JAMA

JAMA

Improving Nutrition to Save Lives

15-10-2019 – Kuehn B.

Greater investment in ensuring access to good nutrition could save 3.7 million lives by 2025, according to a World Health Organization (WHO) report.

Malaria Eradication Is Within Reach

15-10-2019 – Kuehn B.

Malaria eradication is a “bold but attainable goal” that could be achieved by 2050, according to a report from 41 of the world’s leading malaria researchers.

Early Success in Ebola Trial

15-10-2019 – Kuehn B.

Two Ebola virus disease therapies, REGN-EB3 and m
Ab114, were so effective in a clinical trial that the trial was stopped, according to the National Institute of Allergy and Infectious Diseases (NIAID), which cosponsored the trial.

Improving Value in Health Care Through Comprehensive Supply Optimization

15-10-2019 – Thiel C, Horwitz LI.

This Viewpoint characterizes the costs of medical supply acquisition and waste as an underrecognized contributor to health care expenditures and proposes policy and practice reforms, such as standardizing reuse of some supplies and extending expiration dates on others that could optimize supply availability and generate savings without adverse effects on patients.

JAMA

15-10-2019 –

When You Can’t Find a Heartbeat

15-10-2019 – Buelow BJ, Buelow MW.

In this narrative medicine essay, a married pair of pediatricians share the story of the loss of their first pregnancy, the compassionate care they received, the challenges those around them faced in offering consolation, and, ultimately, the successful pregnancies that brought children to their family.

Unarranged

15-10-2019 – Pretti S.

I chose pink, a cluster of carnations lifted from their bin and carried home.

Candida auris Infection

15-10-2019 – Bradley SF.

This JAMA Patient Page describes causes, control, and prevention of infection with the yeast Candida auris.

Effect of a Nutritional and Behavioral Intervention on Energy-Reduced Mediterranean Diet Adherence

15-10-2019 – Sayón-Orea C, Razquin C, Bulló M, et al.

This preliminary exploratory analysis of the ongoing PREDIMED-Plus randomized trial reports dietary adherence among Spanish community-dwelling participants with metabolic syndrome randomized to an energy-reduced Mediterranean diet, physical activity, and behavioral support vs an energy-unrestricted Mediterranean diet alone.

Challenges of Dual-Physician Couples—Reply

15-10-2019 – Ferrante L, Mody L.

In Reply Our Viewpoint on dual-physician households was intended to serve as a resource for early-career dual-physician couples across the spectrum of gender, sexual orientation, and marital status. Throughout our careers, we, as professional women, have sought advice from more senior professional women on similar career paths in the same way that dual-physician couples have sought advice from other dual-physician couples for decades. As stated in our Viewpoint, we recognize that many of the challenges and strategies we discussed apply to other professional households. Nevertheless, the medical profession does present several unique challenges and experiences (just as other professions have their own), and providing early-career physicians with resources can only help with recruitment and retention of a talented workforce and help them to be more productive.

Reasons for Increases in Complications of Diabetes—Reply

15-10-2019 – Gregg EW, Hora I, Benoit S.

In Reply We agree with Dr Buse’s potential explanation of our findings that the changing characteristics of the underlying population could be a key factor, particularly affected by a shift in the duration of disease. Data from the US National Diabetes Surveillance System indicate that the median duration of disease increased by 2 years between 2010 and 2016 (from a median of 7.4 years to 9.4 years). The shifting distribution of duration of disease may also have multiple causes.

Development Assistance for Health in Low-Income Countries—Reply

15-10-2019 – Dieleman JL, Micah AE.

In Reply Ongoing development of robust, sustainable, and equitable health systems will require investment of domestic resources, particularly government resources. Nonetheless, recent forecasts of gross domestic product, government spending, and government health spending suggest that for the poorest countries in the world, funding the health system exclusively with domestic resources may remain challenging. While development assistance is one avenue to generate more resources for health, Mr Jumbam and colleagues are right to point out that there is evidence that DAH has in the past systematically depressed domestic government spending on health, and this substitution should remain a concern to those hoping to catalyze health gains.

Challenges of Dual-Physician Couples

15-10-2019 – Henderson CE, Roxland BE, Webb RJ.

To the Editor We agree with Drs Ferrante and Mody that dual-physician households face professional and personal challenges. However, we are chagrined by their view that dual-physician couples are unique or in greater need of “21st-century strategies” for dealing with life challenges than other professional women. All working women, whether single, married, or in a committed relationship, and whether they do or do not have children, confront the difficulties of achieving economic stability and work-life balance. Dual-physician couples are not alone in struggling with student loan debt, weighing child-bearing decisions with professional advancement, or trying to fulfill personal and professional goals despite inadequate support or guidance.

Reasons for Increases in Complications of Diabetes

15-10-2019 – Buse JB.

