The Canadian Response To COVID-19
This Viewpoint summarizes federal, provincial, and regional responses to the COVID-19 pandemic in Canada and explores reasons for differences in pandemic outcomes in Canada and the US. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Using Lessons From Sepsis for Recovery From COVID-19
This Viewpoint discusses the possibility that survivors of severe COVID-19 will experience persistent symptoms similar to those of post-sepsis syndrome and reviews best practices for promoting recovery from intensive care illness, including referral to physical and occupational therapy, medication optimization, and structured exercise. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Attacks on Public Health Officials During COVID-19
This Viewpoint discusses ongoing harassment and threats against US public health officials who propose or take steps to protect communities from coronavirus disease 2019 (COVID-19) and it proposes possible responses, including a call to elected leaders to implement protection of the officials from illegal harassment, assault, and violence. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Football-Related Head Injuries Decline Among Children and Teens
A 39% decrease in football-related traumatic brain injuries among children and adolescents helped cut the number of US emergency department (ED) visits for sports- and recreation-related (SRR) traumatic brain injury by one-third between 2012 and 2018. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Lung Diseases Affecting US Workers Cost Billions Annually
Annual expenditures for US workers totaled $7 billion for asthma care and $5 billion for chronic obstructive pulmonary disease (COPD) care between 2011 and 2015, according to CDC researchers. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Behavioral Counseling for Sexually Transmitted Infection Risk Reduction
For the last decade, the US has experienced an escalating crisis of sexually transmitted infections (STIs). Between 2014 and 2018, the Centers for Disease Control and Prevention (CDC) reported disturbing trends in bacterial STI incidence, including a 63% increase in gonorrhea cases (n  = 583 405 cases in 2018), a 71% increase in syphilis cases (n = 115 045 cases in 2018), and a 185% increase in congenital syphilis cases (n = 1306 cases in 2018), the highest number recorded in more than 2 decades. Increases in congenital syphilis occurred in parallel with an increa se in early s...
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

First Tobacco Product Receives “Reduced Exposure” Authorization
Philip Morris International received the first-ever nod to market a tobacco device that claims to expose users to fewer harmful chemicals than cigarettes, according to the FDA. (Source: JAMA)
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

Outpatient Treatment Option for Patients With Blood Cancer
A recently approved oral chemotherapy formulation will allow some patients with blood cancer to be treated at home instead of traveling to a hospital or clinic for intravenous (IV) therapy, the FDA announced. (Source: JAMA)
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

A Plan to Use Modern Data Tools to Fight Foodborne Illness
Imagine scanning a bag of lettuce and being able to immediately know where it came from —information that could help determine whether it’s tied to a foodborne illness outbreak. (Source: JAMA)
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

Using Latent Class Analysis to Identify Hidden Clinical Phenotypes
This JAMA Guide to Statistics and Methods summarizes latent class analysis, a statistical technique that estimates the probability of patients belonging to a discrete group that shares specific combinations of observed variables, and explains how the technique is used and can be interpreted in observational research. (Source: JAMA)
Source: JAMA - August 18, 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 - August 18, 2020 Category: General Medicine Source Type: research

The Death of Huxley
Thomas Henry Huxley, the eminent English naturalist, died June 29, aged 70 years. He was in his twenty-first year when he took his M. B. degree at the University of London, after having studied three years at the Charing Cross Hospital Medical School; he took second honor in anatomy and physiology. In 1846 he joined the medical branch of the Royal Navy, serving first at the Haslar Hospital, and afterward as assistant surgeon on H. M. S., Rattlesnake, during its four years ’ voyage to the South Pacific. In 1853 he resigned from the Navy, to become the professor of natural history in the Royal School of Mines. From tha...
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

Professor Huxley
The death of this very eminent man who was an educated physician and most learned biologist and teacher, brings out one phase of his work which every physician should copy. All his writings are models of concise exact expressions conveying the precise meaning intended. This was not easy to him, but was acquired by hard labor and persistent study. Many of his works were written three and four times over, and cut down and altered continuously. He explained that his idea of good writing was to make it so clear and concise that no critic could draw any other conclusion but the one intended. In this he succeeded, and the variou...
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

Prevalence of Psychotropic and Opioid Prescription Fills Among Community-Dwelling Older Adults With Dementia in the US
This pharmacoepidemiology study uses Medicare data to estimate US prescription fills for antidepressants, anxiolytics, antipsychotics, opioids, and antiepileptics among community-dwelling older adults with dementia in 2014-2015, and identifies the most commonly prescribed medications. (Source: JAMA)
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

