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Journal Cover JAMA The Journal of the American Medical Association
  [SJR: 6.278]   [H-I: 491]   [1032 followers]  Follow
   Full-text available via subscription Subscription journal
   ISSN (Print) 0098-7484 - ISSN (Online) 1538-3598
   Published by American Medical Association Homepage  [11 journals]
  • HHS Awards $94 Million to Treat Opioid Use Disorders
    • Authors: Jacob JA.
      Abstract: To expand treatment programs in community health centers for patients with opioid use disorder and other substance abuse disorders, the Department of Health and Human Services (HHS) has awarded $94 million to 271 health centers in 45 states, as well as the District of Columbia and Puerto Rico ( The awards will enable health centers to hire approximately 800 additional health care clinicians to treat about 124 000 new patients in underserved populations in integrated primary care and behavioral health care programs ( The funds will also assist community health centers to boost screening programs and increase patient access to medication-assisted treatment programs that use a combination of counseling and medications such as methadone or naltrexone to reduce drug cravings and ease withdrawal symptoms. In addition, the grants will help health centers provide clinicians with educational resources and training to help them make informed pain medication prescribing decisions.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Reducing Antibiotic Prescriptions
    • Authors: Slomski A.
      Abstract: Simple feedback in the form of a letter from a high-profile messenger cut unnecessary prescriptions of antibiotics among general practitioners (GPs), according to a randomized trial in England (Hallsworth M et al. Lancet. doi:10.1016/S0140-6736(16)00215-4 [published online February 18, 2016]).
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Mind-Body Program Helps Back Pain
    • Authors: Slomski A.
      Abstract: Older adults with chronic lower back pain frequently suffer loss of physical function from unremitting pain and have limited pharmacologic treatment options. A recent randomized trial found that mindfulness meditation in adults 65 years and older with chronic lower back pain improved physical function in the short-term, but only reduced current and most severe pain in the longer-term (Morone NE et al. JAMA Intern Med. 2016;176[3]:329-337).
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Allergenic Diet in Early Infancy May Not Prevent Food Allergies
    • Authors: Slomski A.
      Abstract: Previous findings have suggested peanut allergies could be dramatically reduced in infants with severe eczema or egg allergies if they were exposed to peanut allergens early in life. Investigators in a new randomized trial asked whether the same would be true for multiple allergenic foods consumed by infants not at high risk for food allergies. The study found that early consumption of allergenic foods was not efficacious in preventing food allergy (Perkins MR et al. N Engl J Med. doi:10.1056/NEJMoa1514210 [published online March 4, 2016]).
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Incorrect Compound
    • Abstract: In the Editorial entitled “Fish Consumption, Brain Mercury, and Neuropathology in Patients With Alzheimer Disease and Dementia” published in the February 2, 2016, issue of JAMA, an incorrect name for a compound was used. A sentence in paragraph 6 twice referred to “α-linoleic acid,” which should be replaced with “α-linolenic acid.” This article was corrected online.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • CDC Avoids Gun Violence Research But NIH Funds It
    • Authors: Rubin R.
      Abstract: This Medical News & Perspectives article discusses why the US Centers for Disease Control and Prevention has not funded research on gun violence prevention for 2 decades, in contrast to other federal agencies such as the National Institutes of Health.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Conflict or Confluence of Interest'
    • Authors: Shaw DM; Morfeld P, Erren TC.
      Abstract: To the Editor A recent Viewpoint suggested that “the term conflict of interest is pejorative” and proposed using “confluence of interest” instead, along with visually mapping the complex system of biases within and around research. The material is thought-provoking but problematic.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Conflict or Confluence of Interest'—Reply
    • Authors: Cappola AR; FitzGerald GA.
      Abstract: In Reply Dr Shaw and colleagues think that the term “conflict of interest” is not pejorative because the implication is that this infers the potential for conflict rather than its reality. We do not think so. A conflict is a clash, a quarrel, a squabble, or a disagreement, often of a protracted nature, not just the prospect of its occurrence. Journals require increasingly “full and transparent reporting,” for example, by provision of metadata, but do not request authors to address a priori their “fabrication of results” unless they detect evidence that this has occurred.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Article Selection and Possible Risk of Bias—Reply
    • Authors: Badhiwala JH; Nassiri F, Almenawer SA.
