JAMA Clinical Reviews

By JAMA Network

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Subscribers: 461
Reviews: 1

Allison
 May 8, 2019
Absolutely excellent podcast. Well researched, and there are targeted and helpful questions that guide the listener through topics well. I started listening to this podcast in medical school, and I still listen often, even to subjects praise of my field of medicine because the content is so good.

Description

Author interviews that explore the latest clinical reviews.

Episode Date
Coronavirus Disease 2019 (COVID-19) Update: PCR Testing and Shortages
31:22

The lack of availability of COVID-19 testing has interfered with the ability to contain the spread of disease. Omai Garner, PhD, laboratory director for Clinical Microbiology in the UCLA health system, explains how PCR testing for COVID-19 works and why testing is in short supply.

Mar 27, 2020
Coronavirus (COVID-19) Update: Lessons Learned From The 2003 SARS Outbreak
38:25

In 2003, Toronto was the North American center for Severe Acute Respiratory Syndrome (SARS). The disease spread through the city’s hospitals before anyone knew what was happening. Dr. Allison McGeer was a clinician caring for SARS patients and ultimately was infected herself. She describes her experience as a patient and provider and reviews lessons learned that might help others manage their regional COVID-19 outbreaks.

Related:

Supporting the Health Care Workforce During the COVID-19 Global Epidemic

Mar 25, 2020
Coronavirus Disease 2019 (COVID-19) Update: How the VA Is Preparing
17:51

As COVID-19 spreads, clinicians and health systems are struggling to prepare for a surge of patients. Richard Stone, MD, the US Veterans Health Administration's Executive in Charge, spoke with JAMA about how the VA health system is preparing for this public health emergency.

Mar 25, 2020
Coronavirus (COVID-19) Update: Chloroquine/Hydroxychloroquine and Azithromycin
17:13

Chloroquine was shown in 2004 to be active in vitro against SARS coronavirus but is of unproven efficacy and safety in patients infected with SARS-CoV-2. The drug's potential benefits and risks for COVID-19 patients, without and with azithromycin, is discussed by Dr. David Juurlink, head of the Division of Clinical Pharmacology and Toxicology at Sunnybrook Health Sciences Centre in Toronto.

Mar 24, 2020
Nonalcoholic Steatohepatitis: The Primary Care Perspective
15:08

Nonalcoholic steatohepatitis (NASH) is becoming more frequent as the population becomes more obese. This is not a benign problem, and NASH can ultimately lead to cirrhosis and liver failure. It is thought that NASH will ultimately become the most common cause for liver transplant. NASH is usually diagnosed as an incidental finding, but once found requires careful monitoring and patient counseling. Lisa N. Kransdorf, MD, MPH, from UCLA Health in California, discusses the diagnosis and management of NASH from a primary care clinician's perspective.

Mar 24, 2020
The Diagnosis and Management of Primary Hyperparathyroidism
19:47

Hyperparathyroidism is a fairly common disease that causes elevated calcium levels and bone depletion, resulting in fractures and kidney problems. There are medications that can effectively manage hyperparathyroidism, and in some cases surgery is indicated. Michael Yeh, MD, professor and chief of endocrine surgery at UCLA, discusses the management of hyperparathyroidism.

Mar 24, 2020
Coronavirus (COVID-19) Update: Early Safety Signals Around Ibuprofen and Renin-Angiotensin Inhibitors
09:28

Emerging information about how SARS-CoV-2 virus infects cells has led to speculation that NSAIDs and ACE inhibitors/angiotensin receptor blockers (ARBs) may worsen clinical disease. Infectious disease physician Carlos del Rio, MD, of Emory University explains the concerns and their clinical implications.

Mar 20, 2020
Nathan Pritikin and His Diet
23:36

Nathan Pritikin was a college dropout who became an entrepreneur. While doing research for the government during World War II, he observed that populations that had extremely limited food availability because of the war had substantially reduced mortality from cardiovascular disease—something unexpected at a time when cardiovascular disease was thought to be due to stress. After the war when food became more available CVD death rates went back up, resulting in Pritikin concluding that CVD was related to diet. Pritikin devised his own very low-fat diet that bears his name and the diet is still in use 65 years later.

Related:

The Pritikin Diet

The Lost Lectures from Nathan Pritikin (drmcdougall.com)

Mar 17, 2020
Who Was Nathan Pritikin and Why Is There a Diet Named After Him?
23:10

This podcast explains the Pritikin diet to patients. Nathan Pritikin was a college dropout who became an entrepreneur. While doing research for the government during World War II, he observed that populations that had extremely limited food availability because of the war had substantially reduced mortality from cardiovascular disease—something unexpected at a time when cardiovascular disease was thought to be due to stress. After the war when food became more available CVD death rates went back up, resulting in Pritikin concluding that CVD was related to diet. Pritikin devised his own very low-fat diet that bears his name and the diet is still in use 65 years later.

Related:

The Pritikin Diet

The Lost Lectures from Nathan Pritikin (drmcdougall.com)

Mar 17, 2020
COVID-19 in Seattle: Clinical Features and Managing the Outbreak
24:00

Seattle was one of the first US cities to have a COVID-19 outbreak, with a cluster of nursing home-related deaths. However, many people who tested positive for the novel coronavirus never became ill, and in some the clinical illness was indistinguishable from influenza. John Lynch, MD, MPH, an infectious disease physician and medical director for infection prevention and control at the Harborview Medical Center, summarizes his hospital’s experience managing the patients and outbreak.

