November 13, 2018 Issue of JAMA

November 13, 2018, Vol 320, No. 18, Pages 1833-1948

This Week in JAMA

Highlights

Abstract Full Text

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JAMA. 2018;320(18):1833-1835. doi:10.1001/jama.2017.12625

Podcast: ICU Ventilation Strategies, Deprescribing in Older Adults, Naloxone Availability, Alcohol Screening Guideline, and more

Original Investigation

Caring for the Critically Ill Patient

Effect of a Low vs Intermediate Tidal Volume Strategy on Ventilator-Free Days in Intensive Care Unit Patients Without ARDS: A Randomized Clinical Trial

Writing Group for the PReVENT Investigators

Abstract Full Text

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JAMA. 2018;320(18):1872-1880. doi:10.1001/jama.2018.14280

This randomized trial compares the effects of low vs intermediate tidal volumes on ventilator-free days and mortality among intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS).

Video: Conference Presentation: Effect of a Low vs Intermediate Tidal Volume Strategy on Ventilator-Free Days in Intensive Care Unit Patients Without ARDS: A Randomized Trial

Podcast: Observations From ICU Patients We Thought Were Asleep, but Were Not

Editorial
Lessons From ARDS for Non-ARDS Research: Remembrance of Trials Past
Gordon D. Rubenfeld, MD, MSc; Manu Shankar-Hari, PhD, MSc

JAMA

Caring for the Critically Ill Patient

Effect of Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Weaning on Time to Liberation From Mechanical Ventilation Among Patients With Respiratory Failure: The Breathe Randomized Clinical Trial

Gavin D. Perkins, MD; Dipesh Mistry, PhD; Simon Gates, PhD; et al.

Abstract Full Text

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JAMA. 2018;320(18):1881-1888. doi:10.1001/jama.2018.13763

This randomized trial compares the effects of protocolized weaning via early extubation to noninvasive ventilation vs standard weaning from invasive ventilation on time to liberation from mechanical ventilation among adults with respiratory failure ready to wean but with an unsuccessful spontaneous breathing trial.

Video: Conference Presentation: Effect of Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Weaning on Time to Liberation From Mechanical Ventilation Among Patients With Respiratory Failure: A Randomized Trial
Video: Conference Commentary: Effect of Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Weaning on Time to Liberation From Mechanical Ventilation Among Patients With Respiratory Failure: A Randomized Trial

Editorial
Weaning From Mechanical Ventilation: What Should Be Done When a Patient鈥檚 Spontaneous Breathing Trial Fails?
Laveena Munshi, MD, MSc; Niall D. Ferguson, MD, MSc

JAMA

Effect of a Pharmacist-Led Educational Intervention on Inappropriate Medication Prescriptions in Older Adults: The D-PRESCRIBE Randomized Clinical Trial

Philippe Martin, PhD; Robyn Tamblyn, PhD; Andrea Benedetti, PhD; et al.

Abstract Full Text

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JAMA. 2018;320(18):1889-1898. doi:10.1001/jama.2018.16131

This cluster randomized trial investigates the effects on medication discontinuation of a program in which pharmacists educated older patients taking benzodiazepines, sedative-hypnotics, first-generation antihistamines, and selective NSAIDs about why the drugs are inappropriate for their age groups and offered potential alternative treatment options.

Video: Effect of a Pharmacist-Led Intervention on Inappropriate Prescriptions in Older Adults

Editorial
Overcoming Inertia to Improve Medication Use and Deprescribing
Michael A. Steinman, MD; C. Seth Landefeld, MD

JAMA

Research Letter

Provision of Naloxone Without a Prescription by California Pharmacists 2 Years After Legislation Implementation

Talia Puzantian, PharmD, BCPP; James J. Gasper, PharmD, BCPP

Abstract Full Text

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JAMA. 2018;320(18):1933-1934. doi:10.1001/jama.2018.12291

This study assesses the availability of pharmacist-furnished naloxone 2 years after implementation of legislation in California allowing provision of the drug without a physician鈥檚 prescription.

Editorial
Overcoming Inertia to Improve Medication Use and Deprescribing
Michael A. Steinman, MD; C. Seth Landefeld, MD

JAMA

Naloxone Accessibility Without a Prescriber Encounter Under Standing Orders at Community Pharmacy Chains in Texas

Kirk E. Evoy, PharmD, BCACP, BC-ADM, CTTS; Lucas G. Hill, PharmD, BCPS, BCACP; Lindsey Groff, BS; et al.

Abstract Full Text

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JAMA. 2018;320(18):1934-1937. doi:10.1001/jama.2018.15892

This study evaluated naloxone accessibility from chain pharmacies in Texas 32 months after state legislation allowing pharmacists to dispense naloxone under standing orders from authorizing prescribers.

