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Journal Cover JAMA The Journal of the American Medical Association
  [SJR: 6.278]   [H-I: 491]   [1095 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]
  • Abaloparatide vs Placebo for Vertebral Fracture Prevention in Osteoporotic
    • Authors: Miller PD; Hattersley G, Riis B, et al.
      Abstract: This randomized clinical trial compares the effects of subcutaneous abaloparatide vs placebo on risk of new vertebral and nonvertebral fractures in postmenopausal women with osteoporosis.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Introducing JAMA Professionalism
    • Authors: Livingston EH; Ginsburg S, Levinson W.
      Abstract: This issue of JAMA marks the introduction of a new department: JAMA Professionalism. The goal of the articles in this section is to help physicians fulfill required competencies on this topic. According to the American Board of Medical Specialties definition, professionalism is “…a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diverse patient populations.” Taking responsibility for executing professional responsibility seems intuitive enough. But what does it mean to adhere to ethical principles' How are the ethical principles defined' Recently, the American Medical Association issued an update to its Code of Medical Ethics stating that in order to conduct themselves ethically, physicians should “uphold the standards of professionalism.” These definitions create an apparent dilemma—being ethical means exhibiting professionalism and professionalism is defined, in part, by being ethical.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Boundaries for Prenatal Carrier Screening
    • Authors: Grody WW.
      Abstract: In this issue of JAMA, Haque et al report the results of the use of high-throughput molecular biologic techniques for prenatal carrier screening. As numerous reports in JAMA and elsewhere have illustrated, the technique is now in fairly wide use in the evaluation of patients with undiagnosed but presumably genetic disorders and in the detection of drug sensitivity and resistance mutations in malignant tumors. Initial results of these studies have yielded some surprising findings.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Pain and Physical Function Following Bariatric Surgery—Reply
    • Authors: King WC; Chen J, Belle SH.
      Abstract: In Reply We agree with Dr Soriano-Maldonado and colleagues that future studies would benefit from evaluating whether participation in exercise programs or change in physical activity level following bariatric surgery are associated with changes in pain and physical function. These associations were not examined in the study due to a lack of information regarding participation in exercise programs and objective physical activity data in the full Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) cohort, although the discussion noted that physical activity participation may contribute to changes in pain and function. The associations of function and pain with physical activity level in subsets of the LABS-2 cohort who wore an activity monitor have been examined. At baseline, perceived and objectively measured walking limitations were associated with less physical activity (ie, fewer steps per day and minutes per week of moderate-to-vigorous intensity physical activity). Also, more bodily pain prior to surgery was associated with less physical activity 1 year postsurgery after adjustment for baseline physical activity level and other potential confounders. Because observational studies have found most patients only make small changes in objectively measured physical activity following bariatric surgery, with few meeting physical activity guidelines, a randomized clinical trial may be required to adequately evaluate whether physical activity or exercise provides benefit in pain or physical function following bariatric surgery.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Pain and Physical Function Following Bariatric Surgery
    • Abstract: To the Editor The study by Dr King and colleagues concluded that pain and self-reported and objectively measured physical function improved significantly over a period of 3 years following bariatric surgery. A number of relevant factors associated with pain and physical function improvements were identified. However, the authors did not consider the potentially important influence of the patients’ participation in physical activity and exercise during the follow-up period as a factor related to improvement in pain and function. Exercise can enhance weight reduction, reduce pain intensity, and improve self-reported physical function in overweight and obese patients with knee osteoarthritis. Furthermore, physical activity in morbidly obese patients following bariatric surgery has been shown to enhance weight loss, which might benefit physical function and knee pain. Thus, participation in physical activity or exercise programs following bariatric surgery might be associated with improvement in physical function measures such as the 400-m test used by King and colleagues. We suggest that future observational studies might benefit from assessing presurgery-to-postsurgery changes in physical activity levels.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Tube Feeding in US Nursing Home Residents With Advanced Dementia,
    • Authors: Mitchell SL; Mor V, Gozalo PL, et al.
      Abstract: This study uses Minimum Data Set data to describe trends in feeding tube insertion among US nursing home residents with advanced dementia between 2000 and 2014.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Severe Genetic Disease Risk Identified by Expanded Carrier Screening
    • Authors: Haque IS; Lazarin GA, Kang H, et al.
