Physicians ’ Voices on Gun Violence and Other Important Public Health Issues
In this Viewpoint, Sandro Galea acknowledges reasons physicians have traditionally been hesitant to speak out publicly on matters of politics and public health, and reviews how shifting roles and means of communication are forcing practitioners to reconsider that hesitancy and engage in controversies of public health concern, such as gun violence. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - December 14, 2018 Category: General Medicine Source Type: research

Physicians Are Steering the Conversation About Gun Violence
This Medical News story is an interview with Megan Ranney, MD, MPH, one of the leading voices in the “This Is Our Lane” movement, which discusses the role of physicians and other health-care professionals in addressing firearm violence as a public health issue. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - December 14, 2018 Category: General Medicine Source Type: research

Medicare ’s Approach to Paying for Services That Promote Coordinated Care
This Viewpoint discusses new fee-for-service billing codes introduced by CMS for reimbursement of virtual care including e-consults, remote physiologic monitoring, and video and image review, and proposes strategies to incentivize the activities to promote coordinated care. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - December 13, 2018 Category: General Medicine Source Type: research

A Patient With Elevated α-Fetoprotein Level and Liver Masses
A 55-year-old man with several weeks of malaise, a 6.8-kg weight loss, a CT scan with multifocal liver masses and elevated alkaline phosphatase, ALT, and AFP levels had a heterogeneously enhancing pancreatic-tail mass on triple-phase CT. What would you do next? (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - December 13, 2018 Category: General Medicine Source Type: research

For Nobel Peace Prize Winner Dr Denis Mukwege, His Patients Motivate and Inspire
This Medical News article is an interview with Denis Mukwege, MD, cowinner of the 2018 Nobel Peace Prize. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - December 12, 2018 Category: General Medicine Source Type: research

Black Lung Resurgence Raises New Challenges for Coal Country Physicians
In this Medical News& Perspectives article, experts discuss how physicians deal with increasing black lung disease cases among Appalachian miners, many at younger ages than in the past. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - December 12, 2018 Category: General Medicine Source Type: research

Humanizing Artificial Intelligence
In this Viewpoint, Abraham Verghese and Sonoo Thadaney Israni acknowledge the promise of artificial intelligence (AI) for health care, but argue that developers must work with physicians to ensure that any AI health care system helps clinicians deliver better, more equitable humanistic care, not just more accurate, scientific care. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - December 10, 2018 Category: General Medicine Source Type: research

Questions for Artifical Intelligence in Health Care
This Viewpoint discusses questions that should be addressed to successfully integrate artificial intelligence into clinical care. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - December 10, 2018 Category: General Medicine Source Type: research

Will Free Medical School Tuition Accomplish Its Goals?
This Viewpoint discusses free or reduced tuition programs for medical students and the implications for diversifying the health care workforce, filling shortages in primary care specialties, improving patient access, closing the health disparities gap, and improving population health. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - December 7, 2018 Category: General Medicine Source Type: research

Standardizing “Cancer Clocks” to Communicate Risk
This Viewpoint discusses the practice of using a clock timer analogy to describe population risks of cancer and suggests standardizing the measures of incidence rates used in the clocks to population size to facilitate more accurate comparisons between populations. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - December 7, 2018 Category: General Medicine Source Type: research

Risk-Reducing Mastectomy in BRCA1 and BRCA2 Mutation Carriers —A Complex Discussion
This Viewpoint reviews the benefits and risks of risk-reducing mastectomy in otherwise healthy women withBRCA1 andBRCA2 mutations to inform discussions about the proceeding with or foregoing the procedure, and it calls for continued research to understand how to better individualize risk and prevent disease nonsurgically. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - December 6, 2018 Category: General Medicine Source Type: research

Health as a Way of Doing Business
In this Viewpoint, Howard Koh and colleagues discuss the value the public places on corporations that actively promote community health and environmental responsibility, and innovative business strategies that some corporations have implemented to advance consumer, employee, community, and environmental health. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - December 6, 2018 Category: General Medicine Source Type: research

Unraveling the Mysteries of the Human Placenta
This Medical News article is an interview with the director of the National Institute of Child Health and Human Development about its Human Placenta Project. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - December 5, 2018 Category: General Medicine Source Type: research

