Editor Deborah Grady, MD, speak with medical students, program directors, and other specialists in the ob-gyn training community about new restrictions and their effects on ob-gyn education in the US. Related Content: Implications of the Dobbs Decision for Medical Education Dobbs Decision Threatens Full Breadth of Ob-Gyn Training Medical Indications for Abortion Threats to Evidence-Based Care With Teratogenic Medications in States With Abortion Restrictions Treating Cancer in Pregnant Patients After Roe v Wade Overturned The Challenge of Emergency Abortion Care Following the Dobbs Ruling Clinical and Legal Dilemmas of Providing Reproductive Health Care After the Dobbs Decision Legal Risks and Ethical Dilemmas for Clinicians in the Aftermath of Dobbs The Implications of the Supreme Court Decision to Overturn Roe v Wade for Women With Pregnancy-Associated Cancers Reproductive Rights in Neurology—The Supreme Court's Impact on All of Us Antiabortion Laws and Implications for Patients With Cardiovascular Disease in Pregnancy Conflict of Interest Disclosures: Hannah Nguyen reported that she held leadership positions on Boston University’s School of Medicine chapters of SPA-1 and DREAM. Margaux Zimmerman reported that she held leadership positions on Boston University’s, School of Medicine chapters of ACOG and DREAM. Dr Gariepy reported that she was the Yale Complex Family Planning fellowship director from 2018 to March 2022, for which she received salary support from her institution; taught undergraduate and medical students, ob-gyn residents, and Complex Family Planning fellows; and is a research mentor for Complex Family Planning fellows who received research grants from the Society of Family Planning Research Fund. Dr Gariepy also reported leadership positions on the board of directors for the Society of Family Planning and the Complex Family Planning Fellowship Council and membership with Physicians for Reproductive Health, the National Abortion Federation, and the Society of Family Planning. Dr Steinauer is a member of the Society of Family Planning. Dr Loder reported that she serves as a principal investigator for contraceptive clinical trials for Merck and Sebela Pharmaceuticals Inc, consults for American Medical Students Association, and serves as program director for Complex Family Planning Fellowship, University of Michigan, Michigan Medicine. No other disclosures were reported.

JAMA Associate Editor Linda Brubaker, MD, MS, discusses medication abortion as an alternative to a procedural abortion to terminate a pregnancy in an interview with Stephanie Teal, MD, MPH, University Hospitals Cleveland Medical Center, and Rebecca Cohen, MD, OB/GYN, University of Colorado. Related Content: Medication Abortion Contraception Selection, Effectiveness, and Adverse Effects Conflict of Interest Disclosures: Dr Cohen serves as an unpaid board member for Cobalt, a reproductive rights advocacy group. No other disclosures were reported.

Hypercalcemia affects approximately 1% of the population. Its presence typically indicates an underlying disorder and requires diagnostic evaluation. In this podcast, JAMA Associate Editor Anne Cappola, MD, ScM, interviews Elizabeth Shane, MD, an endocrinologist and professor of medicine at Columbia University Medical Center, about the clinical approach to diagnosing and managing hypercalcemia. Related Content: Hypercalcemia

In the US, pulmonary embolism (PE) affects approximately 370 000 patients annually and is estimated to cause 60 000 to 100 000 deaths per year. In this podcast, JAMA Senior Editor Kristin Walter, MD, MS, discusses the clinical presentation, diagnostic strategies, and treatment of PE with Yonathan Freund, MD, PhD, professor of emergency medicine at Sorbonne University in Paris, France. Related Article(s): Acute Pulmonary Embolism

Hyponatremia affects approximately 5% of adults and approximately 35% of hospitalized patients. Even mild hyponatremia can be associated with cognitive impairment; in hospitalized patients, hyponatremia is associated with longer hospital stays and increased mortality. In this podcast, JAMA Deputy Editor Mary M. McDermott, MD, interviews Nicolaos E. Madias, MD, a nephrologist and professor of medicine at Tufts University School of Medicine, about the clinical approach to diagnosing hyponatremia and management of both acute and chronic hyponatremia. Related Content: Diagnosis and Management of Hyponatremia

