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

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(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

Helping Manufacturers Navigate Novel Coronavirus Variants
The FDA is developing guidance for manufacturers of diagnostics, therapeutics, and vaccines to aid their response to emerging severe acute respiratory syndrome coronavirus 2 variants, Acting Commissioner Janet Woodcock, MD, said in a statement. (Source: JAMA)
Source: JAMA - March 16, 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 16, 2021 Category: General Medicine Source Type: research

2020 Revealed How Poorly the US Was Prepared for COVID-19 —and Future Pandemics
It was not obvious when 2020 began what a grim year it would turn out to be. The first reported US case of coronavirus disease 2019 (COVID-19) was on January 19, 2020, in a man who had returned from Wuhan, China, 4 days earlier. The next day, the US Centers for Disease Control and Prevention started screening at 3 major airports hosting international travelers (John F. Kennedy International Airport, Los Angeles International Airport, and San Francisco International Airport). The first cases that were not related to travel were confirmed on February 26 and 28, 2020, signaling that COVID-19 was not limited to cases being &ld...
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Achievement of the Army Medical Department in the War
Whatever is due to the Medical Department of the United States Army for its achievement during the recent war may be credited to the training and experience of its regular personnel, on the administrative side, and to the generous and efficient cooperation of the physicians and surgeons of this country, on the professional side. When we entered upon this war, every military man in the country realized that we were unprepared for it. Not that the possibility of getting into a war of such dimensions had been ignored by officers of the Army, who in fact, with but small encouragement, had done everything humanly possible to be...
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Alcohol-Related Deaths in Poland During a Period of Weakening Alcohol Control Measures
This population epidemiology study describes trends in overall and age- and sex-specific alcohol-related deaths in Poland between 2002 and 2017, following the weakening in 2001 of policy measures designed to reduce alchohol consumption. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Algorithm to Evaluate Abnormal Liver Function Tests in Liver Transplant Patients
To the Editor In their recent article about outpatient management of liver function test abnormalities in patients with a liver transplant, Dr Graham and colleagues stated that “percutaneous biopsy should not be pursued for patients who underwent transplant within the last 6 months or if coagulopathy and/or residual ascites are present. These patients should undergo transjugular liver biopsy.” (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Evaluation of a Strength-Training Program on Clinical Outcomes in Older Adults
To the Editor We believe that the conclusion of the DO-HEALTH trial that a “strength-training exercise program did not result in statistically significant differences in improvement in…physical performance” warrants further clarification. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Evaluation of a Strength-Training Program on Clinical Outcomes in Older Adults
To the Editor The article by Dr Bischoff-Ferrari and colleagues made misleading claims that its intervention involved strength training. Medically effective strength training for deconditioned muscle has been well defined since 1945, when Capt Thomas DeLorme of the US Army Medical Corps used heavy resistance training, now called progressive resistance training, to rehabilitate wounded World War II soldiers. DeLorme emphasized that progressive resistance training was the best medical practice because “we have seen many patients fail to obtain any appreciable…hypertrophy after several months of low-resistance ex...
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Evaluation of a Strength-Training Program on Clinical Outcomes in Older Adults
To the Editor The recent DO-HEALTH randomized clinical trial failed to demonstrate a benefit of a strength-training exercise program on blood pressure, nonvertebral fractures, physical performance, infection rates, or cognitive function in adults aged 70 years or older without major comorbidities. While the study excels in its rigorous design, large sample size, and high adherence rate, the ineffectiveness of the strength-training program is surprising and deserves further discussion. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Algorithm to Evaluate Abnormal Liver Function Tests in Liver Transplant Patients —Reply
In Reply In our JAMA Performance Improvement article about outpatient management of liver function test abnormalities, we advocated using transjugular liver biopsy for patients within 6 months of liver transplant, irrespective of the presence of coagulopathy and/or ascites. This recommendation was based on observations by us and others that highlight the safety and efficacy of transjugular liver biopsy in liver transplant recipients with various conditions including ascites. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Evaluation of a Strength-Training Program on Clinical Outcomes in Older Adults —Reply
In Reply We agree that the findings of our home-based exercise program on the primary end points of DO-HEALTH do not invalidate the well-established benefits of exercise programs in older adults. Several arguments provided by the Letter authors are valid, including the fact that the exercise program intensity may have been too low for these study participants, 83% of whom already engaged in moderate- to high-intensity exercise. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Effect of Marine Omega-3 Fatty Acid and Vitamin D Supplementation on Incident Atrial Fibrillation
This 2 × 2 factorial trial compares the effects of omega-3 fatty acids (460 mg/d of EPA and 380 mg/d of DHA) vs placebo, vitamin D₃ vs placebo, both, or neither on risk of incident atrial fibrillation (AF) among adults aged 50 years or older over a median of more than 5 years of treatment. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Patient Information: Spontaneous Bacterial Peritonitis
This JAMA Patient Page explains the causes, symptoms, diagnosis, and treatment of spontaneous bacterial peritonitis, an infection of fluid (ascites) that accumulates in the abdomen in liver disease and other conditions. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

