Nothing New Under the Sun
What I want back are not my breasts, though they were the exact ones I would have chosen in the breast shop. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

A Call for Help: Reflections on Burnout, CABG Surgery, and the Super Bowl
In this narrative medicine essay, a surgeon uses the example of an NFL coach who after taking time away for burnout led his team to a Super Bowl championship to reflect on how a supportive environment that cares for patients and physicians could reduce burnout and subsequent adverse health outcomes. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Malpractice Liability and Health Care Quality: A Review
This systematic review summarizes evidence of associations between malpractice liability risk, defined as the extent to which clinicians face the threat of being sued and having to pay damages, and measures of health care quality and safety. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Prediabetes in Youth
Nearly 1 in 5 adolescents and about 1 in 4 young adults have prediabetes, according to a study by CDC scientists published in JAMA Pediatrics. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Studies Support HPV Safety
With more than 28 million doses administered since 2014, the CDC hasn ’t identified any new or unexpected safety concerns with the human papillomavirus vaccine, according to a pair of CDC studies published in Pediatrics. (Source: JAMA)
Source: JAMA - January 28, 2020 Category: General Medicine Source Type: research

Incorrect Value in Results
This article has been corrected online. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Incorrect Data in Table and Discussion Section
This article has been corrected online. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Tracing the Evidence to Address Painful Chronic Pancreatitis With Surgery
Chronic pancreatitis is characterized by pancreatic endocrine and exocrine insufficiency, along with persistent, and in some cases, unrelenting pain. While pancreatic insufficiency is effectively managed with pharmacologic intervention, the pain associated with this condition is difficult to control and commonly leads to severe consequences for the patient. A search of ClinicalTrials.gov for chronic pancreatitis revealed 152 studies, nearly all of which consist of interventions for pain. The current modalities, including pain medication, pancreatic enzyme replacement, behavioral therapy, endoscopic treatment, and surgery, ...
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Hydroxyethyl Starch for Fluid Replacement Therapy in High-Risk Surgical Patients
Hydroxyethyl starch (HES) solutions have had a turbulent history as resuscitation fluids. There was initial optimism that these products would efficiently expand the intravascular space with a prolonged intravascular half-life and therefore would be “volume sparing,” with less edema. However, enthusiasm was tempered when HES solutions were reported to be harmful when administered to critically ill patients, including those with sepsis. Despite these concerns, HES is still used in surgery under the premise that lower doses infused under stri ct protocols would be safe. In this issue of JAMA, Futier and colleague...
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Systemic Absorption of Sunscreen
UV radiation is the most important known modifiable risk factor for the development of skin cancer including melanoma. Behavioral measures to reduce this risk factor include seeking shade, wearing hats and protective clothing, avoiding outdoor activities during peak sunlight hours, and regularly using sunscreen. Sunscreen ingredients fall into 2 distinct categories: mineral or chemical. Mineral sunscreens contain physical UV filters, such as zinc oxide and titanium dioxide, that offer broad-spectrum UV coverage by reflecting or refracting UV radiation from skin. Chemical sunscreens contain UV filters that absorb UV radiati...
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Improving Outcomes in Patients With Atrial Fibrillation and Hypertension
Atrial fibrillation and hypertension represent 2 of the most important national public health priorities. Atrial fibrillation is the most common sustained cardiac arrhythmia among adults, affecting up to 2% of the US population. The prevalence of atrial fibrillation is expected to increase 3-fold in the next 3 decades. Robust data have identified hypertension as an independent modifiable risk factor for atrial fibrillation and as the most common cardiovascular condition associated with it. Hypertension is present in up to 80% of individuals with atrial fibrillation. Fulfilling a fundamental principle of evidence-based medi...
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

New Test Detects MRSA in Hours Rather Than Days
The FDA has authorized a new diagnostic test based on bacteriophage technology to detect methicillin-resistant Staphylococcus aureus (MRSA) colonization more quickly than traditional culture-based techniques allow. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

