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Medical Device Tracking—How It Is and How It Should Be
Madris Kinard, MBA; Lisa McGiffert, BA
doi : 10.1001/jamainternmed.2020.7797
JAMA Intern Med. 2021;181(3):305-306
in 2007, Congress mandated that medical device manufacturers create a unique identifying number for each of their products that was similar to a vehicle identification number on automobiles.1 Work to implement the law did not begin until in 2012, when Congress added a deadline. In 2013, the US Food and Drug Administration (FDA) adopted the final rule.2
The COVID-19 Pandemic—An Opportune Time to Update Medical Licensing
Samyukta Mullangi, MD, MBA; Mohit Agrawal, MS, MBA; Kevin Schulman, MD
doi : 10.1001/jamainternmed.2020.8710
JAMA Intern Med. 2021;181(3):307-308
during the coronavirus disease 2019 (COVID-19) pandemic, many states waived requirements that physicians and other health care professionals with out-of-state licenses be licensed in the state in which they are providing services. Some states also extended this reciprocity for the provision of telehealth services. These crisis responses highlight the barriers that physician licensure procedures have created for the delivery of health care. Although state licensing requirements are largely similar across the country, most states require that physicians be separately licensed in each state in which they practice.
Effectiveness of Mindfulness Meditation vs Headache Education for Adults With MigraineA Randomized Clinical Trial
Rebecca Erwin Wells, MD, MPH; Nathaniel O’Connell, PhD; Charles R. Pierce, MS;
doi : 10.1001/jamainternmed.2020.7090
JAMA Intern Med. 2021;181(3):317-328
Importance Migraine is the second leading cause of disability worldwide. Most patients with migraine discontinue medications due to inefficacy or adverse effects. Mindfulness-based stress reduction (MBSR) may provide benefit.
Association of Stratification by Proportion of Patients Dually Enrolled in Medicare and Medicaid With Financial Penalties in the Hospital-Acquired Condition Reduction Program
Sukruth A. Shashikumar, AB; R. J. Waken, PhD; Alina A. Luke, MPH; et al.
doi : 10.1001/jamainternmed.2020.7386
JAMA Intern Med. 2021;181(3):330-338
Importance The Hospital-Acquired Condition Reduction Program (HACRP) is a value-based payment program focused on safety events. Prior studies have found that the program disproportionately penalizes safety-net hospitals, which may perform more poorly because of unmeasured severity of illness rather than lower quality. A similar program, the Hospital Readmissions Reduction Program, stratifies hospitals into 5 peer groups for evaluation based on the proportion of their patients dually enrolled in Medicare and Medicaid, but the effect of stratification on the HACRP is unknown.
Comparing Health Outcomes of Privileged US Citizens With Those of Average Residents of Other Developed Countries
Ezekiel J. Emanuel, MD, PhD; Emily Gudbranson, BA; Jessica Van Parys, PhD; et al.
doi : 10.1001/jamainternmed.2020.7484
JAMA Intern Med. 2021;181(3):339-344
Importance The average health outcomes in the US are not as good as the average health outcomes in other developed countries. However, whether high-income US citizens have better health outcomes than average individuals in other developed countries is unknown.
Treatment and Outcomes of Inpatient Hypertension Among Adults With Noncardiac Admissions
Radhika Rastogi, MD, MPH; Megan M. Sheehan, BS; Bo Hu, PhD; et al.
doi : 10.1001/jamainternmed.2020.7501
JAMA Intern Med. 2021;181(3):345-352
Importance Despite high prevalence of elevated blood pressure (BP) among medical inpatients, BP management guidelines are lacking for this population. The outcomes associated with intensifying BP treatment in the hospital are poorly studied.
Comparison of Saliva and Nasopharyngeal Swab Nucleic Acid Amplification Testing for Detection of SARS-CoV-2A Systematic Review and Meta-analysis
Guillaume Butler-Laporte, MD; Alexander Lawandi, MD, MSc; Ian Schiller, MSc; et al.
doi : 10.1001/jamainternmed.2020.8876
JAMA Intern Med. 2021;181(3):353-360.
