Enjoy the Vase —Everything Changes
In this narrative medicine essay, a psychiatrist finally at peace after his wife's death to cancer learns that his prostate-specific antigen levels have begun to rise, reminding him to embrace uncertainty, a loss of control, and change. (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Diagnosis and Treatment of Metastatic Colorectal Cancer
This narrative review summarizes treatment options for patients with unresectable metastatic colorectal cancer, focusing on the importance of genomic profiling to identify KRAS/NRAS/BRAF variants to guide immunotherapy. (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

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

Declining Life Expectancy in the United States —The Need for Social Policy as Health Policy
This Viewpoint reviews the social and economic drivers of declines in longevity in the US, especially among lower socioeconomic status groups, and proposes policy options for the Biden-Harris administration to mitigate the trend, including an increase in the federally mandated minimum wage. (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

A Blueprint for Comprehensive Medicaid Reform
This Viewpoint proposes broad principles to guide Medicaid reform as a means to advance health equity, including stabilization of its funding and coverage; coordination of its infrastructure; alignment of health care and social spending at the point of care; and a value-based approach to benefits. (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

High-Income Countries Have Secured the Bulk of COVID-19 Vaccines
High-income countries have reserved more than half of the world ’s coronavirus disease 2019 (COVID-19) vaccine doses despite representing just 14% of the world’s population, according to an analysis of publicly available data on premarket purchase agreements. (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Clinical Trials Overlook Diseases of Low-Income Countries
Conditions like respiratory infections, tuberculosis, and enteric infections that disproportionately affect low-income countries are consistently understudied in clinical trials, according to a recent study. (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Global Partnership Aims to Improve Infant HIV Care
After stakeholders secured lower prices for a recently approved pediatric HIV medication, an international partnership has urged low- and middle-income countries to procure the drug and make it widely available. (Source: JAMA)
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Death by Massive Hemorrhage in Robert Frost ’s “Out, Out–”
This Arts and Medicine feature uses poet Robert Frost ’s poem “Out, Out–”, about the tragic death of a boy in the premodern era from a work injury and hemorrhagic shock, to discuss the stakes of developing a more effective public health response to traumatic injury. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Model Predicts Emergency Department Patients ’ COVID-19 Outcomes
A new artificial intelligence algorithm uses chest x-ray severity scores and clinical variables collected during emergency department (ED) visits to predict whether patients with coronavirus disease 2019 (COVID-19) will be intubated or will die. If further validated in larger studies with additional patient populations, the proof-of-concept model, described in Radiology: Artificial Intelligence, could be used to appropriately triage ED patients before they become seriously ill with COVID-19. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

CRISPR-Based COVID-19 Smartphone Test in Development
A simplified point-of-care assay that turns a smartphone into a fluorescence microscope could expand coronavirus disease 2019 (COVID-19) testing capability, researchers reported in a study in Cell. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Phone Apps and Wearable Trackers Modestly Improve Activity
Smartphone fitness applications and wearable activity trackers seem to have a small to moderate positive effect on physical activity, a systematic review and meta-analysis of randomized trials found. The improvements, reported in the British Journal of Sports Medicine, corresponded to an additional 1850 steps per day. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Searching for the Optimal Exercise Training Regimen in Heart Failure With Preserved Ejection Fraction
Heart failure with preserved ejection fraction (HFpEF) is increasing in prevalence, associated with high morbidity and mortality, and continues to be refractory to available pharmacotherapies. HFpEF is a multiorgan disease with complex pathophysiology that culminates in debilitating exercise intolerance as its essential clinical manifestation. Exercise intolerance is preceded by an accelerated decline in exercise capacity, measured objectively as peak exercise oxygen consumption (peak V ̇o2), and manifests clinically as dyspnea, fatigue, and reduced quality of life (QoL). Accordingly, there is an increasing emphasis on de...
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Bicuspid Aortic Valve —A Common Form of Structural Heart Disease
By the ninth week of human embryonic development, many of the unique anatomical structures of the heart have appeared, including the semilunar valves. The aortic valve is derived from an endocardial outflow tract cushion, and in most instances the valve consists of 3 nearly identical leaflets, or cusps. (Source: JAMA)
Source: JAMA - February 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 - February 9, 2021 Category: General Medicine Source Type: research

