In this episode of JAMA+ AI Conversations, Associate Editor Yulin Hswen and JAMA Health Forum Editor Sandro Galea discuss the issues surrounding AI’s move from the laboratory into health policy.
Science Journals
Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA.
This study aimed to assess whether intravenous tenecteplase before endovascular treatment (EVT) improves outcomes in patients with ischemic stroke due to proximal middle cerebral artery occlusion presenting 4.5 to 24 hours after symptom onset.
A 52-year-old man had 2 days of cough, dyspnea, and fever. Physical examination showed a rash on the trunk and back with clear vesicles on an erythematous base, imaging showed pulmonary infiltrates, and results of laboratory testing were positive for varicella zoster virus DNA and negative for herpes simplex virus 1 and 2. What is the diagnosis and what would you do next?
This randomized clinical trial compares the effects of adjunctive intra-arterial alteplase after successful thrombectomy vs thrombectomy alone on functional outcomes and cerebral reperfusion.
To the Editor Sibling comparison designs have reemerged as an important analytical approach for addressing unmeasured familial confounding in observational studies, particularly in perinatal and life-course epidemiology. The recent JAMA Guide to Statistics and Methods by Dr Ahlqvist and colleagues emphasized a renewed need for this study across pregnancy, environmental, psychiatric, and neurological research and discussed its potential utility in strengthening causal inference.
This cohort study compares financial, operational, and quality-of-care measures among US nonprofit hospitals that used a management consultant firm for the first time from 2009 to 2023 with observations among matched hospitals that did not use management consultants.
Patients with syphilis may have an increased risk of adverse cardiovascular outcomes, according to a study published in JAMA Network Open.
This review discusses current evidence on the epidemiology, virology, pathogenesis, clinical presentation, diagnosis, treatment, and prevention of hepatitis B virus infection, with a focus on evidence applicable to clinical practice.
This Perspective describes the challenges of prescribing exercise for weight loss, with and without the use of glucagon-like peptide 1 (GLP-1) receptor agonists, and discusses strategies clinicians can use to improve adherence to exercise recommendations.
The glutamine-binding protein GlnBP is part of an ATP-binding cassette transporter system in <i>Escherichia coli</i> and uses two well-characterized conformational states, an open ligand-free and a closed-liganded state, to facilitate active amino-acid uptake. Existing literature on its ligand-binding mechanism lacked sufficient evidence to univocally assign the kinetic type of binding mechanism for GlnBP: ligand binding prior to conformational change, that is an induced fit, or the conformational selection, in which the ligand binds the matching conformation from a pre-existing ensemble. Since such mechanistic questions are relevant for our fundamental understanding of how this and other biomacromolecules regulate cellular processes, we here revisit the question for GlnBP. We present a biochemical and biophysical analysis using a combination of calorimetry, single-molecule and surface-plasmon resonance spectroscopy, and molecular dynamics simulations. We found that both apo- and holo-GlnBP show no detectable exchange between open and (semi-)closed conformations on timescales between 100 ns and 10 ms and that ligand binding and conformational changes in GlnBP are correlated. A global analysis of our experimental results suggests that the conformational selection model is only compatible with GlnBP for the extreme scenario of very fast conformational exchange between the open and closed states on timescales <100 ns. In contrast, all data remains compatible with an induced-fit mechanism, where the ligand binds GlnBP prior to conformational rearrangements. Importantly, our work demonstrates that it is an intricate task to identify the type of kinetic binding mechanism and that this requires not only a sufficient set of data, but also an integrative experimental and theoretical framework to address the question. Based on this concept, we propose that various protein systems, for which so far only insufficient kinetic data are available, should be revisited.
Use of alternative medicines has increased among US children, a study recently published in Pediatrics Open Science suggests.
Daytime naps were associated with mortality in older adults, according to research published in JAMA Network Open.
This Viewpoint discusses how overreliance on artificial intelligence (AI) can lead to deskilling and mis-skilling among clinicians still in training and the importance of thoughtful design and implementation into the clinical learning environment.
The rapid increase in use of ambient scribes and the potential implications for clinical practice are the focus of this installment of the Healthy Dialogue podcast, featuring JAMA Senior Editor Derek C. Angus, MD, MPH, and Vincent X. Liu, MD, MS, chief data officer of The Permanente Medical Group at Kaiser Permanente.