Importance Nasopharyngeal swab nucleic acid amplification testing (NAAT) is the noninvasive criterion standard for diagnosis of coronavirus disease 2019 (COVID-19). However, it requires trained personnel, limiting its availability. Saliva NAAT represents an attractive alternative, but its diagnostic performance is unclear.
Effectiveness of a Nurse-Led Multidisciplinary Intervention vs Usual Care on Advance Care Planning for Vulnerable Older Adults in an Accountable Care OrganizationA Randomized Clinical Trial
Jennifer Gabbard, MD; Nicholas M. Pajewski, PhD; Kathryn E. Callahan, MD, MS; et al.
doi : 10.1001/jamainternmed.2020.5950
JAMA Intern Med. 2021;181(3):361-369
Importance Advance care planning (ACP), especially among vulnerable older adults, remains underused in primary care. Additionally, many ACP initiatives fail to integrate directly into the electronic health record (EHR), resulting in infrequent and disorganized documentation.
Advance Care Planning and the Cost of Pragmatism
Vinay Guduguntla, MD; Tracy Wang, MD, MHS, MSc; Deborah Grady, MD, MPH
doi : 10.1001/jamainternmed.2020.5935
JAMA Intern Med. 2021;181(3):309-310
Advance care planning (ACP) is a stepwise process that addresses patient preferences for advance directives, durable power of attorney, and end-of-life care. These discussions often lead to higher-quality, goal-concordant care for patients.1 Yet, ACP rarely occurs in the ambulatory care setting.2 Moreover, current approaches to ACP often fail to engage patients and their families or are not well integrated into clinician workflow.3
The Updated US Preventive Services Task Force Hepatitis B Screening Recommendations—Staying Committed
Chelsea Q. Xu, MD; Kali Zhou, MD; Danielle Brandman, MD, MAS
doi : 10.1001/jamainternmed.2020.7858
JAMA Intern Med. 2021;181(3):310-312
Hepatitis B virus (HBV) remains a major public health concern worldwide, and an estimated 850?000 to 2 million individuals are infected with chronic HBV in the United States.1 While the United States remains a low endemic region with an overall HBV prevalence of 0.4%, there are subpopulations with higher prevalence, such as foreign-born individuals and injection drug users. In an updated recommendation statement,2 along with the updated evidence report and systematic review,3 the United States Preventive Services Task Force (USPSTF) recommends screening for HBV in nonpregnant adolescents and adults at increased risk for HBV infection (B recommendation). Individuals at increased risk include foreign-born immigrants from a region of hepatitis B surface antigen (HBsAg) prevalence of 2% or greater, regardless of vaccination history, as well as US-born individuals not vaccinated as infants and whose parents were born in a region with high HBsAg prevalence of 8% or greater (Figure4,5). The USPSTF also recommends screening individuals with behavioral risk factors, including past or current intravenous drug use, men who have sex with men, persons with HIV, and household contacts and sexual partners of HBsAg-positive individuals. The recommendation is unchanged from 2014, but the level of evidence is bolstered by new studies on screening and the benefits of antiviral therapy.3
Modernize Medical Licensing, and Credentialing, Too—Lessons From the COVID-19 Pandemic
Donnie L. Bell, MD; Mitchell H. Katz, MD
doi : 10.1001/jamainternmed.2020.8705
JAMA Intern Med. 2021;181(3):312-315
the coronavirus disease 2019 (COVID-19) pandemic has revealed how ill prepared our current state licensure and individual hospital credentialing procedures are to respond to a crisis, which requires hiring more physicians. In the past year, various states have been in desperate need of additional physicians to care for critically ill patients. Because physician licensure is by state, states had to waive this requirement to hire physicians licensed in other states. In addition, hospitals had to implement their disaster plans to streamline credentialing requirements to bring on additional physicians whether from in-state or out-of-state.
