Misguided Use of Hydroxychloroquine for COVID-19
This study, from the National Heart, Lung, and Blood Institute PETAL Clinical Trials Network, focused on hospitalized patients with moderate to severe disease. In this well-conducted, appropriately powered clinical trial, the authors randomized 479 patients to receive hydroxychloroquine (400 mg twice daily for 2 doses, then 200 mg twice daily for 8 doses) (n  = 242) or placebo (n = 237). The trial was stopped early at the fourth interim analysis for futility. For the primary outcome, clinical status at 14 days measured on a 7-category ordinal scale, there was no significant difference between th...
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Effect of Hydroxychloroquine on Clinical Status at 14 Days in Hospitalized Patients With COVID-19
This randomized trial compares the effects of hydroxychloroquine vs placebo on clinical status at 14 days (home, requiring noninvasive or invasive ventilation or extracorporeal membrane oxygenation, hospitalized, died) among adults hospitalized with coronavirus disease 2019 (COVID-19). (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Younger Adults Cautioned to Take COVID-19 Seriously as Demographics Shift
This Medical News article discusses the health implications of severe acute respiratory syndrome coronavirus 2 infection among young and middle-aged adults. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

The Challenges Ahead With Monoclonal Antibodies —From Authorization to Access
This Viewpoint discusses questions about clinical indication, supply, distribution, and cost and coverage that will need to be resolved if monoclonal antibodies are be granted Emergency Use Authorization or licensure and become available as treatment for COVID-19. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Therapy for Early COVID-19 —A Critical Need
In this Viewpoint, Fauci and NIAID colleagues review leading candidates for treatment of mild to moderate coronavirus disease 2019 (COVID-19) to prevent disease progression and longer-term complications, including emerging antiviral drugs, immune-modulating agents, and antibody-based therapies, and the challenges of developing randomized trials to rapidly evaluate the safety and efficacy of each. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Hospital-Acquired SARS-CoV-2 Infection
This Viewpoint reviews the rare incidence of nosocomial SARS-CoV-2 infection and discusses ways it can be minimized, including use of surgical masks, proper ventilation, physical distancing, eye protection, regular testing, and the availability of sick leave for health care workers. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

The Need for More and Better Testing for COVID-19
This Viewpoint proposes criteria for more effective COVID-19 testing strategies to manage population transmission, including use of rapid antigen tests and self-administered nasal and salivary tests, emphasizing that more effective testing alone cannot control the pandemic without continued public health interventions, such as mask wearing, physical distancing, and avoidance of large gatherings. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

How Targeting Fat Cells ’ Estrogen Receptors Could Fight Obesity
In adipocytes, fat cells, a particular estrogen receptor appears critical for energy-supplying mitochondria to function properly. The discovery points to a potential drug target for boosting fat tissue metabolism, which could help combat obesity and other metabolic conditions. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Cannabis and Impaired Driving
Impaired driving is a major cause of preventable death worldwide. Alcohol-impaired driving accounted for a mean of 19% (range, 3%-34%) of the motor vehicle crash deaths in 20 countries in 2016; in 2018, 29% of the 36  560 crash deaths in the US were attributed to impaired driving.By comparison, driving under the influence of cannabis was estimated to account for 8700 road traffic deaths worldwide in 2013. Alcohol and cannabis are often consumed together, and their combined use is associated with greater crash risk than the use of either substance alone. Notably, cannabinoids are the most commonly detected other drugs (be...
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

New Partnership Aims to Intercept Illegal Drugs and Devices
The FDA has joined with US Customs and Border Patrol (CPB) and US Immigration and Customs Enforcement, Homeland Security Investigations (ICE-HSI) to stop harmful products that threaten the public ’s health from entering the US through International Mail Facilities. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Essential Medicines Identified for Future Public Health Emergencies
As it prepares for the next potential public health emergency, the FDA collaborated with other federal agencies to develop a list of essential medicines, medical countermeasures, and pharmaceutical ingredients considered necessary to protect the public from infectious diseases and chemical, biological, radiological, and nuclear threats. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Ivermectin Lotion for Head Lice No Longer Needs a Prescription
The head lice treatment ivermectin lotion, 0.5% will be marketed in the US as a nonprescription drug and will no longer be available by prescription, the FDA announced. (Source: JAMA)
Source: JAMA - December 1, 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 - December 1, 2020 Category: General Medicine Source Type: research

