Improving Stroke Preparedness Among Blacks and Hispanics
A culturally tailored film on stroke preparedness did not lead to greater recognition of stroke symptoms in black and Hispanic individuals at high risk for stroke, according to a trial in JAMA Neurology. (Source: JAMA)
Source: JAMA - August 27, 2019 Category: General Medicine Source Type: research

Ketamine to Help Treat Cocaine Use Disorder
A single ketamine infusion in individuals with cocaine use disorder, coupled with a mindfulness behavioral modification program, promoted abstinence and reduced the risk of relapse, reported a trial in the American Journal of Psychiatry. (Source: JAMA)
Source: JAMA - August 27, 2019 Category: General Medicine Source Type: research

Whole Food Combination Diet for Kids With Crohn Disease
A whole food –rich diet combined with partial enteral nutrition (PEN) resulted in sustained remission in children with mild to moderate Crohn disease and was better tolerated than exclusive enteral nutrition (EEN), reported a trial in Gastroenterology. (Source: JAMA)
Source: JAMA - August 27, 2019 Category: General Medicine Source Type: research

Antidepressants May Affect Pain Neural Network
Patients with persistent depressive disorder (PDD) treated with antidepressants showed reduced functional connectivity in a neural network associated with pain, a finding that may point to a target of novel antidepressant treatment, according to a study reported in Lancet Psychiatry. (Source: JAMA)
Source: JAMA - August 27, 2019 Category: General Medicine Source Type: research

Association Between Educational Attainment and Causes of Death Among White and Black US Adults, 2010-2017
This population epidemiology study uses US National Vital Statistics System data to describe trends in life expectancy at age 25 among US adults by race and education level and contributions of specific causes of death to between-group differences in those trends between 2000 and 2017. (Source: JAMA)
Source: JAMA - August 27, 2019 Category: General Medicine Source Type: research

Tandem vs Single Autologous Stem Cell Transplant and Event-Free Survival in High-Risk Neuroblastoma
This randomized trial compares the effect of intensification of consolidation therapy using sequential or “tandem” vs single autologous transplant after induction therapy on event-free survival among children and young adults with high-risk neuroblastoma. (Source: JAMA)
Source: JAMA - August 27, 2019 Category: General Medicine Source Type: research

Effect of High-Dose Vitamin D Supplementation on Volumetric Bone Density and Bone Strength
This randomized trial compares the effects of 400 vs 4000 vs 10  000 IU of vitamin D on total volumetric bone mineral density and bone strength of the radius and tibia. (Source: JAMA)
Source: JAMA - August 27, 2019 Category: General Medicine Source Type: research

Chest Tubes
This JAMA Patient Page describes reasons for use of chest tubes and the process of chest tube insertion and removal. (Source: JAMA)
Source: JAMA - August 27, 2019 Category: General Medicine Source Type: research

Washbasin
A light flickers. Palmfuls of water scooped slowly out of the sink cleanse an angular face now shaven. Another scoop and levels recede. Droplets lost through cracks in weary hands wet the lino. The remainder drip into the soft fabric of a loose towel that could wrap itself twice round this body. (Source: JAMA)
Source: JAMA - August 27, 2019 Category: General Medicine Source Type: research

A Difficult Conversation: Delivering News of Fatal Illness to Your Partner
In this narrative medicine essay, a physiatrist recalls his role in telling his wife of her diagnosis of metastatic ovarian cancer, his support during her inexorable decline, and how the experiences of her passing drew his family closer, nurtured his appreciation for relationships, the wonder of nature, and the renewed sense of connection to the world. (Source: JAMA)
Source: JAMA - August 27, 2019 Category: General Medicine Source Type: research

Systemic Therapy for Locally Advanced and Metastatic Non –Small Cell Lung Cancer
This narrative review summarizes advances in molecular testing for mutations in non –small cell lung cancer, selection of molecularly targeted therapies based on those mutations, and the use of PD-1 inhibitor immunotherapies for the management of metastatic and stage III nonmetastatic disease. (Source: JAMA)
Source: JAMA - August 27, 2019 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - August 27, 2019 Category: General Medicine Source Type: research

Less Addictive Cigarettes
Eight in 10 smokers favor requiring cigarette manufacturers to lower nicotine levels in cigarettes to make them less addictive, according to a study published by CDC scientists in the American Journal of Preventive Medicine. (Source: JAMA)
Source: JAMA - August 27, 2019 Category: General Medicine Source Type: research

Rising PrEP Awareness
Awareness about the potential benefits of preexposure prophylaxis (PrEP) has increased from 60% in 2014 to 90% in 2017 among men who have sex with men (MSM) at high risk of HIV, according to a survey by the CDC. (Source: JAMA)
Source: JAMA - August 27, 2019 Category: General Medicine Source Type: research