Mar 15, 2020
The Effect of the COVID-19 Pandemic on Clinic Operations
20:48

Seattle has been a focal point for the US in the coronavirus pandemic. Doug Paauw, MD, professor of medicine at the University of Washington, in Seattle, describes the UW primary care clinic experience as this pandemic evolved. Major lessons learned included accommodating for significant numbers of staff not available to work in the clinic because of school closures, change in workflow because of shortages of personal protective equipment, physicians having to accommodate very large numbers of patient queries via telephone, email, or electronic health record, and the importance of the rapid development of local ability to test for SARS-CoV-2 independent of public health agencies.

Mar 13, 2020
Update on Coronavirus: March 6, 2020, by NIAID’s Anthony Fauci, MD
33:17

Coronovirus (the virus SARS-CoV-2) continues to spread throughout the world. In recent weeks, there has been an increasing number of cases and deaths in the US. As concern about the virus increases, there is an increasing need for accurate information about the disease and how much concern we should have. Anthony Fauci, MD, is the director of the National Institute for Allergy and Infectious Diseases (NIAID) and has been the main spokesperson for the US government about coronavirus. Dr Fauci spoke with JAMA Editor in Chief Howard Bauchner, MD, about where we are as of today with the SARS-CoV-2 epidemic.

JAMA Coronavirus Resource Center

Mar 09, 2020
Unprofessional Behavior Leads to Complications
10:28

Physicians who act out cause all sorts of problems. Fortunately, only a few clinicians have behavior problems and in the modern era, bad behaviors are not tolerated. Bad behaviors get reported these days and actions are taken against these sorts of clinicians. Clinicians who act out frequently say they are doing so to protect their patients. But are they? William Cooper, MD, MPH, and Gerald B. Hickson, MD, from Vanderbilt University Medical Center in Nashville, Tennessee, discuss a study they published in relating bad behaviors to having more complications of surgical care.

Related article:

Association of Coworker Reports About Unprofessional Behavior by Surgeons With Surgical Complications in Their Patients

Feb 25, 2020
The 2020 Influenza Epidemic—More Serious Than Coronavirus in the US
31:03

Although coronavirus disease 2019 (COVID-19) dominates the news in early 2020, it affects few people in the US. In contrast, at the same time the US is experiencing a severe influenza epidemic, which has caused an estimated 250 000 hospitalizations and 14 000 deaths. Timothy Uyeki, MD, lead for the CDC’s 2019 novel coronavirus response team and Chief Medical Officer of CDC’s influenza division, discusses influenza in the US, how it compares to coronavirus, and what both patients and clinicians should know about this year’s flu season.

CDC's Influence site

CDC's Weekly U.S. Influenza Surveillance Report

HealthMap Vaccine Finder

Feb 18, 2020
AIDS-Related Chronic Inflammation Leading to Chronic Disease
09:00

Great strides have been made in treating HIV, as Anthony Fauci, MD, discusses in this podcast episode. But even substantial viral suppression leaves some virus behind, causing chronic inflammation. Many chronic diseases, including atherosclerotic coronary vascular disease, are worsened by this chronic inflammatory state. Because HIV patients are now living very long lives, they are also developing chronic diseases at a more rapid rate than their non-HIV-infected peers because of this chronic inflammation.

Feb 18, 2020
Parkinson Disease
26:24

More than 6 million people worldwide have Parkinson disease. Even though it is classically associated with tremors, the disease has many manifestations and is very treatable for most patients. Michael S. Okun, MD, from the Department of Neurology at the University of Florida, Gainesville, discusses the pathophysiology, clinical presentation, diagnosis, and treatment of Parkinson disease.

Related article:

Parkinson Disease

AMA Manual of Style

Feb 11, 2020
Testing for Breast Cancer Susceptibility Genes
13:38

Breast cancer is a leading cause of death in women. Some women have a cancer susceptibility gene known as BRCA, and women should be tested for BRCA under some circumstances. Carol Mangione, MD, division chief of General Internal Medicine and Health Services Research at UCLA, discusses when testing is appropriate, and Ranjit Manchanda, MD, PhD, from Barts Cancer Institute in London, UK, discusses the cost-effectiveness of BRCA screening for women who have had breast cancer.

Feb 11, 2020
Management of Chronic Stable Angina in 2020
07:12

Controversy exists regarding how to best manage chronic stable angina. Intuitively, it seems that because it is usually caused by coronary artery lesions, addressing those lesions either via percutaneous coronary angiography or coronary artery bypass operations would be the best way to manage this problem. Several studies have suggested that this is not the case and that results of these interventions are no better than optimal medical management. Recently, a very large trial examining this clinical question has provided results suggesting that any approach works about the same. We interviewed Donald Lloyd-Jones, MD, chair of the department of preventive medicine at Northwestern University, during the recent American Heart Association meeting about this issue.

