JAMA

JAMA

US Narrowly Preserves Measles Elimination Status

26-11-2019 – Kuehn B.

Journal Article

The official end of New York State’s measles outbreak allowed the United States to narrowly retain its measles elimination status, according to the US Department of Health and Human Services (HHS). Four other countries have already lost their measles elimination status in the past year, including the United Kingdom and Brazil.

Recommended Vaccines Underused During Pregnancy

26-11-2019 – Kuehn B.

Journal Article

Most US mothers-to-be (65%) have not been vaccinated for both influenza and pertussis, according to a CDC report.

JAMA

26-11-2019 –

Life Expectancy and Mortality Rates in the United States, 1959-2017

26-11-2019 – Woolf SH, Schoomaker H.

Journal Article, Research Support, N.I.H., Extramural

This population epidemiology study uses data from the National Center for Health Statistics and the US Mortality Database to assess changes and state-level trends in US life expectancy and mortality rates from 1959 to 2017, and to identify potential contributing factors.

Two Rooms: Reflections on Empathy, Openness, and Parenthood

26-11-2019 – Waldman E.

Journal Article

In this narrative medicine essay a pediatric palliative care physician reflects on the contrast between his healthy children and the dying patients he cares for and expresses his struggle to bridge the gap between being fully present for his patients’ families through their grieving and the deep gratitude he feels that his family is healthy and not forced to confront the same loss and grief.

It Will Be Good for Us

26-11-2019 – Okonkwo JT.

Would it be wrong for us to take this moment out to dance. For us to let fall the iron that sits on our chins that binds our eyes and our arms in solemn diligence. It would only be a moment. We would unleash the blistering frenzy that pushes us and tap out a medley under the canopy of the weight of the world.

What Is Norovirus?

26-11-2019 – Desai AN.

Patient Education Handout

This JAMA Patient Page describes the symptoms, diagnosis, treatment, and prevention of norovirus.

Intense Exercise Improved Motor Function in Parkinson Disease

26-11-2019 – Slomski A.

Journal Article

Patients with mild Parkinson disease who exercised strenuously at home improved their motor scores and showed good adherence to a minimally supervised exercise program, reported a trial in Lancet Neurology.

Polypill More Effective Than Usual Care for Reducing Cardiovascular Risks

26-11-2019 – Slomski A.

Journal Article

Taking a low-cost polypill to prevent cardiovascular disease significantly reduced systolic blood pressure and low-density lipoprotein (LDL) cholesterol among patients at high risk for cardiovascular disease (CVD), a New England Journal of Medicine trial found.

Gaming Intervention Increased Physical Activity in Overweight Adults

26-11-2019 – Slomski A.

Journal Article

Of gaming interventions with social incentives, one incorporating competition most effectively increased physical activity among overweight and obese adults, according to a trial in JAMA Internal Medicine.

Low Back Pain Guideline Didn’t Improve Outcomes

26-11-2019 – Slomski A.

Journal Article

Primary care physicians trained to treat low back pain based on guideline recommendations gained greater confidence and knowledge, but the training didn’t improve patient outcomes, reported a trial in PLOS Medicine.

H pylori Treatment May Reduce Gastric Cancer Risk

26-11-2019 – Slomski A.

Journal Article

Short-term treatment for Helicobacter pylori infection and vitamin or garlic supplementation may afford long-term protection against gastric cancer among people at high risk, according to a BMJ follow-up study.

Use of an ICU Diary and Patient Posttraumatic Stress Disorder Symptoms—Reply

26-11-2019 – Garrouste-Orgeas M, Bailly S, Timsit J.

Letter, Comment

In Reply The widespread use of ICU diaries has occurred without a high standard of proof. Our study showed that 30% of patients developed PTSD symptoms 3 months after ICU discharge. Given this prevalence, it is important to identify efficient interventions. Our study was the first multicenter and assessor-blinded study in this field, to our knowledge.

Professionalism and the Review of Systems—Reply

26-11-2019 – Hendrickson MA, Melton GB, Pitt MB.

Letter, Comment

In Reply We agree with Dr Taitsman that precompleted checklist defaults embedded within the EHR can be a setup for unintentional inaccuracy or even fraud. However, we would not want a focus on improving the means of accurately capturing compliance with existing Centers for Medicare & Medicaid Services (CMS) requirements to detract from our central point that current CMS requirements in and of themselves provide conflicting and problematic incentives.

Use of an ICU Diary and Patient Posttraumatic Stress Disorder Symptoms

26-11-2019 – Kredentser M, Olafson K, Sareen J.

Letter, Comment

To the Editor The randomized clinical trial by Dr Garrouste-Orgeas and colleagues examined the effect of intensive care unit (ICU) diaries on posttraumatic stress disorder (PTSD) symptoms in ICU survivors. This large trial found no significant differences in PTSD symptoms between the ICU diary group and a control group. This finding is surprising, given the promising evidence and widespread use of diaries in reducing PTSD, anxiety, and depression, as well as being acceptable to patients and families.