Myelodysplastic neoplasms, or myelodysplastic syndromes, are diagnosed in approximately 4 of 100 000 people each year in the US and are associated with a 5-year survival rate of approximately 37%. In this JAMA podcast and author interview, JAMA Deputy Editor Mary M. McDermott, MD, discusses the diagnosis and treatment of myelodysplastic syndromes with Mikkael A. Sekeres, MD, MS, chief of hematology and professor of medicine of the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine. Related Content: Diagnosis and Treatment of Myelodysplastic Syndromes

JAMA Associate Editor Preeti Malani, MD, MSJ, discusses testing, treatment, and prevention of monkeypox infection and the current state of the 2022 outbreak with Carlos del Rio, MD, from Emory University’s Department of Medicine. Recorded August 19, 2022. Related Content: Monkeypox in 2022—What Clinicians Need to Know What Is Monkeypox? What to Know About Monkeypox Global Monkeypox Outbreaks Spur Drug Research for the Neglected Disease Diagnosis, Prevention, and Treatment of Monkeypox Compassionate Use of Tecovirimat for the Treatment of Monkeypox Infection

JAMA Associate Editor Preeti Malani, MD, MSJ, discusses the transmission, diagnosis, and treatment of monkeypox and the 2022 outbreak with Jeannette Guarner, MD, and Carlos del Rio, MD, both of the Division of Infectious Diseases at Emory University’s School of Medicine. Recorded July 11, 2022. Related Content: Monkeypox in 2022—What Clinicians Need to Know What Is Monkeypox? What to Know About Monkeypox Global Monkeypox Outbreaks Spur Drug Research for the Neglected Disease The WHO Declaration of Monkeypox as a Global Public Health Emergency Update on the Monkeypox Outbreak Update on Monkeypox (podcast)

Barrett esophagus affects approximately 5% of people in the US and approximately 1% worldwide; it's associated with an increased risk of esophageal adenocarcinoma. JAMA Deputy Editor Mary M. McDermott, MD, interviews Prateek Sharma, MD, a gastroenterologist and professor of medicine at University of Kansas School of Medicine, about the diagnosis, surveillance, and available therapy for patients affected by Barrett esophagus. Related Article(s): Barrett Esophagus

Malaria is diagnosed in approximately 2000 people in the US each year. Delay in diagnosis or inappropriate treatment of malaria is associated with increased mortality. In this podcast, JAMA Deputy Editor Mary M. McDermott, MD, interviews Johanna P. Daily, MD, MS, Albert Einstein College of Medicine, an infectious disease expert and scientist studying malaria, on the diagnosis, treatment, and prevention of malaria in the US. Related Content: Diagnosis, Treatment, and Prevention of Malaria in the US

Pregnancy inherently increases the risk of death, but certain conditions during pregnancy are considered life-threatening. In this podcast, JAMA Associate Editor Linda Brubaker, MD, discusses with maternal-fetal medicine specialists William A. Grobman, MD, The Ohio State University, and Cynthia Gyamfi-Bannerman, MD, MS, University of California, San Diego, the categories of life-threatening conditions, as well as the racial and ethnic disparities associated with pregnancy-associated mortality. Related Content: The Leaked Supreme Court Ruling Opinion What Overturning Roe v Wade May Mean for Assisted Reproductive Technologies in the US

In July 2022, Kirsten Bibbins-Domingo, PhD, MD, MAS, took on a new role as the 17th editor in chief of JAMA and the JAMA Network. In conversation with Nobel laureate Harold Varmus, MD, Bibbins-Domingo discusses her research background, approaches to leadership in health care, and the critical role that journals play in communication about public health and science. Related Content: The Urgency of Now and the Responsibility to Do More—My Commitment for JAMA and the JAMA Network A Conversation With Dr Kirsten Bibbins-Domingo, JAMA’s New Editor in Chief (video) A Conversation With Dr Kirsten Bibbins-Domingo, JAMA’s New Editor in Chief (audio)

