Communicating Science in the Time of a Pandemic
This Viewpoint uses the example of rapid changes to public reporting on the efficacy of hydroxychloroquine and remdesivir for COVID-19 to illustrate how misinformation damages the public ’s trust in science and medicine, and urges accuracy and circumspection in news reports of developments in the pandemic. (Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

SARS-CoV-2 Positivity Rate for Latinos in the Baltimore –Washington, DC Region
This study characterizes the trends in rates of SARS-CoV-2 positive test results among individuals in the Baltimore –Washington, DC area by self-reported race/ethnicity. (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Figure Error
In the Original Investigation titled “Effect of a Chikungunya Virus–Like Particle Vaccine on Safety and Tolerability Outcomes: A Randomized Clinical Trial,” published in the April 14, 2020, issue of JAMA, a decimal was missing in the lowest number on the y-axis of Figure 3. The number “75” should have been “7.5.” This art icle was corrected online. (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Menopausal Hormone Therapy and Long-term Breast Cancer Risk
Reports from the Women ’s Health Initiative (WHI), first published in 2002, have informed and complicated the narrative of the relative benefits and potential harms of menopausal hormone therapy (HT) over the past 20 years. Prior to the initiation of the WHI trials, hormone therapy had already experienced a tumultuous p ublic stature. Initially heralded as the cure for menopause in the 1960s, unopposed estrogen therapy was vilified when its association with increased risk of endometrial hyperplasia and cancer emerged. The discovery that the addition of progesterone to estrogen therapy mitigated this risk propelled ho...
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Better HHS Planning Needed for National Disaster Medical System
The US Department of Health and Human Services (HHS) needs better strategic planning to ensure it has enough physicians, nurses, and other health care professionals enrolled in the National Disaster Medical System (NDMS), according to a recent report from the US Government Accountability Office (GAO). (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Higher Rate of Opioid-Related Stays in Urban Than Rural Hospitals
In most parts of the country, hospitals in metropolitan areas had a higher average rate of opioid-related inpatient stays than hospitals in rural areas, according to a recent analysis of 2016 data by the Healthcare Cost and Utilization Project (HCUP), which is sponsored by the Agency for Healthcare Research and Quality. (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

NIH Launches Platform to Serve as Depository for COVID-19 Medical Data
The National Institutes of Health (NIH) recently launched the National COVID Cohort Collaborative (N3C) to store and study medical record data from people across the country who have been diagnosed with coronavirus disease 2019 (COVID-19). (Source: JAMA)
Source: JAMA - July 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 - July 28, 2020 Category: General Medicine Source Type: research

Prescribing Paid Sick Leave —An Important Tool for Primary Care During the Pandemic
“Fourteen days—no work, no outings. Please stay home.” (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