Editorial
Overcoming Inertia to Improve Medication Use and Deprescribing
Michael A. Steinman, MD; C. Seth Landefeld, MD

JAMA

US Preventive Services Task Force

Recommendation Statement

Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement

US Preventive Services Task Force

Abstract Full Text

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JAMA. 2018;320(18):1899-1909. doi:10.1001/jama.2018.16789

This 2018 Recommendation Statement from the US Preventive Services Task Force recommends screening for unhealthy alcohol use in primary care settings in adults, including pregnant women, and providing brief behavioral counseling to reduce unhealthy alcohol use (B recommendation) and concludes that evidence is insufficient to assess balance of benefits and harms of screening and counseling for alcohol use in primary care settings in adolescents (I statement).

Podcast: USPSTF Recommendation: Screening and Interventions for Unhealthy Alcohol Use

Editorial
Screening for Unhealthy Alcohol Use
Angela Bazzi, PhD; Richard Saitz, MD, MPH

JAMA
Unhealthy Alcohol Use in Primary Care鈥擳he Elephant in the Examination Room
E. Jennifer Edelman, MD, MHS; Jeanette M. Tetrault, MD

JAMA Intern Med
Alcohol Use Screening and Behavioral Counseling With Adolescents in Primary Care: A Call to Action
Carolyn A. McCarty, PhD; Sharon Levy, MD, MPH; Sion Kim Harris, PhD

JAMA Pediatr

Evidence Report

Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Elizabeth A. O鈥機onnor, PhD; Leslie A. Perdue, MPH; Caitlyn A. Senger, MPH; et al.

Abstract Full Text

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JAMA. 2018;320(18):1910-1928. doi:10.1001/jama.2018.12086

This systematic review to support the 2018 US Preventive Services Task Force Recommendation Statement on screening and behavioral counseling to reduce unhealthy alcohol use summarizes published evidence on the benefits and harms of screening and behavioral counseling to reduce unhealthy alcohol use among adults.

Editorial
Screening for Unhealthy Alcohol Use
Angela Bazzi, PhD; Richard Saitz, MD, MPH

JAMA
Unhealthy Alcohol Use in Primary Care鈥擳he Elephant in the Examination Room
E. Jennifer Edelman, MD, MHS; Jeanette M. Tetrault, MD

JAMA Intern Med
Alcohol Use Screening and Behavioral Counseling With Adolescents in Primary Care: A Call to Action
Carolyn A. McCarty, PhD; Sharon Levy, MD, MPH; Sion Kim Harris, PhD

JAMA Pediatr

Viewpoint

Gadolinium Retention After Contrast-Enhanced MRI

Deborah Levine, MD; Robert J. McDonald, MD, PhD; Herbert Y. Kressel, MD

Abstract Full Text

JAMA. 2018;320(18):1853-1854. doi:10.1001/jama.2018.13362

This Viewpoint discusses the retention of gadolinium, used in contrast-enhanced MRI, in skin and kidney tissue and the efforts of experts from radiological societies, the NIH, and the FDA to study the safety of this element in clinical use.

Using Quality Improvement to Promote Clinical Trials of Emergency Trauma Therapies

John A. Harvin, MD, MS; Susan H. Wootton, MD; Charles C. Miller, PhD

Abstract Full Text

JAMA. 2018;320(18):1855-1856. doi:10.1001/jama.2018.13607

This Viewpoint discusses the use of quality improvement reviews to build consensus about when randomized trials of competing treatment strategies are indicated and to inform the design and conduct of comparative effectiveness trials in emergency trauma.

Million Hearts 2022: Small Steps Are Needed for Cardiovascular Disease Prevention

Janet S. Wright, MD; Hilary K. Wall, MPH; Matthew D. Ritchey, PT, DPT, OCS, MPH

Abstract Full Text

JAMA. 2018;320(18):1857-1858. doi:10.1001/jama.2018.13326

This Viewpoint describes the Million Hearts initiative, a US Centers for Disease Control and Prevention (CDC) and Centers for Medicare & Medicaid Services program aimed at preventing 1 million acute cardiovascular (CV) events by improving key cardiovascular disease (CVD) risk factors, and summarizes two 2018 CDC reports describing the burden of preventable CVD deaths and the slow rate of improving population-level measures of CV health.

Group Purchasing Organizations, Health Care Costs, and Drug Shortages

William E. Bruhn; Elizabeth A. Fracica, MD, MPH; Martin A. Makary, MD, MPH

Abstract Full Text

JAMA. 2018;320(18):1859-1860. doi:10.1001/jama.2018.13604

This Viewpoint explains how group purchasing organizations (GPOs) 鈥� companies that purchase devices, supplies, and medication from multiple manufacturers and serve as single supply sources for hospitals and medical centers 鈥� contribute to supply shortages, higher prices, and limited product selection, and proposes policy solutions to overcome the adverse effects of the arrangements.

