Systole and Diastole: A Metaphor for Living
In this narrative medicine essay, a physician finds in the motion of diastole, the process of letting go and filling up, an apt metaphor for how to handle the burnout, anxiety, and depression of medical training. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Reflections on Women in Leadership —Holding up Half
In this narrative medicine essay, a medical school dean talks about the reticence most women feel when considering leadership roles and urges women to work out of their comfort zones, seize diverse opportunities, and step into leadership roles. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

The Sound of Silence —When There Are No Words
In this narrative medicine essay, a surgeon and palliative care physician describes the isolating silence that she felt her after the slaying of her father in Egypt when she was 18 years old and how that lingering silence has come to guide her when sitting with patients, when there are no words. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

You Did Not Teach Me What You Thought You Did
In this narrative medicine essay, a clinical educator uses her experiences enduring the aftermath of treatment for acute myeloid leukemia to reflect on the difference between physician-teachers and patients ’ experience of illness and to locate meaning in what she can offer her colleagues and trainees despite persistent disability. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Typographical Error
This article was corrected online. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

USPSTF Recommendations for Prevention and Cessation of Tobacco Use in Children and Adolescents
In this issue of JAMA, the US Preventive Services Task Force (USPSTF) presents updated recommendations on prevention and cessation of tobacco use among children and adolescents seen in primary care settings. The USPSTF recommends education and brief counseling with a clinician to prevent initiation of tobacco use (B recommendation). The USPSTF also concludes that evidence is insufficient to assess the balance of benefits and harms of primary care –feasible interventions for the cessation of tobacco use among school-aged children and adolescents (I statement). These recommendations reflect the accompanying Evidence Review. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Using 2 Prostate Biopsy Techniques Optimizes Cancer Diagnosis
Combining a traditional biopsy with a magnetic resonance imaging (MRI) –targeted biopsy more accurately diagnoses clinically significant prostate cancer than either technique alone, according to a recent study by National Institutes of Health (NIH) researchers. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

New AHRQ Patient Safety Guidance
The Agency for Healthcare Research and Quality (AHRQ) recently issued a review of 47 practices that can improve patient safety in various settings. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Lower Out-of-Pocket Insulin Costs for Medicare Plan D Beneficiaries
The Centers for Medicare& Medicaid Services (CMS) recently announced it will test a voluntary model for Medicare Part D plans to lower out-of-pocket expenses for insulin. (Source: JAMA)
Source: JAMA - April 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 - April 28, 2020 Category: General Medicine Source Type: research

