When Can Intermediate Outcomes Be Used in Clinical Trials?
This JAMA Guide to Statistics and Methods reviews how and under what conditions surrogate outcomes can replace patient-centered outcomes in randomized trials and stresses the importance of properly validating outcomes as surrogates for direct measures of patient experiences. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 27, 2020 Category: General Medicine Source Type: research

RT-PCR Test Results in Patients Recovered From COVID-19
This case series describes reverse transcriptase –polymerase chain reaction (RT-PCR) test results in 4 health professionals discharged from hospitalization or quarantine after 2 negative RT-PCR test results and resolution of clinical COVID-19 infection. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 27, 2020 Category: General Medicine Source Type: research

The Inevitable Reimagining of Medical Education
This Viewpoint summarizes trends in preclinical medical education away from in-person classroom experiences toward online learning, and imagines the transformation of medical schools into programs that provide clinical rotations and residency training only. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 27, 2020 Category: General Medicine Source Type: research

Coronavirus Disease 2019 and Influenza
(Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 26, 2020 Category: General Medicine Source Type: research

The Low-FODMAP Diet Helps IBS Symptoms, but Questions Remain
This Medical News article discusses the best studied IBS dietary treatment. There ’s evidence it works, but its implementation can be tricky and its long-term effects aren’t well-known. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 26, 2020 Category: General Medicine Source Type: research

Explaining Health State Utility Assessment
This JAMA Guide to Statistics and Methods reviews how health state utility assessment can be used to calculate quality-adjusted life-years, a patient-specific measure of preference for health outcomes that incorporates quantity and quality of life. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 24, 2020 Category: General Medicine Source Type: research

What Does It Mean to Be a Physician?
This Viewpoint provides a historical perspective on the evolution of the roles and responsibilities of physicians and proposes a response to the trends in dysfunctional health care systems, lifestyle changes that favor distancing from patients, disruptions in care continuity, and expectations that doctors manage social determinants of health that threaten physician identity. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 24, 2020 Category: General Medicine Source Type: research

Healthy Tensions in the Evolution of Schools of Thought in Medicine
This Viewpoint reviews the modern evolution of medicine, from William Osler ’s efforts to systematize practice through evidence-based and precision medicine, and highlights unifying themes in the continued fracturing of scientific approaches to medicine, including the need for medical care to stay patient-centered despite advances in medical science and technology. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 24, 2020 Category: General Medicine Source Type: research

The Coronavirus Disease 2019 (COVID-19) Outbreak in China —Summary of a China CDC Report
This Viewpoint summarizes key epidemiologic and clinical findings from all cases of coronavirus disease 2019 (COVID-19) reported through February 11, 2020, in mainland China, and case trends in response to government attempts to control and contain the infection. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 24, 2020 Category: General Medicine Source Type: research

Preventing Surgical Site Infections —Looking Beyond the Current Guidelines
This JAMA Insights Clinical Update summarizes current guidelines for prevention of surgical site infections and discusses emerging prevention strategies, such as preoperative bowel preparation and negative-pressure wound therapy, that are challenging longstanding surgical practices. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 21, 2020 Category: General Medicine Source Type: research

Presumed Asymptomatic Carrier Transmission of COVID-19
This study describes possible transmission of novel coronavirus disease 2019 (COVID-19) from an asymptomatic Wuhan resident to 5 family members in Anyang, a Chinese city in the neighboring province of Hubei. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 21, 2020 Category: General Medicine Source Type: research

Effect of Intravenous Tenecteplase Dose on Cerebral Reperfusion Before Thrombectomy in Patients With Ischemic Stroke
This randomized clinical trial compares the effects of 2 tenecteplase doses (0.40 vs 0.25 mg/kg) prior to endovascular thrombectomy on blood flow restoration to brain ischemic territory in patients with large vessel occlusion ischemic stroke. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 20, 2020 Category: General Medicine Source Type: research