ECG Diagnosis of Atrial Arrythmias
This Clinical Challenge reviews ways to distinguish atrial ectopy, AV block, multifocal atrial tachycardia, and other supraventricular tachycardias from atrial fibrillation in patients with absent P waves, irregularly irregular R-R intervals, and f waves on electrocardiography. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Numbers of Patients Transposed in Text
In the Original Investigation entitled “Effect of Pressure Support vs T-Piece Ventilation Strategies During Spontaneous Breathing Trials on Successful Extubation Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial,” published in the June 11, 2019, issue of JAMA, patient numbers were transposed in a sentence i n the Results section of the text. The first sentence in the Secondary Outcomes subsection on page 2178 should have read “After the first SBT, 532 patients (92.5%) undergoing the 30-minute PSV SBT and 486 patients (84.1%) undergoing the 2-hour T-piece SBT were extubated (diff...
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Maintenance Treatment for Psychotic Depressive Disorders
Psychotic features, such as delusions of guilt or persecution, in major depressive disorder (MDD) attracted little research interest before the observation that patients with psychotic depression responded poorly to tricyclic antidepressants. Subsequent work showed that other depressive symptoms, particularly those of the melancholic subtype, are substantially more severe in this condition than they are in MDD without psychotic features. Second only to those with catatonic features, patients with psychotic features are most likely to experience hyperactivity of the hypothalamic-pituitary-adrenal axis and are much less like...
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Broadening Criteria for BRCA1/2 Evaluation
Pathogenic variants (ie, mutations) in the breast cancer susceptibility 1 and 2 (BRCA1/2) genes are associated with a high risk of ovarian and female breast cancer as well as, particularly for BRCA2, elevated risks of male breast cancer, aggressive prostate cancer, and pancreatic cancer. The risks of ovarian cancer and breast cancer are as high as 45% and 70%, respectively. The detection of a BRCA1/2 pathogenic variant can significantly alter medical management (by early detection or risk reduction strategies) and improve outcomes. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Thyroid Function Test Abnormalities During Pregnancy
Thyroid hormones affect the growth, metabolism, and function of multiple organs in the body. If adaptive mechanisms were not in place during pregnancy, physiological increases in the quantity of circulating thyroid hormone –binding proteins would result in lower concentrations of unbound (free) thyroid hormones and subsequent adverse maternal and fetal consequences. Fortunately, the hypothalamic-pituitary-thyroid axis compensates, matching thyroidal output to maternal requirements, and, as long as the thyroid has ad equate reserves, thyrotropin (often referred to as thyroid-stimulating hormone or TSH) and free thyrox...
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Smoking Cessation and Reduction of Cardiovascular Disease Risk
Smoking cessation improves cardiovascular health, but not right away. Studies have come to different conclusions about how long it takes for the excess risk associated with smoking to subside to the level of a never smoker, with estimates varying widely, from 2 to 20 years. The study by Duncan et al, which was based on repeated assessments of tobacco exposure, other risk factors, and cardiovascular disease (CVD) outcomes, provides estimates of cardiovascular risk among former smokers that are likely to be more precise and accurate than those of previous studies. This information is important for clinicians and patients. Ac...
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Another Option for Hypoactive Sexual Desire
The FDA recently approved bremelanotide for acquired generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. It ’s the first “as-needed” treatment for HSDD, a common condition characterized by low libido that causes distress or interpersonal difficulty and isn’t attributed to a coexisting medical or psychiatric condition, relationship problems, or medications. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Ventilator Recall
More than 4000 Hamilton-G5 ventilators have been recalled due to a sporadic error message that can cause it to stop working, the FDA recently announced. The device provides breathing support for adult, pediatric, infant, and neonatal patients in intensive care. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

First Treatment for Rare Autoimmune Neuromyelitis
The humanized monocolonal antibody eculizumab has been approved for adults with neuromyelitis optica spectrum disorder (NMOSD), a rare autoimmune inflammatory condition of the central nervous system (CNS). The disorder causes recurrent optic neuritis and myelitis, which may lead to permanent vision loss and paralysis. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Prevalence and Treatment of Chronic Obstructive Pulmonary Disease (COPD) in the United States
(Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Highlights for August 20, 2019
(Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Catheter Ablation for Atrial Fibrillation in 2019
This JAMA Insights Clinical Update reviews management approaches to atrial fibrillation (AF), including assessment of the need for anticoagulation, and controversies over the need for rhythm control and the role of catheter ablation for maintaining sinus rhythm and reducing AF-associated symptoms. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Averting Alert Fatigue to Prevent Adverse Drug Reactions
Although various electronic health records (EHRs) have different features, nearly all seem to have alerts for potential problems with drug prescribing. It ’s one thing that many believe that EHRs do very well. However, a recent study warns that when it comes to opioids and benzodiazepines, we shouldn’t always assume that such alerts work as intended. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

