Prevalence of SARS-CoV-2 Antibodies in Health Care Personnel in the New York City Area
This seroprevalence survey study describes severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity among health care workers at a New York City –based health system by age, sex, race, county of residence, and prior PCR-confirmed viral exposure. (Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

Universal Masking in the United States: the Role of Mandates, Health Education, and the CDC
This Viewpoint proposes legal and policy options for promoting universal face mask wearing in the US and, recognizing the limits of state-by-state implementation, proposes strengthening the authority, independence, and funding of the CDC to enact responses to this and future comparable public health emergencies. (Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

RNA Aptamers Deliver Chemotherapy Directly to Tumors
Scientists have harnessed synthetic RNA molecules that behave like antibodies —with high affinity and specificity for a target—to shuttle chemotherapy agents directly into tumors. (Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

CAR-T Therapy Is Approved for Mantle Cell Lymphoma
The first cell-based gene therapy for adults with mantle cell lymphoma (MCL) has received FDA approval. (Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

New FDA-EPA Protocol Covers Agricultural Water Safety
The FDA and the US Environmental Protection Agency (EPA) have developed a new protocol that may help farmers protect produce such as romaine lettuce and other leafy greens from contamination that can cause foodborne illnesses. (Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

FDA Targets Illegal Hangover Relief
Forget the Happy Hour Vitamins, milk thistle, and prickly pear. Not only will they fail to prevent or cure a hangover, the FDA said they ’re illegally being marketed as remedies for having one too many. (Source: JAMA)
Source: JAMA - September 1, 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 - September 1, 2020 Category: General Medicine Source Type: research

Treatment of Patients Following Bariatric Surgery in 2020-2021
This JAMA Insights Clinical Update reviews long-term complications of bariatric surgery, including GERD, gallstones, hypoglycemia, substance use disorder, and vitamin and other nutritional deficiencies, and proposes a schedule of testing and management strategies for each. (Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

The Importance of Reestablishing a Pandemic Preparedness Office at the White House
As the country tries to make sense of all that has happened during the coronavirus disease 2019 (COVID-19) pandemic, one idea that should cause little controversy is the importance of health to the security of the US, to its economy, and to the well-being of its citizenry. Given health ’s fundamental importance to national security, a disaster preparedness and response unit should be reestablished as part of the National Security Council (NSC) and remain there on a permanent basis. This response unit would be in addition to, not a replacement for, the Office of Pandemics and Eme rging Threats. The latter currently re...
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

Rambling Notes of a Roving Doctor
Paris, August, 1900. (Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

Incidence of Malformations After Early Pregnancy Exposure to Modafinil in Sweden and Norway
This pharmacoepidemiology study uses Scandinavian birth registry data to estimate the association between modafinil use during early pregnancy and major congenital malformations among infants born in Norway and Sweden between 2005-2006 and 2016-2017. (Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

Reducing Vasopressor Exposure in Patients With Vasodilatory Hypotension
To the Editor A clinical trial by Dr Lamontagne and colleagues showed that reducing exposure to vasopressors through a lower mean arterial pressure (MAP) target during resuscitation in older patients with vasodilatory hypotension decreased 90-day mortality, although it did not reach statistical significance. Three large randomized clinical trials also showed that early goal-directed therapy did not improve outcomes in patients with septic shock. (Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

Nonalcoholic Steatohepatitis
To the Editor The Review by Dr Sheka and colleagues omitted 2 important facts: (1) nonalcoholic fatty liver disease (NAFLD) is an independent cardiovascular risk factor, increasing the risk of a cardiovascular event by nearly 2-fold and (2) an individual with metabolic syndrome and NAFLD has a 2- to 5-fold increased risk of progressing to diabetes compared with someone without NAFLD. (Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

Payer Mix Among Patients Receiving Dialysis
To the Editor The Research Letter by Ms Hoffman and colleagues described trends in payer mix among patients receiving dialysis in the United States. We share the authors ’ concerns that shifting patients from publicly funded insurance to commercial insurance could increase the overall cost of dialysis care. Although the Affordable Care Act increased access to the commercial insurance market through the creation of health insurance exchanges, we were surprised by t he magnitude of non-Medicare coverage reported. (Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

