Confronting State Medicaid Drug Spending Pressures
In the context of declining state Medicaid revenues and rising enrollment related due to coronavirus disease 2019, this Viewpoint proposes policy and payment reforms related to mandated drug coverage and manufacturer rebates that could assist states financially while maintaining patient access to life-saving medications. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Sensible Medicine —Balancing Intervention and Inaction During the COVID-19 Pandemic
This Viewpoint discusses the tensions between rapid adoption of interventions for coronavirus disease 2019 (COVID-19) before adequate evidence justifies their use and therapeutic nihilism, and argues for sensible medicine between the 2, which favors usual care, disfavors unnecessary interventions, but embraces rapid scientific evaluation with clinical translation of options proven effective. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Could Frequent Testing Help Squelch COVID-19?
This Medical News feature examines the debate about the value of frequent testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

COVID-19 Antibody Tests Perform Well in Head-to-Head Comparison
Four widely used severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody tests had high sensitivity and specificity in what scientists said was the first large head-to-head comparison of commercial immunoassays developed during the coronavirus disease 2019 (COVID-19) pandemic. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Investigational KRAS Inhibitor Tested for Advanced Solid Tumors
No dose-limiting toxic effects or treatment-related deaths occurred with sotorasib, an experimental drug that targets the cancer-causing KRAS p.G12C genetic variant, in a phase 1 trial involving patients with heavily treated advanced solid tumors. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Tinnitus Symptoms Improve With Sound and Tongue Stimulation
A noninvasive device that delivers sound to the ears and electrical stimulation to the tongue improved tinnitus symptoms in a trial reported in Science Translational Medicine. No drugs or devices are approved for tinnitus, which affects 10% to 15% of people. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Randomized Trials of e-Cigarettes for Smoking Cessation
Few topics in public health and medicine are as contentious as electronic cigarettes (e-cigarettes), a diverse and rapidly evolving array of products that appeared on the consumer market a decade ago. e-Cigarettes are battery-powered devices that heat a solution, typically containing nicotine and other chemicals including flavorings, to produce an aerosol that users inhale or “vape.” e-Cigarettes do not burn tobacco to generate smoke, and it is the many chemicals in tobacco smoke—not the nicotine—that are responsible for the global burden of tobacco-related disease that accounts for an estimated 6 m...
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Preprints Involving Medical Research —Do the Benefits Outweigh the Challenges?
A preprint is a complete manuscript posted to a preprint server by authors before peer review and publication in a journal. The goals of preprints are to enable authors to obtain timely feedback and comments on research before submission to a peer-reviewed journal, to claim provenance of an idea, and to facilitate and expedite dissemination of and access to research. Preprints can be amended or updated, commented on by others, and remain on the preprint server even if subsequently published in a journal. They can be cited and indexed and increasingly are given attention in the news and social media. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

The US Preventive Task Force Recommendation on Screening for Blood Pressure in Children
In this issue of JAMA the US Preventive Services Task Force (USPSTF) updates its 2013 report on screening of blood pressure in children and adolescents with a new recommendation statement and updated evidence report and systematic review. After reviewing publications since the earlier report, the USPSTF again concludes that, while there is evidence of tracking of blood pressure between childhood and adulthood and some evidence of a relation to subclinical cardiovascular disease, overall there was insufficient evidence to make a recommndation for or against screening for high blood pressure in children and adolescents (I st...
Source: JAMA - November 10, 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 - November 10, 2020 Category: General Medicine Source Type: research

