After COVID-19: Thinking Differently About Running the Health Care System
Wars and other national crises force society to act differently for a while. But in doing so, they highlight organizational actions and innovations that should not end with the crisis and should be allowed to play a greater role in the future. The coronavirus disease 2019 (COVID-19) pandemic has similar features, and it should spur policy makers who shape the US health care system, to —as Apple Computer cofounder Steve Jobs often urged—“think different.” (Source: JAMA)
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

Clearness in Medical Speech
When Polonius asked Hamlet, “What do you read, my lord?” Hamlet replied, “Words, words, words.” Any one who has served for five years as an officer of this section cannot fail to recall a great deal that was brilliantly conceived and skilfully presented; but if his memory is good he will not have forgotten the occasion al paper which, because of its structure and the manner of its presentation, represented to the audience little more than words. (Source: JAMA)
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

Trends in the Prevalence of Metabolic Syndrome in the United States, 2011-2016
This study uses US national survey data to characterize trends in the prevalence of metabolic syndrome among adults in the US between 2011 and 2016. (Source: JAMA)
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

Vegetable Consumption and Progression of Prostate Cancer
To the Editor Dr Parsons and colleagues conducted a phase 3 nutrition intervention trial among 443 men with prostate cancer. The intervention group was encouraged to consume at least 7 servings of vegetables and fruits daily, including at least 2 servings each of tomatoes and cruciferous vegetables. (Source: JAMA)
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

Vegetable Consumption and Progression of Prostate Cancer
To the Editor In the Men ’s Eating and Living (MEAL) randomized clinical trial, men with early-stage prostate cancer were randomized to receive counseling to increase vegetable consumption to 7 servings per day or more vs the control group receiving written dietary information. We would caution that the generalizability o f the findings may be limited to men with the baseline dietary habits of those recruited to the study. At baseline, the mean total vegetable intake was 3.38 servings per day, an amount twice the mean intake of US men (1.5 servings per day). Hence, most men in the US are likely to have lower vegetabl...
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

Vegetable Consumption and Progression of Prostate Cancer —Reply
In Reply Dr Kerley raises 4 concerns with the design and conduct of the MEAL trial: (1) evidence of dietary changes in the control group; (2) a potential placebo effect in the control group; (3) an inability to achieve predefined dietary targets in the intervention group; and (4) a failure of the intervention to incorporate fat intake. We believe these issues do not change the validity of our conclusions. (Source: JAMA)
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

Physical Therapy Outperforms Injections for Knee Osteoarthritis
Physical therapy reduced pain and functional disability more effectively than glucocorticoid injections among patients with osteoarthritis of the knee, a trial in the New England Journal of Medicine reported. (Source: JAMA)
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

C-Reactive Protein Test Reduces Antibiotics for COPD Flare-ups
In a recent UK trial, use of a C-reactive protein (CRP) point-of-care test to guide treatment decisions reduced antibiotic use among patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Previous research suggests that CRP levels correlate with antibiotic efficacy among patients with AECOPD. (Source: JAMA)
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

Prostate Cancer Drug Degarelix Rapidly Treats Pedophilic Disorder
Degarelix, an advanced prostate cancer drug, rapidly reduced the risk of committing child sexual abuse among men with pedophilic disorder, a phase 2 trial in JAMA Psychiatry found. (Source: JAMA)
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

Plant Extracts May Relieve Hangover Symptoms, Trial Suggests
A dietary supplement drink containing plant extracts improved hangover symptoms after moderate alcohol consumption in a trial published in BMJ Nutrition, Prevention& Health. (Source: JAMA)
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

Clopidogrel Noninferior to Ticagrelor With Less Bleeding
Among older patients with acute coronary syndrome, platelet inhibition with clopidogrel significantly reduced bleeding risk without increasing thrombotic events compared with ticagrelor, a noninferiority trial in The Lancet reported. (Source: JAMA)
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

Feasibility of Ultra-Rapid Exome Sequencing in Critically Ill Infants and Children With Suspected Monogenic Conditions
This descriptive study characterizes time from sample receipt to sequence report as a measure of the feasibility of ultra-rapid genomic diagnosis of critically ill pediatric patients with suspected monogenic conditions in an Australian public health care system. (Source: JAMA)
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

Effect of Intraoperative Dexamethasone on Major Complications and Mortality Among Infants Undergoing Cardiac Surgery
This randomized trial compares the effect of intravenous dexamethasone vs saline on death, need for ECMO or CPR, and other complications among infants younger than 12 months undergoing cardiac surgery with cardiopulmonary bypass. (Source: JAMA)
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

Patient Information: Dog Bites
This JAMA Patient Page describes complications and management of dog bites, emphasizing the importance of washing the wound and close monitoring for infection. (Source: JAMA)
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

Fragments
I stand at the head of a gurney, stroking the bristled scalp of a man with inoperable cancer. He is ten years younger than I am, hollow-boned —wringing the siderail. (Source: JAMA)
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

Cultivating Laughter as an Antidote to COVID-19
In this narrative medicine essay, a physician reviews the science supporting the beneficial health effects of humor and offers tips on how to bring humor into one ’s everyday personal and professional life during and after the COVID-19 pandemic. (Source: JAMA)
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