Moving Patient Care Forward in the Biden Era
Robert Steinbrook, MD; Mitchell H. Katz, MD; Rita F. Redberg, MD, MSc
doi : 10.1001/jamainternmed.2021.0050
JAMA Intern Med. 2021;181(3):315-316
when Joseph Biden is inaugurated as the 46th president of the United States on January 20, 2021, the chaos of the Trump era1 should eventually begin to fade and the formidable task of controlling and ending the coronavirus disease 2019 (COVID-19) pandemic must move forward in earnest. The speed and effectiveness of the response is likely to define the Biden era. COVID-19 has dwarfed the myriad of other health care challenges, and removing its threat, which has paralyzed the country since March 2020, will determine whether the new administration will be able to restore trust in the competence of the US government with regard to science and public health.
Are Methods for Evaluating Medications Appropriate for Evaluating Nonpharmacological Treatments for Pain?—Challenges for an Emerging Field of Research
Daniel C. Cherkin, PhD
doi : 10.1001/jamainternmed.2020.7081
JAMA Intern Med. 2021;181(3):328-329
Interest in identifying safe and effective nonpharmacological treatments for chronic or recurrent pain conditions has rapidly grown in recent years, largely because of growing concerns about the adverse effects and questionable effectiveness of opioids and other pharmacological treatments. In this issue of JAMA Internal Medicine, Wells and colleagues1 present the results of their randomized clinical trial comparing the effectiveness of mindfulness meditation (specifically mindfulness-based stress reduction [MBSR]) and headache education (HAE) for persons experiencing 4 to 20 migraines per month for at least 1 year. Ninety-six participants were enrolled, 49 (51%) to MBSR and 47 (49%) to HAE. The primary outcome, improvement in diary-reported migraine day frequency from baseline to 12 weeks, did not differ significantly in the 2 groups. However, the MBSR group had significantly greater improvements in disability, quality of life, self-efficacy, pain catastrophizing, and depression. The effect sizes for these measures were moderate to large and persisted at least 36 weeks. Finally, MBSR participants reported significantly greater decreases from baseline in pain unpleasantness and intensity following experimentally induced pain.
Media Portrayals of Extracorporeal Membrane OxygenationThe Unforeseen Harm of Unfounded Optimism
Jessica N. Holtzman, MD; Sanket S. Dhruva, MD, MHS
doi : 10.1001/jamainternmed.2020.6091
JAMA Intern Med. 2021;181(3):394-395
The news media can be a powerful ally to the field of medicine. Because of its central role in shaping patient perceptions through news stories, the media can positively influence patient behavior and affect decisions about treatment options.1 Ideally, news stories about medical therapies would provide balanced, accurate evidence about risks and benefits; such balance is particularly important for high-stakes procedures, such as extracorporeal membrane oxygenation (ECMO).
Regardless of Age, Obesity and Hypertension Increase Risks With COVID-19
Mitchell H. Katz, MD
doi : 10.1001/jamainternmed.2020.5415
JAMA Intern Med. 2021;181(3):381
older age has consistently been associated with higher mortality in patients with coronavirus disease 2019 (COVID-19).1,2 Unfortunately, as shown by Cunningham et al3 in this issue of JAMA Internal Medicine, COVID-19 does not spare young people. Using a national all-payer hospital database, the investigators identified 3222 nonpregnant adults aged 18 to 34 years who were admitted to US hospitals for COVID-19. Morbidity was substantial: 21% required intensive care, and 2.7% died. Mortality was higher among those who had obesity, hypertension, and male sex, as has been noted in general adult populations.
Amplifying Access to Hearing Aids
Jennifer Claytor, MD, MS; Kenneth E. Covinsky, MD, MPH
doi : 10.1001/jamainternmed.2020.5638
JAMA Intern Med. 2021;181(3):385-386
In this issue of JAMA Internal Medicine, Reed et al1 describe trends in hearing aid use from 2011 to 2018 and note differences by race and socioeconomic status. Disabling hearing loss, defined by the National Institute on Deafness and Other Communication Disorders as hearing loss of at least 35 dB in the better ear, affects an estimated quarter of adults aged 65 to 74 years and more than half of adults 75 years and older and has been linked to social isolation, poor psychosocial outcomes, and a heightened fall risk. However, only a small proportion of people in the US who could benefit from a hearing aid have ever used one (https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing).