Use of Gastric Balloons for Weight Loss in 2020
This JAMA Insights Clinical Update discusses evidence for the efficacy and safety of gastric balloon systems for weight loss, and their clinical indications as part of a multidisciplinary approach to weight management in patients who are not candidates for bariatric surgery. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

The Right to Strike
The employees of a small railway that furnishes the sole access to a town at the head of a valley go on a strike and demand an absolute acceptance of their terms. As this shuts off all supplies from the local hospital, its directors institute a motor truck service to meet the needs of the institution. On the first day of this arrangement, a car is overturned by a steel wire stretched across the road, and the newly wedded doctor, son of the local practitioner, is killed on the spot. Under the leadership of the chief surgeon of the hospital, an agreement is made by which all medical service is withheld from the strikers and ...
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Dispensing of Zolpidem and Low-Dose Trazodone Among Commercially Insured Adults in the US, 2011-2018
This study uses IBM MarketScan database data to describe trends in zolpidem and low-dose trazodone dispensing among adults with employer-sponsored insurance or Medicare supplemental plans between 2011 and 2018, before and after a 2017 clinical practice guideline discouraged trazodone use for insomnia. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Prejudices of a Referenced Philosopher
To the Editor The message of “social solidarity” and collaboration in Dr Berwick’s Viewpoint was eloquent. Unfortunately, it was undermined by referencing a philosopher, Immanuel Kant, whose “racist and sexist prejudices had a profound impact on the shape of his moral and political theory.” The Kant reference to the “ moral law within” that underscored the entire article was misrepresented in a way that gave a skewed perception of its meaning. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Developments in Heart Failure With Reduced Ejection Fraction
To the Editor The review by Dr Murphy and colleagues on heart failure with reduced ejection fraction (HFrEF) did not mention surgical options for this patient population. Advances in the field of mechanical circulatory support that include new-generation continuous-flow devices have resulted in improved patient outcomes and merit discussion. Recent American College of Cardiology (ACC) guidelines state that mechanical circulatory support is beneficial in carefully selected patients with stage D heart failure in whom definitive therapy such as cardiac transplantation is planned or when native heart recovery is anticipated. U...
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Developments in Heart Failure With Reduced Ejection Fraction
To the Editor Dr Murphy and colleagues provided a comprehensive review of HFrEF. We wish to discuss 2 key issues. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Prejudices of a Referenced Philosopher —Reply
In Reply I am grateful for the clarity offered by Ms Alsalihi and colleagues regarding Immanuel Kant ’s horrific racist and sexist prejudice. When I cited his words in the Viewpoint, I was not aware of this well-documented component of his work. I should have been more diligent and at least called it to the attention of readers. I shall not make this mistake again. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Developments in Heart Failure With Reduced Ejection Fraction —Reply
In Reply In response to our recent review of HFrEF, Dr Dowling and colleagues correctly highlight that mechanical circulatory support devices are anticipated to play an expanding role in the management of patients with advanced heart failure, particularly as technological advancements result in development of devices with greater efficacy and more favorable safety profiles. With improvements in device technology, early identification and referral of appropriate patients to a heart failure specialist will become even more important, so that patients do not present late with multiorgan failure, rendering them noncandidates f...
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Driving Under the Influence of Cannabis and Its Constituents
This Medical News feature discusses research into how cannabidiol and tetrahydrocannabinol affect driving performance. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Association of Meningococcus Group B Vaccine With Group B Invasive Meningococcal Disease Among Children
This case-control study uses national hospital and immunization records in Portugal to estimates the difference in incidence of invasive group B meningococcal disease among children and adolescents who were immunized vs not immunized with 4CMenB, a 4-component meningococcus group B vaccine licensed in 2013. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Cannabidiol and Δ 9 -Tetrahydrocannabinol Effects on Driving Performance
This crossover randomized clinical trial evaluated driving test performance of healthy young adult volunteers after vaporized consumption of cannabis ( Δ9-tetrahydrocannabinol [THC] and cannabidiol [CBD]) vs placebo. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Patient Information: Urinary Diversion
This JAMA Patient Page describes the 3 surgical techniques used to divert urine away from the bladder as a part of surgical treatment of bladder cancer. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Life Review
This is what you do when you ’re my age if you’re lucky enough to have the time, which you certainly do in these months of pandemic, and your mind. (I still have my mind your old patient Maggie once pointed out from her bed of many winters.) (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Always More to Be Done —The Presence of Comfort in Patient Care
In this narrative medicine essay a medical student recalls discovering the power of meaningful palliative care, contrasting patients ’ relief from suffering through caring and comfort with her father’s awful experience of pain and neglect in his closing days. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

