“This Level of Death, It’s New”—Health Care Workers in Their Own Words
The surge in hospitalizations for coronavirus disease 2019 (COVID-19) around the country has led many physicians and other health care workers to speak out. We created this post directly from the recent words of frontline health care workers and medical administrators in 19 states, with the sources linked to the first word or two of each quote. Their words reflect an unprecedented time for the US health care community in the midst of the pandemic. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Appendicitis in France and in America
From the discussion regarding appendicitis by the Paris Surgical Society (Bull. et m ém. de la Soc. de Chir. de Paris, T. xviii), it is evident that unanimity of opinion upon some points as to treatment is not yet established in France, and that the French are somewhat behind the progress of American surgeons. The discussion as brought out in the society includes the etiology and p athology, the expectant opium treatment and early and late operations upon the inflamed vermiform, and is based upon the histories of cases presented and the results of operations performed. The adherents of the opium treatment (Berger, M...
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Hospital Revenue Under Maryland ’s Total Cost of Care Model During the COVID-19 Pandemic, March-July 2020
This study compares revenue of Maryland hospitals in March-July 2020 vs historical trends and assesses whether rate increases for inpatient and outpatient services that were permitted to offset pandemic-related decines in revenues were associated with changes to state hospital revenue. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Update on Lipids and Lipoproteins
To the Editor In their JAMA Insights Clinical Update on lipids and lipoproteins, Dr Ference and colleagues emphasized the pivotal role of apolipoprotein B (apoB) in atherosclerosis and recommended the measurement of apoB levels to capture all atherogenic lipoprotein particles. However, this apoB assay is not readily available in many clinical laboratories around the world and is not completely standardized. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Update on Hepatitis A Management
To the Editor Drs Desai and Kim provided a brief overview of hepatitis A management. Their JAMA Insights article was timely considering the widespread person-to-person outbreaks of hepatitis A across the US since 2016. However, we note some discrepancies between this publication and the Advisory Committee on Immunization Practices (ACIP) recommendations that could affect the public health response to hepatitis A. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Update on Lipids and Lipoproteins —Reply
In Reply We agree with Drs Jialal and Devaraj that total cholesterol and HDL-C can be measured accurately and precisely in clinical laboratories, and that the difference, referred to as non –HDL-C, is a good measure of the total cholesterol content carried by circulating apoB-containing lipoproteins. However, our article did not focus on the best way to measure lipids in the laboratory. Furthermore, apoB is not a lipid, but instead is a lipoprotein that carries lipids in plasma. Conf lating lipids measured in the standard lipid panel with lipoproteins is a common mistake that leads to confusion about the role of lipi...
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Update on Hepatitis A Management —Reply
In Reply We agree with Dr Weng and colleagues that the risk of acquiring hepatitis A in certain occupational settings is low. We mentioned this consideration in our JAMA Insights article because certain public health bodies deployed vaccination of food service workers in the setting of an outbreak. However, we acknowledge that this is not standard practice and that the efficacy of such interventions is unknown. Second, we agree that health care workers who work in settings that provide services for injection and noninjection drug users are not at higher risk of acquiring hepatitis A as noted in the most recent ACIP recomme...
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Simplified Regimen Expands Options for Dual-Therapy HIV Maintenance
As a preferred HIV drug based on its efficacy and high barrier to drug resistance, dolutegravir has been combined in treatment regimens with several other anti-HIV agents. Now investigators in Switzerland have reported in PLOS Medicine that dolutegravir taken with emtricitabine was noninferior to standard combination antiretroviral therapy (cART), and it improved patients ’ quality of life. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Fecal Immunochemical Testing vs Sigmoidoscopy for Cancer Screening
Repeated fecal immunochemical testing (FIT) detected more colorectal cancer and advanced adenomas and had greater patient participation than sigmoidoscopy, a trial in Gastroenterology reported. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Intravenous Iron Therapy Prevents Heart Failure Rehospitalizations
Intravenous (IV) ferric carboxymaltose reduced subsequent hospitalizations among patients with acute heart failure and iron deficiency, according to a 15-country trial in The Lancet. Patients with acute heart failure often have iron deficiency, which contributes to poor prognosis regardless of anemia. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Ablation Beats Drugs for Initial Atrial Fibrillation Treatment
Although guidelines recommend medical therapy before catheter ablation for atrial fibrillation, antiarrhythmic drugs fail to prevent recurrence for up to 67% of patients. In a pair of multicenter trials published in the New England Journal of Medicine, fewer recurrences occurred with cryoballon ablation than with medication as first-line therapy. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Incidence of Transient Ischemic Attack and Association With Long-term Risk of Stroke
This cohort study uses Framingham Heart Study (FHS) data to assess population-based incidence of transient ischemic attack (TIA), and the timing and long-term trends of stroke risk after TIA, among participants in the FHS Original, Offspring, and Third Generation cohorts from 1948 to 2017. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Effect of Behavioral Therapy With In-Clinic or Telephone Group Visits vs In-Clinic Individual Visits on Weight Loss in Obesity
This randomized trial compares the effects on 24-month weight change of behavioral therapy delivered at US rural clinics via in-clinic individual visits or in-clinic group visits vs telephone group visits to patients with obesity. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Patient Information: Amblyopia
This JAMA Patient Page explains the causes, symptoms, and management of amblyopia, reduced vision in one or both eyes due to abnormal visual development during childhood. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