Whole-Fat or Nonfat Dairy? The Debate Continues
This Medical News& Perspectives story examines the debate over whether opting for whole-fat dairy or nonfat dairy or avoiding dairy altogether is optimal for health. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - December 5, 2018 Category: General Medicine Source Type: research

The Ethics of Heritable Genome Editing
This Viewpoint examines the 2018 Nuffield Council on Bioethics report on the social and ethical issues of heritable genome editing, and discusses the report ’s rejection of the notion of genomic essentialism. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - December 3, 2018 Category: General Medicine Source Type: research

The Direct Antiglobulin Test for Evaluating Anemia
A 68-year-old woman with chronic lymphocytic leukemia (CLL) presents with dyspnea on exertion, conjunctival pallor and scleral icterus, and moderate anemia with elevated reticulocytes and LDH and a 3+ anti-IgG direct antiglobulin test (DAT). How do you interpret the results? (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - December 3, 2018 Category: General Medicine Source Type: research

Mental Health Screening of Physicians —Risks and Benefits
This Viewpoint discusses the barriers to physicians ’ seeking treatment for depression, burnout, and suicide ideation; reviews the pros and cons of establishing a mental health screening protocol for physicans; and calls for research on the effect screening has on mental health outcomes. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 30, 2018 Category: General Medicine Source Type: research

Challenges of Improving Treatments for Depression
In this Viewpoint, the author discusses the need for studying treatments that help patients with persistent depression. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 30, 2018 Category: General Medicine Source Type: research

Transparency in Improving Electronic Health Record Usability and Safety
This Viewpoint discusses ways in which vendors of electronic health record (EHR) systems can block the conduct and dissemination of EHR usability and safety research and calls for policies that promote the identification and communication of usability and safety issues. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 29, 2018 Category: General Medicine Source Type: research

Fever, Rash, and Abnormal Liver Function Test Results
A man in his 30s had a 5-day history of fever, rhinorrhea, nonproductive cough, fever, and a maculopapular rash on his neck and trunk that spread to the extremities. He had leukopenia, and liver enzyme levels were elevated. What would you do next? (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 29, 2018 Category: General Medicine Source Type: research

Ebola and War in the Democratic Republic of Congo
In this Viewpoint, Gostin and colleagues review recommendations developed by experts convened by Georgetown University on how the international community can respond to the 2018 Ebola outbreak in the Democratic Republic of Congo (DRC) in the midst of active conflict and insecurity from armed rebels. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 29, 2018 Category: General Medicine Source Type: research

States Move to Substitute Opioids With Medical Marijuana to Quell Epidemic
This Medical News& Perspectives article discusses recently enacted state laws that allow prescribed opioids to be substituted with medical marijuana. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 28, 2018 Category: General Medicine Source Type: research

Professionalism, Performance, and the Future of Physician Incentives
This Viewpoint calls out the limited evidence supporting current pay-for-improvement incentives in the US, and argues that performance improvement programs that emphasize nonfinancial rewards, resources for quality improvement, and team-based recognition would be more consistent with physician motivation and professionalism and would be worth evaluating as a means to reduce health care costs and waste and improve quality. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 26, 2018 Category: General Medicine Source Type: research

Diagnosis and Management of Nonalcoholic Liver Disease
This JAMA Clinical Guidelines Synopsis summarizes the 2017 practice guidance from the American Association for the Study of Liver Diseases on diagnosis and management of nonalcoholic liver disease. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 26, 2018 Category: General Medicine Source Type: research

Is It Possible to Get a Flu Shot Too Early?
This Medical News article examines the ongoing debate about whether people should begin getting immunized against influenza as soon as the vaccine becomes available. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 21, 2018 Category: General Medicine Source Type: research

Protecting the Value of Medical Science in the Age of Social Media and “Fake News”
This Viewpoint discusses the spread of scientific misinformation through social media, and countermeasures scientists and institutions can use to monitor and respond to it. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 19, 2018 Category: General Medicine Source Type: research

A Young Woman With Chest Pain
A 36-year-old gravida 3, para 3 woman who had elective cesarean delivery 11 days prior presented with 3 days of exertional chest pain, an elevated troponin I level, ST-segment depression on electrocardiography, and coronary artery dissection on angiography. What would you do next? (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 19, 2018 Category: General Medicine Source Type: research

Expansion of the Medicare 340B Payment Program
In this Viewpoint, the authors review Medicare& Medicaid Services 340B Payment program and recent rules to curtail expansion of drug discounts beyond serving poor patients. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 16, 2018 Category: General Medicine Source Type: research