A Fib
Only a small untruth, and not, they say, a worry except that while we blindly celebrated birthday, anniversary, went to opera, theater, dined with friends, the device was sending whispered messages that all was not quite what it seemed. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Somebody ’s Sunshine
In this narrative medicine essay a geriatrics fellow describes the experience of preparing for and meeting her foster son and discusses her feelings of uncertainties that (mostly) melt away when sharing her new child's photo with a colleague the day after bringing him home. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke
This narrative review provides an update on management of transient ischemic attack (TIA) and acute ischemic stroke, emphasizing advances in use of dual antiplatelet therapy and fibrinolysis vs mechanical thrombectomy for secondary and tertiary prevention. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Improving Health Among Rural Residents in the US
This Viewpoint summarizes health care challenges faced by US rural residents and suggests how administrative strategies, such as ensuring rural representation in policy development and implementation, and legislative strategies, such as ensuring rural broadband access, could help achieve health equity for residents in rural areas. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Improving the Health of the American Indian and Alaska Native Population
This Viewpoint reviews evidence of poor health outcomes experienced by American Indian/Alaska Native persons owing to structural disadvantage and proposes an aggressive agenda to improve their health and well-being by addressing social determinants of health, improving access to and quality of care, and improving data availability and transparency. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Saving Tens of Thousands of Lives by Cutting Air Pollution
Reducing particulate matter and nitrogen dioxide pollution in nearly 1000 European cities to the World Health Organization (WHO) target levels could save about 50  000 lives a year, a multinational team of investigators reported. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Most Patients Hospitalized With COVID-19 Have Lasting Symptoms
Three-quarters of patients hospitalized with coronavirus disease 2019 (COVID-19) still had at least 1 symptom 6 months after they became ill, according to recently published follow-up research. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

New WHO Guideline for Treating Chronic Pain in Children
Clinicians should consider chronic pain in children as more than a biomedical condition when they choose appropriate treatment. A new World Health Organization guideline has advised health workers to include biopsychosocial factors such as the child ’s age, social environment, and cultural background. (Source: JAMA)
Source: JAMA - March 16, 2021 Category: General Medicine Source Type: research

Addiction Screening —The A Star Is Born Movie Series and Destigmatization of Substance Use Disorders
This Arts and Medicine feature uses the A Star is Born movie series to chart trends in popular cultural representations of addiction and to argue for more authentic Hollywood depictions of substance use disorder. (Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

Saliva Tests Comparable With Nasal Swabs for SARS-CoV-2 Detection
During the coronavirus disease 2019 (COVID-19) pandemic, polymerase chain reaction testing with nasopharyngeal swabs has been the standard diagnostic approach, but the method is uncomfortable and requires a trained health professional. Now, 2 meta-analyses have concluded that self-administered saliva tests are on par with nose and throat swabs for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). (Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

Prolonged SARS-CoV-2 Infection in a CAR T-Cell Therapy Recipient
In a recent case report, a team of physicians described an immunosuppressed patient with severe coronavirus disease 2019 (COVID-19) who was contagious for more than 2 months. Infectious virus was present in the patient ’s endotracheal aspirate (ETA) 72 days after his COVID-19 diagnosis and 2 days before he died from the massive lung infection. The findings from the 73-year-old man, who had recently undergone chimeric antigen receptor T-cell (CAR-T) therapy, suggest that patients with COVID-19 who are severely im munosuppressed may need isolation for longer than the currently recommended 20 days. (Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research