Audio Highlights
Listen to the JAMA Editor ’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA. (Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

Time to Consider a New Look at Physician-Owned Hospitals to Increase Competition in Health Care?
In most sectors of the economy, competition is regarded as the way to improve quality and efficiency, lower costs, and increase innovations. Whether competition effectively achieves these improvements in health care, particularly with respect to hospital services, which remains the largest sector of spending for health care, is open to debate. Also debated, at least among some physicians, is whether functionally banning new physician-owned hospitals by prohibiting their participation in Medicare under the Affordable Care Act (ACA) was too blunt an instrument to correct a problem that could have been fixed with a more nuanc...
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

The Bubonic Plague in San Francisco
We have always regarded the plague as something very distant and impossible, and have read of its ravages in India and China with much the same feeling of composure and security that we read about an uprising of the natives in Madagascar. Or perhaps we have considered it as a matter of historic interest on account of the fearful epidemics which in pre-sanitary days used to sweep over Europe, devastating countries and hardly leaving enough people behind to keep up the archives and records of the state. Even now that it is among us, and in America for the first time, there seems to be a tendency to underrate its importance a...
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

Coverage for Biosimilars vs Reference Products Among US Commercial Health Plans
This study uses US commercial health plan insurance data to characterize coverage for biosimilar drugs compared with reference products. (Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

Balancing Past vs Future Values in Decision-making
To the Editor For 30 years, philosophers and legal scholars have pondered the possible disconnect when a person dictates treatment preferences in advance directives for their future self. Psychologists and disability scholars followed, demonstrating that individuals are poor predictors of how they will feel in the future, potentially locking themselves into unwelcome commitments. (Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

Cognitive Screening of Older Practitioners
To the Editor A JAMA Performance Improvement article reported the use of a cognitive screening battery as the primary basis of recredentialing older practitioners by Yale New Haven Hospital. Some modifications and caveats would enhance this program and those at other centers for testing the cognition of physicians. (Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

Cognitive Screening of Older Practitioners
To the Editor Drs Cooney and Balcezak described an innovative and well-intentioned effort at Yale New Haven Hospital to assess the cognitive ability and professional competency of aging clinicians. However, the understandably benevolent procedure of allowing older physicians whose safety to treat patients has been called into question to subsequently retire or limit their practice voluntarily raises real questions of compliance with federal law. It is important that physicians who sit on hospital peer review committees be apprised of this issue because failure on the part of the hospital to make mandatory reports may compr...
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

Balancing Past vs Future Values in Decision-Making —Reply
In Reply Dr Shapiro comments on our Viewpoint on improving conversations regarding treatment decisions in the intensive care unit. To accomplish truly informed, patient-centered treatment decisions, be it with would-be patients in advance of a crisis (advance care planning) or with the family members of incapacitated patients in the intensive care unit, sensitive, skillful, and honest communication is key. (Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

Cognitive Screening of Older Practitioners —Reply
In Reply We agree with Dr Wijeratne that more information on the results of cognitive testing of older physicians would be helpful, including the optimal age at which to start testing. The screening test created domain-specific results for executive function and other domains, and we did evaluate individuals who were impaired in 1 or more specific domains despite an overall passing score. We extended our screening process in these domains for these clinicians. We proceeded with full neuropsychological testing for individuals with worrisome results in specific domains. (Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

Drospirenone (Slynd) — A New Progestin-Only Oral Contraceptive
This Medical Letter review summarizes the mechanism of action and drug interactions of drospirenone, a new progestin-only oral contraceptive, and compares it with norethindrone, its competitor. (Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

Association Between Antenatal Maternal Corticosteroid Treatment and Mental/Behavioral Disorders in Children
This population cohort study uses national Finnish birth registry data to assess associations between antenatal corticosteroid treatment to accelerate fetal maturation and mental and behavioral disorders in term and preterm children. (Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

Association of Blood Pressure Lowering With Incident Dementia or Cognitive Impairment
This systematic review and meta-analysis examines whether blood pressure lowering is associated with a reduced risk of dementia or cognitive impairment. (Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

The Sound of Grief
I watch in silence as another boy lies still upon this shrouded cot. Garnet jelly pools beside his chest and bubbles seep from holes torn in the pale soft skin. A sigh escapes the room as if the air has been released and all the noise replaced by softer sounds, the closing up of drawers the final keyboard clicks the wide broom brushes on the trash strewn floor the contents to be bagged and tied for homicide or simply thrown away. (Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

Psoriasis: A Review
This narrative review summarizes current evidence regarding the pathogenesis, clinical presentation, diagnosis, and treatments of plaque psoriasis. (Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

WHO: Strengthen Nurse Workforce
An urgent global effort is needed to bolster the nurse workforce, according to a report from the World Health Organization (WHO), the International Council of Nurses, and Nursing Now, an international campaign to raise nurses ’ status. (Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