Related articles:

Baseline Characteristics and Risk Profiles of Participants in the ISCHEMIA Randomized Clinical Trial

Does This Patient With Chest Pain Have Acute Coronary Syndrome?: The Rational Clinical Examination Systematic Review

Coronary Microvascular Dysfunction Causing Cardiac Ischemia in Women

Acupuncture as Adjunctive Therapy for Chronic Stable Angina: A Randomized Clinical Trial

Feb 04, 2020
Treating Conjunctivitis and Dry Eye Disease
18:54

Conjunctivitis and dry eye disease are some of the most common conditions patients present with. They are usually benign entities that respond well to conservative measures and usually don’t require medications. However, if medications are necessary, clinicians can find a comprehensive assessment of these drugs recently published in the December 2, 2019, issue of The Medical Letter. An excerpt from this article summarizing information about conjunctivitis and dry eye disease was published in the February 4, 2020 issue of JAMA. Kathryn Colby, MD, PhD, chair of the Department of Ophthalmology & Visual Science at the University of Chicago, explains in this podcast how to treat conjunctivitis and dry eye disease.

Feb 04, 2020
2019 Novel Coronavirus: An Update From NIAID Director Anthony Fauci, MD
08:23

A new virus known as the 2019 novel coronavirus (2019-nCoV) is rapidly spreading through China. The rapid spread and severity of this illness are worrisome and the possibility that it develops into a pandemic is very real. Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, provides an update on this new disease.

Jan 30, 2020
Football Players and Erectile Dysfunction Associated With Repetitive Head Injury
07:43

American football is a dangerous sport and is characterized by violent contact between people that often leads to repetitive head injury. A multitude of health effects may result from this sort of head injury, but a new finding reported in the December issue of JAMA Neurology maintains that football players are at risk for developing low testosterone levels and erectile dysfunction. Rachel Grashow, PhD, from Harvard T.H. Chan School of Public Health and the Football Players Health Study at Harvard Medical School discusses the findings regarding the relationship between head injury and erectile dysfunction.

Jan 29, 2020
The Keto, Atkins, and Pritikin Diets
15:04

There are many named diets that receive a great deal of attention. But what are they and do they work? David Heber, MD, PhD, from the UCLA Center for Human Nutrition explains these diets.

Related articles:

Ketogenic Diets (Patient Page)

Interest in the Ketogenic Diet Grows for Weight Loss and Type 2 Diabetes

Comparison of Weight Loss Among Named Diet Programs in Overweight and Obese Adults: A Meta-analysis

Jan 28, 2020
The Keto Diet: Advice for Patients
09:58

The keto diet is very popular and involves eating very few carbohydrates, a fair amount of fat, and normal amounts of protein. It is one of many ways to lose weight. David Heber, MD, formerly the chair of Clinical Nutrition at UCLA, explains the keto diet.

Related article:

Ketogenic Diets

 

Jan 28, 2020
The American Heart Association Takes a Stance Against e-Cigarettes
07:00

e-Cigarettes are dangerous, but the public has been falsely led to believe that they are safe. Because of this misconception and the inherent dangers, the American Heart Association (AHA) has taken an aggressive stance to educate the public about e-cigarettes, especially their use by kids. Rose Marie Robertson, MD,deputy chief science and medical officer for the AHA, spoke to JAMA about e-cigarettes and the frightening increase in their use among kids.

Read the article: The American Heart Association Takes on Vaping

Jan 21, 2020
An Inconvenient Tooth
44:44

Animal bites can be a cause of significant injury and on occasion, fatalities. In this episode, JAMA Fishbein Fellow Angel Desai, MD, MPH discusses the prevention, treatment, and epidemiological oddities of animal bites with Dr Sandra Nelson, Assistant Professor of Medicine at Massachusetts General, Dr Justin Hensley from Children’s Hospital of San Antonio, and others. Desai also talks prevention and risk of rabies acquisition with Dr Catherine Brown, state epidemiologist and public health veterinarian from the Massachusetts Department of Public Health.

Jan 14, 2020
NICE Guidelines for Heavy Menstrual Bleeding: What to Make of Them
20:34

The UK’s National Institute for Health and Care Excellence (NICE) recently issued guidelines for how to manage heavy menstrual bleeding. Guidelines only provide guidance and they must be interpreted for an individual patient's clinical context. Andrew Kauntiz, MD, professor and associate chair in the department of obstetrics and gynecology, University of Florida College of Medicine in Jacksonville, an expert in this topic, discusses these new NICE guidelines and how clinicians should use them.

Read the article: Assessment and Management of Heavy Menstrual Bleeding

Dec 19, 2019
The Medical and Political Response to the 2019 Christchurch Mosque Mass Shooting
26:33

On March 15, 2019, a lone gunman walked into 2 mosques within minutes of each other in Christchurch, New Zealand, and opened fire with semiautomatic weapons, killing 51 and wounding many more. We spoke to Greg Robertson, MB ChB, the surgeon who coordinated the medical response to this mass casualty event. Robertson talks about what his hospital had to do to manage all these casualties and also how New Zealand quickly changed its laws to restrict the availability of weapons used for these sorts of attacks.

Dec 10, 2019
What Do I Need to Know About e-Cigarettes and If They Help People Stop Smoking?
17:14

Electronic cigarette (e-cigarette) use, otherwise known as “vaping,” has been increasing since 2010. This podcast reviews research on the epidemiology and possible adverse health effects of e-cigarette and nicotine use, and the pitfalls associated with using e-cigarettes as a method to stop smoking. These issues are discussed by Suchitra Krishnan-Sarin, PhD, a professor with the Department of Psychiatry at Yale University School of Medicine, and JAMA Associate Editor George O’Connor, a professor of medicine at Boston University.

