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 Michael E. Pichichero, MD, author of Combined Tetanus, Diphtheria, and 5-Component Pertussis Vaccine for Use in Adolescents and Adults, published in the June 22/29 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Need: The combined tetanus-diphtheria 5-component pertussis vaccine is needed; There has been a 300% increase of pertussis among US adolescents in the last three years. 2. Safety: The combined tetanus-diphtheria 5-component pertussis vaccine is safe, as the reactions are the same as the tetanus vaccine. 3. Universal: On June 30, 2005, the American Academy of Pediatrics (ASAP), America Academy of Family Physicians (AFAR), and the Advisory Committee on Immunization Practices (ACID) all recommended the universal use of the combined tetanus-diphtheria 5-component pertussis vaccine or its competitor vaccine for adolescents.

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.

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 discusses considerations that might lead physicians to change their practice based on RCTs reporting non–statistically significant differences in primary outcomes, including trial methodology, totality of evidence, cost, invasiveness, and labor-intensiveness of the interventions being compared.

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 essay, the author relays his personal experience with ethnicity-based discrimination and discusses the “microaggressions” that medical trainees from underrepresented groups based on race/ethnicity, gender, or sexual orientation experience.

In this essay, a critical care pediatric hospitalist finds herself on the other side of the office table advocating for the specific medical care needed to address her son’s rare skeletal dysplasia and her search for a pediatric specialist with whom to travel on this quest.