Reappraising Medical Syntax—Does Race Belong in the First Line of the Patient History?
Jesse C. Ikeme, MD; James W. Salazar, MD, MAS; Richard W. Grant, MD, MPH
doi : 10.1001/jamainternmed.2020.5789
JAMA Intern Med. 2021;181(3):388-391
In the midst of the resurgent movement for racial justice, physicians and health care institutions should carefully look within for potential sources of racial and ethnic health disparities. In this issue of JAMA Internal Medicine, Balderston et al1 report on differential documentation of race in the first line of the history of present illness (HPI). In 1200 admissions to an academic medical center in Richmond, Virginia, 33% of Black patients had their race documented in the first line of their admission note compared with 17% of White patients (adjusted odds ratio, 1.57; 95% CI, 1.11-2.25). Black clinicians had 58% lower odds of documenting race than White clinicians (adjusted odds ratio, 0.42; 95% CI, 0.20-0.80), and attending physicians had 2.37 times greater odds of documenting race than resident physicians (95% CI, 1.73-3.27) in adjusted analyses.
Compounded Bioidentical Hormone TherapyThe National Academies Weigh In
Cynthia A. Stuenkel, MD; JoAnn E. Manson, MD, DrPH
doi : 10.1001/jamainternmed.2020.7232
JAMA Intern Med. 2021;181(3):370-371
On July 1, 2020, the National Academies of Sciences, Engineering, and Medicine (NASEM) published The Clinical Utility of Compounded Bioidentical Hormone Therapy: A Review of Safety, Effectiveness, and Use,1 a report commissioned in September 2018. The US Food and Drug Administration (FDA) charged the NASEM to summarize the available evidence on compounded bioidentical hormone therapy (cBHT) and develop recommendations on the clinical utility of cBHT drug products, whether the current safety and effectiveness evidence supports use of these products to treat patients, and the patient populations that might require a cBHT drug product in place of an FDA-approved drug product.1
Clinical Outcomes in Young US Adults Hospitalized With COVID-19
Jonathan W. Cunningham, MD; Muthiah Vaduganathan, MD, MPH; Brian L. Claggett, PhD; et al.
doi : 10.1001/jamainternmed.2020.5313
JAMA Intern Med. 2021;181(3):379-381
Coronavirus disease 2019 (COVID-19) is increasing rapidly among young adults in the US.1 Often described as a disease affecting older adults, to our knowledge, few studies have included younger patients to better understand their anticipated clinical trajectory. We investigated the clinical profile and outcomes of 3222 young adults (defined by the US Census as age 18-34 years) who required hospitalization for COVID-19 in the US.
Outcomes of Contact Tracing in San Francisco, California—Test and Trace During Shelter-in-Place
Darpun D. Sachdev, MD; Hannah K. Brosnan, MPH; Michael J. A. Reid, MD, MPH; et al.
doi : 10.1001/jamainternmed.2020.5670
JAMA Intern Med. 2021;181(3):381-383
Given the pressing need to reopen economic activity prior to the availability of a vaccine, the US and other nations are investing in contact tracing as a core component of the coronavirus disease 2019 (COVID-19) response.1 An estimated 75% of infected contacts need to be quarantined to contain COVID-19.2,3 We evaluated case investigation and contact tracing outcomes in San Francisco, California, during shelter-in-place restrictions.