The Influenza Outbreak
As set forth elsewhere in this issue, widespread outbreaks of acute respiratory infection have occurred at irregular intervals for many centuries. The general clinical manifestations and the complications have been always practically the same. Owing to conditions that are far from being adequately understood, such infection now and again spreads over the world with great rapidity and in a manner that was altogether mysterious and disconcerting until we learned that it never spreads faster than human travel. It seems as if in the course of evolutionary processes there suddenly is liberated a form of infectious agent against...
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Quality Measure Development and Associated Spending by the Centers for Medicare & amp; Medicaid Services
This study uses data from the publicly available Centers for Medicare& Medicaid Services (CMS) Inventory Tool to determine the proportion of CMS quality measures that are used or finalized for use in a CMS program, under development or consideration for use, or not in use. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Premature Menopause and Risk for Cardiovascular Disease
To the Editor The cohort study by Dr Honigberg and colleagues found that natural and surgical premature menopause were associated with increased risks of cardiovascular diseases among postmenopausal women. Some important issues were not addressed. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Premature Menopause and Risk for Cardiovascular Disease
To the Editor Venous thromboembolism (VTE) is a global health concern because of its significant morbidity and mortality. To our knowledge, few studies have investigated the associations of reproductive life characteristics with VTE risk in women. Analysis of UK Biobank data by Dr Honigberg and colleagues highlights the role of premature natural or surgical menopause in increasing both atherosclerotic and nonatherosclerotic cardiovascular risk, including VTE risk. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Health Outcomes With Vitamin D Supplementation
To the Editor In an Editorial, Drs Lucas and Wolf stated that randomized clinical trials (RCTs) of vitamin D and health outcomes have failed to confirm observational study findings. However, that is not the case for several health outcomes. Secondary analyses of the Vitamin D and Omega-3 Trial (VITAL) revealed significant reductions in overall cancer incidence with supplementation with 2000 IU/d of vitamin D3 in participants with a body mass index (BMI) of less than 25 and in black individuals and reduced overall cancer mortality when the first 1 or 2 years of data were omitted. Secondary analyses of the Vitamin D and Type...
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Premature Menopause and Risk for Cardiovascular Disease —Reply
In Reply Dr Scarabin highlights our finding that menopausal hormone therapy use at study enrollment was not associated with incident VTE. At enrollment, women in the UK Biobank reported whether they had ever used menopausal hormone therapy, the age at which they started and (if applicable) stopped using therapy, and whether they were currently using hormones. In our postmenopausal cohort, it is unlikely that women who were never users of menopausal hormone therapy at enrollment subsequently started using it after the study began —particularly in the era following publication of the Women’s Health Initiative res...
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Health Outcomes With Vitamin D Supplementation —Reply
In Reply Our Editorial accompanied the report of the VITAL-DKD trial. The focus of that article and our Editorial was the lack of benefit of vitamin D supplementation over placebo for prevention of chronic kidney disease end points. We concluded that the VITAL-DKD and D2d trials “provide strong clinical trial–grade evidence against … kidney-protective effects of routine vitamin D3 supplementation in the vast majority of patients with prediabetes or established type 2 diabetes,” and emphasized the discrepancy between the “negative” results of these trials relativ e to previous observatio...
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Long-Acting Injectable HIV Therapy Noninferior to Daily Pills
A pair of trials in the New England Journal of Medicine found that long-acting monthly injectable therapy for HIV-1 infection was noninferior to standard daily oral regimens for maintaining viral suppression. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Methotrexate and Adverse Events in CIRT Secondary Analysis
Although low-dose methotrexate has long been the first-line treatment for rheumatoid arthritis, the drug ’s safety is based on inconclusive and contradictory case reports and observational studies. The drug was associated with a small to modest increase in adverse events (AEs) among patients at high cardiovascular risk in a study in the Annals of Internal Medicine. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Limiting Vulnerable Infants ’ Secondhand Smoke Exposure
A hospital-initiated intervention to protect fragile infants from tobacco smoke exposure at home was successful only among a subset of mothers, a trial in the Journal of Pediatrics found. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Palliative Care Benefits Patients With Parkinson Disease
Outpatient palliative care (PC) improved quality of life and symptoms among patients with Parkinson disease and related disorders in a trial in JAMA Neurology. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Alteplase Inhibits Nerinetide, a Novel Stroke Drug
The investigational neuroprotectant nerinetide did not reduce disability in all patients with ischemic stroke who were treated with endovascular thrombectomy, a trial in The Lancet reported. However, patients who were not concurrently treated with alteplase had a large benefit from nerinetide. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Preventing Tobacco Use in Children and Adolescents
This JAMA Patient Page describes the US Preventive Services Task Force ’s recent recommendations for prevention and cessation of tobacco use in children and adolescents. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Thangkhali Hospital at Night II
I was lying in bed swaddled in synthetic blankets in the on-call room. But what does it really mean to be “on-call”’ in a place like this? Really, everyone here is kind of “on-call”— ready to leave at a moment’s notice to somewhere better. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

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

USPSTF Review: Tobacco and Nicotine Use Prevention and Cessation in Children and Adolescents
This systematic review to support the 2020 US Preventive Services Task Force Recommendation Statement on interventions for prevention and cessation of tobacco and nicotine use summarizes published evidence on the benefits and harms of primary care –relevant interventions for tobacco and nicotine use prevention and cessation in children and adolescents. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

USPSTF Recommendation: Tobacco Use Prevention and Cessation in Children and Adolescents
This 2020 Recommendation Statement from the US Preventive Services Task Force recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents (B recommendation) and concludes that current evidence is insufficient to assess the benefits and harms of primary care interventions for cessation of tobacco use among school-aged children and adolescents (I statement). (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