The Strange Cabinet
—Mexico City, 1986 (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Shared Grief —Bridging the Health Equity Gap
In this narrative medicine essay a neonatal ICU nurse afraid to hold her newborn daughter after she dies draws comfort and a sense of connection years later from the memory of a parent she had unconsciously stigmatized, who held and loved her infant son at his death. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Acute Pancreatitis: A Review
This narrative review summarizes the pathogenesis, diagnosis, and management of acute pancreatitis, including advances in risk stratification, fluid and nutritional management, and follow-up care and risk-reduction strategies. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Addressing the Risk of Medicare Trust Fund Insolvency
This Viewpoint proposes policy options to forestall insolvency of the Medicare Hospital Insurance Trust Fund, including practical and politically palatable strategies to increase revenues and decrease spending to prevent looming shortfalls. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Drug-Resistant Bacteria Outbreak Linked to COVID-19 Patient Surge
Breaches in infection control practices during last spring ’s coronavirus disease 2019 (COVID-19) surge likely contributed to a 34-patient outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) infections at a New Jersey hospital. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Racial Variations in Parents ’ Attitudes About Reopening Schools
Black, Hispanic, Asian, American Indian, and Alaska Native parents expressed more concern than White parents about the safety of reopening schools last fall, according to a survey commissioned by the CDC. (Source: JAMA)
Source: JAMA - January 26, 2021 Category: General Medicine Source Type: research

Table Inversion Error
This article was corrected online. (Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Intravenous Thrombolysis Before Endovascular Thrombectomy for Acute Ischemic Stroke
The 2 reperfusion therapies of proven benefit for acute ischemic stroke, mechanical endovascular thrombectomy (EVT) and pharmacologic intravenous thrombolysis (IVT), have complementary advantages. EVT, which involves mechanical debulking, works well for accessible sizeable thrombi that occlude large cerebral vessels and are resistant to rapid thrombolytic dissolution. IVT, which involves chemical dissolution, works well for smaller thrombi that occlude medium and small cerebral vessels inaccessible or poorly accessible to endovascular technology. An open, important question has been whether the modest efficacy of IVT for l...
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

A Comprehensive Approach to Increase Adult Tobacco Cessation
Quitting smoking is one of the most important changes individuals can make to improve their health. The US Surgeon General concluded in 2020 that smoking cessation reduces the risk for all-cause mortality, cardiovascular diseases, chronic obstructive pulmonary disease, adverse reproductive health outcomes, and 12 types of cancer. Although considerable progress has been made in the US in reducing smoking over the past half century, there is still work to be done: it is estimated that 34 million US adults smoke cigarettes, more than 480  000 die annually from smoking or tobacco smoke exposure, and more than 16 million are ...
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Health Care Is a Right, Not a Privilege
Two fundamental questions about health care in the US remain unanswered: is health care a right or a privilege and, relatedly, is the US committed to ensuring that every individual has access to some form of health insurance like in every other modern high-resource country. President Obama, despite the success of the Affordable Care Act (ACA) in increasing the number of individuals with health insurance in this country, seldom addressed this issue directly, even in a wide-ranging special communication in JAMA. President Trump has done little with respect to increasing the number of individuals with insurance; instead, his ...
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Avoid Masks With Metal During Magnetic Resonance Imaging
Although face masks that contain metal can protect against coronavirus disease 2019, they could also cause injury during a magnet resonance imaging (MRI) examination, the FDA has cautioned. (Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

