Collecting Data About COVID-19 –Related Brain Symptoms
The National Institutes of Health (NIH) is planning to launch a new database and biobank to collect information from clinicians about neurological problems associated with coronavirus disease 2019 (COVID-19). (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Detecting Heart Transplant Rejection Earlier, More Easily
A blood test performed better than a tissue biopsy —the standard diagnostic tool—in detecting acute heart transplant rejection, National Heart, Lung, and Blood Institute (NHLBI) researchers found in a recent study. (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Locating COVID-19 Monoclonal Antibody Therapies
Physicians and patients in search of outpatient monoclonal antibody therapies for coronavirus disease 2019 (COVID-19) can turn to a recently launched federal government website and enter their zip code. (Source: JAMA)
Source: JAMA - February 23, 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 - February 23, 2021 Category: General Medicine Source Type: research

From Economic Recovery to Health Resilience
For decades, scholars have debated not whether the economy and public health are interlinked, but how. Several recent studies indicate a strong and persistent correlation between lower incomes and excess mortality, though this link sometimes manifests over years or even generations. As it has with so much else, the coronavirus disease 2019 (COVID-19) pandemic has compressed time in a way that reveals the interconnection between the economy and public health. With the change in the federal administration, there is a renewed chance to challenge the false dichotomy of economic growth vs public health and adopt policies that a...
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

The Worth of a Miracle
Many major open-heart operations are costly in terms of money, effort, and manpower. Would it not be wiser to divert this vast expenditure to wider uses? This question rarely bothers the people who are directly involved with the patient, but it causes much concern to those who evaluate priority. How can the equation of needs, logistics, and cost to society be sensibly resolved? (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Risk of Spinal Hematoma After Lumbar Puncture
To the Editor The recently published article by Dr Bodilsen and colleagues reported the association between lumbar puncture and spinal hematoma in patients with coagulopathy. When interpreting their results, some issues should be considered. First, this study defined spinal hematoma based on diagnosis codes regarding spinal hematoma –related symptoms or treatments. The diagnosis of spinal hematoma should be based on neuroimaging data, including magnetic resonance imaging and computed tomographic scan results since diagnosis codes without regard to neuroimaging data may cause a misdiagnosis of spinal hematoma. Second,...
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Risk of Spinal Hematoma After Lumbar Puncture
To the Editor Dr Bodilsen and colleagues showed very low rates of spinal hematoma in patients both with and without coagulopathy in their large patient cohort. In a subgroup analysis of 1694 lumbar punctures among 1237 patients, the authors reported that the median needle size was 22 gauge (interquartile range, 22-22), and listed the number of procedures performed with traumatic vs atraumatic needles. Needle size and the use of atraumatic pencil-point needles have been previously shown to modulate the risk of other post –lumbar puncture complications; the use of smaller, atraumatic needles reduces the risk of complic...
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

The Effect of Surgical Treatment on Obstructive Sleep Apnea
To the Editor The recent trial by Dr MacKay and colleagues, undertaken in a cohort of patients with sleep apnea, supported previous research that uvulopalatopharyngoplasty, with or without other surgical procedures, produces some benefits to patients. However, we have concerns not addressed by this trial regarding whether these benefits persist over time. In particular, we are interested to learn why the authors chose not to follow up their study cohort beyond 6 months. Furthermore, this study did not address the question of whether uvulopalatopharyngoplasty with tongue volume reduction has a greater benefit than uvulopala...
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Cervical Cancer Screening in Low- and Middle-Income Countries
To the Editor In their recent article, Ms Lemp and colleagues presented data about lifetime prevalence of cervical cancer screening in 55 low- and middle-income countries (LMICs). As leaders of Basic Health International, a nonprofit dedicated to the elimination of cervical cancer, we believe these data can help guide initiatives to implement cervical cancer prevention in locations where women are at highest risk. However, we are concerned that the methods used in this study did not capture a full picture of current cervical cancer screening programs in LMICs because the study used only data from surveys. Surveys from Cent...
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Risk of Spinal Hematoma After Lumbar Puncture —Reply
In Reply Dr Xu and colleagues raise several interesting questions about our study. First, they correctly point out that neuroimaging is the gold standard for the diagnosis of spinal hematoma and suggest that we may have missed some asymptomatic cases. However, neuroimaging data were unavailable for the registry-based part of the study, and we focused on clinically meaningful end points of neurological deficits requiring hospitalization. Reassuringly, in a medical record review of all lumbar punctures performed in patients with coagulopathy in the North Denmark Region during a 20-year period, we confirmed the very low absol...
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

