Continuous Glucose Monitoring in Adolescent, Young Adult, and Older Patients With Type 1 Diabetes
The advent of continuous glucose monitoring (CGM) technology has revolutionized outpatient diabetes care in the past decade. A CGM device consists of a sensor that continuously measures subcutaneous glucose and sends data wirelessly to a display device through a transmitter. CGM offers real-time blood glucose monitoring (BGM) with alerts for trends in blood glucose levels and decreases the need for fingerstick glucose monitoring for people with diabetes. Studies of CGM have shown improvement in glycemic control in adults and children with type 1 diabetes and equivalence to glucometers for self-monitoring of blood glucose. ...
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Targeted Therapy and Diagnostic Test For Non –Small -Cell Lung Cancer
The FDA has approved a targeted therapy for certain adults with metastatic non –small cell lung cancer (NSCLC) as well as an in vitro diagnostic test to detect genetic alterations in their cancer. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Fourth-Line Treatment Approved For Gastrointestinal Tumor
The kinase inhibitor ripretinib has received approval as a fourth-line treatment for adults with advanced gastrointestinal stromal tumor (GIST) who already have been treated with 3 or more kinase inhibitors. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

New Drug Is a Triple Threat Against RET -Altered Cancer
The first drug indicated for patients with 3 types of cancer, all of which have a specific genetic alteration, has received FDA approval. (Source: JAMA)
Source: JAMA - June 16, 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 - June 16, 2020 Category: General Medicine Source Type: research

COVID-19 Reveals Urgent Need to Strengthen the World Health Organization
From the time China reported a novel coronavirus to the World Health Organization (WHO) on December 31, 2019, it took barely 4 months to become a pandemic, killing hundreds of thousands, and growing daily. It is now clear that the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had been circulating in Wuhan, China, for weeks before China reported it to the WHO, and that authorities hid information. China maintained SARS-CoV-2 was not readily transmissible between humans. The WHO published China ’s data, but without independently verifying their accuracy. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

The “Sense” of Humor—Art & amp; Science
In the undefined Good Old Days, a quality known as the “bedside manner” was held to be important to the success of a physician. Then, the good doctor was knowing, sensitive, and, perhaps above all, good-humored. Time, in its march, has heeled good humor in deference to the advances of knowledge, including the important “know-how.” But what of th e “know-why”? (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Physician Notification Regarding Nonadherence to Colorectal Cancer Screening and Cancer Detection
This cluster randomized clinical trial compares the effect of physician notification for colorectal cancer screening and cancer detection on patients who were in a patient-specific reminders group in which physicians received a list of nonadherent patients, in a generic reminders group in which physicians received general information about regional screening adherence, or in a usual care group in which physicians received no reminders. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Pulse Pressure and Isolated Diastolic Hypertension
To the Editor Dr McEvoy and colleagues performed cross-sectional analyses of several large databases to investigate clinical outcomes related to isolated diastolic hypertension (IDH) based on the 2017 hypertension guidelines of a diastolic blood pressure of 80 mm Hg or greater. They found no associations and implied that clinicians need not be clinically concerned by IDH. I disagree. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Home Noninvasive Positive Pressure Ventilation for Chronic Obstructive Pulmonary Disease
To the Editor Dr Wilson and colleagues reviewed bilevel positive airway pressure (BPAP) and home mechanical ventilation for chronic obstructive pulmonary disease (COPD). We are concerned about certain issues related to their methodology. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Pulse Pressure and Isolated Diastolic Hypertension —Reply
In Reply We agree with Dr Anstadt about the tetrad linking systolic and diastolic blood pressure and that pulse pressure is a critically important consideration in any analysis of the relationship between blood pressure and CVD outcomes. Pulse pressure adds prognostic information to systolic or diastolic blood pressure values because pulse pressure, which is calculated as the absolute difference between systolic and diastolic blood pressure, is related to both stroke volume and the compliance of large arteries (with the latter influencing vascular resistance). Therefore, pulse pressure can be an important surrogate marker ...
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Home Noninvasive Positive Pressure Ventilation for Chronic Obstructive Pulmonary Disease —Reply
In Reply The issue of combining randomized clinical trials and nonrandomized studies in a meta-analysis is a common challenge faced during evidence synthesis. When an abundance of well-done randomized clinical trials does not exist, clinical decision-making has to proceed based on the available evidence. In our systematic review about home noninvasive positive pressure ventilation (NIPPV) in COPD, we judged that combining these 2 types of studies was appropriate. For transparency purposes, we presented estimates separately from each study design. When examining the 2 designs, we observed similar trends, consistent results ...
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Effect of Continuous Glucose Monitoring on Hypoglycemia in Older Adults With Type 1 Diabetes
This randomized clinical trial compares the effect of continuous glucose monitoring vs standard blood glucose monitoring on percentage of time spent with hypoglycemia (glucose
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Effect of Continuous Glucose Monitoring on Glycemic Control in Adolescents and Young Adults With Type 1 Diabetes
This randomized clinical trial examines the effect of continuous glucose monitoring vs standard blood glucose monitoring on glycemic outcomes among adolescents and adults with type 1 diabetes and suboptimal glycemic control. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Ticagrelor Monotherapy vs Ticagrelor With Aspirin and Adverse Events in Acute Coronary Syndrome
This randomized trial compares the effects of ticagrelor-based 12-month dual antiplatelet therapy (DAPT) vs 3-month DAPT switching to 9-month ticagrelor monotherapy on rates of major bleeding and cardiovascular events in patients with acute coronary syndromes (ACS) undergoing PCI with drug-eluting stent (DES) placement. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Spinal Metastases
This JAMA Patient Page describes spinal metastases, their diagnosis, and their treatment options. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Recurrence
Because I ’m a poet I try to make music of her diagnosis: scan the adonics of glioblastoma, terminal cancer, clinical trials. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