Study Suggests a Second Patient Has Been Cured of HIV
For only the second time, a patient with HIV who received an allogeneic hematopoietic stem cell transplant from a donor with an HIV resistance gene appears to have been cured of the disease, according to a recent study. (Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

Studies Explore HIV Treatment and Prevention in Pregnant Women
Taking dolutegravir along with a single pill containing emtricitabine (FTC) and tenofovir alafenamide fumarate (TAF) is the safest, most effective option for pregnant women with HIV and their infants, according to a large international study presented recently at the Conference on Retroviruses and Opportunistic Infections (CROI). (Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

Ankle Robots Could Make Running Easier, Encourage Exercise
Stanford University ’s Steven Collins, PhD, spends much of his time developing prostheses and exoskeletons to help people with disabilities walk more easily. Now he and his collaborators are designing a wearable ankle robot to aid in running. In treadmill tests, an exoskeleton emulator tethered to a power source decr eased competitive runners’ net metabolic rate by 15% on average compared with jogging in normal shoes. (Source: JAMA)
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

PET-CT Improved High-risk Prostate Cancer Staging in Trial
In a recent phase 3 trial, a novel imaging technique that identifies prostate-specific membrane antigen (PSMA) on tumor cells was more accurate than the scans typically used to stage high-risk prostate cancer before surgery or radiotherapy. The crossover study compared a combination of PSMA positron emission tomography (PET) and computed tomography (CT) —or PSMA PET-CT—with conventional imaging using CT and bone scans. (Source: JAMA)
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

Soy Scaffoldings Poised to Make Cultured Meat More Affordable
Scientists have used a novel soy-based scaffolding to grow a meat-like prototype, opening the door to more affordable and sustainable cell-based meat. (Source: JAMA)
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

Pulmonary Rehabilitation and Improved Survival for Patients With COPD
Chronic obstructive pulmonary disease (COPD) is highly prevalent worldwide, is estimated to affect more than 16 million people in the US, and is the fourth leading cause of death in the US. COPD causes disabling physical and psychosocial symptoms for patients and adversely affects caregivers. Hospitalizations for COPD exacerbations are a key contributor to morbidity, mortality, and health care costs for individuals with COPD. Evidence-based interventions that reduce mortality are needed and would be welcomed by patients with COPD and clinicians alike. (Source: JAMA)
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

Audio Highlights
Listen to the JAMA Editor ’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA. (Source: JAMA)
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

The Case for Remedial Germline Editing —The Long-term View
(Source: JAMA)
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

Serums and Vaccines in Influenza
With respect to serums and vaccines in influenza, there are certain simple facts and considerations that physicians will do well to keep in mind at this time. The main point to keep always in sight is that unfortunately we as yet have no specific serum or other specific means for the cure of influenza, and no specific vaccine or vaccines for its prevention. Such is the fact, all claims and propagandist statements in the newspapers and elsewhere to the contrary notwithstanding. This being the case, efforts at treatment and prevention by serums and vaccines, now hurriedly undertaken, are simply experiments in a new field, an...
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

Rural-Urban Differences in Cardiovascular Mortality in the United States, 1999-2017
This study used data from the US Centers for Disease Control and Prevention WONDER database to examined temporal trends in cardiovascular disease age-adjusted mortality rates overall and across subgroups stratified by rural-urban area designation in the US. (Source: JAMA)
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

Delivery of Talc for Pleurodesis of Malignant Pleural Effusions
To the Editor Dr Bhatnagar and colleagues examined the effect of thoracoscopic talc poudrage vs talc slurry on pleurodesis in individuals with malignant pleural effusions and found no significant differences between the procedures. We have a number of concerns about the study. (Source: JAMA)
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

Delivery of Talc for Pleurodesis of Malignant Pleural Effusions —Reply
In Reply The methods for our study were fully detailed in the eAppendix in the Supplement and included a comprehensive, 28-step recommended approach to performing medical thoracoscopy. One of these steps was ensuring even pleural coverage of talc. The article also made clear that procedures were performed while individuals were under local anesthesia and moderate sedation rather than general anesthetic. (Source: JAMA)
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

Effect of Surgery vs Functional Bracing on Functional Outcome for Closed Displaced Humeral Shaft Fractures
This randomized trial compares the effects of open reduction and internal fixation vs functional bracing for treating patients with closed displaced humeral shaft fractures. (Source: JAMA)
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

Effect of Biomechanical Footwear on Knee Pain in People With Knee Osteoarthritis
This randomized trial compares the effect of shoes with adjustable external convex pods attached to the outsole vs usual footwear on knee pain over 24 weeks in patients with symptomatic, radiologically confirmed knee osteoarthritis. (Source: JAMA)
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

Association Between Pulmonary Rehabilitation After Hospitalization for COPD and 1-Year Survival
This inception cohort study uses Medicare fee-for-service claims data to assess the association between initiation of pulmonary rehabilitation within 90 days of hospital discharge and 1-year survival among US patients hospitalized for chronic obstructive pulmonary disease in 2014. (Source: JAMA)
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

