FDA Says It Supports Cannabis Drug Development via Regulatory Pathways
A key FDA official told members of Congress last month that the agency supports the development of new drugs that contain cannabis or are derived from the plant. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

FDA Assesses Potential Cancer Risk Associated With Weight Loss Drug
A recent drug safety communication alerted health professionals and the public about a potential increased risk of cancer associated with the weight management medication lorcaserin. The FDA has advised clinicians to consider whether the drug ’s benefits outweigh its potential risks when deciding to prescribe or continue prescribing it. (Source: JAMA)
Source: JAMA - February 18, 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 - February 18, 2020 Category: General Medicine Source Type: research

Book Notices
Contributions to Medical and Biological Research. Dedicated to Sir William Osler, Bart., M.D., F.R.S., in honor of his seventieth birthday, July 12, 1919, by his pupils and co-workers. Two volumes. Pp. 1268. Paul B. Hoeber, New York. Edition limited to 1,600 copies. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Private Equity Acquisitions of Physician Medical Groups Across Specialties, 2013-2016
This study characterizes practice characteristics and specialties of physicians and medical groups acquired by private equity firms between 2013 and 2016. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Selepressin for Patients With Septic Shock
To the Editor Compared with placebo, the nonadrenergic vasopressor angiotensin II was shown to increase mean arterial pressure after 3 hours in patients with vasodilatory shock in the Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) trial (primary end point). In addition, angiotensin II also reached the secondary goal of a greater reduction in the cardiovascular Sequential Organ Failure Assessment (SOFA) score after 48 hours vs placebo. As a consequence, research with angiotensin II continued and it was approved by the US Food and Drug Administration. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Unmeasured Confounding in Observational Studies of Management of Cerebellar Intracranial Hemorrhage
To the Editor In a propensity score –matched cohort of 578 patients from 4 observational cohort studies, Dr Kuramatsu and colleagues showed that evacuation of medium-sized intracerebellar hematomas (approximate volume, 20 cm3) was not associated with better functional outcome. Assessing treatment effectiveness in observational data is challenging because treatment decisions are based on patient characteristics that also are typically predictive of outcome, causing confounding by indication. Although the authors addressed this potential bias with propensity scores, we would like to emphasize the possibility of residua...
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Risk of Offspring Birth Defects in Women After Bariatric Surgery
To the Editor In a Research Letter, Dr Neovius and colleagues investigated the association between gastric bypass surgery and risk of birth defects in offspring. The authors found that bariatric surgery was protective against birth defects. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Error in USPSTF Report on Statin Use
The 2016 review for the US Preventive Services Task Force on statins for prevention of cardiovascular disease in adults had errors in the analysis of statins vs placebo and cardiovascular mortality. For the JUPITER trial, we interpreted “MI, stroke or cardiovascular death” as reported in the main trial publication as “myocardial death, stroke death, or cardiovascular death,” when it meant “nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death.” Therefore, the analysis erroneously included nonfatal myo cardial infarction and stroke events (83/8901 vs 157/8901 in the ros...
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Unmeasured Confounding in Observational Studies of Management of Cerebellar Intracranial Hemorrhage —Reply
In Reply We agree with Dr van Essen and colleagues that observational studies harbor the risk of unmeasured confounding. Treatment of patients with intracerebral hemorrhage has been studied in only a few trials with considerable variance in management protocols. Hence, large multicenter observational studies must be relied on to provide treatment estimates. To address the limitation of unmeasured confounding, we compared our study results (propensity score –matched analysis) with instrumental variable analysis, which is potentially more resilient to unmeasured confounding, as suggested by van Essen and colleagues. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Selepressin for Patients With Septic Shock —Reply
In Reply We agree with Dr Rehberg and colleagues that our study demonstrated that selepressin had a number of advantageous physiologic effects on blood pressure, urine output, and other features associated with septic shock. In this way, as the authors suggest, it appears that selepressin shares a set of properties similar to that of other agents used for cardiovascular support in septic shock, including the recently approved angiotensin II. In contrast to the study on which angiotensin II was approved, we chose a primary outcome designed to determine whether care with selepressin improved downstream patient-centered outco...
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Risk of Offspring Birth Defects in Women After Bariatric Surgery —Reply
In Reply We agree with Dr Auger and colleagues that there are several effects of gastric bypass surgery that may influence the risk of birth defects, including positive effects from weight loss and improved glucose control, as well as negative effects such as nutrient deficiencies and increased risk of substance abuse. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Predictive Accuracy of a Polygenic Risk Score Compared With a Clinical Risk Score for Incident Coronary Heart Disease
This pooled cohort involving US adults with white European ancestry compares the accuracy of a polygenic risk score vs 2013 ACC/AHA pooled cohort equations for predicting 10-year risk of coronary heart disease. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Change in Accuracy From Adding Polygenic Risk Information to a Clinical Risk Prediction Score for CAD
This study uses UK Biobank data to examine whether adding polygenic risk information to the pooled cohort equations improves the accuracy of risk prediction for coronary artery disease (CAD). (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Association Between Genetically Proxied Inhibition of HMG-CoA Reductase and Epithelial Ovarian Cancer
This study uses mendelian randomization to estimate the associations between genetic variants related to reduced HMG-CoA reductase activity and epithelial ovarian cancer in the general population and in BRCA1/2 mutation carriers. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Aspirin for Prevention of Cardiovascular Disease
This JAMA Patient Page describes new guideline recommendations on the use of aspirin for primary and secondary prevention of cardiovascular disease. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