The Effect of Surgical Treatment on Obstructive Sleep Apnea —Reply
In Reply Drs Alderman and Agbetile raise several concerns about our SAMS trial findings, specifically that the 6-month surgical improvements may not persist over time, that long-term cardiovascular outcomes were not assessed, and that there should be a mortality benefit with OSA surgery. (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Cervical Cancer Screening in Low- and Middle-Income Countries —Reply
In Reply We agree with Dr Cremer and colleagues that in countries with older surveys, our estimates do not reflect the impact of more recent programs that have conducted cervical cancer screening. Our study used the most recent nationally representative surveys for which we were able to access microdata. Given the relatively low frequency with which such surveys are carried out and the time required to do so, our estimates for each country are inevitably somewhat outdated. We have therefore highlighted in our article that readers should interpret our findings as pertaining to the year(s) of data collection of the survey in...
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Oral Rimegepant Safe, Effective for Migraine Prevention
Rimegepant is safe and effective for preventing migraines, a phase 2 and 3 trial published in The Lancet reported. The orally administered calcitonin gene –related peptide receptor antagonist is already approved for acute migraine treatment. No oral drugs are currently approved to both prevent and treat migraines. (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Finerenone for Patients With CKD and Type 2 Diabetes
Finerenone reduced the risks of chronic kidney disease (CKD) progression and cardiovascular events among patients with CKD and type 2 diabetes in an international phase 3 trial. (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Common Weight Loss Surgeries ’ Benefits Sustained at Year 7
Years after bariatric surgery, patients had sustained weight loss and similar quality of life improvements regardless of whether they had laparoscopic sleeve gastrectomy (LSG) —currently the favored procedure—or laparoscopic Roux-en-Y gastric bypass (LRYGB), according to results from a randomized equivalence trial. (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Navigators Improve Autism Evaluations but Not Referrals to Care
Family navigators led to more toddlers being evaluated for autism spectrum disorder (ASD) in primary care clinics but not to more referrals for autism services, a trial published in Autism found. (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Physician Videos Improve COVID-19 Knowledge Among Minorities
Informational videos starring physicians modestly improved coronavirus disease 2019 (COVID-19) knowledge among US Black and Latino adults regardless of the clinician ’s race, according to a trial published in the Annals of Internal Medicine. (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Effect of Vitamin C, Thiamine, and Hydrocortisone on Ventilator- and Vasopressor-Free Days in Patients With Sepsis
This randomized trial compares the effect of vitamin C, thiamine, and hydrocortisone vs matching placebo on 30-day ventilator- and vasopressor-free days among patients with sepsis-induced respiratory and/or cardiovascular dysfunction. (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Association of Rare CYP39A1 Variants With Exfoliation Syndrome Involving the Anterior Chamber of the Eye
This case-control study uses whole-exome sequencing to identify coding-sequence genetic variants associated with exfoliation syndrome, a form of glaucoma caused by abnormal fibrillar protein aggregates in the anterior eye. (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Effect of Baclofen on Agitation Events in Patients With Unhealthy Alcohol Use Receiving Mechanical Ventilation
This randomized clinical trial compares the effects of high-dose baclofen vs placebo on agitation-related events among adults in the ICU with unhealthy alcohol use receiving mechanical ventilation. (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Patient Information: Nystagmus
This JAMA Patient Page describes the types, causes, and treatment of nystagmus, a rhythmic involuntary movement of the eyes. (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Knows
My brother who I told you died, his daughter's grown. She's thirty-five. She's grown but she's a child because she's got that syndrome, what's-it-called, it's like she's happy all the time. Not Asperger's. What is that called? It's like she can't be sad. It's strange. Autism. Down ’s. It's really strange. Down Syndrome. Right. So anyway, her father died, my brother who I told you died. That's his daughter, she's my niece, and we were worried how to tell her her dad had died because we didn't know how she'd react. And then my other niece, her sister, she's the younger one bu t in a way she's always been the older one,...
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Covid-19 Communication —The Need for Humanity, Empathy, and Grace
In this narrative medicine essay, a medical school professor expresses gratitude for the caring and empathy expressed by the team caring for her mother hospitalized with COVID-19 and emphasizes the importance of humanity and compassion over facts and statistics for families physically separated from their critically ill loved ones. (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Diagnosis and Treatment of Multiple Sclerosis
This narrative review discusses the epidemiology and pathophysiology of multiple sclerosis and summarizes current evidence on its diagnosis and treatment using disease-modifying therapies and nonpharmacological interventions. (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Surprise Billing —A Flashpoint for Major Policy Issues in Health Care
This Viewpoint discusses the unexpected large billing that can occur when a patient receives care from an out-of-network physician or center (surprise billing) —its root causes and recent legislation that will provide some patients with protection, but not all. (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