Social Isolation and Loneliness: Imperatives for Health Care in a Post-COVID World
The importance of social determinants of health has been gaining traction in the health care sector during the last decade. Social determinants of health have been found to be responsible for 80% to 90% of health outcomes, and an abundance of research has demonstrated that no matter the advancements in medicine and health care, the health of individuals and communities will not improve if these root-cause social factors are not addressed. The coronavirus disease 2019 (COVID-19) pandemic is highlighting one of these factors: social isolation. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Income Tax Credit for Charity Practice of Physicians
The value of the services rendered annually by physicians of this country in the treatment of the indigent sick for which they receive no compensation has been estimated as in excess of $300,000,000. Recognition of this tremendous contribution made by physicians for the public good is reflected in a bill, H. R. 5296, introduced in the Congress January 30 by Representative Clare Boothe Luce of Connecticut. The measure provides that physicians, surgeons and dentists, commencing with the taxable year 1946, shall be allowed an additional credit as a deduction on their income tax equal in terms of percentages to that portion of...
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Prevalence and Outcomes of SARS-CoV-2 Infection Among Migrant Workers in Singapore
This study examines the prevalence and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among migrant workers in Singapore. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Financing of US Graduate Medical Education
To the Editor In their recent Viewpoint, Dr Grischkan and colleagues provided a synopsis of the forces behind the contemporary financing of US graduate medical education (GME). They claimed that training of residents by teaching hospitals is a profitable endeavor. Supporting their position, the authors observed that more than 15  000 resident positions have been created since 2003, despite no increase in federal funding for these positions. Two points deserve further consideration. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Update on Blood Pressure Control Among US Adults With Hypertension
To the Editor In their recent article, Dr Muntner and colleagues demonstrated that despite the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guidelines recommending more intensive BP treatment, there was a striking decrease in BP control among US adults with hypertension from 2013-2014 to 2017-2018. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Algorithmic Stewardship in Health Care
To the Editor The Viewpoint by Ms Eaneff and colleagues proposed the role of stewardship for predictive algorithms by benchmarking to best practices from other clinical areas of medicine. In our opinion, to ensure the equality and safety of predictive algorithms, the health system could also learn from the high standards in other industries in which quality control and supervision of predictive algorithms are well established. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Financing of US Graduate Medical Education —Reply
In Reply Teaching hospitals continue to expand the number of resident physicians, exceeding the number of government-funded residency spots, without additional government funding. This is a clear signal that the marginal benefit of employing a resident physician, even in the absence of government funding, clearly exceeds the cost —a narrative at odds with the public advocacy for more federal GME support. We applaud the work done by Dr Royce and others analyzing the distribution of GME funding as it pertains to higher revenue–generating specialties and primary care. It is important to note that there are no nati...
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Update on Blood Pressure Control Among US Adults With Hypertension —Reply
In Reply In response to our recent article about trends in BP control among US adults, Dr Kovell and colleagues emphasize the importance of hypertension control to reduce cardiovascular disease mortality in women and to prevent maternal morbidity and mortality. They note that women had a larger reduction in BP control between 2013-2014 and 2017-2018 compared with men. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Algorithmic Stewardship in Health Care —Reply
In Reply Mr Li and Dr Wang highlight valuable examples of regulation from other industries, including banking and insurance. We agree that best practices from these industries provide lessons for health care and that health system –level algorithmic stewardship should complement clear guidance and oversight from those with regulatory authority. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Drugs for Osteoarthritis
This Medical Letter review reproduces a Table summarizing key information about drugs for osteoarthritis published as part of a comprehensive review on the topic. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Intensity of Physical Activity and Peak Oxygen Consumption in Patients With Heart Failure
This randomized trial compares the effects of high-intensity interval training, moderate continuous training, and guideline-based physical activity on change in peak oxygen consumption (V ̇o2) in patients with heart failure with preserved ejection fraction (HFpEF). (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Prevalence of Bicuspid Aortic Valve and Associated Aortopathy in Danish Newborns
This population epidemiology study describes the prevalence of bicuspid aortic valve (BAV) and BAV subtypes, and of accompanying enlarged aortic diameter or coarctation, in Danish newborns born in Copenhagen 2016-2018. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Effect of Restrictive vs Liberal Blood Transfusion Strategy on Adults With Myocardial Infarction and Anemia
This noninferiority trial compares the effects of a restrictive (hemoglobin ≤8 g/dL) vs liberal (hemoglobin ≤10 g/dL) transfusion strategy on 30-day cardiovascular events among adults with acute myocardial infarction (AMI) and anemia (hemoglobin 7-10 g/dL). (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Patient Information: Treatment of Alcohol Use Disorder
This JAMA Patient Page explains the medications (naltrexone, acamprosate, disulfiram) and behavioral treatments (cognitive behavior therapy [CBT]) used to manage alcohol use disorder. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