COVID-19 in Singapore —Experience and Critical Issues That Require Attention and Action
This Viewpoint discusses public health measures implemented in Singapore to manage potential COVID-19 infection based on the country ’s experience with SARS in 2003 and reviews critical information gaps necessary to help manage the outbreak, such as viral shedding patterns and optimal timing of antiviral treatment after exposure. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 20, 2020 Category: General Medicine Source Type: research

Discussing the ABCs of Health Security —Antibiotic Resistance, Biothreats, and Coronavirus
In this Medical News article, Tom Inglesby, MD, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, speaks about natural and deliberate biological threats to US national security. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 19, 2020 Category: General Medicine Source Type: research

The Need to Improve the Clinical Utility of Direct-to-Consumer Genetic Tests: Either Too Narrow or Too Broad
This Viewpoint summarizes current shortcomings in direct-to-consumer genetic tests, which often lack clinical utility for consumers, and explains how tests that encompass entire genes and include only genes with well-established risk estimates and medical management guidelines could provide more valuable insight into their disease risk. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 19, 2020 Category: General Medicine Source Type: research

Preparing for the Most Critically Ill Patients With COVID-19: The Potential Role of ECMO
This Viewpoint discusses the potential role of ECMO (extracorporeal membrane oxygenation) in the management of novel coronavirus disease 2019 (COVID-19) and cautions about the risk of overuse and the shortage of ECMO capability given the numbers of people infected if the technology is not appropriately utilized. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 19, 2020 Category: General Medicine Source Type: research

Lack of Clinical Benefit of Interferon β-1a Among Patients With Severe Acute Respiratory Distress Syndrome
In acute respiratory distress syndrome (ARDS), the alveolar-capillary units are disrupted, with lung endothelial and epithelial injury resulting in exudative pulmonary edema containing inflammatory mediators, solutes, proteins, and leukocytes. Treating pulmonary endothelial injury in ARDS may improve patient outcomes. Interferon β-1a (IFN-β-1a), a type 1 IFN, is one such treatment that may improve pulmonary endothelial barrier function. In addition to its myriad immunologic effects, IFN-β-1a upregulates cluster of differentiation 73 (CD73) on pulmonary endothelial cells, thereby increasing extracellular aden...
Source: JAMA - Journal of the American Medical Association - February 17, 2020 Category: General Medicine Source Type: research

Effect of interferon β-1a on Death and Days Free From Mechanical Ventilation in Moderate to Severe ARDS
This randomized trial compares the effects of intravenous interferon β-1a vs placebo on 28-day mortality and on ventilator-free days in patients with moderate to severe acute respiratory distress syndrome (ARDS). (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 17, 2020 Category: General Medicine Source Type: research

Randomized Clinical Trials of Artificial Intelligence
As patient data are increasingly captured digitally, the opportunities to deploy artificial intelligence (AI), especially machine learning, are increasing rapidly. Machine learning is automated learning by computers using tools such as artificial neural networks to search data iteratively for optimal solutions. Typical applications include searching for novel patterns (eg, latent cancer subtypes), making a diagnosis or outcome prediction (eg, diabetic retinopathy), and optimizing treatment decisions (eg, fluid and vasopressor titration for septic shock). Although many express excitement regarding the promise of AI, others ...
Source: JAMA - Journal of the American Medical Association - February 17, 2020 Category: General Medicine Source Type: research

Effect of a Machine Learning –Derived Early Warning System vs Standard Care on Hypotension During Noncardiac Surgery
This unblinded randomized trial compares the effect of a machine learning –derived system that uses arterial waveform information to predict cardiovascular decompensation vs standard monitoring by anesthesiologists on the depth and duration of intraoperative hypotension in patients undergoing elective noncardiac surgery. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 17, 2020 Category: General Medicine Source Type: research

