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

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

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 really made it in the therapeutic world. Now that multiple-drug-resistant bacteria are becoming increasingly common, there is renewed interest in using bacteriophages to treat bacterial infection. Links: YouTube video summarizing the career and science of Félix d'Hérelle-one of the discoverers of bacteriophages Dr. Felix d'Herelle Canadian Medical Hall of Fame Laureate 2007 Detailed history of the development of bacteriophage research in Georgia A Stalinist Antibiotic Alternative from New York Times Magazine, February 6, 2000 Reprint of Twort’s initial description of a substance killing bacteria discovered while trying

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 Hopkins School of Medicine, and JAMA medical writer M.J. Friedrich about this new technology. Related articles: Cancer DNA in the Circulation: The Liquid Biopsy Going With the Flow: The Promise and Challenge of Liquid Biopsies Finding the Rare Pathogenic Variants in a Human Genome  

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 diagnosis and treatment of delirium, and Dr Maria Duggan provides additional insights about diagnosis and management from her perspective as a clinician and researcher. Related article: Delirium in Older Persons: Advances in Diagnosis and Treatment

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 Diagnosis for Mendelian Conditions  

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. Califf, MD, discuss their articles characterizing studies used for the approval of high-risk medical devices and accelerated approval of drugs by the FDA. Discussed in this podcast: FDA Online

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 patient with high cholesterol. Familial hypercholesterolemia is fairly common and when patients have very high cholesterol levels they and their families should undergo cascade screening. Interviewees: Scott M. Grundy, MD, PhD, and author Joshua W. Knowles, MD, PhD Links discussed in this episode: Cascade Screening for Familial Hypercholesterolemia and the Use of Genetic Testing Dietary Guidelines for Americans Interview with Karen DeSalvo, MD, MPH, MSc, author of Dietary Guidelines for Americans