Trends in Hearing Aid Ownership Among Older Adults in the United States From 2011 to 2018
Nicholas S. Reed, AuD; Emmanuel Garcia-Morales, PhD; Amber Willink, PhD
doi : 10.1001/jamainternmed.2020.5682
JAMA Intern Med. 2021;181(3):383-385
Hearing loss is common among older adults, and those with hearing loss have greater levels of health care use and are more likely to have dementia.1,2 However, cross-sectional, nationally representative data from the 1999 through 2006 cycles of the National Health Examination and Nutrition Study suggest that fewer than 20% of adults with hearing loss in the US report hearing aid use.3 High cost, poor access, and stigma have previously been reported as barriers to hearing aid uptake in the US.4 To date, most estimates of hearing aid use in the US are cross-sectional, and there is a paucity of studies examining trends in hearing aid ownership in nationally representative longitudinal data sets.
Trends in Physician Voting Practices in California, New York, and Texas, 2006-2018
Hussain S. Lalani, MD, MPH; David H. Johnson, MD; Ethan A. Halm, MD, MPH, MBA; et al.
doi : 10.1001/jamainternmed.2020.6887
JAMA Intern Med. 2021;181(3):383-385
From 1996 to 2002, eligible physicians voted approximately 9 percentage points less than the general population.1 Since then, physician voter engagement has not been reported. We investigated physician voter participation, voter registration, and voter turnout from 2006 through 2018 in California, New York, and Texas, which are states with the largest number of physicians.
Differential Documentation of Race in the First Line of the History of Present Illness
Jessica R. Balderston, MD; Zachary M. Gertz, MD; Raees Seedat, MS; et al.
doi : 10.1001/jamainternmed.2020.5792
JAMA Intern Med. 2021;181(3):386-388
Black patients frequently fare worse than White patients with respect to numerous health outcomes even after controlling for socioeconomic factors.1 In clinical situations where pathophysiology does not vary by race, patient race may predict differences in treatment and ultimate outcome.2-4 This suggests that racial bias is present and may be associated with variations in patient care. Our study looked for evidence of explicit racial bias in clinician documentation.
Trends in Outpatient Care Delivery and Telemedicine During the COVID-19 Pandemic in the US
Sadiq Y. Patel, PHD, MS, MSW; Ateev Mehrotra, MD, MPH; Haiden A. Huskamp, PhD; et al.
doi : 10.1001/jamainternmed.2020.5928
JAMA Intern Med. 2021;181(3):388-391
The coronavirus disease 2019 (COVID-19) pandemic has dramatically altered patterns of health care delivery in the US. In the context of declining in-person outpatient visits, many clinicians began using telemedicine for the first time, spurred in part by regulatory changes that expanded public and private insurer reimbursement for a wider range of telemedicine services.1,2 To understand how telemedicine compensated for declining outpatient volume and geographic variation in changing patterns of outpatient care, we examined telemedicine and in-person outpatient visits in 2020 among a national sample of 16.7 million individuals with commercial or Medicare Advantage insurance.
Media Portrayals of Outcomes After Extracorporeal Membrane Oxygenation
Shannon M. Fernando, MD, MSc; Rebecca Mathew, MD; Arthur S. Slutsky, MD, MASc; et al.
doi : 10.1001/jamainternmed.2020.6094
JAMA Intern Med. 2021;181(3):391-394
Extracorporeal membrane oxygenation (ECMO) can provide temporary cardiac or respiratory support for the most severely ill patients in the intensive care unit. Use of ECMO has rapidly increased recently,1 with studies suggesting favorable outcomes in selected patient populations.2,3 However, ECMO is associated with important complications1; it consumes considerable resources4; and patients receiving ECMO remain at substantial risk of short- and long-term morbidity and mortality.1,4
Effect and Reach of Medical Articles Posted on Preprint Servers During the COVID-19 Pandemic
Ye Eun (Grace) Jung, MD; Yifei Sun, PhD; Neil W. Schluger, MD
doi : 10.1001/jamainternmed.2020.6629
JAMA Intern Med. 2021;181(3):395-397
There are ongoing controversies about the evaluation and dissemination of medical and scientific research.1-3 Preprint servers offer researchers the opportunity to post manuscripts before publication in peer-reviewed journals and regardless of whether they have been submitted to journals for review. The global coronavirus disease 2019 (COVID-19) pandemic has focused attention on the timely reporting and dissemination of research findings, and the respective roles of preprint servers and traditional peer-reviewed journals. We compared the effect and reach of studies about therapies for COVID-19 posted on the medRxiv preprint server, subsequent publications in medical journals of some of these studies, and journal articles that were not posted on either medRxiv or another preprint server.
