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Antiretroviral Drug Recommendations for HIV Treatment and Prevention

JAMA - Mar, 02/03/2021 - 02:00
To the Editor As HIV clinicians, we read with interest the new antiretroviral treatment guidelines published on behalf of the International Antiviral Society–USA. Nevertheless, we believe these guidelines failed to integrate emerging evidence and may have reflected implicit commercial bias.

The De-adoption of Low-Value Health Care

JAMA - Mar, 02/03/2021 - 02:00
To the Editor In their Viewpoint, Dr Powers and colleagues analyzed 3 forces governing de-adoption of low-value care: evidence, eminence, and economics. A common denominator underlies them: the interest and convenience of the health care producers, providers, and purchasers. Fee-for-service creates strong incentives to continue delivering low-value but profitable care and technological abuse. More generally, it incentivizes provision of services with a profitable differential between the production costs and the fee applied by purchasers. The production cost is physician- or hospital team–specific, based also on specific skills and preferences, whereas the applied fees are not hospital- or physician-specific, further limiting targeted tariff policies. Aligned with pressure from patients and induced by technology producers and professional societies, fee-for-service multiplies outputs, which translates into financial and career benefits for hospitals, physicians, and producers. Therefore, low-value care for patients and society can be of high value for the producers, hospitals, and physicians selling it. A distorted rewarding model for health players puts the health systems in structural conflict of interest with health.

Association Between COVID-19 Lockdown Measures and ED Visits for Violence-Related Injuries in Wales

JAMA - Mar, 02/03/2021 - 02:00
This study investigates emergency department visits for violence-related injuries occurring at home and outside the home in Cardiff, Wales, before and after COVID-19 lockdown measures were instituted in March 2020.

“A General Practitioner,” or All for Mercy’s Sake

JAMA - Mar, 02/03/2021 - 02:00
As long ago as in the issue of this Journal for Oct. 13,1894, the promising merits of Ian Maclaren, the now popular story-teller, were recognized. We there spoke of Maclaren’s “A General Practitioner,” as “a classic of its kind,” although it was far from being in classic dress at that time; it was then to be found only in a penny paper of London, called the British Weekly. Since that time, the features of the Highland country doctor, Dr. Weelum MacLure, have been made known all the world round in the “Bonnie Brier Bush” stories. And his physiognomy is everywhere recognized as that of one of the sturdiest and noblest medical characters that have ever appeared in fiction. If there is anywhere in fiction a more worthy, admirable and attractive personage than Dr. MacLure of Drumtochty, we will be thankful to have him pointed out to us. As his portrait has not, so far as we know, been seen in any medical gallery, we will here give space to a sketch taken from the earliest publication by Maclaren:

Trade-offs in Public Health Insurance Design

JAMA - Mar, 02/03/2021 - 02:00
The importance of access to health care and the financial protections that insurance should provide have never been more salient, and the potential consequences of the costs and gaps within the patchwork system in the US have never been more dire. Would the US population be better off with a simple, single-payer, uniform Medicare-for-all type of insurance plan?

Hair Loss Diagnosis and Treatment in Primary Care

JAMA - Mar, 02/03/2021 - 02:00
This JAMA Insights Clinical Update reviews the differential diagnosis, patterns, evaluation, and management of the most common causes of nonscarring hair loss, including male pattern balding, telogen effluvium, and alopecia areata.

Audio Highlights

JAMA - Mar, 02/03/2021 - 02:00
Listen to the JAMA Editor’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA.

Import Alert on Hand Sanitizers From Mexico

JAMA - Mar, 02/03/2021 - 02:00
All hand sanitizers from Mexico are under an FDA import alert to protect consumers from potentially dangerous products.

Monthly Injection Is Approved for Patients With HIV

JAMA - Mar, 02/03/2021 - 02:00
The FDA has approved a treatment regimen that will allow some patients with HIV infection to trade their daily pills for a once-a-month injection.

Rules Finalized for New Tobacco Product Approvals

JAMA - Mar, 02/03/2021 - 02:00
Two recently finalized rules provide tobacco product manufacturers with additional information on federal requirements they must meet to get their products on the market. Then-FDA Commissioner Stephen Hahn, MD, said finalization of the rules “is an important milestone in the FDA’s regulation of tobacco products.”