To a Firstborn Son
Months we all gelled —pills, probes, we pried, we eyed you. Scouring echoes mottled like the Moon, I found your face. Eighteen weeks in, too soon to fly your flawed cocoon, our doctor spied your two feet thrust through. Though your mother tried a banked bed, buoying you, her water broke. The wits I lacked, her nurses lent. “Just stroke her hair, don't look,” they pled—so I complied. But when your cord got clamped, before you ceased your windless breaths, I should've made a stand: amidst those steel stirrups, laying a hand that said, “We love you Lincoln. Go in peace.” What now? Stroke pr...
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Donning and Doffing —Hiding Cancer Treatment in Plain Sight
In this narrative medicine essay an internal medicine hospitalist explores what the new diagnosis of breast cancer means for her professional identity and considers how the COVID-19 pandemic facilitates the hiding of serious illness but also complicates disclosing the news to colleagues and friends. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Diagnosis and Treatment of Hip and Knee Osteoarthritis
This narrative review summarizes the pathophysiology, diagnosis, and treatment of osteoarthritis (OA) of the hip and knee, including use of structured exercise, acetaminophen and NSAIDs, corticosteroid injections, and surgery to manage symptoms. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

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

COVID-19 Pandemic, an Opportunity for a More Successful Future for Science and Public Health
This Viewpoint suggests that the COVID-19 pandemic provides an opportunity to build trust in science and update federal agencies to improve public health and poses questions and offers recommendations for consideration. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Cancer Care Under the Biden Administration
This Viewpoint evaluates Biden ’s health care proposals to help reduce the cost burden on patients with cancer should they be enacted legislatively. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Accelerated Overdose Deaths Linked With COVID-19
More than 81  000 people died of drug overdoses in the US between June 2019 and May 2020, a record-breaking number that CDC officials suggested is related to the coronavirus disease 2019 (COVID-19) pandemic. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Updated Recommendations for Gonorrhea Treatment
Updated recommendations for treating gonorrhea aim to combat rising drug resistance. (Source: JAMA)
Source: JAMA - February 9, 2021 Category: General Medicine Source Type: research

