JAMA Clinical Reviews

Approximately one-third of all medical school graduates report having been abused as students. Medical student and resident abuse has long been considered unacceptable behavior but still persists in the teaching environment. In this podcast we discuss how students and residents might respond to these events. We interview Geoffrey Young, MD, from the Association of American Medical Colleges and Thomas J. Nasca, MD, from the Accreditation Council for Graduate Medical Education, who discuss how they expect medical schools to respond to abusive behaviors and what resources are available to students and residents who have been abused to report those experiences without fearing retribution.

Article discussed in this episode:

Medical Student Mistreatment

As people age, loss of muscle mass is inevitable, resulting in sarcopenia. Muscle loss contributes to overall weakness, which causes frailty. Frailty, in turn, is the generalized susceptibility to disease and injury, all of which causes loss of autonomy. Because of the potential for progressive decline in physical function in very elderly patients, accurate tools are needed to predict mortality risk to individualize treatments intended to improve longevity such as chemotherapy, management of chronic diseases, and surgery. In this podcast, sarcopenia, frailty, and risk prediction are discussed in the context of major trials studying them being conducted in Europe.

Managing hypertension in elderly patients is complicated. Recent studies have shown that elderly patients may benefit from aggressive hypertension management, but other studies have shown that some are harmed by overly aggressive hypertension management. These issues were discussed in detail at the 2016 European Union Geriatric Medicine Society meeting. In this podcast we discuss how to best manage hypertension in elderly patients with Athanase Benetos, MD, PhD, a professor of internal medicine from Nancy, France, and the academic director of the European Union Geriatric Medicine Society.

Older patients tend to have multiple comorbid conditions requiring treatment with many medications. Managing polypharmacy is challenging. In this podcast we discuss 2 tools that help deal with this problem: The Beer’s list and the START/STOPP criteria. To help understand these tools we spoke with Michael Steinman, MD, a professor of medicine from University of California-San Francisco, and Denis O’Mahony from University College Cork, Ireland.

Links:

JAMA reviews on polypharmacy in the elderly: Evaluation and Treatment of Older Patients With Hypercholesterolemia (Sep 17, 2014)

Polypharmacy in the Aging Patient: Management of Hypertension (July 14, 2015)

Polypharmacy in the Aging Patient: Review of Glycemic Control in Older Adults With Type 2 Diabetes (DM article has polypharmacy podcast - Mar 8, 2016

SPRINT Trial of Hypertension Control in the Elderly: American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults or geriatricscareonline.org, click on the link for Clinical Guidelines & Recommendations–

The EU(7)-PIM list: Potentially Inappropriate Medications for Older People

STOPP/START Criteria for Potentially Inappropriate Prescribing in Older People

Workplace violence–related injuries occur disproportionately in health care settings. In this podcast, we discuss how individual clinicians should manage violent patients who might attack them. Article discussed in this episode: Ensuring Staff Safety When Treating Potentially Violent Patients

Between 8% and 10% of the population will have a seizure at one point in life. It's important to distinguish seizures from other entities that can look like them and, once a diagnosis of a seizure is established, know how to treat them. In this podcast we discuss seizures and epilepsy with Jay Gavvala, MD, author of New-Onset Seizure in Adults and Adolescents: A Review.

Article discussed in this episode:

New-Onset Seizure in Adults and Adolescents: A Review

Medicare recently developed a star rating system to help consumers determine the quality of care delivered at various hospitals. This rating system was considered controversial by many. In this podcast we discuss the rating system with one of its critics, Karl Y. Bilimoria, MD, MS, and with Kate Goodrich, MD, the Director of the Center for Clinical Standards and Quality at Medicare.

Article discussed in this episode:

The New CMS Hospital Quality Star Ratings: The Stars Are Not Aligned

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

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?”

Drug prices continue to rise in the US. Many solutions have been proposed but few have been implemented. Drs. Janet Woodcock from the FDA and Aaron Kesselheim, author of The High Cost of Prescription Drugs in the United States from the Harvard Medical School discuss the role of brand name drugs and generics and how they influence the cost of pharmaceuticals.

Also see The Cost of US Pharmaceutical Price Reductions: A Financial Simulation Model of R&D Decisions by Thomas A. Abbott and John A. Vernon.

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 Disorder (JAMA Clinical Guidelines Synopsis)
• The Vancouver Opioid Use Disorder Guideline
• Model Policy on DATA 2000 And Treatment of Opioid Addiction in the Medical Office