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

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

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