Cross-Training in Neurology and Psychiatry
To the Editor In their Viewpoint on training in neurology and psychiatry, Dr Keshavan and colleagues, argued that the interface between the mind and the brain is neglected in training; the addition of residency training in clinical neuroscience may allow physicians to better address those diseases that cause neurological and psychiatric symptoms. However, by suggesting that all trainees in neurology and psychiatry focus more heavily on the neurosciences, I believe that they went too far. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

Cross-Training in Neurology and Psychiatry —Reply
In Reply Mr Butchart agrees that the interface between the brain and the mind has been neglected by the fields of both neurology and psychiatry. However, he also suggests that our proposal of increased neuroscience training for all trainees in neurology and psychiatry goes too far. We would like to emphasize some key aspects of our Viewpoint that may place this issue in a clearer context. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

Exercise Intensity Unrelated to Older Adults ’ Mortality Risk
Researchers in Norway found no significant difference in all-cause mortality among older adults following standard exercise guidelines or supervised high- or moderate-intensity exercise regimens, a trial published in the BMJ reported. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

Empagliflozin Cuts Cardiovascular Deaths in Advanced Heart Failure
Patients treated for advanced but stable heart failure, including those with diabetes, had a 25% lower risk of cardiovascular death or hospitalization for heart failure when they received empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, according to an international trial in the New England Journal of Medicine. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

High-Calorie Treatment Leads to Faster Gains in Anorexia Nervosa
Adolescents and young adults hospitalized with anorexia nervosa became medically stable more quickly with higher-calorie foods reintroduced to their diet compared with standard lower-calorie refeeding (LCR), according to short-term outcomes published in JAMA Pediatrics. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

Reliving Childhood Trauma Details Isn ’t Needed to Treat PTSD
Two treatments that don ’t require lengthy recollection of traumatic memories were equally effective for adults with posttraumatic stress disorder (PTSD) arising from childhood experiences, an international trial in the British Journal of Psychiatry reported. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

Early Physical Therapy Relieves Sciatica Disability and Pain
A primary care clinician ’s referral to physical therapy within 90 days of sciatica symptom onset improved pain and functional capabilities compared with usual care, a trial in the Annals of Internal Medicine found. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

Association of First Primary Cancer With Risk of Subsequent Primary Cancer in US Adults
This cohort study uses SEER registry data to estimate overall and cancer-specific risk for secondary primary cancers among US adults with first primary cancers who lived at least 5 years past their initial diagnosis. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

Effect of Digoxin vs Bisoprolol for Heart Rate Control in Patients With Permanent Atrial Fibrillation
This randomized trial compares the effect of low-dose digoxin vs bisoprolol for heart rate control on quality of life in patients aged 60 years or older with permanent atrial fibrillation and dyspnea. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

Patient Information: Peyronie Disease
This JAMA Patient Page describes Peyronie disease, a scarring of tissue in the penis that may affect sexual function, and available procedural treatment options. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

Patient Information: Gastroesophageal Reflux Disease (GERD)
This JAMA Patient Page describes the causes, symptoms and signs, and treatments, including medication (eg, proton pump inhibitors) and surgery (eg, fundoplication), for gastroesophageal reflux disease (GERD). (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

A Social Medicine Team for Emergency Department Patients With High Psychosocial Burden
This JAMA Performance Improvement article describes experience at Zuckerberg San Francisco General Hospital with an emergency department social medicine (EDSM) team to facilitate care of ED patients with low-acuity medical illnesses and complex psychosocial comorbidities (homelessness, mental illness, substance use, poverty). (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

An Essential Worker ’s List of Pandemic Chores for the Kids
Sorry I had to leave before you woke up. You ’re right, it isn’t fair. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

The Light Princess —Pregnancy Loss
In this narrative medicine essay a family physician recalls her bereavement after a pregnancy loss and her slow process of healing through mentoring and lasting relationships with premed students, following their lives and careers with the same pride as a parent. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

Gastroesophageal Reflux Disease
This narrative review summarizes recent advances in the diagnosis and management of gastroesophageal reflux disease (GERD), including updates on pharmacologic options and surgical approaches. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

Assessing Progress in Health Care Quality Through the Lens of COVID-19
This Viewpoint describes US health system performance during the COVID-19 pandemic using the National Academy of Medicine's 2001 Quality Chasm framework, focusing on system cohesion, organizational capabilities, and environment of care. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

Accelerating Global Improvements in Health Care Quality
This Viewpoint proposes a policy framework for thinking about health care quality in low- and middle-income countries, emphasizing the importance of infrastructure, enforceable quality standards, safety practices, guideline-directed clinical care, and patient and family involvement. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

A Roadmap to Advance Patient Safety in Ambulatory Care
This Viewpoint emphasizes the need for research and initiatives related to patient safety in outpatient settings and proposes practice, policy, and patient and caregiver milestones to give patient harm reduction in ambulatory care settings the same priority as in inpatient settings. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

Progress in Patient Safety in Anesthesia
This Viewpoint describes the history of patient safety improvements in the practice of anesthesiology, with a shift in focus from reducing procedural mortality to improving systems, including optimization of teamwork, communication, interdisciplinary care, and standards for new technologies. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