“Pseudodoxia Pediatrica”
Under the heading “pseudodoxia pediatrica” Bakwin calls attention to a number of doubtful practices in current use among pediatricians. The worst offender among these, he believes, is indiscriminate tonsillectomy. The American Child Health Association, some ten years ago, surveyed a group of 1,000 children 11 yea rs of age from the public schools of New York City; 61 per cent had had their tonsils removed. The remaining 39 per cent were subjected to examination by a group of physicians who, in turn, selected 45 per cent of these for tonsillectomy and rejected the rest. The rejected children were reexamined b y ...
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Trends in HIV PrEP Prescribing in the US, 2012-2018
This study uses national pharmacy claims data to describes trends in prescriptions for HIV preexposure prophylaxis (PrEP) overall and by specialty between 2012 and 2018. (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Drug Prices, Rebates, and Discounts
To the Editor Dr Hernandez and colleagues found that list and net prescription drug prices have increased out of proportion to inflation, and that the gap between list and net prices has widened. Most prominently, among non-Medicaid patients (who are mostly covered by Medicare Part D or commercial insurance plans), rebates and other price concessions increased from 23% in 2007 to 51% in 2018. The authors used estimates of discounts (including manufacturer rebates) calculated by SSR Health, which uses a proprietary algorithm to estimate net prices by dividing publicly reported manufacturer revenue by the volume of filled pr...
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Pathogenic Variants in Breast Cancer Susceptibility Genes in Older Women
To the Editor The advent of sequencing technologies has brought genetic information to the forefront of clinical decision-making for cancer patients. Universal germline testing for hereditary cancer is not yet recommended; rather, there are guidelines on who to test based on certain features suggestive of hereditary predisposition, such as early age at diagnosis and family history. (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Drug Prices, Rebates, and Discounts
To the Editor The analysis of prescription drug net price growth by Dr Hernandez and colleagues has 2 methodological issues that affect the interpretation of results. First, the authors overestimated the increase in discounts provided by drug manufacturers to non-Medicaid payers and underestimated the increase in discounts to Medicaid. Second, their methodology for estimating the mean growth in prices and discounts cannot be linked to drug spending. (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Drug Prices, Rebates, and Discounts —Reply
In Reply In our study, we estimated changes in list prices, net prices, and discounts for branded drugs from 2007 to 2018. We found that discounts offset 62% of increases in list prices, and that after discounts, net prices still increased by 60% from 2007 to 2018, or 4.5% per year. (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Pathogenic Variants in Breast Cancer Susceptibility Genes in Older Women —Reply
In Reply We wish to emphasize that we did not in fact recommend that all postmenopausal breast cancer patients undergo multiple gene panel testing. Instead, we commented that the prevalence of BRCA1/2 PVs among patients with breast cancer diagnosed at age 64 years or younger was 2.2%, comparable with that of people of Ashkenazi Jewish ancestry (2.5%), for whom BRCA1/2 testing is supported by guidelines. This result, together with our finding that the prevalence of any breast cancer –associated PV was 3.55%, led us to conclude that prevalence in postmenopausal breast cancer patients “may be high enough to warran...
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Telehealth Reduces Excess Weight Gain in Pregnancy
A telehealth lifestyle intervention substantially decreased excess gestational weight gain (GWG) among pregnant women who were overweight or obese and improved insulin resistance markers, a trial in The Lancet Diabetes& Endocrinology reported. (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Rivaroxaban Reduces Complications of PAD Revascularization
Daily rivaroxaban and aspirin significantly reduced major limb and cardiovascular events among patients with peripheral artery disease (PAD) who had undergone lower-extremity revascularization, a trial in the New England Journal of Medicine reported. (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Intervention Improves Kids ’ Attitudes About Mental Disorders
A school-based intervention reduced mental health stigma among preadolescent students and resulted in more children seeking treatment, according to a trial in Pediatrics. (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Novel Therapy Eradicates H pylori
Antimicrobial resistance to existing therapies has made Helicobacter pylori infection increasingly difficult to treat. In a phase 3 trial published in the Annals of Internal Medicine, a 3-drug combination of amoxicillin, omeprazole, and rifabutin in 1 capsule achieved high eradication rates of H pylori infection. (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Wellness Program Failed to Improve Employee Health
A comprehensive workplace wellness program did not improve health outcomes, a trial in JAMA Internal Medicine reported. (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Association of Menopausal Hormone Therapy With Long-term Breast Cancer Incidence and Mortality
This study reports 20-year breast cancer incidence among participants in Women ’s Health Initiative (WHI) trials randomized to conjugated equine estrogen (CEE) alone or with medroxyprogesterone acetate vs placebo. (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

The Healthy, Hunger-Free Kids Act and Dietary Quality Among Children in the US School Lunch Program
This national survey study assesses the dietary quality of lunch for students participating in the National School Lunch Program (NSLP) before and after implementation of the Healthy, Hunger-Free Kids Act, which, in 2012, aligned school lunch nutrition standards with the 2010 Dietary Guidelines for Americans. (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Effect of Intravenous Acetaminophen on Postoperative Hypoxemia After Abdominal Surgery
This randomized trial compares the effect of intravenous acetaminophen vs placebo on duration of hypoxemia during the initial 48 postoperative hours among patients undergoing colorectal and other abdominal surgeries. (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Patient Information: The Trauma Scene
This JAMA Patient Page reviews some of the actions bytanders, first responders, and medical personnel can take at the scene of a trauma (eg, car crash, gunshot, drowning) to stabilize a patient for transportation to a trauma center hospital. (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Lullaby
I sang to it, turning the key on the small white lace musical pillow given at birth to my son by a man now dust. Its quivering mechanical pitches pulsed against my bruised skin, the deepening twilight yellow from the biopsy needle. No longer afraid, my fingers glided over its smooth globe, vacant ballroom, mirrors draped and crackled. If I loved it, maybe it would leave me. I held it, honed tiger steps, red velvet walls of the heart, paws large enough to carry us through any cold room, hips swaying like a pendulum, lugubrious tail trailing the polished floor, chairs knocked over. Other nights, (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