Hearing Loss in Children
This narrative review summarizes the etiologies of pediatric hearing loss, screening strategies for identifying it early, consequences of delayed diagnosis, and diagnosis and management of the condition, with a detailed discussion of criteria for choice of hearing devices to remediate hearing impairment. (Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - December 1, 2020 Category: General Medicine Source Type: research

COVID-19 and Excess All-Cause Mortality in the US and 18 Comparison Countries
This Viewpoint compares the COVID-19 per capita overall and excess mortality rates in the US vs that of 18 OECD countries and the timing of any increases in excess mortality between February and September 2020. (Source: JAMA)
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research

Headache, Confusion, and Somnolence in a 27-Year-Old Woman
A woman who had immigrated from Guatemala 1 year prior developed headache, photophobia, vomiting, somnolence, and confusion but no focal neurologic deficits. Brain CT showed ventriculomegaly, hydrocephalus, and cerebral edema, while brain MRI showed a nonenhancing lesion obstructing the aqueduct of Sylvius that moved to the fourth ventricle with hydrocephalus resolution on repeat imaging 5 days later. What is the diagnosis and what would you do next? (Source: JAMA)
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research

Is It Lawful and Ethical to Prioritize Racial Minorities for COVID-19 Vaccines?
This Viewpoint considers how COVID-19 vaccines can be distributed strategically, ethically, and legally given conflicts between consensus public health recommendations to prioritize allocation to disadvantaged racial and ethnic minorities and laws discouraging explicit consideration of race in policy decisions. (Source: JAMA)
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research

Answering Key Questions About Coronavirus Vaccines
This Viewpoint offers provisional answers to common questions the public will have about approved COVID-19 vaccines, including what they can expect regarding its effectiveness and safety, trustworthiness of the approval process, and whether society can return to normal once sufficient numbers of people are immunized. (Source: JAMA)
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research

Herd Immunity and Implications for SARS-CoV-2 Control
This JAMA Insights Clinical Update discusses herd immunity in the context of the COVID-19 pandemic and explains the herd immunity threshold as a function of transmissibility (R0), the role of an effective vaccine and vaccination program in sustaining herd immunity, and the risks of an infection-based herd immunity approach. (Source: JAMA)
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research

Patient Information: What Is Herd Immunity?
This JAMA Patient Page describes what herd immunity is, how it limits disease spread, and how it is achieved in a population either by vaccination or by infection and recovery from a disease. (Source: JAMA)
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research

Principles Underlying ACIP Recommendations for Phased Implementation for COVID-19 Vaccination
This Viewpoint summarizes the principles guiding coronavirus disease 2019 (COVID-19) vaccine recommendations made by the Advisory Committee on Immunization Practices (ACIP), a nongovernment advisory standing committee that counsels the Centers for Disease Control and Prevention on US population vaccine use, emphasizing that any final recommendations await phase 3 safety and efficacy data from ongoing trials. (Source: JAMA)
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research

Clinical Genome Sequencing —The Importance of Implementation Data
This Viewpoint discusses the importance of understanding how next-generation genomic sequencing is being implemented —for whom noninvasive prenatal testing, whole-exome and -genome sequencing for suspected genetic disorders, and tumor sequencing is being used and who is paying for it—as precondition for knowing how the technologies can best serve patients. (Source: JAMA)
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research

New Guideline Calls for Cervical Cancer Screening to Begin at Age 25 Years
This Medical News article discusses updates in the American Cancer Society ’s cervical cancer screening guideline. (Source: JAMA)
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research

SARS-CoV-2 Testing Hesitancy Could Hamper Mitigation Efforts
This Medical News feature examines the problem of people refusing to be tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). (Source: JAMA)
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research

