A First in Surgical Devices for Transvaginal Hysterectomy
A new robotically assisted surgical device designed to have a surgeon ’s dexterity has received FDA authorization for use in benign transvaginal procedures including benign hysterectomy. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

3D-Printed Implant Is Approved to Replace Ankle Joint Bone
The FDA has approved a 3-dimensional (3D) –printed implant designed to treat people with avascular necrosis (AVN) of the ankle joint. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

To JAMA Authors, Reviewers, and Especially Physician Readers —A Profound Thank You
The global COVID-19 pandemic continues to permeate virtually every aspect of society and daily life, including government, business, travel, education, and especially the health care system. With more than 120 million cases of SARS-CoV-2 infection worldwide, including nearly 30 million cases in the US, and with more than 2.5 million deaths worldwide, including more than 500  000 deaths in the US, health care systems, hospitals, physicians, other health care professionals, and researchers worldwide have been challenged like never before, not only to care for overwhelming numbers of severely ill patients with COVID-19, but...
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Opportunities to Improve Antimicrobial Use in US Nursing Homes
Inappropriate use of antibiotic therapy is a major driver of adverse effects related to medications and antibiotic resistance in nursing homes. Despite formal calls for the enhancement of prescribing practices, along with improvements in structure and process, antibiotic stewardship in nursing homes remains suboptimal. Measuring antibiotic use in nursing homes and comparing observed patterns with relevant benchmarks is a core component of antibiotic stewardship. However, to date, nationally representative data to which nursing homes can benchmark have been lacking. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Celecoxib for Stage III Colon Cancer
Observational studies have linked aspirin and selective cyclooxygenase-2 (COX-2) inhibitors to prevention of colorectal adenomas and colorectal cancer, and reduction in recurrence following resection or improved survival for patients with advanced or metastatic disease. There are plausible mechanistic hypotheses linking inhibition of prostaglandin synthesis, nuclear factor κB activation, and the transcription factor RUNX1 to the anticancer effects of aspirin and celecoxib. In addition, there is evidence from a meta-analysis across multiple studies of the potential effects in terms of enhanced response rates when COX-...
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Two Incomplete Author Names
This article was corrected online. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Update of Image Credit and Word Choice
This article was corrected online. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Errors in Results
The Original Investigation titled “Effect of Dapagliflozin on Worsening Heart Failure and Cardiovascular Death in Patients With Heart Failure With and Without Diabetes,” published in the April 14, 2020, issue of JAMA, included errors in the Results section. This included labeling weight decline in those with diabetes as weight d ecline in those without diabetes at 8 months, citing reference 18 rather than reference 16 in footnote “b” in Table 2, and not indicating that the absolute difference in cardiovascular death or hospitalization for heart failure among patients with diabetes was presented as a...
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

Group Name Omitted
This article was corrected online. (Source: JAMA)
Source: JAMA - April 6, 2021 Category: General Medicine Source Type: research

“Self-Portrait as Exit Wounds”
This wordless graphic story conveys the loss and powerlessness felt by health care workers, patients, and families confronting the coronavirus pandemic, and was drawn by a community hospitalist as a tribute to each. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Evaluation of Hypokalemia
This case report describes the evaluation of a 52-year-old woman taking a thiazide diuretic with hypokalemia (potassium, 2.6 mEq/L) and hypertension (blood pressure, 159/94 mm Hg) and presents an algorithm for the diagnosis and management of underlying causes of low serum potassium levels. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

