Phase 2 Chikungunya Virus –Like Particle Vaccine: A Randomized Clinical Trial
This clinical trial tested whether the chikungunya virus –like particle vaccince was safe for participants living in chikungunya endemic areas. (Source: JAMA)
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research

Preemptive Therapy vs Antiviral Prophylaxis and CMV in Seronegative Liver Transplant Recipients With Seropositive Donors
This randomized trial compares preemptive therapy vs antiviral prophylaxis with valganciclovir in cytomegalovirus (CMV)-seronegative liver transplant recipients with seropositive donors for the prevention of CMV disease. (Source: JAMA)
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research

Choosing a Parkinson Disease Treatment
This JAMA Patient Page describes treatment options for individuals with Parkinson disease. (Source: JAMA)
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research

Imaging
I used to be Doctor, my white coat a well-chosen label, quick and to the point now I ’m Sweetpea to the cheerful and efficient redhead at check-in, please wait here hands me a clipboard, nods to Door A which I will enter when called, Honey (Source: JAMA)
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research

Listless —A Mother Struggles With Her Son’s Constipation
In this narrative medicine essay, a neonatologist struggles with the perfectionism she cultivated during her pediatric training in knowing how to help her son ’s constipation and in the process learns true compassion for patients’ families. (Source: JAMA)
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research

Diagnosis and Management of Obstructive Sleep Apnea
This review provides an update on the epidemiology, pathophysiology, diagnosis, and management of obstructive sleep apnea, including the incorporation of questions regarding snoring, breathing pauses at night, and excessive fatigue or sleepiness during the day at routine clinician visits and the increased use of home sleep apnea testing rather than in-hospital testing for diagnostic purposes. (Source: JAMA)
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research

Legionnaires Disease Death Linked to Home Water Contamination
An immunocompromised Wisconsin man in his 70s died from an infection with a strain of Legionella bacteria traced to water supplies in his home, according to a CDC report. (Source: JAMA)
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research

US-Acquired Chagas Disease Case Found After Blood Donation
A Missouri woman whose Chagas disease was diagnosed through screening when she donated blood is likely the state ’s first autochthonous case, according to a CDC report. (Source: JAMA)
Source: JAMA - April 14, 2020 Category: General Medicine Source Type: research

After Heart Attack, Growth Factor Improves Scar Quality and Heart Function in Pig Study
Composed primarily of collagen and strengthened with cross-linked fibers, scar tissue that forms after a heart attack doesn ’t contract as well as healthy muscle tissue. It can therefore compromise the organ’s ability to pump blood, which may lead to heart failure, arrhythmias, and sudden cardiac death. Scientists who developed a therapy that targets such scar formation, or fibrosis, recently brought their strategy a step closer to the clinic. After demonstrating its effectiveness in rodents, their latest work—a randomized, double-blinded pig study—validates the approach in a large-animal model. (Source: JAMA)
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

Incorrect Affiliation
This article was corrected online. (Source: JAMA)
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

Inprecise Language
This article was corrected online. (Source: JAMA)
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

USPSTF 2020 Recommendations on Screening for Asymptomatic Bacterial Vaginosis in Pregnancy
Bacterial vaginosis during pregnancy is associated with higher risks of pregnancy complications, including preterm birth, whether or not symptoms are reported. Bacterial vaginosis is currently considered to be a microbial imbalance of the lower genital tract characterized by low levels of “healthy” Lactobacillus and overgrowth of a mixed population of other bacterial genera, including Gardnerella, Atopobium, Prevotella, Mobiluncus, Sneathia, and other taxa. Many of these microbes are also common isolates from sites of intrauterine infection, including the placenta and amniotic fl uid. These findings have motiva...
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

Treatment for Advanced Soft Tissue Sarcoma
The treatment of soft tissue sarcomas (STSs), which encompass a group of more than 70 histologically and biologically distinct subtypes of cancer, is emblematic of an orphan disease. About 13  000 patients are diagnosed as having STS in the United States every year, survival rates are poor and have not changed in the last 40 years, and there is little funding to support scientific discovery of disease biology to improve treatment regimens. Clinical presentation and prognosis are influe nced not only by the extent of disease and histological subtypes, but by tumor location as well. There is a significant unmet need for im...
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