From Digitization to Digital Transformation
This Viewpoint lays out policy priorities for advancing the digital transformation of US health information systems, including funding of infrastructure and enforcement of standards for EHR interoperability, data sharing, and usability. (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

COVID-19 Rates Increased Where In-Person College Classes Were Held
Coronavirus disease 2019 (COVID-19) incidence increased by 56% in counties where colleges held in-person classes after the start of last fall ’s school year, the CDC reported. (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Drug-Resistant Yeast Infections Spread in COVID-19 Unit
Pandemic-related lapses in infection control practices may have caused an outbreak of multidrug-resistant Candida auris yeast infections in a Florida hospital ’s coronavirus disease 2019 (COVID-19) unit, investigators from the CDC and the Florida Department of Health reported. (Source: JAMA)
Source: JAMA - February 23, 2021 Category: General Medicine Source Type: research

Error in Results Section
The Original Investigation titled “Effect of Vaginal Mesh Hysteropexy vs Vaginal Hysterectomy With Uterosacral Ligament Suspension on Treatment Failure in Women With Uterovaginal Prolapse: A Randomized Clinical Trial,” published in the September 17, 2019, issue of JAMA, included errors in the data in the Results section. The dat a have been corrected in the Results section, including in the tables and figures. (All other information in the Results section was correct and is unchanged.) (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Maternal Cardiovascular Health
Historically, the focus on the development of atherosclerotic cardiovascular disease has been on individual risk factors. These factors, which are associated with increased risk of myocardial infarction and stroke, were identified in the Framingham Study and other longitudinal observational studies of adults. The traditional risk factors are hypertension, dyslipidemia, obesity, diabetes, and cigarette smoking. Subsequently, other potential risk factors, such as inflammation and insulin resistance, have been included in the discussion. The recognition of risk factors was a substantial advance because it provided clinical ta...
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Generic Glucagon Approved for Severe Hypoglycemia
The first generic version of injectable glucagon for treating severe hypoglycemia has received FDA approval. Packaged as an emergency kit with a 1-mg dose, the drug treats extremely low blood glucose in patients with diabetes. The drug is also indicated to slow bowel motion during radiological examinations to provide a clear picture of abdominal and pelvic areas. (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Advice for n-of-1 Drug Developers
The FDA has issued draft recommendations to help developers of antisense oligonucleotide (ASO) therapies for rare, debilitating genetic diseases to conduct human trials with a single participant, known as n-of-1 trials. (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

More Scrutiny for Laparoscopic Power Morcellator Procedures
In an updated safety communication, the FDA recommended that clinicians who perform laparoscopic power morcellation for gynecologic procedures should do so with a legally marketed containment system to prevent unsuspected cancer from spreading within the abdomen and pelvis. (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Immortal Time Bias in Observational Studies
This JAMA Guide to Statistics and Medicine explains immortal time bias, an error in estimating the association between an exposure and an outcome that results from misclassification or exclusion of time intervals; explains how this misclassification or exclusion can occur; and presents approaches to minimize or avoid immortal time bias. (Source: JAMA)
Source: JAMA - February 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 - February 16, 2021 Category: General Medicine Source Type: research

Diagnosis and Treatment of Anal Fissures in 2021
This JAMA Insights Clinical Update reviews the diagnosis and management of anal fissures, including use of supportive, topical, injection, and surgical treatment options. (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Current Comment
(Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Wound Dressings for Obese Women After Cesarean Delivery
In this study, the dressings in the control group were removed after 24 hours. However, the authors did not provide any data about whether these wounds were redressed, frequency of dressing changes, or whether there was any change in the type of dressing after the initial postoperative dressing was removed. Variations in these factors are potential confounders that make it difficult to draw conclusions about the comparative efficacy of negative pressure wound therapy in obese women after cesarean delivery. (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