New York Hospital Was Likely Source of Young Man ’s HIV Infection
A young man with chronic kidney disease likely contracted HIV infection while receiving care in 2017 at a New York City hospital, according to a CDC investigation. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Head Injury Deaths on the Rise
Fall-related head injury deaths in the United States increased by 17% from 2008 to 2017, according to a CDC report. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Corrections to Address Revised Analysis in Related Study
In the Editorial entitled “Improving Access to Kidney Transplantation: Business as Usual or New Ways of Doing Business?” published in the September 10, 2019, issue of JAMA, has been corrected to address coding errors in the related study, which has been retracted and replaced. This Editorial was corrected online. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Sexual Misconduct in Academic Medicine
The Me Too movement began in 2006 but was popularized in 2017 by women in Hollywood who had been sexually harassed. Since then, the pervasiveness of sexual misconduct across many segments of society has become apparent, and medicine has not been exempt. Although many studies have described sexual misconduct from the point of view of the person who was the target of the sexual misconduct, few studies have focused on the perpetrators. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Overuse of Continuous Pulse Oximetry for Bronchiolitis
Bronchiolitis, a viral infection of the lower respiratory tract, is the most common cause of hospitalization among children younger than 2 years, and generated estimated direct hospital costs of $734 million in 2016. Clinical practice recommendations from the Choosing Wisely campaign and the American Academy of Pediatrics (AAP) specifically target medical overuse for children with bronchiolitis in an effort to improve value of medical care for the approximately 130  000 infants admitted each year with this disease. Amid recommendations related to prevention, diagnosis, and management of bronchiolitis, these guidelines re...
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Correcting the Scientific Record —Retraction and Replacement of a Report on Dialysis Ownership and Access to Kidney Transplantation
The September 10, 2019, issue of JAMA included an Original Investigation titled “Association Between Dialysis Facility Ownership and Access to Kidney Transplantation” by Gander and colleagues, and an accompanying Editorial by Boulware and colleagues. The authors of the research report subsequently notified the editors that a major coding error had occurred in their data man agement and analyses, and that they discovered these errors had resulted in incorrect data in their published article. As reported in their letter of explanation, the authors performed a thorough reanalysis of their data to address these err...
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Graphic Health Images Are Coming to Cigarette Packaging
Beginning in June 2021, people who buy cigarettes will get their tobacco fix from packages with stark images that depict lesser-known smoking risks such as stunted fetal growth or increased odds of developing bladder cancer. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

HCV Drug Used in Adults Receives Approval for Pediatric Patients
A combination drug used to treat hepatitis C virus (HCV) infection in adults has been approved for pediatric patients 6 years or older or those who weigh at least 37 lb and don ’t have cirrhosis or only a mild case. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

New Therapy Offers Direct Cortisol Control for Cushing Disease
A new drug for adults with Cushing disease is the first FDA-approved treatment that directly addresses excessive cortisol by blocking an enzyme involved in cortisol production. (Source: JAMA)
Source: JAMA - April 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 - April 21, 2020 Category: General Medicine Source Type: research