Association of Political Party Affiliation With Physical Distancing Among Young Adults During the COVID-19 Pandemic
Adam M. Leventhal, PhD; Hongying Dai, PhD; Jessica L. Barrington-Trimis, PhD; et al.
doi : 10.1001/jamainternmed.2020.6898
JAMA Intern Med. 2021;181(3):399-403
Public messages about physical distancing during the coronavirus disease 2019 (COVID-19) pandemic in the US have diverged across government officials and news media outlets with different political leanings.1 Prior studies found that people with Republican (vs other) political party affiliations report less physical distancing.2,3 These studies used crowdsourced internet samples, inadequately adjusted for confounders, collected data before widespread public health messaging about physical distancing, or included few young adults.2,3
The de Winter Electrocardiogram Pattern Evolving From Hyperacute T Waves
Yi-Wei Cao, MD; Hao-Yu Wu, MD; Lei Liang, MD
doi : 10.1001/jamainternmed.2020.7084
JAMA Intern Med. 2021;181(3):372-373
A man in his 40s with a long-term smoking history was referred to the emergency department with persistent chest pain accompanied by sweating and nausea, which had been present for a half-hour. On admission, the patient’s vital signs were as follows: blood pressure of 116/74 mm Hg, a regular pulse of 86 beats/min, and a respiratory rate of 19 breaths/min. Cardiopulmonary examination showed no remarkable findings. The initial troponin I level was less than 0.03 ng/mL (normal range, <0.03 ng/mL; to convert to ?g/L, multiply by 1.0). An initial 12-lead electrocardiogram (ECG) was performed immediately on admission (Figure, A). Approximately 1 hour later, a preoperative ECG was performed (Figure, B).
A Young Man With Generalized Muscle Weakness and a Peculiar ElectrocardiogramCarpe Diem
Dinkar Bhasin, MD, DM; Rahul Kumar, MD; Anunay Gupta, MD, DM
doi : 10.1001/jamainternmed.2020.7119
JAMA Intern Med. 2021;181(3):374-376
A man in his 20s presented to the emergency department with acute-onset, bilateral lower-limb weakness. He reported performing physical activity he was unaccustomed to 1 day prior to the presentation. When he woke up in the morning, he was unable to move both of his lower limbs. The weakness rapidly progressed to involve the upper limbs. There was no facial or respiratory muscle weakness or sensory or autonomic symptoms. His medical history was unremarkable. On examination, the patient’s vitals were stable. Lower-limb weakness was more severe compared with the upper limbs, and proximal muscle weakness was more than the distal muscle weakness. Deep tendon reflexes were markedly diminished. Other findings of the examination were normal. A 12-lead electrocardiogram (ECG) was among the first investigations to be done (Figure, A).
Acute Coronary Syndrome With Anterior Precordial ST DepressionNip It in the Bud
Aayush K. Singal, MD; Bharath Raj Kidambi, MD, DM; Raghav Bansal, MD, DM
doi : 10.1001/jamainternmed.2020.7379
JAMA Intern Med. 2021;181(3):377-378
A man in his 60s with no history of diabetes, hypertension, or smoking presented to the emergency department with history of acute-onset left-sided chest pain associated with breathlessness for 16 hours. On examination, the patient was distressed and had a room air oxygen saturation of 88%. Chest auscultation revealed bilateral basal crepitations along with a short systolic murmur at cardiac apex. The Figure, A, shows the electrocardiogram (ECG) taken at the time of presentation.
