JAMA Clinical Reviews: Interviews about ideas & in

JAMA Clinical Reviews: Interviews about ideas & in


Author interviews that explore the latest clinical reviews.


The High Cost of Prescription Drugs in the United States  

Drug prices continue to rise in the US. Many solutions have been proposed but few have been implemented. Drs. Janet Woodcock from the FDA and Aaron Kesselheim, author of The High Cost of Prescription Drugs in the United States from the Harvard Medical School discuss the role of brand name drugs and generics and how they influence the cost of pharmaceuticals.

Also see The Cost of US Pharmaceutical Price Reductions: A Financial Simulation Model of R&D Decisions by Thomas A. Abbott and John A. Vernon.


Clinical Management of Opioid Use Disorder  

Edward H. Livingston, MD, discusses the British Columbia Ministry of Health’s 2015 guidelines on clinical management of opioid use disorder in adults with Keith Ahamad, MD,  Evan Wood, MD, PhD, ABIM, FRCPC, Tony L. Yaksh, PhD, and Humayun J. Chaudhry, DO, MS, MACP, FACOI.

Articles and resources discussed in this episode: 

Opioid Use and Addiction Microsite Clinical Management of Opioid Use Disorder (JAMA Clinical Guidelines Synopsis) The Vancouver Opioid Use Disorder Guideline Model Policy on DATA 2000 And Treatment of Opioid Addiction in the Medical Office
Review of Lyme Disease  

Lyme disease is very common in certain regions of the country and is caused by the spirochete Borrelia bergdorferi. Lyme disease is transmitted by tick bites and in this podcast we review the discovery of Lyme disease, its major clinical features, and how to diagnose and treat it, as told by Dr Alan Steere, Dr Lyndon Hu, and Dr Paul Auerwerter.

Related article:

Persistent Diarrhea  

Persistent diarrhea is a poorly recognized syndrome in all populations that requires proper assessment and diagnosis to ensure that affected individuals receive the treatment needed to experience improvement of clinical symptoms. Listen to Drs Herbert DuPont and Annie Feagins discuss how to diagnose and treat diarrhea. Related article:

Interview with Dr Allen Steere on Lyme Disease  

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

Histologic Changes in the Esophagus in Patients With GERD  

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

Treatment of Attention-Deficit/Hyperactivity Disorder in Adolescents  

Attention-Deficit/Hyperactivity Disorder, or ADHD is a very common problem affecting about 10% of all adolescents. Children with ADHD have short attention spans, are hyperactive, talk a great deal, can be disruptive in the classroom etc.-features that are common in many adolescents. However, to have true ADHD, children must be significantly impaired by these problems. An array of medical and behavioral treatments can successfully help manage ADHD. These are reviewed in a series of articles appearing in the May 10, 2016, issue of JAMA. In this podcast, we discuss ADHD with the authors of some of those papers, Eugenia Chan, MD, MPH from Harvard and Philip Shaw, MD, PhD from the National Human Genome Research Institute.

Articles discussed in this episode:

Treatment of Attention-Deficit/Hyperactivity Disorder in Adolescents
: A Systematic Review Quantifying the Benefits and Risks of Methylphenidate as Treatment for Childhood Attention-Deficit/Hyperactivity Disorder Methylphenidate for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents
Diagnosing Infectious Mononucleosis  

Mononucleosis is a common disease of young adults manifested by lethargy, fever, pharyngitis, lymphadenopathy and splenomegaly. In this podcast, we review the clinical features of the disease and how good each of them is at establishing a diagnosis of mononucleosis. We also review how Epstein Barr virus was discovered as the cause of mononucleosis and talk to Mark H. Ebell, MD, MS, author of Does This Patient Have Infectious Mononucleosis? The Rational Clinical Examination Systematic Review.

Articles discussed in this episode:

Does This Patient Have Infectious Mononucleosis? The Rational Clinical Examination Systematic Review (2016) Acute Lymphatic Leukemia and Infectious Mononucleosis (1931) Infectious Mononucleosis: Part I. Clinical Aspects (1935)  Infectious Mononucleosis: Clinical Manifestations in Relation to EB Virus Antibodies (1968)
Opioid Prescribing: Rising to the Challenge  

An opioid abuse epidemic now plagues US healthcare. It was caused, in part, by overzealous advocacy for controlling chronic pain resulting in overuse of narcotics. There are now 2 million Americans addicted to opioids. The approach for treating chronic pain must change. In this podcast, we summarize recent CDC guidelines for the proper use of opioids for treating chronic pain.