Reducing Vasopressor Exposure in Patients With Vasodilatory Hypotension —Reply
In Reply Dr Das and colleagues raise a number of concerns about the 65 Trial. The explanation for the median blood pressure being higher than the MAP target relates, in part, to the protocol. When MAP values were above 65 mm Hg, the protocol stipulated that vasopressor dose rates should be reduced until, if possible, they were stopped. As such, it was possible to adhere to the protocol by continuously reducing vasopressor doses and still record MAP values above 65 mm Hg until stopping the medication, at which time MAP values were not recorded. MAP values without vasopressor dose rates are not good indicators of protocol ad...
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

Nonalcoholic Steatohepatitis —Reply
In Reply We agree with Dr Grajower that addressing cardiovascular risk is important in treating patients with NAFLD and NASH, as mentioned in the article. As he points out, NAFLD, NASH, and metabolic syndrome are closely related, and treatment is therefore also interrelated. It was simply not feasible to address all components of cardiovascular risk reduction in the Review, which was focused on NASH specifically. Similarly, we did not address screening and treatment for hepatocellular carcinoma, varices, and end-stage liver disease, although these are closely related to NASH. We did think it was important to mention statin...
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

Payer Mix Among Patients Receiving Dialysis —Reply
In Reply We agree with Drs Lin and Erickson on the importance of using patient-level data to corroborate facility-level trends in payer mix for ESKD. Significant changes were shown in facility-reported Medicare and non-Medicare enrollment in our study, but the patient-level statistics that Lin and Erickson provide from the USRDS Annual Data Reports showed almost no change in Medicare and non-Medicare enrollment. (Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

Rimegepant (Nurtec ODT) for Acute Treatment of Migraine
This Medical Letter review summarizes evidence supporting the use of rimegepant (Nurtec), a small-molecule calcitonin gene-related peptide receptor antagonist, for acute treatment of migraine with or without aura in adults. (Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

Association Between New-Onset Atrial Fibrillation After Noncardiac Surgery and Subsequent Stroke and TIA
This retrospective study compared the rate of ischemic stroke or transient ischemic attack among Olmstead County, Minnesota, residents with vs without new-onset postoperative atrial fibrillation after undergoing noncardiac surgery. (Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

Effect of Intraoperative Low vs Conventional Tidal Volume on Postoperative Pulmonary Complications After Major Surgery
This randomized clinical trial compares the effect of intraoperative ventilation with low vs conventional tidal volume (6 vs 10 mL/kg predicted body weight) on pulmonary complications in the first 7 postoperative days among patients undergoing major surgery lasting longer than 2 hours. (Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

Patient Information: Sleeve Gastrectomy
This JAMA Patient Page explains who should undergo gastric sleeve procedure, a type of obesity surgery; how to prepare for it; and what to expect afterward. (Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

The Nerve
I took a trip to death one day, a boat to carry all my pain. The captain said I wouldn ’t need to bring my shoes or coat, but I should lie here quietly till dead. The waves revolted every nerve. I stood and took my pain and wrecked it shore to shore, my inner artists weaving what they could. I didn’t want to die. I wanted more of air in leaves, the loving wind, the crow shining he r velvet feathers on my face. I told the captain that I wouldn’t go and struggled through a fog to leave that place. But clouds and sea turned into hopeless rain. What little raft I had sank in the pain. (Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

Benefits and Risks of Bariatric Surgery in Adults: A Review
Precis This narrative review summarizes the efficacy and safety of bariatric surgery, mainly sleeve gastrectomy and the Roux-en-Y procedure, in assisting weight loss and in patients with type 2 diabetes and other obesity-related comorbidities. (Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research