Professionalism and the Review of Systems

26-11-2019 – Taitsman JK.

Letter, Comment

To the Editor The Viewpoint by Dr Hendrickson and colleagues on review of systems (ROS) and electronic health record (EHR) systems suggested reimbursement incentives might encourage clinicians to complete, or falsely claim to have completed, a full ROS, even when not clinically useful. The authors noted that EHR systems can facilitate false documentation when “a generic phrase asserting that the ROS was conducted is automatically included in physician note templates” or “a single mouse click in a series of required clicks records its completion,” and that “a prepopulated attestation statement endorsing that a 10-point ROS was completed may have the unintended effect of introducing dishonesty….” I share this concern and propose that physicians demand greater control of EHR functionalities and eschew functionalities that set them up to fail.

Object-Related Aspiration Deaths in Children and Adolescents in the United States, 1968 to 2017

26-11-2019 – Cramer JD, Meraj T, Lavin JM, et al.

Journal Article

This study uses National Vital Statistics System data to characterize trends in deaths among children and adolescents aged 0 to 17 years caused by object-related aspiration.

Change in Prevalence of Disabilities and Accommodation Practices Among US Medical Schools, 2016 vs 2019

26-11-2019 – Meeks LM, Case B, Herzer K, et al.

Journal Article

This survey study assesses the prevalence of students with disabilities and types of accomodation provided at US allopathic medical schools in 2019, and compares the numbers with those of a 2016 survey to characterize 3-year changes.

An English Experiment in Social Medicine

26-11-2019 –

Journal Article, Classical Article

In England, the medical profession and the public are apparently in a state of readjustment. Social insurance in the four years preceding the war, the needs and emergencies of war times, and the discussion of the last year culminating in the creation of a national health ministry, all have combined to arouse and concentrate interest and discussion on the improvement of medical services. An experiment now being carried on in Glasgow is, therefore, of special interest. Dr. David Mc
Kail, lecturer on public health at St. Mungos College, and Mr. William Jones, clerk and treasurer of the Glasgow Insurance Committee, have worked out a plan for a public medical service as a substitute for the social insurance scheme now in operation. Beginning with a criticism of social insurance, which they condemn for failure to provide any form of institutional treatment and for furnishing medical services to only about one third of the total population, they propose to build up a complete medical service, furnishing unrestricted treatment to every citizen needing it, and involving the enrolment of the medical profession and the public control of all general hospitals and infirmaries.

Highlights for November 26, 2019

26-11-2019 –

HHS Guide for Tapering or Stopping Long-term Opioid Use

26-11-2019 – Rubin R.

Journal Article

Physicians should not taper or discontinue patients’ long-term opioid pain medicine use without discussing it with them, emphasizes a new guide from the US Department of Health and Human Services (HHS).

New NIH Strategic Research Plan Focuses on Tickborne Diseases

26-11-2019 – Rubin R.

Journal Article

A recently announced National Institutes of Health (NIH) 5-year strategic plan aims to accelerate research initiatives leading to better prevention, diagnosis, and treatment of tick-borne diseases.

Proposed Rule for Lowering Lead Levels in Drinking Water

26-11-2019 – Rubin R.

Journal Article

The US Environmental Protection Agency (EPA) recently announced a proposed rule designed to reduce lead in drinking water.

Confronting the Rise and Fall of US Life Expectancy

26-11-2019 – Koh HK, Parekh AK, Park JJ.

Editorial, Comment

For decades US life expectancy at birth increased. Many clinicians and demographers assumed it would always be that way. However, an exhaustive, detailed long-term analysis by Woolf and Schoomaker in this issue of JAMA strengthens reports from the National Center for Health Statistics (NCHS) documenting recent declines in US life expectancy. Combined, the studies confirm that downward trends in life expectancy, which declined after 2014 for 3 successive years, represent a US health disadvantage compared with peer high-income nations, despite the United States having the highest per capita health care spending in the world.

Incorrect Terminology in Table 2

26-11-2019 –

Journal Article, Published Erratum

In the Special Communication entitled “Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies: The PRISMA-DTA Statement” published in the January 23/30, 2018, issue of JAMA, incorrect terminology appeared in Table 2. In Table 2, in the ninth row up from the bottom of the table, “Results of individual studiesb,” “receiver operating characteristic curve” should have been “receiver operating characteristic plot.” This article was corrected online.

Study Identifies Primary Care Knowledge Gaps and Barriers in Type 2 Diabetes Prevention

26-11-2019 – Voelker R.

Journal Article

This Medical News article discusses knowledge deficiencies and health system barriers that keep some primary care physicians from caring adequately for patients with prediabetes.

The Search for a Universal Flu Vaccine Heats Up

26-11-2019 – Abbasi J.

Journal Article

This Medical News article discusses the urgent need for a more broadly protective, durable influenza vaccine—and advancements toward it.

Vaping—Seeking Clarity in a Time of Uncertainty

26-11-2019 – Baldassarri SR, Fiellin DA, Friedman AS.

