COVID-19 Halts Reproductive Care for Millions of Women
Since coronavirus disease 2019 ushered in lockdowns and limited movement, London-based Marie Stopes International reported that roughly 2 million fewer women have received reproductive care services through its programs in 37 countries. The result could be 1.5 million additional unsafe abortions, 900  000 unintended pregnancies, and 3100 additional deaths, according to the nonprofit organization that provides contraception and safe abortion. (Source: JAMA)
Source: JAMA - October 20, 2020 Category: General Medicine Source Type: research

New Insights on COVID-19 ’s Hyperinflammation in Children
A rare, life-threatening hyperinflammatory syndrome that some children develop after coronavirus disease 2019 (COVID-19) is distinct from Kawasaki disease, according to a collaboration among European scientists. (Source: JAMA)
Source: JAMA - October 20, 2020 Category: General Medicine Source Type: research

Pandemic Accelerates the Threat of Global Hunger
Acute hunger is expected to affect 270 million people worldwide by this year ’s end—an 82% increase since the coronavirus disease 2019 pandemic began, according to the United Nations World Food Programme (WFP). (Source: JAMA)
Source: JAMA - October 20, 2020 Category: General Medicine Source Type: research

That Dragon, Cancer —Exploring End of Life Through an Unwinnable Video Game
This Arts and Medicine feature reviews That Dragon, Cancer, a 2016 video game that challenges players to love and care for a 4-year-old with brain cancer whose treatment options gradually narrow and disappear. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Combining Rapid PCR and Antibody Tests Improved COVID-19 Diagnosis
Nose and throat swab polymerase chain reaction (PCR) testing can miss up to 50% of coronavirus disease 2019 (COVID-19) cases, in part because the virus may have already cleared the upper respiratory tract. But by then, patients may have developed antibodies against the virus. An approach that combines rapid PCR and antibody testing could help physicians quickly diagnose more cases, a recent small study of hospitalized patients with suspected COVID-19 suggested. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Portable MRI —Coming to the ICU?
A portable magnetic resonance imaging (MRI) scanner used to assess brain injury at the bedside was feasible and safe in a study involving 50 critically ill patients at Yale New Haven Hospital ’s intensive care units (ICUs). The prototype portable MRI plugs into a standard wall outlet and maneuvers easily in an ICU room, researchers reported in JAMA Neurology. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Heritable Genome Editing Not Ready for the Clinic, Panel Says
Two years after the “CRISPR babies” controversy, a committee of international experts has concluded in a new consensus report that pregnancies with genome-edited human embryos aren’t ready for prime time. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Incorrect Information in Text and Table Heading
This article has been corrected online. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Intensive Smoking Cessation Counseling for Patients With Cancer
Smoking remains the leading cause of preventable death in the United States. Tobacco use increases the risk of multiple cancers, including lung, oropharyngeal, pancreas, bladder, stomach, and colon. Continued tobacco use following a cancer diagnosis increases the risk of cancer recurrence, new primary cancers, and adverse treatment-related outcomes, including postoperative pulmonary complications, poor surgical healing, and decreased response to chemotherapeutic drugs. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Palliative Care for Patients With Noncancer Illnesses
The term palliative care was coined in 1975 to describe the core goals of a newly created hospital-based service in Quebec, Canada, designed to improve quality of life and mitigate sources of distress for patients with serious life-threatening illness. Now, 45 years later, palliative care retains its central focus on improving quality of life for individuals with serious life-limiting illnesses and their families by addressing physical and psychological symptoms and social and spiritual needs and aligning patient and family values with available care options. (Source: JAMA)
Source: JAMA - October 13, 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 13, 2020 Category: General Medicine Source Type: research