App Enables Sharing Off-label Treatments for Infectious Diseases
A new app will allow health professionals to share how they ’ve used FDA-approved drugs for off-label indications with patients who have difficult-to-treat infectious diseases. The internet-based repository, called CURE ID, is a collaboration between the FDA and the National Center for Advancing Translational Sciences, which is part of the National Institu tes of Health (NIH). (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Duchenne Screening Test Is OK ’d
The first test to aid in screening newborns for Duchenne muscular dystrophy (DMD) has received FDA authorization for marketing. (Source: JAMA)
Source: JAMA - January 21, 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 - January 21, 2020 Category: General Medicine Source Type: research

New Budgeting Tools Will Help Foster Social Determinants of Health
The growing interest in addressing social determinants of health —nonclinical factors influencing health—raises practical issues about the way we budget for collaborative efforts across governmental departments. In particular, the expanding research on the relationship between such factors as housing, transportation, and community services and the health cond ition of many households indicates the importance of giving program leaders the flexibility and incentive to coordinate resources from multiple sources. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Asclepius —Man or Myth
Asclepius, Asclepios, Asklepios, Aesculapius (Latin), or Ασκληπιος (Greek), if one has a yearning for the good old days of resinated wine and chariot races, is probably the most venerated physician of all times. Scholia in Homer’s Iliad suggests that the name Asklepios was derived from words meaning applying (askein) and making the limbs gentle (epia). Another interpretation ascribes his name to “healing soothingly and for deferring the withering that comes with death.” Yet a third writer affirms that Asklepios was originally known as Epios because of hi...
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Trends in Buprenorphine Treatment in the United States, 2009-2018
This study assessed the number of individuals receiving treatment for opioid use disorder in the United States by age group and sex using a national prescription database to compare between the number of buprenorphine prescriptions filled and the number of US opioid-related overdose deaths. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Medical Assessment of Head Collision Events in Elite Women ’s and Men’s Soccer
This study uses data from the 2019 F édération Internationale de Football Association Women’s World Cup to determine the incidence rate and subsequent medical assessment of head collision events. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Price Transparency in the Electronic Health Record
To the Editor Dr Miller and colleagues discussed implementing price transparency for health care products and services in electronic health record (EHRs). Price display interventions on paper, before EHRs, were associated with reduced costs. However, a recent analysis reviewing only EHR-based interventions concluded that they were not beneficial. The explanation why remains unclear, and it may include information overload or the price display lacking notable visibility. Additionally, as Mummadi and Mishra pointed out, it may be attributable to the phenomenon of screen inferiority —learning from an electronic screen i...
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Price Transparency in the Electronic Health Record
To the Editor A Viewpoint proposed implementing price transparency for physicians in EHRs as a means of achieving cost-conscious care. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

US Organ Donation Policy
To the Editor Ms Glazier and Mr Mone touted the success of the current opt-in organ donation system and argued for focusing on increasing registered donors to 75% of the adult population. A challenge is the intrinsic difficulty of such a task: more coordinated promotional efforts and new incentives like giving registered donors priority on organ waiting lists would likely be required. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

US Organ Donation Policy
To the Editor The Viewpoint on organ donation policy maintained that the US opt-in organ donation system performs among the best in the world. Donors per potential eligible donor were used as evidence despite this metric being criticized for potentially overestimating organ procurement organization (OPO) performance. Organ procurement organizations self-regulate and may be incentivized to modify eligibility of missed cases to meet performance requirements. Also, countries with opt-out programs consider cases when death occurs unexpectedly, often termed uncontrolled donation after circulatory determination of death. Impleme...
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

US Organ Donation Policy
To the Editor The article on organ donation by Ms Glazier and Mr Mone comparing deceased organ donation in the United States with countries using an opt-out system minimized the continued shortfall in transplants in the United States. The central reason for this deficit is that the OPOs managing donation in the United States operate without objective metrics by which to standardize and compare performance. As a result, many OPOs have claimed improvement when the gains are merely the product of circumstance. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Price Transparency in the Electronic Health Record —Reply
In Reply Regarding our Viewpoint on price transparency in EHRs, Dr Cho and colleagues suggest that clinicians are not adequately trained to discuss costs with patients. While we agree that clinicians are not traditionally trained to discuss costs with patients, these discussions are already occurring. Many patients face significant financial burdens affecting access; transparency merely provides information to help make decisions currently made in a vacuum. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

