Error in Key Points and Omission of Collaborators in Article Information
This article has been corrected online. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 1, 2020 Category: Internal Medicine Source Type: research

Clinical Course and Molecular Viral Shedding Among Patients With SARS-CoV-2 Infection
This cohort study quantitatively describes molecular viral shedding in asymptomatic and symptomatic patients with SARS-CoV-2 infection. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 1, 2020 Category: Internal Medicine Source Type: research

Error in Text
Conclusions. The sentence should read as follows: “Our findings furthe r suggest that resources should be devoted to increasing the underuse of baseline BMD [bone mineral density] testing among women aged between 65 and 85 years, one-quarter of whom do not receive an initial BMD test.” This article has been corrected online. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 1, 2020 Category: Internal Medicine Source Type: research

Cognition and Take-up of the Medicare Savings Programs
This cross-sectional study examines the association between cognition and Medicare Savings Program enrollment among qualified elderly Medicare beneficiaries. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 1, 2020 Category: Internal Medicine Source Type: research

A Further Weakening of Contraceptive Coverage Under the Affordable Care Act
This Viewpoint discusses how a recent US Supreme Court decision raises questions about whether an employer-based health care system can continue to best serve employees and the public at large. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 1, 2020 Category: Internal Medicine Source Type: research

Error in Figure 2
This article was corrected online. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 1, 2020 Category: Internal Medicine Source Type: research

Errors in Wording and a Percentage
In the Special Communication “Drug Reimbursement Regulation in 6 Peer Countries,” published online in JAMA Internal Medicine on September 28, 2020, there were errors in 2 statements. In first sentence of the fourth paragraph, the phrase “as part of marketing approval” has been removed from the sentence, which now reads: “In Australia, pharmaceutical companies submit clinical and economic evaluations and cost-effectiveness analyses (CEAs) to the Pharmaceutical Benefits Advisory Committee (PBAC), an independent body appointed by the government composed of health care professionals, economists, a...
Source: JAMA Internal Medicine - November 1, 2020 Category: Internal Medicine Source Type: research

JAMA Internal Medicine
Mission Statement: To promote the art and science of medicine and the betterment of human health by publishing manuscripts of interest and relevance to internists practicing as generalists or as medical subspecialists. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 1, 2020 Category: Internal Medicine Source Type: research

Error in Abstract Results
This article was corrected online. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - October 1, 2020 Category: Internal Medicine Source Type: research

JAMA Internal Medicine
Mission Statement: To promote the art and science of medicine and the betterment of human health by publishing manuscripts of interest and relevance to internists practicing as generalists or as medical subspecialists. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - October 1, 2020 Category: Internal Medicine Source Type: research

Identification and Market Removal of Risky Medical Devices
Reporting of adverse events to the US Food and Drug Administration (FDA) has long been the primary mechanism of identifying safety issues with medical devices —ranging from nasal swabs to cardiac defibrillators to in vitro diagnostic test kits. Each day, approximately 3500 adverse event reports are collected in the agency’s Manufacturer and User Facility Device Experience (MAUDE) database. As anyone who has tried to use it will attest, the database pr ovides a difficult-to-use interface to search these reports. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 28, 2020 Category: Internal Medicine Source Type: research

Outcomes of Cardiopulmonary Resuscitation in Patients With COVID-19
Cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest (IHCA) in patients with coronavirus disease 2019 (COVID-19) presents unique challenges. Cardiopulmonary resuscitation may be delayed because of isolation procedures, and advanced life support resources may be limited. Additionally, CPR for patients with COVID-19 exposes health care workers to increased risk of viral transmission. Improving our understanding of the likelihood of successful outcomes after CPR is crucial to informing goals-of-care discussions, determining the appropriateness of resuscitative efforts, and guiding policy. To date, to our knowled...
Source: JAMA Internal Medicine - September 28, 2020 Category: Internal Medicine Source Type: research

Clinical Outcomes of In-Hospital Cardiac Arrest in COVID-19
This case series examines outcomes of in-hospital cardiac arrest among patients with COVID-19. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 28, 2020 Category: Internal Medicine Source Type: research

The Exclusion of Older Persons From Vaccine and Treatment Trials for COVID-19
This cross-sectional study evaluates the risk of exclusion for older adults in randomized clinical trials for treatment and vaccine interventions in coronavirus disease 2019. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 28, 2020 Category: Internal Medicine Source Type: research

