JAMA is an international peer-reviewed general medical journal published weekly online and in print, and a member of the
@JAMANetwork
family of journals.
🧵 Just published: USPSTF recommends all women undergo routine
#breastcancer
screening every other year beginning at age 40, an update from the 2016 recommendation to start at age 50.
"The Pfizer/BioNTech vaccine prevents clinical disease but it it still unclear if it prevents asymptomatic infection, or asymptomatic transmission." Anthony Fauci, MD
Complete interview at
#COVID19
#Coronavirus
#Fauci
#covidvaccine
Diabetic foot ulcers are wounds on the feet that develop in patients with type 1 or type 2 diabetes.
This JAMA Patient Page describes diabetic foot ulcers and their evaluation and treatment.
Given the essential role of TMPRSS2 in
#SARSCoV2
entry, higher nasal expression of TMPRSS2 may contribute to the higher burden of
#COVID19
among Black individuals
1/8 Corticosteroids and COVID19
*Three* RCTs and a new
@WHO
meta-analysis add to
#RECOVERY
trial data that corticosteroids reduce mortality in critically ill
#COVID19
patients
A recent systematic review of studies suggests that medical students in countries around the world haven’t been getting the education they need to counsel patients on healthy eating
"This is a race we want everyone to win. If Russia, China have an effective vaccine maybe they can take care of themselves, even other countries. Success anywhere helps everyone & is a step toward global protection"
#CovidVaccine
#COVID19
#SputnikV
#fauci
In a study of unvaccinated US adults up to 20 months, antibodies were detected in 99% of people who reported a positive COVID-19 test result, in 55% who believed they had COVID-19 but were never tested, and in 11% who believed they had never had
#COVID19
.
Very low-carbohydrate, high-fat
#KetogenicDiets
cause the body to switch from burning carbs to burning fat. A meta-analysis of 13 RCTs suggested that people on ketogenic diets tend to lose more weight and keep more of it off than people on low-fat diets.
Among hospitalized adults, the risk of acute kidney injury did not differ between cefepime and piperacillin-tazobactam, but neurological dysfunction was more common with cefepime.
#IDWeek2023
People who've had
#COVID19
develop anti-
#SARSCoV2
antibodies in plasma, the yellow liquid portion of blood. This convalescent plasma can be transfused into COVID19 patients, but the effectiveness of the treatment hasn't yet been shown in RCTs
Masks should not be worn by healthy people to prevent respiratory infection; there is no evidence that wearing masks prevents healthy people from getting sick and masks can be in short supply and unavailable for people who need them
The rising tide of medical misinformation requires a robust and coordinated response from health professionals, organizations, institutions, and mainstream media
The Chinese CDC today published the largest case series to date of
#COVID19
in mainland China (72 314 cases through 2/11/20). Here are some of the data:
Case-fatality rate
• 2.3% Overall
• 14.8% age >= 80
• 8.0% age 70-79
• 49.0% in critical cases
"It’s all in your head” is a phrase sometimes said by physicians to patients presenting w symptoms unexplained by medical disease. As a neurologist specializing in neuropsychiatry I find myself constantly trying to repair the damage these words can cause.
It now seems safe to conclude that many prior epidemiological associations between
#vitaminD
deficiency and adverse health outcomes were driven by unmeasured residual confounding or reverse causality
#KidneyWk
The decision to undergo surgery for older adults should include considerations of how much the procedure will improve quantity and quality of life, and how much it will preserve their independence.
Why is it acceptable care if P.T. doesn’t come every day but unacceptable if antibiotics aren't given daily? Or acceptable to miss meals waiting for procedures that are cancelled? Why do alarms go off in patients' rooms to notify nurses who are elsewhere?
.
@PLOSMedicine
reports taking
#melatonin
about an hour before turning in for the night improved sleep disturbances and sleep-related impairments in patients who had trouble falling asleep at their chosen bedtime and difficulty waking the next day
"Tony Fauci has one goal - to restore America to some semblance of health so that it can once again be a functioning society. He deserves our deepest gratitude and support."
July 14 Open Letter from
@jamanetwork
's Editor-in-Chief
#Coronavirus
in Italy:
@DrMCecconi
,
@ESICM
president-elect and ICU physician in Lombardy has helped develop a
#COVID19
ICU Network to manage the surge of critical care patients. He discusses his experiences and lessons learned with Howard Bauchner.
Prediabetes is a condition in which blood glucose levels are high but lower than in type 2 diabetes.
This JAMA Patient Page describes prediabetes and its symptoms, diagnosis, and management strategies.
