The Enduring Importance of Trust in Leadership of Health Care Organizations
This Viewpoint discusses the declining trust in the US health care system, especially in the midst of the COVID-19 pandemic, and the importance that maintaining public trust should hold in the culture of health care organizations. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Human-Centered Design and Trust in Medicine
This Viewpoint discusses how human-centered design (HCD) that involves all stakeholders can improve patient trust in physicians and health care systems, describes its methods, and provides examples of its successful application. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Urgent Action Needed to Prevent Measles, Polio Resurgence
Leaders from the United Nations Children ’s Fund (UNICEF) and the World Health Organization (WHO) have issued an urgent call to prevent a worldwide resurgence of measles and polio as pandemic-related disruptions caused vaccination rates to fall to 50% in some areas. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Creating More Climate-Proof Health Care Facilities
Building more resilient and environmentally sustainable health care systems is essential to ensuring access to care as the world ’s climate continues to change, according to new guidance from the World Health Organization (WHO). (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Global Regulators Set Standards for Safe Vaccines
The International Coalition of Medicines Regulatory Authorities (ICMRA) and the World Health Organization (WHO) are collaborating to create standards that ensure safe and equitable access to coronavirus disease 2019 (COVID-19) medicines and vaccines. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Diagnosing Hypomagnesemia
A 63-year-old woman with type 2 diabetes was referred for refractory hypomagnesemia (1.4 mg/dL; low normal, 1.8 mg/dL). Her medications included liraglutide, metformin, lisinopril, and magnesium oxide (400 mg twice daily). A recent hemoglobin A1c level was 10.8%, and her urinary magnesium was 117 mg. How do you interpret the urine level, and what would you do next? (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Peripheral Oxygen Saturation in Older Persons Wearing Nonmedical Face Masks in Community Settings
This study describes changes in portable oximeter –measured peripheral oxygen saturation (Spo2 or O2sat) in older adults before, during, and after wearing a 3-layer plane-shaped disposable nonmedical face mask widely used to protect against COVID-19. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Preparing for the 2020-2021 Influenza Season
This JAMA Insights Clinical Update discusses the importance of established influenza prevention and control measures, including influenza vaccination and antiviral treatment, as the Global North enters its first influenza season in the COVID-19 pandemic. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Patient Information: High-risk Groups for Influenza Complications
This JAMA Patient Page describes the groups of people who are at high risk of complications from influenza infection, how to reduce risk through vaccination, and steps high-risk people should take if they develop influenza symptoms. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Science Denial and COVID Conspiracy Theories —Lessons From Clinical Disease About Possible Neurophysiological Mechanisms
This Viewpoint discusses possible parallels between the distortion in sensory information and faulty monitoring of ideas characteristic of some patients with neurodegenerative diseases (dementia with Lewy bodies and Capgras syndrome, frontotemporal dementia) and the creation and maintenance of false conspiratorial beliefs about the COVID-19 pandemic in healthy populations that has hobbled an effective national response in the US. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Preventing Clinical Deterioration in COVID-19 Infection
More than 38 million individuals worldwide have been infected with severe acute respiratory syndrome coronavirus 2, the virus causing coronavirus disease 2019 (COVID-19). For primary prevention, traditional public health approaches include wearing masks, physical distancing, contact tracing, and quarantine. These steps are the current standard of care as the world awaits the results of randomized trials of vaccines and monoclonal antibodies. For the treatment of patients with serious illness in the hospital, corticosteroids have emerged as the standard of care. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Effect of Fluvoxamine vs Placebo on Clinical Deterioration in Outpatients With Symptomatic COVID-19
This randomized trial compares the effects of fluvoxamine, a selective serotonin reuptake inhibitor with immunomodulatory effects vs placebo on a composite of dyspnea or pneumonia and oxygen desaturation among adult outpatients with polymerase chain reaction –confirmed mild coronavirus disease 2019 (COVID-19) illness. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Effects of Omega-3 Fatty Acids on Major Adverse Cardiovascular Events
Hypertriglyceridemia is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD), independent of low-density lipoprotein cholesterol (LDL-C) control. Standard treatment strategies have included lifestyle modification, weight and diabetes management, and statin therapy. Previous triglyceride-lowering trials with niacin, fibrates, and mixed omega-3 fatty acids have not demonstrated consistent risk reduction of ASCVD. However, strong evidence has recently emerged for the role of eicosapentaenoic acid (EPA), an omega-3 fatty acid, in its highly purified ethyl ester derivative, icosapent ethyl (IPE), ...
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Do Omega-3 Fatty Acids Benefit Health?
An important clinical trial of omega-3 fatty acids in patients at high risk of cardiovascular disease is published in JAMA. In the STRENGTH trial (the Long-Term Outcomes Study to Assess Statin Residual Risk with Epanova in High Cardiovascular Risk Patients with Hypertriglyceridemia), 13  078 patients were randomized to receive 4 g/d of a carboxylic acid formulation of omega-3 fatty acids (a combination of eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) or corn oil as a comparator. After a median follow-up of 42 months, there was no significant difference between the o mega-3 fatty acid group (6539 patients) a...
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Omega-3 Fatty Acids vs Corn Oil and Major Adverse Cardiovascular Events in Patients at High Risk
This randomized trial examines the effects on cardiovascular outcomes of a carboxylic acid formulation of EPA and DHA (omega-3 CA) with documented favorable effects on lipid and inflammatory markers in patients with atherogenic dyslipidemia and high cardiovascular risk. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