Trump vs Biden on Health Care
There was always an expectation that health care would be one of the biggest issues in this year ’s presidential campaign, as was the case in the 2018 mid-term elections. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Women in Medicine
Florence deL. Lowther, Ph.D. and Helen R. Downes, Ph.D., Barnard College, New York (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Diagnostic Imaging for Kidney Stones
To the Editor Dr Rule and colleagues concluded that computed tomography (CT) should be used as the first diagnostic test in patients with suspected kidney stones because it is the most accurate diagnostic test and because small stones can be missed on ultrasonography. We disagree and believe that the evidence supports an ultrasonography first strategy, with CT as needed. This will result in improved patient outcomes for several reasons. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Replicability of Treatment Effect in Study of Blood Pressure Lowering With Dementia
To the Editor Dr Hughes and colleagues found that blood pressure lowering with antihypertensive agents was associated with a reduced risk of dementia or cognitive impairment compared with a control. This conclusion was primarily driven by a statistically significant odds ratio of 0.93 (95% CI, 0.88-0.98) resulting from performing a meta-analysis on 13 effect estimates from 12 randomized clinical trials. We would like to point to one particular consideration regarding the conclusions drawn from this meta-analysis. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Door-to-Needle Time and Long-term Outcomes in Patients With Stroke
To the Editor We are interested in the relationship between door-to-needle time and 1-year outcomes in patients with acute ischemic stroke in the study by Dr Man and colleagues. We think potential correlation between door-to-needle time and stroke care quality might explain the association between door-to-needle time and outcomes. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Diagnostic Imaging for Kidney Stones —Reply
In Reply We stand by our recommendation of CT first for a diagnostic evaluation of renal colic. Dr Wang and colleagues raise 3 objections to this recommendation and advocate for ultrasonography first instead. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Replicability of Treatment Effect in Study of Blood Pressure Lowering With Dementia —Reply
In Reply Dr Panagiotou and colleagues suggest that a replicability analysis would enhance our meta-analysis. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Door-to-Needle Time and Long-term Outcomes in Patients With Stroke —Reply
In Reply Although factors other than faster door-to-needle times may have contributed to the associations between door-to-needle times and 1-year mortality and readmission in our study, there are multiple lines of evidence to suggest that door-to-needle times contributed to improved clinical outcomes and were not just an index for generic stroke care quality. The hospitals providing data for our study were participating in Get With The Guidelines (GWTG) –Stroke, a national quality improvement initiative. Prior studies have analyzed conformity of GWTG-Stroke hospitals with standard stroke care measures, including 7 pe...
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Palliative Care and Health Care Use and Patient-Centered Outcomes in Adults With Noncancer Illness
This meta-analysis estimates the association between palliative care and health care use, disease-generic and disease-specific measures of quality of life, and symptom burden among adults with noncancer illness. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Association Between Change in Geography and Change in Likelihood of Uncontrolled CVD Risk Factors in US Veterans
This cohort study uses Veterans Health Administration data to estimate the change in prevalence of chronic cardiovascular disease (CVD) risk factors among veterans whose residential zip code changed vs remained the same between 2008 and 2018 to better understand the contribution of geography vs individual patient characteristics to poor risk factor control. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Sustained Smoking Cessation Counseling/Medication vs Shorter-term Counseling/Medication Advice on Smoking Abstinence
This randomized trial compares the effect of sustained telephone counseling and medication vs shorter-term telephone counseling and medication advice on 6-month smoking abstinence among patients at academic cancer hospitals recently diagnosed with cancer. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Association of Lumbar Puncture With Spinal Hematoma in Patients With and Without Coagulopathy
This cohort study uses Danish registry data to assess the risk of spinal hematoma following lumbar puncture in patients with vs without coagulopathy (platelets1.4, or APTT>39 seconds). (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Patient Information: Smoking Cessation and Cancer Survivorship
This JAMA Patient Page describes available smoking cessation treatments and explains how quitting smoking can improve quality of life and survival among patients with cancer. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Babinski Sign
More often than not, my patients are embarrassed when I ask them to take off their socks. They trust me with great boluses of fear, but naked feet? Their knobby bunions are like our drought-brown hills. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