On-premises restaurant dining has been associated w increases in daily
#COVID19
case growth rates 41-100 d after implementation & increases in daily death growth rates 61-100 d after implementation. Changes over time amplify exponentially
@CDCgov
@CDCMMWR
Marfan syndrome is a disorder that affects connective tissue throughout the body. This JAMA Patient Page discusses the diagnosis and treatment of
#MarfanSyndrome
.
Although
#measles
#vaccination
has saved more than 21 million lives since 2000, reported measles cases increased worldwide by 31% from 2016 to 2017 in large part because of falling vaccination coverage, according to a recent report
The speed and volume of clinical trials launched to investigate potential therapies for
#COVID19
highlight both the need and capability to produce high-quality evidence even in the middle of a
#pandemic
The primary benefit of wearing a mask is in limiting the spread of
#COVID19
from others who are symptomatic or asymptomatic. Masks also remind others to continue practicing
#physicaldistancing
In both my life and my clinical career I am awed by the therapeutic value of silence. When there are no words, I sit quietly with patients and and their families, allowing time and space for their stories to unfold.
#medhum
Despite widespread availability and use of calcium and vitamin D to prevent osteoporotic fractures, this meta-analysis of 33 clinical trials found no effect of the supplements' use on hip, other nonvertebral, vertebral, or total fractures
The risk of contracting
#COVID19
during air travel is lower than from an office building, classroom, or supermarket. Airplanes circulate a mix of fresh air and air recycled through HEPA filters. Wear a mask and don’t travel if you feel unwell
A 3-year experiment in providing housing to frequent emergency department patients at
@UIHealth
has been so successful that in 2018, the hospital decided to double the housing program’s size
In this preliminary uncontrolled case series of 5 critically ill patients with
#COVID19
and
#ARDS
, administration of convalescent plasma containing neutralizing antibody was followed by improvement in the patients’ clinical status
#Coronavirus
Older women who walked more than their peers had lower death rates in a recent observational study in
@JAMAInternalMed
, and the mortality benefit was seen with as few as 4400 steps
SARS-CoV-2 uses the SARS-COV receptor angiotensin converting enzyme (ACE) 2 for entry into target cells, raising the hypothesis that ACE-inhibitor/angiotensin-receptor blockade could increase expression of ACE2 receptor in virus-targeted cells and lead to worse outcomes.
Exercise preconditioning triggers adaptive responses of the heart and coronary arteries that protect against ischemia and infarction. This narrative evidence review concludes that even short exercise can create clinically relevant cardioprotection
Diabetic foot ulcers are wounds on the feet that develop in patients with type 1 or type 2 diabetes.
This JAMA Patient Page describes diabetic foot ulcers and their evaluation and treatment.
5 practices may enhance physician presence and connection w patients in clinical encounters:
(1) Prepare w intention;
(2) Listen intently & completely;
(3) Agree on what matters most;
(4) Connect w the patient’s story;
(5) Explore emotional cues
Today, the FDA approved two sickle cell treatments, including one that uses gene therapy.
For more on sickle cell disease, read this 2022 JAMA review article.
The decision to undergo surgery for older adults should include considerations of how much the procedure will improve quantity and quality of life, and how much it will preserve their independence.
Read one of our most cited articles of 2021, “Diagnosis and Treatment of Multiple Sclerosis | A Review,” which discusses the epidemiology and pathophysiology of MS and summarizes evidence on its diagnosis and treatment.
The American Heart Association’s new cardiovascular disease risk calculator, PREVENT, is set to be released in January.
Here's how it improves on the decade-old pooled cohort equations.
#MedicalNews
How to interpret 2 types of diagnostic tests commonly in use for
#SARSCoV2
infections—RT-PCR and IgM and IgG enzyme-linked immunosorbent assay (ELISA)—and how the results may vary over time
#COVID19
#Coronavirus
Declines in SARSCoV2 IgG neutralizing Abs raise concerns of susceptibility to reinfection. But acute Ab levels always decline post-infection, and Ab recall responses come from a pool of long-lived memory B cells
Less medicine is better medicine. Physical exam maneuvers are more performative than informative. Physicians complete suicide. These modern concepts are documented in a novel that recently celebrated its 40th anniversary, Samuel Shem’s The House of God.
In this small crossover study, wearing a 3-layer nonmedical mask was not associated with a decline in oxygen saturation in older adults. The results refute claims that wearing masks in community settings is unsafe for
#COVID19
mitigation
@McMasterU
This article summarizes the recent update of guidelines on health care for transgender and gender diverse people, including primary care, gender-affirming care, mental health care, and education of the clinical workforce.
Published Friday with
#CCR23
:
Continuous administration of meropenem, compared with intermittent administration, does not improve clinically relevant outcomes in critically ill patients with
#sepsis
.