He Who Keeps Going
for Peter You sail into the garage on your bike, report on the miles wheeled in the woods, on the serpent that crossed your path, a turtle bobbing its head amid puddles, and all the creatures bounding away from your human scent. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Finding Faith —Religion, Prayer, Spirituality, and Medicine
In this narrative medicine essay, a pediatric palliative oncologist meditates on the intersection of faith and medicine and of varying expressions of spirituality in the face of abject pain and suffering among her pediatric patients with cancer. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Dial-In Mobile Service Enables Patient Feedback on Community Health Care
A simple mobile phone –based technology could enable patients in rural Africa to provide valuable feedback about the care they receive from community health workers, according to a study presented at the recent Association for Computing Machinery conference on computer-supported cooperative work and social computing. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Poor Infection Control Led to Child HIV Outbreak in Pakistan
Poor infection control practices led to an unprecedented HIV outbreak among hundreds of children in Pakistan, according to a recent study. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Zoonotic Virus Linked to Severe Encephalitis in Southern Germany
A recent study suggested that Borna disease virus 1 (BoDV-1), which is carried by wild shrews in Germany, Austria, Switzerland, and Liechtenstein, could be a more common cause of severe or fatal encephalitis among people in endemic areas than previously realized. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Artificial Intelligence Improves Breast Cancer Screening in Study
An artificial intelligence (AI) system for breast cancer screening outperformed radiologists in a recent study in Nature. The technique spotted more cancers and raised fewer false alarms. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Investigational Hemophilia A Gene Therapy Shows Sustained Benefit
An experimental gene therapy for hemophilia A remained effective up to 3 years after a single infusion, researchers recently reported in the New England Journal of Medicine. BioMarin Pharmaceutical ’s valoctocogene roxaparvovec encodes factor VIII, the blood-clotting protein that’s missing or low in people with hemophilia A, the most common form of the disease. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Ultrasound Brain Stimulation Piloted in Alzheimer Study
Patients with probable Alzheimer disease (AD) had sustained memory improvements 3 months after ultrasound brain stimulation in a small pilot study. The noninvasive technique, called transcranial pulse stimulation (TPS), is designed to apply ultrashort ultrasound pulses to small brain areas. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Calculation Adjustment in Article on Waste and Savings in Health Care
In the Special Communication entitled “Waste in the US Health Care System: Estimated Costs and Potential for Savings” published in the October 15, 2019, issue of JAMA, one of the source studies was placed in the wrong category, with the result that the upper end of the range of estimated potential savings should be $286 billion (ins tead of $282 billion). As a result, the references have been renumbered, the Supplement has been updated (eTable 2 and eReferences), and the related video has been emended. All elements have been corrected online. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Calculation Adjustment in Related Article
In the Editorials entitled “Waste in the US Health Care System” and “Toward Evidence-Based Policy Making to Reduce Wasteful Health Care Spending” published in the October 15, 2019, issue of JAMA, the upper end of the range of estimated potential savings should be $286 billion (instead of $282 billion) due to reclassif ication of one of the source studies in the related Special Communication. These articles have been corrected online. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