Serum Creatinine in the Critically Ill Patient With Sepsis
Following esophageal resection for cancer, a 73-year-old man was admitted to the ICU with pneumonia and progressive acute respiratory failure, and he was placed on mechanical ventilation. At day 5, his creatinine level continued to increase. How would you proceed? (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 16, 2018 Category: General Medicine Source Type: research

Monitoring Jet Engines and the Health of People
In this Viewpoint, Eric Topol and Lionel Tarrasenko, a biomedical engineer known for developing early-warning systems in critical care settings, contrast the precision monitoring of jet engines with existing monitoring systems in patients, and discuss how sensors, artificial intelligence, and other contemporary digital technologies used to monitor the maintenance needs of engines can be used to personalize treatment and improve outcomes for patients without generating false alarms. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 15, 2018 Category: General Medicine Source Type: research

Inconsistent Reporting of Potential Conflicts of Interest in JAMA
To the Editor I am writing to provide additional information regarding my conflict of interest disclosures in articles I published inJAMA between 2014 and 2018. In my previous reporting, I included disclosures of potential conflicts of interest that seemed “reasonably related” to the topic of the article, as suggested in ICJME guidance. Consequently, I included my status as an independent board member of Johnson& Johnson in articles that focused on drug or device payment or regulation, and I included my activities related to accountable care organizations and other specific provider payment reforms in artic...
Source: JAMA - Journal of the American Medical Association - November 15, 2018 Category: General Medicine Source Type: research

Inconsistent Conflict of Interest Disclosure
In articles published inJAMA, there were inconsistent conflict of interest disclosures reported by Mark B. McClellan, MD, PhD. The disclosures should have included the following: “Dr McClellan reports earning fees as an independent board member for Johnson& Johnson and Alignment Health Care, and co-chairing the Accountable Care Learning Collaborative and the Guiding Committee for the Health Care Payment Learning and Action Network ” and “Dr McClellan reports earning fees as an independent board member for Johnson& Johnson. ” Dr McClellan has written a Letter to the journal explaining this in...
Source: JAMA - Journal of the American Medical Association - November 15, 2018 Category: General Medicine Source Type: research

Institutional Conflicts of Interest and Public Trust
This Viewpoint discusses recent problems with undisclosed conflicts of interest and proposes broadening disclosure requirements beyond individuals to include the institutions funding the research. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 14, 2018 Category: General Medicine Source Type: research

Addressing Health-Related Misinformation on Social Media
This Viewpoint discusses strategies for debunking health misinformation on social media and ideas for ways to spread accurate health information. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 14, 2018 Category: General Medicine Source Type: research

Effect of Transitional Care and Long-term Self-management Support on Patients With COPD
This randomized clinical trial compares the effects of a program combining transition and long-term self-management support vs transition support alone on 6-month hospitalizations and emergency department visits among patients with chronic obstructive pulmonary disease (COPD). (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 12, 2018 Category: General Medicine Source Type: research

Intensive Intervention to Improve Outcomes for Patients With COPD
Chronic obstructive pulmonary disease (COPD) is one of the most common chronic conditions contributing to morbidity and mortality. In 2016, it was the third leading cause of years of life lost and diasbility-adjusted life-years in the United States, with an estimated 164  000 deaths. Even with aggressive inpatient management, patients who are hospitalized for COPD often experience a recurrent cycle of rehospitalizations, resulting in reductions in overall health and quality of life (QOL). To help interrupt this cycle, the Centers for Medicare& Medicaid Services incorporated COPD into the Hospital Readmission Reductio...
Source: JAMA - Journal of the American Medical Association - November 12, 2018 Category: General Medicine Source Type: research

Physical Activity Guidelines for Health and Prosperity in the United States
This Viewpoint from the US Assistant Secretary for Health discusses thePhysical Activity Guidelines for Americans, 2nd edition, and proposes ways in which the medical care system, new technologies, workplace initiatives, and enhanced youth participation in sports can promote physical activity. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 12, 2018 Category: General Medicine Source Type: research

Physical Activity Guidelines for Americans
This Special Communication from the US Department of Health and Human Services summarizes key guidelines and recommendations in thePhysical Activity Guidelines for Americans, 2nd edition. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 12, 2018 Category: General Medicine Source Type: research