In the
#news
: “Any amount of physical activity -- even two minutes' worth -- can add up to huge benefits for your immediate and long-term health,” Read more via
@UPI
Congratulations to JAMA Medical Illustrator Nick Reback on being recognized with an
@amidotorg
Award of Merit for his illustration “Will This Patient Be Difficult to Intubate?” Check out the awesome work that won him the award at !
@IDrawPicsAllDay
Emerging evidence suggests that optimal lipid lowering therapy produces the greatest absolute reduction in apoB. Because 90% of circulating apoB particles are LDL, therapy that reduces LDL-C (eg
#statins
) are optimal first therapy for most people
The US continued to experience significantly higher
#COVID19
and excess all-cause mortality compared with peer countries during 2021 and early 2022, a difference accounting for 150 000-470 000 deaths.
Physicians are stressed by this pandemic—by the fear of being infected by a contagious and deadly virus, by the fear of infecting our own loved ones, by the constant reminder of our own mortality. We are not immune just because we are doctors
A man in his 40s given pembrolizumab for malignant melanoma developed diffuse darkening of his skin, nail beds, and sclera after starting treatment; the image shows him holding a recent driver’s license photo. What is the cause of the change?
The FDA approved use of the SGLT2 inhibitor dapagliflozin for treatment of HFrEF irrespective of diabetes status, and it's expected to become guideline-directed medical therapy for all patients with HFrEF in the 2021 ACC/AHA
#heartfailure
guideline
Study found robust secretion of
#SARSCoV2
specific IgA and IgG antibodies in breast milk for 6 weeks after maternal vaccination, suggesting a potential protective effect against infection in the infant.
“Seize diastole,” my med school professor said. The words were a clever metaphor for living life well. Diastole isn't passive. It takes work to relax. to give oneself permission to feel, to let one's heart expand fully. Thank you
@colleenfarrell
“Digital addiction” represents a real and potential widespread problem that defies easy solutions or prevention strategies. Time spent on a device or activity is not as important as how that time is spent that matters.
Interval training, intermittent physical effort interspersed by recovery, seems to be a time-efficient approach for promoting fat loss compared to moderate-intensity continuous training
@jenabbasi
One of our most cited articles of 2021, “Pancreatic Cancer | A Review,” summarizes evidence regarding pathobiology, diagnosis, and management of pancreatic ductal adenocarcinoma.
Narrative review summarizes current evidence regarding the diagnosis and management of cirrhosis and its complications.
Article discussed during a top JAMA 2023 Clinical Reviews podcast.
Topical NSAIDs are associated with greater pain relief without increase in adverse events when treating musculoskeletal conditions such as sprains, strains, and contusions.
Red blood cell transfusion threshold guidelines from the
@AABB
have been updated to incorporate an expanded evidence base and to introduce guidance specific to children.
Private equity acquisition of hospitals, on average, was associated with increased hospital-acquired adverse events despite a likely lower-risk pool of admitted Medicare beneficiaries, suggesting poorer quality of inpatient care.
Alpha-gal syndrome is a type of food allergy to mammalian (red) meat products. This JAMA Patient Page discusses alpha-gal syndrome and its symptoms, diagnosis, treatment, and prevention.
I keep the kind notes
From grateful patients in my
Second desk drawer.
For mistakes, I keep
A mental file that replays
On nights I can’t sleep.
The near misses, the
Missed diagnoses, the wrong
Decisions live there.
#medhum
A recent
@JAMANetworkOpen
study suggests that mindfulness-based stress reduction may reduce stress and improve well-being and performance among surgical residents
Study suggests increases in screen time when children are 12 to 36 months of age is associated with decreases in talking and interaction during the early years.
Patients w
#COVID19
are likely to have fatigue and decreased energy for 6-8 weeks. It may be difficult to resume the same activity and exercise as before COVID-19, but it is important to remain active and increase exercise gradually
Because older people are so often excluded from medical studies, little is known about how best to treat them. Learn more via
@NYTHealth
@nytimeswell
:
#news
#Antibiotic
overuse during the
#COVID19
#pandemic
could accelerate the global problem of antimicrobial resistance according to
@WHO
, which has published guidance on judicious use of antimicrobials for patients with COVID-19
#Clopidogrel
reduced bleeding risk without increasing thrombotic events vs
#ticagrelor
in older patients with acute coronary syndrome, a recent noninferiority trial reported
Receiving at least 2 doses of wild-type BNT162b2 vaccine was associated with a reduced risk of emergency department or urgent care and outpatient visits for COVID-19 in children younger than 5 years.