e-Cigarette Hoodies and Backpacks Prompt FDA Warnings
Ten companies have received FDA warnings to stop manufacturing or selling products such as backpacks and hoodies that are designed to hold or hide electronic cigarettes. (Source: JAMA)
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research

Hemodialysis Device for Very Small Pediatric Patients
A new device that provides continuous hemodialysis or hemofiltration therapy to critically ill pediatric patients has received FDA marketing authorization. (Source: JAMA)
Source: JAMA - June 2, 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 2, 2020 Category: General Medicine Source Type: research

Fact and Opinion on the Present Epidemic
The recent meeting of the American Public Health Association in Chicago was devoted largely to the present epidemic of influenza. An abstract of the proceedings of the sessions devoted to this subject appears in this issue of The Journal. This abstract is not, of course, a verbatim report of the proceedings, but represents that which seems of permanent value, eliminating a large mass of discussion that was argumentative rather than of the nature of scientific evidence. There are certain large phases of the subject on which much evidence was presented leading to what might be expressed as a consensus of opinion. It must be ...
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research

Surgery vs Endoscopy for Early Treatment of Chronic Pancreatitis
To the Editor In the ESCAPE randomized clinical trial, Dr Issa and colleagues concluded that early surgery compared with an endoscopy-first approach resulted in significantly less pain over 18 months among patients with chronic pancreatitis. We are concerned about the generalizability of the finding. (Source: JAMA)
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research

Vitamin C, Hydrocortisone, and Thiamine for Septic Shock
To the Editor The Vitamin C, Hydrocortisone, and Thiamine in Patients With Septic Shock (VITAMINS) trial found that vitamin C, hydrocortisone, and thiamine, compared with hydrocortisone alone, did not improve outcomes in patients with septic shock. (Source: JAMA)
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research

Surgery vs Endoscopy for Early Treatment of Chronic Pancreatitis —Reply
In Reply Dr Qian and colleagues are concerned about the generalizability of the ESCAPE trial and call for a standardized endoscopy strategy for better control of painful chronic pancreatitis. (Source: JAMA)
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research

Vitamin C, Hydrocortisone, and Thiamine for Septic Shock —In Reply
In Reply We agree with Dr Long and colleagues that the timing of interventions is important in the management of sepsis. They suggest that early administration of vitamin C is essential for the intervention to have beneficial effects, even though no data on the timing of intervention were reported in the study by Marik et al. In the VITAMINS trial, an elevated lactate level was required to meet the consensus definition of septic shock. During the study period, sepsis resuscitation in Australasian emergency departments for patients with suspected septic shock was administration of 27 mL/kg of intravenous fluids before start...
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research

Drugs for Depression
This Medical Letter provides a Table summarizing key information about drugs for depression published as part of a comprehensive review on the topic. (Source: JAMA)
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research

Association Between Thrombolytic Door-to-Needle Times and Ischemic Stroke Outcomes
This cohort study estimates associations between intravenous tissue plasminogen activator (tPA) door-to-needle times of less than 4.5 hours for acute ischemic stroke and 1-year mortality or readmission among Medicare beneficiaries aged 65 years or older. (Source: JAMA)
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research

Effect of a Patient-Centered Decision Support Tool on Rates of Trial of Labor After Previous Cesarean Delivery
This randomized clinical trial compares the effect of a patient-centered decision support tool vs usual care on rates of trial of labor among women with a previous cesarean delivery. (Source: JAMA)
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research

Effect of C-Reactive Protein –Guided or Fixed Antibiotic Duration on Clinical Failure in Patients With Gram-Negative Bacteremia
This randomized trial compares the effects of C-reactive protein (CRP) –guided antibiotic duration (discontinuation once CRP declined by 75% of peak value) vs fixed 7- vs 14-day durations on 30-day clinical failure rate among patients with gram-negative bacteremia. (Source: JAMA)
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research