Articles discussed in this episode:

CDC Guideline for Prescribing Opioids for Chronic Pain— United States, 2016 The CDC Guideline on Opioid Prescribing: Rising to the Challenge (Yngvild Olsen, MD, MPH) The DSM-V definition for opioid use disorder and 11 point checklist
Treating Geriatric Polypharmacy by Deintensifying Unnecessary Diabetes Treatment  

Polypharmacy is a rapidly worsening problem that hits elderly patients particularly hard.  As patients grow older, they need more medications but at the same time become less capable of managing the complexity of drug treatments.  In order to simplify treatment regimens for older patients, it is necessary to consider the evidence supporting treatment of various conditions and when the evidence is not particularly strong, reduce or eliminate medications accordingly.  Diabetes management in the elderly is highlighted in this podcast with specific attention given to deintensifying diabetes treatment in the elderly.

Articles discussed in this episode:

Polypharmacy in the Aging Patient: Glycemic Control in Older Adults With Type 2 Diabetes: A Review (Kasia J. Lipska, MD, MHS) Evaluation and Treatment of Older Patients With Hypercholesterolemia: A Clinical Review (Timo E. Strandberg, MD, PhD) Trends in Prescription Drug Use Among Adults in the United States From 1999-2012 (Elizabeth D. Kantor, PhD, MPH)
2015 Breast Cancer Screening Recommendations for Women at Average Risk  

The American Cancer Society breast cancer screening guidelines have been changed to recommend annual screening for women older than 45 and every other year screening for women older than 55. Older women should only pursue screening if they have a more than 10 year life expectancy. These guidelines were somewhat controversial and were published in the October 15, 2015 issue of JAMA. JAMA Senior editor Mary McDermott interviews Nancy Keating, Evan Myers and Elizabeth Fontham to discuss these guidelines in detail.

Antibiotic Therapy for Community-Acquired Pneumonia in Adults  

Community acquired pneumonia accounts for 600,000 hospital admissions a year. Many patients with this disease are quite ill and have a very high mortality. To save lives, the appropriate antibiotics should be given in a timely basis, but it is not clear what the best antibiotics are and how long they should be given. In this podcast we interview the author of a JAMA review on community acquired pneumonia, Dr Jonathan Lee, author of Antibiotic Therapy for Adults Hospitalized With Community-Acquired Pneumonia, who performed a systematic review of the literature to determine the best way to treat community acquired pneumonia.

Dietary Guidelines for Americans, part 2  

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  

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.

Advances in Diagnosis and Treatment of Constipation  

Constipation is one of the most frequent problems clinicians are asked to deal with. Despite how common it is, constipation is frequently not treated adequately. In this podcast, Arnold Wald, MD, explains a stepwise approach to the management of constipation ranging from very simple measures to the most novel and complicated new medical therapies.

Articles discussed in this episode:

JAMA Clinical Review: Constipation: Advances in Diagnosis and Treatment JAMA Clinical Guidelines Synopsis: Evaluation and Treatment of Patients With Constipation From The Medical Letter on Drugs and Therapeutics: Naloxegol (Movantik) for Opioid-Induced Constipation JAMA Patient Page: Constipation
Antibiotics vs Appendectomy for Uncomplicated Appendicitis Treatment  

Appendicitis is one of the most common reasons people undergo abdominal surgery. Lost in history are the reasons why appendectomy was performed in the first place, and in the hundred years since appendicitis was first described, many changes in patient management have occurred improving both the diagnosis and treatments for appendicits. A major trial, Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis, was recently published in JAMA showing that most patients with acute, uncomplicated appendicitis can be treated with antibiotics alone and avoid surgery.

Head Trauma  

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.

Graves Disease  

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

Prostate Cancer Screening  

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

Dan Merenstein about losing a malpractice case despite following evidence-based medicine guidelines (PSA Screening — I Finally Won!). Otis Brawley about Prostate Cancer Incidence and PSA Testing Patterns in Relation to USPSTF Screening Recommendations. David F. Penson about The Pendulum of Prostate Cancer Screening. Victor M. Montori about The Connection Between Evidence-Based Medicine and Shared Decision Making.
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