Warning About Cleaning CPAP Devices With Ozone Gas, UV Light
A recent FDA safety communication has warned patients and health professionals that the agency has not cleared any devices that use ozone gas or UV light to clean, sanitize, or disinfect continuous positive airway pressure (CPAP) devices. (Source: JAMA)
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

Another Targeted Therapy for Patients With Multiple Myeloma
A monoclonal antibody that targets the CD38 receptor on multiple myeloma cells has been approved for adults who ’ve received at least 2 prior treatments for the incurable blood cancer. (Source: JAMA)
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

Boxed Warning for Allergy Drug
The FDA is requiring that the allergy and asthma medication montelukast carry a boxed warning —its most prominent type of alert—to caution consumers and clinicians about the risk of neuropsychiatric events associated with the drug. Montelukast is marketed as Singulair and in generic form. (Source: JAMA)
Source: JAMA - April 7, 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 7, 2020 Category: General Medicine Source Type: research

The Environment: A Death of Air
During recent months, if it wasn ’t in the air (and it was) it was surely in the news—pollution. Of course there is nothing new about air pollution in the United States. For years residents and visitors in Los Angeles have complained about that city’s eye-smarting smog. And in 1948 Donora, Pa, lay under a five-day poisonous f og labeled “the brown plague.” As a result, 22 people died and 5,910 became ill. (Source: JAMA)
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

Medicare Enrollment Among Patients With End-Stage Kidney Disease Receiving Dialysis in Outpatient Facilities Between 2005 and 2016
This study characterizes annual changes in enrollment of Medicare and non-Medicare patients treated at dialysis facilities before and after 2011 payment reforms and 2014 Affordable Care Act changes that influenced reimbursements. (Source: JAMA)
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

Cardiac Resynchronization Therapy for Chemotherapy-Induced Cardiomyopathy
To the Editor Dr Singh and colleagues reported that patients with chemotherapy-induced cardiomyopathy (CHIC) who met class I or II indications for cardiac resynchronization therapy (CRT) showed improvement in left ventricular ejection fraction (LVEF) and heart failure symptoms by 6 months following CRT implantation. We would like to raise a few points for consideration. (Source: JAMA)
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

Clinician Burnout and Professional Well-being
To the Editor Our experiences from clinical practice improvement projects suggest very different approaches to resolving physician burnout from those advanced by Dr Carayon and colleagues. Their stated purpose to “…encourage health care leaders to prioritize the actions, procedures, and policies that deliver the greatest value to direct patient care…” implies that clinicians should continue trusting their future well-being to those who have been responsible for the “industrialization of health care delivery.” Furthermore, the authors’ proposals do not reflect our understanding of...
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

Cardiac Resynchronization Therapy for Chemotherapy-Induced Cardiomyopathy —Reply
In Reply We agree with Dr Schwartz and colleagues that it would be worthwhile examining the time from the last anthracycline dose on the extent of CRT benefit. However, for CRT to work, there needed to have been concomitant conduction tissue disease because all the patients in our study had an accompanying LBBB contributing to the mechanical dyssynchrony that was corrected with CRT. The temporal relationship of the LBBB to the development of cardiomyopathy could influence the degree of response. We do not have data to examine the relationship between the last dose of anthracycline, the development of LBBB, and the onset of...
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

Clinician Burnout and Professional Well-being —Reply
In Reply Our Viewpoint was a summary of a comprehensive National Academies of Sciences, Engineering, and Medicine (NASEM) report. Time pressure and high workload are work system factors that contribute to clinician burnout and affect patient care; however, many other work system factors can also increase clinician burnout. The review of the evidence in the NASEM report showed that there is not a single root cause of burnout among clinicians, including physicians, nurses, pharmacists, dentists, and other health care professionals who provide direct care to patients. (Source: JAMA)
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