Related article: e-Cigarette Use Among Youth in the United States, 2019

Nov 25, 2019
The Underappreciated Problem of Cardiac Disease in Women
10:31

Barbra Streisand and Noel Bairey Merz, MD, director of the Streisand Women’s Heart Center at Cedars-Sinai in Los Angeles, California, discuss the problem of cardiovascular disease in women and especially coronary microvascular disease, which causes an unusual presentation of cardiac ischemic disease in women.

Nov 18, 2019
Review of Atrial Fibrillation Treatment
25:24

Atrial fibrillation is a very common problem that is treated with a variety of medications and interventions. Sandip Mukherjee, MD, a contributing editor to The Medical Letter, is the Medical Director of Physician Liaison Services with the Office of the Chief Medical Officer at Yale New Haven Hospital, and an associate professor of medicine at Yale. He summarizes the latest information published in The Medical Letter on treatments for atrial fibrillation.

Nov 12, 2019
Influenza Vaccination in 2019-2020
13:29

Winter is coming…and with it, the onset of flu season. In this episode, Jean-Marie Pflomm, PharmD, Editor in Chief of The Medical Letter, decodes flu vaccines: trivalent vs quadrivalent, live attenuated vs inactivated, and much more.

Nov 06, 2019
How Adolescent Boys’ Need for Friendship Affects Their Mental Health
37:52

Adolescent boys are notoriously difficult to deal with. However, some of their behaviors mask a need they have for developing intimate friendships. Being adolescent boys living in a macho culture, many deny that they need these relationships. Niobe Way, EdD, professor of Developmental Psychology at New York University, has spent her professional career studying adolescent boys’ relationships with each other and how they affect their behaviors. She explains how to intervene to help them better understand their needs for intimacy, which, in turn, helps them to better relate with people and avoid unpleasant behaviors.

Related article: Loneliness Might Be a Killer, but What’s the Best Way to Protect Against It?

CME Quiz

The Listening Project

 

Nov 05, 2019
Emerging Applications for Ketamine
25:29

Even though it gained notoriety for recreational uses, Ketamine is experiencing a resurgence in clinical settings given its versatility and potential applications, including for pain treatment and depression. David Juurlink, MD, from Sunnybrook Health Sciences Center and John Krystal, MD from Yale University discuss current and emerging applications of this drug.

Oct 22, 2019
Understanding Lipids and Cardiovascular Risk Through Mendelian Randomization
27:58

Mendelian randomization is a powerful technique that enables investigators to mimic randomized clinical trials by characterizing genetic differences between groups of people and studying their clinical outcomes. Brian A. Ference, MD, MPhil, from the University of Cambridge in England, is a leading expert on this topic and spoke with us about how mendelian randomization has facilitated a better understanding of lipid biology and how it relates to cardiovascular risk.

Oct 08, 2019
Pancreatic Cancer
26:50

Pancreatic cancer is the third most common cause of cancer death in the United States. Timothy Donohue, MD, chief of surgical oncology at the University of California, Los Angeles, provides an overview of the disease.

Read the articles:

Screening for Pancreatic Cancer

Pancreatic Cancer

 

Oct 08, 2019
Personal Protective Equipment for Health Care Infection Control
19:37

Personal protective equipment comprises gloves, gowns, masks, regular respirators, and powered air purifying respirators (PAPRs). In this Clinical Review podcast Trish Perl, MD, of UT Southwestern Medical Center reviews the indications for each and the results of the RESPECT trial, which reported no difference in incidence of laboratory-confirmed influenza among health care personnel randomized to wear N95 respiratory or medical masks. She’s interviewed by JAMA Fishbein fellow Angel Desai, MD.

Oct 07, 2019
Improving Uptake of Preexposure Prophylaxis (PrEP) for HIV in Primary Care
11:46

JAMA Fishbein Fellow Angel Desai, MD interviews Douglas S. Krakower, MD at the IDWeek 2019 conference in Washington, D.C.

Related article: Rising PrEP Awareness

Oct 06, 2019
Update in Clinical Infectious Diseases 2019-2020
14:35

This Clinical Review podcast reviews some of the most important advances in clinical infectious diseases presented at IDWeek 2019 including data on rapid testing, new antimicrobial agents, and new strategies for using existing antibiotics to manage antimicrobial resistance. JAMA Fishbein Fellow Angel Desai, MD interviews Helen Boucher, MD of Tufts University.

Oct 06, 2019
A New Path for Gun Research Funding
16:54

Since the passage of the Dickey Amendment in 1996, federal funding for gun violence research has been withheld from the CDC and other federal agencies that should be tasked with figuring out the origins and solutions to this problem. But while the US government has been locked in a political stalemate, other entities are stepping up in a new model for getting the job done.

Sep 10, 2019
Bariatric Surgery and Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity
14:13

JAMA Deputy Editor Ed Livingston, MD, interviews Steven Nissen, MD, at the European Society of Cardiology's 2019 conference in Paris, France.

