Jama Clinical Reviews: Interviews About Ideas & Innovations In Medicine, Science & Clinical Practice. Listen & Earn Cme Credi

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

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

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

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