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

Dramatic Increase in US Congenital Syphilis Cases
A nearly 4-fold increase in US congenital syphilis cases between 2013 and 2018 underscores many missed opportunities to prevent the disease, the CDC reported. (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

More Than 1 in 3 US Adults Use Disinfectants Unsafely
In a recent online survey, 39% of US adults reported using disinfectants and other cleaning products in potentially harmful ways as they tried to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. (Source: JAMA)
Source: JAMA - July 28, 2020 Category: General Medicine Source Type: research

Validation and Utility Testing of Clinical Prediction Models —Issues About Uptake and Clinical Utility
In this Viewpoint, John Ioannidis and colleagues discuss the proliferation of undervalidated or unvalidated clinical prediction models (CPMs) and propose an open-source repository where risk prediction scores could be updated in real time and validated as a means to facilitate identification of best-performing and reduce creation of duplicate or unhelpful models. (Source: JAMA)
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research

Errors in Data and Statistical Significance
This article was corrected online. (Source: JAMA)
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research

Watch Your Medicine: Video Game Therapy for Children With ADHD
The first video game therapy to treat children with attention-deficit/hyperactivity disorder (ADHD) was given a nod. Prescription-only EndeavorRx is indicated for children aged 8 to 12 years who have an attention issue. (Source: JAMA)
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research

HIV Antiviral Expanded for Use in Very Young Children
The FDA expanded use of the HIV antiviral dolutegravir to treat children aged 4 weeks or older who weigh at least 3 kg. The drug was previously approved for children aged 6 years or older who weighed at least 30 kg. (Source: JAMA)
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research

Second Drug Okayed for Rare Central Nervous System Disease
The FDA approved a second treatment for neuromyelitis optica spectrum disorder (NMOSD), a neuroinflammatory disease that can cause permanent blindness and paralysis. An estimated 4000 to 8000 people in the US have NMOSD, mostly women. (Source: JAMA)
Source: JAMA - July 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 - July 21, 2020 Category: General Medicine Source Type: research

Medications for Primary Prevention of Breast Cancer
This JAMA Insights Clinical Update reviews indications for use of medications for primary prevention of breast cancer and the comparative effectiveness and adverse effects of selective estrogen receptor modulators (tamoxifen, raloxifene) and aromatase inhibitors (anastrozole, exemestane) for this purpose. (Source: JAMA)
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research

Current Comment
(Source: JAMA)
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research

Use of Risk Evaluation and Mitigation Strategies (REMS) by the FDA, 2008-2019
This study uses publicly available FDA.gov data to characterize trends in the US Food and Drug Administration ’s use of Risk Evaluation and Mitigation Strategy (REMS) programs between 2008 and 2019 and to describe the number and classes of medications included, the strategies deployed, and the risks the program was intended to mitigate. (Source: JAMA)
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research

PTSD Treatments for Veterans
To the Editor The JAMA Insights article by Dr Steenkamp and colleagues highlighted the need to improve treatment outcomes of posttraumatic stress disorder (PTSD) for veterans and service members. However, we are concerned because the article failed to accurately characterize the recommendations of the Department of Veterans Affairs (VA)/Department of Defense (DoD) PTSD Practice Guideline and drew erroneous conclusions from the evidence that may be potentially detrimental to this population. (Source: JAMA)
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research

Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump for Cardiogenic Shock
To the Editor The observational study by Dr Dhruva and colleagues suggested that clinical outcomes were worse for patients with an acute myocardial infarction and cardiogenic shock who received an intravascular microaxial LVAD vs an IABP. However, there are statistical problems in this study, and the researchers missed an opportunity to provide a more nuanced test of intravascular microaxial LVAD vs IABP. (Source: JAMA)
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research

Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump for Cardiogenic Shock
To the Editor Dr Dhruva and colleagues reported a higher risk of in-hospital death and bleeding complications in patients treated with an Impella device (intravascular microaxial left ventricular assist device [LVAD]) compared with an intra-aortic balloon pump (IABP) among patients with cardiogenic shock. Randomized clinical trials (RCTs) are expensive and time consuming; while trials are being conducted, retrospective observational studies can provide some insight. In cardiogenic shock, outcome is related to hemodynamic and metabolic state at the time of diagnosis. In this respect, registry data do not provide sufficient ...
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research

Calculation Error in Study of Pregnant Women With COVID-19 and Maternal and Neonatal Outcomes in Spain
To the Editor On behalf of my coauthors, I write to report an error in the study “Association Between Mode of Delivery Among Pregnant Women With COVID-19 and Maternal and Neonatal Outcomes in Spain,” published online in JAMA on June 8, 2020. We have been notified by a reader that a miscalculation was present in our report. Unfortunately, this had been missed by our team. (Source: JAMA)
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research

PTSD Treatments for Veterans —Reply
In Reply Our article summarized the findings from recent trials of first-line psychotherapies for military-related PTSD, which showed mixed outcomes. We argued for a conceptual shift toward developing and testing multifaceted individualized treatments and the need to counter the narrative that there is sufficiently strong evidence to support existing TF-CBT for most individuals with military-related PTSD. (Source: JAMA)
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research

Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump for Cardiogenic Shock —Reply
In Reply Dr Ravn and colleagues note several limitations of observational studies. The potential for unmeasured confounding and lack of hemodynamic and metabolic parameters were discussed in the article. Nonetheless, real-world studies, including our analysis, provide important insights into the performance of mechanical circulatory support devices in routine practice. Moreover, the association of intravascular microaxial LVAD use with significantly higher rates of in-hospital mortality and major bleeding compared with IABP among patients with acute myocardial infarction complicated by cardiogenic shock was consistent acro...
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research

Effect of Levothyroxine on LVEF in Patients With Subclinical Hypothyroidism and Acute Myocardial Infarction
This randomized trial evaluates the effect of levothyroxine vs placebo on left ventricular ejection fraction (LVEF) in patients with acute myocardial infarction and subclinical hypothyroidism. (Source: JAMA)
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research

Public Attitudes Regarding Hospitals and Physicians Encouraging Donations From Grateful Patients
This survey study assesses US public attitudes about practices used by health care institutions to encourage philanthropic donations from grateful patients. (Source: JAMA)
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research

Patient Information: Breast Cancer Risk –Reducing Medications
This JAMA Patient Page describes the indications for use of medications to reduce breast cancer risk and the benefits and risks of the 2 major drug classes, SERMs (tamoxifen, raloxifene) and aromatase inhibitors (anastrozole, exemestane). (Source: JAMA)
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research

Quarantine
Even though our 500 ft2 apt is a petri dish Even though the bathroom pretends to be an office Even though the TP clock is ticking Even though even a good song may grow old Even though I have eaten all the almond butter Even though you won ’t wear headphones Even though we can’t help but be together Even though I can only take you out to take-out Even though florists are nonessential Even though a kiss carries more than we know Even with this Still will I wish: Won’t you be mine, My quarantine. (Source: JAMA)
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research

Do No Harm as a Stay-at-Home Physician Dad
In this narrative medicine essay, a primary care physician finds little solace in his medical training while caring for his 2 young daughters as a stay-at-home dad. (Source: JAMA)
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research

Perioperative Cardiovascular Risk Assessment and Management for Noncardiac Surgery: A Review
This narrative review summarizes evidence that addresses commonly asked questions about cardiovascular risk assessment prior to noncardiac surgery, such as the role of preoperative stress testing and medication to reduce surgical risk and the need to discontinue anticoagulants. (Source: JAMA)
Source: JAMA - July 21, 2020 Category: General Medicine Source Type: research