Varicoceles
This JAMA Patient Page explains the anatomy, causes, possible effects on fertility, and treatment of varicoceles, varicose veins in the testicle. (Source: JAMA)
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research

I Remember Wells of Nausea Worse Than Pain
Trying to decide if we should get our son a phone — my belly button still popped out forever because of him— seems like all sixth graders get one by Christmas, but we were going to hold out until seventh at least, maybe when his voice begins to crack open his childhood like split wood, grinning. His dad says, Why buy him a ticket to misery? Eve ryone we know wants to shoot themselves— I remember the cool flavor and smell of the ceramic sink as I pressed my palms on it during a contraction. Always on, selfies, the endless texting and commenting and liking and congratulating. The porn and the paroxetine. Ho...
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research

Securing the Sails of Love in the Tempest
In this narrative medicine essay, a pediatrician confronts an impending neurofibromatosis type 1 diagnosis in her infant son and finds heroic parents of her patients who have profound medical challenges. (Source: JAMA)
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research

Nervous Breakdown-and-Across
This Arts and Medicine feature presents a neurology-themed crossword puzzle with clinical clues and other brain teasers. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

The Pass/Fail Decision for USMLE Step 1 —Next Steps
On February 12, 2020, the Federation of State Medical Boards and the National Board of Medical Examiners announced a change in score reporting of Step 1 of the United States Medical Licensing Examination (USMLE) from a 3-digit numerical score to pass/fail. As explained in the Viewpoint by Chaudhry et al, 3-digit numerical scoring is perceived to have had deleterious effects on student well-being and the medical education learning environment. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Deprescribing Antihypertensive Medications for Patients Aged 80 or Older
The treatment of hypertension in older adults is a major public health concern. Among the nearly 13 million persons in the United States aged 80 years or older, approximately 80% have high blood pressure (BP). Hypertension is the most potent modifiable risk factor for cardiovascular disease in older adults and has been strongly associated with stroke, myocardial infarction, heart failure, peripheral artery disease, kidney failure, and dementia. Thus, defining optimal strategies for managing elevated BP in older individuals is a high priority. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Nonparametric Statistical Analysis
This JAMA Guide to Statistics and Methods reviews common types of nonparametric statistics, which make no assumptions about underlying population distribution, and explains when they are appropriate to use. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Fish-Rich Mediterranean Diet Associated With Higher Cognition
Consuming a Mediterranean diet, particularly with lots of fish, was associated with higher cognitive function, National Eye Institute (NEI) researchers and colleagues reported recently. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Disposing of Controlled Substances After Home Hospice Deaths
Patients who die while receiving hospice care at home often leave behind unused controlled substances that aren ’t disposed of properly and could be diverted or misused, according to a recent US Government Accountability Office (GAO) report. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Traumatic Brain Injuries ’ Health Care Costs
Traumatic brain injury (TBI) was diagnosed in more than 1 million US inpatient stays and emergency department (ED) visits in 2017, a recent Agency for Healthcare Research and Quality (AHRQ) report estimated. (Source: JAMA)
Source: JAMA - May 26, 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 - May 26, 2020 Category: General Medicine Source Type: research