Physicians and Social Determinants of Health
To the Editor The Viewpoint by Dr Schwenk addressed the troubling issues with physician practice and the decline of the patient-physician relationship. However, his caution that physicians should not be responsible for attending to social determinants of health is shortsighted. Although I agree that physicians cannot be the sole arbiters responsible for social determinants of health, they can be vocal agents of change, particularly in an era of reduced funding for public programs and preventive measures, reductions that will assuredly limit access to underserved populations. (Source: JAMA)
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

Uncemented vs Cemented Hemiarthroplasty for Hip Fracture
To the Editor Dr Okike and colleagues found that uncemented hemiarthroplasty, compared with cemented fixation, was associated with a higher risk of aseptic revision. We have several concerns. (Source: JAMA)
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

Uncemented vs Cemented Hemiarthroplasty for Hip Fracture —Reply
In Reply Dr Yu and colleagues highlight the lack of information on surgical approach as a limitation to our study. Surgical approach was not considered to represent a confounder a priori because it is not associated with the exposure (ie, surgical approach does not influence the choice of cemented or uncemented fixation). While the direct anterior approach has recently been associated with worse early outcomes following elective total hip arthroplasty for osteoarthritis, this surgical approach is not routinely used in hemiarthroplasty treatment of femoral neck fractures. In addition, the findings of our multivariable analy...
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

Physicians and Social Determinants of Health —Reply
In Reply Dr Rousseau vigorously defends the role of physicians in addressing social determinants of health for the benefit of their patients. I agree with him up to the point of expecting physicians to be responsible for resolving the socioeconomic deficiencies that affect their patients. Knowledgeable —yes. Aware—yes. Supportive—yes. Responsible—no. (Source: JAMA)
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

Collaborative Care for Diabetes and Depression
This randomized clinical trial compares the effect of a collaborative care model that integrates management of depression and enhanced diabetes care on depressive symptoms and HbA1c, SBP, and LDL cholesterol measures among individuals with depression and diabetes in India. (Source: JAMA)
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

Effect of Ascorbic Acid, Corticosteroids, and Thiamine on Organ Injury in Septic Shock
This randomized clinical trial compares the effect of combination hydrocortisone, ascorbic acid, and thiamine (the HAT or Marik protocol) vs placebo on SOFA score –measured organ injury at 72 hours in patients with septic shock. (Source: JAMA)
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

USPSTF Guideline: Behavioral Counseling to Reduce Sexually Transmitted Infections
This JAMA Patient Page reviews the 2020 US Preventive Services Task Force ’s recommendation in favor of behavioral counseling to reduce sexually transmitted infections (STIs) for all sexually active adolescents and for adults at increased risk of STIs (B recommendation). (Source: JAMA)
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

To My Wasted Eggs
I keep this IUD plugged in, let the progesterone fool my body into not letting you descend (Source: JAMA)
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

USPSTF Report: Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections
This systematic review to support the 2020 US Preventive Services Task Force Recommendation Statement on behavioral counseling interventions to prevent sexually transmitted infections (STIs) summarizes published evidence on the benefits and harms of behavioral counseling interventions in adolescents and adults at increased risk for the infections. (Source: JAMA)
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

USPSTF Recommendation: Behavioral Counseling Interventions to Prevent STIs
This 2020 US Preventive Services Task Force Recommendation Statement recommends behavioral counseling to prevent sexually transmitted infections (STIs) for all sexually active adolescents and for adults at increased risk for STIs (B recommendation). (Source: JAMA)
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

Long-Acting PrEP Shows Promise
An injectable, long-acting preexposure prophylaxis (PrEP) regimen reduced HIV incidence by 66% compared with an oral PrEP regimen, according to a study presented during the 23rd International AIDS Conference (AIDS 2020). (Source: JAMA)
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

Customized Injection Guidelines Reduce Nurses ’ Errors
After a study showed that user-friendly directions for nurses reduced intravenous drug administration errors, the United Kingdom ’s National Health Service will begin user testing of all injection guidelines. (Source: JAMA)
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

Surge in Child Abuse, Harm During COVID-19 Pandemic Reported
A study documenting an alarming rise in abuse-related head injuries among children in the United Kingdom adds to increasing evidence that the novel coronavirus pandemic and efforts to contain it are taking a serious toll on children. (Source: JAMA)
Source: JAMA - August 18, 2020 Category: General Medicine Source Type: research

