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August 3, 2021, Vol 326, No. 5, Pages 373-450

In This Issue of JAMA

Audio Highlights

Abstract Full Text
free access online only has audio
JAMA. 2021;326(5):e2018061. doi:10.1001/jama.2020.18061
  • Audio Editors' Summary: Active vs Expectant Management of Nonviable Pregnancy of Unknown Location, Opioid Dose Tapering and Overdose, FDA Regulation of Medical Devices, and more
Original Investigation

Effect of an Active vs Expectant Management Strategy on Successful Resolution of Pregnancy Among Patients With a Persisting Pregnancy of Unknown Location: The ACT or NOT Randomized Clinical Trial

Kurt T. Barnhart, MD; Karl R. Hansen, MD; Mary D. Stephenson, MD; et al.
Abstract Full Text
has active quiz
JAMA. 2021;326(5):390-400. doi:10.1001/jama.2021.10767

This clinical trial compares the effect of 3 management strategies on successful resolution of pregnancy among patients with a persisting pregnancy of unknown location.

Effect of a Sedation and Ventilator Liberation Protocol vs Usual Care on Duration of Invasive Mechanical Ventilation in Pediatric Intensive Care Units: A Randomized Clinical Trial

Bronagh Blackwood, PhD; Lyvonne N. Tume, PhD; Kevin P. Morris, MD; et al.
Abstract Full Text
JAMA. 2021;326(5):401-410. doi:10.1001/jama.2021.10296

This cluster randomized clinical trial compares a sedation and ventilator liberation protocol intervention for the duration of invasive mechanical ventilation vs usual care in infants and children anticipated to require prolonged mechanical ventilation.

Association of Dose Tapering With Overdose or Mental Health Crisis Among Patients Prescribed Long-term Opioids

Alicia Agnoli, MD, MPH, MHS; Guibo Xing, PhD; Daniel J. Tancredi, PhD; et al.
Abstract Full Text
has active quiz
JAMA. 2021;326(5):411-419. doi:10.1001/jama.2021.11013

This study examines whether there are associations between opioid dose tapering and subsequent rates of overdose and mental health crisis among patients prescribed stable, long-term, high-dose opioids.

Research Letter

Association Between Hospital Voluntary Participation, Mandatory Participation, or Nonparticipation in Bundled Payments and Medicare Episodic Spending for Hip and Knee Replacements

Joshua M. Liao, MD, MSc; Atul Gupta, PhD; Yueming Zhao, MPH; et al.
Abstract Full Text
JAMA. 2021;326(5):438-440. doi:10.1001/jama.2021.10046

This study uses Medicare claims data to compare spending for hip and joint replacements among hospitals with voluntary vs mandatory participation vs nonparticipation in the Medicare Bundled Payments for Care Improvement program between 2011 and 2017.

Special Communication

FDA Regulation and Approval of Medical Devices: 1976-2020

Jonathan J. Darrow, SJD, LLM, JD, MBA; Jerry Avorn, MD; Aaron S. Kesselheim, MD, JD, MPH
Abstract Full Text
has active quiz has audio
JAMA. 2021;326(5):420-432. doi:10.1001/jama.2021.11171

This Special Communication reviews the development of laws and standards affecting the evaluation and oversight of medical devices by the US Food and Drug Administration (FDA) and the outcomes of this regulatory system from 1976 to 2020.

Viewpoint

Potential Benefits of Expanded COVID-19 Surveillance in the US

David R. Holtgrave, PhD; Sten H. Vermund, MD, PhD; Leana S. Wen, MD, MSc
Abstract Full Text
free access
JAMA. 2021;326(5):381-382. doi:10.1001/jama.2021.11211

This Viewpoint proposes several important areas of surveillance expansion by US public health agencies and other institutions for COVID-19 testing, vaccination, infection, and mortality rates.

Will CMS Find Aducanumab Reasonable and Necessary for Alzheimer Disease After FDA Approval?

Kevin A. Schulman, MD; Michael D. Greicius, MD, MPH; Barak Richman, JD, PhD
Abstract Full Text
free access
JAMA. 2021;326(5):383-384. doi:10.1001/jama.2021.11768

This Viewpoint discusses the recently approved drug aducanumab as a treatment for Alzheimer disease and whether it might be covered under Medicare, a decision made by CMS administrators.

Modernizing Public Health Data Systems: Lessons From the Health Information Technology for Economic and Clinical Health (HITECH) Act

Kushal T. Kadakia, MSc; Michael D. Howell, MD, MPH; Karen B. DeSalvo, MD, MPH, MSc
Abstract Full Text
free access
JAMA. 2021;326(5):385-386. doi:10.1001/jama.2021.12000

This Viewpoint describes 5 lessons learned from implementation of the HITECH Act that apply to the modernization of public health data for the COVID-19 era and beyond.

A Piece of My Mind

So Long, Old Friend

David B. Reuben, MD
Abstract Full Text
free access
JAMA. 2021;326(5):387. doi:10.1001/jama.2021.12018

In this narrative medicine essay, a geriatrician muses about his 44-year relationship with his pager, describes its changes in sound and form, and compares it with its smartphone replacement, which he deems is more functional and more frightening.

Editorial

Opioid Tapering Practices—Time for Reconsideration?