Trifarotene (Aklief) —A New Topical Retinoid for Acne
This Medical Letter review summarizes mechanisms of action and evidence of effects of Aklief, a 0.005% topical cream approved in 2019 for treatment of acne vulgaris in patients aged 9 years or older. (Source: JAMA)
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

Effect of Doxorubicin Plus Olaratumab vs Doxorubicin Plus Placebo on Survival in Advanced Soft Tissue Sarcomas
This randomized trial compares the effect of doxorubicin plus olaratumab vs doxorubicin plus placebo on overall survival in patients with advanced/metastatic soft tissue sarcoma and leiomyosarcoma. (Source: JAMA)
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

Celiac Disease and Mortality Risk in a Swedish Population
This population epidemiology study used Swedish histopathology registry data to estimate mortality risk in patients with vs without celiac disease. (Source: JAMA)
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

Screening for Bacterial Vaginosis During Pregnancy
This JAMA Patient Page describes the US Preventive Services Task Force ’s recent recommendations for screening for bacterial vaginosis during pregnancy. (Source: JAMA)
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

The Key
For Charlotte Maud Greene and Peter Devaney Greene (2009-2011) (Source: JAMA)
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

Twins
Careful readers will notice a 2-year-old girl, Charlotte, named in the A Piece of My Mind essay ( “The Peekaboo Visit)” and the poem (“The Key”) in this JAMA issue. They are the same child. Charlotte is a patient, a daughter, and for a too-brief period a twin sister, and submissions from her pediatrician and mother offered JAMA a rare opportunity to represent a family’s story from 2 pe rspectives. We hear much about shared decision-making, perhaps even shared story-telling, but the attempts of a physician and a mother to express their feelings of guilt and loss in poetic language, to find the ...
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

The Peekaboo Visit —
In this narrative medicine essay, a pediatrician describes how a 2-year-old ’s game of peekaboo expresses her bewilderment and grief at the death of her twin brother. (Source: JAMA)
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

USPSTF Report: Screening for Bacterial Vaginosis in Pregnant Adolescents and Women
This systematic review to support the 2020 US Preventive Services Task Force Recommendation Statement on screening for bacterial vaginosis (BV) summarizes published evidence on the benefits and harms of BV screening and treatment in pregnant adolescents and adults to prevent preterm delivery. (Source: JAMA)
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

USPSTF Recommendation: Screening for Bacterial Vaginosis to Prevent Preterm Delivery
This 2020 Recommendation Statement from the US Preventive Services Task Force recommends against screening for bacterial vaginosis (BV) in pregnant persons not at increased risk for preterm delivery (D recommendation) and concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for BV in pregnant persons at increased risk for preterm delivery (I statement). (Source: JAMA)
Source: JAMA - April 7, 2020 Category: General Medicine Source Type: research

Coronavirus Disease 2019 and Influenza 2019-2020
(Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Two Rows Transposed in Table 1
This article was corrected online. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Incorrect Percentage
This article was corrected online. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Errors in Author Affiliations
This article was corrected online. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Newborn Screening for Biliary Atresia
Biliary atresia is a serious pediatric liver disease. It is among the leading causes of newborn cholestasis, the foremost reason for cirrhosis and liver-related death in children, and the most frequent indication for liver transplant in the pediatric population. The condition results from an idiopathic, rapidly progressive, fibrosclerosing obliterative injury to large bile ducts during the first months of life. Although not an inherited disease, biliary atresia is a rare orphan liver disease that occurs in 1:15  000 to 1:20 000 live births in North America and Western Europe, with the highest incidence rates in Asia (1...
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Thank You to JAMA Peer Reviewers, Authors, and Readers
In this issue of JAMA, we are pleased to publish the names of the 2816 reviewers who completed reviews of manuscripts for JAMA in 2019. The thoughtful comments and recommendations of each reviewer for each manuscript are carefully considered in the editorial evaluation and are exceedingly helpful in assessing the novelty and importance of submitted manuscripts and in improving the presentation and quality of published articles. JAMA could not be successful without the efforts of the reviewers. We extend our appreciation to all reviewers for their service to the journal and hope that publishing your names in this issue prov...
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