      Abstract: This study uses gene frequencies from an expanded carrier screening program of reproductive-aged adults of multiple racial backgrounds and ethnicities to estimate the rates of children identified as being at risk for severe genetic disease.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Cost-effectiveness of PCSK9 Inhibitors for Heterozygous FH or ASCVD
    • Authors: Kazi DS; Moran AE, Coxson PG, et al.
      Abstract: This study estimates the cost-effectiveness of adding proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors to statin therapy for patients with heterozygous familial hypercholesterolemia (FH) or atherosclerotic cardiovascular disease (ASCVD).
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Acute Aortic Dissection and Intramural Hematoma
    • Authors: Mussa FF; Horton JD, Moridzadeh R, et al.
      Abstract: This narrative review summarizes published evidence on diagnosis and management of acute aortic syndromes with a focus on the evolving roles of medical therapy vs TEVAR vs a traditional open surgical procedure.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Disclosure of Medical Error
    • Authors: Levinson W; Yeung J, Ginsburg S.
      Abstract: This JAMA Professionalism article presents the case of a medical error and the options for handling the situation, including communicating with the patients.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Review of Commercial Insect Repellents
    • Abstract: This Medical Letter review summarizes the efficacy and safety of commercially available insect repellents to prevent Zika virus infection and other mosquito and tickborne diseases.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Osteoporosis Therapy in Postmenopausal Women With High Risk of Fracture
    • Authors: Cappola AR; Shoback DM.
      Abstract: Forty-six percent of white women 50 years of age and older will sustain an osteoporotic fracture during their remaining lifetime. Vertebral fractures are the most common osteoporotic fracture; two-thirds are asymptomatic, presenting as incidental findings on radiographs. After an initial hip or vertebral fracture, risk of a second fracture more than doubles, with highest risk in the first year. Fall prevention, weight-bearing exercise, and adequate intake of calcium and vitamin D are cornerstones of fracture prevention. However, medical therapy is often required to treat osteoporosis. Patients who have already sustained a fragility fracture of the hip or spine should be considered for medical therapy to prevent additional fractures, even without bone mineral density (BMD) testing.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease
    • Authors: Mora S; Ames JM, Manson JE.
      Abstract: This Viewpoint discusses the challenges clinicians face individualizing decisions for patients about the benefits and risks of using aspirin for primary prevention of cardiovascular disease.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Vital Directions for Health and Health Care
    • Authors: Dzau VJ; McClellan M, McGinnis J.
      Abstract: In this Viewpoint the president of the National Academy of Medicine and colleagues describe the academy’s Vital Directions for Health and Health Care initiative to define evidence-based health policy opportunities and priorities in anticipation of a new US presidential administration.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • A Wild Rotation
    • Authors: Evrony GD.
      Abstract: The patient was rushed into the room, listless, intermittently trying to lift his head only to fall back down. Soon, he became unresponsive and cold. I placed the ultrasound probe on his chest and saw a barely contracting heart—heart failure. A massive clot filled the left atrium. The team became silent, then quickly regained its composure, and the supervising doctor began disbursing orders in rapid fire. We stabilized the patient, though he remained in serious condition, and then we shifted to research mode. We emailed doctors across the country: “Have you seen acute dilated cardiomyopathy before in similar patients' He is a 3-year-old meerkat.”
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Highlights for August 16, 2016
    • PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • The ACO Experiment in Infancy
    • Authors: Song Z; Fisher ES.
      Abstract: This Viewpoint argues that the accountable care organization approach has been successful in controlling health care costs and improving quality of care.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Time for a New Hypothesis for Medicare Reform
    • Authors: Schulman KA; Richman BD.
      Abstract: This Viewpoints argues against Accountable Care Organizations.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Secondary Infection in Patients With Sepsis
    • Authors: Sweeney DA; Kalil AC.
      Abstract: To the Editor Dr van Vught and colleagues explored whether hypoinflammation/immune paralysis rather than hyperinflammation in the wake of a septic insult could predispose patients to secondary infection and higher mortality. The negative findings of this study cast doubt on the clinical implications of the immune suppression theory.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Secondary Infection in Patients With Sepsis
    • Authors: van Vught LA; Klouwenberg P, van der Poll T.
      Abstract: In Reply Drs Sweeney and Kalil argue that our genomic analyses do not support the existence of immunosuppression. However, although the blood genomic response on ICU admission was not different between patients with sepsis who either did or did not develop an ICU-acquired infection, the gene expression signatures of both groups showed features of immune suppression. In addition, at the time of the ICU-acquired infection, blood leukocytes showed decreased expression of genes involved in glucose metabolism, suggestive of immune suppression.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Dexmedetomidine to Reduce Intubation Time in Patients With Agitated
    • Authors: Hamilton M; Amaral A.
