Nursing Homes ’ Next Test—Vaccinating Workers Against COVID-19
This story examines the potential roadblocks to vaccinating millions of long-term care workers against COVID-19, a task that is considered to be a critical step in protecting vulnerable nursing home residents. (Source: JAMA)
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Shear Forces —Work-Family Conflicts and The Importance of Balance
In this narrative medicine essay, an internist shares how the COVID-19 pandemic disrupted the work-life balance she had attained and how the metaphor of aortic dissection —shear forces tearing arterial layers apart, managed with blood pressure—gave her a means to imagine how to reduce the opposing forces in her life on the way toward equilibrium. (Source: JAMA)
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Bioinformatics, Sequencing Accuracy, and the Credibility of Clinical Genomics
The adoption of clinical exome and whole-genome sequencing based on next-generation sequencing technologies has increased rapidly over the last decade; this has been accelerated by increasing coverage of these services by private and public insurers. Examples of use include tumor and germline sequencing in patients with cancer, rapid turn-around sequencing of the genomes of critically ill neonates to diagnose mendelian conditions, and noninvasive prenatal testing for reproductive decision-making. The accuracy of sequencing results is of paramount importance to patients, clinicians, and those paying for testing services; in...
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

FDA Expands Food Safety Collaboration With Mexico
Building on a partnership signed in 2014, the FDA and its counterparts in Mexico have agreed to expand collaborative food safety efforts to cover all human food, rather than just produce, that crosses the border. (Source: JAMA)
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Breast Implant Manufacturers Get Labeling Guidance
New final guidance from the FDA is meant to ensure that patients have accurate, timely information on the risks and benefits associated with breast implants. (Source: JAMA)
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Warning Concerns Respirator Decontamination System
The FDA has warned the Battelle Memorial Institute, a research and development company in Columbus, Ohio, that its adverse event reporting process for an N95 respirator decontamination system is deficient. (Source: JAMA)
Source: JAMA - November 17, 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 17, 2020 Category: General Medicine Source Type: research

To Truly Build the Affordable Care Act Into Universal Coverage, More Creativity Is Needed
Once former Vice President Biden clinched the Democratic Party presidential nomination in early June, it was clear that the chances of a Medicare-for-all –type system in the near future had all but disappeared. Yet, frustration with the fragmented health insurance system crystallized support of progressives for a fundamental rethinking of how US residents pay for health care. Although many progressives will not be satisfied with incremental changes to health care financing, such an approach is considered likely if Biden is elected. Below are several possible concrete steps his administration could take to fulfill his...
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