Assessment of Data Sources That Support FDA Medical Devices Safety Communications
This cross-sectional study assesses the sources of initial safety signals that trigger publication of Medical Device Safety Communications and the potential associations among Medical Device Safety Communication data source, type of safety issue, and subsequent action by the US Food and Drug Administration. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 28, 2020 Category: Internal Medicine Source Type: research

Accuracy of Physicians ’ Electrocardiogram Interpretation
This systematic review and meta-analysis identifies and summarizes published research on the accuracy of physicians ’ interpretations of electrocardiograms. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 28, 2020 Category: Internal Medicine Source Type: research

Effects of Time-Restricted Eating on Weight Loss and Other Parameters in Patients With Overweight and Obesity
This randomized clinical trial examines the effect of 16:8-hour time-restricted eating on weight loss and metabolic risk markers. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 28, 2020 Category: Internal Medicine Source Type: research

The Incompatibility of Patient-Centered Care With Fee-For-Service Payment
This essay details the services provided by primary care clinicians that are not covered by fee-for-service payments but that are more important to patients, especially near the end of life, than many expensive, unwanted tests for which fee-for-service payments are available. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 28, 2020 Category: Internal Medicine Source Type: research

Drug Reimbursement Regulation in 6 Peer Countries
This study delineates drug coverage, price, and reimbursement regulations in 6 countries, emphasizing the relevance for US policy making. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 28, 2020 Category: Internal Medicine Source Type: research

Influence of Prone Positioning on Electrocardiogram in a Patient With COVID-19
This case report presents the electrocardiographic findings a woman in her 50s with COVID-19, fever, and shortness of breath, with comorbidities including morbid obesity and obstructive sleep apnea. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 28, 2020 Category: Internal Medicine Source Type: research

Effects of Counseling by Nonprofessional Humans vs Computers to Increase Walking
This randomized clinical trial examines changes in physical activity with virtual vs human advisors in Latino participants. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 28, 2020 Category: Internal Medicine Source Type: research

Looking Back to Find the Missing P Wave and Diagnose a Narrow Complex Tachycardia
This case report presents the electrocardiographic findings of a woman in her 80s who presented with a challenging arrhythmia. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 21, 2020 Category: Internal Medicine Source Type: research

Wide QRS Complex Tachycardia With a Dominant R-Wave in Lead aVR
A woman in her 50s presented to the emergency department in a comatose condition 1 hour after she had consumed 50 tablets each of doxepin and amitriptyline as a suicide attempt due to depression. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 21, 2020 Category: Internal Medicine Source Type: research

Two Remedies for Inappropriate Percutaneous Coronary Intervention
Less is More (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 21, 2020 Category: Internal Medicine Source Type: research

US False Claims Act Investigations of Unnecessary Percutaneous Coronary Interventions
This case-control study assess the association of US False Claims Act investigations of the overuse of PCIs with PCI volumes. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 21, 2020 Category: Internal Medicine Source Type: research

Potential Association of the ISCHEMIA Trial With the Appropriate Use Criteria Ratings for Percutaneous Coronary Intervention in Stable Ischemic Heart Disease
This cohort study examines the potential implications of the ISCHEMIA trial on the appropriateness of percutaneous coronary intervention in patients with stable ischemic heart disease. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 21, 2020 Category: Internal Medicine Source Type: research

Clinical Laboratory Test Unit Homogeneity —an Urgent Need
To the Editor A recent Letter to the Editor written by Song and Zheng reported corrections to measurement units for a number of laboratory data previously published by Wu et al. Errors in measurement units are frequent in the literature; regrettably, the heterogeneity of measurement units among different commercially available analytical methods for a given biomarker is a key factor introducing an increased likelihood of errors. Several crucial issues arise from this scenario: poor accuracy in the reporting of laboratory test results by authors of clinical trials and experimental studies; poor awareness of the potential ha...
Source: JAMA Internal Medicine - September 21, 2020 Category: Internal Medicine Source Type: research

The Fragility Index and Trial Significance
To the Editor In their Original Investigation, Gaudino et al assessed 216 invasive cardiovascular trials for associations between funding and 4 outcomes: trial result classification, spin, discrepancies between registered and published findings, and fragility. We read about their first 3 outcomes with interest, but we recommend caution when interpreting their reports of trial fragility. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 21, 2020 Category: Internal Medicine Source Type: research