COVID-19, Decarceration –– A NASEM Report on the Role of Clinicians, Health Systems, and Payers
This Viewpoint summarizes a National Academy of Sciences, Engineering, and Medicine (NASEM) consensus panel report recommending ways to reduce populations in prisons and jails as a means to mitigate SARS-CoV-2 transmission and the roles clinicians, health systems, and insurers can play in in process. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Looking to Long-term Survivors for Improved Pancreatic Cancer Treatment
This Medical News article examines how studying the characteristics of long-term pancreatic cancer survivors might improve treatment and boost survival for others who have the disease (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

A Proposed Framework and Timeline for the Clinical Spectrum of SARS-CoV-2 Infection
This Viewpoint uses clinical observations of the natural course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to propose 3 phases of illness: acute infection (what people commonly refer to with the COVID-19 designation); postacute hyperinflammatory illness (referred to clinically as multisystem inflammatory syndrome); and late inflammatory sequelae, manifest as enduring cardiac, neurological, and psychological symptoms. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Improving Care for Heart Failure With Reduced Ejection Fraction (HFrEF) —A Polypill-Based Strategy
This Viewpoint proposes that a polypill combination of a β-blocker, renin angiotensin inhibitor, mineralocorticoid receptor antagonist, and sodium-glucose cotransporter 2 inhibitor might be the most efficient way to deliver guideline-directed HFrEF therapy, and proposes a research roadmap to design and evaluate the pill and implementation strategies for getting it to patients. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Older Adults and the Mental Health Effects of COVID-19
This Viewpoint summarizes evidence suggesting that, counter to expectation, older adults as a group may be more resilient to the anxiety, depression, and stress-related mental health disorders characteristic of younger populations during the COVID-19 pandemic. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Evolving Strategies for Long-term Asthma Management
Research in the 1960s and 1970s revealed increasing prevalence of asthma in the US and internationally, the importance of airway inflammation in asthma, and the role of indoor aeroallergens as causal or aggravating environmental factors in many patients with asthma. The introduction of inhaled corticosteroid (ICS) treatment for asthma in the 1970s provided an effective approach to long-term pharmacologic therapy. In 1991, the National Heart, Lung, and Blood Institute sponsored the development of the National Asthma Education and Prevention Program (NAEPP) Guidelines for the Diagnosis and Management of Asthma, offering clin...
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