State Medicine vs Fads
It is often interesting, as well as instructive, to take a retrospective glance over conditions that apparently have taken the lead in shaping popular opinion. In professional work this is quite as fascinating as it is to follow the ordinary topics of the day. In the present, matters that are non-sensational are relegated to the background, giving place to topics that can be made to excite the imagination, and help to create a sensation. Out of this has been developed the fad of being interviewed by a representative of the public press; in which, many times, the person being interviewed is shrewdly made to say what the pub...
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Financial Penalties Imposed on Large Pharmaceutical Firms for Illegal Activities
This study describes financial penalties levied on pharmaceutical companies for illegal activities by type of activity and dollar value between 2003 and 2016. (Source: JAMA)
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Assessing Alternative Payment Models
To the Editor Dr Navathe and colleagues suggested that alternative payment models have played a key role in slowing the growth of US health care spending despite evidence indicating they have limited effect. They posited that the true effect of alternative payment models has been underestimated in individual evaluations because these models have been compared with a declining spending baseline. (Source: JAMA)
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Testing Clinical Prediction Models
To the Editor The Viewpoint by Mr Adibi and colleagues proposed some novel approaches for evaluating the performance and utility of published CPMs. (Source: JAMA)
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Testing Clinical Prediction Models
To the Editor Mr Adibi and colleagues argued that practitioners are developing too many clinical prediction models (CPMs) and not testing model performance enough. The authors suggested placing all models in a cloud-based environment and allowing for a natural-selection approach to determine the best models. We agree that the current process, in which investigators develop models based on convenience cohorts without clear clinical use cases for their application and with little validation, needs a major overhaul. We also agree that placing models —with appropriate metadata—in a cloud-based environment is a nece...
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Assessing Alternative Payment Models —Reply
In Reply We agree with Mr Gondi and Dr Wadhera that CMS should use rigorous study designs in the evaluation of payment innovations. We have long supported the use of RCTs and mandatory enrollment to ensure rigorous evaluations. The original Comprehensive Joint Replacement program is one excellent example. Unfortunately, the Trump administration subsequently removed the mandatory randomized design by allowing hospitals to drop out of the program. All of the example evaluation designs proposed by Gondi and Wadhera (cluster, stepped-wedge, and adaptive) would be improvements compared with the usual voluntary programs with obs...
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Testing Clinical Prediction Models —Reply
In Reply We agree with Drs Goldstein and Pencina about the necessity of adapting risk models to the clinical use case. We share their vision that a cloud-based platform does not have to be centralized; each practitioner will set up their own environment for the models to compete in based on the specific task at hand. In our Viewpoint, we alluded to the idea that our suggested survival-of-the-fittest approach could help clinicians “adapt models to their local settings.” Models might evolve differently in different settings, based on the applicable evaluation criteria. The unique combination of clinical tasks, pa...
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Effect of an Emergency Department Care Bundle on Older Adults With Acute Heart Failure
This unblinded cluster randomized trial compares the effects of an emergency department (ED) –based comprehensive, guideline-recommended care bundle vs usual care on the number of days alive and out of the hospital at 30 days in older patients with acute heart failure cared for at French hospitals. (Source: JAMA)
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Association of Childhood Lead Exposure With MRI Structural Brain Integrity in Midlife
This study examines the association of blood lead levels in childhood with MRI measures of brain integrity as well as cognitive function assessments at age 45 years in a New Zealand birth cohort. (Source: JAMA)
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Detection of Pathogenic Variants With Germline Genetic Testing in Patients With Prostate Cancer and Melanoma
This study compares pathogenic variant detection accuracy in cancer-disposition genes of prostate cancer and melanoma cohort biopsy samples using deep learning vs standard genetic analysis methods. (Source: JAMA)
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Patient Information: Bladder Cancer
This JAMA Patient Page summarizes treatment options for early, invasive, and advanced bladder cancer. (Source: JAMA)
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Voyager
All the nights you came home with blood on your shoes, in scrubs, in weary neckties that say nothing about hospitals and the thick fluorescence of fear, all the nights you came back to us with rape buoyed in your eyes and your limbs shackled with premature passing, you asked nothing of us, unloaded nothing. (Source: JAMA)
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Bladder Cancer —Review
This narrative review summarizes recent advances in the diagnosis and management of bladder cancer, including updates on its epidemiology, pathophysiology, molecular biology, and developments in surgical procedures and targeted treatments. (Source: JAMA)
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Dried Blood Spots May Offer Route to Wider Antibody Testing
Dried blood spot testing could allow wider, population-level testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies, according to a study by British researchers. (Source: JAMA)
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Partnership to Make 120 Million COVID-19 Rapid Tests Available
A global partnership plans to make 120 million coronavirus disease 2019 (COVID-19) rapid antigen tests available in low- and middle-income countries, according to an announcement from the World Health Organization ’s (WHO) Access to COVID-19 Tools Accelerator. (Source: JAMA)
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

Global Mental Health Services Are Collapsing as Demand Grows
The coronavirus disease 2019 (COVID-19) pandemic has disrupted mental health, neurological, and substance abuse services in 93% of 130 countries surveyed by the World Health Organization (WHO). (Source: JAMA)
Source: JAMA - November 17, 2020 Category: General Medicine Source Type: research

