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

Evaluating Non –Statistically Significant Results From Trials in Practice—Reply
In Reply We submit that clinicians have a responsibility to evaluate major clinical trials and, at times, to implement their findings in advance of clinical guidelines being produced by scientific societies and government agencies. In our Viewpoint, we sought to provide a framework for them to do this in situations in which actionable findings might be hidden behind a non –statistically significant primary outcome. We agree with Dr Piovani and colleagues that when deciding whether to implement clinical trial findings, outcomes that matter to patients are the most important. However, because data pertaining to all pot...
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Polysocial Risk Scores for Assessing Social Determinants of Health —Reply
In Reply Drs Kinner and Borschmann raise important concerns around the development and deployment of polysocial risk scores into real-world practice, a topic we described in a Viewpoint. Issues they highlight include problems related to the dynamic nature of social risk, the difficulty of capturing social complexity in a single score, the fact that there is not an optimal score to capture risk across multiple health outcomes, and the potential danger of interpreting the relationship between risk scores and health outcomes as causal. These are all important issues, and we largely agree, although we offer some points for cla...
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Deprescribing Antihypertensive Medication in Elderly Adults —Reply
In Reply We agree with Dr Applegate and colleagues that antihypertensive deprescribing in patients aged 80 years or older should be based on robust scientific evidence. At present there are few studies examining this question, hence the rationale for doing this trial. A recent Cochrane review of studies examining the effects of antihypertensive withdrawal identified just 6 trials enrolling a total of 1073 participants, meaning that our study alone would increase this sample by more than 50%. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Vitamin D and Calcium Prevent Recurrent Vertigo
Vitamin D and calcium supplements reduced vertigo recurrence after successful vestibular rehabilitation, especially among patients with subnormal vitamin D levels, a trial in Neurology reported. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

No Mortality Differences Among Localized Prostate Cancer Treatments
Compared with active monitoring, radical treatment of localized prostate cancer does not improve disease-specific or overall survival at 10 years, a multicenter UK trial in Health Technology Assessment found. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Daily Aspirin Increases Gastrointestinal Bleeding Among Older Adults
People aged 70 years or older who took daily aspirin had an increased risk of clinically significant gastrointestinal (GI) bleeding in the Aspirin in Reducing Events in the Elderly (ASPREE) trial, researchers reported in Gut. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Colchicine Reduces Cardiovascular Events in Chronic Coronary Disease
The anti-inflammatory drug colchicine has been shown to reduce cardiovascular events after recent myocardial infarction. Now, a trial in the New England Journal of Medicine reports that daily low-dose colchicine also significantly reduces the cardiovascular event risk among patients with chronic coronary disease. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Continuing Prednisone Offers Stable Rheumatoid Arthritis Control
For patients with rheumatoid arthritis, continuing low-dose glucocorticoids is safer and controls disease better than tapering them off, a trial in The Lancet concluded. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Ticagrelor vs Clopidogrel and Adverse Events in Patients With Acute Coronary Syndrome Undergoing PCI
This cohort study compares net risk for ischemic vs hemorrhagic events at 12 months among patients treated with ticagrelor vs clopidogrel during and after percutaneous coronary intervention (PCI) management of acute coronary syndrome (ACS). (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Effect of Catheter Ablation With vs Without Vein of Marshall Ethanol Infusion on Persistent Atrial Fibrillation
This randomized trial compares the effect of transcatheter pulmonary vein isolation during catheter ablation with vs without ethanol infusion into the vein of Marshall, an embryologic remnant of the left superior vena cava implicated in atrial fibrillation pathogenesis, on freedom from atrial arrhythmia at 12 months. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Patient Information: Carotid Artery Stenting
This JAMA Patient Page describes the use of the carotid artery stenting procedure to reduce the risk of stroke in patients with carotid artery atherosclerosis. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Palliative Care Consult
(Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Out of the Park —Encouragement Makes All the Difference
In this narrative medicine essay, a surgical oncologist describes the erosion of her confidence when patients and colleagues question her abilities or ignore her contributions based on her diminutive stature and sex and suggests that colleagues offer encouragement and praise to help stay further damage. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Health Care Worker SARS-CoV-2 Infection Is Flying Under the Radar
A high percentage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections among health care workers appear to go undetected, often because they have mild or no symptoms and workplace testing isn ’t sufficient, investigators from a multistate hospital network reported. (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Shifting Hydroxychloroquine Patterns Raise Concern
The number of hydroxychloroquine prescriptions by specialists who don ’t typically prescribe the drug skyrocketed after preliminary reports in March suggested potential benefits for patients with coronavirus disease 2019 (COVID-19). (Source: JAMA)
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

Helping People With Dementia Exercise Their Right to Vote
This Medical News article discusses the right of people with dementia to vote. (Source: JAMA)
Source: JAMA - October 20, 2020 Category: General Medicine Source Type: research

COVID-19 and Heart Failure With Preserved Ejection Fraction
This Viewpoint discusses the emerging apparent association between COVID-19 and heart failure with preserved ejection fraction (HFpEF), and speculates on the pathophysiology and shared risk factors that may underlie the association and the possibility that SARS-CoV-2 infection may unmask or exacerbate existing HFpEF. (Source: JAMA)
Source: JAMA - October 20, 2020 Category: General Medicine Source Type: research

