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

Author interviews that explore the latest clinical reviews.
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JAMA Clinical Reviews: Interviews about ideas & innovations in medicine, science & clinical practice. Listen & earn CME credit.
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Now displaying: 2017

In-depth interviews about current ideas and innovation in medicine, science, and clinical practice.

Jul 18, 2017

Asthma often develops in childhood but also affects a significant number of adults. It can present in various ways and with varying degrees of severity. William J. Calhoun, MD, of the University of Texas Medical Branch, Galveston, discusses the approach to diagnosis and provides tips for management of this common condition.

Jul 11, 2017

Following placement of cardiac stents, patients receive dual antiplatelet therapy (DAPT) to prevent stent thrombosis. Prevention of thrombosis is offset by a risk of bleeding. The optimal balance between thrombosis prevention and bleeding risk is not always known. How to go about optimizing DAPT therapy is discussed by Glen Levine, MD, professor of medicine at Baylor College of Medicine in Houston, Texas, and chair of the combined American College of Cardiology/American Heart Association Guideline Committees.

Jul 3, 2017

Allergy to penicillin is one of the most commonly reported allergies by patients. In reality, true penicillin allergy is uncommon. Dr. Elizabeth Phillips from Vanderbilt University discusses her experience with testing for penicillin allergy in patients who thought they had this problem.

Jun 27, 2017

Multiple guidelines have been issued regarding how aggressively cholesterol should be managed. These guidelines do not agree with one another and the most significant area of disagreement is in recommendations for high intensity statin therapy. In this podcast we discuss this issue with a number of experts in the field to help better understand how high-intensity statin therapy might be applied to patient care.

Jun 27, 2017

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

May 23, 2017

Depression is very common in old age. Because it is associated with many issues related to aging such as having diabetes, hypertension, and other diseases and also the general ability to do less than when a person was younger, it is often assumed that depression is just part of the aging process. Inadequate treatment is often given for depression, frustrating patients and clinicians. However, aggressive depression treatment in elderly individuals can be very successful and greatly improve an older person’s quality of life.

PHQ-9

USPSTF recs

JAMA Patient Page on Screening for Depression

May 9, 2017

Whole-genome sequencing is now easily done for very little cost. It is not known how to interpret the results of this testing. It is inadvisable for healthy individuals to undergo routine whole-genome sequencing but if someone has a reason to suspect a particular disease known to be associated with a unique gene, then targeted genetic sequencing is reasonable.

Interviewee: James P. Evans, MD, PhD, from the University of North Carolina at Chapel Hill.

Apr 3, 2017

Much has changed recently in diabetes management. The treatment goal has shifted from rigorous glucose control with HbA1c as the primary target to cardiovascular risk reduction. Risk reduction can be achieved in a variety of ways and does not necessarily depend on expensive new drugs that were shown to achieve this end point. Older, cheaper drugs may achieve the same goal but were never tested in this context.

Interview with JoAnn E. Manson, MD, PhD, from Brigham and Women's Hospital in Boston and Jane Reusch, MD, from University of Colorado, Denver.

Article: Reusch JEB, Manson JE. Management of type 2 diabetes in 2017: getting to goal. JAMA. 2017;317(10):1015-1016. doi:10.1001/jama.2017.0241

Mar 28, 2017

A resident is asked to remove a drain that was placed in the lumbar space during an operation. Having never seen this sort of drain before not having removed one, the resident proceeded to remove the catheter. Several days later, the patient complained of persistent drainage. An 11-cm segment of retained catheter was removed. This JAMA Performance Improvement article discusses how to avoid this sort of problem as well as how to ensure that resident physicians have sufficient skills to perform procedures on their own. We talk with Drs Cynthia Barnhard, John DeLancey, authors of Retained Lumbar Catheter Tip, and Dr Aaron Reynolds and Dr David Baker.

Related article: Retained Lumbar Catheter Tip

 

Mar 20, 2017

Alzheimer disease causes progressive neurologic deterioration and is reasonably common in elderly patients. It is characterized by specific patterns of memory loss, which progressively worsens and for which there is no treatment. Recent drug trials have been disappointing in that promising medications have failed to affect the disease. Interesting new hypotheses have emerged from basic science research suggesting that the neurofibrillary tangles characteristic of Alzheimer brain lesions form in response to infection of the brain. Interview with Rudolph Tanzi, PhD, of Harvard University; Berislav Zlokovic, MD, PhD, of the University of Southern California; and Andy Josephson, MD, of the University of California San Francisco, and editor of JAMA Neurology.

Related article: Alzheimer Outlook Far From Bleak

Mar 7, 2017

Recent guidelines for how to best manage septic shock have changed. Gone are recommendations for central venous oxygen saturation monitoring and goal-directed therapy. In is the concept that septic shock be treated as an emergency with rapid administration of antibiotics and large amounts of fluids. Our discussants Derek C. Angus, MD, MPH, and Michael D. Howell, MD, MPH, discuss why these recommendations have changed. This is the second podcast in the Surviving Sepsis guideline series. The first podcast reviewed what recommendations are in the guideline itself.

Article discussed in this episode: Management of Sepsis and Septic Shock

Speakers: JAMA Associate Editor Derek C. Angus, MD, MPH, University of Pittsburgh, and Michael D. Howell, MD, MPH, University of Chicago.

Feb 28, 2017

In 2017 the Society for Critical Care Medicine updated its guidelines for sepsis management. These new guidelines differ significantly from ones in the past in that they no longer recommend protocolized resuscitation and emphasize early and aggressive fluid resuscitation when patients present with septic shock. This is the first podcast in the Surviving Sepsis guideline series. The next episode discusses why the new sepsis guideline changed.

Article discussed in this episode: Management of Sepsis and Septic Shock

Speakers:

Laura Evans, MD, MSc, of Bellevue Hospital and NYU Medical Center

Andrew Rhodes, MBBS, MD, of St George’s University Hospitals NHS Trust and co-chair of the Surviving Sepsis guideline panel

Mitchell M. Levy, MD, of the Alpert Medical School of Brown University and Rhode Island Hospital

 

 

Feb 16, 2017

Approximately one-third of all medical school graduates report having been abused as students. Medical student and resident abuse has long been considered unacceptable behavior but still persists in the teaching environment. In this podcast we discuss how students and residents might respond to these events. We interview Geoffrey Young, MD, from the Association of American Medical Colleges and Thomas J. Nasca, MD, from the Accreditation Council for Graduate Medical Education, who discuss how they expect medical schools to respond to abusive behaviors and what resources are available to students and residents who have been abused to report those experiences without fearing retribution.

Article discussed in this episode:

Medical Student Mistreatment

 

Feb 9, 2017

As people age, loss of muscle mass is inevitable, resulting in sarcopenia. Muscle loss contributes to overall weakness, which causes frailty. Frailty, in turn, is the generalized susceptibility to disease and injury, all of which causes loss of autonomy. Because of the potential for progressive decline in physical function in very elderly patients, accurate tools are needed to predict mortality risk to individualize treatments intended to improve longevity such as chemotherapy, management of chronic diseases, and surgery. In this podcast, sarcopenia, frailty, and risk prediction are discussed in the context of major trials studying them being conducted in Europe.

Feb 2, 2017

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

Jan 30, 2017

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

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