Medicaid Work Requirements Shift to New Terrain
State policies requiring low-income adults to work to maintain Medicaid coverage have been gaining traction and sparking debate. With encouragement from the Centers for Medicare& Medicaid Services (CMS), 20 states have proposed some form of “community engagement” requirements. These proposals typically involve mandating Medicaid beneficiaries to work a certain number of hours (usually 20 hours per week), engage in job training or community service, or obtain an exemption (such as having children with disabilities or being family ca regivers). (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Wilhelm Konrad Roentgen —The Centennial of His Birth
On March 27, 1845 Wilhelm Konrad Roentgen was born in Lennep, Germany. He received his early education in the Netherlands and then studied under Clausius, teacher of Willard Gibbs, in Zurich, Switzerland. At W ürzburg he became assistant to Kundt. In 1874 he became privatdozent at Strasbourg University. In 1875 Roentgen was made professor of mathematics and physics at the Agricultural Academy of Hohenheim. He returned to Strasbourg in 1876, where he became extraordinary professor. In 1879 he was appointe d ordinary professor of physics and director of the Physical Institute of Giessen, and in 1885 he became professor ...
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Characteristics of Faculty Accused of Academic Sexual Misconduct in the Biomedical and Health Sciences
This study uses internet search data to identify and characterize biomedical and health sciences faculty at US higher education institutions who had sexual misconduct accusations against them between 1982 and 2019 that led to institutional or legal actions proving or supporting guilt. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Paralytic Agents for Intubation in the Out-of-Hospital Setting
To the Editor The study by Dr Guihard and colleagues is one of the few trials to use endotracheal intubation success as an outcome when comparing rocuronium and succinylcholine for rapid sequence intubation. With the exception of a few observational studies that evaluated intubation success, previous investigations only measured intubation conditions as an outcome. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Paralytic Agents for Intubation in the Out-of-Hospital Setting
To the Editor Dr Guihard and colleagues investigated 1248 patients requiring out-of-hospital rapid sequence tracheal intubation in a multicenter, single-blind, noninferiority randomized clinical trial comparing 1.2 mg/kg of rocuronium with 1 mg/kg of succinylcholine. The authors stated that rocuronium, compared with succinylcholine, failed to demonstrate noninferiority with regard to first-attempt intubation success rate. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Techniques for Treatment of Carotid Stenosis
To the Editor Dr Schermerhorn and colleagues compared transcarotid artery revascularization with transfemoral carotid stenting for treatment of carotid stenosis and found that transcarotid artery revascularization was associated with a lower risk of stroke or death. However, 37% of the patients (n  = 1965) were excluded from the transcarotid artery revascularization group and 50% (n = 3354) from the transfemoral carotid stenting group. When such a large percentage of the registry data are excluded, it becomes difficult to make a fair comparison without eliminating selection bias. The authors sho...
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Use of Frozen Embryo Transfer During Fertility Treatment and Risk of Childhood Cancer
To the Editor Dr Hargreave and colleagues examined the association between fertility treatment and cancer risk in children. They found that the use of frozen embryo transfer was associated with a small increased risk of childhood cancer compared with children born to fertile women. We would like to raise an important technical consideration regarding the cryopreservation method. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Paralytic Agents for Intubation in the Out-of-Hospital Setting —Reply
In Reply Dr Patanwala raises the possibility that our results could be misinterpreted due to inappropriate use of terms related to the interpretation of noninferiority trials. However, as Patanwala points out, the description of our results in the article is correct. Nevertheless, we agree that the term inconclusive could have been used and the figure could have been revised for consistency. We fully agree that failure to demonstrate the noninferiority of rocuronium should not be interpreted as the superiority of succinylcholine. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Techniques for Treatment of Carotid Stenosis —Reply
In Reply In response to Dr Sharma and colleagues, we used propensity score matching methods to account for baseline characteristic differences found between patients undergoing transfemoral carotid artery stenting and transcarotid artery revascularization. Although this led to a 50% exclusion of patients from the transfemoral carotid stenting cohort and a 37% exclusion of patients from the transcarotid artery revascularization cohort, these matching methods are important for controlling intrinsic biases found in observational studies. However, we provided unadjusted complete raw data outcomes in eTable 1 in the supplementa...
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Use of Frozen Embryo Transfer During Fertility Treatment and Risk of Childhood Cancer —Reply
In Reply Drs Parmegiani and Vajta note recent changes in the cryopreservation method from the traditional slow-rate freezing to cryopreservation by vitrification and suggest this may be relevant for the interpretation of our study. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Effect of Zoledronic Acid on Tibiofemoral Cartilage Volume in Knee Osteoarthritis With Bone Marrow Lesions
This randomized trial compares the effects of intravenous zoledronic acid vs placebo on magnetic resonance imaging –assessed knee cartilage volume loss in patients with symptomatic knee osteoarthritis and subchondral bone marrow lesions. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research

Pulse Oximetry Monitoring in Hospitalized Children With Bronchiolitis Not Requiring Supplemental Oxygen
This study characterizes use of continuous pulse oximetry monitoring in hospitalized children with bronchiolitis who do not require supplemental oxygen in Canadian and US hospitals. (Source: JAMA)
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research