Dedicated Device Permits Less Invasive Pancreatic Surgery
A device that ’s specifically indicated to remove necrotic pancreatic tissue in a minimally invasive procedure has been authorized for patients with walled-off pancreatic necrosis. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Management of Immunotherapy-Related Toxicities in Patients Treated With Immune Checkpoint Inhibitor Therapy
This JAMA Clinical Guidelines Synopsis summarizes the National Comprehensive Cancer Network ’s 2019 guidelines on management of immunotherapy-related toxicities, including adverse skin reaction, colitis, and myocarditis. (Source: JAMA)
Source: JAMA - February 2, 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 - February 2, 2021 Category: General Medicine Source Type: research

Dying Poor in the US —Disparities in End-of-Life Care
The coronavirus disease 2019 (COVID-19) pandemic has focused attention on stark disparities in the US, with higher rates of infections and deaths among lower-income populations and communities of color. Illness and death rates are not the only sources of health inequity in this country. There are also substantial differences in the care that patients with serious illnesses receive near the end of life that are based on race or socioeconomic status. Although pandemic-related efforts to improve equity rightfully focus on preventing death, in this and numerous other contexts, policy makers and clinicians should also work to e...
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Current Comment
(Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Screening for Asymptomatic Carotid Artery Stenosis in the General Population
This systematic review to support the 2021 US Preventive Services Task Force Reaffirmation Recommendation Statement on screening for carotid artery stenosis summarizes published evidence on the benefits and harms of screening and treatment of asymptomatic carotid artery stenosis in the general population. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Asymptomatic SARS-CoV-2 Infections Among Persons Entering China From April 16 to October 12, 2020
This population epidemiology study characterizes trends in the prevalence of asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among international entrants testing positive for SARS-CoV-2 at Chinese border checkpoints between mid-April and mid-October 2020. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Determination of Brain Death
To the Editor Dr Greer and colleagues attempted to standardize the diagnosis of BD/DNC within and across countries. However, drug ingestion complicates the diagnosis of BD/DNC. The authors recognized that brain death mimics exist and that some of these mimics are reversible. However, we have several concerns. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Determination of Brain Death
To the Editor Although Dr Greer and colleagues ’ comprehensive review on the determination of BD/DNC provided guidance for protocol development worldwide, we would like to address some considerations regarding ancillary testing in BD/DNC diagnosis. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Determination of Brain Death
To the Editor In their article “Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project,” Dr Greer and colleagues addressed the minimum standards for brain death/death by neurologic criteria (BD/DNC) with the intention of alleviating inconsistencies in clinical practice. The authors followed t he 1981 US President’s Commission in determining that death must be defined by and carry the force of law, both to ensure public acceptance and to protect practitioners. Indeed, the expert consensus recommended that all countries recognize BD/DNC as legal death. Greer and colleagues ...
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Determination of Brain Death
To the Editor The Special Communication by Dr Greer and colleagues aimed to promote international guidelines for the determination of BD/DNC. However, the potential of this article is diminished by an inconsistency in their recommendations. The authors addressed 3 “special circumstances” in which continued or even additional postmortem somatic support may be permissible: if the decedent has a planned organ donation, if the decedent is pregnant, or if family members object to using BD/DNC and the hospital agrees to continue support. For these decedents, Gr eer and colleagues suggested that health care teams mana...
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Determination of Brain Death —Reply
In Reply The World Brain Death Project recommendations and suggestions were produced via multidisciplinary global expert consensus on the process to declare death, recognizing that BD/DNC is accepted as death throughout much of the world but that the standards used to determine BD/DNC differ. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Association Between Changes in Economic Prosperity and Cardiovascular Mortality Among Middle-aged US Adults
This population epidemiology study estimates the association between changes in county-level economic prosperity and changes in cardiovascular mortality in US adults aged 40 to 64 years between 2007-2011 and 2012-2016. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Molecular Diagnostic Yield of Exome Sequencing in Patients With Cerebral Palsy
This cross-sectional study describes the prevalence of pathogenic and likely pathogenic variants detected on exome sequencing of children and adults with cerebral palsy referred for genetic testing. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Association Between Dispatch of Mobile Stroke Units and Functional Outcomes Among Stroke Patients in Berlin
This cohort study compares global disability at 3 months among Berlin patients with out-of-hospital ischemic stroke brought to care via a mobile stroke unit ambulance (with prehospital CT scanning with or without angiography, point-of-care laboratory testing, prehospital thrombolysis) vs conventional ambulance alone. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

USPSTF Recommendation: Screening for Carotid Artery Stenosis
This JAMA Patient Page summarizes the US Preventive Services Task Force ’s 2021 recommendation not to screen for asymptomatic carotid artery stenosis in the general population. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