In the US, approximately 100 000 people have sickle cell disease, a chronic condition characterized by hemolytic anemia, acute and chronic pain, increased rates of stroke and nephropathy, and an average lifespan that is 20 years less than that of the general population. In this podcast, JAMA Deputy Editor Mary McDermott, MD, interviews review article author Patricia Kavanaugh, MD, on the diagnosis and management of sickle cell disease. Discussion includes a summary of 3 new therapies for sickle cell disease and some of the social, structural, and cultural challenges encountered by patients with sickle cell disease. Related Content: Sickle Cell Disease

Carpal tunnel syndrome and trigger finger are common hand conditions in primary care practice that are associated with pain and disability. In this JAMA podcast, JAMA Deputy Editor Mary M. McDermott, MD, and Kelly Currie, MD, assistant professor in the Washington University Division of Plastic & Reconstructive Surgery in St Louis, Missouri, discuss the diagnosis and treatment of these conditions and other hand problems that are commonly encountered in primary care. Related Content: Common Hand Conditions Patient Information: Carpal Tunnel Syndrome

JAMA Associate Editor Ethan Basch, MD, and Melanie Calvert, PhD, from the University of Birmingham, UK, discuss barriers to and strategies for including rigorous patient-reported outcomes in clinical trials, and reflect on Dr Calvert’s recent JAMA paper on related ethical implications. Related Content: Ethical Considerations for the Inclusion of Patient-Reported Outcomes in Clinical Research

Lumbar spinal stenosis is a common cause of low back pain and disability in older people. Both nonoperative and operative therapies can improve symptoms from spinal stenosis. In this podcast, Jeffrey Katz, MD, MSc, from Harvard Medical School joins JAMA Deputy Editor Mary M. McDermott, MD, to discuss current evidence regarding diagnosis and optimal treatment of lumbar spinal stenosis, including when to consider invasive therapies for patients with symptoms of lumbar spinal stenosis. Related Content: Diagnosis and Management of Lumbar Spinal Stenosis

JAMA Associate Editor Linda Brubaker, MD, MS, from University of California San Diego, discusses the implications of self-monitoring of blood pressure in higher-risk pregnancies with Richard J. McManus, MBBS, PhD, from University of Oxford, UK, and Lucy C. Chappell, MB BChir, PhD, from King's College London. Related Content: Effect of Self-monitoring of Blood Pressure on Diagnosis of Hypertension During Higher-Risk Pregnancy Effect of Self-monitoring of BP on BP Control in Pregnant Individuals With Chronic or Gestational Hypertension Management of Chronic Hypertension During Pregnancy Self-monitoring of Blood Pressure During Pregnancy

After certain adverse pregnancy outcomes, an individual’s risk for cardiovascular and other diseases increases. JAMA Associate Editor Linda Brubaker, MD, discusses these complications as indicators of future health problems, who is at risk, and what can be done to improve health for at-risk individuals and populations with Lynn M. Yee, MD, MPH, and JAMA Senior Editor Philip Greenland, MD, from Northwestern University, and Eliza C. Miller, MD, MS, from Columbia University. Related Content: Mitigating the Long-term Health Risks of Adverse Pregnancy Outcomes To Prevent Cardiovascular Disease, Pay Attention to Pregnancy Complications

Pulmonary arterial hypertension is a rare condition that requires a thorough workup to evaluate for potential causes and right heart catheterization for definitive diagnosis and decision-making about treatment options. JAMA Associate Editor Kristin Walter, MD, MS, discusses the recent JAMA review article titled “Pulmonary Arterial Hypertension Classification, Diagnosis, and Treatment” with one of the authors, Nicole Ruopp, MD, assistant professor of medicine at Tufts Medical Center and Tufts University School of Medicine. Related Content: Diagnosis and Treatment of Pulmonary Arterial Hypertension

