Measuring Clinical Importance in a Trial of Interventions for Mixed Urinary Incontinence
To the Editor In a randomized clinical trial, Dr Sung and colleagues found that behavioral and pelvic floor muscle therapy combined with surgery, compared with surgery alone, improved urinary incontinence symptoms, but the difference did not meet the minimal clinically important difference (MCID). Although it is important to interpret the clinical magnitude of the difference observed between the experimental and control conditions in a randomized clinical trial, be it statistically significant or not, the way the authors used the MCID is misplaced. This is a common misuse of the MCID (also called the minimal important diff...
Source: JAMA - February 4, 2020 Category: General Medicine Source Type: research

HIPAA in the Era of Data Sharing —Reply
In Reply We agree with Mr Kels that HIPAA has involved burdens for physicians —some real and others amplified by uncertainty and fear of liability. However, Kels misread our Viewpoint insofar as he suggests that we are arguing for a private right of action to increase physicians’ liability under HIPAA. Such a move would do little to help regulate many uses of health data by technology companies because they fall outside HIPAA’s scope. (Source: JAMA)
Source: JAMA - February 4, 2020 Category: General Medicine Source Type: research

Herd Protection Against Oral HPV Infection —Reply
In Reply Mr Zhuang and Dr Xu comment on 2 aspects of our study of oral HPV infection in the United States: HPV types with potential vaccine cross-protection and results by age group. (Source: JAMA)
Source: JAMA - February 4, 2020 Category: General Medicine Source Type: research

Measuring Clinical Importance in a Trial of Interventions for Mixed Urinary Incontinence
In Reply Dr Furukawa discusses the use and interpretation of the MCID as a within-group as opposed to a between-group measure for a patient-reported outcome. (Source: JAMA)
Source: JAMA - February 4, 2020 Category: General Medicine Source Type: research

Drugs for Bacterial Conjunctivitis and Dry Eye Disease
This Medical Letter review summarizes drugs available for the treatment of bacterial conjunctivitis and dry eye disease, including detail on formulations, dosage, and cost. (Source: JAMA)
Source: JAMA - February 4, 2020 Category: General Medicine Source Type: research

Association Between Neurological Disorders and Death by Suicide in Denmark
This population epidemiology study uses Danish registry data to examine associations between neurological disorders and higher suicide rates from 1980 through 2016. (Source: JAMA)
Source: JAMA - February 4, 2020 Category: General Medicine Source Type: research

Noninvasive Positive Pressure Ventilation and Clinical Outcomes in Chronic Obstructive Pulmonary Disease
This meta-analysis of trials and observational studies evaluates the association of the use of home noninvasive positive pressure ventilation (NIPPV) via home mechanical ventilator (HMV) and bilevel positive airway pressure (BPAP) devices with clinical outcomes and adverse events in patients with chronic obstructive pulmonary disease (COPD) and hypercapnia. (Source: JAMA)
Source: JAMA - February 4, 2020 Category: General Medicine Source Type: research

Effects of Iron Isomaltoside vs Ferric Carboxymaltose on Hypophosphatemia in Iron-Deficiency Anemia
Because intravenous (IV) iron can induce hypophosphatemia, the 2 clinical trials in this report directly compare the effects of 2 IV iron formulations, iron isomaltoside (now known as ferric derisomaltose) and ferric carboxymaltose, on phosphate levels in patients with iron-deficiency anemia unresponsive to oral iron. (Source: JAMA)
Source: JAMA - February 4, 2020 Category: General Medicine Source Type: research

Causes of Memory Loss in Elderly Persons
This JAMA Patient Page describes different possible causes of memory loss, including neurodegenerative dementias and other conditions that may be reversible or permanent. (Source: JAMA)
Source: JAMA - February 4, 2020 Category: General Medicine Source Type: research

