JAMA Clinical Reviews is a podcast series produced by the Journal of the American Medical Association. It provides expert discussions on current clinical topics across a broad range of medical specialties.
Progressive gait change, cognitive decline and urinary dysfunction in older adults can signal idiopathic normal pressure hydrocephalus, but ventricular enlargement alone is insufficient; timed gait assessment before and after cerebrospinal fluid drainage, including delayed response, helps select patients for shunting.
Rheumatoid arthritis can begin with only a few inflamed joints and negative serology, so diagnosis remains clinical; early disease-modifying treatment, structured disease-activity targets and coordinated primary care–rheumatology follow-up aim to prevent progressive joint and systemic damage.
Chronic symptoms that worsen upright and improve supine should prompt structured heart-rate and blood-pressure measurement through ten minutes of standing. Diagnosis also requires exclusion of mimics, while treatment begins with volume expansion, compression and recumbent exercise.
Treatment goals, opioid exposure, kidney and liver function, comorbidity and likely adherence determine medication choice for alcohol use disorder. Naltrexone, acamprosate, supervised disulfiram and topiramate offer different mechanisms, limitations and opportunities for treatment during hospital admission.
Circulating tumour DNA can identify actionable mutations in metastatic cancer or signal molecular residual disease after curative-intent treatment. Tumour-informed assays offer high specificity for the original cancer, but negative results can miss low-shedding disease and do not justify unsupported treatment de-escalation or exclude a new primary cancer.
Permission-based conversations can make physical activity advice less stigmatising and more achievable for people with chronic conditions. Distinguishing everyday movement from structured exercise, starting with a sustainable dose and using specific behavioural goals, social support or self-monitoring can support longer-term change.
Primary-care, endocrine and respiratory clinicians get a practical review of short sleep, appetite regulation, obesity and obstructive sleep apnoea. It connects sleep duration, leptin and ghrelin, resistant hypertension and daytime sleepiness with cognitive behavioural therapy for insomnia, CPAP and weight-loss treatment used alongside established sleep care.
Cardiology and primary-care clinicians get a structured update on cardiovascular risk estimation and lipid-lowering treatment. Ten-year and longer-term risk, lipoprotein(a), coronary artery calcium, risk-enhancing conditions and combination therapy with statins, ezetimibe, PCSK9 inhibitors or bempedoic acid inform shared decisions.
Trauma, geriatric and primary-care teams get a practical review of hip fracture recognition and secondary prevention. Groin pain, inability to weight bear and external rotation after a fall are linked to fracture anatomy, operative treatment, orthogeriatric care, delirium prevention, mobilisation, nutrition and osteoporosis therapy.
Primary-care, gastroenterology and acute medicine teams get a structured approach to alcohol-related steatosis, fibrosis, cirrhosis, decompensation and alcohol-associated hepatitis. It combines non-judgemental alcohol history, AUDIT-C, phosphatidylethanol, FIB-4, transient elastography and cardiometabolic optimisation.
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