Epilepsy affects approximately 65 million people worldwide and is associated with increased rates of bodily injuries and mortality when not optimally treated. The primary goal of epilepsy treatment is to eliminate seizures while minimizing adverse effects of antiseizure drugs. JAMA Senior Editor Christopher Muth, MD, and Professor of Clinical Neurology at the University of Miami Miller School of Medicine Andres Kanner, MD, discuss establishing a diagnosis of epilepsy and the use of antiseizure medications for adult patients with epilepsy. Related Content: Treating Epilepsy With Antiseizure Medications A Review of Antiseizure Medications for Adults With Epilepsy

More than 200 000 individuals in the US develop acute cholecystitis annually. The majority of these cases are caused by gallstones blocking the cystic duct. However, about 5% to 10% of people with acute cholecystitis have acalculous cholecystitis. JAMA Associate Editor Kristin Walter, MD, MS, discusses the recent JAMA article “Acute Cholecystitis: A Review” with one of the authors, JAMA Associate Editor Anthony Charles, MD, MPH, who is Chief of the Division of Trauma, Critical Care and Acute Care Surgery, Director of the ECMO program, and Director of Global Surgery at University of North Carolina in Chapel Hill. Related Content: Acute Cholecystitis

Treatment strategies for acute ischemic stroke are continuing to evolve. JAMA Associate Editor and vascular neurologist Jeffrey Saver, MD, from the University of California Los Angeles, and JAMA Senior Editor Christopher Muth, MD, discuss 2 articles recently published in JAMA about alteplase in the treatment of acute ischemic stroke and provide a broader overview of the recent advances and future directions for the use of thrombolytics and endovascular thrombectomy for acute ischemic stroke.Treatment strategies for acute ischemic stroke are continuing to evolve. JAMA Associate Editor and vascular neurologist Jeffrey Saver, MD, from the University of California Los Angeles, and JAMA Senior Editor Christopher Muth, MD, discuss 2 articles recently published in JAMA about alteplase in the treatment of acute ischemic stroke, and provide a broader overview of the recent advances and future directions for the use of thrombolytics and endovascular thrombectomy for acute ischemic stroke. Related Content: Association of Recent Use of Non–Vitamin K Antagonist Oral Anticoagulants With Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Treated With Alteplase

Pregnant and recently pregnant individuals who become infected with the COVID-19 virus are at high risk of requiring extra medical care. JAMA Associate Editor Linda Brubaker, MD, MS, from University of California San Diego discusses the rapidly evolving data around COVID-19 and vaccine effectiveness and safety as it relates to pregnancy, breastfeeding, and fertility with 3 experts in the field: Laura E. Riley, MD, from Weill Cornell Medicine, Christina Chambers, PhD, MPH, from University of California San Diego School of Medicine-Pediatrics, and Denise Jamieson, MD, MPH, from Emory University. Related Content: COVID-19 and Pregnancy COVID-19 Vaccination During Pregnancy: Maternal Protection and Neonatal Immunity Widespread Misinformation About Infertility Continues to Create COVID-19 Vaccine Hesitancy Conflict of Interest Disclosures: Dr Chambers reported receiving research funding from Pfizer-BioNTech to study the safety of its COVID-19 vaccine in pregnancy. Dr Jamieson reported no disclosures. Dr Riley reported receiving compensation from UpToDate for work on several infections disease cards, receiving royalties from Turner Publishing, and serving on an advisory board for Maven. Dr Riley also reported serving on a CDC Advisory Committee on Immunization Practices workgroup on COVID-19 vaccines and vaccine safety and workgroups for the American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine of COVID-19 vaccination, without compensation.

Acute coronary syndromes are characterized by a sudden reduction in blood supply to the heart, and the syndromes include ST-segment elevation myocardial infarction (or STEMI), non-ST-segment elevation myocardial infarction (or NSTEMI), and unstable angina. Each year, an estimated more than 7 million people in the world are diagnosed with acute coronary syndromes, including more than 1 million people hospitalized in the US. In this podcast with Deepak L. Bhatt, MD, MPH, of Brigham and Women’s Hospital Heart and Vascular Institute, we bring our listeners up-to-date on these common and potentially serious conditions. Related Content: Diagnosis and Treatment of Acute Coronary Syndromes

