Jama
(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

Screening for Adverse Childhood Experiences —Reply
In Reply I agree with Dr Harris and with Dr Gordon and colleagues that screening for ACEs may reduce child abuse, improve the outcome of physical and mental disorders, and result in better public health, but this has yet to be proven. Where we primarily disagree is whether there are interventions that have been proven to improve health outcomes for children and adults who report high levels of ACEs on screening. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Intraoperative Dexamethasone During Pediatric Cardiac Surgery —Reply
In Reply Mr Wang and colleagues questioned the sample size estimate and use of open-label steroids in our study. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Association of African American Race and Outcomes in Low-Risk Prostate Cancer With Active Surveillance
This cohort study estimates 10-year risk for disease progression, surgery, metastasis, and cause-specific and all-cause mortality among African American men with low-risk prostate cancer managed with active surveillance. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Association Between Industry Payments to Physicians and Device Selection in ICD Implantation
This cross-sectional study examines the association between payments from device manufacturers to physicians and device selection for patients undergoing first-time implantation of a cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D). (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Effect of an Online Weight Management Program With vs Without Individualized Management on Weight Change
This cluster randomized trial compares the effects of an online weight management program with vs without a health manager monitoring progress vs usual care on 12-month weight change among adults with overweight or obesity and a diagnosis of hypertension or type 2 diabetes. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

The Daughter
Give me your hand, you used to say, because I was afraid to wade through the lily pads of the lake on my own. So, my hand in yours, we defeated those red and writhing stems, pushed aside those lavender waterlilies that floated atop them, shuffled through the snails and the grime that lived at the bottom, fish nipping at our toes, dragonflies perching on our shoulders, until we made it to the center of the lake. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Memento Mori
In this narrative medicine essay a cardiologist with a previously treated astrocytoma describes his thoughts and fears of managing a tumor recurrence when he experiences frightening symptoms during the COVID-19 pandemic. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Diagnosis and Treatment of Lower Extremity Venous Thromboembolism (VTE)
This narrative review summarizes recent developments in the diagnosis and management of lower extremity deep vein thrombosis (DVT), including discussion of risk factors, clinical presentation, and risks for pulmonary embolism (PE) and other complications. (Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - November 3, 2020 Category: General Medicine Source Type: research

Nutrient Warnings on Unhealthy Foods
This Viewpoint argues for inclusion of simply worded nutrition warnings on foods with excessive levels of sugar, sodium, and saturated fat, discussing international experience with the practice and its potential to incentivize healthier food products and reduce health inequities. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

De-Adopting Low-Value Care —Evidence, Eminence, and Economics
This Viewpoint proposes that varying combinations of evidence, physician influence, and economics guide the continuation or de-adoption of low-value health services and can help organize and prioritize policy initiatives to drive down the prevalence of wasteful care. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Telephone Visits Surge During the Pandemic, but Will They Last?
This Medical News article describes the use of telephone visits to deliver care during the pandemic. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults
This guideline from the International Antiviral (formerly AIDS) Society –USA updates practice recommendations for managing HIV infection including when to initiate antiviral therapy, how to monitor patients’ response, when to change antiviral regimens, and use of preexposure prophylaxis (PrEP) to prevent infection in those at risk. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Regional Citrate vs Systemic Heparin Anticoagulation and Filter Life Span and Mortality in AKI Patients
This randomized clinical trial compares the effect of regional citrate vs systemic heparin anticoagulation on dialysis filter life span and 90-day mortality among critically ill adults with acute kidney injury (AKI) receiving continuous kidney replacement therapy. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Trains and Outer Space —The Unique Worlds Within Autism
This Arts and Medicine feature presents “Outer Space”, a neo-punk song written, played, and produced by a practicing neurogenetics psychiatrist to honor the brilliance of people with autism spectrum disorder and their families. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Error in Table
The Original Investigation titled “Effect of Out-of-Hospital Tranexamic Acid vs Placebo on 6-Month Functional Neurologic Outcomes in Patients With Moderate or Severe Traumatic Brain Injury,” published in the September 8, 2020, issue, included an error in Table 2 that presented the number of participants in the bolus-only group t hat had more than 3% of clot lysed at 30 minutes following maximum amplitude as 3 rather than 31. The Table has been corrected online and now indicates 31 participants. (All other information in the Table was correct and is unchanged.) (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Net Adverse Clinical Events With Antiplatelet Therapy in Acute Coronary Syndromes
Clopidogrel, prasugrel, and ticagrelor are oral platelet P2Y12 receptor inhibitors that decrease the risk of platelet-mediated coronary artery thrombosis. Clinical guidelines have recommended ticagrelor or prasugrel over clopidogrel in combination with aspirin as dual antiplatelet therapy (DAPT) for 1 year after acute coronary syndrome (ACS), whether or not percutaneous coronary intervention (PCI) is performed. The ticagrelor recommendation was based on the Study of Platelet Inhibition and Patient Outcomes (PLATO) trial, which enrolled 18  624 patients with ACS and randomized them to receive DAPT with either clopidogrel ...
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Substance Use Disorder Linked to Higher COVID-19 Risk
People with substance use disorder (SUD), particularly those with opioid use disorder (OUD) and Black individuals, are at an increased risk of coronavirus disease 2019 (COVID-19), according to a recent study coauthored by Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA). (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