      Abstract: To the Editor Dr Reade and colleagues assessed the effect of dexmedetomidine on ventilator-free time in patients with agitated delirium. We have concerns about their definition of outcomes, potential clinician subconscious cognitive biases, and randomization imbalances.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Dexmedetomidine to Reduce Intubation Time in Patients With Agitated
    • Authors: Reade MC; Bailey M, Bellomo R.
      Abstract: In Reply In the dexmedetomidine trial, there was a significant difference in the unadjusted comparison of the primary outcome, ventilator-free hours at 7 days (median, 145 hours [interquartile range {IQR}, 114-156 hours] vs 128 hours [IQR, 92-143 hours]; P = .01), and after stratification adjustment for site (median between-group difference, 17.0 hours [95% CI, 4.0-33.2 hours]; P = .04). The primary outcome had to account for patients who underwent tracheostomy. Options included equating tracheostomy with extubation (but this would equate failure to extubate with success), excluding patients with tracheostomy (when this was done there was no difference in the significance of the primary outcome), or defining no longer intubated as equivalent to the time after tracheostomy when all sedation opioids were first discontinued for a prolonged period (defined as 4 hours).
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Prescribing Opioids for Chronic Pain
    • Authors: McAuliffe WE.
      Abstract: To the Editor The Centers for Disease Control and Prevention (CDC) guideline for prescribing opioids for chronic pain is a welcome correction of opioid-prescribing practices that stemmed from inadequate evidence and flawed reviews.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Prescribing Opioids for Chronic Pain
    • Authors: Wen LS; Lloyd M.
      Abstract: To the Editor The CDC’s new guidelines for prescribing opioids represent a milestone in addressing the opioid epidemic. They bring national attention to the prescribing practices that drive this crisis and offer concrete steps to correct the course. However, to truly end this epidemic, efforts must extend even further.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Prescribing Opioids for Chronic Pain
    • Authors: Dowell D; Haegerich TM, Chou R.
      Abstract: In Reply As Dr McAuliffe notes, estimates of the risk of problematic opioid use associated with opioid prescription have varied widely depending on a number of factors including outcome measured, methods used to ascertain the outcome, and population studied. In our article, we reported estimates of the prevalence of DSM-IV opioid dependence from 3 studies of primary care patients on long-term opioid therapy in which opioid dependence was assessed using diagnostic interviews. As McAuliffe suggests, estimates for opioid dependence might underestimate rates of opioid use disorder. Opioid use disorder as a single, unifying diagnosis with different levels of severity is a relatively recent construct introduced in DSM-5 to replace the 2 DSM-IV diagnoses of opioid dependence and opioid abuse. Few studies to date have assessed opioid use disorder using DSM-5 criteria. However, estimates for DSM-IV opioid dependence and opioid abuse cannot simply be combined into an estimate for DSM-5 opioid use disorder, as McAuliffe recommends, because the diagnostic criteria do not align completely. Although the studies’ different time frames for meeting criteria for opioid dependence likely affected the studies’ results, this was less relevant given that we were reporting prevalence and not incidence, and we reported on studies in which participants had been receiving opioids for at least a year or close to a year. Ideally future studies will assess opioid use disorder using DSM-5 criteria and systematic diagnostic interviews.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Expanded Explanation of the Sample Size Calculation
    • Abstract: In the Preliminary Communication entitled “Effect of Dexmedetomidine Added to Standard Care on Ventilator-Free Time in Patients With Agitated Delirium: A Randomized Clinical Trial” published in the April 12, 2016, issue of JAMA, the authors would like to expand on the explanation of the sample size calculation. In the 15th paragraph in the Methods section, the first sentence should be “Based on a pilot study with a mean control estimate of 108 ventilator-free hours (SD, 46 ventilator-free hours) and a mean dexmedetomidine group estimate of 148 ventilator-free hours (SD, 15 ventilator-free hours),12 a sample size of 96 patients was estimated to provide 80% power to detect a 20-hour difference (ie, half the effect size observed in the pilot study) using a 2-tailed hypothesis at an α level of .05.” This article was corrected online.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Attention Returns to Medical Errors
    • Authors: Abbasi J.
      Abstract: This Medical News article discusses challenges in estimating the number of deaths from medical errors.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Place Matters for Tobacco Control
    • Authors: Koh H.
