Production vs. volatility: Can a quarterback outproduce a bad turnover-worthy throw rate?

Interview with Henry M. Blumberg, MD, author of Update on the Treatment of Tuberculosis and Latent Tuberculosis Infection, published in the June 8 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Tuberculosis is a public health problem. The responsibility for prescribing an appropriate regimen and assuring that treatment is completed is assigned to the public health program or the treating physician, not the patient. 2. Directly observed therapy is recommended for all patients being treated for active TB, this will necessitate the need for greater collaboration between the treating physician and the public health department. 3. Initial therapy for newly diagnosed patients with tuberculosis consists of a 4-drug regimen including isoniazid, rifampin, pyrazinamide and ethambutol. 4. Testing for latent TB infection should be targeted at those who are at increased risk of progression to active TB. 5. Despite its limitations, the tuberculin skin test remains the most commonly used test for the diagnosis of latent TB infection; newer diagnostic tests for latent TB infection are on the horizon. 6. Active tuberculosis should be excluded before beginning treatment for latent tuberculosis infection. 7. Nine months of isoniazid is the preferred therapy for the treatment of latent TB infection.

Interview with Judith K. Ockene, PhD, MEd, author of Symptom Experience After Discontinuing Use of Estrogen Plus Progestin, published in the July 13 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Of the women who stopped E plus P, 21.2% had menopausal symptoms (hot flashes or night sweats) after stopping study medication compared to 4.8% of women who were on placebo. 2. Of the women who had menopausal symptoms when they started the study (about 12%) and were in the active hormone group, over 50% had a recurrence of symptoms after they stopped MHT compared to 21% of placebo users who had a recurrence of symptoms. 3. Women in the E plus P group reported higher rates of pain or stiffness (36.8%) after they stopped study medication compared to women who had been on placebo (22.2%). 4. Women who had symptoms after they stopped study medication reported using a wide range of strategies to manage symptoms and a large proportion found the strategies to be helpful.

Interview with Matthew H. Samore, MD, author of Clinical Decision Support and Appropriateness of Antimicrobial Prescribing: A Randomized Trial, published in the November 9 issue of JAMA, the Journal of the American Medical Association. Summary points: 1. Repetitive use of a diagnostic and treatment algorithm to ingrain new prescribing habits was a valuable part of this practice change intervention. 2. Clinical decision support systems (CDSS) are feasibly implemented in practice settings that lack electronic medical records, including rural communities. 3. CDSS needs to be integrated with tools that save clinicians' time to be sustainable.

Interview with Melanie A. Thompson, MD, and Paul A. Volberding, MD, authors of Antiretroviral Treatment of Adult HIV Infection 2012 Recommendations of the International Antiviral Society-USA Panel. Summary Points:

• Antiretroviral treatment is recommended and should be offered to all persons with HIV, regardless of CD4 cell count.
• Particular attention should be paid to the design of an antiretroviral regimen for persons with concurrent conditions, such as viral hepatitis, opportunistic infections, and other medical diseases, because of the potential for drug interactions.
• Monitoring of entry into and retention in HIV care, adherence to antiretroviral therapy, and quality of care indicators are recommended and should be used to increase care engagement and quality.

This JAMA Clinical Guidelines Synopsis summarizes the American Gastroenterological Association Institute’s 2018 guideline on initial management of acute pancreatitis.

This Viewpoint attributes improved understanding of the role of autoantibodies and B-cell activity in MS pathogenesis and the development of effective therapies to the ability of physician-scientists to bring clinical insights to laboratory research and it emphasizes the importance of supporting and encouraging these investigators to reinvigorate science at the bedside.

This Viewpoint proposes a framework for international cooperation among governments and organizations to replace competition and hoarding with equitable global distribution of COVID-19 therapeutics and vaccines as they are developed.

This Viewpoint proposes that universal respiratory precautions in the operating room—use of respirators with face masks and eye protection—could protect staff from possible coronavirus disease 2019 (COVID-19) infection and facilitate resumption of elective surgeries canceled during the first wave of the pandemic.

Forty years ago, in 1980, Jimmy Carter was president. Pac-Man debuted. In medicine, smallpox was declared to be eradicated. Additionally, on May 9, 1980, A Piece of My Mind was inaugurated in JAMA. The first essay, “Tuna on Rye, 1984,” was written by then–senior editor Samuel Vaisrub under the pen name Sam Vee. He introduced the column with an editorial entitled “For the Peace of Your Mind.”

We hasten to assure our readers that a piece of my mind...is not intended as a sounding board for peevish gripes, nit-picking beefs, or sundry assortments of righteous indignation, which are usually prefaced by an angry “let me give you a piece of my mind.” Nor is this section of The Journal meant to be a podium for pompous preachments and ex cathedra pronouncements. Nor again is it designed to be a forum for half-baked speculations and warmed-over hypotheses. Least of all is a piece of my mind envisaged as a jamboree of jokes and a shivaree of limericks.

As my Italian father would say, since the house is burning      let us warm ourselves, and so

In this narrative medicine essay, a level-one trauma nurse compares Arizona’s 2 seasons with the waning and the waxing of patient admissions and with the cycle of grief for loss of her mother and son, realizing how much their deaths have affected her nursing.

In this narrative medicine essay, a psychologist peels back the layers of her reticence and comes to terms with working with transgender patients as a member of LGBT community.

In this narrative medicine essay, a primary care physician describes a drawing by a 7-year-old patient who is sitting on an examination table with her mother cradling her baby sister with the physician’s back to them entering data in the computer as an example of a system that is sacrificing human contact for electronics.

In this narrative medicine essay, Donald M. Berwick shares the story of his patient Isaiah with the 2012 Harvard Medical School graduating class as an example of a patient who deserved the treatment that cured him of leukemia but whose life was lost to poverty and exhorts them to regard health care as human right that must be preserved in the clinic and in public.

In this narrative medicine essay, a resident physician recalls the joy she felt while learning the formal language of medicine as a student and anticipates the lifelong joy of learning to interpret that language in ways most helpful for her patients.

In this narrative medicine essay, an attending physician shares his observations of how the changing nature of electronic medical record (EMR) hospital progress notes—often entered out of sequence and becoming ever longer and more unreadable—can hamper interacting with patients and providing patient care.

In this narrative medicine essay, a surgeon and palliative care physician describes the isolating silence that she felt her after the slaying of her father in Egypt when she was 18 years old and how that lingering silence has come to guide her when sitting with patients, when there are no words.