To Make a Living
An ophthalmologist died last week. I saw his obituary in the New York Times: 50 years as a devoted hospital employee, director, chairman, and trustee. And 140 peer-reviewed publications to remember his name. I think this is what it means to make a living: to worship the body for its productivity and pray at the altar of work. So he must have been dead on the morning he called in sick, lying in bed with his half-dreaming lover, preparing for the sloth of seacoast and sun damage. And dead again after pocketing an extra jelly donut to bring home for his daughter when the breakroom note said, please take just one. Which makes ...
Source: JAMA - February 4, 2020 Category: General Medicine Source Type: research

The Farewell and the Power of a Healing Lie
In this narrative medicine essay, an Asian American hospital chaplain reviews the film The Farewell, which tells the story of a Chinese family taking elaborate measures to hide a cancer diagnosis from the family matriarch, and compares it to her own professional and personal experience. (Source: JAMA)
Source: JAMA - February 4, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - February 4, 2020 Category: General Medicine Source Type: research

Health System Billing Quality as Medical Quality
This Viewpoint discusses the adverse effects on patients of low billing quality (such as extremes in billing practices, pricing, and collection tactics), and proposes a 5-item rating system benchmarking billing quality to reduce financial harms and barriers to care, and improve health care quality and patient outcomes. (Source: JAMA)
Source: JAMA - February 4, 2020 Category: General Medicine Source Type: research

Data Errors in Table 1 of Study of Vitamin C in Sepsis
This article has been corrected online. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Malpractice Liability and Quality of Care
In this issue of JAMA, Mello and colleagues report findings from a review of 37 studies and conclude that increased liability exposure (such as numbers of malpractice claims, dollar amounts of liability insurance premiums, or changes to state malpractice laws) was not associated with improvement in the quality of patient care. Their review draws effectively from databases of peer-reviewed medical literature, economics scholarship, and legal publications, and presents a thorough, necessary, and rigorous analysis of recent research. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

HHS Provides Free PrEP Medication to People Without Drug Coverage
The US Department of Health and Human Services (HHS) recently began making pre-exposure prophylaxis (PrEP) available for free to people without prescription drug insurance coverage. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Too Much Screen Time for Young Children, Experts Say
Nearly 9 in 10 infants and young children spend more time in front of a television, computer, or mobile device screen than recommended by the American Academy of Pediatrics (AAP), suggests a study published recently in JAMA Pediatrics by researchers at the National Institutes of Health (NIH) and 2 academic centers. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Rural Veterans Less Likely to Get Medication for Opioid Use Disorder
Less than a third of veterans who were treated for a substance use disorder (SUD) by the Department of Veterans Affairs (VA) in 2018 received specialty services for their disorder, according to a recent Government Accountability Office (GAO) report. (Source: JAMA)
Source: JAMA - January 28, 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 - January 28, 2020 Category: General Medicine Source Type: research

Competitors in Unpopularity
The physician is not the only scientific man who is made the sport of the pseudo-scientist or the disappointed layman. The Scientific American, under the heading “Our Unpopular Weather Man,” draws a pertinent comparison in an editorial that is so good that we quote it in full: (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