Sep 03, 2019
Management of Heart Failure in 2019-2020, Part 2
11:20

JAMA Deputy Editor Ed Livingston, MD, interviews James Januzzi, MD, at the European Society of Cardiology's 2019 conference in Paris, France.

Sep 02, 2019
Management of Heart Failure in 2019-2020, Part 1
16:45

JAMA Deputy Editor Ed Livingston, MD, interviews Akshay Desai, MD, at the European Society of Cardiology's 2019 conference in Paris, France.

Sep 02, 2019
The Influence of Obesity on Cancer
20:54

Jennifer A. Ligibel, MD, from the Dana-Farber Cancer Institute and Harvard Medical School, Boston, explains how obesity influences the risk of developing cancer and how it influences the prognosis of existing cancer.

Aug 20, 2019
Responsible Use of Opioids to Treat Cancer Pain
29:03

Dr. Eduardo Bruera, Chair of the Department of Palliative Care at MD Anderson, discusses how to responsibly manage cancer pain using opioids.

Aug 06, 2019
Diagnosing Menopause
15:38

Menopause is inevitable for women. It symptoms are uncomfortable and distressing. For women to best cope with menopause, it is useful to firmly establish the onset so that appropriate counseling can follow. In this podcast, an expert in this field, Nanette Santoro, MD, from the University of Colorado, explains how to diagnose menopause.

Read the article: Diagnosing the Onset of Menopause

Jul 22, 2019
Guns and Suicide
27:09

Using firearms to commit suicide is one of the most common causes of firearm related deaths. This can happen even in families where it seems highly unlikely to occur. In this podcast, we tell the story of a policeman’s daughter who got a hold of his gun and tried to kill herself.

Jul 16, 2019
Subclinical Hypothyroidism
16:32

Subclinical hypothyroidism is common, but it is not clear how best to treat it. Anne R. Cappola, MD, ScM, professor of medicine at the University of Pennsylvania, explains how to manage this important clinical condition.

Read the article: Subclinical Hypothyroidism: A Review

 

Jul 09, 2019
The Clinical Ramifications of Dense Breasts
23:28

There are now 36 states and recent federal legislation that require that clinicians inform women about breast density results from mammography. Consequently, clinicians must be aware of the clinical ramifications of dense breasts and what to do about them when found. Karla Kerlikowske, MD, from UCSF explains the risks associated with dense breasts and how to manage patients who have them. CME will be available on July 2 when the print/online issue of JAMA is published.

Jul 02, 2019
California’s Attempt to Improve Measles Vaccination Rates
19:56

California enacted 3 aggressive laws between 2014 and 2016 in an effort to improve measles vaccination rates. To a large extent these laws were effective in increasing vaccination rates, but some of the improvements were offset by clinicians granting inappropriate medical exemptions for vaccinations. S. Cassandra Pingali, MPH, MS, and Saad B. Omer, MBBS, MPH, PhD, from the Department of Epidemiology at Emory University, Atlanta, Georgia, discuss measles and what happened in California when legislators tried to improve measles vaccination rates. CME will be available on July 2 when the print/online issue of JAMA is published.

Jul 02, 2019
Reducing the Intensity of Antiplatelet Therapy Following Coronary Stent Procedures
11:31

A conversation with Greg Curfman, MD, JAMA Deputy Editor and a cardiologist, who reviews 2 new studies showing that a short duration of dual antiplatelet therapy may not result in more myocardial ischemic events.

Read the article: Effect of 1-Month Dual Antiplatelet Therapy Followed by Clopidogrel vs 12-Month Dual Antiplatelet Therapy on Cardiovascular and Bleeding Events in Patients Receiving PCI: The STOPDAPT-2 Randomized Clinical Trial

 

Jun 25, 2019
The Gabby Giffords Shooting
32:20

Over the span of less than a minute, a gunman with a history of mental health issues turned a Safeway parking lot into the scene of a mass shooting, killing 6 and wounding 13 in 20 seconds. In this inaugural episode of the In Our Lane podcast series, we hear the stories of the survivors who wrestled the gunman to the ground and treated the injured during the wait for first responders.

Jun 11, 2019
Abnormal Uterine Bleeding
34:54

Andrew M. Kaunitz, MD, from the Department of Obstetrics and Gynecology at the University of Florida, Jacksonville, explains how to diagnose and treat various patterns of abnormal uterine bleeding.

Read the article: Abnormal Uterine Bleeding in Reproductive-Age Women

 

Jun 04, 2019
Menopausal Hormone Therapy
29:33

Jan L. Shifren, MD, from the department of obstetrics and gynecology, Massachusetts General Hospital, and Harvard Medical School discusses menopausal symptoms such as hot flashes and how they can be effectively treated by the administration of hormones when given appropriately.

Read the article: Menopausal Hormone Therapy

CME will be available on June 25 when this article appears in the print edition of JAMA.

May 30, 2019
Cervical Cancer Screening
09:28

George F. Sawaya, MD, professor of obstetrics and gynecology at the University of California, San Francisco, discusses cervical cancer screening in the modern era.

Read the article: Cervical Cancer Screening: More Choices in 2019

Read the transcript

 

May 28, 2019
Treating Nonmetastatic Breast Cancer in 2019
29:05

Breast cancer outcomes continue to improve. Treatments for the disease are very effective and continually evolving. We spoke with Patricia A. Ganz, MD, from UCLA about what is new in breast cancer treatment.