I Dream of Animals During the Pandemic
I find a lobster in the swimming pool. It looks me in the eye, the way people do when they don ’t want to, and with its voice like glass, says, Your grandmother is dying again. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

The In-between —a Forever Altered Life and Uncertain Future
In this narrative medicine essay, a geriatrician memory of a neuroradiology fellow ’s words of calm when breaking the news that her 8-year-old daughter had a brain tumor often bubbles up years later when she breaks bad news to patients with COVID who are without the support of friends or family. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

USPSTF Recommendation: Screening for Asymptomatic Carotid Artery Stenosis
This 2021 US Preventive Services Task Force Recommendation Statement recommends against screening for asymptomatic carotid artery stenosis in the general adult population (D recommendation). (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Reducing Administrative Waste in the US Health Care System
This Viewpoint reviews the history and sources of administrative waste in the US health care system and proposes concrete ways the federal government can use its regulatory authority to reduce it based on the ACA and more recent legislative precedents. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Ensuring Quality in the Era of Virtual Care
This Viewpoint discusses residual questions about virtual health care as a substitute for in-person visits during the COVID-19 pandemic and proposes principles of safety, effectiveness, efficiency, patient-centeredness, and equitability to guide the growth of telehealth care in the future. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Paying for Telemedicine After the Pandemic
This Viewpoint discusses the importance of value as policy makers consider the role of telemedicine for the remainder of and following the COVID-19 pandemic, and how to calibrate payment for services to that value in a likely expansion of video and audio-only visits. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Numerical Error in Text
This article was corrected online. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Funding Efforts to Reduce COVID-19 Testing Hesitancy
The National Institutes of Health (NIH) recently announced the second round of awards for its Rapid Acceleration of Diagnostics Underserved Populations (RADx-UP) program, which is intended to increase testing for coronavirus disease 2019 (COVID-19) among populations disproportionately affected by the disease. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Obstacles to Implementing AI Tools in Health Care
Artificial intelligence (AI) tools have shown promise in predicting patients ’ health trajectories, recommending treatments, guiding surgical care, monitoring patients, and supporting efforts to improve the health of a community, according to a recent Government Accountability Office (GAO) report. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

The Costs of US Emergency Department Visits
The US population made 144.8 million emergency department (ED) visits in 2017, costing a total of $76.3 billion, estimated a recent statistical brief from the Agency for Healthcare Research and Quality ’s Healthcare Cost and Utilization Project (HCUP). (Source: JAMA)
Source: JAMA - January 26, 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 - January 26, 2021 Category: General Medicine Source Type: research

Pancreatic Cysts —An Overview and Summary of Society Guidelines, 2021
This JAMA Insights review summarizes and interprets specialty society guidelines on the diagnosis and management of pancreatic cysts for primary care physicians, focusing on high-risk features, management, and surveillance (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