Emerging Lessons From COVID-19 Response in New York City
In a little more than 1 month, US society and its hospitals were transformed by coronavirus disease 2019 (COVID-19). The once-boisterous streets of New York City became quiet, while the hospital wards reverberated with the swooshes and beeps usually heard in intensive care units (ICUs). COVID-19 echoed that duality. There are so many outside the hospital who were silently infected, while so many fought for their lives in the hospital, struggling just to breathe. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Pellagra
The etiology of pellagra has attracted the consideration of a number of investigators who have been able to study it on an unusually large scale and with exceptional facilities. In this country the zeist theory, which related pellagra in some way to the dietary use of maize and maize products, has been finally abandoned. An exclusive diet of corn is unquestionably inadequate; and corn damaged by microbiotic changes may well be harmful at times to persons ingesting it. But no adequate review of the actual incidence of pellagra, as it has occurred in different places and among different peoples, will any longer justify the a...
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Prevalence, Types, and Sources of Bullying Reported by US General Surgery Residents in 2019
This survey study describes surgical trainees ’ self-reported experiences of bullying and symptoms of burnout and suicidality assessed at the time of their board certification examination. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Genital Powder Use and Ovarian Cancer
To the Editor Dr O ’Brien and colleagues combined data on powder use in the genital area and ovarian cancer from 4 cohort studies and reported an overall hazard ratio (HR) of 1.08 (95% CI, 0.99-1.17). Except for data from the Nurses’ Health Study II and additional follow-up, little new information was presented. P reviously, combined data from 3 of the cohorts showed an odds ratio (OR) for perineal powder use and ovarian cancer of 1.06 (95% CI, 0.90-1.25). In the latter study, the cohort data did not outweigh the evidence from 24 case-control studies, with a combined OR of 1.31 (95% CI, 1.24-1.39). (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Genital Powder Use and Ovarian Cancer
To the Editor We disagree with the analysis and interpretation of the findings presented by Dr O ’Brien and colleagues. The increased risk of ovarian cancer in women with intact genital tracts exposed to powder (HR, 1.13) is actually greater than the estimated 10% increased incidence of ovarian cancer attributable to cumulative talc exposure with 10 000 or more applications previously repor ted in women with intact genital tracts. The lack of association in women without an intact genital tract is consistent with their curtailed exposure. O’Brien and colleagues discounted the results because their statistical...
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Ondansetron Use in Pregnancy and Congenital Malformations
To the Editor Dr Huybrechts and colleagues conducted a population-based cohort study of intravenous ondansetron use during pregnancy and congenital malformations and found no association. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Genital Powder Use and Ovarian Cancer —Reply
In Reply As pointed out by Dr Cramer, the cohorts in our pooled analysis assessed powder use with less detail compared with prior case-control studies. He is also correct that most participants were postmenopausal at enrollment, although ever use included premenopausal time and we considered menopausal status and hormone use as effect modifiers. We noted that genital powder exposure was likely misclassified for some individuals, especially with regard to frequency and duration, and we did not have data on changes in use over time, use during specific exposure windows, or use of different types of powder. This lack of detai...
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Ondansetron Use in Pregnancy and Congenital Malformations —Reply
We reported an adjusted relative risk (RR) of oral clefts of 0.95 (95% CI, 0.63-1.43) for intravenous ondansetron and 1.24 (95% CI, 1.03-1.48) for oral ondansetron in an earlier publication. Although the point estimate is lower for intravenous ondansetron compared with oral ondansetron, the 95% CI was wide, with an upper limit similar to that for oral ondansetron. Although the increase in risk was statistically significant for oral ondansetron and was not for intravenous ondansetron, interpretation of risk estimates from epidemiological studies should focus on the magnitude of the observed increase in risk and the precisio...
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