Variation in Biosimilar Uptake in Europe
Jon Tr?rup Andersen, MD, PhD; Thomas Bo Jensen, MD, BSc
doi : 10.1001/jamainternmed.2020.6567
JAMA Intern Med. 2021;181(3):403-404
To the Editor We are pleased with the continuous focus on biosimilars to reduce the cost of biological drugs. In their Research Letter, Chen and colleagues1 describe the shift in use of infliximab from biooriginator to biosimilar in patients enrolled in Medicare fee-for-service. In the 2 years after launch, infliximab biosimilar uptake was only 10%. The authors1 compare this with a 40% uptake of filgrastim biosimilars and speculate that the modest infliximab shift could be due to barriers to adopting biosimilars for chronic conditions. They further suggest that one of the reasons could be physicians being hesitant to switch patients already treated with the biooriginator due to unfamiliarity with the biosimilar.1 The authors argue that the experience of patients in the US is similar to that of patients in Europe, but we believe this is too simplistic a comparison and would like to emphasize that implementation varies widely across Europe.
Variation in Biosimilar Uptake in Europe—Reply
Alice J. Chen, PhD; Karen Van Nuys, PhD
doi : 10.1001/jamainternmed.2020.6570
JAMA Intern Med. 2021;181(3):404
In Reply In their Letter to the Editor regarding our Research Letter,1 Andersen and Jensen highlight several cases in Denmark where uptake rates for biosimilar versions of infliximab, etanercept, and adalimumab ranged from 85% to 97% within 1 year of market entry. They credit thorough planning—in addition to determination, discussions with clinicians, and economic incitement—for the dramatic adoption of these biosimilars. With near-100% uptake of several biosimilars, Denmark stands out in terms of its biosimilar switching initiatives.2
Differential Diagnosis for Electrocardiography Challenge
Chakrapani Mahabala, MD; Sushmita R. S. Upadhya, MBBS; Ashraf Malik, BSc, MBBS
doi : 10.1001/jamainternmed.2020.7113
JAMA Intern Med. 2021;181(3):404-405
To the Editor This letter is in reference to the Challenge in Clinical Electrocardiography by Choxi et al1 describing an irregular narrow complex tachycardia. The article described an interesting and unusual case of occurrence of dual atrioventricular nodal nonreentrant tachycardia and the need to differentiate it from atrial fibrillation. We would like to commend the authors for sharing their observations and discussing the differential diagnosis. We would like to offer atrial bigeminy as another differential diagnosis for the electrocardiogram (ECG) mentioned in the article.
Differential Diagnosis for Electrocardiography Challenge—Reply
Ravi Choxi, DO; Todd Teigeler, MD; Richard Shepard, MD
doi : 10.1001/jamainternmed.2020.7078
JAMA Intern Med. 2021;181(3):405
In Reply This letter is written as a reply to the astute Letter to the Editor written by Mahabala and colleagues offering atrial bigeminy as another differential diagnosis regarding a regularly irregular narrow complex tachycardia presented in our Challenge in Clinical Electrocardiography.1 The authors interpret the electrocardiogram (ECG) presented in the article1 and highlight the possibility of atrial bigeminy with a sinus P wave with a PR interval of 240 milliseconds followed by an ectopic P wave with a shorter PR interval of 160 milliseconds, as summarized in their ladder diagram.
Implementing Group-Based Pelvic Floor Muscle Training in Clinical Practice
Satoshi Funada, MD; Yan Luo, MD
doi : 10.1001/jamainternmed.2020.7116
JAMA Intern Med. 2021;181(3):405-406
To the Editor In a randomized controlled noninferiority trial, Dumoulin et al1 demonstrated that group-based pelvic floor muscle training (PFMT) was noninferior to individual PFMT for its efficacy in treating elderly women with stress or mixed urinary incontinence. In general, a poor-quality study can introduce bias that underestimates the intertreatment differences, easily leading to an apparent noninferiority conclusion that may be incorrect. Therefore, particular attention should be paid to how the noninferiority study was planned and implemented. This study has a refined protocol that conforms to the guidelines,2 and it was very well implemented, especially for the following 2 points. First, the margin of noninferiority was set at 10% difference in this study, which was reasonably clinically meaningful, and it was prespecified in the trial protocol. Second, the dropout rate was 13% in the group-based PFMT arm and 10% in the individual PFMT arm at 1 year follow-up, which were low enough to decrease the bias favoring noninferiority caused by significant dropouts. Moreover, adherence to intervention was also high. In terms of those criteria, this study was well-designed and conducted with high quality, thus the conclusion of noninferiority was trustworthy.