First Drug Approved for Rare Genetic Disorder Affecting Kidneys
The first treatment for the rare metabolic disease primary hyperoxaluria type 1 (PH1) has received FDA approval. (Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Imaging Drug for Prostate Cancer
The FDA has approved a radioactive tracer for use with positron emission tomographic (PET) imaging to treat patients with prostate cancer. (Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Initiating Pharmacologic Treatment in Tobacco-Dependent Adults
This JAMA Clinical Guidelines Synopsis summarizes the American Thoracic Society ’s 2020 recommendations for treating tobacco dependence with pharmacologic therapy in adults. (Source: JAMA)
Source: JAMA - January 19, 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 - January 19, 2021 Category: General Medicine Source Type: research

The Cause of Cancer
To any one who is familiar with the long years of research in the domain of the etiology of neoplasms and who is conversant with the literally enormous literature to which the subject has given rise, the headline of these comments will not awaken any undue enthusiasm. The fundamental problem of the cause of cancer, a theme of undisputed medical importance, has not yet been solved, nor is the “facile triumph” in sight. One may measure the gradual gains of knowledge on this subject in the course of years; but there is great danger that the innumerable failures and disappointments encountered in cancer research th...
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Effect of Tidal Volume on Pulmonary Outcomes After Surgery
To the Editor Dr Karalapillai and colleagues concluded that intraoperative ventilation with low tidal volume compared with conventional tidal volume did not significantly reduce pulmonary complications within the first 7 postoperative days in patients undergoing major surgery. We have some questions about this study. First, the complication rate of 10.8% in the conventional tidal volume group was based on a study that did not mention postoperative pulmonary complications. The estimated 10.8% incidence in the conventional tidal volume group must be referenced to other similar studies on postoperative pulmonary complications. (Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Effect of Tidal Volume on Pulmonary Outcomes After Surgery
To the Editor In the article by Dr Karalapillai and colleagues, more than 20% of the patients underwent spinal surgery in a prone surgical position. Mechanical ventilation in the prone position homogenizes ventilation distribution in dorsal regions of lungs, which decreases pulmonary shunt fraction and thereby reduces hypoxemia. Although studies have demonstrated that mechanical ventilation in the prone position is associated with lower mortality in patients with lung injury, a more recent meta-analysis portrays an equivocal benefit of this intervention. Therefore, patients undergoing spine surgery should have been exclude...
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Effect of Tidal Volume on Pulmonary Outcomes After Surgery
To the Editor The inherent physiological rationale for lowering tidal volume during mechanical ventilation is to decrease strain on the lung tissue to avoid ventilator-induced lung injury. In the study by Dr Karalapillai and colleagues, there was a considerable difference in tidal volumes between the groups (mean, 396.6 [SD, 83.5] mL vs 611.1 [SD, 111.9] mL). However, ventilator-induced lung injury is not only a function of static parameters such as strain from tidal volume or stress from inspiratory pressures, but also from the complex interplay between static and dynamic variables, including the rate of lung deformation ...
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Physician Performance in the Medicare Merit-based Incentive Payment System
To the Editor In their recent article, Dr Johnston and colleagues reported that health system affiliation was associated with significantly better performance scores and more favorable value-based reimbursement for clinicians participating in the inaugural payment year (2019) of the Medicare Merit-based Incentive Payment System (MIPS). Even though this program may accelerate clinician consolidation within health systems, I believe their findings may be overstated for 3 reasons. (Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Effect of Tidal Volume on Pulmonary Outcomes After Surgery —Reply
In Reply We agree with Dr Zhao and colleagues that the estimation of postoperative pulmonary complications in our study was overly conservative. This estimate, however, was based on preliminary local unpublished data at the time of the trial design in 2013. At this time, it was considered the best evidence available of the postoperative pulmonary complication rate in our center. We acknowledge that this rate was not reported in the subsequent final report by Weinberg and colleagues published in 2018. As stated in the statistical analysis section, we wished to identify a minimal clinically important difference of greater th...
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Physician Performance in the Medicare Merit-based Incentive Payment System —Reply
In Reply We agree with Dr Rathi ’s main observation about our recent article that the financial incentives were small in the MIPS 2019 performance year, and the performance threshold for avoiding a payment penalty was low. In fact, the performance threshold was so low in 2019 that only clinicians who did not comply with the MIPS (did not report any performance measures to the CMS) received payment penalties. (Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis in Acute Ischemic Stroke
This noninferiority trial compares the effects of mechanical thrombectomy with vs without intravenous thrombolysis (0.6-mg/kg alteplase) on 90-day disability among patients with acute large vessel occlusive ischemic stroke. (Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Effect of Endovascular Treatment With vs Without IV Alteplase on Functional Independence After Acute Ischemic Stroke
This noninferiority trial compares the effects of endovascular treatment with vs without intravenous alteplase on 90-day functional independence among patients with acute ischemic stroke. (Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Effect of Discontinuing vs Continuing ACEIs and ARBs in Patients Admitted With COVID-19
This randomized clinical trial compares the effect of discontinuing vs continuing angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) on days alive and out of the hospital at 30 days among patients with COVID-19 taking the drugs prior to hospitalization. (Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

