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Donning and Doffing—Hiding Cancer Treatment in Plain Sight

JAMA - Mar, 09/02/2021 - 02:00
In this narrative medicine essay an internal medicine hospitalist explores what the new diagnosis of breast cancer means for her professional identity and considers how the COVID-19 pandemic facilitates the hiding of serious illness but also complicates disclosing the news to colleagues and friends.

To a Firstborn Son

JAMA - Mar, 09/02/2021 - 02:00
Months we all gelled—pills, probes, we pried, we eyed you. Scouring echoes mottled like the Moon, I found your face. Eighteen weeks in, too soon to fly your flawed cocoon, our doctor spied your two feet thrust through. Though your mother tried a banked bed, buoying you, her water broke. The wits I lacked, her nurses lent. “Just stroke her hair, don't look,” they pled—so I complied. But when your cord got clamped, before you ceased your windless breaths, I should've made a stand: amidst those steel stirrups, laying a hand that said, “We love you Lincoln. Go in peace.” What now? Stroke prints inked by lifeless feet then? Too late. You'll never be that close again.

Patient Information: Treatment of Alcohol Use Disorder

JAMA - Mar, 09/02/2021 - 02:00
This JAMA Patient Page explains the medications (naltrexone, acamprosate, disulfiram) and behavioral treatments (cognitive behavior therapy [CBT]) used to manage alcohol use disorder.

Effect of Restrictive vs Liberal Blood Transfusion Strategy on Adults With Myocardial Infarction and Anemia

JAMA - Mar, 09/02/2021 - 02:00
This noninferiority trial compares the effects of a restrictive (hemoglobin ?8 g/dL) vs liberal (hemoglobin ?10 g/dL) transfusion strategy on 30-day cardiovascular events among adults with acute myocardial infarction (AMI) and anemia (hemoglobin 7-10 g/dL).

Prevalence of Bicuspid Aortic Valve and Associated Aortopathy in Danish Newborns

JAMA - Mar, 09/02/2021 - 02:00
This population epidemiology study describes the prevalence of bicuspid aortic valve (BAV) and BAV subtypes, and of accompanying enlarged aortic diameter or coarctation, in Danish newborns born in Copenhagen 2016-2018.

Intensity of Physical Activity and Peak Oxygen Consumption in Patients With Heart Failure

JAMA - Mar, 09/02/2021 - 02:00
This randomized trial compares the effects of high-intensity interval training, moderate continuous training, and guideline-based physical activity on change in peak oxygen consumption (V?o2) in patients with heart failure with preserved ejection fraction (HFpEF).

Drugs for Osteoarthritis

JAMA - Mar, 09/02/2021 - 02:00
This Medical Letter review reproduces a Table summarizing key information about drugs for osteoarthritis published as part of a comprehensive review on the topic.

Algorithmic Stewardship in Health Care—Reply

JAMA - Mar, 09/02/2021 - 02:00
In Reply Mr Li and Dr Wang highlight valuable examples of regulation from other industries, including banking and insurance. We agree that best practices from these industries provide lessons for health care and that health system–level algorithmic stewardship should complement clear guidance and oversight from those with regulatory authority.

Update on Blood Pressure Control Among US Adults With Hypertension—Reply

JAMA - Mar, 09/02/2021 - 02:00
In Reply In response to our recent article about trends in BP control among US adults, Dr Kovell and colleagues emphasize the importance of hypertension control to reduce cardiovascular disease mortality in women and to prevent maternal morbidity and mortality. They note that women had a larger reduction in BP control between 2013-2014 and 2017-2018 compared with men.

Financing of US Graduate Medical Education—Reply

JAMA - Mar, 09/02/2021 - 02:00
In Reply Teaching hospitals continue to expand the number of resident physicians, exceeding the number of government-funded residency spots, without additional government funding. This is a clear signal that the marginal benefit of employing a resident physician, even in the absence of government funding, clearly exceeds the cost—a narrative at odds with the public advocacy for more federal GME support. We applaud the work done by Dr Royce and others analyzing the distribution of GME funding as it pertains to higher revenue–generating specialties and primary care. It is important to note that there are no nationally coordinated GME performance metrics, and the few that exist are ad hoc and unvalidated. While it is important to collect validated measures of performance for benchmarking programs, they should not be used to justify the GME program, and Congress should use these GME funds, which amount to billions of dollars, for higher priorities.

