Cost-effectiveness analysis defines trade-offs between costs, harms, and benefits of alternative treatments and combines them into a single metric, the incremental cost-effectiveness ratio (ICER), that can inform decisions about which interventions to recommend when limited resources are available. Gillian Sanders-Schmidler, PhD, professor of population health sciences and medicine at Duke University, explains the method in terms clinicians can understand.
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Rules for the regulation of medical devices, such as hip prostheses and implantable defibrillators, are complex and differ from those for drugs. Aaron Kesselheim, MD, JD, MPH, and Jonathan Darrow, SJD, LLM, JD, MBA, both faculty members in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham & Women’s Hospital, review device classes and approval pathways used by the US Food and Drug Administration (FDA), and prospects for improvements and reform in the agency’s processes.
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Anabolic drugs activate osteoblasts and are an alternative to bisphosphonates for treating osteoporosis. Kristine Ensrud, MD, MPH, professor of medicine and epidemiology at the University of Minnesota and Minneapolis VA Healthcare System, joins JAMA Associate Editor Carolyn Crandall, MD, MS, to discuss the role of teriparatide, abaloparatide, and romosozumab in the management of osteoporosis.
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Several new therapeutic drug classes are now available to manage lipid levels. John Wilkins, MD, MS, and Donald Lloyd-Jones, MD, ScM, of the Department of Preventive Medicine and Division of Cardiology at Northwestern University Feinberg School of Medicine, discuss the use of ezetimibe, PCSK-9 inhibitors, bempedoic acid, and icosapent ethyl to manage lipid levels in patients taking statins who require additional LDL lowering.
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Alcoholic liver disease is increasing in incidence, especially in younger age groups. Ashwani Singal, MD, MS, professor of medicine at University of South Dakota, reviews the diagnosis, clinical presentation, and management of alcoholic liver disease, from acute alcoholic hepatitis to cirrhosis.
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Approximately 1 in 8 women of reproductive age seek treatment for infertility. JAMA Associate Editor Linda Brubaker, MD, joins Sandra Ann Carson, MD, of Yale School of Medicine, to discuss causes and clinical correlates of infertility as well as evaluation options and treatment approaches.
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Transcatheter valve repair has emerged as an important therapeutic option for patients with aortic and mitral valve disease. JAMA Deputy Editor Gregory Curfman, MD, interviews Charles Davidson, MD, clinical chief of Cardiology at Northwestern University, to review the range of indications and procedures now available, including transcatheter aortic valve implantation (TAVI), valve-in-valve procedures after bioprosthetic valve failure, and mitral valve transcatheter edge-to-edge repair.
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Chronic pelvic pain is a challenging condition that affects an estimated 26% of the world’s female population. JAMA Associate Editor Linda Brubaker, MD, and Georgine Lamvu, MD, of the University of Central Florida, discuss recommendations from consensus guidelines intended to improve the care of women with chronic pelvic pain and to facilitate positive clinical experiences for them.
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Routine wellness or "checkup" visits are popular with patients and physicians but questions persist about their value, goals, and effective components. JAMA Associate Editor Anne Cappola, MD, ScM, discusses the evidence for and against the practice with Jeffrey Linder, MD, MPH, of the Northwestern University Feinberg School of Medicine, and Allan S. Brett, MD, of the University of Colorado School of Medicine.
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Lower extremity peripheral artery disease (PAD) affects approximately 8.5 million people in the US and about 230 million worldwide. JAMA Deputy Editor Greg Curfman, MD, interviews Mary M. McDermott, MD, of Northwestern University Feinberg School of Medicine, to discuss current evidence regarding diagnosis and optimal medical treatment of people with PAD to prevent cardiovascular events, improve walking impairment, and prevent lower extremity ischemic events such as amputation or limb ischemia.
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Lower Extremity Peripheral Artery Disease Without Chronic Limb-Threatening Ischemia
Interview with Aaron B. Caughey, MD, PhD, USPSTF member and coauthor of Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement
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Interview with Michael Barry, MD, USPSTF vice chairperson and author of Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement
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Headache disorders are one of the most common reasons patients visit emergency rooms and medical offices. Matthew S. Robbins, MD, associate professor of neurology and neurology residency program director at Weill Cornell and New York Presbyterian Hospital, discusses effective migraine treatment approaches.