The Fragility Index and Trial Significance —Reply
In Reply We have read the Letter to the Editor by Chaitoff et al regarding the use of the fragility index (FI) for the evaluation of trial robustness in our analysis of contemporary clinical trials of invasive cardiovascular interventions. Their criticism is based on the limitations of the FI concept which, of note, represented only 1 of the 6 components of our analysis. Their points are well taken but must be interpreted in the context of the rest of our study, as well as a correct understanding of the application of the concept. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 21, 2020 Category: Internal Medicine Source Type: research

Efficacy of Smartphone Applications for Smoking Cessation
This randomized clinical trial examines the efficacy of a smartphone application for smoking cessation based on acceptance and commitment therapy vs a National Cancer Institute smoking cessation application based on US clinical practice guidelines. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 21, 2020 Category: Internal Medicine Source Type: research

Tobacco Dependence Treatment Is Critical to Excellence in Health Care
This Viewpoint discusses the importance of including tobacco dependence treatment as a measure of excellence in the provision of health care. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 21, 2020 Category: Internal Medicine Source Type: research

Severe COVID-19 Infections —Knowledge Gained and Remaining Questions
Patients with acute respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have overwhelmed critical care capacity in some cities and countries. The mortality of patients who require critical care is high but varies widely among hospitals. Despite a rapidly increasing understanding of the pathogenesis of coronavirus disease 2019 (COVID-19), uncertainty remains about the reasons that some patients develop respiratory failure and others have no to minimal symptoms, as well as about the optimal management of patients with severe COVID-19 disease. We review the evidence for the management of pa...
Source: JAMA Internal Medicine - September 18, 2020 Category: Internal Medicine Source Type: research

A Solution for Guideline Overkill —More Guidelines or Shared Understanding?
Less is More (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 14, 2020 Category: Internal Medicine Source Type: research

Association of Sleep Duration and Variability With Body Mass Index
This cohort study examines sleep and demographic data from wearable activity tracking devices to assess for an association of sleep duration and variability with body mass index. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 14, 2020 Category: Internal Medicine Source Type: research

Out-of-Pocket Costs for Novel Guideline-Directed Diabetes Therapies Under Medicare Part D
This study examines cost sharing for novel second-line diabetes treatment agents under Medicare Part D. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 14, 2020 Category: Internal Medicine Source Type: research

Decision Aids and the Absence of Expected Longevity Benefits of Mammography Screening
To the Editor In their recently published Original Investigation, Schonberg et al correctly reported that “guidelines recommend not screening women 75 years and older at low or average risk regardless of their life expectancy”(p837) and that “a threshold of at least a 3% 5-year risk has been recommended to define high risk; however, increasingly higher thresholds are used, such as at least a 6% 5- year risk. Only 3 women in our study had a 5-year risk of at least 6%.”(p839) Therefore, almost all of these women (mean age, 78-79 years) could reasonably have stopped the screening. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 14, 2020 Category: Internal Medicine Source Type: research

Decision Aids and the Absence of Expected Longevity Benefits of Mammography Screening in Women 75 Years and Older —Reply
In Reply In their letter about our cluster randomized clinical trial of a mammography screening decision aid (DA) for women 75 years and older, Donzelli and Giudicatti recommended that the DA be more explicit about the lack of data that mammography screening extends life. To inform the DA, we reviewed outcomes from mammography screening trials and from simulation models. A 2016 meta-analysis of mammography screening trials found a 33% reduction in breast cancer mortality with screening for women 60 to 69 years (risk ratio [RR], 0.67 [95% CI, 0.54-0.83]) and a 20% reduction in breast cancer mortality for women 70 to 74 year...
Source: JAMA Internal Medicine - September 14, 2020 Category: Internal Medicine Source Type: research

Identifying Recommendations for Stopping or Scaling Back Unnecessary Services in Primary Care
This systematic review describes recommendations made by an expert panel across internal medicine disciplines on decreasing the frequency of or discontinuing testing and therapy not deemed to be necessary. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 14, 2020 Category: Internal Medicine Source Type: research

Affordable Care Act Returns to the Supreme Court
This Viewpoint examines the consequences of the government withholding on its monetary promises made to private insurance companies owing to the passing of the Affordable Care Act. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 14, 2020 Category: Internal Medicine Source Type: research

Immune Stimulation With Recombinant Human Granulocyte Colony –Stimulating Factor for Coronavirus Disease 2019 (COVID-19)
The sobering mortality of coronavirus disease 2019 (COVID-19), the pandemic triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the few proven treatments have stimulated a global effort to rapidly discover and disseminate novel therapies. A noteworthy feature of the disease is the marked degree of lymphopenia in many hospitalized patients with COVID-19 and the association of lymphopenia with adverse outcomes. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 10, 2020 Category: Internal Medicine Source Type: research