New Therapeutic Strategies for Asthma
For more than 25 years, national and international guidelines have recommended standardized approaches to control the symptoms of asthma and reduce the risk of exacerbation using strategies that are relevant to the majority of patients with asthma. As new evidence emerges from randomized clinical trials, clinicians must modify treatment strategies to be consistent with new evidence. In this issue of JAMA, 2 JAMA Insights articles highlight new evidence that clinicians should consider when treating patients with asthma. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Combination Therapy for MRSA Bacteremia —Not Ready for Prime Time
Enhanced infection control efforts have helped reduce the rate of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia over the past decade, but the decline has stalled in recent years, and associated mortality remains steady at 20% to 25%. In terms of both clinical burden and absolute number of patients, MRSA bacteremia remains a common and highly morbid infection. While clinical practice guidelines, evidence-based management algorithms, and infectious diseases consultation can contribute to improved patient outcomes, a substantial proportion of patients still experience treatment failures. Vancomycin or daptomyc...
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Incisional Negative Pressure Wound Therapy Following Surgical Repair of Lower Extremity Fractures
Negative pressure wound therapy is commonly used for both acute and chronic wounds and involves applying either continuous or intermittent subatmospheric pressure to a wound that is beneath an occlusive dressing. Negative pressure wound therapy provides mechanical enhancement to wound healing by increasing blood flow to the wound, maintaining a moist environment, reducing tissue edema, and placing the wound under tension that enhances healing. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Surprise Billing in Surgery —Time for Action
“Surprise” billing occurs when patients with health insurance receive care from a clinician or facility included in their insurer’s network (“in-network”) but unexpectedly receive “surprise” bills from other clinicians involved in their care who are not in the patient’s insurer’s n etwork (“out-of-network”) and therefore not covered by their insurance. In this issue of the JAMA, Chhabra and colleagues present a thorough analysis of out-of-network billing for elective operations and find the practice to be both common and potentially financially devastating. ...
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

US Statistics on Surprise Medical Billing
(Source: JAMA)
Source: JAMA - February 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 - February 11, 2020 Category: General Medicine Source Type: research

Management of Chronic Asthma in 2020
This JAMA Insights Clinical Update reviews recent evidence favoring use of inhaled corticosteroids (ICS)in all patients with asthma, regardless of frequency, and summarizes the SMART (single maintenance and reliever therapy) treatment approach, which uses an inhaler combining ICS and formoterol for control and relief of symptoms, and differences between SMART and symptom-driven therapy. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Management of Acute Asthma in Adults in 2020
This JAMA Insights Clinical Update reviews management of asthma exacerbations, including the use of inhaled corticosteroids (ICS), azithromycin, magnesium sulfate, and nebulized bronchodilators vs metered-dose inhalers (MDIs), and discusses the potential future role of benralizumab and other biological therapies. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Legal Solutions for Universal Health Coverage
Among all global health initiatives —such as the Global Polio Eradication Initiative, Roll Back Malaria (the RBM Partnership to End Malaria), and the Stop TB Partnership—universal health coverage (often abbreviated as UHC) has garnered the most political attention. The “sustainable development goals,” adopted by all United Nat ions (UN) member states in 2015, have a single health goal: to ensure healthy lives and promote well-being “for all at all ages.” Its most important target is to achieve universal health coverage by 2030. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