New Physical Activity Guidelines
This issue ofJAMA includes a summary of the newPhysical Activity Guidelines for Americans, 2nd edition. These guidelines update those presented in 2008 and expand the medical conditions for which physical activity is likely beneficial. The final recommendations are based on a systematic literature review by a committee of exercise and health experts and include only those recommendations judged to have strong, or moderately strong, scientific support. Achieving the guideline-recommended levels of physical activity will be difficult for the entire nation, given that approximately 80% of US adults and adolescents do not pres...
Source: JAMA - Journal of the American Medical Association - November 12, 2018 Category: General Medicine Source Type: research

Effect of Linagliptin vs Placebo on Major Cardiovascular Events in High-Risk Adults With Diabetes
This randomized clinical trial compares the effects of the dipeptidyl peptidase 4 inhibitor linagliptin vs placebo plus usual care on cardiovascular (CV) and renal outcomes in adults with type 2 diabetes and high CV and renal risk. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 9, 2018 Category: General Medicine Source Type: research

Vaccines as an Integral Component of Cancer Immunotherapy
This Viewpoint reviews recent preclinical developments in the use of therapeutic cancer vaccines to induce immune responses to tumor-associated antigens, alone or in combination with other therapies, such as tumor checkpoint inhibitor monoclonal antibodies, to render resistant (cold) tumor cells susceptible to T-cell antitumor activity. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 8, 2018 Category: General Medicine Source Type: research

Incidental Pulmonary Nodules Detected on CT Images
This JAMA Clinical Guidelines Synopsis summarizes the 2017 Fleischner Society guidelines on management of incidental pulmonary nodules detected on computed tomography (CT) imaging. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 8, 2018 Category: General Medicine Source Type: research

Oncology in Transition
Contemporary challenges and changes in the field of oncology reflect and often magnify medicine more broadly. Morbidity and mortality are often substantial, treatment is expensive, and management is complex necessitating interdisciplinary coordination across every field of medicine. The recent emergence of immunotherapy and adoptive cellular therapy has generated tremendous excitement because these approaches can sometimes achieve cure or durable responses, even in the setting of advanced cancer. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 8, 2018 Category: General Medicine Source Type: research

Increasing the Participation of Pregnant Women in Clinical Trials
This Viewpoint discusses widespread perceptions of vulnerability and risk that discourage enrollment of pregnant women in clinical trials, and calls for actionable guidelines to overcome those perceptions and eliminate barriers to their participation. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 7, 2018 Category: General Medicine Source Type: research

Have Tent, Will Do Pop-up HIV Screening
This Medical News article is an interview with the founders of One Tent Health, a nonprofit free HIV screening initiative that serves high-risk neighborhoods in Washington, DC. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 7, 2018 Category: General Medicine Source Type: research

Clinical Decision Support in the Era of Artificial Intelligence
This Viewpoint discusses the potential capabilities and challenges of decision support systems that are designed to be used interactively by clinicians. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 5, 2018 Category: General Medicine Source Type: research

Protocol Deviations, Reanalyses, and Corrections to PREDIMED Trial
To the Editor As reported elsewhere, my coinvestigators and coauthors of the PREDIMED trial have identified protocol deviations, including enrollment of household members without randomization, assignment to a study group without randomization of some participants at 1 of 11 study sites, and apparent inconsistent use of randomization tables at another site. Briefly, in the overall trial, 425 members of the same household as a previous study participant were directly allocated during the trial to the same group as their previously randomized relative. In addition, 441 individual participants and 26 participant members of th...
Source: JAMA - Journal of the American Medical Association - November 5, 2018 Category: General Medicine Source Type: research

Protocol Deviations and Reanalyses in a Derivative Study of the PREDIMED Trial
This article has been corrected online. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 5, 2018 Category: General Medicine Source Type: research

Efforts to Make US Health Care More Equitable and Less Costly
This Viewpoint argues for reform of the US health care system, starting with the elimination of employment-based insurance. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 2, 2018 Category: General Medicine Source Type: research

Influenza Vaccine for 2018-2019
This Medical Letter review summarizes information on the timing, composition, effectiveness, and adverse effects of the 2018-2019 influenza vaccine. (Source: JAMA - Journal of the American Medical Association)
Source: JAMA - Journal of the American Medical Association - November 2, 2018 Category: General Medicine Source Type: research