Implementing Group-Based Pelvic Floor Muscle Training in Clinical Practice—Reply
Chantale Dumoulin, PhD; Licia Cacciari, PhD; Marie-Hélène Mayrand, MD, PhD
doi : 10.1001/jamainternmed.2020.7110
JAMA Intern Med. 2021;181(3):406-407
In Reply We are grateful to Funada and Luo for raising the important question of the baseline characteristics and outcomes of the participants in the group-based pelvic floor muscle training (PFMT) arm of our Original Investigation1 who requested a 20-minute private session. The baseline characteristics of the subgroup of 12 participants who requested 1 private session with the physiotherapist to improve their understanding and capacity to contract their pelvic floor muscle (PFM) during PFM exercises were not significantly different from those of the other 166 women in the group-based intervention arm who did not request an individual assessment.
Protein Intake and Cause-Specific Mortality
Zhengyu Ren, BA; William Kwame Amakye, MA; Maojin Yao, PhD
doi : 10.1001/jamainternmed.2020.7257
JAMA Intern Med. 2021;181(3):407-408
To the Editor We appreciate the meticulous work performed by Huang et al1 in the Original Investigation “Association Between Plant and Animal Protein Intake and Overall and Cause-Specific Mortality,” recently published in JAMA Internal Medicine. However, there are some issues to which we wish to draw attention.
Protein Intake and Cause-Specific Mortality—Reply
Jiaqi Huang, PhD; Demetrius Albanes, MD
doi : 10.1001/jamainternmed.2020.7260
JAMA Intern Med. 2021;181(3):407-408
In Reply We thank Ren and colleagues for their comments regarding our recent Original Investigation.1 The issues of complex nutritional components (including protein) in foods do have biological implications and can in part be addressed through statistical analyses, comparison of risk patterns, and interpretation.
Coding Errors in Study of Meta-analyses With Falsified Data in the Results
Craig A. Garmendia, PhD, MS
doi : 10.1001/jamainternmed.2020.7164
JAMA Intern Med. 2021;181(3):408-409
To the Editor In 2019, my colleagues and I were privileged with the publication of our study, “Evaluation of the Inclusion of Studies Identified by the FDA as Having Falsified Data in the Results of Meta-analyses: The Example of the Apixaban Trials.”1 Our study showed the need to ensure that medical literature is accurate. Thus, it would be hypocritical to not correct errors discovered within our own study. On behalf of my coauthors, I summarize the errors and corrections herein.
Coding Errors in Study of Meta-analyses With Falsified Data in the Results
doi : 10.1001/jamainternmed.2020.7217
JAMA Intern Med. 2021;181(3):409
the Research Letter titled “Evaluation of the Inclusion of Studies Identified by the FDA as Having Falsified Data in the Results of Meta-analyses: The Example of the Apixaban Trials,”1 published online first on March 4, 2019, and in the April 2019 print issue of JAMA Internal Medicine, contained an analysis that should not have been counted, and further analysis uncovered 2 coding errors. When these errors were corrected, the main conclusions of the original publication did not change, but the point estimates and percentages of the results were increased. A full explanation of these errors is provided in an accompanying Letter to the Editor,2 and the article has been corrected online.
Error in the Byline
doi : 10.1001/jamainternmed.2021.0245
JAMA Intern Med. 2021;181(3):409
in the Original Investigation titled, “Comparison of Saliva and Nasopharyngeal Swab Nucleic Acid Amplification Testing for Detection of SARS-CoV-2: A Systematic Review and Meta-analysis,”1 which published online January 15, 2021, Ms Yao’s name and academic degree were incorrect. Her name should be listed as Mandy Yao, BSc. This article was corrected online.
