Methotrexate and Adverse Events in CIRT Secondary Analysis
Although low-dose methotrexate has long been the first-line treatment for rheumatoid arthritis, the drug ’s safety is based on inconclusive and contradictory case reports and observational studies. The drug was associated with a small to modest increase in adverse events (AEs) among patients at high cardiovascular risk in a study in the Annals of Internal Medicine. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Limiting Vulnerable Infants ’ Secondhand Smoke Exposure
A hospital-initiated intervention to protect fragile infants from tobacco smoke exposure at home was successful only among a subset of mothers, a trial in the Journal of Pediatrics found. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Palliative Care Benefits Patients With Parkinson Disease
Outpatient palliative care (PC) improved quality of life and symptoms among patients with Parkinson disease and related disorders in a trial in JAMA Neurology. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Alteplase Inhibits Nerinetide, a Novel Stroke Drug
The investigational neuroprotectant nerinetide did not reduce disability in all patients with ischemic stroke who were treated with endovascular thrombectomy, a trial in The Lancet reported. However, patients who were not concurrently treated with alteplase had a large benefit from nerinetide. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Preventing Tobacco Use in Children and Adolescents
This JAMA Patient Page describes the US Preventive Services Task Force ’s recent recommendations for prevention and cessation of tobacco use in children and adolescents. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Thangkhali Hospital at Night II
I was lying in bed swaddled in synthetic blankets in the on-call room. But what does it really mean to be “on-call”’ in a place like this? Really, everyone here is kind of “on-call”— ready to leave at a moment’s notice to somewhere better. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

USPSTF Review: Tobacco and Nicotine Use Prevention and Cessation in Children and Adolescents
This systematic review to support the 2020 US Preventive Services Task Force Recommendation Statement on interventions for prevention and cessation of tobacco and nicotine use summarizes published evidence on the benefits and harms of primary care –relevant interventions for tobacco and nicotine use prevention and cessation in children and adolescents. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

USPSTF Recommendation: Tobacco Use Prevention and Cessation in Children and Adolescents
This 2020 Recommendation Statement from the US Preventive Services Task Force recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents (B recommendation) and concludes that current evidence is insufficient to assess the benefits and harms of primary care interventions for cessation of tobacco use among school-aged children and adolescents (I statement). (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

New York Hospital Was Likely Source of Young Man ’s HIV Infection
A young man with chronic kidney disease likely contracted HIV infection while receiving care in 2017 at a New York City hospital, according to a CDC investigation. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Head Injury Deaths on the Rise
Fall-related head injury deaths in the United States increased by 17% from 2008 to 2017, according to a CDC report. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Corrections to Address Revised Analysis in Related Study
In the Editorial entitled “Improving Access to Kidney Transplantation: Business as Usual or New Ways of Doing Business?” published in the September 10, 2019, issue of JAMA, has been corrected to address coding errors in the related study, which has been retracted and replaced. This Editorial was corrected online. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Sexual Misconduct in Academic Medicine
The Me Too movement began in 2006 but was popularized in 2017 by women in Hollywood who had been sexually harassed. Since then, the pervasiveness of sexual misconduct across many segments of society has become apparent, and medicine has not been exempt. Although many studies have described sexual misconduct from the point of view of the person who was the target of the sexual misconduct, few studies have focused on the perpetrators. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Overuse of Continuous Pulse Oximetry for Bronchiolitis
Bronchiolitis, a viral infection of the lower respiratory tract, is the most common cause of hospitalization among children younger than 2 years, and generated estimated direct hospital costs of $734 million in 2016. Clinical practice recommendations from the Choosing Wisely campaign and the American Academy of Pediatrics (AAP) specifically target medical overuse for children with bronchiolitis in an effort to improve value of medical care for the approximately 130  000 infants admitted each year with this disease. Amid recommendations related to prevention, diagnosis, and management of bronchiolitis, these guidelines re...
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Correcting the Scientific Record —Retraction and Replacement of a Report on Dialysis Ownership and Access to Kidney Transplantation
The September 10, 2019, issue of JAMA included an Original Investigation titled “Association Between Dialysis Facility Ownership and Access to Kidney Transplantation” by Gander and colleagues, and an accompanying Editorial by Boulware and colleagues. The authors of the research report subsequently notified the editors that a major coding error had occurred in their data man agement and analyses, and that they discovered these errors had resulted in incorrect data in their published article. As reported in their letter of explanation, the authors performed a thorough reanalysis of their data to address these err...
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Graphic Health Images Are Coming to Cigarette Packaging
Beginning in June 2021, people who buy cigarettes will get their tobacco fix from packages with stark images that depict lesser-known smoking risks such as stunted fetal growth or increased odds of developing bladder cancer. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