      Abstract: In Reply Dr Elgendy and colleagues suggest that the SYNTHESIS trial should have been excluded from our meta-analysis because the endovascular therapy group did not receive intravenous tPA. At the time SYNTHESIS and the Interventional Management of Stroke III (IMS III) were designed, there was limited data on combining intravenous tPA with endovascular thrombectomy. The rationale for combination therapy was the yet unproven assumption that endovascular thrombectomy and intravenous tPA could work in synergy; however, there was also concern about a possible higher risk of hemorrhagic transformation, especially at full doses of tPA. Reflecting these opposing hypotheses, the SYNTHESIS trial aimed to evaluate direct endovascular intervention, whereas IMS III sought to test the safety and efficacy of endovascular therapy after intravenous thrombolysis. With the state of the available literature, we thought it would be most informative to perform an overall pooled analysis of endovascular thrombectomy (with or without intravenous tPA) vs standard medical care, and subsequent analyses stratified by concurrent use of intravenous tPA with mechanical thrombectomy. We found more favorable functional outcomes when thrombectomy was combined with intravenous tPA than when performed in isolation. This has important implications on a systems level, as it lends support to “drip-and-ship” (tPA intravenous drip and shipping patients to the angiogram catheter suite for endovascular thrombectomy) paradigms of care. Moreover, Elgendy and colleagues allude to the THERAPY and THRACE trials. Both studies have yet to be published, and only intermediary results from THRACE are available. The inclusion of incomplete data from these trials, yet selective exclusion of SYNTHESIS, could bias their meta-analysis.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Article Selection and Possible Risk of Bias
    • Authors: Rodrigues F; Langhorne P, Costa J.
      Abstract: To the Editor Dr Badhiwala and colleagues followed the Cochrane Collaboration standards to conduct a systematic review on the use of mechanical thrombectomy in acute ischemic stroke. Reviewing 8 randomized clinical trials, the authors concluded that, in selected patients, endovascular thrombectomy was associated with improved functional outcomes over standard medical care, without differences in adverse events.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Article Selection and Possible Risk of Bias
    • Authors: Elgendy IY; Bhatt DL, Bavry AA.
      Abstract: To the Editor The 2015 American Heart Association/American Stroke Association focused update for the early management of acute ischemic stroke recommended endovascular therapy as an adjunctive therapy to intravenous thrombolysis. Dr Badhiwala and colleagues performed a meta-analysis regarding endovascular thrombectomy for acute ischemic stroke and found that endovascular thrombectomy was associated with improved functional outcomes (odds ratio [OR], 1.56 [95% CI, 1.14-2.13]; P = .005) and no significant difference in all-cause mortality (OR, 0.87 [95% CI, 0.68-1.12]; P = .27) at 90 days compared with standard medical care. The authors included the SYNTHESIS (Intra-arterial vs Systemic Thrombolysis for Acute Ischemic Stroke) expansion trial, which randomized patients with acute ischemic stroke to receive endovascular therapy alone (without intravenous tissue plasminogen activator [tPA]) vs tPA. We argue that the SYNTHESIS study should have been excluded from the analysis because it is fundamentally different from the other included studies. Including SYNTHESIS in the Badhiwala et al analysis could have underestimated the effect of interventional treatment on important outcomes.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • TP53 Gene and Cancer Resistance in Elephants
    • Authors: Schiffman JD; Schmitt DL, Maley CC.
      Abstract: In Reply We agree with Dr Casola that we may have misused the term allele in reference to the additional elephant TP53 (ep53) genes. We also agree, as highlighted in our article, that the exact role of ep53 remains to be determined. Ep53 appears to originate from ancient reverse transcription of TP53 mRNA, followed by a large number of gene duplications. A retrotransposed gene can still encode a protein even if not identical to the ancestral protein, as indicated by our experiments with ep53 retrogene 9. It is unclear if the additional ep53 genes should be called retrogenes or retropseudogenes. Laboratory experiments to answer these questions are ongoing.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • TP53 Gene and Cancer Resistance in Elephants
    • Authors: Perez RP; Komiya T.
      Abstract: To the Editor Dr Abegglen and colleagues confirmed a low cancer incidence in elephants and hypothesized that this relates to increased genomic protection by p53, possibly due to high copy numbers (20-40) of transcribed p53 pseudogenes. Also, peripheral lymphocytes and fibroblasts in elephants showed greater apoptotic sensitivity to ionizing radiation or doxorubicin than similar cells from humans.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • TP53 Gene and Cancer Resistance in Elephants
    • Authors: Pessier AP; Stern JK, Witte CL.
