2018 JAMA
doi: 10.1001/jama.2017.12692pmid: 31381702
Editorial Staff Editor in Chief Howard Bauchner, MD Executive Editor Phil B. Fontanarosa, MD, MBA Deputy Editors Michael Berkwits, MD, MSCE (Electronic Editor), Gregory Curfman, MD (Author Outreach), Robert M. Golub, MD (Scientific Content), Edward H. Livingston, MD (Clinical Reviews and Education), Jody W. Zylke, MD (Letters Editor) Executive Managing Editor Annette Flanagin Managing Editor Stacy L. Christiansen Senior Editors Philip Greenland, MD, Demetrios N. Kyriacou, MD, PhD, Mary McGrae McDermott, MD, Christopher C. Muth, MD Associate Editors Derek C. Angus, MD, MPH, Ethan Basch, MD, Charlene Breedlove, Linda Brubaker, MD, Anne Rentoumis Cappola, MD, ScM, Thomas B. Cole, MD, MPH, Carolyn J. Crandall, MD, MS, W. Gregory Feero, MD, PhD, Donald C. Goff, MD, Jill Jin, MD, Karen E. Joynt Maddox, MD, MPH, Preeti N. Malani, MD, MSJ, David H. Mark, MD, MPH, George T. O’Connor, MD, MS, Eric D. Peterson, MD, MPH, Richard Saitz, MD, MPH, Jeffrey L. 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All articles published, including opinion articles, represent the views of the authors and do not reflect the policy of JAMA, the American Medical Association, or the institution with which the author is affiliated unless otherwise indicated. ©2018 American Medical Association. All rights reserved. Reproduction without permission is prohibited.
Green, Michael J.; Mahato, Mita
2018 JAMA
doi: 10.1001/jama.2018.18009pmid: 30575860
This Arts and Medicine essay reviews the 2 best graphic medicine publications of 2018: Ellen Forney’s Rock Steady, about her approach to self-managing her bipolar disorder, and Marnie Galloway’s Slightly Plural, about overcoming cultural myths of pregnancy and motherhood to develop one’s own story of parenting.
2018 JAMA
doi: 10.1001/jama.2018.17692pmid: 30516799
This Medical News & Perspectives story examines the debate over whether opting for whole-fat dairy or nonfat dairy or avoiding dairy altogether is optimal for health.
2018 JAMA
doi: 10.1001/jama.2018.18200pmid: 30516800
This Medical News article is an interview with the director of the National Institute of Child Health and Human Development about its Human Placenta Project.
Goldman, Matthew L.; Bernstein, Carol A.; Summers, Richard F.
2018 JAMA
doi: 10.1001/jama.2018.18403pmid: 30500057
This Viewpoint discusses the barriers to physicians’ seeking treatment for depression, burnout, and suicide ideation; reviews the pros and cons of establishing a mental health screening protocol for physicans; and calls for research on the effect screening has on mental health outcomes.
2018 JAMA
doi: 10.1001/jama.2018.17824pmid: 30500053
In this Viewpoint, the author discusses the need for studying treatments that help patients with persistent depression.
Adashi, Eli Y.; Cohen, I. Glenn
2018 JAMA
doi: 10.1001/jama.2018.18270pmid: 30508029
This Viewpoint about heritable genome editing–the modification of DNA of an embryo, sperm, or egg to alter its characteristics for future generations–summarizes the 2018 Nuffield Council on Bioethics report on social and ethical issues raised by the technique, and questions its rejection of a distinction between gene editing for therapeutic vs feature enhancement purposes.
Ratwani, Raj M.; Hodgkins, Michael; Bates, David W.
2018 JAMA
doi: 10.1001/jama.2018.14079pmid: 30489619
This Viewpoint discusses ways in which vendors of electronic health record (EHR) systems can block the conduct and dissemination of EHR usability and safety research and calls for policies that promote the identification and communication of usability and safety issues.
Lee, Wen-Chung; Chiang, Chun-Ju; Yang, Ya-Wen
2018 JAMA
doi: 10.1001/jama.2018.18756pmid: 30534991
This Viewpoint discusses the practice of using a clock timer analogy to describe population risks of cancer and suggests standardizing the measures of incidence rates used in the clocks to population size to facilitate more accurate comparisons between populations.
2018 JAMA
doi: 10.1001/jama.2018.19199pmid: 30575885
In this narrative medicine essay, a neonatologist-in-training finds that small, ordinary treasures—the first blooms of forsythia, the brilliant flash of an ignited Amaretti wrapper, incandescent cracks of lightning on a muggy summer night—mitigate some of the pain of her memories of having watched her father’s struggle with alcoholism, his failed marriage, and his suicide.
Wadhera, Rishi K.; Joynt Maddox, Karen E.; Wasfy, Jason H.; Haneuse, Sebastien; Shen, Changyu; Yeh, Robert W.
2018 JAMA
doi: 10.1001/jama.2018.19232pmid: 30575880
Key PointsQuestionWas the announcement and implementation of the Hospital Readmissions Reduction Program (HRRP) associated with an increase in patient-level mortality? FindingsIn this retrospective cohort study that included approximately 8 million Medicare beneficiary fee-for-service hospitalizations from 2005 to 2015, implementation of the HRRP was associated with a significant increase in trends in 30-day postdischarge mortality among beneficiaries hospitalized for heart failure and pneumonia, but not for acute myocardial infarction. MeaningThere was a statistically significant association with implementation of the HRRP and increased post-discharge mortality for patients hospitalized for heart failure and pneumonia, but whether this finding is a result of the policy requires further research.