Read the article here.

May 07, 2019
JAMA Women's Health Series Introduction by Dr Carolyn Crandall
02:58

Dr Carolyn Crandall, professor of medicine at the David Geffen School of Medicine at UCLA and JAMA Associate Editor, introduces JAMA's new series of articles on women's health.

May 07, 2019
Beyond the Rhetoric: Gun Control That Works, Part 3
25:17

Congressman Mike Thompson chairs the US House Gun Violence Prevention Taskforce. He spoke with us about what the House has done to address gun violence and what you can do to help them see necessary legislation make it into law. We also talk with Joshua Sharfstein, MD, about strategies that can be undertaken by the physician community to reduce gun violence.

Apr 09, 2019
How to Reduce Maternal Mortality Rates in the United States
27:38

Maternal mortality rates in most of the United States are high. These rates were successfully lowered in the United Kingdom and also in California. Many of these deaths are preventable. In this podcast we interview Elizabeth A. Howell, MD, MPP, from the Icahn School of Medicine at Mt Sinai in New York, who explains the relatively simple ways to address this problem.

See related article.

Apr 02, 2019
Beyond the Rhetoric: Gun Control That Works, Part 2
26:04

Almost nothing is more controversial than gun control in the United States. Yet while passions flare and legislators posture but do little, deaths from gun violence are all too common. Almost every proposal put forward to address gun violence eventually fails. Seemingly, the Second Amendment stops any attempt to control guns. Despite this, there have been commonsense approaches to reducing gun violence that have been very effective in some communities. How gun violence has been managed in these communities is reviewed in this podcast with JAMA author April M. Zeoli, PhD, MPH, from the School of Criminal Justice at Michigan State University, Lansing. Part 2 of 3.

Mar 26, 2019
Update on Atrial Fibrillation: Review of the New AHA/ACC/HRS Treatment Guidelines
42:01

Cardiologist and JAMA Deputy Editor Greg Curfman, MD, discusses the many changes in the new AHA/ACC/HRS atrial fibrillation guidelines with University of Chicago cardiologists Gaurav Upadhyay, MD, and Francis Alenghat, MD, PhD. Major changes include recommendations for the use of various agents for anticoagulation, catheter ablation, and left atrial appendage occlusion.

Read the article: Management of Patients With Atrial Fibrillation

Index of content:

2:19 Summary of the new ACC/AHA Atrial Fibrillation Guideline

8:04 Cost and efficacy of NOACs used to treat atrial fibrillation

11:42 Preference for specific NOACs

14:00 Rate vs rhythm control

20:00 How catheter ablation is performed

26:20 Anticoagulation requirements following ablation

31:23 How to achieve rate control

32:25 Left atrial appendage occlusion devices

36:29 New lifestyle recommendation

37:44 More about rate vs rhythm control

 

Mar 15, 2019
Beyond the Rhetoric: Gun Control That Works, Part 1
27:45

Almost nothing is more controversial than gun control in the United States. Yet while passions flare and legislators posture but do little, deaths from gun violence are all too common. Almost every proposal put forward to address gun violence eventually fails. Seemingly, the Second Amendment stops any attempt to control guns. Despite this, there have been commonsense approaches to reducing gun violence that have been very effective in some communities. How gun violence has been managed in these communities is reviewed in this podcast with JAMA author April M. Zeoli, PhD, MPH, from the School of Criminal Justice at Michigan State University, Lansing.

Mar 12, 2019
Is It Safe? What Happens When Your Surgeon Is Not Actually Doing Some of Your Operation?
24:43

Great controversy exists regarding the safety of surgery when the attending surgeon allows someone else to perform parts of the operation. These practices are necessary components of surgical training, but how safe this is for patients remains unknown. In this podcast we discuss the risks and benefits associated with overlapping and concurrent surgery with a recognized expert in this topic, Michelle M. Mello, JD, PhD, a professor of law at Stanford University and the Department of Health Research and Policy, Stanford University School of Medicine, California.

Feb 26, 2019
COPD: All You Need to Know in 20 Minutes
21:52

COPD is common enough that it is responsible for 3% of all clinic visits in the United States. Clinicians will undoubtedly deal with this disease in their practice. How to diagnose and manage it is reviewed by Frank C. Sciurba, MD, a professor of medicine from the University of Pittsburgh, Pennsylvania.

Feb 26, 2019
Next Generation Sequencing of Infectious Pathogens in Public Health and Clinical Practice
25:11

Next-generation sequencing is a catchall term for new, high-throughput technologies that allow rapid sequencing of a full genome. It can be used to sequence a patient’s DNA in diagnosing a genetic disorder or characterizing a cancer, but can also be used to sequence the genome of a pathogenic bacteria, virus, fungi, or parasites. In this JAMA clinical review podcast, we talk with authors Marta Gwinn, MD, MPH, and Gregory L. Armstrong, MD, from the CDC, about how next-generation sequencing of infectious pathogens is being implemented in clinical practice and in public health surveillance for infectious disease.