To the Editor Dr Gregg and colleagues identified a resurgence in diabetes complications in the United States beginning in 2010 and analyzed potential underlying contributors and policy implications. However, there may be another underlying mediator of the effect that the authors did not consider.

Development Assistance for Health in Low-Income Countries

15-10-2019 – Jumbam DT, Vervoort D, Park KB.

To the Editor In a Viewpoint, Dr Dieleman and colleagues emphasized the need for increasing development assistance for health (DAH) to attain the United Nations Sustainable Development Goals. We agree that even with substantial increases in domestic funding, many low-income countries will not be able to attain their health financing needs.

Association of Maternal Gastric Bypass Surgery With Offspring Birth Defects

15-10-2019 – Neovius M, Pasternak B, Näslund I, et al.

This cohort study uses Swedish Medical Birth Register data to investigate risk of birth defects in infants born to women who had Roux-en-Y bariatric surgery between 2007 and 2014.

Current Comment

15-10-2019 –

Is Affording Undocumented Immigrants Health Coverage a Radical Proposal?

15-10-2019 – Gostin LO.

During the Democratic presidential debate on July 31, all 10 candidates raised their hands when asked if they would provide health insurance to undocumented immigrants. Among all Democratic ideas for health reform, this is least popular. A recent poll found that only 38% of respondents approve. The idea drew extensive criticism, which is understandable: Why should the United States provide health coverage for people who don’t have a legal right to be here? Extending coverage could be seen as rewarding individuals who have violated the law.

Highlights for October 15, 2019

15-10-2019 –

US Public’s Perspective on Prescription Drug Costs

15-10-2019 – Kirzinger A, Muñana C, Fehr R, et al.

Tether Device for Treating Pediatric Idiopathic Scoliosis

15-10-2019 – Sancar F.

The FDA recently approved the first spinal tether device for children and adolescents with idiopathic scoliosis—the most common form of this spinal deformity.

First Treatment for Lung Disease Related to Scleroderma

15-10-2019 – Sancar F.

Nintedanib has received an expanded indication to include interstitial lung disease (ILD) that’s associated with scleroderma—a rare autoimmune disorder that causes abnormal connective tissue growth throughout the body. Nintedanib is the first therapy approved for adults with this rare lung condition. It was approved in 2014 to treat idiopathic pulmonary fibrosis, another interstitial lung disease.

Device for Improving Heart Failure Symptoms

15-10-2019 – Sancar F.

An implantable neuromodulation device was approved for symptom improvement in patients with advanced heart failure who aren’t eligible for cardiac resynchronization therapy. Heart failure is the fourth leading cause of death attributable to cardiovascular disease, affecting 5.7 million people in the United States.

Dietary Adherence in a Clinical Trial of a Nutritional and Behavioral Intervention

15-10-2019 – Greenland P.

Nutrition is essential to life; as a minimum, it is necessary to eat enough to fuel basic energy needs. But eating is also pleasurable, and the popularity of diet books and food preparation television shows suggests that many people are fascinated, perhaps even preoccupied, with dietary choices and dietary indulgences. Food options are ubiquitous as well; even hardware stores and gasoline stations offer food options, and many other nonrestaurant or food markets offer food for purchase. Dietary advice is widely sought, and often new diet studies garner wide media attention. As an example, a 2019 article published in JAMA on the association of egg intake with incident cardiovascular disease and mortality had collected 13 citations, 42 000 views, and an Altmetric score higher than 3500 within 4 months of publication. With all of this attention, there is still great disagreement and controversy about what are the healthiest diet choices.

Waste in the US Health Care System

15-10-2019 – Shrank WH, Rogstad TL, Parekh N.

Journal Article

This Special Communication uses a systematic literature review to update previous dollar estimates of waste in the US health care system attributable to failure of care delivery and coordination, low-value care, price inflation, fraud, and administrative complexity.

Waste in the US Health Care System

15-10-2019 – Bauchner H, Fontanarosa PB.

Journal Article

In this issue of JAMA, Shrank and colleagues examine the critically important issue of waste in the US health care system. Their Special Communication represents an analytic update of 2 prominent previous analyses on waste in US health care, one by the Institute of Medicine in 2010 and the other by Berwick and Hackbarth in 2012.

Elusive Waste

15-10-2019 – Berwick DM.

Journal Article

In 1950, at lunch with 3 colleagues, the great physicist Enrico Fermi is alleged to have blurted out a question that became known as “the Fermi paradox.” He asked, “Where is everybody?” referring to calculations suggesting that extraterrestrial life forms are abundant in the universe, certainly abundant enough that many of them should have by then visited our solar system and Earth. But, apparently, none had.

Toward Evidence-Based Policy Making to Reduce Wasteful Health Care Spending

15-10-2019 – Joynt Maddox KE, McClellan MB.