      Abstract: For too long, tobacco industry strategies to normalize and glamorize use of their product have perpetuated a preventable epidemic. Although US adult smoking rates declined to 15.1% in 2015 (, nearly half a million people die annually just from cigarette use in the United States ( Projections are that 5.6 million US children alive today will die prematurely from tobacco-related disease ( For every tobacco-related death, approximately 30 more individuals live with chronic tobacco-induced disease and disability (
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Global Disparities in HPV Vaccination Programs
    • Authors: Friedrich MJ.
      Abstract: Vaccination for human papillomavirus (HPV) varies according to the income level of countries, with HPV immunization programs in low- and middle-income countries being practically nonexistent, despite the fact that most new cervical cancer cases and deaths occur in these countries, report researchers from Spain and France (Bruni L et al. Lancet Glob Health. 2016;4[7]:e453-e463).
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • More Insights Into Zika Virus Infection and Birth Outcomes
    • Authors: Friedrich MJ.
      Abstract: Physicians are finding a wider range of congenital abnormalities beyond microcephaly that appear to be associated with Zika virus infection in utero, observations that suggest the presence of a new congenital syndrome, according to a report from the World Health Organization (Costello A et al. Bull World Health Org. 2016;94[6]:406-406A). Zika-related abnormalities include craniofacial disproportion, spasticity, seizures, eye problems, irritability, brainstem dysfunction, and neurological problems that range in severity are being observed in infants born with normal head circumference. Zika infection may also cause problems in cardiac, digestive, and genitourinary systems in infants. Antenatal and postnatal histories as well as follow-up data, laboratory findings, and neuroimaging results will be used to define the new syndrome.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Surge in Cutaneous Leishmaniasis Cases in Syria
    • Authors: Friedrich MJ.
      Abstract: The Syrian conflict has created conditions conducive to the outbreak of cutaneous leishmaniasis (CL) in Syria and surrounding areas in the Middle East and North Africa, according to an editorial authored by experts from the United Kingdom and United States who reviewed literature on the emergence of neglected tropical diseases such as CL in these conflict regions (Du R et al. PLoS Negl Trop Dis. 2016;10[5]:e0004545).
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Assay Detects Drug-Resistance Genes
    • Authors: Voelker R.
      Abstract: The FDA has approved an assay to detect specific genetic markers indicating that bacteria are resistant to carbapenem antibiotics, which are widely used in hospitals to treat severe infections.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • New Drug Targets All 6 HCV Types
    • Authors: Voelker R.
      Abstract: Joining the wave of recently approved hepatitis C virus (HCV) drugs that act directly on the virus is a tablet containing sofosbuvir, which was approved in 2013, and velpatasvir—the first drug to treat all 6 major forms of HCV infection (
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Regulating Genetic Tests
    • Authors: Voelker R.
      Abstract: As part of its role in the federal Precision Medicine Initiative, the FDA has released draft recommendations outlining the agency’s approach toward ensuring that diagnostic tests based on next-generation sequencing technology are safe and effective.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Face Mask
    • Authors: Butt CA.
      Abstract: When critics assess the work of Bruce Nauman (1941-   ), they invariably invoke two points of view simultaneously. Nauman is incredibly innovative and influential, but his work is uncomfortable and irritating to experience as he tediously prods his viewers’ psyche. The irritability is probably enhanced by the fact that Nauman accomplishes this discomfort via means that seem deceptively simple. In 1995, writing for the New York Times, Andrew Solomon wrote, “Nauman is the guy who makes you feel incredibly upset and existentially nervous. … You can recognize a Nauman by the way it makes you want to go home.”
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Janus
    • Authors: McMahon T.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Senile Osteoporosis of the Spinal Column
    • Abstract: The syndrome of senile osteoporosis as it is understood today is different in some respects from its early description. In the early cases the diagnosis was made on the basis of the clinical findings and was confirmed at necropsy; as a consequence the diagnosis was usually made in the advanced stages and the postmortem examination showed extensive osteoporosis. Today, with improved methods for diagnosis, routine roentgenologic examination may disclose the condition even without clinical signs and symptoms.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • Dietary Guidelines for Americans—Eat Less Salt
    • Authors: Frank AP; Clegg DJ.
      PubDate: Tue, 16 Aug 2016 00:00:00 GMT
  • JAMA
    • PubDate: Tue, 16 Aug 2016 00:00:00 GMT
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