Feb 14, 2019
Can I Believe the Results From Observational Studies? Using E-Values That Anyone Can Calculate for Evaluating the Risk of Confounding
28:14

E-values are a new tool that enables investigators to estimate the likelihood that some unmeasured confounder might overcome seemingly positive results. They are very easy to calculate and any reader of the medical literature can do this calculation to get a sense for how likely it is that there is some unmeasured factor in an observational study that might negate otherwise seemingly positive findings.

Read the article: Using the E-Value to Assess the Potential Effect of Unmeasured Confounding in Observational Studies

E-Value Calculator

Feb 12, 2019
Finding a Serious Arrhythmia Using a Watch
14:53

Saved by a Fitbit. Technology is developing at a pace far exceeding its application in medical care. An exception is in consumer devices, which as long as they do not hold themselves out as diagnostic tools, can apply as many technologies to wearable devices as companies want to put into them. In this episode we discuss how a clinician used a wearable device to diagnose his father's rapid heart rates consistent with dangerous cardiac arrhythmias.

Read the article: Wearable Devices for Cardiac Rhythm Diagnosis and Management

 

Jan 29, 2019
Screening for Breast Cancer: Is It Worth It?
17:55

Breast cancer screening is debated passionately among those who advocate for very aggressive screening and other experts who believe that screening can be harmful. The arguments for all sides of the debate are best understood by knowing the numbers of women who will benefit or be harmed by breast cancer screening. Both sides of the debate are explained in this podcast by Nancy Keating, MD, and Lydia Pace, MD, both from the Brigham and Women's Hospital and Harvard Medical School in Boston.

Jan 22, 2019
Major Societies Agree – A New Approach to Penicillin Allergy Is Needed
35:35

Very few people who think they are allergic to penicillin actually are. Yet, even if someone reports a remote and vague history of penicillin allergy, these very useful medications will not be given. This forces many patients to use antibiotics that may be too broad spectrum, not very effective, or expensive. Three major societies have come together to agree on an approach for assessing if penicillin allergy is really present when a patient reports an allergy to these medications. Erica S. Shenoy, MD, PhD, from Massachusetts General Hospital in Boston, author of a JAMA review on the topic, discusses this very important problem.

Read the article: Evaluation and Management of Penicillin Allergy: A Review

 

Jan 15, 2019
Medical Emergencies While Flying
29:22

When flying and they call "Is there a licensed medical professional on board," should physicians respond? If so, what should they do? Are they liable if things go wrong? We interview Christian Martin-Gill, MD, MPH, Department of Emergency Medicine, University of Pittsburgh, who is an expert on in-flight emergencies and authored a JAMA review on the topic.

Dec 21, 2018
Bayes for Clinicians Who Need to Know but Don’t Like Math
28:32

The statistical concept of Bayes comes up in clinical medicine all the time. It simply means that what you know about something factors into how you analyze it. This contrasts with the commonly used statistical approach called frequentist analysis of hypothesis testing, in which it is assumed that every situation is unique and not influenced by the past. Bayesian analysis accounts for how prior information gets factored into decision making and is important to understand when applying clinical research findings to the delivery of medical care. In this interview Anna E. McGlothlin, PhD, senior statistical scientist at Berry Consultants in Austin, Texas, explains these concepts for clinicians.

Read the article: Bayesian Hierarchical Models

Dec 11, 2018
Battle of the Heart Societies, Part 2: Who Is Right – the US or Europe Regarding How to Manage Hypertension? Their Differences
38:27

Within the last 2 years, major guidelines have been issued from US-based and European organizations that differ in their recommendations for the diagnosis and treatment of hypertension. Experts from both sides of the Atlantic--Paul Whelton, MD, from the United States and Bryan Williams, MD, from Europe--discuss the similarities and differences in these guidelines and the basis for the differences. They were interviewed by JAMA editors Greg Curfman, MD, and Ed Livingston, MD. Part 1 [LINK] of this 2-part series, reviewed the similarities between the 2 guidelines and discussed issues regarding how to best treat hypertension in elderly individuals. In this Part 2 episode, the differences between the guidelines are reviewed and how clinicians should use this information to treat patients is presented. See also the JAMA website on hypertension guidelines at https://sites.jamanetwork.com/jnc8/.

Nov 20, 2018
A Family’s Struggle With Alcoholism
31:21

What is it like to go through alcohol withdrawal at home? What is it like for a mother to sit by her son's side while he goes through withdrawal and supporting him? Why does someone who doesn't have any particular reason to drink misuse alcohol? The answers to these questions can be found by listening to a narrative from one patient and his mother about his descent into alcohol misuse, his experiences with withdrawal, and his eventual overcoming of a dreadful alcohol addiction.

Read the article: Will This Hospitalized Patient Develop Severe Alcohol Withdrawal Syndrome?: The Rational Clinical Examination Systematic Review

 

Nov 13, 2018
Battle of the Heart Societies: Who Is Right – the US or Europe Regarding How to Manage Hypertension?
32:25

Within the last 2 years, major guidelines have been issued from US-based and European organizations that differ in their recommendations for the diagnosis and treatment of hypertension. Experts from both sides of the Atlantic—Paul Whelton, MD, from the United States (Tulane University, New Orleans, Louisiana) and Bryan Williams, MD, from Europe (University College London in England)—discuss the similarities and differences in these guidelines and the basis for the differences. They were interviewed by JAMA editors Greg Curfman, MD, and Ed Livingston, MD.