The Advantages of Medicare Advantage
To the Editor In a recent JAMA Forum, Dr Butler considered the political appeal of Medicare Advantage expansion, including growing enrollment, promotion of managed care, and lower federal spending. However, this appeal misses the purpose of health care reform, succinctly summarized by William Kissick, MD, as the simultaneous achievement of increased access, decreased costs, and improved outcomes. A simpler description is better care to more people for less money. (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Geographic Differences in Uncontrolled Chronic Medical Conditions
To the Editor Using Veterans Health Administration records, Dr Baum and colleagues estimated the differences in the prevalence of uncontrolled chronic conditions across the population of veterans who moved and the likelihood of uncontrolled chronic conditions after moving. They also provided an E-value estimating the strength of association that an unknown confounder must explain the observed association. However, this article did not provide a measure of the original strength of the association. It would have been illustrative if the authors had provided an original odds ratio or relative risk of disease for comparison pu...
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Database Updates and Resulting Changes in Data in Study of Vaginal Mesh Hysteropexy vs Vaginal Hysterectomy
To the Editor My coauthors and I report some database updates and resulting changes in our Original Investigation titled “Effect of Vaginal Mesh Hysteropexy vs Vaginal Hysterectomy With Uterosacral Ligament Suspension on Treatment Failure in Women With Uterovaginal Prolapse: A Randomized Clinical Trial,” published in the September 17, 2019, issue of JAMA. During the final database cleaning for the final 5-year stu dy database lock, a biannual study-wide audit review of the Pelvic Organ Prolapse Quantification (POPQ) examination data identified some updates that influenced the value of the primary outcome (treat...
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Wound Dressings for Obese Women After Cesarean Delivery —Reply
In Reply Drs Vo and Richards express concerns about the difference in duration of the prophylactic negative pressure wound therapy device vs standard wound dressing in our recent study involving obese women after cesarean delivery. As a pragmatic trial, our study compared effects of typical use of prophylactic negative pressure wound therapy and standard wound dressing. The average duration of use of prophylactic negative pressure wound therapy was 4 days, which is within the 2 to 7 days recommended by the manufacturer. Similarly, consistent with practice in most clinical settings in the US, the duration of standard wound ...
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

The Advantages of Medicare Advantage —Reply
In Reply Even though I agree with Dr Metz that a key criterion of health care reform is to provide “better care to more people for less money,” this should not be the only factor considered when choosing a reform strategy. In the US, many people value choice and the avoidance of disruption of familiar forms of health care coverage. (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Geographic Differences in Uncontrolled Chronic Medical Conditions —Reply
In Reply Dr Tompkins and colleagues suggest additional analyses to clarify the relationship between moving and chronic medical conditions in reference to our recent publication. We would first emphasize that our study does not argue that there is a relationship between moving itself and the prevalence of uncontrolled chronic conditions. Rather, our study sought to estimate the association between changes in individuals ’ likelihood of an uncontrolled chronic condition after moving and the difference in the prevalence of the uncontrolled chronic condition between movers’ destination vs origin zip code. Conceptua...
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Associations of Maternal Cardiovascular Health in Pregnancy With Offspring Cardiovascular Health in Early Adolescence
This international cohort study examines associations between the cardiovascular (CV) health of pregnant women (defined by 5 CV risk factors) and CV health of their offspring at ages 10 to 14 years. (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Effect of High-Intensity Strength Training on Pain From Knee Osteoarthritis
This randomized trial compares the effects of high- vs low-intensity strength training vs control on 18-mo knee pain and knee joint compressive force among adults with knee pain and radiographic evidence of osteoarthritis. (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Patient Information: Lateral Internal Sphincterotomy
This JAMA Patient Page explains lateral internal sphincterotomy, a surgical procedure used for treatment of anal fissures unresponsive to supportive or medical therapy. (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Hospital Vigil
While doctors operate, striving to save your life, I walk a windowless corridor —no clocks, surely past midnight—find the neurosurgery waiting room, open the door and stop, ambushed by aromas of Sunday dinner. A family eats, rosary beads slid wordlessly, chairs and loveseats pulled around a table spread with fried chicken in a bucket, quarts of slaw, baked beans, mashed pot atoes. Plastic cutlery and napkins sealed in packets like surgical instruments. A stranger offers me a paper plate, blank as a communion wafer, inviting me to sit down with them, break bread, pray this picnic won’t become a wake. (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research