Tobacco smoking is responsible for more deaths in the US each year than any other preventable cause of mortality. Approximately 14% of US adults smoke cigarettes, of whom an estimated 70% want to quit smoking. JAMA Associate Editor Kristin Walter, MD, MS, discusses the recent JAMA article titled “Treatment of Smoking Cessation—A Review” with one of the authors, Nancy Rigotti, MD, who is director of the Tobacco Research and Treatment Center at Massachusetts General Hospital and is a professor at Harvard Medical School. Related Content: Treatment of Tobacco Smoking

Multiple myeloma is a hematologic malignancy characterized by abnormal plasma cells in the bone marrow, with potential uncontrolled growth causing destructive bone lesions, kidney injury, anemia, and hypercalcemia. Edward Libby, MD, of the University of Washington, joins JAMA Associate Editor Ethan Basch, MD, of the University of North Carolina, for a discussion of the diagnosis, complications, and management of myeloma, as well as the related conditions of monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma. Related Content: Diagnosis and Management of Multiple Myeloma Patient Information: Multiple Myeloma

Approximately 1 in 5 adults in the US had a sexually transmitted infection in 2018. Khalil Ghanem, MD, PhD, of Johns Hopkins University joins JAMA Deputy Editor Mary McDermott, MD, to discuss the newest recommendations regarding the diagnosis and treatment of sexually transmitted infections, including gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, and trichomoniasis. Related Content: Diagnosis and Treatment of Sexually Transmitted Infections

Pulmonary nodules are commonly found on lung imaging studies. Evaluation and management depends on the size and other characteristics of pulmonary nodules and patient risk factors for malignancy. JAMA Associate Editor Kristin Walter, MD, MS, discusses the recent JAMA article “Evaluating the Patient With a Pulmonary Nodule: A Review” with one of the authors, Peter Mazzone, MD, MPH, a pulmonologist and director of the Lung Cancer Program for the Respiratory Institute at the Cleveland Clinic. Related Content: Evaluating the Patient With a Pulmonary Nodule

The last few years have seen a tremendous increase in the conduct of platform clinical trials, a type of randomized clinical trial that can simultaneously evaluate the effects of multiple interventions, often in combination, with the available treatments changing over time as more is learned about their effectiveness. Jay J.H. Park, PhD, and Edward J. Mills, PhD, from the University of British Columbia and McMaster University, respectively, join JAMA Statistical Editor Roger J. Lewis, MD, PhD, to discuss how clinicians should evaluate the results of platform clinical trials when considering incorporating the results into their clinical practice. Related Content: How to Use and Interpret the Results of a Platform Trial

Approximately 87% of US women will use contraception during their lifetime. Stephanie Teal, MD, MPH, from University Hospitals Cleveland Medical Center, and JAMA Associate Editor Linda Brubaker, MD, MS, from University of California San Diego, discuss factors to consider during contraception selection, balancing highest effectiveness and lowest risks. Related Content: Contraception Selection, Effectiveness, and Adverse Effects

Nearly all pregnant individuals use at least 1 medication, either prescribed or over-the-counter, during their pregnancy. Denise Jamieson, MD, MPH, professor and chair of Gynecology and Obstetrics at Emory University in Atlanta, Georgia, joins JAMA Associate Editor Linda Brubaker, MD, MS, to discuss the current FDA system and other resources for communicating medication safety data to clinicians. Related Content: Assessment of the Safety of Common Medications Used During Pregnancy

Appendectomy remains the first-line therapy for acute appendicitis, but treatment with antibiotics rather than surgery is appropriate in selected patients with uncomplicated appendicitis. JAMA Associate Editor Anthony Charles, MD, MPH, from UNC School of Medicine summarizes this and other aspects of acute appendicitis in adults along with author Theodore N. Pappas, MD, from Duke University Medical Center. Related Content: Diagnosis and Management of Acute Appendicitis in Adults Acute Appendicitis

Acne vulgaris is one of the most common skin disorders seen in the outpatient clinic setting. Lawrence F. Eichenfield, MD, of the University of California San Diego School of Medicine, joins JAMA Dermatology Web/Associate Editor Adewole S. Adamson, MD, MPP, to discuss the latest developments in the evaluation and management of acne vulgaris and answer common questions related to acne subtyping, treatment selection, medication side effects, and diet. Related Content: Management of Acne Vulgaris Patient Information: Acne Treatment

