JAMA Clinical Reviews

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. D...

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...

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 Pittsbu...

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 Nor...

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...

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 No...

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 real...

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 Hopkin...

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...

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 Diagn...

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....

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 patie...

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...

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.

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...

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 m...

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, aggr...

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,...

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...