Hepatitis E
This JAMA Patient Page describes the symptoms, prevention, diagnosis, and treatment of hepatitis E. (Source: JAMA)
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

Truth Machine
A colleague once called CT scanners truth machines, as if passing people through them could coax secrets out of the body and into the air of darkened reading rooms. (Source: JAMA)
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

Cultivating Hope Through Advocacy, Love, and Resilience
In this narrative medicine essay, a pediatric psychiatrist relates how her younger sister with Down syndrome and congenital heart disease has lived well beyond expectation inspired her to help children cultivate hope through love and resilience. (Source: JAMA)
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

Discovering Why Some Infants Have Delayed Hearing Loss Detection
Several socioeconomic factors were linked in a recent study with delayed hearing loss diagnoses in Minnesota infants. Launching initiatives to pinpoint these populations and identify infants with hearing loss more quickly could help reduce their risk of delayed speech and language development, the study ’s authors noted. (Source: JAMA)
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

Despite Gains, Progress Toward TB Elimination Has Slowed
Although the US incidence of tuberculosis (TB) reached an all-time low in 2019, CDC researchers expressed concern in a recent report that the rate of decline has slowed in recent years. (Source: JAMA)
Source: JAMA - May 12, 2020 Category: General Medicine Source Type: research

Writing Medicine
My first glimpse into the craft of physician-writers did not come through Anton Chekhov, Walker Percy, or William Carlos Williams, whose works I only came to after medical school. As a schoolboy, I loved W. Somerset Maugham, although he never practiced medicine, and his craft had little to do with his medical degree. My introduction to physicians as writers came through my textbooks. Boyd ’s Pathology made me aware of literary voice, the ability of authors to place themselves in the text, let their personality come through, and subtly become a character in the reading experience. On the topic of defining the moment o...
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Forty Years of A Piece of My Mind
Forty years ago, in 1980, Jimmy Carter was president. Pac-Man debuted. In medicine, smallpox was declared to be eradicated. Additionally, on May 9, 1980, A Piece of My Mind was inaugurated in JAMA. The first essay, “Tuna on Rye, 1984,” was written by then–senior editor Samuel Vaisrub under the pen name Sam Vee. He introduced the column with an editorial entitled “For the Peace of Your Mind.” (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Audio Highlights
Listen to the JAMA Editor ’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

For the Peace of Your Mind
We hasten to assure our readers that a piece of my mind...is not intended as a sounding board for peevish gripes, nit-picking beefs, or sundry assortments of righteous indignation, which are usually prefaced by an angry “let me give you a piece of my mind.” Nor is this section of The Journal meant to be a podium for pompous preachments and ex cathedra pronouncements. Nor again is it designed to be a forum for half-baked speculations and warmed-over hypotheses. Least of all is a piece of my mind envisaged as a j amboree of jokes and a shivaree of limericks. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Tuna on Rye, 1984
“Your medical clearance, sir?” (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

The Environment: People Pollution
Meeting basic food and shelter needs of a growing population and catering to the insatiable consumer demands of people profoundly influences the quality of our environment. President Nixon observed that many of our present social problems may be related to the fact that we have had only 50 years in which to accommodate the second 100 million Americans. To provide for the increasing needs and demands of people, we are polluting our air, soil, and water. Unchecked population growth, people pollution, is not merely a problem, it is a paradox. It is an issue that is intimately private and yet inescapably public. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

My Friend Claims Her Second Round of Cancer
As my Italian father would say, since the house is burning      let us warm ourselves, and so (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

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with a weak smile the rabbi (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

The Changing of the Seasons
In this narrative medicine essay, a level-one trauma nurse compares Arizona ’s 2 seasons with the waning and the waxing of patient admissions and with the cycle of grief for loss of her mother and son, realizing how much their deaths have affected her nursing. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Doppelg änger—Parallel Struggles to Lose Weight
In this narrative medicine essay, a primary care physician describes his patient ’s struggle with obesity, sees himself in his patient, and wonders if his own struggles with weight loss impede his patient’s efforts to lose weight. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Miles Together —A Patient-Physician Journey
In this narrative medicine essay, a family physician shares the beginning and ending of a near 12-year journey with a patient, helping him reach sobriety that led to a full though short life and feeling humbled to have been so entrusted to travel with him. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Of What Am I Afraid? Plumbing the Depths
In this narrative medicine essay, a psychologist peels back the layers of her reticence and comes to terms with working with transgender patients as a member of LGBT community. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

The Cost of Technology —Patient-Centered Care
In this narrative medicine essay, a primary care physician describes a drawing by a 7-year-old patient who is sitting on an examination table with her mother cradling her baby sister with the physician ’s back to them entering data in the computer as an example of a system that is sacrificing human contact for electronics. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research