White Blood Cells Might Provide Clues to Breast Cancer Risk
The proportions of certain white blood cell types in a woman ’s blood might predict her risk of being diagnosed with breast cancer in the short-term and in the long-term, according to a recent study in JAMA Network Open by researchers from the National Institute of Environmental Health Sciences (NIEHS). (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Government Cites California for Violating Federal Conscience Laws
The US Department of Health and Human Services (HHS) recently issued a Notice of Violation of federal conscience laws to the state of California because it mandated that all health insurance plans provide coverage for abortions. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

New Resource for Managing Patients Receiving Long-term Opioid Therapy
The Agency for Healthcare Research and Quality (AHRQ) recently updated a toolkit for primary care practices who treat patients with chronic pain who take opioids. As AHRQ noted, most patients taking opioids for chronic pain are managed by primary care practitioners and their staffs. (Source: JAMA)
Source: JAMA - March 24, 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 - March 24, 2020 Category: General Medicine Source Type: research

Spirits and the Medical Mind
The linguistic devices by which we distinguish between a specialist in the laws of the behavior of matter, one who deals with the functions of the body, and still another who ministers to the body diseased, indicate that for human ends we must divide what in nature is joined. We call the one man a physicist, the second a physiologist, the third a physician. The names, like the pursuits, all begin alike, for they are but phases of a common nature. So when any doctrines come forward that threaten to overturn the common foundation of science, physicist, physiologist and physician are equally concerned, and with them in these ...
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Medical Exemption From Disconnection of Utilities in Connecticut
This study uses data from the Connecticut Public Utilities Regulatory Authority to describe trends in medical exemptions from utility disconnection and characteristics and health care use of adults applying for such exemptions at a Yale New Haven Hospital care practice between 2011 and 2017. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Confirming Point-of-Care INR Test Results
To the Editor The authors of the JAMA Diagnostic Test Interpretation article on point-of-care (POC) testing for vitamin K antagonist monitoring suggested confirming POC international normalized ratio (INR) test results greater than 3.5. There are numerous INR tests cleared by the US Food and Drug Administration (FDA), and the FDA recommends confirming all POC test results with an INR value greater than 4.5. Variation between whole blood POC and citrated plasma-based laboratory methods can be expected. One significant source of variation between INR testing methods is the animal source of thromboplastin. The authors did not...
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Cultural Influences in Psychiatry
To the Editor Dr Guinart and colleagues asked if transcultural psychiatry is possible. The answer for clinicians in cultural psychiatry is “yes.” However, I have some comments about the article. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Cultural Influences in Psychiatry
To the Editor In a Viewpoint, Dr Guinart et al highlighted the need for fuller consideration of transcultural psychiatry to better explain cultural variation in clinical trials of psychotropic medicines. As the article suggested, such research is bedeviled by questions of interrater reliability, variations in the expression of stigmatizing emotional experience, and capacity for measuring treatment response. Neglecting cultural contexts distorts the results of clinical trials. Such concerns about cultural validity for effective clinical practice, in fact, motivated formulation of the “new cross-cultural psychiatry&rdq...
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

Confirming Point-of-Care INR Test Results —Reply
In Reply We agree with Dr Fantz and the FDA guidance that confirmation venipuncture INR testing should be performed, at minimum, for all patients with POC INR testing results of 4.5 or greater. However, we recommend that each institution examine whether a lower threshold for performing POC INR testing (such as>3.5) would better meet patient safety goals. Donaldson et al conducted a single-institution study comparing POC INR values using 2 different POC devices (CoaguChek XS Plus and i-STAT) vs venipuncture INR (Stago). Based on prior studies, the authors defined a clinically significant INR difference (one that would re...
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research