HCV Drug Used in Adults Receives Approval for Pediatric Patients
A combination drug used to treat hepatitis C virus (HCV) infection in adults has been approved for pediatric patients 6 years or older or those who weigh at least 37 lb and don ’t have cirrhosis or only a mild case. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

New Therapy Offers Direct Cortisol Control for Cushing Disease
A new drug for adults with Cushing disease is the first FDA-approved treatment that directly addresses excessive cortisol by blocking an enzyme involved in cortisol production. (Source: JAMA)
Source: JAMA - April 21, 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 - April 21, 2020 Category: General Medicine Source Type: research

Medicaid Work Requirements Shift to New Terrain
State policies requiring low-income adults to work to maintain Medicaid coverage have been gaining traction and sparking debate. With encouragement from the Centers for Medicare& Medicaid Services (CMS), 20 states have proposed some form of “community engagement” requirements. These proposals typically involve mandating Medicaid beneficiaries to work a certain number of hours (usually 20 hours per week), engage in job training or community service, or obtain an exemption (such as having children with disabilities or being family ca regivers). (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Wilhelm Konrad Roentgen —The Centennial of His Birth
On March 27, 1845 Wilhelm Konrad Roentgen was born in Lennep, Germany. He received his early education in the Netherlands and then studied under Clausius, teacher of Willard Gibbs, in Zurich, Switzerland. At W ürzburg he became assistant to Kundt. In 1874 he became privatdozent at Strasbourg University. In 1875 Roentgen was made professor of mathematics and physics at the Agricultural Academy of Hohenheim. He returned to Strasbourg in 1876, where he became extraordinary professor. In 1879 he was appointe d ordinary professor of physics and director of the Physical Institute of Giessen, and in 1885 he became professor ...
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Characteristics of Faculty Accused of Academic Sexual Misconduct in the Biomedical and Health Sciences
This study uses internet search data to identify and characterize biomedical and health sciences faculty at US higher education institutions who had sexual misconduct accusations against them between 1982 and 2019 that led to institutional or legal actions proving or supporting guilt. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Paralytic Agents for Intubation in the Out-of-Hospital Setting
To the Editor The study by Dr Guihard and colleagues is one of the few trials to use endotracheal intubation success as an outcome when comparing rocuronium and succinylcholine for rapid sequence intubation. With the exception of a few observational studies that evaluated intubation success, previous investigations only measured intubation conditions as an outcome. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Paralytic Agents for Intubation in the Out-of-Hospital Setting
To the Editor Dr Guihard and colleagues investigated 1248 patients requiring out-of-hospital rapid sequence tracheal intubation in a multicenter, single-blind, noninferiority randomized clinical trial comparing 1.2 mg/kg of rocuronium with 1 mg/kg of succinylcholine. The authors stated that rocuronium, compared with succinylcholine, failed to demonstrate noninferiority with regard to first-attempt intubation success rate. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Techniques for Treatment of Carotid Stenosis
To the Editor Dr Schermerhorn and colleagues compared transcarotid artery revascularization with transfemoral carotid stenting for treatment of carotid stenosis and found that transcarotid artery revascularization was associated with a lower risk of stroke or death. However, 37% of the patients (n  = 1965) were excluded from the transcarotid artery revascularization group and 50% (n = 3354) from the transfemoral carotid stenting group. When such a large percentage of the registry data are excluded, it becomes difficult to make a fair comparison without eliminating selection bias. The authors sho...
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Use of Frozen Embryo Transfer During Fertility Treatment and Risk of Childhood Cancer
To the Editor Dr Hargreave and colleagues examined the association between fertility treatment and cancer risk in children. They found that the use of frozen embryo transfer was associated with a small increased risk of childhood cancer compared with children born to fertile women. We would like to raise an important technical consideration regarding the cryopreservation method. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Paralytic Agents for Intubation in the Out-of-Hospital Setting —Reply