2020 Asthma Guideline Update From the National Asthma Education and Prevention Program
This guideline summarizes updated recommendations for management of asthma in adolescents and adults, focusing on evidence for use of inhaled corticosteroids (ICSs), add-on long-acting muscarinic antagonists (LAMAs), fractional exhaled nitric oxide (FeNO) testing, indoor allergen mitigation, immunotherapy, and evidence against use of bronchial thermoplasty. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Let Me Not Be Mad —My Story of Unraveling Minds
This Arts and Medicine feature reviews a memoir by a pseudonymous UK neuropsychologist who, through creative telling of case histories, questions the boundaries between doctor and patient, brain and mind, language and thought, and well and unwell. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Long-acting Cabotegravir Shot Prevents HIV Among Women
For the first time, a long-acting shot has been shown to prevent HIV among women in a large-scale trial, the National Institute of Allergy and Infectious Diseases (NIAID) said in a statement. The institute announced interim phase 3 trial results for an injectable form of cabotegravir, an investigational HIV drug. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Using Smartwatch Data to Detect COVID-19 Cases Early
Early this year, investigators at the Scripps Research Translational Institute found that resting heart rate and sleep data from wearable sensors could predict population-level trends in influenza-like illness. Now, a new study from the same team suggests that wearable sensor data combined with self-reported symptoms might aid in the early detection of coronavirus disease 2019 (COVID-19). (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Neurodegenerative Dementias Are Differentiated on PET Scans
In a recent study, positron emission tomography (PET) could distinguish Alzheimer disease from frontotemporal lobar degeneration (FTLD) disorders among living patients based on the location of tau protein deposits in the brain. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Data Inaccuracies in Text and Tables
In the Research Letter titled “Prevalence of SARS-CoV-2 Antibodies in Health Care Personnel in the New York City Area,” published online first on August 6, 2020, and in the September 1, 2020, issue of JAMA, there were inaccuracies that resulted from a coding error. The errors, once corrected, affect the relative risks and 95 % CIs for the associations reported in the tables. Working in direct patient care (but not intensive care) is now significant in bivariable but not multivariable analysis, and several demographic variables (including increasing age and non-White race or ethnicity) that were previously repor...
Source: JAMA - December 8, 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 - December 8, 2020 Category: General Medicine Source Type: research

Four COVID-19 Lessons for Achieving Health Equity
The coronavirus disease 2019 (COVID-19) pandemic has underscored the deep inequities in our health care system. The disproportionately high levels of COVID-19 cases, hospitalizations, and deaths among non-White racial groups reflect poorer underlying health, housing, and job conditions among these minority groups, as well as an inequitable distribution of health resources and persistent gaps in insurance coverage. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

The Fly in Court
The housefly is a vicious cuss: He has no fear or shame; He has no business in the soup, But he gets there just the same. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

A Supreme Court ’s Pronouncement Against the Fly
(Williams v. Sweet (Me.), 110 Atl. R. 316) (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Neurodevelopmental Outcomes at Age 5 Years After Prophylactic Early High-Dose Recombinant Human Erythropoietin in Very Preterm Infants
This study reports 5-year neurodevelopmental outcomes for Swiss children born before 32 weeks ’ gestation and randomized at birth to receive early high-dose recombinant human erythropoietin (rhEpo) vs placebo. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Coding Errors in Study of Factors Associated With SARS-CoV-2 Antibodies in Health Care Personnel
To the Editor On behalf of my coauthors, I write to report errors in our Research Letter, “Prevalence of SARS-CoV-2 Antibodies in Health Care Personnel in the New York City Area,” published online first on August 6, 2020, and in the September 1, 2020, issue of JAMA. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Intravenous Acetaminophen in Postoperative Patients
To the Editor In the randomized clinical trial on the effect of intravenous acetaminophen (paracetamol) on postoperative hypoxemia after abdominal surgery, the authors did not find a significant opioid-sparing effect of intravenous acetaminophen and therefore no statistically significant reduction in the adverse effect of hypoxemia. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Intravenous Acetaminophen in Postoperative Patients —Reply
In Reply Dr Shankar asserts that 1 g of acetaminophen (paracetamol) given every 6 hours would not reach steady-state plasma concentrations until late in our 48-hour treatment period. In fact, pharmacokinetic studies indicate that 1 g of intravenous acetaminophen given every 6 hours provides steady plasma concentrations. But more importantly, therapeutic concentrations are reached within 1 hour of the initial dose, and no further effect is seen with an increasing dose. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Effect of Co-trimoxazole vs Placebo Among Patients With Moderate and Severe Idiopathic Pulmonary Fibrosis
This randomized clinical trial compares the effects of co-trimoxazole (trimethoprim-sulfamethoxazole [TMP-SMX]) vs placebo on time to death, lung transplant, or hospital admission in patients with moderate or severe idiopathic pulmonary fibrosis (IPF). (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Notes on Perimenopause
Forty years of flow and ebb and then this wobble: the body ’s reversal. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Prejudice
In this narrative medicine essay, a senior faculty investigator describes common reactions to her visible disability and calls for recruitment of a diverse workforce into academic medicine ’s workforce and leadership positions to normalize physical differences immaterial to the pursuit of outstanding science and patient care. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Pulmonary Fungal Infections Affect Patients With COVID-19
Investigators in Spain and the United States have added 20 new case reports to mounting evidence that patients with coronavirus disease 2019 (COVID-19) are vulnerable to developing pulmonary aspergillosis. Authors of the case series noted that increased physician awareness in recent years of an association between severe influenza and the fungal infection may have led to more rapid recognition of coronavirus disease –associated pulmonary aspergillosis (CAPA). (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Supplement Use Is Common Among Children and Adolescents
Although the proportion of US children and adolescents who use a dietary supplement has remained steady at about one-third for the past decade, a growing number now use 2 or more, according to a CDC report. (Source: JAMA)
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research