Nov 06, 2018
Observations From ICU Patients We Thought Were Asleep, but Were Not
25:44

What if the patient you are managing in the ICU is not asleep when you thought they were? Patients relate their very disturbing stories about what they experienced while in an ICU and their treating clinicians thought they were asleep.

Oct 23, 2018
An Update on the Diagnosis and Treatment of Venous Thromboembolic Disease
17:19

Venous thromboembolic disease is common. There are many steps necessary to establish a diagnosis or treat this disease. These are summarized in this JAMA Clinical Reviews podcast and interview with Philip S. Wells, MD, from the Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada, and author of a recent JAMA review on the topic.

Oct 16, 2018
Alcohol Withdrawal Syndrome
20:36

Alcohol withdrawal is a serious problem that can lead to mortality. How to predict if it will occur when a patient who is misusing alcohol is admitted to the hospital is challenging. This Rational Clinical Examination article reports results of a systematic review of the literature to determine the best way to predict the occurrence of alcohol withdrawal.

Read the article: Will This Hospitalized Patient Develop Severe Alcohol Withdrawal Syndrome?: The Rational Clinical Examination Systematic Review

Oct 02, 2018
Treating Appendicitis Without Surgery – 5-Year Follow-up From a Randomized Clinical Trial of Antibiotic Treatment
29:51

In 2015, JAMA published results of a randomized clinical trial showing that antibiotic treatment for acute appendicitis was feasible. Doubters of the efficacy of antibiotics for treating appendicitis were concerned about what the long-term recurrence rate would be for those patients treated without surgery. The 5-year results of the study are now presented, showing that only about 40% of patients treated with antibiotics ultimately go on to have an appendectomy.

Read the article: Five-Year Follow-up of Antibiotic Therapy for Uncomplicated Acute Appendicitis in the APPAC Randomized Clinical Trial

Sep 25, 2018
Treating Lyme Disease in 2018, Part 2
29:38

There are new findings about another form of Borrelia: Borrelia miyamotoi. This form of Borrelia causes a relapsing fever but is spread in the same way that Lyme disease is. To help understand these new findings we spoke with Eugene Shapiro, MD, from the Department of Pediatrics and Department of Epidemiology of Microbial Diseases at Yale.

Sep 18, 2018
Treating Lyme Disease in 2018, Part 1
24:19

In this JAMA Clinical Reviews podcast, we talk to Eugene D. Shapiro, MD, from Yale University School of Medicine for an update on Lyme disease, including new ideas about its diagnosis and treatment.

Sep 11, 2018
What you need to know about syphilis in 2018
30:04

Syphilis is on the rise despite prior successful efforts to control it. Why is it coming back and what needs to be done about it? Dr Charles Hicks from UC San Diego explains. This podcast coincides with updated syphilis screening recommendations from the USPSTF that were published in the September 4, 2018 issue of JAMA.

Sep 04, 2018
Treating Alcohol Use Disorder
23:57

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

Aug 28, 2018
Saving Lives by Stopping Bleeding
21:30

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

Aug 14, 2018
Working on the Precipice: On the Frontlines of the AIDS Epidemic at the CDC, Part II
26:10

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.

Aug 01, 2018
Working on the Precipice: On the Frontlines of the AIDS Epidemic at the CDC, Part I
24:30

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.

Jul 24, 2018
Return of the IUD: Long-acting Reversible Contraception Is Safe and Effective
26:20

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.

Jul 06, 2018
Health Care Spending Gone Wild: Using Expensive Insulin Analogs With Few Clinical Advantages
27:07

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.

Jun 23, 2018
A Goal Too Far: Rethinking HbA1c Targets for Diabetes Treatment
29:24

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

Jun 19, 2018
When Will It Stop? Clinicians Are Still Ordering Routine ECGs Despite Recommendations to the Contrary
22:12

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

 

Jun 12, 2018
Replacing the Trachea: An Exciting New Procedure; But How Do We Know It Really Works?
21:55

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.

May 20, 2018
Update: New Recommendations for Prostate Cancer Screening
25:41

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

May 08, 2018
Peanut Allergy: The Recommendations Have Changed
19:11

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

Mar 06, 2018
What Is New in Acute Respiratory Disease Syndrome?
30:19

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

Feb 20, 2018
Medical Findings In U.S. Government Personnel Reporting Symptoms After Exposure To Sensory Phenomena in Havana, Cuba
29:37

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.

 

Feb 14, 2018
The Health of Players of American Football
30:34

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

 

Feb 01, 2018
Gastric Sleeve Resection for Obesity: How good Is It?
29:48

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 Permanente Medical Group, Bellevue, WA

Read the article: Comparing the Outcomes of Sleeve Gastrectomy

Jan 16, 2018
Surveillance for Thyroid Cancer
16:37

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

Jan 02, 2018
Diagnosis and First-Line Treatment of Chronic Sinusitis
30:23

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

Dec 19, 2017
Managing Hypertension: Understanding the New AHA/ACC Hypertension Guideline, Part II
10:37

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

Dec 12, 2017
Managing Hypertension: Understanding the New AHA/ACC Hypertension Guideline
39:43

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

Dec 05, 2017
Matching Drugs to Genetic Abnormalities to Precisely Treat Cystic Fibrosis
26:07

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

Dec 05, 2017