Reflections of a COVID-19 Long Hauler
In this narrative medicine essay, an emergency medical physician describes the lasting physical symptoms of a mild case of COVID-19, the effects of the illness on his family and professional community, and the lessons he ’s learned about caring for symptomatic patients with normal test results. (Source: JAMA)
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research

Incorrect Dosages in Table
In the Review article entitled “Heart Failure With Reduced Ejection Fraction: A Review,” published in the August 4, 2020, issue of JAMA, incorrect dosages were reported in Table 3. For the row reporting dosage for eplerenone, the starting dosage should be 25 mg once daily, and the target dosage should be 50 mg once daily. Thi s article was corrected online. (Source: JAMA)
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research

Cardiovascular Health Promotion for Prevention of CVD
Life expectancy in the US stalled in 2010 and has declined since 2014. After decades of increases in life expectancy, this concerning shift has been attributed, in part, to increasing rates of midlife cardiovascular mortality among adults aged 35 to 64 years. Concurrently, prevalence of underlying cardiometabolic risk factors has increased, including obesity and diabetes, and control of hypertension has declined. These unfavorable trends have also been observed among youth and younger adults. Thus, the need to reemphasize health promotion for successful cardiovascular disease (CVD) prevention beginning earlier in the life ...
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research

Revisiting States ’ Experience With Certificate of Need
Many states enforce certificate of need regulations that require hospitals to obtain approval from a designated state agency before opening new facilities, adding capacity, or offering particular complex, costly services, such as heart transplants. Yet at least 9 states took steps in 2019 to modify their certificate of need rules, often because those laws are viewed as ineffective in controlling overutilization or improving quality. As Yuce and colleagues observed in this issue of JAMA, most of the literature examining the association between certificate of need and measures of utilization and patient outcomes is more than...
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research

Study Aims to Identify Drugs That Could Be Repurposed for COVID-19
The National Institute of Allergy and Infectious Diseases (NIAID) recently launched a study to determine whether drugs that are already approved or in the late stage of clinical development might merit testing in larger clinical trials as a coronavirus disease 2019 (COVID-19) treatment. (Source: JAMA)
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research

Importance of Patient Input in Designing CRISPR Trials
Clinical trials of genome editing to treat sickle cell anemia must be designed with input from patients and their parents and physicians, a recent study by National Human Genome Research Institute (NHGRI) scientists concluded. (Source: JAMA)
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research

Aid for American Indian, Alaska Native Individuals Who Want to Quit Smoking
The Indian Health Service (IHS) recently launched SmokefreeTXT, a mobile messaging tool to help American Indian and Alaska Native individuals quit smoking. (Source: JAMA)
Source: JAMA - November 24, 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 - November 24, 2020 Category: General Medicine Source Type: research

Ecology and Medicine
“All life is controlled by two great forces, heredity and environment, and ecology is the science dealing with the environment.” Ecology has generally been considered as the special concern of botanists and zoologists; at least they have been the ones who have most used the term as applying to a distinct department of their sciences; but obviously, from the definition, it is related to every science that touches life. Physicians have always recognized environment as of fundamental importance in all problems of medicine, and hence have unconsciously been ecologists, much like the man who, o n taking up in his la...
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research

Pediatric Magnet Ingestions After Federal Rule Changes, 2009-2019
This study describes trends in emergency department visits for ingestions by children of small neodymium magnets between 2009 and 2019, before, during, and after a 2014 Consumer Product Safety Commission rule restricting their sales. (Source: JAMA)
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research

Maternal Docosahexaenoic Acid Supplementation and Bronchopulmonary Dysplasia in Infants
To the Editor In the Maternal Omega-3 Supplementation to Reduce Bronchopulmonary Dysplasia in Very Preterm Infants (MOBYDIck) trial, Dr Marc and colleagues reported no difference in bronchopulmonary dysplasia –free survival but higher rates for bronchopulmonary dysplasia in premature infants whose breastfeeding mothers received docosahexaenoic acid (DHA) supplementation vs placebo. A similar increase in rates for bronchopulmonary dysplasia also was reported in the N3RO trial, in which DHA supplementati on or placebo was directly administered to premature infants. We would like to suggest a pathophysiological explanat...
Source: JAMA - November 24, 2020 Category: General Medicine Source Type: research