Iron deficiency anemia can be caused by either decreased iron availability or increased iron requirements after blood loss from the gastrointestinal (GI) tract. Nabil M. Abou Baker, MD, and Andrew M. Davis, MD, MPH, both of the University of Chicago, join JAMA Deputy Editor Michael Berkwits, MD, MSCE, to discuss the evaluation of iron deficiency anemia and 2020 AGA recommendations for the workup of GI causes, including revised thresholds for ferritin values and the use of upper and lower (bidirectional) endoscopy. Related Content: Gastrointestinal Evaluation of Iron Deficiency Anemia

Romina Brignardello-Petersen, DDS, PhD, and Gordon Guyatt, MD, of McMaster University talk with JAMA Executive Deputy Editor Robert Golub, MD, about how to interpret clinical practice guidelines and recommendations, the subject of a recent Users’ Guides to the Medical Literature article in JAMA. Related Content: How to Interpret and Use a Clinical Practice Guideline or Recommendation

Bilateral salpingo-oophorectomy (BSO) causes premature menopause in younger women and is associated with reduced quality of life and cardiovascular, neurologic, and skeletal morbidity and mortality. Ekta Kapoor, MBBS, Associate Professor of Medicine and Assistant Director, Mayo Clinic Center for Women’s Health, joins JAMA Editor Carolyn Crandall, MD, MS, from UCLA Health, to discuss care and treatment of women with early surgical menopause. Related Content: Treatment of Women After Bilateral Salpingo-oophorectomy Performed Prior to Natural Menopause

Recognizing a potentially difficult intubation can help clinicians prepare for complications by getting assistance from colleagues with airway training and by ensuring advanced airway management equipment is available. Michael E. Detsky, MD, MSHP, assistant professor of medicine at the University of Toronto and the Mount Sinai Health System, discusses findings from a Rational Clinical Examination systematic review identifying physical findings and risk factors that can help predict difficult endotracheal intubation. Related Content: Will This Patient Be Difficult to Intubate? The Rational Clinical Examination Systematic Review Will This Patient Be Difficult to Intubate? (video)

Critically ill patients often require IV fluids for resuscitation but questions remain about the optimal type of IV fluid and best rate of IV fluid bolus infusion. JAMA Associate Editor Kristin Walter, MD, MS, discusses a recent clinical trial that examined the effect of 2 different crystalloid solutions and 2 IV fluid bolus infusion rates on ICU patient mortality with Alexandre B. Cavalcanti, MD, PhD, director of the Research Institute HCor in San Paulo, Brazil, and Craig M. Coopersmith, MD, professor of surgery and director of the Critical Care Center at Emory University School of Medicine in Atlanta, Georgia. Related Content: Effect of Slower vs Faster Intravenous Fluid Bolus Rates on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial Does Crystalloid Composition or Rate of Fluid Administration Make a Difference When Resuscitating Patients in the ICU? Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial Effect of Intravenous Fluid Treatment With a Balanced vs Normal Saline Solution at a High vs Low Infusion Rate on Mortality in Critically Ill Patients

Interview with Chien-Wen Tseng, MD, USPSTF member and coauthor of Screening for Prediabetes and Type 2 Diabetes: US Preventive Services Task Force Recommendation Statement. Related Content: Screening for Gestational Diabetes Screening for Prediabetes and Type 2 Diabetes Updated USPSTF Screening Recommendations for Diabetes

Interview with Chien-Wen Tseng, MD, USPSTF member and coauthor of Screening for Gestational Diabetes Related Content: USPSTF Review: Screening for Gestational Diabetes USPSTF Recommendation: Screening for Prediabetes and Type 2 Diabetes