A National Commitment to Improve the Care of Patients With Hypertension in the US
This Viewpoint from the US Surgeon General ’s office announces the 2020 release of the Surgeon General’s Call to Action to Control Hypertension and summarizes its key goals and recommendations aimed at making hypertension control a national public health priority and ensuring communities and patients have the resources to achieve it. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Pandemic-Driven Posttraumatic Growth for Organizations and Individuals
This Viewpoint discusses how disruptions from the coronavirus disease 2019 (COVID-19) pandemic can set the stage for beneficial personal and organizational change, and proposes steps that can be taken to catalyze the posttraumatic growth process. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Confronting State Medicaid Drug Spending Pressures
In the context of declining state Medicaid revenues and rising enrollment related due to coronavirus disease 2019, this Viewpoint proposes policy and payment reforms related to mandated drug coverage and manufacturer rebates that could assist states financially while maintaining patient access to life-saving medications. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Sensible Medicine —Balancing Intervention and Inaction During the COVID-19 Pandemic
This Viewpoint discusses the tensions between rapid adoption of interventions for coronavirus disease 2019 (COVID-19) before adequate evidence justifies their use and therapeutic nihilism, and argues for sensible medicine between the 2, which favors usual care, disfavors unnecessary interventions, but embraces rapid scientific evaluation with clinical translation of options proven effective. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Could Frequent Testing Help Squelch COVID-19?
This Medical News feature examines the debate about the value of frequent testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

COVID-19 Antibody Tests Perform Well in Head-to-Head Comparison
Four widely used severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody tests had high sensitivity and specificity in what scientists said was the first large head-to-head comparison of commercial immunoassays developed during the coronavirus disease 2019 (COVID-19) pandemic. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Investigational KRAS Inhibitor Tested for Advanced Solid Tumors
No dose-limiting toxic effects or treatment-related deaths occurred with sotorasib, an experimental drug that targets the cancer-causing KRAS p.G12C genetic variant, in a phase 1 trial involving patients with heavily treated advanced solid tumors. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Tinnitus Symptoms Improve With Sound and Tongue Stimulation
A noninvasive device that delivers sound to the ears and electrical stimulation to the tongue improved tinnitus symptoms in a trial reported in Science Translational Medicine. No drugs or devices are approved for tinnitus, which affects 10% to 15% of people. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Randomized Trials of e-Cigarettes for Smoking Cessation
Few topics in public health and medicine are as contentious as electronic cigarettes (e-cigarettes), a diverse and rapidly evolving array of products that appeared on the consumer market a decade ago. e-Cigarettes are battery-powered devices that heat a solution, typically containing nicotine and other chemicals including flavorings, to produce an aerosol that users inhale or “vape.” e-Cigarettes do not burn tobacco to generate smoke, and it is the many chemicals in tobacco smoke—not the nicotine—that are responsible for the global burden of tobacco-related disease that accounts for an estimated 6 m...
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Preprints Involving Medical Research —Do the Benefits Outweigh the Challenges?
A preprint is a complete manuscript posted to a preprint server by authors before peer review and publication in a journal. The goals of preprints are to enable authors to obtain timely feedback and comments on research before submission to a peer-reviewed journal, to claim provenance of an idea, and to facilitate and expedite dissemination of and access to research. Preprints can be amended or updated, commented on by others, and remain on the preprint server even if subsequently published in a journal. They can be cited and indexed and increasingly are given attention in the news and social media. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

The US Preventive Task Force Recommendation on Screening for Blood Pressure in Children
In this issue of JAMA the US Preventive Services Task Force (USPSTF) updates its 2013 report on screening of blood pressure in children and adolescents with a new recommendation statement and updated evidence report and systematic review. After reviewing publications since the earlier report, the USPSTF again concludes that, while there is evidence of tracking of blood pressure between childhood and adulthood and some evidence of a relation to subclinical cardiovascular disease, overall there was insufficient evidence to make a recommndation for or against screening for high blood pressure in children and adolescents (I st...
Source: JAMA - November 10, 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 10, 2020 Category: General Medicine Source Type: research

The Great Coronavirus Pandemic of 2020 —7 Critical Lessons
The world is experiencing a once-in-a-lifetime pandemic, causing untold human suffering and death, unraveling of social relationships, and robbing individuals of livelihoods and countries of prosperity. The coronavirus pandemic has strained health systems, revealed unconscionable inequalities, and upended international institutions. Here are 7 critical lessons. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Nice Baby
The April 1970 issue of Population Bulletin, a publication of Population Reference Bureau, Inc., is devoted to “Whose Baby is the Population Problem?”—an extraordinarily perceptive essay by Rufus E. Miles, Jr. He notes that although demographers disagree about whether the US population is growing at an alarming rate, and although there is no problem in Malthusian terms of domestic food supply, there ar e other reasons for concern. For example, further growth in US population inevitably will lead to additional crowding of our cities. In spite of the fact that they might prefer it otherwise, people will hav...
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Preprint Servers ’ Policies, Submission Requirements, and Transparency in Reporting and Research Integrity Recommendations
This study describes the policies, submission requirements, and transparency in reporting and research integrity recommendations of academic preprint servers. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Submissions and Downloads of Preprints in the First Year of medRxiv
This study describes submissions, postings, abstract views, downloads, comments, and withdrawals on the medRxiv preprint server from June 2019 to June 2020 and compares submissions and postings before and after COVID-19. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Noninvasive Oxygenation Strategies for Acute Hypoxemic Respiratory Failure
This study could support wider use of noninvasive ventilation during the current coronavirus disease 2019 pandemic, especially if the availability of ventilators is limited. However, some issues should be discussed further to better interpret the results of the study. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

