TMAO and Heart Disease: The New Red Meat Risk?
This Medical News article discusses trimethylamineN-oxide, or TMAO, a dietary metabolite that ’s increasingly associated with cardiovascular disease. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 22, 2019 Category: General Medicine Source Type: research

For Fat Burning, Interval Training Beats Continuous Exercise
This Medical News article discusses a recent meta-analysis comparing high-intensity interval training, sprint interval training, and moderate-intensity continuous training for fat loss. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 22, 2019 Category: General Medicine Source Type: research

A Troubling Court Decision for Reproductive Rights
This Viewpoint examines a recent case filed in Alabama involving a man naming the aborted fetus as a co-plaintiff in a suit against the manufacturer of an abortion pill and the clinic that provided it to his then-girlfriend who ended her pregnancy at 6 weeks, and the challenges this case could have for reproductive rights in the United States. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 22, 2019 Category: General Medicine Source Type: research

A Febrile, Hypotensive Patient With Bilateral Lung Crackles
A 61-year-old man with 1 day of dyspnea and weakness was febrile (38.4 °C), hypotensive, tachycardic, diaphoretic, and had poor dentition, a soft S1, and basilar bilateral crackles on examination and aortic regurgitation on transesophageal echocardiography. 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 - May 20, 2019 Category: General Medicine Source Type: research

The “Conscience” Rule: How Will It Affect Patients’ Access to Health Services?
On May 2, 2019, the US Department of Health and Human Services (HHS) and Office of Civil Rights (OCR) released afinal rule that heightens the rights of hospitals and health workers to refuse to participate in patients ’ medical care based on religious or moral grounds. The rule coversOCR ’s authority to investigate and enforce violations of 25 federal “conscience protection” laws. Tied to the US Constitution’s spending power, the rule applies to state and local governments, as well as public and private health care professionals and entities if they receive federal funds such as Medicare or Me...
Source: JAMA - Journal of the American Medical Association - May 20, 2019 Category: General Medicine Source Type: research

Artificial Intelligence in Health Care —Will the Value Match the Hype?
In this Viewpoint, Ezekiel Emanuel and Robert Wachter discuss reasons for the hype surrounding the use of artificial intelligence (AI) in health care and emphasize the need for changes in structures and culture that can change behaviors of clinicians if AI-derived evidence is to be effectively translated into practice. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 20, 2019 Category: General Medicine Source Type: research

Recombinant Human Soluble Thrombomodulin in Patients With Sepsis-Associated Coagulopathy
Sepsis is a heterogeneous syndrome caused by an unbalanced host response to an infection resulting in organ dysfunction. Sepsis is associated with activation of the coagulation system, and 30% to 60% of patients have disseminated intravascular coagulation (DIC). Fulminant DIC is characterized by` activation of the coagulation system combined with an impaired function of endogenous anticoagulant mechanisms resulting in widespread microvascular thrombosis and concurrent hemorrhage secondary to consumption of clotting factors and platelets. Strong and bimodal interactions exist between coagulation and inflammation, wherein co...
Source: JAMA - Journal of the American Medical Association - May 19, 2019 Category: General Medicine Source Type: research

New Phenotypes for Sepsis
In this issue ofJAMA, Seymour and his multidisciplinary team of coauthors aim to improve the current understanding of sepsis by identifying new clinical phenotypes using machine learning clustering techniques. The authors assume that current sepsis definitions are too broad and clinically imprecise to untangle complex clinical and biological interactions in sepsis and that better-defined phenotypes represent the key to ultimately identifying new and successful therapeutic approaches. Their analytic approaches, such as unsupervised clustering, may be unfamiliar to many readers. Unsupervised learning is a type of machine lea...
Source: JAMA - Journal of the American Medical Association - May 19, 2019 Category: General Medicine Source Type: research

Effect of Thrombomodulin on Mortality in Patients With Sepsis-Associated Coagulopathy
This randomized trial compares the effect of recombinant human soluble thrombomodulin vs placebo in patients with sepsis-associated coagulopathy on 28-day all-cause mortality. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 19, 2019 Category: General Medicine Source Type: research

Derivation, Validation, and Potential Treatment Implications of Novel Clinical Phenotypes for Sepsis
In this study, Sepsis-3 investigators use electronic health record and trial data from patients with sepsis within 6 hours of hospital presentation to define clinical phenotypes that correlate with host-response patterns, sepsis biomarkers, mortality, and treatment effects. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 19, 2019 Category: General Medicine Source Type: research