Physician Orders for Life-Sustaining Treatment and Limiting Overtreatment at the End of Life
In this issue of JAMA, Lee and colleagues examine the association between Physician Orders for Life-Sustaining Treatment (POLST), which involve portable medical orders that document treatment limitations for out-of-hospital emergency care and for limiting overtreatment at the end of life. The authors studied adults with chronic life-limiting illnesses who were hospitalized within the last 6 months of life and who had completed a POLST before their last inpatient admission. Among 1818 patients enrolled, 656 (36%) had POLST orders for “full treatment” and 1162 had orders for either “limited additional inter...
Source: JAMA - Journal of the American Medical Association - February 16, 2020 Category: General Medicine Source Type: research

Association of Physician Orders for Life-Sustaining Treatment With ICU Admission Near the End of Life
This cohort study uses electronic health record (EHR) data to evaluate the association between Physician Orders for Life-Sustaining Treatment (POLST) and intensive care unit (ICU) admission and the incidence of and risk factors for POLST-discordant intensive care among adult patients hospitalized 6 months or less before death. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 16, 2020 Category: General Medicine Source Type: research

Genetic Ancestry Testing: What Is It and Why Is It Important?
This Genomics and Precision Health article explains how genetic testing is used to identify the probable geographic origins of one ’s ancestors and how it can aid in risk assessment for some heritable conditions, and summarizes the contexts in which its information provides clinically relevant information. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 14, 2020 Category: General Medicine Source Type: research

Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China
This study characterizes the demographic, epidemiologic, and clinical characteristics of hospitalized infants diagnosed with coronavirus disease 2019 infection between December 8, 2019, and February 6, 2020, in China. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 14, 2020 Category: General Medicine Source Type: research

Diagnostic Testing for Acute Hepatitis
An 18-year-old man who recently emigrated from India presented with fever, malaise, and anorexia for 4 days. He was afebrile with scleral icterus and a palpable liver edge; had a white blood cell count of 3.9  × 103/μL with elevations in total and direct bilirubin, alkaline phosphatase, and liver enzymes; and laboratory test results were positive for HBsAg and HBV core IgG. What is the cause of his hepatitis, and what would you do next? (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 13, 2020 Category: General Medicine Source Type: research

Special Needs Plans for People Experiencing Homelessness
This Viewpoint proposes the creation of a homelessness-focused special needs plan, a Medicare Advantage insurance plan aimed at meeting the unique care needs of specific populations, to help offer the intensive case management and care coordination necessary for providing health care to homeless individuals. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 13, 2020 Category: General Medicine Source Type: research

US Emergency Legal Responses to Novel Coronavirus —Balancing Public Health and Civil Liberties
This Viewpoint discusses the policy and legal ramifications of the national public health emergency declared by the US government in response the coronavirus disease 2019 (COVID-19) outbreak, and examines the lawfulness of quarantine and other compulsory measures. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 13, 2020 Category: General Medicine Source Type: research

Choosing the Best Blood Pressure Target for Vasopressor Therapy
Medical research drives innovation and improves outcomes. In cardiology, advances in diagnosis, prevention, and treatment reduced the 30-day mortality from acute myocardial infarction from 20% to 12.4% between 1995 and 2014. Similarly, for women diagnosed with breast cancer, 5-year survival has increased from 74% to 88.5% over the past 4 decades in parallel with advances in diagnosis and targeted therapy, including chemotherapeutic regimens such as cyclophosphamide, methotrexate, and fluorouracil (CMF), trastuzumab, and aromatase inhibiors. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 12, 2020 Category: General Medicine Source Type: research

Effect of Reduced Exposure to Vasopressors on 90-Day Mortality in Older Critically Ill Patients With Vasodilatory Hypotension
This randomized clinical trial compares the effect of vasopressors guided by a mean arterial pressure (MAP) target of 60 to 65 mm Hg with a MAP level determined by the treating physician on 90-day mortality among critically ill older patients with vasodilatory hypotension. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 12, 2020 Category: General Medicine Source Type: research