A Bond
In this narrative medicine essay, an infectious disease fellow describes her discomfort treating patients behind masks and glass doors, laments the distance it creates, and hopes when the COVID-19 pandemic ends that face-to-face medicine resumes. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Study Explores Psychological Harm to Health Workers During Outbreaks
Researchers in Australia have identified dozens of factors that can either increase or decrease clinicians ’ risk of psychological harm during emerging disease outbreaks. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

New Hypertension Guidelines Apply to Diverse Socioeconomic Settings
The International Society of Hypertension has released a simplified guideline for managing hypertension. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Genetic Analysis Tracks SARS-CoV-2 Mutations in Human Hosts
An analysis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes collected from more than 7500 patients worldwide has identified mutations in the virus that could aid in drug and vaccine development. (Source: JAMA)
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research

Bionic Arm With Sensation Tested in Multiyear Study
Researchers recently reported that 4 men with transhumeral amputations have used a self-contained robotic arm with sensory feedback in daily life for several years. The prosthetic ’s hand has sensation, allowing the men to do complex tasks such as ski, repair cars, and canoe. One man became employed full-time thanks to the arm’s improved functionality, and patients also reported complete relief of phantom limb pain. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Existing Drugs Might Treat COVID-19
Drugs already marketed for conditions including schizophrenia might have potential as treatments for coronavirus disease 2019 (COVID-19), a Nature  study suggests. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Blood Test Flags Multiple Cancers in Large Study
A recent study in Science suggests that a blood test to detect different types of cancer is safe when used with positron emission tomography –computed tomography (PET-CT) to confirm the results. The researchers emphasized that, if approved for use, multicancer blood tests should be used alongside standard-of-care screenings to increase detection. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Screening for Unhealthy Drug Use
In this issue of JAMA, the US Preventive Services Task Force (USPSTF) presents a Recommendation Statement and an accompanying Evidence Review on screening for unhealthy drug use. “Unhealthy drug use” refers to drugs that are illegal or medications not used for medical purposes, including cannabis, but not including alcohol, nicotine, or tobacco. Unlike alcohol screening, drug screening approaches aim to capture any drug use and are not restricted to a specific substance; they capture the full spectrum of unhealthy use, from any use through a drug use disorder. (Source: JAMA)
Source: JAMA - June 9, 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 - June 9, 2020 Category: General Medicine Source Type: research

How Will COVID-19 Affect the Health Care Economy?
Coronavirus disease 2019 (COVID-19) has created an economic crisis alongside a health care crisis. During the 2 weeks ending on March 28, nearly 10 million people filed for unemployment insurance, dwarfing any previous monthly numbers. Estimates suggest that the US economy will contract by 10% to 25% during the second quarter. The US has entered a COVID-19 recession. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Immunization Against Plague
The reiterated plea of scientists for accurately controlled experiments in the determination of the value of measures adopted against disease may seem to some physicians to be somewhat too emphatic. Again and again, however, the disinterested scientist is compelled to protest against the use of statistics and experiments by those commercially interested and by overenthusiastic advocates of the prophylactic use of certain products. How difficult it really is to arrive at definite conclusions relative to the efficacy of many such preventive measures is pointed out by Flu, in a recent discussion of experiments on immunization...
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Revisiting Leonardo da Vinci ’s Vitruvian Man
This study uses 3D body scanner measurements of US Air Force recruits to compare ideal body proportions represented by Leonardo da Vinci ’s Vitruvian Man with contemporary body proportions in young adult men and women. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Incisional Negative Pressure Wound Therapy After Surgery for Major Trauma –Related Fractures
To the Editor The results of the Wound Healing in Surgery for Trauma (WHIST) trial by Dr Costa and colleagues should be interpreted with caution until the authors provide information regarding the actual duration of the incisional negative pressure wound therapy because duration is associated with effectiveness. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

An Early Result Acceptance Program for Residency Application
To the Editor Although the residency match system has become increasingly complicated and has a number of problems, the implementation of an early result acceptance program (ERAP), as suggested by Dr Hammoud and colleagues, raises a number of concerns. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Incisional Negative Pressure Wound Therapy After Surgery for Major Trauma –Related Fractures—Reply
In Reply We agree with Mr Zwanenburg and colleagues that the duration of application of the incisional negative pressure wound therapy dressing after surgery is an important variable. Based on their meta-analysis, they suggest that “it is essential to provide incisional negative pressure wound therapy for a sufficient amount of time for the therapy to be effective (eg, for 7 days).” (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