      Abstract: To the Editor The study by Dr Abegglen and colleagues affirmed the Peto paradox and suggested that elephants are cancer resistant by virtue of multiple TP53 gene copies and enhanced responses to DNA damage. This study epitomizes a “One Health” approach to solving important disease problems shared by humans and animals. However, from our experience working in a large zoo-based veterinary pathology program, we were surprised by the results because, unlike in the notoriously cancer-resistant naked mole rats, we have diagnosed cancers in several elephants.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Content, Readability, and Understandability of Dense Breast Notifications
           by State
    • Authors: Kressin NR; Gunn CM, Battaglia TA.
      Abstract: This study characterizes the content and reading level of text in state-mandated dense breast notifications sent to women in the United States.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • TP53 Gene and Cancer Resistance in Elephants
    • Authors: Casola C.
      Abstract: To the Editor Dr Abegglen and colleagues proposed that the occurrence of multiple copies of the TP53 gene in elephants may be an evolutionary innovation associated with cancer resistance in pachyderms. These extra TP53 copies have been described as alleles of the “ancestral” TP53 gene. However, according to the Genetics Home Reference curated by the US National Library of Medicine, the word allele refers to “one of the alternative versions of a gene at a given location (locus) along a chromosome.” Copies of a given gene, such as the multiple TP53 copies found in elephants, should be referred to as paralogous genes, or paralogs. Alleles represent the range of biological variation of a gene in a species, including deleterious alleles responsible for mendelian disorders, whereas most paralogs perform separate biological functions, are expressed in different tissues or at different developmental stages (for example, the genes encoding globin proteins), or both. Therefore, suggesting that African elephants possess “40 TP53 alleles” is not only semantically incorrect but also biologically inaccurate.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Body Fat Distribution and Diabetic Retinopathy
    • Authors: Klein R; Klein BK.
      Abstract: This commentary discusses a cross-sectional study published in JAMA Ophthalmology that investigated association of body fat distribution with diabetic retinopathy in an Asian population with type 2 diabetes.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Lyme Disease Serology
    • Authors: Lantos PM; Auwaerter PG, Nelson CA.
      Abstract: A 10-year-old girl’s 2.0-cm annular lesion on the neck persists following 10 days of antifungal therapy, and she undergoes serologic testing for Lyme disease, which shows equivocal enzyme immunoassay results and negative immunoblots. How do you interpret results'
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Outcomes With Screening Tomosynthesis and Digital Mammography in Women
           With Dense Breasts
    • Authors: Rafferty EA; Durand MA, Conant EF, et al.
      Abstract: This study compares cancer detection and recall rates with digital mammography combined with tomosynthesis vs digital mammography alone in women with dense breasts.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Review of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis
    • Authors: Sanchez E; Vannier E, Wormser GP, et al.
      Abstract: This narrative review summarizes published evidence about the diagnosis, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Rotating Night Shift Work and Risk of CHD Among Women
    • Authors: Vetter C; Devore EE, Wegrzyn LR, et al.
      Abstract: This cohort study assesses whether rotating night shift work is associated with risk of coronary heart disease (CHD) over 24 years of follow-up among women in the Nurses’ Health Studies.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Prediction Rule for Long-term Dual Antiplatelet Therapy After PCI
    • Authors: Yeh RW; Secemsky EA, Kereiakes DJ, et al.
      Abstract: This study used data from the Dual Antiplatelet Therapy (DAPT) Study to develop a clinical decision tool to identify patients expected to derive benefit vs harm from continuing thienopyridine 1 year after percutaneous coronary intervention.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Association Between Income and Life Expectancy in the United States
    • Authors: Chetty R; Stepner M, Abraham S, et al.
      Abstract: This study uses deidentified US tax records to estimate race- and ethnicity-adjusted life expectancy at 40 years of age by household income percentile, sex, and geographic area, and to evaluate factors associated with differences in life expectancy.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • House Dust Mite Immunotherapy in Adults With Allergic Asthma
    • Authors: Virchow J; Backer V, Kuna P, et al.
