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

First-in-Class HIV Drug Is Approved
A new medication has been approved for patients with HIV infection who, after receiving multiple treatments, have exhausted other options because of drug resistance, intolerance, or safety issues. (Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

Immunotherapy Is Now First-line Therapy for Some Colorectal Cancers
Pembrolizumab is the first immunotherapy drug approved as a first-line treatment for patients with certain types of colorectal cancer that can be administered without initial chemotherapy. (Source: JAMA)
Source: JAMA - August 4, 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 4, 2020 Category: General Medicine Source Type: research

COVID-19 and Massive Job Losses Will Test the US Health Insurance Safety Net
With massive and rapid job losses during the current economic crisis related to the coronavirus disease 2019 (COVID-19) pandemic, the US is at risk of a historic decrease in job-based health insurance. (Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

The Future of the Physician
(Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

Prevalence, Characteristics, and Costs of Urgent Care Center Membership Programs
This study uses simulated patient phone calls to a random selection of US urgent care clinics (UCCs) to describe the proportion that offer membership programs with access to discounted visits for recurring fees and the characteristics (affiliations, accreditations, population income) and fees and charges of those that do. (Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

Intravenous Interferon β-1a for Severe ARDS
To the Editor Dr Ranieri and colleagues found that intravenous interferon (IFN) β-1a administered for 6 days, compared with placebo, did not result in significant improvement in a composite score that included death and ventilator-free days over a total of 28 days in patients with acute respiratory distress syndrome (ARDS). Some important issues remain to be discussed. (Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

Research and Development Costs of New Drugs
To the Editor Using publicly available data, Dr Wouters and colleagues estimated a mean cost for research and development of 63 products of $1335.9 million. This finding is noteworthy given that DiMasi and colleagues estimated a mean research and development cost of $2800 million based on data for 106 products developed by 10 large firms. Wouters and colleagues attributed this difference, among other reasons, to higher clinical costs incurred by larger pharmaceutical firms in the sample of DiMasi et al. The sample used by Wouters and colleagues contained 41% of US pharmaceutical firms with a market capitalization greater t...
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

Research and Development Costs of New Drugs
To the Editor The study by Dr Wouters and colleagues estimated the cost of pharmaceutical research and development using publicly available data. However, the discussion failed to address certain salient factors. (Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

Research and Development Costs of New Drugs
To the Editor The article by Dr Wouters and colleagues compared their estimate of the mean cost of developing a new drug with that found in a study by myself and colleagues. Their base case mean cost per approved new drug of $1.3 billion (in 2018 US dollars) stands in contrast to our estimate of $2.8 billion (2018 US dollars). The authors acknowledged that their sample was nonrepresentative in a number of drug characteristics (including therapeutic class) and by firm size (primarily small firms). Given that our sample consisted of midsized to large firms, their results could be viewed as complementary. Wouters and colleagu...
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

Errors in Trial of Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19
To the Editor My coauthors and I recently undertook a review of the Original Investigation “Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19: A Randomized Clinical Trial,” published online in JAMA on June 3, 2020. In this trial, we assessed the effect of convalescent plasma therapy in addition to standard treat ment vs standard treatment alone among 103 patients with coronavirus disease 2019 (COVID-19), stratified by disease severity. The primary outcome was time to clinical improvement within 28 days. We found that among patients with s...
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

Intravenous Interferon β-1a for Severe ARDS—Reply
In Reply Drs Zhou and Tang comment that the survival curves crossed each other in our study, and thus they questioned whether the proportionality assumption was met. Although the 1-year survival curves in the Kaplan-Meier plot overlapped at some points, the lines were generally distinct and there was no actual line crossing except at the very end, when there were few patients left in follow-up. In a diagnostic graph of log( −log[survival]) vs log of survival time, there was visible crossing of lines only in the very beginning of the log-time axis. Thus, overall, the time proportionality assumption seemed to hold well...
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

Research and Development Costs of New Drugs —Reply
In Reply The correspondents raise concerns about the nonrepresentativeness of our sample, which arose because we restricted ourselves to publicly available data. Other studies have relied on confidential data that companies agreed to share. To the best of our knowledge, none of the previous studies on this topic, including that by DiMasi et al, which involved only 10 midsized to large companies, are representative. (Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

Tafamidis (Vyndaqel; Vyndamax) for Transthyretin Amyloid Cardiomyopathy
This Medical Letter review describes how tafamidis prevents transthyretin protein complexes from disocciating into amyloid fibrils, and its recent approval in 2 different formulations (Vyndaqel and Vyndamax) for treatment of adults with transthyretin-mediated amyloid cardiomyopathy (ATTR-CM). (Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

Diagnosis Coding and Differences in Mortality Between Critical Access Hospitals (CAHs) and Non-CAHs
This study uses Medicare data to estimate mortality differences for common medical conditions (pneumonia, heart failure, chronic obstructive pulmonary disease, urinary tract infection, others) at US critical access vs non –critical access hospitals between 2007 and 2017 with vs without adjustment for discharge diagnosis counts to assess the extent to which coding practices rather than illness severity might account for observed mortality differences. (Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

Effect of Vitamin D 3 Supplementation vs Placebo on Risk of Depression or Relevant Depressive Symptoms
This randomized clinical trial compares the effects of vitamin D ₃ supplementation vs placebo on depression risk and mood scores in men and women aged 50 years or older. (Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

Remains
Gone is the body (Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

Heart Failure With Reduced Ejection Fraction: A Review
This narrative review summarizes the epidemiology, pathophysiology, diagnosis, management, and prognosis of heart failure with reduced ejection fraction. (Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

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

Airborne Transmission of SARS-CoV-2 —Theoretical Considerations and Available Evidence
This Viewpoint discusses physical and epidemiological evidence supporting droplet vs aerosol transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and concludes on balance that aerosol transmission seems unlikely to be the dominant mode of coronavirus disease 2019 (COVID-19) spread. (Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

Safeguards Needed for Development of COVID-19 Vaccines
This Viewpoint lists 4 safeguards policy makers should consider before release of a COVID-19 vaccine, including ensuring effectiveness through clinical trials, providing evidence of safety, requiring informed consent before vaccination, and establishing comprehensive adverse effects monitoring systems. (Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

Academic Medicine and Black Lives Matter —Time for Deep Listening
In the context of the Black Lives Matter movement, this Viewpoint considers the demand that academic medicine address its own structural racism, and concludes on the basis of its history, culture, role, and influence that the institution can, should, and must make racial justice a part of its work and mission. (Source: JAMA)
Source: JAMA - August 4, 2020 Category: General Medicine Source Type: research

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