Management of Hepatitis C in 2019
This JAMA Insights Clinical Update reviews current standards of management of HCV infection, including use of antibody and RNA tests to identify infected patients, use of direct acting antivirals (DAAs) to obtain sustained viral response (SVR), and management of treatment failure. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 17, 2019 Category: General Medicine Source Type: research

Vision for the Future of Continuing Board Certification
This Viewpoint discusses the recommendations of the Vision Initiative Commission to improve the structure of continuing certification, including setting standards that integrate life-long learning with formative and timely assessments of knowledge and skills and learning activities that advance practice and improve care. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 17, 2019 Category: General Medicine Source Type: research

MedMen and the Need for Federal Regulation on Marijuana Marketing
This Viewpoint uses the commercial rise of MedMen, a US company that operates licensed cannabis facilities and uses youth-oriented media campaigns to advance unproven health claims for marijuana, to highlight the health risks for young people and to argue for evidence-based regulation of marijuana marketing and sales. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 16, 2019 Category: General Medicine Source Type: research

The Challenges of Defining and Studying “Digital Addiction” in Children
In this Viewpoint,JAMA Pediatrics Editor Dimitri Christakis discusses the the conceptual and methodological challenges of studying digital media use by children and adolescents, and calls on the leadership of device and social media companies to collaborate with child health researchers, sharing data as the companies already do with advertisers, to help mediate digital media use in the best interest of children. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 16, 2019 Category: General Medicine Source Type: research

Sleeping in Doesn ’t Mitigate Metabolic Changes Linked to Sleep Deficit
This Medical News story discusses a recent study that suggests sleeping late on the weekend cannot mitigate the metabolic dysregulation associated with recurrent insufficient sleep during the week. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 15, 2019 Category: General Medicine Source Type: research

Life and Death in Norway and the United States
Life expectancy is lower in the United States than in other high-income countries. Among the 36 countries in the Organisation for Economic Co-operation and Development, average life expectancy at birth exceeds life expectancy in the United States by 1.7 years. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 13, 2019 Category: General Medicine Source Type: research

Association of Household Income With Life Expectancy and Cause-Specific Mortality
This population epidemiology study uses Norwegian registry data to describe differences in life expectancy based on income and to compare those differences to income and life expectancy differences in the United States. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 13, 2019 Category: General Medicine Source Type: research

Trust in Health Care Between Teachers and Learners
This Viewpoint discusses the importance of trust between physician teachers and their students and trainees, proposing that the trust learned in early educational experiences is a foundation and model for physicians ’ career-long trusting relationships with institutions, colleagues, patients, and the public. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 13, 2019 Category: General Medicine Source Type: research

The Relationship Between Trust in Journalism and Trust in Medicine
This Viewpoint discusses how proliferation of health misinformation to the public undermines trust in science and medicine, and proposes ways the medical community and media might work together to make medical professionals better producers and consumers of accurate health information and to make the news media better at story curation and communication of uncertainty. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 13, 2019 Category: General Medicine Source Type: research

Hip Fracture Prevention in Older Adults in 2019
This JAMA Insights Clinical Update reviews approaches to fracture prevention in older adults, including estimating fracture risk and life expectancy, selecting and managing appropriate medications, and understanding nonpharmacologic strategies. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 10, 2019 Category: General Medicine Source Type: research

Dual-Physician Households in the 21st Century
This Viewpoint discusses common challenges faced by dual-physician couples and proposes institutional and individual strategies to improve work-life balance. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 10, 2019 Category: General Medicine Source Type: research

Abnormal Uterine Bleeding in Reproductive-Age Women
This JAMA Clinical Insights article summarizes the diagnosis and treatment of abnormal uterine bleeding in reproductive-age women, distinguishing between heavy menstrual bleeding, ovulatory dysfunction, and other patterns and causes. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 9, 2019 Category: General Medicine Source Type: research

Does Employment-Based Insurance Make the US Medical Care System Unfair and Inefficient?
In this Viewpoint, Victor Fuchs reviews the evolution of the US employer-based health insurance toward a system favoring higher-income individuals, and proposes reforms in health care financing and in accessibility of lower-cost care as a way to make the system more fair and efficient. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 9, 2019 Category: General Medicine Source Type: research

