JAMA Clinical Reviews

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

Exploring how gene variants can mimic randomized trials, challenging beliefs about HDL in heart disease, leveraging human genetics for causal inference, and studying the impact of lipid biomarkers on heart disease risk using 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 to grow viruses. Although Twort did not identify bacteriophages in his experiment, he believed there was some toxic entity that killed bacteria present in his experiments. An investigation on the nature of ultra-microscopic viruses1 by Twort FW, L.R.C.P. Lond., M.R.C.S. Reprint and translation of d’Herelle’s original 1917 description of bacteriophages isolated from soldiers recovering from dysentery. On an invisible microbe antagonistic to dysentery bacilli. Note by M. F. d’Herelle, presented by M. Roux. Comptes Rendus Academie des Sciences 1917; 165:373–5 Review of the non-English-language literature on bacteriophage therapy of infection Bacteriophage Therapy Antimicrob Agents Chemother. 2001 Mar; 45(3): 649–659. Review of the history bacteriophage research and its effect on scientific development and clinical medicine The Murky Origin of Snow White and Her T-Even Dwarfs Genetics 155: 481–486 (June 2000) News report from UC San Diego on treatment of the patient described in the podcast Novel Phage Therapy Saves Patient with Multidrug-Resistant Bacterial Infection 2017 JAMA Medical News article on the use of bacteriophage to treat a patient with multidrug-resistant Acinetobacter infection Phage Therapy’s Role in Combating Antibiotic-Resistant Pathogens

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.