First-Trimester Pregnancy Exposure to Modafinil and Risk of Congenital Malformations
This study uses pharmacoepidemiology data from Danish national health registries to examine the association between first-trimester exposure to modafinil and risk of major congenital malformations. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Treatment of Iron Deficiency After Gastric Bypass
To the Editor In a JAMA Diagnostic Test Interpretation article, Dr Murali described a patient with combined vitamin B12 and iron deficiency after bariatric surgery. The patient had a low mean corpuscular volume because the iron deficiency was primary. I am concerned about the recommendation to prescribe 60 mg of oral iron twice daily. In the section on the treatment of adults with iron deficiency on the UpToDate website, oral iron is specifically proscribed. Ingested iron must be conjugated to vitamin C, amino acids, and sugars in the presence of gastric acid in the stomach to protect the iron from the alkaline secretions ...
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Home-Based Physical Therapy for Older Adults After Hip Fracture
To the Editor A randomized clinical trial of a multicomponent home-based physical therapy intervention, compared with an active control intervention, for older adults recovering from hip fracture reported 6 falls in the intervention (training) group vs 4 in the control group. Two of the falls in the training group occurred during supervised training sessions, resulting in 1 hip fracture. There was a fatality in the training group of unclear etiology. The rate and consequence of falls during supervised exercise training in this study are unusual for exercise intervention trials in older adults. Their circumstances warrant c...
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Home-Based Physical Therapy for Older Adults After Hip Fracture
To the Editor The Community Ambulation Project (CAP) randomized clinical trial showed that a multicomponent home-based physical therapy intervention failed to improve ambulation (ability to walk ≥300 m in 6 minutes) among older patients with a hip fracture compared with an active control intervention. However, the result may be partly attributed to the low rate of intervention adherence. In the trial, 27.6% of training participants did not complete 80% of expected intervention visits and only 34.3% to 65.7% of training participants achieved intervention targets in 25 to 38 visits. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Treatment of Iron Deficiency After Gastric Bypass —Reply
In Reply Dr Auerbach takes issue with the treatment of a patient with vitamin B12 and iron deficiency after gastric bypass with oral iron. His claim that all patients who undergo bariatric surgery have an obligate need for parenteral iron because of poor absorption or increased risk with oral iron supplementation lacks clinical nuance and scientific evidence. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Home-Based Physical Therapy for Older Adults After Hip Fracture —Reply
In Reply In response to Dr Schlicht, there are several reasons why we believe the results of the CAP trial do not suggest that physical activity for older adults is unsafe. First, the incidence of falls in the training group of our study (6/105 over 16 weeks) is considerably lower than that reported in studies following people for 6 to 12 months after hip fracture. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Prednisolone Reduces Hand Osteoarthritis Pain
A short course of a potent dose of prednisolone safely reduced finger pain and local joint inflammation in patients with hand osteoarthritis, a trial in The Lancet reported. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

HIV Tests Increase Diagnoses
Free HIV self-tests mailed to men who have sex with men increased HIV testing and diagnosis in a randomized trial in JAMA Internal Medicine. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Skip Physiotherapy for Pediatric Constipation
Adding physiotherapy to conventional treatment for functional constipation in children had no beneficial effect, a trial in the Journal of Pediatrics concluded. Physiotherapy trains pelvic floor and abdominal muscles for better intra-abdominal pressure during bowel movements. In the study, conventional treatment consisted of toilet training, nutritional advice, and laxatives. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Should Younger Male Cancer Survivors Get Testosterone Therapy?
Male cancer survivors aged 25 through 50 years who received testosterone replacement had decreased body fat and increased muscle mass in a PLOS Medicine trial. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Dapagliflozin Cuts Risk of Worsening Heart Failure
Dapagliflozin reduced the risk of worsening heart failure and death in patients with and without diabetes, a trial in the New England Journal of Medicine found. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Association Between Isolated Diastolic Hypertension Defined by the 2017 ACC/AHA Blood Pressure Guideline and Incident CVD
This study uses NHANES survey and population cohort data to compare the prevalence of isolated diastolic hypertension (IDH) in the United States by 2017 ACC/AHA and 2003 Joint National Committee (JNC7) definitions and to compare associations with cardiovascular disease (CVD). (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Yield of a Public Health Screening of Children for Islet Autoantibodies in Bavaria, Germany
This study categorizes the prevalence of 2 or more islet autoantibodies identified in preschool children in a population screening program, and the progression from presymptomatic to clinical symptomatic type 1 diabetes. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Ketogenic Diets
This JAMA Patient Page describes ketogenic diets, their medical uses, and their potential health benefits, risks, and side effects. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Nothing New Under the Sun
What I want back are not my breasts, though they were the exact ones I would have chosen in the breast shop. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