Preparation for Possible Sustained Transmission of 2019 Novel Coronavirus
This Viewpoint discusses the concepts of transmissibility and severity as the critical factors that determine the extent of an epidemic, drawing on the previous pandemic of influenza A(H1N1) and epidemics of SARS and MERS to consider what the scope, morbidity, and mortality of the 2019 novel coronavirus (2019-nCoV) epidemic might be. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 11, 2020 Category: General Medicine Source Type: research

Microaxial Left Ventricular Assist Devices: In Search of an Appropriate Indication
Since 1999, after the SHOCK trial demonstrated a reduction in mortality with early myocardial revascularization in patients with acute myocardial infarction complicated by cardiogenic shock, intensive care specialists and interventionalists have searched for additional ways to reduce the persistently high mortality, often in the range of 40% to 50%. After other reports demonstrated that intra-aortic balloon pump (IABP) support failed to reduce mortality, the next step was development and evaluation of other approaches for active mechanical circulatory support, including microaxial left ventricular assist devices (LVADs), i...
Source: JAMA - Journal of the American Medical Association - February 10, 2020 Category: General Medicine Source Type: research

Use of an Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump
This study uses registry data to compare risk of in-hospital mortality and major bleeding among patients with acute coronary syndrome and cardiogenic shock managed with an intravascular microaxial left ventricular assist device (LVAD) vs intra-aortic balloon pulsation (IABP). (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 10, 2020 Category: General Medicine Source Type: research

Diagnosis and Management of Primary Hyperparathyroidism
This JAMA Insights article reviews the presentation and diagnostic workup of primary hyperparathyroidism, and indications for surgical vs surveillance management. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 7, 2020 Category: General Medicine Source Type: research

Clinical Characteristics of Patients With Novel Coronavirus (2019-nCoV) Infection Hospitalized in Beijing, China
This case series uses patient hospital data to summarize the clinical presentation and laboratory and imaging findings of 13 patients with confirmed 2019-nCoV infection admitted to hospitals in Beijing in January 2020. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 7, 2020 Category: General Medicine Source Type: research

Clinical Characteristics of Patients With 2019 Novel Coronavirus (2019-nCoV) –Infected Pneumonia in Wuhan, China
This single-center case series describes the demographics, symptoms, laboratory and imaging findings, treatment, and clinical course of 138 patients hospitalized with 2019 novel coronavirus (2019-nCoV) –infected pneumonia (NCIP) in Wuhan, China, highlighting presumed human-to-human hospital-associated transmission in many cases. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 7, 2020 Category: General Medicine Source Type: research

Potential Consequences of Changing Disease Classifications
This Viewpoint discusses the potential harms that can emerge from changing disease classifications, generally to broaden criteria for diagnosing greater numbers of patients, and calls for a balanced and systematic evaluation of the benefits and risks of shifting illness thresholds before formalizing changes. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 7, 2020 Category: General Medicine Source Type: research

Diagnosis and Treatment of Adults With Community-Acquired Pneumonia
This JAMA Guidelines Synopsis summarizes the American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) 2019 recommendations on diagnosis and treatment of adults with community-acquired pneumonia. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 6, 2020 Category: General Medicine Source Type: research

Corticosteroids in Community-Acquired Pneumonia
This Medical Letter review summarizes evidence underlying American Thoracic Society and Infectious Diseases Society of America guideline recommendations on the use of corticosteroids as an adjunct to antimicrobials for the treatment of community-acquired pneumonia (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 6, 2020 Category: General Medicine Source Type: research

Enhancing Private Sector Health System Preparedness for 21st-Century Health Threats
This Viewpoint summarizes recommendations made by National Academies of Sciences, Engineering, and Medicine (NASEM) experts to address the US health system ’s preparedness for major threats, highlighting 5 principles to help regions prepare for specific threats as a prelude to partnerships that would facilitate more comprehensive national preparedness. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 6, 2020 Category: General Medicine Source Type: research

Taking Medicine to the Streets to Care for Those Who Live There
This Medical News feature discusses “street medicine,” the practice of caring for unsheltered homeless individuals. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 5, 2020 Category: General Medicine Source Type: research