Algorithmic Stewardship in Health Care

JAMA - Mar, 09/02/2021 - 02:00
To the Editor The Viewpoint by Ms Eaneff and colleagues proposed the role of stewardship for predictive algorithms by benchmarking to best practices from other clinical areas of medicine. In our opinion, to ensure the equality and safety of predictive algorithms, the health system could also learn from the high standards in other industries in which quality control and supervision of predictive algorithms are well established.

Update on Blood Pressure Control Among US Adults With Hypertension

JAMA - Mar, 09/02/2021 - 02:00
To the Editor In their recent article, Dr Muntner and colleagues demonstrated that despite the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guidelines recommending more intensive BP treatment, there was a striking decrease in BP control among US adults with hypertension from 2013-2014 to 2017-2018.

Financing of US Graduate Medical Education

JAMA - Mar, 09/02/2021 - 02:00
To the Editor In their recent Viewpoint, Dr Grischkan and colleagues provided a synopsis of the forces behind the contemporary financing of US graduate medical education (GME). They claimed that training of residents by teaching hospitals is a profitable endeavor. Supporting their position, the authors observed that more than 15?000 resident positions have been created since 2003, despite no increase in federal funding for these positions. Two points deserve further consideration.

Prevalence and Outcomes of SARS-CoV-2 Infection Among Migrant Workers in Singapore

JAMA - Mar, 09/02/2021 - 02:00
This study examines the prevalence and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among migrant workers in Singapore.

Income Tax Credit for Charity Practice of Physicians

JAMA - Mar, 09/02/2021 - 02:00
The value of the services rendered annually by physicians of this country in the treatment of the indigent sick for which they receive no compensation has been estimated as in excess of $300,000,000. Recognition of this tremendous contribution made by physicians for the public good is reflected in a bill, H. R. 5296, introduced in the Congress January 30 by Representative Clare Boothe Luce of Connecticut. The measure provides that physicians, surgeons and dentists, commencing with the taxable year 1946, shall be allowed an additional credit as a deduction on their income tax equal in terms of percentages to that portion of their time each year which is devoted to charity, free clinic work and public research work. The Commissioner of Internal Revenue will prescribe by regulation, it is contemplated, the method of computing such time and the proof which shall be required in substantiation.

Social Isolation and Loneliness: Imperatives for Health Care in a Post-COVID World

JAMA - Mar, 09/02/2021 - 02:00
The importance of social determinants of health has been gaining traction in the health care sector during the last decade. Social determinants of health have been found to be responsible for 80% to 90% of health outcomes, and an abundance of research has demonstrated that no matter the advancements in medicine and health care, the health of individuals and communities will not improve if these root-cause social factors are not addressed. The coronavirus disease 2019 (COVID-19) pandemic is highlighting one of these factors: social isolation.

Audio Highlights

JAMA - Mar, 09/02/2021 - 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.

Bicuspid Aortic Valve—A Common Form of Structural Heart Disease

JAMA - Mar, 09/02/2021 - 02:00
By the ninth week of human embryonic development, many of the unique anatomical structures of the heart have appeared, including the semilunar valves. The aortic valve is derived from an endocardial outflow tract cushion, and in most instances the valve consists of 3 nearly identical leaflets, or cusps.

Searching for the Optimal Exercise Training Regimen in Heart Failure With Preserved Ejection Fraction

JAMA - Mar, 09/02/2021 - 02:00
Heart failure with preserved ejection fraction (HFpEF) is increasing in prevalence, associated with high morbidity and mortality, and continues to be refractory to available pharmacotherapies. HFpEF is a multiorgan disease with complex pathophysiology that culminates in debilitating exercise intolerance as its essential clinical manifestation. Exercise intolerance is preceded by an accelerated decline in exercise capacity, measured objectively as peak exercise oxygen consumption (peak V?o2), and manifests clinically as dyspnea, fatigue, and reduced quality of life (QoL). Accordingly, there is an increasing emphasis on developing therapeutic approaches to improve exercise capacity and QoL in patients with HFpEF.

Phone Apps and Wearable Trackers Modestly Improve Activity

JAMA - Mar, 09/02/2021 - 02:00
Smartphone fitness applications and wearable activity trackers seem to have a small to moderate positive effect on physical activity, a systematic review and meta-analysis of randomized trials found. The improvements, reported in the British Journal of Sports Medicine, corresponded to an additional 1850 steps per day.
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