The Relation of Pathology to Practice
With the swinging of the pendulum in the science of medicine has come the fashion of neglecting pathology, the pathology of the type called, in the olden days, morbid anatomy. This neglect is shown in many ways: in a diminution in the volume of published work; in the lessened number of necropsies performed, and in the smaller number of men who are actively interested in the subject. It may be that the great days of Rokitansky, of Virchow and of Cohnheim have passed never to return; but it is more likely that the next swing of the pendulum will bring with it a renewed interest in the study of the anatomic changes which acco...
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Monitoring Adherence to Inhaled Medications
To the Editor Drs Hew and Reddel highlighted the importance of adherence to inhaled controller medications in the treatment of chronic respiratory conditions. Some of their claims regarding adherence monitoring systems for inhalers lacked a balanced perspective. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Resuming Anticoagulation After Cerebral Intraparenchymal Hemorrhage
To the Editor Dr Gross and colleagues reviewed the management options for cerebral intraparenchymal hemorrhage (IPH) to help guide clinical decision-making. The review captured the most up-to-date evidence for clinical management of IPH; however, the authors ’ suggestion to resume oral anticoagulation therapy 1 to 2 months after deep IPH unrelated to cerebral amyloid angiopathy may not be supported by firm evidence. We believe the recommendations should be more cautious. The 2015 American Heart Association guidelines do not provide a definitive recomm endation for resumption of anticoagulation therapy after nonlobar ...
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Treating Hypercholesterolemia in Older Adults
To the Editor In his Viewpoint, Dr Skolnik discussed the 2018 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on the management of blood cholesterol and its implications for older adults. We would like to highlight relevant features of the guidelines that merit greater recognition. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Monitoring Adherence to Inhaled Medications —Reply
In Reply While we agree with the important points that Dr Bryant and colleagues have made about the role of multidisciplinary teams in improving adherence, we believe they may have misinterpreted our main thesis by inadvertently conflating adherence monitoring with adherence management. We have argued that input from pharmaceutical companies is essential to rectify the current lack of adherence monitoring. We do not, however, equate this with delivering overall adherence management, which is a far broader endeavor, needing to take into account multiple contributory factors and requiring an adequately resourced multidiscipl...
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Resuming Anticoagulation After Cerebral Intraparenchymal Hemorrhage —Reply
In Reply We agree with Ms Leasure and Dr Sheth that there is no firm evidence to support timing of restarting anticoagulation therapy following IPH, particularly for new-generation anticoagulants. We stated in our review that restarting anticoagulation therapy should be delayed by 1 to 2 months in patients with nonlobar IPH unrelated to amyloid angiopathy, but we did not state that anticoagulation therapy must be restarted in all cases at this time. In patients with a correctable etiologic cause of IPH and stronger indications for anticoagulation therapy, such as mechanical heart valves, anticoagulation therapy may need to...
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Treating Hypercholesterolemia in Older Adults —Reply
In Reply Dr Forman and colleagues, in a response to my Viewpoint, provide clarification regarding the IIb grade of the recommendation for management of hypercholesterolemia in older adults. A IIb recommendation indicates that a recommendation is based on weak evidence that the benefit is greater than the risk. The fact that clinical judgment should be used in carrying out a IIb recommendation is true but not distinct to IIb recommendations. Clinical judgment needs to be used for all recommendations. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Association of Smoking Cessation With Subsequent Risk of Cardiovascular Disease
This cohort study uses Framingham Heart Study data to assess the association between years since smoking cessation and incident cardiovascular disease (CVD), compared with current and never smoking, among participants without baseline CVD over a median follow-up of 26 years. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Effect of Continuing Olanzapine vs Placebo on Relapse Among Patients With Psychotic Depression in Remission
This randomized clinical trial compares the effect on relapse of continuing olanzapine vs placebo among patients with psychotic depression who achieved remission of psychosis and depressive symptoms while taking olanzapine and sertraline. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Association of Thyroid Function Test Abnormalities and Thyroid Autoimmunity With Preterm Birth
This individual participant data meta-analysis pooled data from 19 cohort studies to assess whether maternal thyroid function test abnormalities and thyroid autoimmunity are risk factors for preterm birth among pregnant women without overt thyroid disease. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Testing for BRCA Mutations
This JAMA Patient Page describes the US Preventive Services Task Force ’s recently published recommendations on risk assessment and genetic counseling and testing for BRCA mutations and BRCA-related cancers. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Playing Word Games
I sprinkle hints, seeds in the withering garden of your brain, hope words will sprout, blossom on your lips. But deep in the gray matter, atrophy spreads like a biblical pestilence. In that un-Eden, hummingbirds dart, like crazed syllables, scatter alphabets like fallen petals amid stems of thought — bare, but pretending to be bright. Colors for flowers, all I could expect. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