New Statin Use and Mortality in Older Veterans
To the Editor The study on the association of new statin use with all-cause and cardiovascular mortality in older veterans found a reduction in all-cause mortality that was significantly larger than the reduction in cardiovascular mortality with statin use. In studies of primary prevention using statins in largely younger populations and in meta-analyses of participants older than 75 years in randomized trials, an effect on noncardiovascular mortality has not been demonstrated. It is also surprising that the risk of mortality decreased during follow-up, with the greatest effect seen in the initial 2 years, when randomized ...
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

New Statin Use and Mortality in Older Veterans
To the Editor Dr Orkaby and colleagues reported an association between receiving a new statin prescription among veterans 75 years and older and all-cause and cardiovascular mortality. However, several aspects of their results are concerning. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

New Statin Use and Mortality in Older Veterans
To the Editor The article by Dr Orkaby and colleagues reported a significantly lower risk of all-cause mortality associated with statin use among US veterans at least 75 years old who were free of atherosclerotic cardiovascular disease at baseline. Although formal sensitivity analyses were not performed to estimate potential bias due to unmeasured baseline characteristics, propensity scores were used to achieve balance in measured baseline characteristics. Furthermore, their use of a new-user design addressed the concern for prevalent-user bias. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Noninvasive Oxygenation Strategies for Acute Hypoxemic Respiratory Failure —Reply
In Reply We agree with Dr Antonucci and colleagues that endotracheal intubation, the secondary outcome in our network meta-analysis of noninvasive oxygenation strategies for acute hypoxemic respiratory failure, may not be an appropriate outcome for patients who do not wish to receive invasive mechanical ventilation. As an end point, endotracheal intubation is also vulnerable to manipulation in trials in which blinding of treatment allocation is not possible. This was the main rationale for choosing mortality as the primary end point in our review. Of note, most of the studies included in our network meta-analysis did not i...
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

New Statin Use and Mortality in Older Veterans —Reply
In Reply Dr Whittle and Ms Digitale and Dr Newman raise concerns about the plausibility of our findings indicating a lower risk of all-cause and cardiovascular mortality in older veterans who newly used statins, which has not been clearly demonstrated previously. Randomized trials have been conducted mostly in patients younger than 75 years. Until randomized clinical trials are completed in older adults, the magnitude of statin benefits or harms in this population will not be known. Our study was based on observational data, and therefore we cannot exclude unmeasured or residual confounding and other types of biases as par...
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Effect of Vitamin D, Omega-3 Fatty Acids, or Strength Training on Clinical Outcomes in Older Adults
This randomized trial compares the effects of vitamin D, omega-3s, and a strength-training exercise program alone or in combination vs no supplementation and control exercise on changes in blood pressure, physical and cognitive function, nonvertebral fractures, and infections over 3 years among older adults. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Effect of e-Cigarettes Plus Counseling vs Counseling Alone on Smoking Cessation
This randomized trial compares the effect of using e-cigarettes with individual counseling vs individual counseling alone for smoking cessation on point prevalence abstinence at 12 weeks. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research

Skilled Nursing Facilities and a Bundled Payment Model for Joint Replacement Surgery
This study compares mean levels of institutional spending for Medicare beneficiaries after lower extremity joint replacement at skilled nursing facilities (SNFs) participating vs not participating in Medicare ’s bundled payment program, before vs after implementation of the program. (Source: JAMA)
Source: JAMA - November 10, 2020 Category: General Medicine Source Type: research