The Great Coronavirus Pandemic of 2020 —7 Critical Lessons
The world is experiencing a once-in-a-lifetime pandemic, causing untold human suffering and death, unraveling of social relationships, and robbing individuals of livelihoods and countries of prosperity. The coronavirus pandemic has strained health systems, revealed unconscionable inequalities, and upended international institutions. Here are 7 critical lessons. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Nice Baby
The April 1970 issue of Population Bulletin, a publication of Population Reference Bureau, Inc., is devoted to “Whose Baby is the Population Problem?”—an extraordinarily perceptive essay by Rufus E. Miles, Jr. He notes that although demographers disagree about whether the US population is growing at an alarming rate, and although there is no problem in Malthusian terms of domestic food supply, there ar e other reasons for concern. For example, further growth in US population inevitably will lead to additional crowding of our cities. In spite of the fact that they might prefer it otherwise, people will hav...
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Preprint Servers ’ Policies, Submission Requirements, and Transparency in Reporting and Research Integrity Recommendations
This study describes the policies, submission requirements, and transparency in reporting and research integrity recommendations of academic preprint servers. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Submissions and Downloads of Preprints in the First Year of medRxiv
This study describes submissions, postings, abstract views, downloads, comments, and withdrawals on the medRxiv preprint server from June 2019 to June 2020 and compares submissions and postings before and after COVID-19. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Noninvasive Oxygenation Strategies for Acute Hypoxemic Respiratory Failure
This study could support wider use of noninvasive ventilation during the current coronavirus disease 2019 pandemic, especially if the availability of ventilators is limited. However, some issues should be discussed further to better interpret the results of the study. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

New Statin Use and Mortality in Older Veterans
To the Editor The study on the association of new statin use with all-cause and cardiovascular mortality in older veterans found a reduction in all-cause mortality that was significantly larger than the reduction in cardiovascular mortality with statin use. In studies of primary prevention using statins in largely younger populations and in meta-analyses of participants older than 75 years in randomized trials, an effect on noncardiovascular mortality has not been demonstrated. It is also surprising that the risk of mortality decreased during follow-up, with the greatest effect seen in the initial 2 years, when randomized ...
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

New Statin Use and Mortality in Older Veterans
To the Editor Dr Orkaby and colleagues reported an association between receiving a new statin prescription among veterans 75 years and older and all-cause and cardiovascular mortality. However, several aspects of their results are concerning. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

New Statin Use and Mortality in Older Veterans
To the Editor The article by Dr Orkaby and colleagues reported a significantly lower risk of all-cause mortality associated with statin use among US veterans at least 75 years old who were free of atherosclerotic cardiovascular disease at baseline. Although formal sensitivity analyses were not performed to estimate potential bias due to unmeasured baseline characteristics, propensity scores were used to achieve balance in measured baseline characteristics. Furthermore, their use of a new-user design addressed the concern for prevalent-user bias. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Noninvasive Oxygenation Strategies for Acute Hypoxemic Respiratory Failure —Reply
In Reply We agree with Dr Antonucci and colleagues that endotracheal intubation, the secondary outcome in our network meta-analysis of noninvasive oxygenation strategies for acute hypoxemic respiratory failure, may not be an appropriate outcome for patients who do not wish to receive invasive mechanical ventilation. As an end point, endotracheal intubation is also vulnerable to manipulation in trials in which blinding of treatment allocation is not possible. This was the main rationale for choosing mortality as the primary end point in our review. Of note, most of the studies included in our network meta-analysis did not i...
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

New Statin Use and Mortality in Older Veterans —Reply
In Reply Dr Whittle and Ms Digitale and Dr Newman raise concerns about the plausibility of our findings indicating a lower risk of all-cause and cardiovascular mortality in older veterans who newly used statins, which has not been clearly demonstrated previously. Randomized trials have been conducted mostly in patients younger than 75 years. Until randomized clinical trials are completed in older adults, the magnitude of statin benefits or harms in this population will not be known. Our study was based on observational data, and therefore we cannot exclude unmeasured or residual confounding and other types of biases as par...
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Effect of Vitamin D, Omega-3 Fatty Acids, or Strength Training on Clinical Outcomes in Older Adults
This randomized trial compares the effects of vitamin D, omega-3s, and a strength-training exercise program alone or in combination vs no supplementation and control exercise on changes in blood pressure, physical and cognitive function, nonvertebral fractures, and infections over 3 years among older adults. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Effect of e-Cigarettes Plus Counseling vs Counseling Alone on Smoking Cessation
This randomized trial compares the effect of using e-cigarettes with individual counseling vs individual counseling alone for smoking cessation on point prevalence abstinence at 12 weeks. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Skilled Nursing Facilities and a Bundled Payment Model for Joint Replacement Surgery
This study compares mean levels of institutional spending for Medicare beneficiaries after lower extremity joint replacement at skilled nursing facilities (SNFs) participating vs not participating in Medicare ’s bundled payment program, before vs after implementation of the program. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Patient Information: Screening for High Blood Pressure in Children and Adolescents
This JAMA Patient Page summarizes the 2020 USPSTF recommendation statement on blood pressure screening in children, which concludes that the current evidence is insufficient to assess the balance of benefits and harms of the practice (I statement). (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Outpatient Management of Liver Function Test Abnormalities in Patients With a Liver Transplant
This JAMA Performance Improvement article describes development of a protocol for workup and management of elevated liver function tests in liver transplant patients without readmission to their transplant referral center, and findings and outcomes for a case series of 80 patients managed with the new protocol from 2017 to 2019. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