In Reply Dr Patanwala raises the possibility that our results could be misinterpreted due to inappropriate use of terms related to the interpretation of noninferiority trials. However, as Patanwala points out, the description of our results in the article is correct. Nevertheless, we agree that the term inconclusive could have been used and the figure could have been revised for consistency. We fully agree that failure to demonstrate the noninferiority of rocuronium should not be interpreted as the superiority of succinylcholine. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Techniques for Treatment of Carotid Stenosis —Reply
In Reply In response to Dr Sharma and colleagues, we used propensity score matching methods to account for baseline characteristic differences found between patients undergoing transfemoral carotid artery stenting and transcarotid artery revascularization. Although this led to a 50% exclusion of patients from the transfemoral carotid stenting cohort and a 37% exclusion of patients from the transcarotid artery revascularization cohort, these matching methods are important for controlling intrinsic biases found in observational studies. However, we provided unadjusted complete raw data outcomes in eTable 1 in the supplementa...
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Use of Frozen Embryo Transfer During Fertility Treatment and Risk of Childhood Cancer —Reply
In Reply Drs Parmegiani and Vajta note recent changes in the cryopreservation method from the traditional slow-rate freezing to cryopreservation by vitrification and suggest this may be relevant for the interpretation of our study. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Effect of Zoledronic Acid on Tibiofemoral Cartilage Volume in Knee Osteoarthritis With Bone Marrow Lesions
This randomized trial compares the effects of intravenous zoledronic acid vs placebo on magnetic resonance imaging –assessed knee cartilage volume loss in patients with symptomatic knee osteoarthritis and subchondral bone marrow lesions. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Pulse Oximetry Monitoring in Hospitalized Children With Bronchiolitis Not Requiring Supplemental Oxygen
This study characterizes use of continuous pulse oximetry monitoring in hospitalized children with bronchiolitis who do not require supplemental oxygen in Canadian and US hospitals. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Half Her
My girl is 29 and I watch her deteriorate like we ’re an elderly couple. Doctor after doctor. Symptom after symptom. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Empathy Revisited —Understanding Patients’ Pain From Experienced Pain
In this narrative medicine essay, a cardiologist recalls the effects his wife ’s death had on his young family and the humility he brings to being with patients in their traumas as a result. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Notice of Retraction and Replacement
. Gander et al. Association between dialysis facility ownership and access to kidney transplantation. JAMA. 2019;322(10):957-973 (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Boosting Rwanda ’s Health Workforce
Rwanda ’s physician specialist workforce tripled and the ranks of nurses and midwives grew substantially as a result of the country’s Human Resources for Health (HRH) Program, according to an evaluation by the National Academies of Science, Engineering, and Medicine. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Ramping up Diagnostics in Resource-Poor Countries
The World Health Organization (WHO) and the Foundation for Innovative New Diagnostics (FIND) are teaming up to boost diagnostic capabilities in resource-poor countries. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

End Obesity Stigma, International Panel Urges
To bridge the gap between damaging beliefs about obesity and the condition ’s scientific underpinnings, an international panel of experts has issued a consensus statement condemning weight stigma. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Universal Flu Vaccine Candidate Advances
A broad-spectrum influenza vaccine candidate is poised for larger phase 3 trials after demonstrating immunogenicity and safety in a recent phase 2b study. The findings could bring a long-awaited universal influenza vaccine one step closer to reality. (Source: JAMA)
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research

Alzheimer Disease Blood Test in Development
Two recent studies suggest that a simple blood test can distinguish Alzheimer disease (AD) from other neurodegenerative diseases and predict which patients may develop AD regardless of their cognitive status when they ’re tested. (Source: JAMA)
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research

