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

COVID-19 “Liquid Biopsy” Could Offer Monitoring, Prognostic Tool
Cornell University researchers are developing a “liquid biopsy” that detects and quantifies injury to internal organs from coronavirus disease 2019 (COVID-19). The test profiles epigenetic changes in circulating cell-free DNA (cfDNA)—small fragments of genetic material from dead cells, including those killed off by infection or immune-relat ed injury. The DNA chemical modifications are specific to different cell, tissue, and organ types, revealing the origin of injury. (Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

Minor Clarification
In the A Piece of My Mind article titled “We Are All the Same,” published in the January 22, 2019, and May 5, 2020, issues of JAMA, a minor clarification was added to the third paragraph. Both versions of this article were corrected online. (Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

Broadened Eligibility for Lung Cancer Screening
In 2013, the US Preventive Services Task Force (USPSTF) recommended annual lung cancer screening with low-dose computed tomography (CT) in US adults aged 55 to 80 years who currently smoke or formerly smoked with a 30 pack-year history, and for those who formerly smoked, quitting within the past 15 years (grade “B” recommendation). In this issue of JAMA, the USPSTF updates this recommendation, proposing 2 significant changes, both related to the population recommended to undergo screening. The first change reduces the age at which to initiate annual screening from 55 to 50 years. The second change redu ces the ...
Source: JAMA - March 9, 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 9, 2021 Category: General Medicine Source Type: research

Building Health Care Better Means Reining In Costs
President Biden has promised an economic plan to Build Back Better. After the disaster wrought by the coronavirus disease 2019 (COVID-19) pandemic, that is absolutely necessary. But rebuilding involves more than just repairing the damage from the virus itself. The US economy had glaring weak points before COVID-19, and President Biden will need to address those flaws. Of necessity, this will take the president into the economics of health care. (Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

Cancer of the Lung
Cancer of the lung seems unmistakably to be steadily increasing in frequency. This increase, both relative and absolute, cannot be explained as being solely due to improvement in diagnostic technic and to more careful postmortem studies. Accurate descriptions may be found in the writings of Rokitansky, Virchow, La ënnec, Graves and many others. Whereas older clinicians regarded it as rare, it has in the past two decades come to occupy a place second in importance only to such common localizations of malignant growths as the stomach, the uterus and the rectum.… The incidence, as cited in recent statistical repor...
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

Association Between Changes in Social Distancing Policies in Ohio and Traffic Volume and Injuries, January Through July 2020
This study compares traffic volume and motor vehicle crash injuries before, during, and after state-of-emergency and stay-at-home orders in the state of Ohio from January to July 2020 vs the same period in 2019. (Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

Use of e-Cigarettes for Smoking Cessation
To the Editor The role of electronic cigarettes (e-cigarettes) in smoking cessation is unclear. We are concerned about the interpretation of the recent trial by Dr Eisenberg and colleagues, which demonstrated an increased rate of smoking cessation that did not persist at 24 weeks. Although this study did not demonstrate harm from e-cigarettes, neither did it demonstrate harm from combustible cigarettes. It is discordant to tout the potential safety of e-cigarettes from examining short-term outcomes in small numbers while acknowledging that harms from combustible cigarettes often take decades to manifest and occur only in a...
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

Effect of Emergency Department Care Bundle on Elderly Patients With Acute Heart Failure
To the Editor The ELISABETH trial by Dr Freund and colleagues implemented an early guideline-recommended care bundle in the emergency department for older patients to reduce the delay to treatment and to promptly manage precipitating factors of acute heart failure. Although frontline physicians use clinical symptoms, laboratory values, and radiographic findings to make the diagnosis of acute heart failure, accurate judgment about cardiac preload and intravascular volume status remains difficult in patients with obesity, chronic venous stasis, underlying kidney dysfunction, or pulmonary disorders. A common cause for faulty ...
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

Use of e-Cigarettes for Smoking Cessation —Reply
In Reply We agree with Dr Lanspa and colleagues that the role of e-cigarettes in smoking cessation is unclear. However, despite the surprising dearth of randomized clinical trials in this area, many smokers have spontaneously turned to e-cigarettes as a potential method for quitting conventional cigarettes. Therefore, we believe that multiple studies in different settings are required to examine the efficacy and safety of e-cigarettes for smoking cessation. The adverse effects of smoking conventional cigarettes are well known. Although the long-term effects of vaping e-cigarettes are unknown, most experts agree that, while...
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