USPSTF Recommendation: Interventions to Promote Tobacco Cessation
This JAMA Patient Page summarizes the USPSTF 2020 guideline recommending that physicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and drugs shown effective for stopping cigarette and other tobacco use. (Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Use of Central Line Insertion Teams to Manage Venous Access Volume and Safety During the COVID-19 Pandemic
This JAMA Performance Improvement article summarizes findings from an international survey study of hospital experience with central venous access line insertion teams to manage high procedural volume and safety during the COVID-19 pandemic. (Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Spraying Cotton in Bolivar County, Mississippi, the Summer Following My First Year of Medical School
The John Deere wheels cut hard coming to the turn row that runs along the county line near the evergreen copse in Paradise ’s south forty acres. In the wake of the tire tread, a dull patch flashes within the white blur beneath me. Exposed bone blooms among lobed leaves of cotton. Five vertebrae lie bleached and unstrung. I idle the machine, lurching to rest as diesel fumes rise in a dirge to these remains at the field ’s edge. I stand to see better. They are lumbar (without facets for ribs) but unknown. All bones being the same beneath skin. I have seen others, too: a woman's, this past fall. The instructors st...
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Root Cause Analysis —A Means of Self-Healing From PTSD
In this narrative medicine essay, a neonatologist describes the fear of losing her twin boys after assisted reproduction and their premature births and relies on a form of root cause analysis to identify the sources of her trauma and to learn from it enough to support her patients and their families. (Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

USPSTF Review: Interventions for Tobacco Cessation in Adults, Including Pregnant Persons
This systematic review to support the 2021 US Preventive Services Task Force Recommendation Statement on interventions for tobacco cessation in adults summarizes published evidence on the benefits and harms of interventions for tobacco cessation in adults, including pregnant persons. (Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

USPSTF Recommendation: Interventions for Tobacco Smoking Cessation in Adults
This 2021 US Preventive Services Task Force Recommendation Statement recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and pharmacotherapy for cessation (A recommendation) and concludes that evidence is insufficient to assess the benefits and harms of tobacco cessation pharmacotherapy in pregnant persons and e- cigarettes for tobacco cessation in any adult (I statement). (Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

The Language of Health Care Reform
This Viewpoint posits that the US will engage in another debate about health care reform to consider expanding coverage, improving affordability, and containing costs. (Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Executive Action to Expand Health Services in the Biden Administration
This Viewpoint proposes measures the incoming Biden administration can take to increase access to health insurance coverage under the Affordable Care Act (ACA) and Medicaid, including limiting short-term ACA coverage provisions, rolling back state Medicaid waivers, and simplifying Medicaid eligibility. (Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

WHO Launches Global Push to Eliminate Cervical Cancer
By boosting human papillomavirus vaccination, cervical cancer screening, diagnosis, and treatment, the World Health Organization (WHO) hopes to slash new cervical cancer cases by 40% and deaths by 5 million by 2050. The effort is the first time the World Health Assembly ’s 194 member states have signed on to eliminate a type of cancer. (Source: JAMA)
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research