A Tale of Two Lungs: Helping Patients Make Decisions
In this narrative medicine essay, a critical care physician works through lessons he learned from his experience with a man with end-stage lung disease going into terminal respiratory failure who consented to intubation only if he had a chance for a lung transplant and considers how to balance patient autonomy with medical paternalism when good outcomes are unlikely and the best decisions are uncertain. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

USPSTF Report: Risk Assessment, Genetic Counseling, and Testing for BRCA- Related Cancer
This systematic review to support the 2019 US Preventive Services Task Force Recommendation Statement on risk assessment, genetic counseling, and genetic testing for BRCA-related cancer summarizes published evidence on the benefits and harms of assessment, counseling, and testing in women without recently diagnosed BRCA1/2-related cancer. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

USPSTF Recommendation: Assessment, Counseling, and Testing for BRCA -Related Cancer
This 2019 Recommendation Statement from the US Preventive Services Task Force recommends that women with a family or personal history associated with increased risk for harmful mutations in the BRCA1/2 genes and with a positive result on a brief familial risk assessment tool should receive genetic counseling and, if indicated, genetic testing (B recommendation) and recommends against routine risk assessment, genetic counseling, or genetic testing for women whose personal or family history is not associated with potentially harmful BRCA1/2 gene mutations (D recommendation). (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Gag Rule May Increase Abortions
Abortion rates in some sub-Saharan African countries increased by 40% when a US policy that pulled federal funding from overseas organizations that performed or discussed abortion was in effect, according to a study in The Lancet Global Health. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Viruses Drive Children ’s Pneumonia
Respiratory syncytial virus and other viruses have replaced bacteria as the leading cause of severe childhood pneumonia in low- and middle-income countries, according to a study in The Lancet that examined childhood pneumonia in 7 Asian and African countries. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Fighting Epilepsy Stigma
Greater efforts are needed worldwide to combat stigma and discrimination against patients with epilepsy, according to a World Health Organization report. (Source: JAMA)
Source: JAMA - August 20, 2019 Category: General Medicine Source Type: research

Detecting Circulating Tumor Cells Through the Skin
Today ’s methods of detecting circulating tumor cells (CTCs) in blood are hampered by poor sensitivity, which limits the so-called liquid biopsies’ usefulness for catching low-level CTCs present before metastasis, when prognosis is better. A new photoacoustic liquid biopsy approach that peers through the skin was more sensitive than existing assays in detecting CTCs in patients with melanoma. (Source: JAMA)
Source: JAMA - August 13, 2019 Category: General Medicine Source Type: research

Smart Devices Detect Agonal Breathing in Cardiac Arrest
Roughly half of people who experience a cardiac arrest demonstrate agonal breathing, a brainstem reflex during severe hypoxia. Researchers at the University of Washington in Seattle are teaching smart devices to detect this audible biomarker, often described as gasping breaths. Agonal breathing sounds from Seattle-area 911 cardiac arrest calls were used to train and validate a detection system recently introduced in npj Digital Medicine. (Source: JAMA)
Source: JAMA - August 13, 2019 Category: General Medicine Source Type: research

Meditation App Improves Attention in Young Adults
Healthy young adults had significant improvements in sustained attention on cognitive tasks after using a meditation-inspired mobile app for 6 weeks in a recent randomized clinical trial, which appeared in Nature Human Behavior. (Source: JAMA)
Source: JAMA - August 13, 2019 Category: General Medicine Source Type: research

Gluten and Celiac Disease Risk
Celiac disease provides a unique model for autoimmune research because the following key elements are known: the specific genes involved in its pathogenesis and the environmental trigger. Substantial genetic research has uncovered the strong influence of the HLA antigen and its mechanistic role in presenting deamidated gluten to effector immune cells involved in the pathogenesis of celiac disease. Researchers also have identified more than 57 alleles in addition to HLA genes that confer risk. Although this information is crucial to understanding celiac disease, it cannot explain the substantial increase in the prevalence o...
Source: JAMA - August 13, 2019 Category: General Medicine Source Type: research