Journal Article

In this issue of JAMA, Shrank and colleagues report a thorough review of studies published over the past decade to provide updated estimates on the proportion of US health care spending that is wasteful, defined in 6 broad categories: failure of care delivery, failure of care coordination, overtreatment or low-value care, pricing failure, fraud and abuse, and administrative complexity. The authors estimate total annual waste to be $760 billion to $935 billion—smaller as a share of total spending than previous estimates, yet clearly showing that a gulf remains between the current efficiency in the US health care system and what may be possible. But the authors go further than previous studies to assess evidence on how much of this theoretical gulf could potentially be closed, and they conclude that approximately a quarter of that total ($190 billion to $282 billion) could be eliminated if evidence-based strategies to reduce waste were scaled nationally.

Postextubation High-Flow Nasal Oxygen With Noninvasive Ventilation vs High-Flow Nasal Oxygen Alone and Reintubation

15-10-2019 – Thille AW, Muller G, Gacouin A, et al.

Journal Article

This randomized clinical trial compares the effect of high-flow nasal oxygen with prophylactic noninvasive ventilation applied immediately after extubation vs high-flow nasal oxygen alone on the rate of reintubation in patients at high risk of extubation failure in the intensive care unit (ICU).

Effect of Selepressin vs Placebo on Ventilator- and Vasopressor-Free Days in Septic Shock

15-10-2019 – Laterre P, Berry SM, Blemings A, et al.

Journal Article

This phase 2b/3 randomized clinical trial compares the effects of selepressin, a selective vasopressin V1a receptor agonist and noncatecholaminergic vasopressor, vs placebo on ventilator- and vasopressor-free days within 30 days among adult patients with septic shock receiving norepinephrine.

Added Benefit of Noninvasive Ventilation to High-Flow Nasal Oxygen to Prevent Reintubation in Higher-Risk Patients

15-10-2019 – Telias I, Ferguson ND.

Journal Article

Liberating patients from ongoing invasive mechanical ventilation is typically a 3-step process. First, clinicians must recognize that patients may no longer require mechanical ventilation—ie, when the reasons for intubation are substantially improved and a number of clinical stability criteria are met. Second, patients who meet these “readiness to wean” criteria are then assessed for their ability to breathe through the endotracheal tube with little or no assistance from the ventilator during a so-called spontaneous breathing trial (SBT). Third, for patients who pass their SBT, clinicians must judge whether those patients will be able to sustain ventilation once the endotracheal tube has been removed, maintaining airway patency and clearance of secretions.

Toward a Blood Test for PTSD

15-10-2019 – Abbasi J.

Journal Article

This Medical News article discusses a biomarker panel being developed to screen for war zone–related posttraumatic stress disorder.

High Unintended Pregnancy Rate Spurs Efforts to Ease Contraceptive Access

15-10-2019 – Rubin R.

Journal Article

This Medical News story discusses efforts to remove barriers faced by women seeking birth control pills and other hormonal contraceptives.

Candida auris Update, 2019-2020

15-10-2019 – Bradley SF.

Journal Article

This JAMA Insights Clinical Update reviews infection control and treatment strategies to manage Candida auris, a new drug-resistant fungal species that can cause severe invasive infection with high morbidity and mortality in patients with underlying comorbid illnesses.

What Is the Value of Market-Wide Health Care Price Transparency?

15-10-2019 – Sinaiko AD.

Journal Article

In the wake of a 2019 executive order requiring hospitals to publicly post paid prices and requiring clinicians, insurers, and health plans to provide estimated out-of-pocket costs to patients, this Viewpoint reviews available evidence about the likelihood that price transparency might influence consumer choice, put downward pressure on prices, and influence insurers to incentivize patients to seek lower-cost care.

Joint Pain and Proteinuria

15-10-2019 – Al Saleh AS, Sidiqi M, Gertz MA.

Journal Article

A 66-year-old man had bilateral carpal tunnel syndrome and 6 years of chronic joint pain and stiffness of the shoulders, hips, and knees. He reported occasional bruising around his eyes; physical examination showed raised soft tissue masses around the sternoclavicular joints and scapulae, and laboratory examination was notable for significant levels of protein and albumin. What is the diagnosis and what would you do next?

Upholding the Hippocratic Oath in US Immigration Detention Facilities

15-10-2019 – Spiegel P, Kass N, Rubenstein L.

Journal Article

This Viewpoint proposes conditions under which physicians might sign on to deliver humane and ethical medical treatment of immigrants in US detention facilities while managing dual loyalty conflicts with immigration enforcement agencies, including exemption from nondisclosure agreements, use of 3rd-party hiring agencies, and establishment of independent health oversight committees.

Physicians Talking With Their Partners About Patients

15-10-2019 – Morris NP, Eshel N.

Journal Article

This Viewpoint discusses the phenomenon of physicians talking about patients with their partners and spouses, and the tensions between balancing patient privacy with having a personal outlet and support for processing challenging clinical experiences.