The God of Small Things
Sina and I are reminiscing about med school. Those nights we escaped third year, he plastered to my back, bowling down San Francisco hills. Admiring our velocity. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Relationships Between Academic Medicine Leaders and Industry
In this narrative medicine essay, a Brigham and Women ’s Hospital (BWH) clinician uses the resignation of BWH's president from Moderna's board of directors after a stock sale reportedly paying her millions to question why leaders of academic medical centers are allowed to develop lucrative relationships with industry that prioritize mutual profits ov er patient well-being and public health. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

USPSTF Report: Screening for Hypertension in Children and Adolescents
This systematic review to support the 2020 US Preventive Services Task Force Recommendation Statement on screening for hypertension in children and adolescents summarizes published evidence on the benefits and harms of screening for hypertension in asymptomatic children and adolescents and on the effect of treating childhood hypertension on outcomes in adulthood. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

USPSTF Recommendation: Screening for High Blood Pressure in Children and Adolescents
This 2020 US Preventive Services Task Force Recommendation Statement concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for high blood pressure in children and adolescents (I statement). (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

COVID-19 Deaths Among US Clinicians
More than 100  000 US health care personnel have contracted coronavirus disease 2019 (COVID-19) since February and at least 641 have died, according to a report by health officials from the CDC and several states. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

COVID-19 Poses Pregnancy Risks
Preventing and identifying coronavirus disease 2019 (COVID-19) in pregnant women is essential, as new data suggest some are at risk of severe illness or pregnancy loss. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Risk of COVID-19 From Flying
This JAMA Patient Page describes the risk of acquiring the COVID-19 virus associated with air travel, steps that airlines and airports are taking to mitigate risk, and steps that passengers can take to reduce their risk. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Influenza Vaccines for 2020-2021
This Medical Letter review summarizes available influenza vaccine formulations for use during the 2020-2021 flu season, with guidance on which to choose for specific age groups and populations. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Preserving Elective Surgeries in the COVID-19 Pandemic and the Future
This Viewpoint describes the health burden imposed on patients and the logistical and financial burdens posed to health systems by the temporary halting of elective surgery during the COVID-19 pandemic, and proposes organizational and policy responses to maintain standards of quality and safety while sustaining the surgical services patients need. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Long-term Health Consequences of COVID-19
This Viewpoint discusses long-term consequences of COVID-19 infection, including cardiovascular, pulmonary, neurologic, and mental health sequelae, and calls for an integrated, multidisciplinary approach to better characterize how post –acute phase disease manifests in organ systems and overall health. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Large Meta-analysis Digs Into Obesity ’s COVID-19 Risks
This Medical News article is an interview with nutrition expert Barry Popkin, PhD, lead author of a new systematic review and meta-analysis of studies on coronavirus disease 2019 among individuals who are obese. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Newly Discovered Cellular Protection Pathway Blocks Ebola, COVID-19 Viruses
Faced with the urgent need for new antiviral strategies, investigators recently uncovered a surprising pathway that host cells use to protect against diverse viruses, including those that cause Ebola and coronavirus disease 2019 (COVID-19). The findings, published in Science, point to a potential novel treatment target. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Active Surveillance for Black Men With Low-Risk Prostate Cancer
Overtreatment of patients with early-stage prostate cancer is a widely recognized clinical problem. Most patients with low-risk prostate cancer (defined as prostate-specific antigen [PSA] level ≤10 ng/mL, biopsy Gleason score 6, and clinical stage T1c or T2a by the National Comprehensive Cancer Network guidelines) do not benefit from immediate aggressive treatment in terms of lengthening survival. Patients may be harmed by surgical or radiation treatments that lead to negative short-term and long-term effects on quality of life. Overtreatment of early-stage prostate cancer is associated with an estimated more than $300 ...
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Reconsidering Health Care Fraud and Abuse Laws
When financial incentives influence physicians ’ clinical decision-making, there may be cause for concern. Not all inducements aimed at affecting the utilization of medical services, however, are ill-intentioned. At a time when medical spending is stressing the US health care system, financial inducements aimed at encouraging cost controls or improving outcomes should be supported. To more accurately distinguish between public-minded vs detrimental financial inducements, the time has come to revisit the health care fraud and abuse laws that regulate these inducements. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