Journal Article

This Viewpoint attempts to provide public health context to the 2019 emergence of e-cigarette, or vaping, product use–associated lung injury (EVALI), emphasizing that EVALI is likely caused by vaping exposure to THC-containing products and is a public health risk far less than that of smoking combustible tobacco, and suggesting ways physicians might use awareness of the phenomenon to counsel patients about the risks of smoking electronic and traditional cigarettes.

Baclofen Use in CKD and Risk of Encephalopathy

26-11-2019 – Muanda FT, Weir MA, Bathini L, et al.

Journal Article

This pharmacoepidemiology study uses Canadian health care database data to estimate the risk of encephalopathy among patients with chronic kidney disease (CKD) in Ontario prescribed higher (≥20 mg) vs lower (<20 mg) doses of baclofen.

Levothyroxine Treatment and Thyroid-Related Symptoms in Older Adults With Subclinical Hypothyroidism

26-11-2019 – Mooijaart SP, Du Puy RS, Stott DJ, et al.

Journal Article

This cohort study combines data from 2 randomized trials to estimate associations between use of levothyroxine to manage subclinical hypothyroidism and hypothyroid symptoms and fatigue at 1 year among community-dwelling adults aged 80 years and older.

The Thyrotropin Reference Range Should Be Changed in Older Patients

26-11-2019 – Cappola AR.

Journal Article

In endocrinology and many other disciplines, laboratory test results discriminate between patients who require treatment and those who do not. The reference range provided with the laboratory test result should align with the threshold for additional clinical action. When the reference range denoting a normal result is not aligned with the reference range needed for optimal health, confusion arises. Patients interpret the reference range as a normal range and question why abnormal test results are being ignored. Clinicians looking for an explanation for a patient’s symptoms may incorrectly focus on a result outside of the reference range. Accurate laboratory reference ranges are essential for good clinical care.

Colorado End-of-Life Options Act—A Clash of Organizational and Individual Conscience

26-11-2019 – Wynia M.

Journal Article

This Viewpoint discusses the pending case of Mahoney Morris v Centura Health, in which a physician employed by a Catholic-affiliated health system in Colorado sued to be able to provide medical aid-in-dying (MAID) to a patient with end-stage cancer under the 2016 Colorado End-of-Life Options Act, which permits health care professionals to write and fill life-ending prescriptions without regard to their employer’s position on the law.

Protecting the Sanctity of the Patient-Physician Relationship

26-11-2019 – Harman S, Verghese A.

Journal Article

In this issue of JAMA, Wynia describes a patient in Colorado with terminal cancer for whom a physician agreed to prescribe aid-in-dying medications in accordance with new state legal guidelines. However, the health care organization that employed the physician objected to her actions, even though by doing so it was violating state law. The patient and physician filed suit against her employer. Chillingly, in a move that should alarm physicians long concerned about erosion of their autonomy, the physician’s dismissal letter chided her for violating the ethical directives of Catholic health care services, which view assisted suicide as “intrinsically immoral” and state that “Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.”

Bisphosphonates for Postmenopausal Osteoporosis

26-11-2019 – Ensrud KE, Crandall CJ.

Journal Article

This JAMA Women’s Health summarizes evidence-based use of bisphosphonates for fracture prevention in women with postmenopausal osteoporosis, and reviews potential harms of the drugs and alternative agents (denosumab, raloxifene) for patients with contraindications or intolerance to alendronate, risedronate, or zoledronate.

Effect of Fibrinogen Concentrate vs Cryoprecipitate on Transfusion Volume After Cardiac Surgery

26-11-2019 – Callum J, Farkouh ME, Scales DC, et al.

Journal Article

This noninferiority trial compares the effects of fibrinogen concentrate vs cryoprecipitate on the number of red blood cell (RBC), platelet, and plasma units transfused 24 hours after cardiopulmonary bypass in adult patients with clinically significant bleeding and hypofibrinogenemia after cardiac surgery.

Should Fibrinogen Concentrate Replace Cryoprecipitate in Cardiac Surgery?

26-11-2019 – Hess AS, Hess JR, Coursin DB.

Journal Article

Excessive bleeding presents a critical medical challenge. Many of the problems encountered at the bedside, such as inadequate measures of coagulation, challenges in delivering blood components, uncertain role of prothrombotic drugs or antifibrinolytics, dilutional coagulopathy, varied clinical settings, and patient comorbidities, have occupied a great deal of recent research effort and still have only imperfect solutions. Fibrinogen is an essential component of hemostasis: it is cleaved by thrombin into fibrin, which polymerizes into factor XIII–crosslinked fibers that have important functions in adhesion, platelet aggregation, and inflammation. A low fibrinogen level is an ominous finding in patients with bleeding, but it has been difficult to prove the utility of direct fibrinogen replacement. More than 20 small trials have suggested that using fibrinogen concentrate reduces bleeding and transfusions in various clinical situations, but any general conclusions are limited by the study sizes, quality, and heterogeneity in methods.