Categorization and compartmentalization evolved in medicine to help clinicians in the daunting work of specifying a diagnosis and dispensing appropriate treatment. Such organization can make sense, safety, and efficiency out of what may seem vast and chaotic. However, can this impulse to order go too far, and can the rigid containers that result become hindersome walls that block seeing the larger whole? The poem “Cardiology in a Field of Wildflowers” demonstrates poetry’s contrasting ability to blur boundaries and expand thinking, to incite instead a more holistic vision of healing. Drawing from a deep well of imagination, the speaker whimsically daydreams about what can happen when the “boundaries of self” are “dissolve[d]” in the clinical encounter. Poetry allows the contemplative clinician to step beyond the constrained space of the examination room and into the creative, turning the static identity of “doctor” in the active verb form of the word, thus conjuring the lost magic in daily clinical work. Poetry enables exploration of this forgone realm, as the repetitive acts of palpating the pulse and auscultating the heart, while remaining essential aspects of the physical examination, become conduits of transcendent interpersonal connection. We can feel that thrilling “rush,” typically sought outside of the clinic, accessed via poetry’s reimagining of our closeness to patients, even when we routinely examine them. Roaming colorful fields and indulging in fairy tales, the actively doctoring doctor becomes a reminder of the very real liberating value of the arts in medical practice.
To the Editor The recent Perspective highlights the metabolic hazards (such as visceral adiposity) implicit in the recommendation from the 2025-2030 Dietary Guidelines for Americans (DGAs) to double protein intake. Yet, regarding stone disease, we see an important omission in the risk of nephrolithiasis.
In Reply The 2025-2030 DGAs recommend higher intake of dietary protein (1.2-1.6 g/kg per day or approximately 16%-21% of calories). This change may seem inconsequential given that the average person already meets this target, consuming approximately 16% to 17% of calories from protein. However, this new major emphasis on protein from the DGAs and the accompanying media messaging from the US Department of Agriculture and the US Department of Health and Human Services are likely to spur a significant further increase in protein consumption.
In Reply We thank Dr Hswen for her thoughtful engagement with our recent JAMA Guide to Statistics and Methods on sibling comparisons in observational studies. In that guide, we outlined the principles underlying this design, along with its key assumptions and potential threats to validity. Sibling comparisons leverage the fact that family members often share genetic and environmental factors that may confound associations in conventional observational analyses. By comparing exposed and unexposed siblings within families, the design can address confounding due to shared, often unmeasured, confounders. However, as with any other observational method, it rests on strong assumptions.
In Reply I thank Dr Tang and colleagues for the questions they raise. The study reported the effect of proactive symptom assessment led by lay health workers on reductions in emergency department and hospitalization use among older adults with cancer. While proactive, frequent assessment and algorithm-driven access to timely interventions are underlying mechanisms of action, patient engagement is a foundational determinant. The success of any proactive cancer symptom assessment intervention relies heavily on patient engagement—patients must actively report their symptoms and symptom burden over time. Current modalities, such as electronic-based approaches alone, are fraught with high attrition, especially over time, thereby diminishing the reach and effectiveness. Furthermore, the engagement of older adults in these approaches is difficult to ascertain, given that few older adults were included in the studies that established effectiveness of electronic-based approaches.
This JAMA Patient Page describes keratinocyte carcinomas and their risk factors, signs and symptoms, diagnosis, and treatment.
Virtual visits may be appropriate for first-time neurology evaluations, new research suggests.
This JAMA Insights examines the efficacy of different management strategies for anterior cruciate ligament rupture, including surgical reconstruction and structured rehabilitation.
Liu Q, Xiao Q, Sun Z, Wang B, Wang L, Wang N, Wang K, Song C, Yang Q. 2021. Exosome component 1 cleaves single-stranded DNA and sensitizes human kidney renal clear cell carcinoma cells to poly(ADP-ribose) polymerase inhibitor. eLife 10:e69454. doi: 10.7554/eLife.69454.
Published 23 June 2021
Following post-publication review of our manuscript, we identified errors in the manuscript.
In Figure 1—figure supplement 1A, the top-ranked genes of each substitution type (Supplementary file 1) were used for Gene Ontology (GO) enrichment analysis with Metascape (metascape.org). During data processing, the data corresponding to the C>T/G>A substitution were misapplied to the C>G/G>C group. The C>T/G>A mutation should be shown to be enriched in GO:0140053 mitochondrial gene expression, GO:0000959, GO:0007005, GO:1902775 and GO:0034620. We have updated Figure 1—figure supplement 1A and source data accordingly. Because the findings and conclusions were based on the original data, these corrections do not affect the conclusion that substitution mutations were enriched in ‘mitochondrial gene expression’.
In Figure 2J and Figure 2—figure supplement 1D, the labels for the A>G/T>C and A>C/T>G mutations were inadvertently reversed. In addition, the mutation frequency of A>G/T>C should be 3.13% but not 31.3%. The figures and source data have been corrected accordingly. These corrections do not affect the conclusion for C>A/G>T mutation.
In Figure 2B-2D and Figure 5E, illustrative images based on the incomplete experiments were mistaken as final experimental images. During the handover of research work, illustrative images based on incomplete experiments were applied to show the study information and figure layout. Due to a miscommunication between the authors, the illustrative images (EXOSC1 and several groups in Figure 2B-2D, and TUHR14TKB cells in Figure 5E) were mistaken as final images for publication. To rectify these issues, the authors reviewed all original data and experiment…
A new study found that acetaminophen use during pregnancy was not associated with increased risk of autism.