No Benefit for Lopinavir –Ritonavir in Severe COVID-19
Treatment with the HIV combination drug lopinavir-ritonavir did not accelerate recovery or improve mortality rates among hospitalized patients with severe coronavirus disease 2019 (COVID-19), a trial in the New England Journal of Medicine reported. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Daily Aspirin Not Neuroprotective in ASPREE Trial
Daily low-dose aspirin does not reduce the risk of dementia, mild cognitive impairment (MCI), or cognitive decline, according to a secondary analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial, published in Neurology. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Integrated Care Cut Mortality in Patients With Atrial Fibrillation
An integrated-care intervention conducted in primary care practices reduced all-cause mortality among elderly patients with atrial fibrillation (AF), a noninferiority trial in the European Heart Journal demonstrated. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Gabapentin Treats Alcohol Use Disorder With Withdrawal Symptoms
Gabapentin prevented heavy drinking and promoted alcohol abstinence among patients with alcohol use disorder (AUD) and a history of alcohol withdrawal symptoms in a trial in JAMA Internal Medicine. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Psoriasis Drug Guselkumab Improved Psoriatic Arthritis Symptoms
Guselkumab, a biologic drug approved to treat patients with moderate or severe psoriasis, significantly and safely improved psoriatic arthritis, a phase 3 trial in The Lancet concluded. Guselkumab is a human monoclonal antibody that inhibits interleukin-23. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Antihypertensive Medication Reduction vs Usual Care in Short-term Blood Pressure Control
This randomized clinical trial compares the effects of antihypertensive medication withdrawal vs usual care on systolic blood pressure (SBP) among adults ≥80 years with SBP
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Effect of Doxycycline on Aneurysm Growth of Small Infrarenal Abdominal Aortic Aneurysms
This randomized trial compares the effect of doxycycline with placebo on reducing CT-measured abdominal aortic aneurysms over 2 years among patients with small infrarenal abdominal aortic aneurysms. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Interventions to Prevent Illicit Drug Use in Children, Adolescents, and Young Adults
This JAMA Patient Page summarizes the 2020 US Preventive Services Task Force recommendation concluding that evidence is insufficient to assess the balance of benefits and harms of primary care –based behavioral counseling interventions to prevent illicit drug use in children, adolescents, and young adults. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Blue Madonna
Mother is less noun than predicate in the daily liturgy of care for a second body, childhood ’s parade of sensation as in tickle here come the monkeys, now elephants, the clown of a graham cracker bobbing in its dunk-tank of milk, trapeze act of noodles sidling down the tines. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

USPSTF Report: Interventions to Prevent Drug Use in Children, Adolescents, and Young Adults
This systematic review to support the 2020 US Preventive Services Task Force Recommendation Statement on interventions to prevent illicit and nonmedical drug use summarizes published evidence on the benefits and harms of primary care –based interventions to prevent illicit and nonmedical drug use in children, adolescents, and young adults. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

USPSTF Recommendation: Interventions to Prevent Illicit Drug Use in Children and Young Adults
This 2020 Recommendation Statement from the US Preventive Services Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care –based behavioral counseling interventions to prevent illicit drug use, including nonmedical use of prescription drugs, in children, adolescents, and young adults (I statement). (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Hybrid Influenza Strain Found in Idaho Teenager
A 13-year-old Idaho boy was treated in February 2019 for a hybrid influenza strain that contained genetic components of both seasonal influenza and 2009 influenza A(H1N1), according to a CDC report. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Nonfatal, Fatal Overdoses Rising
Nonfatal drug overdoses treated in US emergency departments have increased for every type of drug except benzodiazepines, the CDC has reported. (Source: JAMA)
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research

Antenatal Corticosteroids
Antenatal corticosteroids, when administered to a pregnant woman before delivery of a very premature infant, accelerate fetal lung maturation and prevent neonatal mortality, respiratory distress syndrome, and brain injury. Even though the first trial to demonstrate benefits of antenatal corticosteroid exposure was published in 1972, widespread use of this therapy did not occur until 20 years later. The first systematic review of antenatal corticosteroid therapy was so influential in the obstetric and neonatal care communities that a forest plot from this study is depicted in the logo for the Cochrane Database of Systematic...
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

Therapy Approved for Hard-to-Treat Upper Tract Urothelial Cancer
The first treatment for low-grade upper tract urothelial cancer (UTUC) has received FDA approval. (Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

A New Treatment for Children With Neurofibromatosis Type 1
Selumetinib is the first drug approved for pediatric patients aged 2 years or older with neurofibromatosis type 1 (NF1), a rare disfiguring disease. (Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

Generic Albuterol Inhaler Approved
The FDA has approved the first generic version of Proventil HFA Metered Dose Inhaler, 90 μg per inhalation, to treat or prevent bronchospasm in patients aged 4 years or older who have reversible obstructive airway disease. The generic albuterol sulfate inhaler also is indicated for exercise-induced bronchospasm prevention in the same age group. (Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research