International Variation in Intubation and Extubation
Requiring invasive mechanical ventilation acutely outside an operating room is, for many, the definition of critical illness. Although there may be debate regarding whether patients treated with noninvasive ventilation or vasoactive infusions can be safely managed outside an intensive care unit (ICU), there is likely unanimous agreement that patients with an endotracheal tube should be cared for in an ICU. Understanding how invasive mechanical ventilation is provided is therefore essential to understanding one of the primary tasks in critical care medicine. In 2016, the Large Observational Study to Understand the Global Im...
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Screening for Hearing Loss in Older Adults
In this issue of JAMA, in the updated Recommendation Statement on screening for hearing loss, the US Preventive Services Task Force (USPSTF) “concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for hearing loss in older adults (I statement)”; this recommendation is unchanged from the 2012 USPSTF review. The recommendations have important implications for the US population becau se the incidence of hearing loss increases substantially with age and the number of people 65 years or older is 54.2 million, which has increased by more than one-third (34%, or ne...
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Another Explanation for Why Cloth Masks Reduce COVID-19 Severity
It ’s not just the mask, it’s the humidity created inside the mask that helps protect against severe COVID-19, a recent study by National Institutes of Health (NIH) researchers suggests. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

VA Nursing Homes ’ History of Infection Control Shortcomings
Virtually all nursing homes owned and operated by the Department of Veterans Affairs (VA) were cited for infection control deficiencies during the 5 fiscal years before the novel coronavirus pandemic, according to a recent Government Accountability Office (GAO) report. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

HHS Expands Number of People Who Can Vaccinate Against COVID-19
The US Department of Health and Human Services (HHS) recently added more categories of individuals qualified to prescribe, dispense, and administer COVID-19 vaccines. (Source: JAMA)
Source: JAMA - March 23, 2021 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 - March 23, 2021 Category: General Medicine Source Type: research

The Coronavirus Pandemic 1 Year On —What Went Wrong?
January 30, 2021, marked the first anniversary of the declaration by the World Health Organization (WHO) of COVID-19 as a public health emergency of international concern (PHEIC). Thus far, the world has been no match for SARS-CoV-2, with more than 100 million cases and 2.5 million deaths. The US has been among the world ’s poorest performers in addressing the pandemic, with more than 500 000 deaths. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Beware, the Sporothrix
Lying “under the haystack fast asleep,” Little Boy Blue of nursery rhyme fame could not have suspected that he might become infected by the Sporotrichum schenckii. Clearly, like the rest of us, he has been lulled into believing that, unlike marsh hay, prairie hay does not harbor this fungus. Dahl and associates (p 1980) disabuse us of this notion. They report from Kansas an outbreak of lymphocutaneous sporotrichosis involving nine children who had been playing among bales of prairie hay, which were later proved to be contaminated by the Sporotrichum. Not only is the report the first to incrimina te a hitherto u...
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Association Between Proportion of Black Patients Cared for at Hospitals and Penalties in CMS Value-Based Payment Programs
This study evaluates whether US hospitals with mostly Black patients are more likely than other hospitals to have penalties associated with Centers for Medicare& Medicaid Services (CMS) value-based payment programs. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Association of Clinician Minority Patient Caseload With Performance in the 2019 Medicare MIPS
This study assesses the association between US clinicians ’ caseload of minority patients and their 2019 Medicare Merit-based Incentive Payment System performance score. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Review of Hearing Loss in Children
To the Editor The article by Dr Lieu and colleagues about hearing loss in children notably omitted the important topic of noise-induced hearing loss. Prevention of disease is almost always better and less expensive than treatment. The only treatment currently available for hearing loss is amplification, via hearing aids, personal sound amplification products, or cochlear implants. Hearing loss with age, which is predominantly due to noise-induced hearing loss, begins at an early age and is theoretically preventable with avoidance of loud noise. The only evidence-based noise exposure level to prevent noise-induced hearing l...
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Driving Impairment Following Vaporization of Cannabis
To the Editor In the article by Dr Arkell and colleagues, a few questions need clarification regarding the short-term driving test impairment with vaporized THC-dominant cannabis and THC/CBD-equivalent cannabis compared with placebo. First, did the primary outcome vary by sex or by history of driving under the influence of cannabis, which represented 20% of the participants? Second, did the primary outcome differ by recent episodes of cannabis use or by distance driven in the last year? (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Driving Impairment Following Vaporization of Cannabis
To the Editor We wish to discuss the effects of CBD and THC on visual function, which may influence driving but may not be detected by road-tracking tests as performed in the article by Dr Arkell and colleagues. A double-blind study reported that 15 mg of THC produced transient color discrimination impairment in the blue and red to yellow region of the color circle, while 8 mg of THC and placebo did not impair color discrimination ability. This transient color perception impairment may impair the development of numerous adaptations that individuals with congenital color defects use, such as memorization of the order of tra...
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Driving Impairment Following Vaporization of Cannabis
To the Editor We read with interest the recent findings reported by Dr Arkell and colleagues concerning the effect of vaporized Δ9-tetrahydrocannabinol (THC)–dominant and THC/cannabidiol (CBD)–equivalent cannabis on on-road driving performance. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Review of Hearing Loss in Children —Reply
In Reply We appreciate the attention that Dr Fink brings to the issue of noise-induced hearing loss. In our Review of pediatric hearing loss, we chose to focus on the developments germane to children specifically and did not delve into noise-induced hearing loss, which has a growing body of literature that is not yet specific to children. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Driving Impairment Following Vaporization of Cannabis —Reply
This study confirmed previous findings from on-road and driving simulator studies showing that THC produces modest but clinically relevant driving impairment similar to that seen in drivers with a blood alcohol concentration of 0.05%. It also showed that THC-induced impairment was transient and no longer present between 240 minutes and 300 minutes after vaporization, even though most drivers still tested positive for THC in blood. The presence of THC in the blood of a driver is therefore not necessarily an indicator of cannabis-induced driving impairment. Importantly, the time window of THC-induced impairment is neither fi...
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