Effect of Recombinant Human Granulocyte Colony –Stimulating Factor for Patients With COVID-19 and Lymphopenia
This randomized clinical trial examines the effect of recombinant human granulocyte colony-stimulating factor on peripheral blood leukocyte and lymphocyte cell counts and clinical improvement in Chinese patients with COVID-19. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 10, 2020 Category: Internal Medicine Source Type: research

Regardless of Age, Obesity and Hypertension Increase Risks With COVID-19
Older age has consistently been associated with higher mortality in patients with coronavirus disease 2019 (COVID-19). Unfortunately, as shown by Cunningham et al in this issue of JAMA Internal Medicine, COVID-19 does not spare young people. Using a national all-payer hospital database, the investigators identified 3222 nonpregnant adults aged 18 to 34 years who were admitted to US hospitals for COVID-19. Morbidity was substantial: 21% required intensive care, and 2.7% died. Mortality was higher among those who had obesity, hypertension, and male sex, as has been noted in general adult populations. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 9, 2020 Category: Internal Medicine Source Type: research

Clinical Outcomes in Young US Adults Hospitalized With COVID-19
This case series examines the clinical outcomes for young adults hospitalized with COVID-19. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 9, 2020 Category: Internal Medicine Source Type: research

Troubleshooting a Transcutaneous Pacemaker
This case report presents the electrocardiographic findings of an older adult woman with altered mental status, weakness, slurred speech, emesis, and headache. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 8, 2020 Category: Internal Medicine Source Type: research

Observational Study Design Challenges
Recent observational cohort studies have reported a possible association between fluoroquinolone use and aortic aneurysm and aortic dissection (AA/AD). Based on this evidence, the US Food and Drug Administration issued a warning in December 2018 recommending avoiding fluoroquinolone use in patients with AA/AD or who are at risk for these conditions. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 8, 2020 Category: Internal Medicine Source Type: research

Inclusion Across the Lifespan in Cardiovascular Trials —A Long Road Ahead
In January 2019, the National Institutes of Health (NIH), responding to many years of advocacy, expanded their inclusivity requirements for clinical trials to include representation of older adults. What is the current state of inclusion of older adults in cardiovascular trials? The answer is distressing. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 8, 2020 Category: Internal Medicine Source Type: research

Representation of Older Adults in Cardiovascular Disease Trials Since the Inclusion Across the Lifespan Policy
This review compares representation of older adults in interventional cardiovascular disease studies in the US before and after implementation of the National Institutes of Health ’s Inclusion Across the Lifespan Policy. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 8, 2020 Category: Internal Medicine Source Type: research

Trends in e-Cigarette Use in Adults in the United States, 2016-2018
This cross-sectional study uses data from the Behavioral Risk Factor Surveillance System to assess trends in e-cigarette use in the United States. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 8, 2020 Category: Internal Medicine Source Type: research

Challenges in Prediction and Diagnosis of Alcohol Withdrawal Syndrome and Wernicke Encephalopathy
To the Editor Alcohol withdrawal syndrome (AWS) and Wernicke encephalopathy (WE) are medical emergencies associated with considerable morbidity and mortality, and are still greatly underdiagnosed and misdiagnosed in clinical practice, either in primary or in secondary care. The best aid for diagnosis in both diseases, particularly in individuals with chronic alcohol misuse, is a detailed medical history. In particular, an accurate understanding of the natural history of alcohol withdrawal, including the temporal progression of neurological signs, is essential for a diagnosis of AWS, while an intelligent search for any fact...
Source: JAMA Internal Medicine - September 8, 2020 Category: Internal Medicine Source Type: research

Challenges in Prediction and Diagnosis of Alcohol Withdrawal Syndrome and Wernicke Encephalopathy —Reply
In Reply We thank Sechi and Sechi for their interest in our recent article describing challenges in the diagnosis and management of alcohol withdrawal in medically ill hospitalized patients. We certainly agree that Wernicke encephalopathy (WE) should always be included in the differential diagnosis for delirium in patients with a history of heavy alcohol use, and parenteral thiamine should be provided empirically without delay. Urgent treatment with parenteral thiamine can reverse WE, whereas untreated patients may progress to permanent cognitive impairment and Korsakoff syndrome, coma, or death. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - September 8, 2020 Category: Internal Medicine Source Type: research