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In This Issue of JAMA
October 15, 2019


JAMA. 2019;322(15):1427-1429. doi:10.1001/jama.2018.15553


High-flow nasal oxygen with noninvasive ventilation can improve gas exchange and decrease the work of breathing. For the HIGH-WEAN Study Group and REVA Research Network, Thille and colleagues randomized 648 mechanically ventilated patients and found that the use of high-flow nasal oxygen with noninvasive ventilation immediately after extubation significantly decreased the risk of reintubation as compared with high-flow nasal oxygen alone. In an Editorial, Telias and Ferguson discuss how the findings of this trial can be applied in clinical practice.


Visual Abstract and CME

Selepressin is a noncatecholaminergic vasopressor that mitigates sepsis-induced vasodilatation, vascular leakage, and edema. Laterre and colleagues for the SEPSIS-ACT Investigators randomized 868 patients who were receiving norepinephrine for the treatment of septic shock and found that selepressin, compared with placebo, did not reduce vasopressor- and ventilator-free days.

Visual Abstract

A major challenge for studies of nutritional interventions is adherence of the participants to dietary goals. Sayón-Orea and colleagues conducted a preliminary analysis of a randomized trial with 6874 participants and found that encouragement to follow an energy-reduced Mediterranean diet plus physical activity, compared with advice to follow an energy-unrestricted Mediterranean diet, resulted in a significantly greater increase in diet adherence after 12 months.

Editor’s Note

Visual Abstract and CME

Clinical Review & Education

The United States spends more on health care than any other country, and approximately 30% of this spending may be considered waste. Shrank and colleagues estimate the costs of health care waste in the domains of care delivery, care coordination, overtreatment or low-value care, pricing, fraud and abuse, and administrative complexity. In related Editorials by Joynt Maddox and McClellan, Berwick, and Bauchner and Fontanarosa, the authors discuss administrative and political barriers to reducing waste in the US health care system.

Viewpoint and Editorial 1, 2, and 3

Author Audio Interview, Summary Video, and CME

Candida auris is an emerging pathogen that can cause severe infection in patients with underlying comorbid illness. This JAMA Insights article by Bradley discusses recommendations for control of this widely disseminated, drug-resistant pathogen.

JAMA Patient Page

This JAMA Clinical Challenge by Al Saleh and colleagues presents a 66-year-old man who had chronic joint pain associated with soft tissue masses, periorbital purpura, and albuminuria. What would you do next?