Regulatory T Cells Tested in COVID-19 ARDS
Two men with coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) survived after treatment with off-the-shelf regulatory T cells, also known as Tregs, Johns Hopkins physicians recently reported. The investigational allogenic Tregs with lung-homing markers were derived from cord blood. (Source: JAMA)
Source: JAMA - August 11, 2020 Category: General Medicine Source Type: research

Promising Early Results for Potent, Long-Acting HIV Injection
A highly potent, long-acting drug candidate with a novel mode of action showed promising anti-HIV activity in recent phase 1 trials. The slow-release compound, lenacapavir (previously GS-6207), would be used in combination with other antiretroviral agents, researchers said at the 23rd International AIDS Conference. (Source: JAMA)
Source: JAMA - August 11, 2020 Category: General Medicine Source Type: research

In Familial ALS, Antisense Agent Reduces Disease-Related Proteins
An investigational antisense oligonucleotide drug improved cerebrospinal fluid (CSF) levels of the protein responsible for up to a fifth of familial amyotrophic lateral sclerosis (ALS) cases among people of European origin, researchers reported in the New England Journal of Medicine. (Source: JAMA)
Source: JAMA - August 11, 2020 Category: General Medicine Source Type: research

Reducing the Progression of Myopia
Myopia, or nearsightedness, causes blurry vision that usually is corrected with glasses, contact lenses, or refractive surgery. The lifetime prevalence of myopia has been reported to be 80% to 90% in population-based studies in Asia. Myopia is also very common in other parts of the world, with a prevalence of almost 50% in many parts of Europe and an estimated increase in prevalence from 25.0% in 1971-1972 to 41.6% in 1999-2004 in the US. (Source: JAMA)
Source: JAMA - August 11, 2020 Category: General Medicine Source Type: research

Management of Acute Pulmonary Embolism
This JAMA Clinical Guidelines Synopsis summarizes the European Society of Cardiology ’s 2019 guidelines for diagnosis and management of acute pulmonary embolism. (Source: JAMA)
Source: JAMA - August 11, 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 - August 11, 2020 Category: General Medicine Source Type: research

Health Care Cost Growth Benchmarks in 5 States
In 2018, national health care spending increased by 4.6%, reaching $11  000 per person. Amid this growth, states are seeking novel ways to protect their budgets. One approach is to set a cost growth benchmark—a percentage growth rate under which states aim to maintain annual health care costs. (Source: JAMA)
Source: JAMA - August 11, 2020 Category: General Medicine Source Type: research

Internal and External Antisepsis
In the modern history of the biologic sciences and particularly in medicine, antiseptics and germicides have played such unanticipated parts and have been responsible for so much which is good that they have furnished words to conjure with. Every force that can be enlisted against baneful bacteria is promptly welcomed; but there are no “royal roads” to success in the warfare against these invisible foes, just as there are no panaceas with which every human ailment can be relieved. Surgeons of the present day have seen the pendulum of operative practice swing between antisepsis and asepsis without discovering th...
Source: JAMA - August 11, 2020 Category: General Medicine Source Type: research

Trends in Daily Use of Biotin Supplements Among US Adults, 1999-2016
This pharmacoepidemiology study uses NHANES data to characterize the prevalence and trends in use of high-dosage biotin supplementation among US adults between 1999 and 2016. (Source: JAMA)
Source: JAMA - August 11, 2020 Category: General Medicine Source Type: research

Need for Additional Trials of Vitamin C for Sepsis
To the Editor Since a single-center, 94-patient, uncontrolled observational study of the combination therapy of vitamin C, thiamine, and hydrocortisone reported a 32% absolute mortality reduction in patients with sepsis in 2017, several investigators have tested vitamin C and combination therapy in clinical trials. The recently published Vitamin C, Hydrocortisone and Thiamine in Patients With Septic Shock (VITAMINS) trial reported no difference in the primary outcome of time alive and free of vasopressors. We agree that the results of the VITAMINS trial should temper enthusiasm for the use of vitamin C therapy outside of c...
Source: JAMA - August 11, 2020 Category: General Medicine Source Type: research