How Workplace COVID-19 Outbreaks Affect Workers of Color
Almost three-quarters of the people in Utah who acquired coronavirus disease 2019 (COVID-19) at work earlier this year were Hispanic or non-White, even though they make up only about a quarter of the state ’s workforce, according to a recent analysis. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Overdose Education and Naloxone Distribution Expanded
A marked increase in the number of US syringe service programs that offer opioid overdose education and medication occurred between 2013 and 2019, according to a recent national survey. (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Emergency Use Authorizations During the COVID-19 Pandemic —Lessons From Hydroxychloroquine for Upcoming Vaccine Approval
This Viewpoint uses the FDA ’s Emergency Use Authorization (EUA) of hydroxychloroquine for COVID-19 treatment to emphasize the costs of premature regulatory authorizations to public health and trust, and proposes the use of advisory committees, requirements for postmarketing surveillance, and adherence to standards of transp arency for any future EUAs. (Source: JAMA)
Source: JAMA - October 6, 2020 Category: General Medicine Source Type: research

Insight on Sex-Based Immunity Differences, With COVID-19 Implications
Women and men have striking differences in their autoimmune disease risk, their predisposition to and prognosis with various cancers, and their ability to respond to some infections —including the novel coronavirus. New research offers a potential explanation for these distinctions: sex-based differences in neutrophils, humans’ most common circulating immune cells. (Source: JAMA)
Source: JAMA - October 6, 2020 Category: General Medicine Source Type: research

Incorrect Corresponding Author Address
This article was corrected online. (Source: JAMA)
Source: JAMA - October 6, 2020 Category: General Medicine Source Type: research

New Disease Cases, Deaths Related to Breast Implants
During the last half of 2019, the FDA added 160 new cases of disease and 3 deaths to its data set of adverse events related to breast implants. (Source: JAMA)
Source: JAMA - October 6, 2020 Category: General Medicine Source Type: research

Therapy Approved for Rare Neurological Autoimmune Disorder
Another treatment for certain patients with the rare autoimmune disease neuromyelitis optica spectrum disorder (NMOSD) has received FDA approval. (Source: JAMA)
Source: JAMA - October 6, 2020 Category: General Medicine Source Type: research

Deceptive Hand Sanitizer Packaging
The FDA has warned that alcohol-based hand sanitizers are being packaged in containers that resemble food or drinks, endangering people who might accidentally ingest them. (Source: JAMA)
Source: JAMA - October 6, 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 6, 2020 Category: General Medicine Source Type: research

Medicare Advantage for All, Perhaps?
The coronavirus disease 2019 (COVID-19) pandemic is forcing a much-needed questioning of the US health system. What is the right balance of authority between the federal government and the states? How should the profound inequities and gaps in the system be better addressed? Should emergency regulations, like those allowing more telemedicine and flexible funding, become permanent features of the system? (Source: JAMA)
Source: JAMA - October 6, 2020 Category: General Medicine Source Type: research

The Segregation of Pneumonia
The study of means for the protection and care of the child has received a tremendous impetus from the World War, and never before has the attention of so many agencies been concentrated upon its problems. (Source: JAMA)
Source: JAMA - October 6, 2020 Category: General Medicine Source Type: research

Continuous Pulse Oximetry Monitoring in Bronchiolitis Patients Not Receiving Oxygen
To the Editors Dr Bonafide and colleagues found variability among hospitals in the use of pulse oximetry after discontinuation of oxygen therapy in children hospitalized for bronchiolitis. They suggested that oxygen monitoring should be deimplemented. We have 3 concerns. (Source: JAMA)
Source: JAMA - October 6, 2020 Category: General Medicine Source Type: research

Biomechanical Footwear for Osteoarthritic Knee Pain
To the Editor Dr Reichenbach and colleagues reported that among participants with knee pain from osteoarthritis, use of biomechanical footwear compared with control footwear resulted in an improvement in pain after 24 weeks of follow-up. There are several issues regarding the trial that are worth considering. (Source: JAMA)
Source: JAMA - October 6, 2020 Category: General Medicine Source Type: research