Effect of Emergency Department Care Bundle on Elderly Patients With Acute Heart Failure —Reply
In Reply The diagnosis of acute heart failure in our trial was based on clinical symptoms and at least 1 other imaging or biological sign of pulmonary congestion. As Dr Liu states, it can be difficult to accurately diagnose acute heart failure in the emergency department; we agree that we may have included patients with a broad differential diagnosis in the ELISABETH trial. We also concur that a more systematic diagnostic workup could have reduced inclusion bias. However, we believe this bias is limited because previous reports have shown good physician performance in diagnosing acute heart failure in French emergency depa...
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

Prevalence of Central Nervous System –Active Polypharmacy Among Older Adults With Dementia in the US
This pharmacoepidemiology study uses Medicare claims data to describe the prevalence of central nervous system –active polypharmacy among community-dwelling older adults with dementia in the US, including durations of exposure and number of drugs and drug classes. (Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

Effect of Ventral vs Dorsal Spinal Surgery on Physical Functioning in Cervical Spondylotic Myelopathy
This randomized trial compares the effects of ventral surgery (disk removal and fusion) vs dorsal surgery (laminectomy or laminoplasty) on patient-reported physical functioning 1 year after surgery among patients with multilevel cervical spondylotic myelopathy. (Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

Patient Information: Screening for Lung Cancer
This JAMA Patient Page explains the US Preventive Services Task Force 2021 recommendation to screen for lung cancer in adults aged 50 to 80 years who have a 20-pack-year or greater smoking history and currently smoke or have quit within the past 15 years. (Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

Credo
He is disappearing from himself. She is learning to spend time (Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

Trauma Comes Home
In this narrative medicine essay, a surgeon tells of her experience as a caretaker for her partner disabled by chronic sequelae of head trauma, and the challenges it poses as she tries to maintain the professional distance required to do her job as a trauma attending. (Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

USPSTF Report: Screening for Lung Cancer With Low-Dose Computed Tomography
This systematic review to support the 2021 US Preventive Services Task Force Recommendation Statement on screening for lung cancer summarizes published evidence about the relative benefits and harms of low-dose computed tomography to identify lung cancer in persons at high risk. (Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

USPSTF Modeling Study: Benefits and Harms of Lung Cancer Screening With LDCT
This simluation study models the benefits and harms associated with low-dose computed tomography (LDCT) screening for lung cancer based on a range of starting and stopping ages, screening frequencies, cumulative pack-years, and years since quitting smoking. (Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

USPSTF Evidence Report: Screening for Lung Cancer
This US Preventive Services Task Force Recommendation Statement concludes with moderate certainty that annual screening for lung cancer with low-dose computed tomography has a moderate benefit in persons at high risk of lung cancer based on age, total cumulative exposure to tobacco smoke, and years since quitting smoking (Grade B). (Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

CMS ’ Shared Decision-making Requirement for Lung Cancer Screening and the USPSTF 2021 Guideline Update
This Viewpoint discusses implications of the USPSTF 2021 lung cancer screening recommendation update, which broadens the number of patients eligible for screening, for CMS ’ shared decision-making requirement, arguing that to make shared decision-making a reality, CMS should reimburse these visits delivered by nonphysician staff and/or telehealth. (Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

More Resources, Community Outreach Needed to Boost Contact Tracing
Contact tracers facing high caseloads and a lack of community cooperation may have stymied US efforts to slow the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), according to a CDC analysis. (Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

Dramatic Cervical Cancer Screening Decline During Pandemic
During California ’s pandemic-related stay-at-home order from mid-March to mid-June 2020, cervical cancer screenings at a large health system in the state declined by about 80% compared with the same timespan a year earlier, recently analyzed data have shown. (Source: JAMA)
Source: JAMA - March 9, 2021 Category: General Medicine Source Type: research

Blinatumomab for Children With High-risk Relapsed B-Cell Acute Lymphoblastic Leukemia
Acute lymphoblastic leukemia (ALL), the most common childhood cancer, is a highly curable disease, with approximately 85% of patients being long-term survivors when treated with current chemotherapy regimens. Risk-adapted, intensified chemotherapy regimens have greatly improved the outcome for children, adolescents, and young adults with newly diagnosed B-cell ALL (B-ALL), which comprises approximately 20% of patients with ALL, and can be safely delivered with proper supportive care measures. Intensification of chemotherapy as salvage therapy, frequently adopting the same agents used during initial therapy, has also been s...
Source: JAMA - March 2, 2021 Category: General Medicine Source Type: research

Rules Finalized for New Tobacco Product Approvals
Two recently finalized rules provide tobacco product manufacturers with additional information on federal requirements they must meet to get their products on the market. Then-FDA Commissioner Stephen Hahn, MD, said finalization of the rules “is an important milestone in the FDA’s regulation of tobacco products.” (Source: JAMA)
Source: JAMA - March 2, 2021 Category: General Medicine Source Type: research