Marc Larochelle, MD; Pooja A. Lagisetty, MD; Amy S. B. Bohnert, PhD
Abstract Full Text
JAMA. 2021;326(5):388-389. doi:10.1001/jama.2021.11118
JAMA Guide to Statistics and Methods

Interpreting the Results of Intention-to-Treat, Per-Protocol, and As-Treated Analyses of Clinical Trials

Valerie A. Smith, DrPH; Cynthia J. Coffman, PhD; Michael G. Hudgens, PhD
Abstract Full Text
JAMA. 2021;326(5):433-434. doi:10.1001/jama.2021.2825

This JAMA Guide to Statistics and Methods describes how intention-to-treat, per-protocol, and as-treated approaches to analysis differ with regard to the patient population and treatment assignments and their implications for interpretation of treatment effects in clinical trials.

JAMA Clinical Challenge

Alopecia in a 36-Year-Old Man With HIV Infection

Maxime J. Billick, MDCM; Wayne L. Gold, MD
Abstract Full Text
has active quiz
JAMA. 2021;326(5):435-436. doi:10.1001/jama.2021.7082

A 36-year-old man with a history of chronic HIV infection had 3 weeks of generalized weakness; examination revealed a maculopapular rash on his arms and torso and patchy hair loss on his scalp. His CD4+ cell count was 820/μL and his HIV viral load was undetectable. What is the diagnosis and what would you do next?

Medical News & Perspectives

Quick Uptakes

Study Suggests Lasting Immunity After COVID-19, With a Big Boost From Vaccination

Jennifer Abbasi
Abstract Full Text
free access
JAMA. 2021;326(5):376-377. doi:10.1001/jama.2021.11717

This Medical News article discusses the duration of immunity after SARS-CoV-2 infection.

News From the JAMA Network

Evidence for a Colorectal Cancer Screening Benefit After Age 75 Years

Anita Slomski
Abstract Full Text
JAMA. 2021;326(5):378. doi:10.1001/jama.2021.12115

Ridesharing Services May Reduce Alcohol-Associated Car Crashes

Anita Slomski
Abstract Full Text
JAMA. 2021;326(5):378. doi:10.1001/jama.2021.11306

Is Dapagliflozin Cost-effective for Treating Heart Failure?

Anita Slomski
Abstract Full Text
JAMA. 2021;326(5):378. doi:10.1001/jama.2021.12116

Simple Intervention Motivates Expectant Fathers to Quit Smoking

Anita Slomski
Abstract Full Text
JAMA. 2021;326(5):378. doi:10.1001/jama.2021.12117
News From the Food and Drug Administration

Collecting Patient-Reported Outcomes in Cancer Clinical Trials

Bridget M. Kuehn, MSJ
Abstract Full Text
free access
JAMA. 2021;326(5):379. doi:10.1001/jama.2021.12277

FDA Approves Skin Graft Alternative for Thermal Burns

Bridget M. Kuehn, MSJ
Abstract Full Text
free access
JAMA. 2021;326(5):379. doi:10.1001/jama.2021.11703

First Treatment for Plasminogen Deficiency Is Approved

Bridget M. Kuehn, MSJ
Abstract Full Text
free access
JAMA. 2021;326(5):379. doi:10.1001/jama.2021.12278
Poetry and Medicine

A Sea Glass Mind: Reflection on a Grandfather’s Dementia

Lynn Gao Cox
Abstract Full Text
free access
JAMA. 2021;326(5):445. doi:10.1001/jama.2021.8775
JAMA Revisited

Current Comment

Abstract Full Text
free access
JAMA. 2021;326(5):446. doi:10.1001/jama.2020.18062
JAMA Patient Page

Pain Management During Vaginal Childbirth

Jill Jin, MD, MPH; Moeun Son, MD
Abstract Full Text
free access
JAMA. 2021;326(5):450. doi:10.1001/jama.2021.10702

This JAMA Patient Page describes the types of nonpharmacologic and pharmacologic approaches available for pain management during vaginal childbirth.

Comment & Response

The US Preventive Services Task Force Recommendation on Lung Cancer Screening

Bryan S. Squires, MD; Ronald Levitin, MD; Inga S. Grills, MD
Abstract Full Text
JAMA. 2021;326(5):440-441. doi:10.1001/jama.2021.8240

The US Preventive Services Task Force Recommendation on Lung Cancer Screening—Reply

Michael J. Barry, MD; Karina Davidson, PhD, MASc; Carol M. Mangione, MD, MSPH
Abstract Full Text
JAMA. 2021;326(5):441. doi:10.1001/jama.2021.8243

X-Waiver Exemption in the Treatment of Opioid Use Disorder

Riley D. Shearer, MSc; Becky R. Ford, PhD; Benjamin A. Howell, MD, MPH
Abstract Full Text
JAMA. 2021;326(5):441-442. doi:10.1001/jama.2021.8267

X-Waiver Exemption in the Treatment of Opioid Use Disorder—Reply

Melissa B. Weimer, DO, MCR; Sarah E. Wakeman, MD; Richard Saitz, MD, MPH
Abstract Full Text
JAMA. 2021;326(5):442-443. doi:10.1001/jama.2021.8270
JAMA Masthead

JAMA

Abstract Full Text
free access
JAMA. 2021;326(5):373-374. doi:10.1001/jama.2020.18059

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