Cost-effectiveness analysis defines trade-offs between costs, harms, and benefits of alternative treatments and combines them into a single metric, the incremental cost-effectiveness ratio (ICER), that can inform decisions about which interventions to recommend when limited resources are available. Gillian Sanders-Schmidler, PhD, professor of population health sciences and medicine at Duke University, explains the method in terms clinicians can understand. Related Articles: Overview of Cost-effectiveness Analysis Choosing a Time Horizon in Cost and Cost-effectiveness Analyses

Rules for the regulation of medical devices, such as hip prostheses and implantable defibrillators, are complex and differ from those for drugs. Aaron Kesselheim, MD, JD, MPH, and Jonathan Darrow, SJD, LLM, JD, MBA, both faculty members in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham & Women’s Hospital, review device classes and approval pathways used by the US Food and Drug Administration (FDA), and prospects for improvements and reform in the agency’s processes. Related Content: FDA Regulation and Approval of Medical Devices

Anabolic drugs activate osteoblasts and are an alternative to bisphosphonates for treating osteoporosis. Kristine Ensrud, MD, MPH, professor of medicine and epidemiology at the University of Minnesota and Minneapolis VA Healthcare System, joins JAMA Associate Editor Carolyn Crandall, MD, MS, to discuss the role of teriparatide, abaloparatide, and romosozumab in the management of osteoporosis. Related Content: Anabolic Therapy for Osteoporosis

Several new therapeutic drug classes are now available to manage lipid levels. John Wilkins, MD, MS, and Donald Lloyd-Jones, MD, ScM, of the Department of Preventive Medicine and Division of Cardiology at Northwestern University Feinberg School of Medicine, discuss the use of ezetimibe, PCSK-9 inhibitors, bempedoic acid, and icosapent ethyl to manage lipid levels in patients taking statins who require additional LDL lowering. Related Content: Novel Lipid-Lowering Therapies to Reduce Cardiovascular Risk Lipids and Lipoproteins in 2020

Alcoholic liver disease is increasing in incidence, especially in younger age groups. Ashwani Singal, MD, MS, professor of medicine at University of South Dakota, reviews the diagnosis, clinical presentation, and management of alcoholic liver disease, from acute alcoholic hepatitis to cirrhosis. Related Content: Diagnosis and Treatment of Alcohol-Associated Liver Disease

Approximately 1 in 8 women of reproductive age seek treatment for infertility. JAMA Associate Editor Linda Brubaker, MD, joins Sandra Ann Carson, MD, of Yale School of Medicine, to discuss causes and clinical correlates of infertility as well as evaluation options and treatment approaches. Related Content: Diagnosis and Management of Infertility

Transcatheter valve repair has emerged as an important therapeutic option for patients with aortic and mitral valve disease. JAMA Deputy Editor Gregory Curfman, MD, interviews Charles Davidson, MD, clinical chief of Cardiology at Northwestern University, to review the range of indications and procedures now available, including transcatheter aortic valve implantation (TAVI), valve-in-valve procedures after bioprosthetic valve failure, and mitral valve transcatheter edge-to-edge repair. Related Article: Transcatheter Treatment of Valvular Heart Disease

Chronic pelvic pain is a challenging condition that affects an estimated 26% of the world’s female population. JAMA Associate Editor Linda Brubaker, MD, and Georgine Lamvu, MD, of the University of Central Florida, discuss recommendations from consensus guidelines intended to improve the care of women with chronic pelvic pain and to facilitate positive clinical experiences for them. Related Articles: Chronic Pelvic Pain in Women I Have Chronic Pelvic Pain: What Should I Know?

Routine wellness or "checkup" visits are popular with patients and physicians but questions persist about their value, goals, and effective components. JAMA Associate Editor Anne Cappola, MD, ScM, discusses the evidence for and against the practice with Jeffrey Linder, MD, MPH, of the Northwestern University Feinberg School of Medicine, and Allan S. Brett, MD, of the University of Colorado School of Medicine. Related Content: General Health Checks in Adult Primary Care