Postexercise Ankle-Brachial Index Testing
A 61-year-old woman with a history of hypertension presented for evaluation of exertional left calf discomfort. Her lower extremity systolic blood pressure and ankle-brachial index (ABI) measures declined after treadmill testing. What would you do next? (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

From Auto Mechanic to Emergency Medicine Resident: Inspiring Young Blacks to Become Physicians
This Medical News article discusses the circuitous path Carl Allamby, MD, traveled from auto repair shop owner to emergency medicine resident. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Management of Age-Related Macular Degeneration in 2020-2021
This JAMA Insights Clinical Update reviews the epidemiology, clinical manifestations, classification, diagnosis, prevention, and approved and investigational treatment of age-related macular degeneration in older adults. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

CYP2C19 Genotyping and Percutaneous Coronary Interventions
Following percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) with aspirin and an inhibitor of the platelet adenosine diphosphate P2Y12 receptor (P2Y12) is standard care to reduce the occurrence of stent thrombosis and ischemic events. For many years, clopidogrel has been the most commonly used P2Y12 inhibitor for patients with an acute coronary syndrome (ACS) and those undergoing PCI. However, platelet function studies have revealed variability in the response to clopidogrel, with 20% to 40% of patients having persistent, high on-treatment platelet reactivity. This attenuated pharmacodynamic respons...
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Household Composition May Explain COVID-19 Racial/Ethnic Disparities
Exposure to the novel coronavirus at work or at home may be more important than underlying health conditions in explaining why Black and Hispanic adults are more likely to die from coronavirus disease 2019 (COVID-19) than White adults, a recent study from the Agency for Healthcare Research and Quality suggests. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Difficult to Determine Herd Immunity Threshold for COVID-19
Too many questions remain for researchers to reach definitive conclusions about herd immunity for coronavirus disease 2019 (COVID-19), according to a Government Accountability Office report. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Streetlights May Be Keeping Teens Up at Night
Living near higher levels of outdoor artificial light at night (ALAN) was associated with shorter sleep duration and an increased likelihood of a mood disorder in adolescents, according to a study by National Institute of Mental Health researchers. (Source: JAMA)
Source: JAMA - August 25, 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 25, 2020 Category: General Medicine Source Type: research

Renaudot and the First French Newspaper and Medical Journal
The first French newspaper was founded in 1631 by Th éophraste Renaudot, a physician and great humanitarian. Renaudot was graduated from the medical school at Montpellier in 1606 before he had reached his twentieth year. He had inherited a considerable fortune from his parents. “Recognizing the fact that a physician should be of a certain age befor e he can reasonably expect to command the confidence of his fellow men,” Buck says, “he decided to utilize the time following his graduation in visiting some of the more important capitals of Europe.” Renaudot visited Italy, Holland, Belgium, Oxfor...
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Therapies Offered at Residential Addiction Treatment Programs in the United States
This study uses simulated patient calls to a random sample of US residential addiction treatment facilities to investigate the availability of opioid agonist treatment (buprenorphine-naloxone) and nonpharmacologic therapies (eg, CBT) for opioid use disorder, and differences by for-profit vs nonprofit center status. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Reducing Intraoperative Hypotension Using a Machine Learning –Derived Early Warning System
To the Editor Prevention of arterial hypotension is a major concern during anesthesia because its occurrence is associated with increased morbidity and mortality. Dr Wijnberge and colleagues reported use of a machine learning –derived early warning system that lowered the time-weighted average of arterial hypotension compared with standard care. However, several points limit the interpretation of this study. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Drug Shortages and Group Purchasing Organizations
To the Editor Health care group purchasing organizations (GPOs) play an important role in helping to deliver a safe and reliable supply of products to health care clinicians. Unfortunately, a recent Viewpoint on drug shortages misrepresented key aspects regarding GPOs. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Drug Shortages and Group Purchasing Organizations —Reply
In Reply We agree with Ms Calleja that GPOs play an important role in the supply of health care products, including pharmaceuticals. The need for a high-functioning supply chain for health care products has never been more salient than now, during the coronavirus disease 2019 (COVID-19) pandemic. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Reducing Intraoperative Hypotension Using a Machine Learning –Derived Early Warning System—Reply
In Reply Dr de Tymowski and colleagues suggest that a clinical analysis approach should have been compared with the machine learning approach in our study. This is exactly what was done. The control group was free to use blood pressure trend analysis, which was available on the monitors. Furthermore, it was not the physicians who monitored blood pressure more closely in the intervention group but the machine learning –derived algorithm. Moreover, all conventional parameters such as continuous arterial blood pressure were available in both groups. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Experts Discuss COVID-19 —Remdesivir, Vaccines, 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 - August 25, 2020 Category: General Medicine Source Type: research