Hospital Readmission Is Common Among COVID-19 Survivors
Nearly 1 in 10 patients who were discharged after receiving inpatient care for coronavirus disease 2019 (COVID-19) earlier this year were readmitted within 2 months, according to a recent study. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

Shifts in Emergency Mental Health Care for Youth During the Pandemic
The proportion of visits to the emergency department (ED) for mental health concerns rose by about one-quarter among children aged 5 to 11 years and by nearly one-third among 12- to 17-year-olds in 2020 compared with 2019. (Source: JAMA)
Source: JAMA - December 22, 2020 Category: General Medicine Source Type: research

Physiology-Based Revascularization Decisions and Improved Clinical Outcomes Following Percutaneous Coronary Interventions
The introduction of coronary angiography more than 50 years ago led to a major shift in the diagnosis and management of coronary artery disease. As the first technique to visualize the severity and location of obstructive lesions in the coronary arteries of living patients, coronary angiography enabled the development of coronary revascularization by coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI), arguably 2 of the most important advances in cardiovascular medicine. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Association Between Adherence to FFR Thresholds and Major Adverse Cardiac Events in Patients With Coronary Artery Disease
This cohort study assesses adherence to evidence-based fractional flow reserve (FFR) thresholds for percutaneous coronary intervention in Canada between 2013 and 2018, and associations of percutaneous coronary intervention with major adverse clinical outcomes for patients with FFR measures above and beneath ischemic thresholds. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

USPSTF 2020 Hepatitis B Screening Recommendation
According to the National Health and Nutrition Examination Survey (NHANES), the prevalence of chronic hepatitis B virus (HBV) infection based on positive hepatitis B surface antigen (HBsAg) is estimated to be 0.3% overall, 0.15% in US-born individuals, and 1.28% in non –US-born individuals, with the highest prevalence among non–US-born Asian individuals (3.9%). However, the true prevalence is likely higher because high-risk populations are not adequately represented in the survey. A study that used meta-analytic methods to determine country-specific pooled HBV prevalence rates multiplied by the number of non&nd...
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Anti-VEGF Therapy or Vitrectomy Surgery for Vitreous Hemorrhage From Proliferative Diabetic Retinopathy
Diabetic retinopathy remains one of the leading causes of blindness in working-aged adults worldwide. The main causes of vision loss from diabetic retinopathy are proliferative diabetic retinopathy and diabetic macular edema. Laser photocoagulation has been the mainstay of treatment for limiting vision loss in both proliferative diabetic retinopathy and diabetic macular edema since the 1980s. During the last 2 decades, vascular endothelial growth factor (VEGF) has been shown to have a key role in the pathogenesis of diabetic retinopathy, and intraocular (intravitreal) injections of anti-VEGF agents have become standard car...
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Trust in Health Care in the Time of COVID-19
Trust is foundational for the relationship between patients and clinicians. Patients often disclose profound personal information and trust this will remain confidential. Clinicians work to gain trust so patients are willing to accept their diagnoses and recommended treatments, including undergoing invasive procedures and taking medications indefinitely for chronic conditions. To achieve this level of trust, clinicians and health care systems must, above all, convince people that they put patients ’ best interests above any financial or nonfinancial self-interest of their own. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Sesame Should Be on Food Labels to Warn Consumers With Allergy
The FDA has encouraged manufacturers to include the word “sesame” on ingredient labels whenever it’s used as a food flavoring or additive to alert consumers who have a sesame allergy. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Quality Issues Prompt Safety Guidelines for Compounded Drug Pharmacies
Citing persistent quality issues at compounding facilities since a deadly 2012 national fungal meningitis outbreak, the FDA issued final guidance to help prevent contamination of compounded drug products. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Device Approved for Adults With Nightmare Disorder
A new digital device has received FDA authorization to provide adults aged 22 years or older with temporary relief from sleep disturbances caused by nightmare disorder or nightmares from posttraumatic stress disorder (PTSD). (Source: JAMA)
Source: JAMA - December 15, 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 - December 15, 2020 Category: General Medicine Source Type: research