A Piece of My Mind

Grief After Suicide

Neil Orford, MBBS, FCICM

Abstract Full Text

JAMA. 2018;320(18):1861-1862. doi:10.1001/jama.2018.15664

In this narrative medicine essay, the author mourns the suicide of young adult of a friend and relives his brother鈥檚 suicide 30 years earlier in a stream of consiousness montage of grief and advice to succor for those left behind.

Editorial

Lessons From ARDS for Non-ARDS Research: Remembrance of Trials Past

Gordon D. Rubenfeld, MD, MSc; Manu Shankar-Hari, PhD, MSc

Abstract Full Text

JAMA. 2018;320(18):1863-1865. doi:10.1001/jama.2018.14288

Weaning From Mechanical Ventilation: What Should Be Done When a Patient鈥檚 Spontaneous Breathing Trial Fails?

Laveena Munshi, MD, MSc; Niall D. Ferguson, MD, MSc

Abstract Full Text

JAMA. 2018;320(18):1865-1867. doi:10.1001/jama.2018.13762

Overcoming Inertia to Improve Medication Use and Deprescribing

Michael A. Steinman, MD; C. Seth Landefeld, MD

Abstract Full Text

JAMA. 2018;320(18):1867-1869. doi:10.1001/jama.2018.16473

Screening for Unhealthy Alcohol Use

Angela Bazzi, PhD; Richard Saitz, MD, MPH

Abstract Full Text

JAMA. 2018;320(18):1869-1871. doi:10.1001/jama.2018.16069

Editorial
Unhealthy Alcohol Use in Primary Care鈥擳he Elephant in the Examination Room
E. Jennifer Edelman, MD, MHS; Jeanette M. Tetrault, MD

JAMA Intern Med
Alcohol Use Screening and Behavioral Counseling With Adolescents in Primary Care: A Call to Action
Carolyn A. McCarty, PhD; Sharon Levy, MD, MPH; Sion Kim Harris, PhD

JAMA Pediatr

JAMA Insights

Distinguishing Variant Pathogenicity From Genetic Diagnosis: How to Know Whether a Variant Causes a Condition

Leslie G. Biesecker, MD; Robert L. Nussbaum, MD; Heidi L. Rehm, PhD

Abstract Full Text

JAMA. 2018;320(18):1929-1930. doi:10.1001/jama.2018.14900

This Genomics and Precision Health article explains the use of genomic testing in clinical settings when a genetic basis for disease is suspected, but the evaluation has not provided enough specificity to guide selection of a single gene test or a gene panel test.

Medical News & Perspectives

Overdiagnosis of Penicillin Allergy Leads to Costly, Inappropriate Treatment

Rita Rubin, MA

Abstract Full Text

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JAMA. 2018;320(18):1846-1848. doi:10.1001/jama.2018.14358

This Medical News article discusses why many patients have mistakenly been labeled as allergic to penicillin and the impact that can have on their health.

Podcast: Major Societies Agree 鈥� A New Approach to Penicillin Allergy Is Needed

Is There a Seasonal Influence on Cognition and Dementia?

Jennifer Abbasi

Abstract Full Text

JAMA. 2018;320(18):1848-1849. doi:10.1001/jama.2018.16286

This Medical News article discusses a recently discovered association between time of year and cognitive performance even in people with Alzheimer disease.

News From the Centers for Disease Control and Prevention

Antibiotic Resistance Challenge

Bridget Kuehn, MSJ

Abstract Full Text

JAMA. 2018;320(18):1851. doi:10.1001/jama.2018.16587

Alzheimer Burden

Bridget Kuehn, MSJ

Abstract Full Text

JAMA. 2018;320(18):1851. doi:10.1001/jama.2018.16787

Biotech Innovations

Recovery of Voluntary Movement After Paralysis

Jennifer Abbasi

Abstract Full Text

JAMA. 2018;320(18):1850. doi:10.1001/jama.2018.17584

Device Reduces Heart Failure Hospitalizations and Deaths

Jennifer Abbasi

Abstract Full Text

JAMA. 2018;320(18):1850. doi:10.1001/jama.2018.17020

Relapses After CAR-T Therapy

Jennifer Abbasi

Abstract Full Text

JAMA. 2018;320(18):1850. doi:10.1001/jama.2018.17585

Poetry and Medicine

The Surgery

Jane Galin

Abstract Full Text

JAMA. 2018;320(18):1942. doi:10.1001/jama.2018.8747

JAMA Revisited

No Intimations as Yet

Abstract Full Text

JAMA. 2018;320(18):1943. doi:10.1001/jama.2017.12655

JAMA Patient Page

Screening and Counseling to Reduce Unhealthy Alcohol Use

Jill Jin, MD, MPH

Abstract Full Text

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JAMA. 2018;320(18):1948. doi:10.1001/jama.2018.16735

This JAMA Patient Page describes the US Preventive Services Task Force鈥檚 recent recommendations on screening and counseling to reduce unhealthy alcohol use.