A Call for Help: Reflections on Burnout, CABG Surgery, and the Super Bowl
In this narrative medicine essay, a surgeon uses the example of an NFL coach who after taking time away for burnout led his team to a Super Bowl championship to reflect on how a supportive environment that cares for patients and physicians could reduce burnout and subsequent adverse health outcomes. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Malpractice Liability and Health Care Quality: A Review
This systematic review summarizes evidence of associations between malpractice liability risk, defined as the extent to which clinicians face the threat of being sued and having to pay damages, and measures of health care quality and safety. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Prediabetes in Youth
Nearly 1 in 5 adolescents and about 1 in 4 young adults have prediabetes, according to a study by CDC scientists published in JAMA Pediatrics. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Studies Support HPV Safety
With more than 28 million doses administered since 2014, the CDC hasn ’t identified any new or unexpected safety concerns with the human papillomavirus vaccine, according to a pair of CDC studies published in Pediatrics. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Incorrect Value in Results
This article has been corrected online. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Incorrect Data in Table and Discussion Section
This article has been corrected online. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Tracing the Evidence to Address Painful Chronic Pancreatitis With Surgery
Chronic pancreatitis is characterized by pancreatic endocrine and exocrine insufficiency, along with persistent, and in some cases, unrelenting pain. While pancreatic insufficiency is effectively managed with pharmacologic intervention, the pain associated with this condition is difficult to control and commonly leads to severe consequences for the patient. A search of ClinicalTrials.gov for chronic pancreatitis revealed 152 studies, nearly all of which consist of interventions for pain. The current modalities, including pain medication, pancreatic enzyme replacement, behavioral therapy, endoscopic treatment, and surgery, ...
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Hydroxyethyl Starch for Fluid Replacement Therapy in High-Risk Surgical Patients
Hydroxyethyl starch (HES) solutions have had a turbulent history as resuscitation fluids. There was initial optimism that these products would efficiently expand the intravascular space with a prolonged intravascular half-life and therefore would be “volume sparing,” with less edema. However, enthusiasm was tempered when HES solutions were reported to be harmful when administered to critically ill patients, including those with sepsis. Despite these concerns, HES is still used in surgery under the premise that lower doses infused under stri ct protocols would be safe. In this issue of JAMA, Futier and colleague...
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Systemic Absorption of Sunscreen
UV radiation is the most important known modifiable risk factor for the development of skin cancer including melanoma. Behavioral measures to reduce this risk factor include seeking shade, wearing hats and protective clothing, avoiding outdoor activities during peak sunlight hours, and regularly using sunscreen. Sunscreen ingredients fall into 2 distinct categories: mineral or chemical. Mineral sunscreens contain physical UV filters, such as zinc oxide and titanium dioxide, that offer broad-spectrum UV coverage by reflecting or refracting UV radiation from skin. Chemical sunscreens contain UV filters that absorb UV radiati...
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Improving Outcomes in Patients With Atrial Fibrillation and Hypertension
Atrial fibrillation and hypertension represent 2 of the most important national public health priorities. Atrial fibrillation is the most common sustained cardiac arrhythmia among adults, affecting up to 2% of the US population. The prevalence of atrial fibrillation is expected to increase 3-fold in the next 3 decades. Robust data have identified hypertension as an independent modifiable risk factor for atrial fibrillation and as the most common cardiovascular condition associated with it. Hypertension is present in up to 80% of individuals with atrial fibrillation. Fulfilling a fundamental principle of evidence-based medi...
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

New Test Detects MRSA in Hours Rather Than Days
The FDA has authorized a new diagnostic test based on bacteriophage technology to detect methicillin-resistant Staphylococcus aureus (MRSA) colonization more quickly than traditional culture-based techniques allow. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

App Enables Sharing Off-label Treatments for Infectious Diseases
A new app will allow health professionals to share how they ’ve used FDA-approved drugs for off-label indications with patients who have difficult-to-treat infectious diseases. The internet-based repository, called CURE ID, is a collaboration between the FDA and the National Center for Advancing Translational Sciences, which is part of the National Institu tes of Health (NIH). (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Duchenne Screening Test Is OK ’d
The first test to aid in screening newborns for Duchenne muscular dystrophy (DMD) has received FDA authorization for marketing. (Source: JAMA)
Source: JAMA - January 21, 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 - January 21, 2020 Category: General Medicine Source Type: research