US Organ Donation Policy
In Reply In our Viewpoint on the success of opt-in organ donation policy in the United States, we reviewed organ donation rates from opt-in and opt-out legal jurisdictions to provide a high-level comparison between these 2 authorization strategies. The rate was calculated as donors per 10  000 deaths, not donors per potential eligible donor as incorrectly stated by Dr Wall and colleagues. Donors per deaths is the best available data for an international comparison. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Effect of Sunscreen Application on Plasma Concentration of Sunscreen Active Ingredients
This randomized clinical trial assesses the systemic absorption and pharmacokinetics of the 6 active ingredients (avobenzone, oxybenzone, octocrylene, homosalate, octisalate, and octinoxate) in lotion, aerosol spray, nonaerosol spray, and pump spray sunscreen products under single- and maximal-use conditions. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Effect of Hydroxyethyl Starch vs Saline Volume Replacement on Complications After Major Abdominal Surgery
This randomized clinical trial assesses the effect of hydroxyethyl starch 130/0.4 (HES) vs normal saline for intravascular volume expansion in patients at risk of postoperative kidney injury on mortality and postoperative complications up to 14 days after major abdominal surgery. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Effect of Early Surgery vs Stepped Medical-Endoscopic-Surgical Management on Pain in Patients With Chronic Pancreatitis
This randomized clinical trial compares the effects of pancreatic drainage surgery within 6 weeks vs a stepped medical-endoscopy-surgical approach on pain score and relief over 18 months among patients with chronic pancreatitis. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Effect of Catheter Ablation With vs Without Renal Denervation on Atrial Fibrillation Recurrence
This randomized trial compares the effects of pulmonary vein isolation with vs without renal denervation on freedom from atrial fibrillation, atrial flutter, or atrial tachycardia at 1 year among patients with atrial fibrillation and hypertension. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Cryptosporidiosis
This JAMA Patient Page describes cryptosporidiosis, its symptoms, diagnosis, treatment, and prevention methods. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Silence
Cherry blossoms line the Saturday Market near Burnside. Back home, winter (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

This Quiet Lady: Learning to Be With Patients After a Parent ’s Death
In this narrative medicine essay, a surgical oncologist recalls helping her mother through her treatment and death from lung cancer and tells of the lesson she brought back to her own practice from the experience that the essence of clinical care is human connection: the ability to listen to others, witness their suffering, hear their joy, and be present in their company. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Dengue Vaccine Protects Youth
Researchers have reported that a new vaccine against the dengue virus protected children and adolescents in a phase 3 trial conducted in Asia and Latin America. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Climate Change Puts Children at Risk
Urgent action is needed to meet the Paris Agreement climate goals to limit the potential health impacts on children worldwide, according to a statement from 120 international climate experts. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Cesarean Deliveries Not Linked to Obesity in Latest Study
A large Swedish study published in PLOS Medicine appears to debunk the idea that either elective or nonelective cesarean delivery increases the risk that a child will develop obesity. (Source: JAMA)
Source: JAMA - January 21, 2020 Category: General Medicine Source Type: research

Treatment Decisions for a Future Self —Ethical Obligations to Guide Truly Informed Choices
This Viewpoint discusses the reality that most decisions about treatment for incapacitated patients involve surrogate assessments of patients ’ past values at their baseline health, and it proposes that more ethical and informed decision-making would help surrogates consider the degree to which their loved one might be able to adapt to and value a future health state at what is a higher level of disability. (Source: JAMA)
Source: JAMA - January 14, 2020 Category: General Medicine Source Type: research

First US “Donation After Circulatory Death” Heart Transplant
An adult patient received a “donation after circulatory death” (DCD) heart transplant in the first such procedure to take place in the United States. Surgeons at Duke University Hospital in Durham, North Carolina, recently performed the operation as part of a clinical trial evaluating the Organ Care System (OCS) Heart, an investigational normothermic preservation system from Massachusetts-based TransMedics. An alternative to cold storage, the device keeps the donor heart pumping with warm oxygen- and nutrient-rich blood. (Source: JAMA)
Source: JAMA - January 14, 2020 Category: General Medicine Source Type: research