Blinatumomab for Children With High-risk Relapsed B-Cell Acute Lymphoblastic Leukemia

JAMA - Mar, 02/03/2021 - 02:00
Acute lymphoblastic leukemia (ALL), the most common childhood cancer, is a highly curable disease, with approximately 85% of patients being long-term survivors when treated with current chemotherapy regimens. Risk-adapted, intensified chemotherapy regimens have greatly improved the outcome for children, adolescents, and young adults with newly diagnosed B-cell ALL (B-ALL), which comprises approximately 20% of patients with ALL, and can be safely delivered with proper supportive care measures. Intensification of chemotherapy as salvage therapy, frequently adopting the same agents used during initial therapy, has also been successful at inducing sustained remissions for patients with late relapses. However, this approach has been largely unsuccessful for high-risk patients who experience relapse within 3 years from diagnosis because survival outcomes for these patients remain poor. Additionally, mortality associated with toxicity related to therapy contributes significantly to the poor survival.

Experts Discuss COVID-19—Vaccine Doses, Virus Variants, and More

JAMA - Mar, 02/03/2021 - 02:00
JAMA Live Highlights features comments from livestream interviews by JAMA Network Editor in Chief Howard Bauchner, MD. His discussions with experts in clinical care, public health, and health policy focus on critical issues related to the coronavirus disease 2019 (COVID-19) pandemic. Comments have been edited for clarity.

Researchers Investigate What COVID-19 Does to the Heart

JAMA - Mar, 02/03/2021 - 02:00
This Medical News article discusses reports of myocardial injury and myocarditis among patients with COVID-19.

Patient Information: Necessity of 2 Doses of the Pfizer and Moderna COVID-19 Vaccines

JAMA - Mar, 02/03/2021 - 02:00
This JAMA Patient Page describes how the new Pfizer and Moderna COVID-19 vaccines available in the US work and explains why 2 doses of these vaccines are needed to confer adequate immunity.

Association of IVIG Plus Methylprednisolone With Persistent or Recurrent Fever in Children With MIS-C

JAMA - Mar, 02/03/2021 - 02:00
This cohort study estimates the association of use of intravenous immunoglobulins (IVIG) plus methylprednisolone vs IVIG alone with treatment failure for multisystem inflammatory syndrome in children (MIS-C), defined as fever persistence at 2 days or fever recurrence within 7 days.

Vaccine Distribution—Equity Left Behind?

JAMA - Mar, 02/03/2021 - 02:00
Over the past 2 weeks numerous states have announced a major shift in coronavirus disease 2019 (COVID-19) vaccination programs—from a textured approach that includes individual risk factors for morbidity and mortality (eg, age and high-risk medical conditions), occupational risk factors for exposure (eg, first responders and correctional officers), and other societal priorities (eg, essential workers such as teachers, grocery store employees, and public transportation workers) to an approach focused on vaccinating all individuals aged 65 years and older. Concerns have been raised that the more detailed approach has been difficult to implement, thus slowing the rollout of vaccines, and may leave decisions regarding who gets vaccinated to people not adequately trained to make such a decision.

SARS-CoV-2 Vaccines and the Growing Threat of Viral Variants

JAMA - Mar, 02/03/2021 - 02:00
This Viewpoint reviews circulating SARS-CoV-2 genetic variants and mechanisms of immunity by which they might escape coronavirus vaccine-induced protection and proposes 6 measures to address them, including enhanced variant isolation and testing procedures and continued adherence to mask-wearing and other established public health measures.

In-Person Education and the Spread of SARS-CoV-2 Infection

JAMA - Mar, 02/03/2021 - 02:00
This Viewpoint from the CDC summarizes global data about SARS-CoV-2 outbreaks at K-12 schools and emphasizes implementation of community- and school-based policies shown to diminish spread of infection that would allow safer resumption of in-person education in the 2021/22 school year.

Change in Self-Reported Adherence to Nonpharmaceutical Interventions During the COVID-19 Pandemic

JAMA - Mar, 02/03/2021 - 02:00
This study uses national survey data to describe overall and regional trends in adherence to protective behaviors (mask wearing, physical distancing, staying at home, others) among US adults during the COVID-19 pandemic from April to November 2020.

Funding of Pharmaceutical Innovation During and After the COVID-19 Pandemic

JAMA - Mar, 02/03/2021 - 02:00
This Viewpoint considers whether the shift away from private investment toward government funding of drug and vaccine development and commercialization during the coronavirus disease 2019 (COVID-19) pandemic is sustainable, arguing that the same or greater level of public investment will be necessary if drug prices are to remain affordable and if the US wants to maintain its global leadership position.
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