Elagolix Reduces Fibroid-Related Heavy Menstrual Bleeding Long-term
Elagolix, a gonadotropin-releasing hormone antagonist, plus hormonal add-back therapy reduced heavy menstrual bleeding from uterine leiomyomas during up to 12 months of continuous treatment, according to a trial in Obstetrics& Gynecology. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Aspirin Fails to Prevent Depression in Older Adults
Low-dose aspirin did not reduce the risk of depression in healthy older adults, a trial in JAMA Psychiatry reported. Depression is associated with elevated markers of inflammation, which may occur before symptoms arise, particularly in older people. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Shorter Resident Shifts May Not Improve Patient Safety
Residents who worked schedules that eliminated extended shifts made a greater number of serious errors than those who worked schedules with shifts of 24 or more hours, a trial in the New England Journal of Medicine reported. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Aspirin Protects Against Colorectal Cancer in Lynch Syndrome
Daily aspirin use for at least 2 years significantly reduced colorectal cancer risk among patients with Lynch syndrome, according to the 10-year follow-up of a randomized trial. Aspirin ’s protective effect did not become apparent until about 5 years after beginning treatment, the investigators reported in The Lancet. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Mailings, Phone Calls Increase Post-MI Cardiac Rehabilitation
Most patients aren ’t referred to cardiac rehabilitation after a myocardial infarction (MI), and about half discontinue their medication by 1 year. A scalable intervention designed to promote secondary prevention treatments after MI increased patients’ cardiac rehabilitation but not their medication adherence, a t rial in the BMJ reported. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Accuracy of Plasma P-tau217 for Distinguishing Alzheimer Disease From Other Neurodegenerative Disorders
This cross-sectional study compares the accuracy of plasma tau phosphorylated at threonine 217 (P-tau217) levels vs other plasma-, MRI-, CSF-, and PET-based markers for distinguishing Alzheimer from other neurodegenerative diseases in 3 cohorts in Arizona, Sweden, and Columbia with or at risk for dementia. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Effect of Vitamin D 3 on Severe Asthma Exacerbations in Children With Asthma and Low Vitamin D Levels
This randomized trial compares the effects of vitamin D3 vs placebo on time to severe exacerbation in children with asthma and low vitamin D levels. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Effect of Genotype-Guided Oral P2Y12 Inhibitor Selection vs Clopidogrel on Ischemic Outcomes After PCI
This open-label randomized trial compares the effect of a genotype-guided oral P2Y12 inhibitor selection strategy vs conventional clopidogrel prescribing on 12-month ischemic outcomes after percutaneous coronary intervention (PCI) in CYP2C19*2/CYP2C19*3 loss-of-function allele carriers with acute coronary syndromes and stable cardiovascular disease. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

What Is LASIK Eye Surgery?
This JAMA Patient Page describes LASIK, a type of laser surgery that corrects blurry vision usually treated with eyeglasses, and summarizes who can benefit and the procedure ’s risks. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

Patient Information: COVID-19
This JAMA Patient Page provides an overview of COVID-19 transmission, symptoms, diagnosis, disease course, and treatment. (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research

A Song Sung Sweet to Greet the Dead
for Tybias, Levi, Leon, and their grandmother (Source: JAMA)
Source: JAMA - August 25, 2020 Category: General Medicine Source Type: research