With Good Adherence, Daily Aspirin May Prevent Pregnancy Loss
For women with a history of pregnancy loss, taking low-dose aspirin before conception may improve birth outcomes, according to a post hoc analysis of a multicenter US trial. The trial ’s original analysis, published in 2014, found no positive effects of aspirin on miscarriages or live births, but only about half of the participants adhered to the protocol. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Virtual Postoperative Visits Noninferior to In-Person Visits
As postdischarge video –based virtual visits have increased during the COVID-19 pandemic, a trial in JAMA Surgery found that these visits are noninferior to in-person follow-ups after low-risk surgeries. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Better Hypertension Control With Digital Self-monitoring
A digital intervention for hypertension management in primary care lowered patients ’ systolic blood pressure, a trial in The BMJ reported. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Molecular Point-of-Care Test Improved Influenza Care
A point-of-care (POC) polymerase chain reaction (PCR) test quickly detected influenza and improved care among patients hospitalized at 2 UK centers between December 2017 and May 2019, a trial in The Lancet Respiratory Medicine found. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Polypill Plus Aspirin Effective for Cardiovascular Disease Prevention
A trial at 86 centers in 9 countries found that patients at intermediate cardiovascular risk had fewer cardiovascular events after taking aspirin plus a polypill. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Adverse Peri-intubation Events in Critically Ill Patients
This international cohort study describes the incidence and nature of cardiovascular instability, severe hypoxemia, and cardiac arrest surrounding endotracheal intubation. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Ventilator Weaning and Discontinuation Practices in Critically Ill Patients
This critical care epidemiology study describes practice variation in invasive mechanical ventilation weaning and discontinuation practices, associations between initial discontinuation events and outcomes, and factors associated with use of select discontinuation strategies and failed initial spontaneous breathing trials among critically ill patients in ICUs in 19 countries. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Patient Information: Screening for Hearing Loss in Older Adults
This JAMA Patient Page summarizes the US Preventive Services Task Force ’s 2021 recommendation that current evidence is insufficient to assess the balance of benefits and harms of screening for hearing loss in older adults (I statement). (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Shelter
They are home, most of them, eating the shaved ham and avocados, loud with each other and stomping to mark lost known space. How long will this be? No one knows, not yet, though the entire panicked world has a theory. The shelves are gutted, big box curettage and the check-out guy shares a meme that has traveled from San Juan to Shanghai, hinting at the punchline, which is death. Pandemic. But isn ’t that just a movie, a board game, a thing discussed on faraway tongues Isn’t that not our knowing? Why can’t we, how come, my daughter asks, convinced in her own plum fecundity she’ll be alone forever. T...
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