New Center at FDA Will Advance Digital Health Innovation
The FDA is launching a Digital Health Center of Excellence within its Center for Devices and Radiological Health to advance technologies including wearable medical devices and mobile health devices. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Biologic Treatment Approved for Rare Blood Disorders
For the first time in nearly 14 years, the FDA has approved a treatment for adults and adolescents who have had hypereosinophilic syndrome (HES) for 6 months or longer without a known nonhematologic secondary cause. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Combination Therapy Approved for Adults With Mesothelioma
Combination immunotherapy that is used to treat patients with malignant melanoma or non –small cell lung cancer has received FDA approval for adults with unresectable malignant pleural mesothelioma. (Source: JAMA)
Source: JAMA - November 3, 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 - November 3, 2020 Category: General Medicine Source Type: research

Unexpected Health Insurance Profits and the COVID-19 Crisis
The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented financial stress on most of the US health care system, including physician practices, emergency medical service systems, and hospitals. But there is one notable exception: health insurance companies. Sharp declines in elective care during the pandemic have reduced health care expenditures and contributed to earnings that are twice as large as those earned last year. For example, the UnitedHealth Group ’s net income during the second quarter grew from $3.4 billion in 2019 to $6.7 billion in 2020 and Anthem Inc’s net income increased from $...
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Some Medical Humorists
A bit of humor now and then is welcomed by every class of thinkers, no matter how serious minded may be their daily routine. According to Bergson, humor is a lively sense of the incongruous in the world and in life. It is not strange that physicians should see much humor in their work, since no men see life more intimately than they do. Unfortunately, too few record humorously the things they have seen. Thus, Broxholme, first Radcliffe Fellow at Oxford, although known as one of the wittiest men of his time, nevertheless left nothing permanent as a monument to his wit and humor. In the great literature of humor there appear...
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Trends in Industry Payments to Physicians in the United States From 2014 to 2018
This study uses Medicare Open Payments data to characterize trends in the prevalence and value of physicians ’ interactions with industry overall and by specialty between January 2014 and December 2018 after implementation of the federal Open Payments transparency program in 2013. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Screening for Adverse Childhood Experiences
To the Editor Although Dr Campbell counseled caution “before advocating widespread screening for ACEs,” there are many reasons to proceed with enthusiasm. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Screening for Adverse Childhood Experiences
To the Editor Dr Campbell articulated the potential effects of adverse childhood experiences (ACEs) and toxic stress on health. However, the Viewpoint misinterpreted the intended goals of ACE screening and response in primary care. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Intraoperative Dexamethasone During Pediatric Cardiac Surgery
To the Editor In the Intraoperative Dexamethasone in Pediatric Cardiac Surgery (DECISION) randomized clinical trial, Dr Lomivorotov and colleagues reported that intraoperative administration of dexamethasone compared with placebo did not reduce major complications and mortality among infants undergoing cardiac surgery. However, we are concerned about certain aspects of this study. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research