A M A grams
To assist AMA members seeking information from the staff at AMA headquarters in Chicago, a new Member Service Unit has been established in the Circulation and Records Department. All telephone calls, letters, and telegrams not directed to specific individuals or departments will be referred to this unit for immediate response. Of course, if you already know whom you wish to contact, continue to address him or her by name. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Art of Therapy
References have been made in news media and elsewhere to the decline of personal attention in medical care. The physician-patient relationship that allows or prevents personalization includes, among other factors, the art of therapy. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Estimates of Medication Diversion in Hospice
This study uses a random survey of US hospice agencies to estimate rates of confirmed and suspected cases of medication diversion away from patients in hospice and association of diversion rates with agency characteristics and state opioid death rates. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Reported Heroin Use, Use Disorder, and Injection Among US Adults, 2002-2018
This study uses National Surveys on Drug Use and Health data to characterize trends in heroin use, heroin use disorder, and heroin injection overall and by age, race, and geographic region. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Increasing Spending on Primary Care to Reduce Health Care Costs
To the Editor Dr Song and Mr Gondi described the failure of recent efforts to increase total primary care spending to reduce total health care costs of the population. However, they did not explain why the studies they reviewed failed. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Supply Chain Optimization and Waste Reduction
To the Editor Drs Thiel and Horwitz described the importance of supply chain optimization to improve value in health care, focusing on medical waste minimization. Of particular interest was the discussion on physician variation in utilization. Studies have previously demonstrated that physician utilization is a major driver of low-value services: variability in utilization of surgical supplies can lead to 20-fold variation across cost categories for identical procedures. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Increasing Spending on Primary Care to Reduce Health Care Costs —Reply
In Reply Regarding our Viewpoint, Dr Young argues that the main reason increased investments in primary care have often failed to reduce total health care spending is that such investments have focused on expanding care teams. Young asserts that increasing the supply of family medicine physicians is the key for better health outcomes at lower costs and recommends that future efforts should abandon teams in favor of investing in family medicine physicians. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Supply Chain Optimization and Waste Reduction —Reply
In Reply Mr Cahan and colleagues comment on our Viewpoint on the importance of supply optimization in improving the value of health care delivery. We agree with the authors that reducing variability in surgical utilization can be accomplished through consolidating device vendors and integrating purchasing decisions in a way that does not inappropriately drive practice patterns. We only add a caveat that too much consolidation, for example to a single vendor, can increase risk of supply shortages and reduce the opportunity for effective price negotiations. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

“Surprise” Billing for Privately Insured Elective-Surgery Patients With In-Network Primary Surgeons and Facilities
This study uses claims data from a large US health insurer to describe the proportion of times patients who had undergone elective surgery at in-network facilities with in-network primary surgeons received out-of-network bills between 2012 and 2017. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Effect of Incisional Negative Pressure Wound Therapy vs Standard Wound Dressing on Deep SSI
This randomized clinical trial compares the effects of incisional negative pressure wound therapy vs standard wound dressing on deep surgical site infection (SSI) at 30 days among patients undergoing surgery for major trauma –related lower limb fractures. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Effect of Standard Therapy With vs Without an Antistaphylococcal β-Lactam on MRSA Bacteremia Outcomes
This randomized trial compares the effect of combining standard antibiotic therapy (intravenous vancomycin or daptomycin) with an antistaphylococcal β-lactam (intravenous flucloxacillin, cloxacillin, or cefazolin) vs standard therapy alone on a composite outcome of mortality, bacteremia, relapse, or treatment failure in adults with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Medical Cannabis
This JAMA Patient Page describes use of preparations of the cannabis plant to treat medical conditions, the strength of evidence supporting such use, and the risks involved. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

March 26
Late March, the afternoon light falls cold and bright as an operating room. Sparrows are prepping for spring, bathing their wings in the loose dirt. They find the hollows of steel lamp posts (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research

Such Promise —Finding Promise After the Uncertainty of an Unnamed Illness
In this narrative medicine essay, a general pediatrics resident recalls the doubt and fear surrounding her high school diagnosis of ideopathic bone marrow suppression syndrome, her slow journey to recovery, and her how her family and physicians who cared for her nurtured her ambition to become a pediatric oncologist. (Source: JAMA)
Source: JAMA - February 11, 2020 Category: General Medicine Source Type: research