Health Policy in the Supreme Court and a New Conservative Majority
This Viewpoint looks at the range of medical and public health issues that could be adversely affected by appointment of Justice Amy Coney Barrett to the US Supreme Court, including weakening or elimination of the Affordable Care Act, Medicaid work requirements that could reduce eligibility, and reduced reproductive rights and governmental public health emergency powers. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Recommendations for Follow-up Colonoscopy After Polypectomy
This JAMA Clinical Guidelines Synopsis summarizes the US Multi-Society Task Force on Colorectal Cancer ’s 2020 recommendations for follow-up after colonoscopy and polypectomy. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Misguided Use of Hydroxychloroquine for COVID-19
This study, from the National Heart, Lung, and Blood Institute PETAL Clinical Trials Network, focused on hospitalized patients with moderate to severe disease. In this well-conducted, appropriately powered clinical trial, the authors randomized 479 patients to receive hydroxychloroquine (400 mg twice daily for 2 doses, then 200 mg twice daily for 8 doses) (n  = 242) or placebo (n = 237). The trial was stopped early at the fourth interim analysis for futility. For the primary outcome, clinical status at 14 days measured on a 7-category ordinal scale, there was no significant difference between th...
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Effect of Hydroxychloroquine on Clinical Status at 14 Days in Hospitalized Patients With COVID-19
This randomized trial compares the effects of hydroxychloroquine vs placebo on clinical status at 14 days (home, requiring noninvasive or invasive ventilation or extracorporeal membrane oxygenation, hospitalized, died) among adults hospitalized with coronavirus disease 2019 (COVID-19). (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Younger Adults Cautioned to Take COVID-19 Seriously as Demographics Shift
This Medical News article discusses the health implications of severe acute respiratory syndrome coronavirus 2 infection among young and middle-aged adults. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

The Challenges Ahead With Monoclonal Antibodies —From Authorization to Access
This Viewpoint discusses questions about clinical indication, supply, distribution, and cost and coverage that will need to be resolved if monoclonal antibodies are be granted Emergency Use Authorization or licensure and become available as treatment for COVID-19. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Therapy for Early COVID-19 —A Critical Need
In this Viewpoint, Fauci and NIAID colleagues review leading candidates for treatment of mild to moderate coronavirus disease 2019 (COVID-19) to prevent disease progression and longer-term complications, including emerging antiviral drugs, immune-modulating agents, and antibody-based therapies, and the challenges of developing randomized trials to rapidly evaluate the safety and efficacy of each. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Hospital-Acquired SARS-CoV-2 Infection
This Viewpoint reviews the rare incidence of nosocomial SARS-CoV-2 infection and discusses ways it can be minimized, including use of surgical masks, proper ventilation, physical distancing, eye protection, regular testing, and the availability of sick leave for health care workers. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

The Need for More and Better Testing for COVID-19
This Viewpoint proposes criteria for more effective COVID-19 testing strategies to manage population transmission, including use of rapid antigen tests and self-administered nasal and salivary tests, emphasizing that more effective testing alone cannot control the pandemic without continued public health interventions, such as mask wearing, physical distancing, and avoidance of large gatherings. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research