Lower extremity peripheral artery disease (PAD) affects approximately 8.5 million people in the US and about 230 million worldwide. JAMA Deputy Editor Greg Curfman, MD, interviews Mary M. McDermott, MD, of Northwestern University Feinberg School of Medicine, to discuss current evidence regarding diagnosis and optimal medical treatment of people with PAD to prevent cardiovascular events, improve walking impairment, and prevent lower extremity ischemic events such as amputation or limb ischemia. Related Article(s): Lower Extremity Peripheral Artery Disease Without Chronic Limb-Threatening Ischemia

Interview with Aaron B. Caughey, MD, PhD, USPSTF member and coauthor of Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement Related Content: Counseling and Behavioral Interventions for Healthy Weight and Weight Gain in Pregnancy: Evidence Report and Systematic Review for the US Preventive Services Task Force Behavioral Interventions for Healthy Weight Gain During Pregnancy

Interview with Michael Barry, MD, USPSTF vice chairperson and author of Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement Related Article(s): Screening for Colorectal Cancer

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

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

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

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

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

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: Space Travel and Human Health, Part 1 Do Apollo Astronaut Deaths Shine a Light on Deep Space Radiation and Cardiovascular Disease? Association of Structural Changes in the Brain and Retina After Long-Duration Spaceflight

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?

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

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 Authors have declared conflicts of interest related to the article discussed in this podcast. Visit the article on jama.com for the complete disclosure.

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

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

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

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

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

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

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.

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

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

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

Howard Reber, MD, emeritus professor of surgery at UCLA, discusses how to treat acute pancreatitis. Related Article(s): Acute Pancreatitis

Howard Reber, MD, emeritus professor of surgery at UCLA, discusses how to diagnose acute pancreatitis. Related Article(s): Acute Pancreatitis

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

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

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

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

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

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

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.

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.

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

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

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?

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

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

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

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

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?

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

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

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

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

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

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

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

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

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

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

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

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.

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

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”

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

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

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

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

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

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

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

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

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

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

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

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

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)

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

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

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

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.

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

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

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

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

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/  

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

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

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.

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

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

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

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.

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

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

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 

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

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.

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

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.

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

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.

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.

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

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.

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.

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.

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.

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.

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)

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)

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.

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.

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

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

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.

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

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.

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

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 Systematic Review Coronary Microvascular Dysfunction Causing Cardiac Ischemia in Women Acupuncture as Adjunctive Therapy for Chronic Stable Angina: A Randomized Clinical Trial

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.

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.

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.

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

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  

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

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.

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

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.

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

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.

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.

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.

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  

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.

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  

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.

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.

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

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.

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.

JAMA Deputy Editor Ed Livingston, MD, interviews Steven Nissen, MD, at the European Society of Cardiology's 2019 conference in Paris, France.

JAMA Deputy Editor Ed Livingston, MD, interviews James Januzzi, MD, at the European Society of Cardiology's 2019 conference in Paris, France.

JAMA Deputy Editor Ed Livingston, MD, interviews Akshay Desai, MD, at the European Society of Cardiology's 2019 conference in Paris, France.

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.

Dr. Eduardo Bruera, Chair of the Department of Palliative Care at MD Anderson, discusses how to responsibly manage cancer pain using opioids.

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.

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.

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.

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.

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.

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.

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.  

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  

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

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

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

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

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

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

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  

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

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.

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.

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  

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

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.

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  

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

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

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.

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.

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.

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

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.

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

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.

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

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  

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

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.

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    

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  

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.

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

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

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  

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  

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

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?”  

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.  

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

Richard N. Rosenthal, MD discusses a randomized clinical trial demonstrating the efficacy of an implantable buprenorphine-releasing device for treating opioid use disorder.

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

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

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

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

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 Methylphenidate for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

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)

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

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 (Elizabeth D. Kantor, PhD, MPH)

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.

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.

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.

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.

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

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.

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.

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

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.

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.

Interview with David Simel, MD, author of Does This Patient With Chest Pain Have Acute Coronary Syndrome? The Rational Clinical Examination Systematic Review

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.

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.

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.

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.

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?

Edward H. Livingston, MD discusses stroke prevention in atrial fibrillation with Gregory Lip, MD, author of Stroke Prevention in Atrial Fibrillation: A Systematic Review

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.