Skin Cancer Detection Apps Unreliable
Smartphone apps that use artificial intelligence to assess skin cancer risk based on images of suspicious moles aren ’t ready for prime time, a recent systematic review in the BMJ suggests. The 9 studies included in the review “showed variable and unreliable test accuracy” for 6 such apps, 2 of which are approved by European regulators as medical devices. (Source: JAMA)
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research

A New Vaccine for Chikungunya Virus
Arboviruses (arthropod-borne) are a group of viruses that encompass hundreds of members and span multiple viral families making it one of the most genetically diverse, widespread, and dangerous groups of viruses on earth. Arboviruses are transmitted to humans by a variety of geographically widespread arthropod vectors (most commonly, mosquitoes and ticks) so that these viruses can change location with human hosts or arthropod vectors, with potential for rapid spread wherever these vectors are present. Past outbreaks of West Nile virus and recent outbreaks of eastern equine encephalitis virus, Zika virus, and chikungunya vi...
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research

Preventing Cytomegalovirus Infection After Liver Transplant: An Evolving Approach
Despite recent advances in the management of patients following liver transplant, cytomegalovirus (CMV) infection remains a substantial cause of morbidity and mortality among this population. Clinicians and transplant centers have adopted varying approaches to managing CMV-seronegative liver transplant recipients with CMV-seropositive donors, a recipient group that is at highest risk for developing CMV-associated complications. Antiviral prophylaxis is typically initiated soon after transplant for a period of several months. Although the most widely used strategy, prophylaxis is limited by the incidence of delayed-onset CM...
Source: JAMA - April 14, 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 - April 14, 2020 Category: General Medicine Source Type: research

The Prevailing Pandemic of Influenza
During the past two weeks, August 28 to September 11, there has begun a severe and rapidly spreading epidemic of influenza in the First Naval District. More than 2,000 cases have been reported in these two weeks, and there are indications of a rapid spread of the infection. This is undoubtedly the same disease which, first heard of in Spain last spring, and hence called Spanish influenza, has in recent months spread over nearly all of Europe, including Germany, Italy, France, England and Ireland, attacking from 30 to 40 per cent. of the people. The outstanding feature of this epidemic is its high degree of communicability;...
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research

Association Between Nocturnist Supervision and Perceived Overnight Supervision Adequacy in the US
This cross-sectional study uses data from a voluntary survey that was administered during the American College of Physicians Internal Medicine In-Training Examination to assess whether residents in programs with nocturnists perceived nighttime supervision differently than those in programs without nocturnists. (Source: JAMA)
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research

Kidney Function in Patients With Type 2 Diabetes After Vitamin D Supplementation
To the Editor Dr de Boer and colleagues reported that vitamin D3 and/or omega-3 fatty acids compared with placebo did not result in any significant difference in change in estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes at 5 years. There are multiple study limitations that were not discussed. (Source: JAMA)
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research

Suicides Among Opioid Overdose Deaths
To the Editor Dr Olfson and colleagues examined trends in the rates of opioid-related mortality, stratified by intentionality. Concerns about whether a significant proportion of opioid overdose suicides have been misclassified, and therefore that the suicide component of the opioid epidemic is underestimated, cannot be answered with death certificate data. (Source: JAMA)
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research

Kidney Function in Patients With Type 2 Diabetes After Vitamin D Supplementation —Reply
In Reply Dr Peiris suggests that 25(OH)D concentrations, adherence, or vitamin D3 dose may have limited testing the effects of vitamin D3 on change in eGFR in our study. (Source: JAMA)
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research

Suicides Among Opioid Overdose Deaths —Reply
In Reply Dr Nestadt raises 3 concerns regarding our analysis of trends in the intent of overdose deaths involving opioids. His first concern is that suicides may have been misclassified. A prior estimate assumed that because 26.5% of opioid overdose visits to the emergency department were classified as intentional, 20% to 30% of opioid overdose deaths were also intentional. Our findings, which were based on the National Vital Statistics System, revealed that in 2017, 4.0% of overdose deaths involving opioids were certified as suicides, 5.4% were certified as undetermined intent, and 90.6% were unintentional. One reason tha...
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research