An Early Result Acceptance Program for Residency Application —Reply
In Reply We agree with Dr Adler that it is important to think critically about any proposed changes to the current residency selection process, such as an ERAP discussed in our Viewpoint. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Accuracy of the PHQ-2 Alone and in Combination With the PHQ-9 for Screening to Detect Major Depression
This meta-analysis uses individual participant data from diagnostic accuracy studies to estimate the accuracy of the Patient Health Questionnaire –2 (PHQ-2) alone and combined with the PHQ-9 for detecting major depression. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Association of Dysanapsis With COPD Among Older Adults
This study used pooled cohort data to estimate the association between CT-assessed dysanapsis —a mismatch between airway tree caliber and lung size—and incident COPD in adults aged 60 years and older. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Association of Migraine With Aura and Other Risk Factors With Cardiovascular Disease in Women
This cohort study uses Women ’s Health Study data to compare the association of migraine with aura vs other major vascular risk factors (diabetes, hypertension, dyslipidemia, smoking, BMI, CVD family history) with incidence of cardiovascular disease. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Screening for Unhealthy Drug Use in Adults and Adolescents
This JAMA Patient Page summarizes the US Preventive Services Task Force ’s 2020 recommendations on screening for unhealthy drug use in adults and adolescents. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

The Phone Call
In memory of my mother, Dr. Fatima Hashamali, who dedicated her life to caring for vulnerable children. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

The Spectrum of Deaths Encountered by a Young Learner
In this narrative medicine essay, a medical student describes 3 patient deaths whose care she was involved in and expresses her hopes that what she learned will ground her professional course in compassion and patient care. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

USPSTF Report: Screening for Unhealthy Drug Use
This systematic review to support the 2020 US Preventive Services Task Force Recommendation Statement on screening for unhealthy drug use including nonmedical use of prescription drugs in adolescents and adults summarizes published evidence on the benefits and harms of primary care –based screening. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

USPSTF Recommendation: Screening for Unhealthy Drug Use
This 2020 US Preventive Services Task Force Recommendation Statement recommends screening for unhealthy drug use in adults 18 years or older when services for diagnosis, treatment, and care can be offered or referred (B recommendation) and concludes that evidence is insufficient to assess the balance of benefits and harms of screening for unhealthy drug use in adolescents (I statement). (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Spike in Poison Control Calls Related to Disinfectant Exposures
Calls to US poison control centers regarding exposures to cleaning products and disinfectants increased by more than 20% during the first quarter of 2020 compared with 2019, according to a CDC analysis posted online on April 20. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Homeless Shelters Face High COVID-19 Risks
The CDC has recommended steps that homeless shelters should take to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission after studying outbreaks at several facilities across the United States. (Source: JAMA)
Source: JAMA - June 9, 2020 Category: General Medicine Source Type: research

Do Gut Bacteria Play a Role in Preeclampsia?
As investigators from diverse biomedical fields continue to study gut microbes ’ widespread effects on health and disease, 1 group is homing in on preeclampsia. Gut microbiota imbalances have been linked to conditions like obesity and the metabolic syndrome, which can contribute to pregnancy complications. Researchers recently questioned whether these imbalances also might b e associated with preeclampsia, a condition that lacks reliable prediction methods and can lead to serious and even fatal complications for both mother and baby. (Source: JAMA)
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research

Patient and Study Participant Rights to Privacy in Journal Publication
Personal health information is defined as identifiable data related to the past, present, or future health status of an individual. Personal health information has been considered protected health information, which is governed by ethical principles and laws to shield against intrusions into an individual ’s rights to privacy. However, rapid growth in the volume of electronic health records, access to other health information, and increasing use of personal health data by artificial intelligence, social media, technology, and other companies are threatening the traditional tenets of privacy protect ions for personal ...
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research

A Structured, Electronic Approach to Shared Decision-making and Attempted Trial of Labor
In 2018, more than 1.2 million pregnant women in the US underwent a cesarean delivery as part of their birth experience. Maternal indications for cesarean delivery include a lack of progress during labor, placental abnormalities, and complex medical conditions. Fetal conditions include multifetal gestation, fetal malpresentation (breech), congenital anomalies, and fetal intolerance of labor. Although generally safe for mother and fetus, cesarean deliveries are associated with significantly higher risk of maternal morbidity, including maternal transfusion, surgical injury, unplanned hysterectomy, intensive care unit admissi...
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research

Long-term Outcomes After Thrombolytic Therapy for Acute Ischemic Stroke
The role of intravenous thrombolytic therapy in the management of acute ischemic stroke is well established, and faster administration of intravenous tissue plasminogen activator (tPA) has been associated with better short-term outcomes in clinical practice. (Source: JAMA)
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research

Triple-Negative Breast Cancer Drug Receives Approval
The FDA has granted accelerated approval to a new drug for patients with metastatic triple –negative breast cancer. (Source: JAMA)
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research