“This Level of Death, It’s New”—Health Care Workers in Their Own Words
The surge in hospitalizations for coronavirus disease 2019 (COVID-19) around the country has led many physicians and other health care workers to speak out. We created this post directly from the recent words of frontline health care workers and medical administrators in 19 states, with the sources linked to the first word or two of each quote. Their words reflect an unprecedented time for the US health care community in the midst of the pandemic. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Appendicitis in France and in America
From the discussion regarding appendicitis by the Paris Surgical Society (Bull. et m ém. de la Soc. de Chir. de Paris, T. xviii), it is evident that unanimity of opinion upon some points as to treatment is not yet established in France, and that the French are somewhat behind the progress of American surgeons. The discussion as brought out in the society includes the etiology and p athology, the expectant opium treatment and early and late operations upon the inflamed vermiform, and is based upon the histories of cases presented and the results of operations performed. The adherents of the opium treatment (Berger, M...
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Hospital Revenue Under Maryland ’s Total Cost of Care Model During the COVID-19 Pandemic, March-July 2020
This study compares revenue of Maryland hospitals in March-July 2020 vs historical trends and assesses whether rate increases for inpatient and outpatient services that were permitted to offset pandemic-related decines in revenues were associated with changes to state hospital revenue. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Update on Lipids and Lipoproteins
To the Editor In their JAMA Insights Clinical Update on lipids and lipoproteins, Dr Ference and colleagues emphasized the pivotal role of apolipoprotein B (apoB) in atherosclerosis and recommended the measurement of apoB levels to capture all atherogenic lipoprotein particles. However, this apoB assay is not readily available in many clinical laboratories around the world and is not completely standardized. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Update on Hepatitis A Management
To the Editor Drs Desai and Kim provided a brief overview of hepatitis A management. Their JAMA Insights article was timely considering the widespread person-to-person outbreaks of hepatitis A across the US since 2016. However, we note some discrepancies between this publication and the Advisory Committee on Immunization Practices (ACIP) recommendations that could affect the public health response to hepatitis A. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Update on Lipids and Lipoproteins —Reply
In Reply We agree with Drs Jialal and Devaraj that total cholesterol and HDL-C can be measured accurately and precisely in clinical laboratories, and that the difference, referred to as non –HDL-C, is a good measure of the total cholesterol content carried by circulating apoB-containing lipoproteins. However, our article did not focus on the best way to measure lipids in the laboratory. Furthermore, apoB is not a lipid, but instead is a lipoprotein that carries lipids in plasma. Conf lating lipids measured in the standard lipid panel with lipoproteins is a common mistake that leads to confusion about the role of lipi...
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Update on Hepatitis A Management —Reply
In Reply We agree with Dr Weng and colleagues that the risk of acquiring hepatitis A in certain occupational settings is low. We mentioned this consideration in our JAMA Insights article because certain public health bodies deployed vaccination of food service workers in the setting of an outbreak. However, we acknowledge that this is not standard practice and that the efficacy of such interventions is unknown. Second, we agree that health care workers who work in settings that provide services for injection and noninjection drug users are not at higher risk of acquiring hepatitis A as noted in the most recent ACIP recomme...
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Simplified Regimen Expands Options for Dual-Therapy HIV Maintenance
As a preferred HIV drug based on its efficacy and high barrier to drug resistance, dolutegravir has been combined in treatment regimens with several other anti-HIV agents. Now investigators in Switzerland have reported in PLOS Medicine that dolutegravir taken with emtricitabine was noninferior to standard combination antiretroviral therapy (cART), and it improved patients ’ quality of life. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Fecal Immunochemical Testing vs Sigmoidoscopy for Cancer Screening
Repeated fecal immunochemical testing (FIT) detected more colorectal cancer and advanced adenomas and had greater patient participation than sigmoidoscopy, a trial in Gastroenterology reported. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Intravenous Iron Therapy Prevents Heart Failure Rehospitalizations
Intravenous (IV) ferric carboxymaltose reduced subsequent hospitalizations among patients with acute heart failure and iron deficiency, according to a 15-country trial in The Lancet. Patients with acute heart failure often have iron deficiency, which contributes to poor prognosis regardless of anemia. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Ablation Beats Drugs for Initial Atrial Fibrillation Treatment
Although guidelines recommend medical therapy before catheter ablation for atrial fibrillation, antiarrhythmic drugs fail to prevent recurrence for up to 67% of patients. In a pair of multicenter trials published in the New England Journal of Medicine, fewer recurrences occurred with cryoballon ablation than with medication as first-line therapy. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Incidence of Transient Ischemic Attack and Association With Long-term Risk of Stroke
This cohort study uses Framingham Heart Study (FHS) data to assess population-based incidence of transient ischemic attack (TIA), and the timing and long-term trends of stroke risk after TIA, among participants in the FHS Original, Offspring, and Third Generation cohorts from 1948 to 2017. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Effect of Behavioral Therapy With In-Clinic or Telephone Group Visits vs In-Clinic Individual Visits on Weight Loss in Obesity
This randomized trial compares the effects on 24-month weight change of behavioral therapy delivered at US rural clinics via in-clinic individual visits or in-clinic group visits vs telephone group visits to patients with obesity. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Patient Information: Amblyopia
This JAMA Patient Page explains the causes, symptoms, and management of amblyopia, reduced vision in one or both eyes due to abnormal visual development during childhood. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

The Strange Cabinet
—Mexico City, 1986 (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Shared Grief —Bridging the Health Equity Gap
In this narrative medicine essay a neonatal ICU nurse afraid to hold her newborn daughter after she dies draws comfort and a sense of connection years later from the memory of a parent she had unconsciously stigmatized, who held and loved her infant son at his death. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Acute Pancreatitis: A Review
This narrative review summarizes the pathogenesis, diagnosis, and management of acute pancreatitis, including advances in risk stratification, fluid and nutritional management, and follow-up care and risk-reduction strategies. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Addressing the Risk of Medicare Trust Fund Insolvency
This Viewpoint proposes policy options to forestall insolvency of the Medicare Hospital Insurance Trust Fund, including practical and politically palatable strategies to increase revenues and decrease spending to prevent looming shortfalls. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Drug-Resistant Bacteria Outbreak Linked to COVID-19 Patient Surge
Breaches in infection control practices during last spring ’s coronavirus disease 2019 (COVID-19) surge likely contributed to a 34-patient outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) infections at a New Jersey hospital. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Racial Variations in Parents ’ Attitudes About Reopening Schools
Black, Hispanic, Asian, American Indian, and Alaska Native parents expressed more concern than White parents about the safety of reopening schools last fall, according to a survey commissioned by the CDC. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research