Lotta, Luca A.; Wittemans, Laura B. L.; Zuber, Verena; Stewart, Isobel D.; Sharp, Stephen J.; Luan, Jian’an; Day, Felix R.; Li, Chen; Bowker, Nicholas; Cai, Lina; De Lucia Rolfe, Emanuella; Khaw, Kay-Tee; Perry, John R. B.; O’Rahilly, Stephen; Scott, Robert A.; Savage, David B.; Burgess, Stephen; Wareham, Nicholas J.; Langenberg, Claudia
2018 JAMA
doi: 10.1001/jama.2018.19329pmid: 30575882
Key PointsQuestionDo genetic variants that are related to body fat distribution via lower levels of gluteofemoral (hip) fat or via higher levels of abdominal (waist) fat show associations with diabetes or coronary disease risk? FindingsIn genetic studies including up to 636 607 people, distinct polygenic risk scores for increased waist-to-hip ratio via lower gluteofemoral or via higher abdominal fat distribution were significantly associated with higher levels of cardiometabolic risk factors and higher risk for type 2 diabetes and coronary disease. MeaningGenetic mechanisms specifically linked to lower gluteofemoral or higher abdominal fat distribution may independently contribute to the relationship between body shape and cardiometabolic risk.
Gregori, Dario; Giacovelli, Giampaolo; Minto, Clara; Barbetta, Beatrice; Gualtieri, Francesca; Azzolina, Danila; Vaghi, Paola; Rovati, Lucio C.
2018 JAMA
doi: 10.1001/jama.2018.19319pmid: 30575881
Key PointsQuestionWhat is the association of available medications with long-term pain control in knee osteoarthritis? FindingsIn this systematic review and network meta-analysis of 33 pharmacological interventions that included 22 037 patients with knee osteoarthritis in 47 randomized clinical trials lasting at least 12 months, there was uncertainty around the estimates of effect size for change in pain for all comparisons with placebo, including the 2 medications that were associated with improved pain (celecoxib and glucosamine sulfate). MeaningLarger randomized clinical trials are needed to resolve the uncertainty around the long-term efficacy of medications for knee osteoarthritis.
Martin-Gill, Christian; Doyle, Thomas J.; Yealy, Donald M.
2018 JAMA
doi: 10.1001/jama.2018.19842pmid: 30575886
ImportanceIn-flight medical emergencies (IMEs) are common and occur in a complex environment with limited medical resources. Health care personnel are often asked to assist affected passengers and the flight team, and many have limited experience in this environment. ObservationsIn-flight medical emergencies are estimated to occur in approximately 1 per 604 flights, or 24 to 130 IMEs per 1 million passengers. These events happen in a unique environment, with airplane cabin pressurization equivalent to an altitude of 5000 to 8000 ft during flight, exposing patients to a low partial pressure of oxygen and low humidity. Minimum requirements for emergency medical kit equipment in the United States include an automated external defibrillator; equipment to obtain a basic assessment, hemorrhage control, and initiation of an intravenous line; and medications to treat basic conditions. Other countries have different minimum medical kit standards, and individual airlines have expanded the contents of their medical kit. The most common IMEs involve syncope or near-syncope (32.7%) and gastrointestinal (14.8%), respiratory (10.1%), and cardiovascular (7.0%) symptoms. Diversion of the aircraft from landing at the scheduled destination to a different airport because of a medical emergency occurs in an estimated 4.4% (95% CI, 4.3%-4.6%) of IMEs. Protections for medical volunteers who respond to IMEs in the United States include a Good Samaritan provision of the Aviation Medical Assistance Act and components of the Montreal Convention, although the duty to respond and legal protections vary across countries. Medical volunteers should identify their background and skills, perform an assessment, and report findings to ground-based medical support personnel through the flight crew. Ground-based recommendations ultimately guide interventions on board. Conclusions and RelevanceIn-flight medical emergencies most commonly involve near-syncope and gastrointestinal, respiratory, and cardiovascular symptoms. Health care professionals can assist during these emergencies as part of a collaborative team involving the flight crew and ground-based physicians.
Mukaigawara, Mitsuru; Sugita, Shuichi
2018 JAMA
doi: 10.1001/jama.2018.16143pmid: 30489618
A man in his 30s had a 5-day history of fever, rhinorrhea, nonproductive cough, fever, and a maculopapular rash on his neck and trunk that spread to the extremities. He had leukopenia, and liver enzyme levels were elevated. What would you do next?
Eule, Corbin; Gupta, Arjun; Nagalla, Srikanth
2018 JAMA
doi: 10.1001/jama.2018.14317pmid: 30508030
A 68-year-old woman with chronic lymphocytic leukemia (CLL) presents with dyspnea on exertion, conjunctival pallor and scleral icterus, and moderate anemia with elevated reticulocytes and LDH and a 3+ anti-IgG direct antiglobulin test (DAT). How do you interpret the results?
Agarwal, Sumit D.; Barnett, Michael L.; Souza, Jeffrey; Landon, Bruce E.
2018 JAMA
doi: 10.1001/jama.2018.16116pmid: 30575868
This study analyzes Medicare claims data to assess the use of transitional care management and chronic care management services delivered by primary care physicians to fee-for-service beneficiaries.
Peiris, Alan N.; Chaljub, Ellen; Medlock, Dillon
2018 JAMA
doi: 10.1001/jama.2018.17953pmid: 30575883
This JAMA Patient Page describes the symptoms, causes, diagnosis, and treatment of endometriosis.