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 Acute Coronary Syndrome? The Rational Clinical Examination Systematic Review as well as a patient who was diagnosed with myocardial infarction.

Interview with Leonard B. Bacharier, MD, author of Early Administration of Azithromycin and Prevention of Severe Lower Respiratory Tract Illnesses in Preschool Children With a History of Such Illnesses: A Randomized Clinical Trial

Edward H. Livingston, MD, Deputy Editor of Clinical Reviews and Education and Jon Tilburt, MD, from the Mayo Clinic explain prostate cancer screening. For more information, read the JAMA Patient Page on this topic.

Edward H. Livingston, MD, Deputy Editor of Clinical Reviews and Education discusses prostate cancer screening with Otis Brawley, MD, author of Prostate Cancer Incidence and PSA Testing Patterns in Relation to USPSTF Screening Recommendations and David F. Penson, MD, MPH, author of a related editorial entitled The Pendulum of Prostate Cancer Screening.

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 Prostate Cancer Screening.
• Victor M. Montori about The Connection Between Evidence-Based Medicine and Shared Decision Making.

Interview with Ingrid M. Libman, MD, PhD, author of Effect of Metformin Added to Insulin on Glycemic Control Among Overweight/Obese Adolescents With Type 1 Diabetes

Interview with Thomas L. Schwenk, MD, author of Resident Depression: The Tip of a Graduate Medical Education Iceberg

Interview with Roger Stupp, MD, author of Maintenance Therapy With Tumor-Treating Fields Plus Temozolomide vs Temozolomide Alone for Glioblastoma: A Randomized Clinical Trial

Interview with John H. Sampson, MD, PhD, MHSc, MBA, author of Alternating Electric Fields for the Treatment of Glioblastoma

Interview with Debbie A. Lawlor, PhD, author of Live-Birth Rate Associated With Repeat In Vitro Fertilization Treatment Cycles

Interview with Dalane W. Kitzman, MD, author of Effect of Caloric Restriction or Aerobic Exercise Training on Peak Oxygen Consumption and Quality of Life in Obese Older Patients With Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial

Interview with Gaëtan Deslée, MD, PhD, author of Lung Volume Reduction Coil Treatment vs Usual Care in Patients With Severe Emphysema: The REVOLENS Randomized Clinical Trial

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.

Interview with Michael P. Pignone, MD, MPH, author of Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement

Interview with David C. Grossman, MD, MPH, author of Screening for Autism Spectrum Disorder in Young Children: US Preventive Services Task Force Recommendation Statement

Interview with John G. Laffey, MD, MA, author of Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries

Interview with Clifford Deutschman, MD, MS, Mervyn Singer, MD and Derek Angus, MD, MPH, authors of The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

Interview with Michael P. Pignone, MD, MPH, author of Screening for Impaired Visual Acuity in Older Adults: US Preventive Services Task Force Recommendation Statement

Interview with Lynn Babcock, MD, MS, author of Identifying Children and Adolescents at Risk for Persistent Postconcussion Symptoms

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 not particularly strong, reduce or eliminate medications accordingly.  Diabetes management in the elderly is highlighted in this podcast with specific attention given to deintensifying diabetes treatment in the elderly.

Articles discussed in this episode:

• Polypharmacy in the Aging Patient: Glycemic Control in Older Adults With Type 2 Diabetes: A Review (Kasia J. Lipska, MD, MHS)
• Evaluation and Treatment of Older Patients With Hypercholesterolemia: A Clinical Review (Timo E. Strandberg, MD, PhD)
• Trends in Prescription Drug Use Among Adults in the United States From 1999-2012 (Elizabeth D. Kantor, PhD, MPH)

Interview with Saad B. Omer, MBBS, MPH, PhD, author of Association Between Vaccine Refusal and Vaccine-Preventable Diseases in the United States A Review of Measles and Pertussis

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 in this episode:

• CDC Guideline for Prescribing Opioids for Chronic Pain— United States, 2016,
• The CDC Guideline on Opioid Prescribing: Rising to the Challenge (Yngvild Olsen, MD, MPH),
• The DSM-V definition for opioid use disorder and 11 point checklist

Interview with William R. Phillips, MD, MPH, author of Screening for Chronic Obstructive Pulmonary Disease: US Preventive Services Task Force Recommendation Statement

Interview with Raj Chetty, PhD, author of The Association Between Income and Life Expectancy in the United States, 2001-2014, and Angus Deaton, PhD, author of On Death and Money: History, Facts, and Explanations

Interview with Kiros Berhane, PhD, author of Association of Changes in Air Quality With Bronchitic Symptoms in Children in California, 1993-2012

Interview with Céline Vetter, PhD, author of Association Between Rotating Night Shift Work and Risk of Coronary Heart Disease Among Women

Christine Curry, MD, PhD, assistant professor of obstetrics and gynecology at the University of Miami, discusses the challenges of keeping pregnant patients and her colleagues well-informed of the facts as Zika virus fears circulate.