      Abstract: This randomized clinical trial compares the efficacy and adverse events of house dust mite sublingual allergen immunotherapy vs placebo for asthma exacerbations in adults with allergic asthma during an inhaled corticosteroid reduction period.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Moving Predictive Modeling From Clinical Trials to Precision Medicine
    • Authors: Pencina MJ; Peterson ED.
      Abstract: Evidence-based care has been defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” However, until now, most treatments have been designed with a “one-size-fits-all” approach: useful for some patients but not helpful or even harmful for others. Analyses of clinical trials generally focus on summarizing overall average treatment effects without more deliberate investigation of which patients actually benefit. For example, if the number needed to treat using a new therapy is 50, then 50 individuals need to receive this treatment for 1 individual to benefit. But what characterizes that benefiting individual' Therapies can also both help and harm, successfully improving some outcomes while also placing patients at increased risk for other adverse events.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • New Horizons in Allergen Immunotherapy
    • Authors: Wood RA.
      Abstract: Even though allergen immunotherapy has been studied for more than a century, a great deal remains unknown about this commonly used treatment. Immunotherapy, which is of benefit to the majority of appropriately selected patients, still largely relies on the injection of relatively crude allergen extracts, often involving doses that have not been rigorously studied. The renewed interest in the study of immunotherapy over the past decade is encouraging and has resulted in important advances, including development of more refined allergens, assessment of different routes of delivery, and studies on the treatment of food allergy.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Improving Opportunity, Population Health, and Well-being Collectively
    • Authors: Woolf SH; Purnell JQ.
      Abstract: Life expectancy is lower and disease morbidity is higher in the United States than in other high-income countries. This situation, decades old, is not for lack of skilled medical care; the United States has among the world’s best hospitals and technology. Nor is spending on health care inadequate; per capita health expenditures in the United States far exceed spending elsewhere. The poorer health of racial and ethnic minorities does not explain the nation’s low rankings; the US non-Hispanic white population and other advantaged groups also have worse health outcomes than their peers in other countries. The US health care system certainly has deficiencies, notably the lack of universal coverage, but this alone does not explain the pervasive health disadvantage.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Income, Longevity, and Community Health
    • Authors: McGinnis J.
      Abstract: “Protecting health, saving lives—millions at a time” is the motto of the Johns Hopkins Bloomberg School of Public Health. Although not the principal motivation for or lesson from the assessment by Chetty and colleagues published in JAMA, encouraging prospects for community health strategies are suggested by the findings in this article on income and life expectancy.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Associations Between Money and Death
    • Authors: Deaton A.
      Abstract: The finding that income predicts mortality has a long history. Nineteenth-century studies include Villermé on Paris, France, in 1817, Engels on Manchester, England, in 1850, and Virchow on Upper Silesia in 1847 through 1848. Modern analyses include the Whitehall study of British civil servants, whose status was measured by income, as well as similar findings for other European countries. Indeed, the mortality gradient by income is found wherever and whenever it is sought. Virchow’s statement that “medicine is a social science, and politics is nothing but medicine at a larger scale” has lost none of its resonance. By contrast, the medical mainstream, looking back to Koch rather than Virchow, emphasizes biology, genetic factors, specific diseases, individual behavior, health care, and health insurance.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Trustees of Nonprofit Health Care Organizations
    • Authors: Jellinek M.
      Abstract: This Viewpoint discusses the challenges board of trustee members face regarding the societal benefits and potential financial ramifications of moving from fee-for-service reimbursement to population health management in the United States.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • The Patient You Least Want to See
    • Authors: Chen JH.
      Abstract: Signing my first orders as a medical intern was distinctly disconcerting. Wait, I can just sign this order and it will happen' Are we sure this is safe' Safe or not, new physician trainees suddenly wield the power to administer medications that can be lifesaving or life-ending. Pharmacists corrected my orders for excessive doses of insulin or potassium, while senior physicians guided my selection of vasopressor infusions and antibiotics. When it came to intravenous opioids, however, those same pharmacists never hesitated to approve my orders, and I found little structured guidance from supervising physicians. With no questions asked, I included “as needed” acetaminophen, oxycodone, and IV morphine in my standard order set for every patient I admitted. I congratulated myself on a time-saving trick to anticipate patient and nursing needs that would spare me an extra page to respond to. Instead, I unexpectedly found patients skipping the acetaminophen and getting their “as needed for severe pain” intravenous opioids around the clock for days. This often culminated in a last-minute desperate discharge plan, with many demoralizing negotiations over “just one more push of IV Dilaudid and Benadryl.” I came to appreciate a more insidious problem and, even worse, worried that I was contributing to it.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Digital Health and Patient Safety
    • Authors: Agboola SO; Bates DW, Kvedar JC.