Innocence in America —Reading James Baldwin in 2020
This Arts and Medicine feature offers an appreciation of mid-20th century novelist, essayist, memoirist, and civil rights activist James Baldwin and argues for his continuing relevance to medicine and society at large. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Autoantibodies May Drive COVID-19 Blood Clots
In severe cases of coronavirus disease 2019 (COVID-19), patients may develop abnormal blood clots —from pulmonary embolisms in the lungs and deep vein thromboses in the legs, to clots that lead to strokes or heart attacks. A new study reveals that clot–promoting autoantibodies likely cause or contribute to these complications. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Errors in Figure Labels
This article was corrected online. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Improving Stroke Treatment and Outcomes With Mobile Stroke Units
Systemic thrombolysis with tissue plasminogen activator (tPA) improves outcome in patients with acute ischemic stroke. Twenty-five years of clinical research and experience have demonstrated that the sooner tPA is administered, the better the clinical outcomes. Five years ago, clinical trials demonstrating that endovascular thrombectomy can substantially improve outcomes for patients with large vessel occlusions further expanded acute ischemic stroke treatment. Taken together, these therapies provide important treatment options for clinicians, significant reduction in disability for patients, and reduced long-term costs fo...
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Screening for Asymptomatic Carotid Artery Stenosis
In the Recommendation Statement published in this issue of JAMA, the US Preventive Services Task Force (USPTF) has reaffirmed its 2014 recommendation, stating that “The USPTF recommends against screening for asymptomatic carotid artery stenosis in the general adult population (D recommendation),” based on evidence that the harms of screening for carotid artery stenosis in asymptomatic adults outweigh the benefits, with no new evidence that would change the previous recommendation. The rationale for this confirmation is based on a combination of considerations, including the effects of false-positive results whe...
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Economic Prosperity and Cardiovascular Mortality
Numerous factors are known to contribute to cardiovascular disease prevalence and outcomes, including those related to lifestyle, family history and genetics, and clinical care. However, economic factors, such as those involving wealth, prosperity, employment, and power, also might influence health outcomes, including for cardiovascular disease. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Virtual Care and Real Connection in the Era of COVID-19
It is a truism in health care that reimbursement shapes practice. The coronavirus disease 2019 (COVID-19) pandemic in its early months has been an exception. Health care shifted substantially and fairly suddenly to virtual visits to meet the needs of patients without compromising their safety during a shutdown, while reimbursement was still uncertain. Recently, the Centers for Medicare& Medicaid Services reported that between mid-March and mid-October 2020, more than 24.5 million of 63 million eligible patients received a telemedicine service covered by Medicare. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Tighter Requirements to Ensure Safer Opioid Prescribing
The FDA has taken action to reduce inappropriate prescribing of transmucosal immediate-release fentanyls (TIRFs) by strengthening the Risk Evaluation and Mitigation Strategies (REMS) program that imposes restrictions on the drugs ’ distribution. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Adjuvant Therapy Approved for NSCLC
The first adjuvant treatment for patients whose early-stage non –small cell lung cancer (NSCLC) has a specific genetic variant has received FDA approval. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Dedicated Device Permits Less Invasive Pancreatic Surgery
A device that ’s specifically indicated to remove necrotic pancreatic tissue in a minimally invasive procedure has been authorized for patients with walled-off pancreatic necrosis. (Source: JAMA)
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Management of Immunotherapy-Related Toxicities in Patients Treated With Immune Checkpoint Inhibitor Therapy
This JAMA Clinical Guidelines Synopsis summarizes the National Comprehensive Cancer Network ’s 2019 guidelines on management of immunotherapy-related toxicities, including adverse skin reaction, colitis, and myocarditis. (Source: JAMA)
Source: JAMA - February 2, 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 2, 2021 Category: General Medicine Source Type: research

Dying Poor in the US —Disparities in End-of-Life Care
The coronavirus disease 2019 (COVID-19) pandemic has focused attention on stark disparities in the US, with higher rates of infections and deaths among lower-income populations and communities of color. Illness and death rates are not the only sources of health inequity in this country. There are also substantial differences in the care that patients with serious illnesses receive near the end of life that are based on race or socioeconomic status. Although pandemic-related efforts to improve equity rightfully focus on preventing death, in this and numerous other contexts, policy makers and clinicians should also work to e...
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research