Physician Orders for Life-Sustaining Treatment and ICU Admission Near the End of Life
To the Editor Dr Lee and colleagues found that 38% of patients with treatment-limiting Physician Orders for Life-Sustaining Treatment (POLST) received intensive care that was discordant with the POLST. In their Editorial, Drs Truog and Fried suggested reasons for this discordance, including differing health status between time of POLST completion and implementation, and the inability of the form to reflect changes in preferences. We offer a third explanation that may account for the discordant care found in the study: that the POLST form may not be completed correctly at the time of recording. (Source: JAMA)
Source: JAMA - August 11, 2020 Category: General Medicine Source Type: research

Need for Additional Trials of Vitamin C for Sepsis —Reply
In Reply A total of 14 studies (8 randomized trials and 6 observational studies) have already evaluated the effects of high-dose vitamin C, thiamine, and steroids in more than 2000 patients with sepsis in 10 different countries, and the overall results have been disappointing. In addition, 12 other trials are now completed according to ClinicalTrials.gov. Thus, a large amount of new information on this combination treatment will soon be reported. (Source: JAMA)
Source: JAMA - August 11, 2020 Category: General Medicine Source Type: research

Physician Orders for Life-Sustaining Treatment and ICU Admission Near the End of Life —Reply
In Reply We agree with Drs Mehta and Blackhall that a POLST may not always accurately reflect a patient ’s goals of care at the time of completion for a number of reasons, and that this inaccuracy is one potential cause of POLST-discordant intensive care. The fact that patients and surrogates do not always recall or even agree with their own POLSTs strongly suggests that there is room for improvemen t in the initial completion of POLSTs. Additionally, there are emerging data that mapping patients’ values (eg, prioritization of comfort over longevity) to discrete treatment preferences (eg, no cardiopulmonary res...
Source: JAMA - August 11, 2020 Category: General Medicine Source Type: research

Effects of Liberal vs Restrictive Transfusion Thresholds on Outcomes in Extremely Low-Birth-Weight Infants
This randomized clinical trial assesses the effect of liberal vs restrictive red blood cell transfusion thresholds (based on postnatal age and current health state) on death or disability at 24 months of age among extremely low-birth-weight infants. (Source: JAMA)
Source: JAMA - August 11, 2020 Category: General Medicine Source Type: research

Effect of High vs Medium Add Power vs Single-Vision Contact Lenses on Myopia Progression in Children
This randomized trial compares the effects of higher add power (+2.50 D) vs lower add power (+1.50 D) soft multifocal contact lenses vs single-vision contact lenses on myopia progression at 3 years in children aged 7 to 11 years with myopia. (Source: JAMA)
Source: JAMA - August 11, 2020 Category: General Medicine Source Type: research

Reprieve
Relieved that the spot appearing on the x-ray of your back after your fall turns out to be not in your lungs as feared but in your stomach and theoretically a Tums, I jog your memory of the x-ray vans that visited our high school in 1966, how the big fat lot of us filed through so they could look into our clandestine chests. We wonder if the techs enjoyed the shadows of animals and curse words cut from foil some placed beneath their shirts, though in your first love they found a tumor. You say the two of you had sex in his hospital room, that he told you to look out the window, surprising you from behind. Then we laugh, fo...
Source: JAMA - August 11, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - August 11, 2020 Category: General Medicine Source Type: research

Severe Hypoglycemia Linked With Over-the-Counter Supplement
An over-the-counter supplement promising male sexual enhancement led at least 17 men in Virginia to develop severe hypoglycemia in 2019, the CDC reported. (Source: JAMA)
Source: JAMA - August 11, 2020 Category: General Medicine Source Type: research

Emerging Drug-Resistant Meningitis Detected in the US
Although rare in the US, antibiotic-resistant strains of Neisseria meningitidis have been detected in a dozen states, according to a CDC report. (Source: JAMA)
Source: JAMA - August 11, 2020 Category: General Medicine Source Type: research

Virus Surveillance and Diagnosis With a CRISPR-Based Platform
A newly developed technology draws on the latest genome editing advances to detect viruses at scale —including the one that causes coronavirus disease 2019 (COVID-19)—for surveillance and diagnostic purposes. The innovation, recently described in Nature, uses clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR–associated protein 13 (Cas13), gene editing tools based on a bacterial defense system against invading viruses. (Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

Correction to Data in Trial of Convalescent Plasma Treatment for COVID-19
This article was corrected online and a letter of explanation accompanies this correction. (Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

Breast Cancer Drug Can Be Given at Home or in the Clinic
A formulation of pertuzumab and trastuzumab that health care professionals can administer by subcutaneous injection in a patient ’s home instead of intravenously in an infusion center has received approval for adults with certain types of breast cancer. (Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research