Rufus of Ephesus
Rufus (Fr. roux, redhead, redbeard), a common given name in Rome, of Ephesus (Asia Minor) has been described as the medical link between Hippocrates and Galen. Second in stature as a Greek physician, and in clinical acclaim surpassed only by his predecessor and his successor, he lived in the reign of Trajan (98-117 A. D.). Remnants of his teachings were preserved by Oribasius, court physician to Emperor Julianus, a countryman and eclectic physician who lived in the fourth century A. D. Paul of Aegina (625-690 A. D.) was also a chronicler of the writings of Rufus. Paul was the last of the Greek physicians who preserved the ...
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Treatment of Opioid Use Disorder Among Commercially Insured Patients Before and During the COVID-19 Pandemic
This study uses commercial and Medicare Advantage claims data to compare medication fills, outpatient visits, and urine tests for opioid use disorder in January-May 2020 vs 2019. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Changes in Outpatient Buprenorphine Dispensing During the COVID-19 Pandemic
This study examined outpatient buprenorphine dispensing patterns in Texas before vs after the Drug Enforcement Administration temporarily relaxed outpatient buprenorphine prescribing regulations in March 2020 in response to the COVID-19 pandemic. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Exome Sequencing as Part of a Multidisciplinary Approach to Diagnosis
To the Editor The Viewpoint by Dr Friedman and colleagues on whole-exome sequencing claimed that the diagnosis of many genetic diseases cannot be based solely on molecular results but requires a multidisciplinary approach for a final diagnosis. The authors stated “Genomic variants classified as pathogenic or likely pathogenic may be seen in healthy people.” This phenomenon has been described for genetically related kidney diseases in particular. We agree with the authors about using a multidisciplinary approach in the field of adult genetically related k idney diseases, in which the pretest probability of a gen...
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Conversational Agents in Health Care
To the Editor The Viewpoint by Dr McGreevey and colleagues drew attention to the increasing use of conversational agents (CAs) in health care. However, they suggested a less mature field than we find in practice, and their call for CA-specific regulations risks creating confusion. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Conversational Agents in Health Care —Reply
In Reply Dr Darcy and colleagues from Woebot Health cite 2 references when suggesting that the CA field is more developed than our Viewpoint suggested. However, we find the use of these references as being off target for 2 reasons. First, both articles address symptom checkers. Symptom checkers typically ask patients preset questions and permit structured or limited free-text replies. Thus, we would not consider symptom checkers to be CAs. Our Viewpoint focused on technologies that accept and interpret a broad range of typed or spoken words, phrases, and sentences and that offer natural-sounding language responses. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Exome Sequencing as Part of a Multidisciplinary Approach to Diagnosis —Reply
In Reply Dr Doreille and colleagues share our opinion that a genetic disease diagnosis cannot be made on the basis of an exome-sequencing result alone but requires consideration of all of a patient ’s clinical features and consistency with the spectrum of clinical manifestations that occur in the disease being considered. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Trijardy XR —A New 3-Drug Combination for Type 2 Diabetes
This Medical Letter compares a newly approved fixed-dose combination pill comprising the sodium-glucose cotransporter 2 inhibitor empagliflozin, the dipeptidyl peptidase-4 inhibitor linagliptin, and extended-release metformin, with available formulations of each of the pill ’s individual components for oral treatment of type 2 diabetes in adults. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

JAMA Network Articles of the Year 2020
This Medical News article discusses the top-viewed research articles published across the JAMA Network in the past year. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Experts Discuss COVID-19: Vaccine Allocation, Placebo Groups, and More
This JAMA Live Highlights feature provides comments about the coronavirus 2019 pandemic from experts in clinical medicine, public health, and health policy expressed during livestream interviews with JAMA Network Editor in Chief Howard Bauchner, MD. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Effect of Intravitreous Aflibercept vs Vitrectomy With Panretinal Photocoagulation on Visual Acuity in Patients With Diabetic Retinopathy and Vitreous Hemorrhage
This randomized trial compares the effects of initial treatment with intravitreous aflibercept vs vitrectomy with panretinal photocoagulation on visual acuity over 24 weeks among adults with vitreous hemorrhage from proliferative diabetic retinopathy. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Association Between Depressive Symptoms and Incident Cardiovascular Diseases
This international study pooled individual-participant data from several long-term prospective studies to evaluate the relationship between depressive symptoms and incident cardiovascular disease. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

USPSTF Guideline: Screening for Hepatitis B in Nonpregnant Adolescents and Adults
This JAMA Patient Page reviews the US Preventive Services Task Force ’s 2020 recommendation to screen for hepatitis B infection in adolescents and adults at increased risk (B recommendation). (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Home From the Hospital
Last night I dreamed my father came Home from the hospital Standing there in the kitchen with the usual Slab of butter laid out on homemade bread As if it was cheese (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

A Song for Gram —The Music of Grief
In this narrative medicine essay, a critical care fellow returning to the ICU after burying her grandmother learns that grief does not conform to clinical schedules and efficiencies, having instead its own pace and melody, like the songs on violin she loved to performed for her beloved Gram. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

USPSTF Review: Screening for HBV Infection in Nonpregnant Adolescents and Adults
This systematic review to support the 2020 US Preventive Services Task Force Recommendation Statement on screening for hepatitis B virus infection summarizes published evidence on the benefits and harms of screening and interventions for hepatitis B infection in nonpregnant adolescents and adults. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

USPSTF Recommendation: Screening for Hepatitis B Virus Infection in Adolescents and Adults
This 2020 US Preventive Services Task Force Recommendation Statement recommends screening for HBV infection in adolescents and adults at increased risk for infection (B recommendation). (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research

Addressing Medical Misinformation in the Patient-Clinician Relationship
This Viewpoint describes why health misinformation spreads, characterizes a broader set of misinformation types, and discusses solutions to this problem. (Source: JAMA)
Source: JAMA - December 15, 2020 Category: General Medicine Source Type: research