Excess Deaths and the Great Pandemic of 2020
Two new reports in JAMA provide updated estimates regarding the mortality associated with the coronavirus disease 2019 (COVID-19) pandemic in the US. In a research letter by Woolf and colleagues, the authors update their analysis of the number of “excess” deaths in the US related to COVID-19 and other causes from March 1 through August 1, 2020. The authors report that during this 5-month period, a total of 1 336 561 deaths occurred in the US, an estimated 20% increase compared with the number of expected deaths, and representing 225  530 excess deaths. Approximately 67% of these excess deaths were attribu...
Source: JAMA - October 20, 2020 Category: General Medicine Source Type: research

The Toll of COVID-19
Everyone dies eventually. But exactly when did a person die and from what cause? How many deaths were attributable to that cause? These straightforward questions can be challenging to answer, and their answers reveal only part of the effects of a disease on a family, community, and nation, as is the case with deaths from the coronavirus disease 2019 (COVID-19) pandemic. (Source: JAMA)
Source: JAMA - October 20, 2020 Category: General Medicine Source Type: research

Excess Deaths From COVID-19 and Other Causes, March-July 2020
This study updates a previous report of the estimated number of excess deaths in the US during the coronavirus disease 2019 (COVID-19) pandemic through August 1, 2020, and describes causes of those deaths and temporal relationships with state lifting of coronavirus restrictions. (Source: JAMA)
Source: JAMA - October 20, 2020 Category: General Medicine Source Type: research

Excess Deaths From COVID-19, Community Bereavement, and Restorative Justice for Communities of Color
This Viewpoint discusses ways the COVID-19 pandemic has compounded existing health, human rights, and economic disparities in communities of color and proposes a program of restorative justice in response, comprising investments in education and housing, reforms in lending practices and criminal justice, and more. (Source: JAMA)
Source: JAMA - October 20, 2020 Category: General Medicine Source Type: research

Mental Health Disorders Related to COVID-19 –Related Deaths
This Viewpoint discusses the mental health consequences of the coronavirus disease 2019 (COVID-19) pandemic and emphasizes the importance of developing a public health strategy to manage the waves of grief, posttraumatic stress disorder, opioid use, and other mental health consequences of coronavirus-related death and disruption. (Source: JAMA)
Source: JAMA - October 20, 2020 Category: General Medicine Source Type: research

The COVID-19 Pandemic and the $16 Trillion Virus
In this Viewpoint, 2 Harvard economists estimate the cumulative financial costs of the COVID-19 pandemic in the US to date from lost domestic output and health reduction at more than $16 trillion, as a way to put the lesser costs of public health measures, such as population testing, contact tracing, and isolation, in perspective. (Source: JAMA)
Source: JAMA - October 20, 2020 Category: General Medicine Source Type: research

Addition of Inadvertently Omitted Financial Disclosures
In 3 Viewpoints published between June 4 and September 10, 2020, 2 companies should have been included in the disclosure for Ezekiel Emanuel, MD. In addition to those listed in the Conflict of Interest Disclosures, Dr Emanuel reports being a partner at Embedded Healthcare LLC and COVID-19 Recovery Consulting. These articles were corrected online. (Source: JAMA)
Source: JAMA - October 20, 2020 Category: General Medicine Source Type: research

Heart Failure With Preserved Ejection Fraction
Of the estimated 5 million patients in the US diagnosed with heart failure (HF), approximately 50% have HF with preserved ejection fraction (HFpEF), and its prevalence is increasing by about 1% annually relative to that of heart failure with reduced ejection fraction (HFrEF). The mortality associated with HF is substantial, and HF was estimated to account for more than 80  000 deaths annually in the US as of 2017. In addition, because HF is projected to account for an estimated $69.8 billion in annual health care spending by 2030, HFpEF represents an important public health issue that will increase as the population ages...
Source: JAMA - October 20, 2020 Category: General Medicine Source Type: research

Guidelines for Care of Adults With Down Syndrome
Down syndrome continues to be the most common chromosomal condition, with rising prevalence and increased survival. An estimated 1 in 700 infants are born with Down syndrome in the US each year; the median life span is 57 years, with reported survival up to age 82 years. Improved childhood survival is credited to advances in surgery for congenital heart disease, management of respiratory illness, and decreased institutionalization. Mortality after age 20 years is associated with disorders of the cardiovascular and respiratory systems, with severity of the level of intellectual disability, dementia, and mobility restriction...
Source: JAMA - October 20, 2020 Category: General Medicine Source Type: research

Online Sellers of Illegal Opioids Are Targeted
The FDA has warned 17 online pharmacies to stop selling unapproved opioids to consumers without prescriptions or adequate directions for use. (Source: JAMA)
Source: JAMA - October 20, 2020 Category: General Medicine Source Type: research

Youth e-Cigarette Use Drops, More Warnings Issued
Youth e-cigarette use fell by a third after 2 years of increases, according to the 2020 National Youth Tobacco Survey, conducted by researchers at the FDA and the Centers for Disease Control and Prevention. (Source: JAMA)
Source: JAMA - October 20, 2020 Category: General Medicine Source Type: research

Manufacturers Get Advice on Preventing Nitrosamine Impurities
The FDA issued guidance to curtail nitrosamine impurities following a spate of recalls due to unacceptable levels of the probable carcinogen in pharmaceutical products. (Source: JAMA)
Source: JAMA - October 20, 2020 Category: General Medicine Source Type: research