Hypertension Rates in Rural Areas Outpace Those in Urban Locales
Hypertension rates in rural areas are more than 10% higher than in most urban areas, according to a CDC survey. (Source: JAMA)
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

Postpartum Depression Screening Needs More Consistency
About 13% of US women report depressive symptoms after giving birth, according to a CDC survey. Yet 1 in 8 women said they weren ’t asked about feeling depressed during their postpartum care. (Source: JAMA)
Source: JAMA - June 23, 2020 Category: General Medicine Source Type: research

Continuous Glucose Monitoring in Adolescent, Young Adult, and Older Patients With Type 1 Diabetes
The advent of continuous glucose monitoring (CGM) technology has revolutionized outpatient diabetes care in the past decade. A CGM device consists of a sensor that continuously measures subcutaneous glucose and sends data wirelessly to a display device through a transmitter. CGM offers real-time blood glucose monitoring (BGM) with alerts for trends in blood glucose levels and decreases the need for fingerstick glucose monitoring for people with diabetes. Studies of CGM have shown improvement in glycemic control in adults and children with type 1 diabetes and equivalence to glucometers for self-monitoring of blood glucose. ...
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Targeted Therapy and Diagnostic Test For Non –Small -Cell Lung Cancer
The FDA has approved a targeted therapy for certain adults with metastatic non –small cell lung cancer (NSCLC) as well as an in vitro diagnostic test to detect genetic alterations in their cancer. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Fourth-Line Treatment Approved For Gastrointestinal Tumor
The kinase inhibitor ripretinib has received approval as a fourth-line treatment for adults with advanced gastrointestinal stromal tumor (GIST) who already have been treated with 3 or more kinase inhibitors. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

New Drug Is a Triple Threat Against RET -Altered Cancer
The first drug indicated for patients with 3 types of cancer, all of which have a specific genetic alteration, has received FDA approval. (Source: JAMA)
Source: JAMA - June 16, 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 - June 16, 2020 Category: General Medicine Source Type: research

COVID-19 Reveals Urgent Need to Strengthen the World Health Organization
From the time China reported a novel coronavirus to the World Health Organization (WHO) on December 31, 2019, it took barely 4 months to become a pandemic, killing hundreds of thousands, and growing daily. It is now clear that the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had been circulating in Wuhan, China, for weeks before China reported it to the WHO, and that authorities hid information. China maintained SARS-CoV-2 was not readily transmissible between humans. The WHO published China ’s data, but without independently verifying their accuracy. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

The “Sense” of Humor—Art & amp; Science
In the undefined Good Old Days, a quality known as the “bedside manner” was held to be important to the success of a physician. Then, the good doctor was knowing, sensitive, and, perhaps above all, good-humored. Time, in its march, has heeled good humor in deference to the advances of knowledge, including the important “know-how.” But what of th e “know-why”? (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Physician Notification Regarding Nonadherence to Colorectal Cancer Screening and Cancer Detection
This cluster randomized clinical trial compares the effect of physician notification for colorectal cancer screening and cancer detection on patients who were in a patient-specific reminders group in which physicians received a list of nonadherent patients, in a generic reminders group in which physicians received general information about regional screening adherence, or in a usual care group in which physicians received no reminders. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Pulse Pressure and Isolated Diastolic Hypertension
To the Editor Dr McEvoy and colleagues performed cross-sectional analyses of several large databases to investigate clinical outcomes related to isolated diastolic hypertension (IDH) based on the 2017 hypertension guidelines of a diastolic blood pressure of 80 mm Hg or greater. They found no associations and implied that clinicians need not be clinically concerned by IDH. I disagree. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Home Noninvasive Positive Pressure Ventilation for Chronic Obstructive Pulmonary Disease
To the Editor Dr Wilson and colleagues reviewed bilevel positive airway pressure (BPAP) and home mechanical ventilation for chronic obstructive pulmonary disease (COPD). We are concerned about certain issues related to their methodology. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Pulse Pressure and Isolated Diastolic Hypertension —Reply
In Reply We agree with Dr Anstadt about the tetrad linking systolic and diastolic blood pressure and that pulse pressure is a critically important consideration in any analysis of the relationship between blood pressure and CVD outcomes. Pulse pressure adds prognostic information to systolic or diastolic blood pressure values because pulse pressure, which is calculated as the absolute difference between systolic and diastolic blood pressure, is related to both stroke volume and the compliance of large arteries (with the latter influencing vascular resistance). Therefore, pulse pressure can be an important surrogate marker ...
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Home Noninvasive Positive Pressure Ventilation for Chronic Obstructive Pulmonary Disease —Reply
In Reply The issue of combining randomized clinical trials and nonrandomized studies in a meta-analysis is a common challenge faced during evidence synthesis. When an abundance of well-done randomized clinical trials does not exist, clinical decision-making has to proceed based on the available evidence. In our systematic review about home noninvasive positive pressure ventilation (NIPPV) in COPD, we judged that combining these 2 types of studies was appropriate. For transparency purposes, we presented estimates separately from each study design. When examining the 2 designs, we observed similar trends, consistent results ...
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Effect of Continuous Glucose Monitoring on Hypoglycemia in Older Adults With Type 1 Diabetes
This randomized clinical trial compares the effect of continuous glucose monitoring vs standard blood glucose monitoring on percentage of time spent with hypoglycemia (glucose
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Effect of Continuous Glucose Monitoring on Glycemic Control in Adolescents and Young Adults With Type 1 Diabetes
This randomized clinical trial examines the effect of continuous glucose monitoring vs standard blood glucose monitoring on glycemic outcomes among adolescents and adults with type 1 diabetes and suboptimal glycemic control. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Ticagrelor Monotherapy vs Ticagrelor With Aspirin and Adverse Events in Acute Coronary Syndrome
This randomized trial compares the effects of ticagrelor-based 12-month dual antiplatelet therapy (DAPT) vs 3-month DAPT switching to 9-month ticagrelor monotherapy on rates of major bleeding and cardiovascular events in patients with acute coronary syndromes (ACS) undergoing PCI with drug-eluting stent (DES) placement. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Spinal Metastases
This JAMA Patient Page describes spinal metastases, their diagnosis, and their treatment options. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Recurrence
Because I ’m a poet I try to make music of her diagnosis: scan the adonics of glioblastoma, terminal cancer, clinical trials. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