Federal Requirements to Inform Patients About Breast Density
This Viewpoint explains the challenges of effectively communicating information about breast density under the mandates of the Mammography Quality Standards Act. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 9, 2019 Category: General Medicine Source Type: research

Study Puts Eggs and Dietary Cholesterol Back on the Radar
This Medical News article is a discussion with the author of a recent study inJAMA that looked at the association of dietary cholesterol with cardiovascular disease. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 8, 2019 Category: General Medicine Source Type: research

Nearly All Medications Contain Potentially Allergenic Inactive Ingredients, Analysis Shows
This Quick Uptakes article explains that some inactive ingredients in medications can cause adverse events. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 8, 2019 Category: General Medicine Source Type: research

Filling in the Evidence About Sunscreen
Skin cancer is the most common malignancy in the United States and is estimated to affect more than 3.3 million individuals each year. Photoprotection, including sunscreen use for areas of skin not covered by sun protective clothing or shade, aims to reduce exposure to UV radiation, likely the main risk factor for the development of skin cancer. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 6, 2019 Category: General Medicine Source Type: research

Effect of Sunscreen Application on Plasma Concentration of Active Ingredients
This randomized clinical trial recruited healthy volunteers to assess whether the active ingredients of commercially available sunscreen products (avobenzone, oxybenzone, octocrylene, and ecamsule) are absorbed into systemic circulation under maximal use conditions. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 6, 2019 Category: General Medicine Source Type: research

Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum Period
This JAMA Guidelines Synopsis summarizes the 2017 American Thyroid Association guidelines on diagnosis and management of thyroid disease during pregnancy and the postpartum period. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 3, 2019 Category: General Medicine Source Type: research

Health Concerns in Urban Slums
In this Viewpoint, authors from the International Center for Diarrheal Disease Research in Bangladesh discuss rapid urbanization in low- and middle-income countries and the associated challenges of meeting the basic health care needs of growing urban slum populations. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 3, 2019 Category: General Medicine Source Type: research

Using Instrumental Variables to Address Bias From Unobserved Confounders
This JAMA Guide to Statistics and Methods reviews the use of instrumental variable analysis in observational and randomized studies and how, under specific assumptions, they can provide unbiased estimates of treatment effects even if unobserved confounding exists. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 2, 2019 Category: General Medicine Source Type: research

Medication-Based Treatment for Opioid Use Disorder
In this Viewpoint the president of NAM and the former CEO of AAAS emphasize the importance of approaching opioid use disorder (OUD) as a chronic brain disease and of using evidence-based FDA-approved interventions to manage it, urging clinicians to overcome any personal biases that might interfere with provision of evidence-based care to help patients with OUD recover from their addiction. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 2, 2019 Category: General Medicine Source Type: research

Does Skipping Breakfast Lead to Weight Loss or Weight Gain?
This Medical News story discusses the debate over whether skipping breakfast helps or hinders weight management efforts. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 1, 2019 Category: General Medicine Source Type: research

A Day in the Life: Adventures of a Wilderness Medicine Physician
This Medical News story describes a day in the life of a wilderness medicine physician. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - May 1, 2019 Category: General Medicine Source Type: research

Active Surveillance of Low-Risk Thyroid Cancer
This JAMA Insights Clinical Update reviews use of active ultrasonography surveillance of patients with thyroid cancer as a way to postpone or avoid thyroidectomy in patients with lower-risk tumors for whom surgery is more likely to be harmful than beneficial. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - April 30, 2019 Category: General Medicine Source Type: research

Safeguards in the Adoption of Robotic Surgery
This Viewpoint discusses the increasing use of robotic-assisted surgery and the issues, including potential harm, surgeon credentialing, and transparency in informed patient consent, that should be considered by payers, health care organizations, and surgeons to ensure that safeguards remain in place until stronger evidence for or against the use of this technology is available. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - April 30, 2019 Category: General Medicine Source Type: research

Treating Patients With Good Vision and Diabetic Macular Edema
Diabetic retinopathy is the leading cause of blindness and visual impairment in the working-age population in the United States and worldwide. Diabetic macular edema, a vision-threatening form of diabetic retinopathy, is the swelling or thickening of the retina at the macula, the structure that is responsible for the highest resolution of vision. Diabetic macular edema may occur in any stage of diabetic retinopathy, ranging from minimal diabetic retinopathy to severe proliferative diabetic retinopathy, which is the other form of vision-threatening diabetic retinopathy. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - April 29, 2019 Category: General Medicine Source Type: research