      Abstract: This Viewpoint discusses the increasing adoption of digital health technology and how it may be helpful for policy makers, health care administrators, and clinical leaders.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Highlights for April 26, 2016
    • PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Liver Cancer Deaths Increase as Cancer Deaths Decline
    • Authors: Jacob JA.
      Abstract: Between 2008 and 2012, the rate of newly diagnosed liver cancer increased by an average of 2.3% annually, and deaths from liver cancer increased an average of 2.8% for men and 2.2% for women annually from 2003 to 2012, according to an annual report on cancer occurrence and trends ( Hepatitis C virus (HCV) infections accounted for about 20% of liver cancers, according to the report. About twice as many men as women were diagnosed with liver cancer during this time, and the highest death rates occurred among adults born between 1945 and 1965, who are 6 times as likely as adults of other ages to have HCV.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Vendors Commit to Improving Health Information Flow
    • Authors: Jacob JA.
      Abstract: Nearly 50 leading electronic health record (EHR) vendors, health care systems, and major medical and health care associations have voluntarily pledged to take steps to improve the flow and exchange of electronic health care information ( One key step is the adoption of the Health Level 7–Fast Healthcare Interoperability Resources standard, which will enable consumers to quickly retrieve information such as test results from EHRs or contact their physician using their smartphones and tablets. The EHR vendors, health care systems, and associations have committed to sharing electronic health data as permitted by law and refrain from deliberately blocking access to information. In addition, to ensure uniform technical standards, these organizations also agreed to use the recommended best practices for existing and emerging interoperability standards established by the Office of the National Coordinator for Health Information Technology, which is part of the Department of Health and Human Services (HHS) (
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Mixed News on Hospital Infections
    • Abstract: First, the good news: data from some 4000 acute care hospitals showed that the 17 758 central line–associated blood stream infections reported in 2014 represented a 50% decrease since 2008. Now, the not-so-good news: the 101 074 hospital-acquired Clostridium difficile infections reported in 2014 represented an 8% overall decrease since 2011; however, C difficile infections increased by 4% from 2013 to 2014.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Preventing Kids’ Mental and Developmental Problems
    • Abstract: Early intervention can help some children outgrow mental, behavioral, or developmental disorders. But for those with problems that linger into adulthood—attention-deficit/hyperactivity disorder, for example—knowing which factors in a child’s surroundings influence those conditions may aid in preventing them or improving early identification and treatment.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Truncated View of the Broekzijder Mill on the Gein, Wings Facing West
    • Authors: Smith JM.
      Abstract: Whether the paintings of Piet Mondrian (1872-1944) took the form of landscape idylls or abstract configurations, there is in them a feeling of stability and optimism for the future. In his earlier work, a sense of balance was perhaps implied in the pictorial rendering of serene terrain, but later in his career he sought to convey a harmonic state of existence using geometric elements and primary colors (Busignani A. Beamish C, trans. Mondrian. New York, NY/London, UK: Thames and Hudson; 1989:1-79). His hope was that this concept would be embraced by the world, bringing about its transformation to an attitude of accord and cooperation.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • unexpected
    • Authors: Wang L.
      Abstract: cantankerous grump that onepoints the nurse to the mess of stained sheetsand the breathing body beneathas I approach to saysir, how are you today
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • Public Health Laboratories
    • Abstract: An eminent historian has remarked that no science, no department of knowledge, can be thoroughly understood except in the light of its historic genesis and growth. Historical study thus tends not only to be an aid to refinement, breadth of view and sympathy, but also to be helpful in the handling of great questions in any of the sciences relating to man. It is a splendid discipline for reasoning of the practical kind most needed in the affairs of life. This belief may be offered as the reason for reverting to some of the little known facts regarding certain features of the continually increasing public health movement.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • The US Preventive Services Task Force
    • Authors: Jin J.
      PubDate: Tue, 26 Apr 2016 00:00:00 GMT
  • JAMA
    • PubDate: Tue, 26 Apr 2016 00:00:00 GMT
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