Delayed Antibiotic Prescriptions
To the Editor Drs Rowe and Linder argued too strongly that when clinicians prescribe delayed antibiotics, they are abdicating their responsibility and doing harm, and they did not cite relevant evidence. (Source: JAMA)
Source: JAMA - October 6, 2020 Category: General Medicine Source Type: research

Continuous Pulse Oximetry Monitoring in Bronchiolitis Patients Not Receiving Oxygen —Reply
In Reply Dr Keim-Malpass and colleagues raise interesting points about our study of continuous pulse oximetry monitoring in bronchiolitis. First, they comment that the evidence underlying the American Academy of Pediatrics recommendation against continuous pulse oximetry is weak and that parents find physiologic monitoring reassuring; therefore, calls for deimplementation are unwarranted. This logic suggests that weak evidence of harm (without evidence of benefit) and parent preference justify implementation of a medical intervention. We disagree. Similar logic likely contributed to the overprescribing of antibiotics for m...
Source: JAMA - October 6, 2020 Category: General Medicine Source Type: research

Biomechanical Footwear for Osteoarthritic Knee Pain —Reply
In Reply Dr Lei and colleagues correctly state that the positioning of the external pods of the biomechanical footwear in our trial was individually adjusted. The treatment protocol for adjusting the pods was described in detail in Supplement 3 in the article. This is considerably more detail than most physical therapy or exercise intervention trials provide. Adjustments were done according to this protocol by experienced and trained technicians based on gait patterns and patient-reported symptoms. The attempt to shift the center of pressure in the shoe and foot laterally in patients with medial knee osteoarthritis has bee...
Source: JAMA - October 6, 2020 Category: General Medicine Source Type: research

Delayed Antibiotic Prescriptions —Reply
In Reply Dr Little disagrees with our Viewpoint and accuses us of arguing too strongly against the use of delayed antibiotic prescriptions. (Source: JAMA)
Source: JAMA - October 6, 2020 Category: General Medicine Source Type: research

courvoisier's law
she was 37 and i was 26 and she was going to die and i was not and i think i am supposed to tell you something about it with meaning and emotion and hope against the lack of hope and how there are waterfalls in the world that are not discovered where the rivers are still warm and the flows tumble like soft hair on a ceaseless summer's day and there are times when just before the total folding just before the top meets the bottom in complete collapse there is mist that can kiss a face full of a happy life yet all i have is this and she does not and both of these are too soon an end (Source: JAMA)
Source: JAMA - October 6, 2020 Category: General Medicine Source Type: research

Calming the Storm —Managing Anxiety-Related Somatic Symptoms
In this narrative medicine essay a cardiology fellow shares his deep appreciation for a primary care physician who recognized his chest pain as anxiety related and draws lessons for how physicians of all specialties can help patients with somatic symptoms from COVID-19 pandemic-related uncertainties. (Source: JAMA)
Source: JAMA - October 6, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - October 6, 2020 Category: General Medicine Source Type: research

Graduate Medical Education, 2019-2020
This Appendix presents 2019 National GME Census data detailing the numbers and types of ACGME-accredited training programs and the residents and fellows in them. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Medical Schools in the United States, 2019-2020
This Appendix presents data from the 2019-2020 Liaison Committee on Medical Education (LCME) annual questionnaire detailing information on the number of students, student demographics, curriculum content, and enrollment at US medical schools. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

The COVID-19 Pandemic and the JAMA Network
Journal editors sit at the crossroads of new ideas and findings, deciding which are worth refining and making public in their journals and which are best saved for another time and place. The global arrival of coronavirus disease 2019 (COVID-19) has brought an increase in manuscript submissions describing and evaluating the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its morbidity and mortality, distilling what seems like years of science and policy into several months. JAMA Network editors were quickly reeducated in principles of epidemiology and public health related to epidemics ...
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Declines in Lung Cancer Deaths Linked to Treatment Advances
Mortality from non –small cell lung cancer (NSCLC) in the US decreased between 2013 and 2016, a period corresponding with the approval of several targeted therapies for the disease, National Cancer Institute (NCI) researchers recently reported. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research