2019 Novel Coronavirus —Important Information for Clinicians
This Viewpoint summarizes the epidemiology and clinical features of 2019-nCoV infection and reviews CDC criteria to guide evaluation and management of patients with possible infection. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 5, 2020 Category: General Medicine Source Type: research

Refocusing Medication Prior Authorization on Its Intended Purpose
This Viewpoint discusses the challenge prior medication authorization procedures presents for patients, physicians, and practices, and it proposes principles to guide “prior auth” reform, including focusing the procedures on the initial intended purpose of managing use of high-cost drugs that have equivalent lower-cost alternatives, protecting the continuity of medication for patients, and being transparent, efficient, and fair in their requirements. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 3, 2020 Category: General Medicine Source Type: research

Changing the Game of Prior Authorization
In this Viewpoint, Berwick and colleagues review the evolution of prior authorization ( “prior auth”) into a process where insurers deny previously approved coverage, patients receive surprise bills, and clinicians spend time appealing charges, and propose the introduction of legal provisions that make authorization decisions binding and absolve patients, clinicians, and organizati on of financial responsibility for previously approved services. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - February 3, 2020 Category: General Medicine Source Type: research

Dysphagia in a 34-Year-Old Woman
A 34-year-old woman had worsening intermittent retrosternal dysphagia but no heartburn, nausea, vomiting, abdominal pain, weight loss, or changes in bowel habits; ranitidine (150 mg twice daily) provided no relief. CBC results were normal; esophagogastroduodenoscopy showed esophageal furrows and rings, and esophageal biopsy showed intraepithelial eosinophils. What is the diagnosis and what would you do next? (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - January 31, 2020 Category: General Medicine Source Type: research

Clarifying the Language of Clinician Distress
This Viewpoint argues that moral dilemma, moral distress, and moral injury more accurately and etiologically characterize what most people refer to as physician burnout, and proposes that this reconception can lead to more effective prevention strategies and targeted solutions to address physician stress, frustration, dissatisfaction, and depression. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - January 31, 2020 Category: General Medicine Source Type: research

First-Line Psychotherapies for Military-Related PTSD
This JAMA Insights Clinical Update reviews psychotherapy treatments for military-related posttraumatic stress disorder (PTSD) and discusses that psychotherapies do not outperform non –trauma-focused interventions and that attention should be paid to managing nonresponse to treatment, addressing posttreatment residual symptoms, and identifying patients with complex presentations who likely require individualized treatment. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - January 30, 2020 Category: General Medicine Source Type: research

The Need to Incorporate Additional Patient Information Into Risk Adjustment for Medicare Beneficiaries
This Viewpoint discusses concern that current risk adjustment models used by CMS to tie payment to performance do not account for dementia, frailty, and social risk, and proposes ways to add reliable measures of each to the agency ’s CMS-HCC model to more equitably reimburse clinicians and facilities caring for patients with challenging conditions. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - January 30, 2020 Category: General Medicine Source Type: research

The 2019 Novel Coronavirus and Challenges for Global Health Governance
In this Viewpoint, Gostin and colleagues review the emerging novel coronavirus (2019-nCoV) outbreak, discuss the public health benefits and risks of the Chinese government ’s large city quarantines, and call for WHO leadership to coordinate a global coordinated response that could contain this and prevent similar future outbreaks. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - January 30, 2020 Category: General Medicine Source Type: research

Recurrent Urinary Tract Infections in Adult Women
This JAMA Insights summarizes prevention and management recommendations for women with recurrent urinary tract infections (UTIs), and proposes individualizing approaches by age and menopausal status, underlying conditions (eg diabetes), risk of pyelonephritis/sepsis, and patient preferences. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - January 29, 2020 Category: General Medicine Source Type: research

Concussions Linked With Erectile Dysfunction in Football Player Study
This Medical News article discusses a recent JAMA Neurology study that found an association between concussion symptoms and later indicators of erectile dysfunction and low testosterone in former National Football League players. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - January 29, 2020 Category: General Medicine Source Type: research