JAMA Clinical Reviews

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 Disorde...

Richard N. Rosenthal, MD discusses a randomized clinical trial demonstrating the efficacy of an implantable buprenorphine-releasing device for treating opioid use disorder.

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 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:

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

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 Esophagea...

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 behav...

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...

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 i...

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...

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 ed...

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 pn...

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 suc...

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 Ca...

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...

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 Treatme...

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 si...

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

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 Pros...

ACS is a common and potentially lethal problem. However, only about 10% of patients who present to an emergency department with chest pain actually have ACS. In this JAMA Clinical Reviews podcast, we discuss which signs, symptoms and tests used to make the diagnosis of ACS are reliable. Edward H. Livingston MD, speaks with Alexander Fanaroff, MD, author of Does This Patient With Chest Pain Have Ac...

Interview with David Simel, MD, author of Does This Patient With Chest Pain Have Acute Coronary Syndrome? The Rational Clinical Examination Systematic Review

Interview with Ahmedin Jemal, DVM, PhD, author of Temporal Trends in Mortality in the United States, 1969-2013 , and J. Michael McGinnis, MD, MPP, author of Mortality Trends and Signs of Health Progress . Also in this episode is a conversation with Christopher J.L. Murray, MD, DPhil, a Professor of Global Health at the University of Washington and Institute Director of the Institute for Health Met...

Interview with Luke Rudmik, MD, MSc, author of Medical Therapies for Adult Chronic Sinusitis: A Systematic Review. This systematic review summarizes the evidence-based medical treatment of adult chronic sinusitis and proposes a treatment algorithm.

Edward H. Livingston, MD, interviews a war veteran and discusses PTSD with Maria Steenkamp, PhD, author of Psychotherapy for Military-Related PTSD , and Michele Spoont, PhD, author of Rational Clinical Exam: Does This Patient Have Posttraumatic Stress Disorder? The article by Dr Steenkamp reports that many military personnel and veterans with posttraumatic stress disorder achieve clinically meanin...

Edward H. Livingston, MD discusses atrial fibrillation with Eric N. Prystowsky, MD, author of Treatment of Atrial Fibrillation, and talks about new technologies to facilitate screening for atrial fibrillation with Leslie Saxon, MD.