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 behavioral treatments can successfully help manage ADHD. These are reviewed in a series of articles appearing in the May 10, 2016, issue of JAMA. In this podcast, we discuss ADHD with the authors of some of those papers, Eugenia Chan, MD, MPH from Harvard and Philip Shaw, MD, PhD from the National Human Genome Research Institute.

Articles discussed in this episode:

• Treatment of Attention-Deficit/Hyperactivity Disorder in Adolescents: A Systematic Review
• Quantifying the Benefits and Risks of Methylphenidate as Treatment for Childhood Attention-Deficit/Hyperactivity Disorder
• Methylphenidate for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

Interview with Douglas B. White, MD, MAS, author of Prevalence of and Factors Related to Discordance About Prognosis Between Physicians and Surrogate Decision Makers of Critically Ill Patients

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 Esophageal Histologic Changes
Turning the Pathogenesis of Acute Peptic Esophagitis Inside Out

Interview with Cynthia L. Ogden, PhD, author of Trends in Obesity Among Adults in the United States, 2005 to 2014

Interview with Ann E. Kurth, PhD, RN, MSN, MPH, author of Screening for Syphilis Infection in Nonpregnant Adults and Adolescents: US Preventive Services Task Force Recommendation Statement

Interview with Douglas K. Owens, MD, MS, author of Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement

Interview with Jeff D. Williamson, MD, MHS, author of Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial

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: Persistent Diarrhea

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

Interview with Michael P. Pignone, MD, MPH, author of Screening for Skin Cancer: US Preventive Services Task Force Recommendation Statement

Interview with David Grossman, MD, author of Screening for Lipid Disorders in Children and Adolescents: US Preventive Services Task Force Recommendation Statement

Interview with Dhruv S. Kazi, MD, MSc, MS, author of Cost-effectiveness of PCSK9 Inhibitor Therapy in Patients With Heterozygous Familial Hypercholesterolemia or Atherosclerotic Cardiovascular Disease

Interview with Francisco A.R. García, MD, MPH, author of Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement

Patrick Soon-Shiong, MD, physician-scientist and entrepreneur, talks about the National MoonShot Initiative, his MoonShot 2020 Program, as well as promising approaches in cancer immunotherapy. This podcast was originally recorded on June 3, 2016

Interview with Vivian S. Lee, MD, PhD, MBA;, author of Implementation of a Value-Driven Outcomes Program to Identify High Variability in Clinical Costs and Outcomes: Association With Reduced Cost and Improved Quality, and Michael E. Porter, PhD, author of From Volume to Value in Health Care: The Work Begins

What to do when the wrong procedure is performed? In this first installment of JAMA Performance Improvement: Do No Harm we explore the options for dealing with this very difficult problem with Tami Minnier, RN, MSN, Paul Phrampus, MD, Linda Waddell, RN, MSN, and David Baker, MD, MPH, FACP. Air traffic audio courtesy of LiveATC.net, used with permission.

Interview with Jeffrey L Saver, M.D., author of Time to Treatment With Endovascular Thrombectomy and Outcomes From Ischemic Stroke: A Meta-analysis

When managing septic shock, passive leg raising is the best test to determine if a patient is likely to respond to a fluid bolus, better than CVP lines or even bedside ultrasound. Dr Najib Ayas, Associate professor of Critical Care Medicine at the University of British Columbia, discusses shock management from the context of his Rational Clinical examination article in the September 27, 2016 issue of JAMA, entitled “Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids?”

Nearly all women experience some element of nausea and vomiting during their pregnancies. In this podcast we review the entire spectrum of disease all the way up to hyperemesis gravidarum and how to provide care for women experiencing these problems.

Article discussed in this episode:

Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy

Interview with Pieter A. Cohen, MD, author of The Supplement Paradox: Negligible Benefits, Robust Consumption

This Medical News podcast features a Q&A with CDC Director Tom Frieden, MD, commemorating the agency’s historic 70th anniversary. The interview was recorded on August 8th, 2016.

In this episode of JAMA Professionalism: Best Practice, Edward H. Livingston, MD looks at the case of a physician requesting prescription medication from a colleague to examine professional boundaries between physicians and options for managing those boundaries. Shiphra Ginsburg, MD and Wendy Levinson, MD, authors of the related article, join Dr Livingston to discuss the best options for handling this challenging situation. Arthur S. Hengerer, MD, chair of the Federation of State Medical Boards discusses the legal and licensure ramifications of physicians prescribing for other clinicians and Kate E. Engelhardt, MD, and D. Brock Hewitt, MD, MPH, practicing physicians, relate their experience with other clinicians asking them to prescribe medications.

Interview with Ann E. Kurth, PhD, RN, MSN, MPH, Task Force member and co-author of Primary Care Interventions to Support Breastfeeding: US Preventive Services Task Force Recommendation Statement