Can Apple Watches Detect Atrial Fibrillation?
Researchers tested a smartwatch-based irregular pulse notification algorithm for suspected atrial fibrillation among more than 400  000 US participants in a recent trial. The findings, published in the New England Journal of Medicine, came from the Apple Heart Study, a collaboration between technology giant Apple and Stanford Medicine. (Source: JAMA)
Source: JAMA - January 14, 2020 Category: General Medicine Source Type: research

Testing Hypothermic Preservation for Trauma Patients
Only 1 in 20 patients survive cardiac arrest from trauma-related blood loss. “Surgeons don’t have time to stop the bleeding before irreversible damage occurs to the brain and other vital organs,” trauma surgeon Samuel A. Tisherman, MD, of the University of Maryland School of Medicine in Baltimore, said in an email. (Source: JAMA)
Source: JAMA - January 14, 2020 Category: General Medicine Source Type: research

Opportunities and Challenges in Valuing and Evaluating Aging Physicians
In 2017, more than 15% of practicing physicians were older than 65 years. Without a national mandatory retirement age, many physicians plan to practice until they are in their 70s or 80s. Cognitive decline often accompanies aging, and the prevalence of dementia increases rapidly after age 70 years. Thus, it is not surprising that the issue of screening aging physicians for cognitive deficits has gained attention over the last decade. (Source: JAMA)
Source: JAMA - January 14, 2020 Category: General Medicine Source Type: research

Best Practices in Assessing Aging Physicians for Professional Competency
The unprecedented number and proportion of aging physicians in the workforce in both the United States and the world is a unique challenge of the current medical era. Fully 43% of all US physicians are aged 55 years or older, including 61% of psychiatrists, 52% of radiologists, 46% of general surgeons, and 44% of internists. Moreover, approximately 15% of practicing US physicians are older than 65 years, tripling from 23  000 in 1980 to 73 000 in 2012-2016. Every year, 20 000 more US physicians turn 65 years of age, and, even though half retire by age 65, many continue practicing for years and decades more. Indeed, U...
Source: JAMA - January 14, 2020 Category: General Medicine Source Type: research

Reform at the FDA —In Need of Reform
On December 23, 2016, the US Food and Drug Administration (FDA) announced the approval of nusinersen, the first drug for the devastating disease spinal muscular atrophy. The approval was based on an interim analysis of 82 patients in a single randomized trial; 40% of treated children improved, compared with none in the control group. The FDA had requested that the interim analysis be conducted. A press release emphasized the speed of agency action, with the review division director saying, “We worked hard to review this application quickly.” (Source: JAMA)
Source: JAMA - January 14, 2020 Category: General Medicine Source Type: research

How Effective and Safe Is Factor XI Inhibition in Preventing Venous Thrombosis?
The introduction of the direct oral anticoagulants for stroke prevention in atrial fibrillation and the management of thromboembolism has transformed the care of patients with these disorders. These drugs, which selectively and reversibly inhibit factor Xa or thrombin in the common pathway of the coagulation cascade, have a wide therapeutic window; this allows for simplified dosing regimens without laboratory monitoring of most adult patients as contrasted to vitamin K antagonists. This class of drug is also associated with a lower bleeding risk than vitamin K antagonists, which has been most clearly demonstrated by a 50% ...
Source: JAMA - January 14, 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 - January 14, 2020 Category: General Medicine Source Type: research

Early Returns From the Era of Precision Medicine
The era of precision medicine has arrived. A large share of new pharmaceuticals are tested and approved on the basis of biomarkers. Pharmacogenetics —the tailoring of drugs to patients based on 1 or more biomarkers—is used in conditions as diverse as HIV and thromboembolism. (Source: JAMA)
Source: JAMA - January 14, 2020 Category: General Medicine Source Type: research

The Patient Himself
Among the vices of advancing years are carping criticism, garrulity and needless admonition. To all of these I plead guilty and so can only beg your indulgence while I say a few things that I think should be said, knowing that I say them poorly and that I add nothing to our store of knowledge. (Source: JAMA)
Source: JAMA - January 14, 2020 Category: General Medicine Source Type: research

Incidence of Infectious Complications Following Cochlear Implantation in Children and Adults
This cohort study uses data from state health care databases to determine the incidence and timing of infectious complications following cochlear implant surgery among patients in 5 US states between 2006 and 2016. (Source: JAMA)
Source: JAMA - January 14, 2020 Category: General Medicine Source Type: research