US Drug Use Survey Uncovers Both Promising and Concerning Trends
Among people aged 12 years or older in 2019, 60.1% reported having used a substance during the past month, according to the latest National Survey on Drug Use and Health, compiled by the Substance Abuse and Mental Health Services Administration. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Rising Rates of ED Visits for Suicidal Ideation, Suicide Attempt
From 2008 to 2017, the rate of emergency department (ED) visits related to suicidal ideation or suicide attempt increased among all age groups 5 years or older, according to a recent report from the Agency for Healthcare Research and Quality (AHRQ). (Source: JAMA)
Source: JAMA - October 27, 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 - October 27, 2020 Category: General Medicine Source Type: research

Financial Stability as a Goal of Payment Reform —A Lesson From COVID-19
Over the last decade, the US health care system embarked on a journey toward value-based care. The Centers for Medicare& Medicaid Services (CMS) designed and implemented a range of value-based payments through the rollout of alternative payment models, such as accountable care organizations (ACOs). The goal of these efforts was to increase value by improving quality and reducing costs. To date, however, alternative payment models have had modest effects on health outcomes or spending. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

The Physician ’s Responsibility
The recent decision of the Supreme Court of Nebraska, abstracted in the Medicolegal department of The Journal last week, is of importance and interest to practicing physicians, and especially to health officers …. The plaintiff, while stopping at a small hotel, consulted a local physician, the defendant, regarding some sores that had appeared on his body. After an examination, the physician told the plaintiff—his patient—that he believed the disease to be syphilis, but that it was impossible to make a positive diagnosis without a Wassermann test, for which he had no equipment. The defendant physician was...
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Evaluating Non –Statistically Significant Results From Trials in Practice
To the Editor The Viewpoint by Dr Young and colleagues discussed the interpretation of non –statistically significant results from clinical trials. The topic of statistical vs clinical significance has long been debated in medical research. Although there have been attempts to dismiss P values, arguing that the criteria for statistical significance should be substituted with “discussi ng compatible effects,” most of the decisions in medicine remain dichotomous: a new drug will either be licensed or not and it will either be used for a certain condition or not. We believe P values and confidence intervals ...
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Evaluating Non –Statistically Significant Results From Trials in Practice
To the Editor Dr Young and colleagues suggested that there are occasions when clinicians may treat statistically nonsignificant results as clinically meaningful and incorporate them in important clinical decision-making, especially when considering the effect size and associated confidence intervals. This recommendation is problematic because it elevates underpowered studies in clinical decision-making. Even more problematic in this context is the assumption that inferences can be made directly from group-level data to the individual, even if the group-level results are ambiguous or nonsignificant. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Polysocial Risk Scores for Assessing Social Determinants of Health
To the Editor Dr Figueroa and colleagues recognized the importance of social determinants in shaping health outcomes. Echoing a recommendation to study marginalized populations, they recommended multisectoral data linkage as a promising means of examining these complex relationships. We agree with this recommendation but urge caution in pursuing development of a polysocial risk score for 4 reasons. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Deprescribing Antihypertensive Medication in Elderly Adults
To the Editor Deprescribing medications in frail older adults may result in improvements in overall health status. However, deprescribing should be based on a full consideration of scientific evidence. A clinical trial of antihypertensive medication reduction in persons aged 80 years or older with a systolic blood pressure of less than 150 mm Hg (mean, 130 mm Hg) reported that after 12 weeks of follow-up, the intervention group, which underwent removal of 1 medication, was noninferior with regard to systolic blood pressure control compared with the control group, in which there was no change. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research