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Headache is one of the most common reasons patients visit emergency rooms and medical offices. Matthew S. Robbins, MD, associate professor of neurology and neurology residency program director at Weill Cornell and New York Presbyterian Hospital, discusses the diagnostic approach to headache with a focus on distinguishing migraine from other primary headache disorders.
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Chronic stable angina reduces quality of life and only rarely leads to acute coronary syndrome (ACS). Treatment is lifestyle modification to manage atherosclerotic risk factors, with revascularization (eg, PCI or CABG) indicated to reduce symptoms and improve quality of life only once medical therapy is maximized. James De Lemos, MD, professor of medicine in the division of cardiology at UT Southwestern Medical Center, summarizes these and other aspects of chronic stable angina management.
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Interview with John B. Wong, MD, USPSTF member and coauthor of USPSTF Recommendation: Screening for Hypertension in Adults
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Dual antiplatelet therapy, typically aspirin and an oral P2Y12 receptor inhibitor (clopidogrel, prasugrel, ticagrelor, cangrelor), reduces adverse events after acute coronary syndrome (ACS) but choice of agent and optimal duration may be patient-specific. Umair Khalid, MD, a cardiologist at the Baylor School of Medicine in Houston, discusses how to use these agents in management of ACS.
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Interest in space travel has increased since SpaceX’s first commercial launch to the International Space Station (ISS) in May 2020 and with efforts to send humans to Mars. Serena Auñón-Chancellor, MD, MPH, a physician-astronaut who completed a 6-month mission to the ISS in 2018 and is associate professor of clinical medicine at LSU Health Sciences Center in Baton Rouge and associate program director for the Aerospace Medicine Residency Program at University of Texas Medical Branch (UTMB) in Galveston, discusses how the human body and mind adapt to life in space.
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Space Travel and Human Health, Part 1
Do Apollo Astronaut Deaths Shine a Light on Deep Space Radiation and Cardiovascular Disease?
Association of Structural Changes in the Brain and Retina After Long-Duration Spaceflight
Interest in space travel has increased since SpaceX’s first commercial launch to the International Space Station in May 2020 and with efforts to send humans to Mars. Jim Bagian, MD, a physician-astronaut who logged 337 hours in space between 1989 and 1991, is director of the Center for Healthcare Engineering and Patient Safety at the University of Michigan and discusses the effects of space travel on the human body and physiologic readjustments on return to earth.
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Do Apollo Astronaut Deaths Shine a Light on Deep Space Radiation and Cardiovascular Disease?
Shyam Prabhakaran, MD, chairman of neurology at the University of Chicago, discusses the diagnosis and evaluation of patients who present with transient ischemic attack (TIA) and stroke.
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Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke
Semaglutide has recently been shown to induce clinically significant weight loss in patients with obesity that is sustained for as long as the drug is given. Tom Wadden, PhD, from the University of Pennsylvania, discusses results from the series of recent STEP trials and how they compare to the effects of other medications used to treat obesity.
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Authors have declared conflicts of interest related to the article discussed in this podcast. Visit the article on jama.com for the complete disclosure.
Performing repeated statistical comparisons on data can result in false-positive findings. Jing Cao, PhD, associate professor of statistics at Southern Methodist University, explains problems that can arise from multiple testing procedures and how to avoid making false conclusions.
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Irritable bowel syndrome (IBS) is a clinical syndrome of vague abdominal pain and cramping associated with diarrhea or constipation. IBS is a diagnosis of exclusion, and a variety of treatments can improve its symptoms. Michael Camilleri, MD, professor of medicine at the Mayo Clinic, discusses recent advances in the diagnosis and management of IBS.
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Advance directives (ADs) allow patients to express their medical treatment preferences. Patients with ADs are more likely to receive medical care concordant with their wishes and are less likely to die in the hospital than patients without them, but use remains low in the US. Maria Silvera, MD, a palliative care physician and associate professor of medicine at the University of Michigan, and Catherine Auriemma, MD, a fellow in pulmonary/critical care medicine at the University of Pennsylvania, discuss the importance of ADs and strategies to increase their uptake.
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The Pfizer-BioNTech and Moderna COVID-19 mRNA vaccines are the first of many being tested for widespread use. Buddy Creech, MD, MPH, director of the Vanderbilt Vaccine Research Program, reviews these and other vaccines likely to become available, including products that use inactivated, protein subunit, and viral vector immunization strategies.
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