A Bond
In this narrative medicine essay, an infectious disease fellow describes her discomfort treating patients behind masks and glass doors, laments the distance it creates, and hopes when the COVID-19 pandemic ends that face-to-face medicine resumes. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Study Explores Psychological Harm to Health Workers During Outbreaks
Researchers in Australia have identified dozens of factors that can either increase or decrease clinicians ’ risk of psychological harm during emerging disease outbreaks. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

New Hypertension Guidelines Apply to Diverse Socioeconomic Settings
The International Society of Hypertension has released a simplified guideline for managing hypertension. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Genetic Analysis Tracks SARS-CoV-2 Mutations in Human Hosts
An analysis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes collected from more than 7500 patients worldwide has identified mutations in the virus that could aid in drug and vaccine development. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Bionic Arm With Sensation Tested in Multiyear Study
Researchers recently reported that 4 men with transhumeral amputations have used a self-contained robotic arm with sensory feedback in daily life for several years. The prosthetic ’s hand has sensation, allowing the men to do complex tasks such as ski, repair cars, and canoe. One man became employed full-time thanks to the arm’s improved functionality, and patients also reported complete relief of phantom limb pain. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Existing Drugs Might Treat COVID-19
Drugs already marketed for conditions including schizophrenia might have potential as treatments for coronavirus disease 2019 (COVID-19), a Nature  study suggests. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Blood Test Flags Multiple Cancers in Large Study
A recent study in Science suggests that a blood test to detect different types of cancer is safe when used with positron emission tomography –computed tomography (PET-CT) to confirm the results. The researchers emphasized that, if approved for use, multicancer blood tests should be used alongside standard-of-care screenings to increase detection. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Screening for Unhealthy Drug Use
In this issue of JAMA, the US Preventive Services Task Force (USPSTF) presents a Recommendation Statement and an accompanying Evidence Review on screening for unhealthy drug use. “Unhealthy drug use” refers to drugs that are illegal or medications not used for medical purposes, including cannabis, but not including alcohol, nicotine, or tobacco. Unlike alcohol screening, drug screening approaches aim to capture any drug use and are not restricted to a specific substance; they capture the full spectrum of unhealthy use, from any use through a drug use disorder. (Source: JAMA)
Source: JAMA - June 9, 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 - June 9, 2020 Category: General Medicine Source Type: research

How Will COVID-19 Affect the Health Care Economy?
Coronavirus disease 2019 (COVID-19) has created an economic crisis alongside a health care crisis. During the 2 weeks ending on March 28, nearly 10 million people filed for unemployment insurance, dwarfing any previous monthly numbers. Estimates suggest that the US economy will contract by 10% to 25% during the second quarter. The US has entered a COVID-19 recession. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Immunization Against Plague
The reiterated plea of scientists for accurately controlled experiments in the determination of the value of measures adopted against disease may seem to some physicians to be somewhat too emphatic. Again and again, however, the disinterested scientist is compelled to protest against the use of statistics and experiments by those commercially interested and by overenthusiastic advocates of the prophylactic use of certain products. How difficult it really is to arrive at definite conclusions relative to the efficacy of many such preventive measures is pointed out by Flu, in a recent discussion of experiments on immunization...
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Revisiting Leonardo da Vinci ’s Vitruvian Man
This study uses 3D body scanner measurements of US Air Force recruits to compare ideal body proportions represented by Leonardo da Vinci ’s Vitruvian Man with contemporary body proportions in young adult men and women. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Incisional Negative Pressure Wound Therapy After Surgery for Major Trauma –Related Fractures
To the Editor The results of the Wound Healing in Surgery for Trauma (WHIST) trial by Dr Costa and colleagues should be interpreted with caution until the authors provide information regarding the actual duration of the incisional negative pressure wound therapy because duration is associated with effectiveness. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research