Effect of Aflibercept, Laser Photocoagulation, or Observation on Vision Loss in Diabetic Macular Edema
This randomized clinical trial compares the effects of initial management with aflibercept, laser photocoagulation, or observation on vision loss among adults with diabetic macular edema in the center of the macula and good visual acuity at baseline. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - April 29, 2019 Category: General Medicine Source Type: research

Limits on Opioid Prescribing Leave Patients With Chronic Pain Vulnerable
This Medical News story discusses the impact of opioid prescribing restrictions on patients with chronic pain. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - April 29, 2019 Category: General Medicine Source Type: research

Treatment of Patients With Psychogenic Nonepileptic Attacks
This Viewpoint describes the neurological disorder known as psychogenic nonepileptic attacks (PNEA) —including the symptoms, appropriate diagnostic testing, and treatment with cognitive behavioral therapy—and how it can be distinguished from epilepsy to avoid treating patients with PNEA with potentially harmful epileptic medications or surgery. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - April 26, 2019 Category: General Medicine Source Type: research

Recommendations for Colorectal Cancer Screening
This JAMA Clinical Guidelines Synopsis summarizes the 2017 US Multi-Society Task Force on Colorectal Cancer recommendations for colorectal cancer screening. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - April 25, 2019 Category: General Medicine Source Type: research

Global Health Spending and Development Assistance for Health
This Viewpoint reviews the global health role of development assistance for health (DAH) and financial or in-kind assistance provided by western countries via international development agencies and foundations to low- and middle-income countries (LMICs), and proposes best practices to ensure that DAH continues to be a reliable source of support for LMIC health systems and assists them to develop pandemic preparedness. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - April 25, 2019 Category: General Medicine Source Type: research

Wild Health: Dogs and Bats and Chickens, Oh My!
This Medical News feature explains how 3 disparate types of animals help researchers make medical discoveries. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - April 24, 2019 Category: General Medicine Source Type: research

The Arts Dispel Medical Students ’ Qualms About Dementia
In this Medical News article, experts discuss how various arts program can help medical students see people with dementia in a positive new light. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - April 24, 2019 Category: General Medicine Source Type: research

Use of Metformin for Type 2 Diabetes in 2019
This JAMA Insights Clinical Update reviews the clinical use, safety, contraindications, and alternatives to metformin, the first-line treatment for type 2 diabetes. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - April 22, 2019 Category: General Medicine Source Type: research

Counteracting Health Misinformation
This Viewpoint discusses the rising tide of medical misinformation and its adverse effects on global health, and suggests ways in which medical journals can collaborate with health professionals, organizations, institutions, and mainstream media to counteract such misinformation. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - April 22, 2019 Category: General Medicine Source Type: research

Fever, Rash, and Migratory Polyarthralgias
A 24-year-old farmworker had 3 weeks of persistent fever and worsening polyarthralgias, and maculopapular truncal rash that spread to her palms and soles. Results of laboratory tests were normal except for a mildly elevated WBC count and a blood culture gram stain showing filamentous gram-negative rods. What would you do next? (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - April 19, 2019 Category: General Medicine Source Type: research

Time: The Critical Ingredient in Shared Decision Making
This Viewpoint characterizes time as a scarce but vital element of shared patient-clinician decision making and urges development of policies that allocate meaningful time for clinical visits and innovations that create time for physicians to be with patients without compromising access or productivity. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - April 19, 2019 Category: General Medicine Source Type: research

Safe Vaccinations for a Healthy Nation
This Viewpoint discusses public distrust of vaccinations fueled by false information on vaccine safety spread through social media, and discusses the ways in which physicians, public health authorities, states, and social media platforms can help curb the spread of misinformation and instead provide information on the safety and importance of vaccines. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - April 19, 2019 Category: General Medicine Source Type: research

Direct-to-Consumer Genetic Testing, Consumer Privacy, and Nondiscrimination
This Viewpoint discusses privacy and discrimination issues raised when direct-to-consumer (DTC) genetic testing companies give law enforcement agencies access to their data, and gaps in nondiscrimination and HIPAA regulations protecting consumers of DTC genetic testing more generally. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - April 18, 2019 Category: General Medicine Source Type: research