I Am Not Burned Out —I Have Postpartum Depression
In this narrative medicine essay, a pediatrician describes her struggle to recognize postpartum depression with the birth of her third child and how she found her way out. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

USPSTF Review: Screening for Hearing Loss in Older Adults
This systematic review to support the 2021 US Preventive Services Task Force Recommendation Statement on screening for hearing loss in older adults summarizes published evidence on the benefits and harms of screening and interventions for hearing loss in adults aged 50 years or older. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

USPSTF Report: Screening for Hearing Loss in Older Adults
This 2021 US Preventive Services Task Force Recommendation Statement concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for hearing loss in older adults (I statement). (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Envisioning the Veterans Affairs Health Care System of the Future
This Viewpoint proposes strategies the Veterans Affairs (VA) health care system can pursue to shore up its mission in response to declining numbers of veterans and impending budget constraints, including accelerating a transition to value-based care, optimization of infrastructure, and strengthening engagement with employees and the public. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Federally Qualified Health Centers and Related Primary Care Workforce Issues
This Viewpoint proposes education, training, and funding reforms to expand the primary care workforce to supply federally qualified health centers (FQHCs), government-funded community-based health care sites that by providing safety-net primary care in underserved areas will be vital to addressing health inequities in the US. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Survey —Many High School Students Have Experienced Violence
About half of high school students experienced at least 1 type of violence during the previous year, according to data from 9080 US students who participated in the 2019 Youth Risk Behavior Survey. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Sexual Minorities Have Greater COVID-19 Risk Factors
Gay, lesbian, or bisexual adults have higher rates than heterosexual people of health conditions that increase the risk of developing severe COVID-19, according to national survey data. (Source: JAMA)
Source: JAMA - March 23, 2021 Category: General Medicine Source Type: research

Pruritic Rash and Diarrhea
An 82-year-old woman reported 2 months of diarrhea and 2 weeks of pruritic rash on her extremities as well as a recent left radius fracture; she was malnourished but most laboratory parameters were normal except mild hyponatremia and levels of copper and zinc well below normal. What is the diagnosis and what would you do next? (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Transposed Data in a Table
This article was corrected online. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Incorrect Unit of Measure
In the Original Investigation titled “Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China,” published in the March 17, 2020, issue of JAMA, an incorrect unit of measure for D-dimer was reported in Table 2 and Figure 2. It should have been listed as ng/mL. This artic le was corrected online. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Omega-3 Fatty Acids and Atrial Fibrillation
In 2019, the global market for omega-3 fatty acids reached $4.1 billion, and it is expected to double by 2025. These impressive expenditures reflect the worldwide popularity of these products and the belief by many that omega-3 fatty acids are beneficial to their health. Although the health benefits of these products remain questionable, it is important for consumers who take them to understand their potential risks. In this issue of JAMA, the VITAL Rhythm Study examined the risk of atrial fibrillation (AF), the most common cardiac arrhythmia, with intake of omega-3 fatty acids. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Device Uses Electrical Stimulation to Control Snoring
A prescription-only device that uses electrical stimulation to improve tongue muscle function has been authorized to help adults reduce snoring and mild obstructive sleep apnea (OSA). (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

CAR-T Therapy Is Approved for Non-Hodgkin Lymphoma
A cell-based gene therapy to treat adults with large B-cell lymphoma (LBCL) has received FDA approval. Lisocabtagene maraleucel, marketed as Breyanzi, is a chimeric antigen receptor T-cell (CAR-T) therapy indicated for patients who haven ’t responded to or have relapsed after at least 2 other systemic treatments. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research