JAMA✓

💬 Viewpoint by Serge Tonen-Wolyec, MD, PhD, Félicien Munday Mulopo, PhD, Salomon Batina-Agasa, MD, PhD, and Laurent Bélec, MD, PhD, MPH: Integrating field ethicists into incident management systems may improve the social legitimacy of #PublicHealth interventions during outbreaks, including quarantine, safe burials, survivor celebrations, and allocation of investigational therapeutics. This approach has implications for global health governance, including the World Health Organization and Africa Centres for Disease Control and Prevention, by making ethics a core operational function rather than a separate regulatory step.

📊 JAMA Clinical Guidelines Synopsis: For adults with #Rhinosinusitis, the American Academy of Otolaryngology–Head and Neck Surgery Foundation guideline defines acute bacterial rhinosinusitis as purulent nasal drainage with nasal obstruction and facial pain, pressure, or fullness that persists without improvement for at least 10 days or worsens within 10 days after initial improvement. The guideline recommends against routine radiologic imaging unless a complication or alternative diagnosis is suspected, which may help reduce unnecessary testing in ambulatory care.

Among patients with #AtrioventricularBlock, preserved left ventricular ejection fraction, and anticipated high ventricular pacing burden, left bundle-branch area pacing reduced the 24-month composite of all-cause death, heart failure events, or upgrade to biventricular pacing vs right ventricular pacing. Device-related complications were similar between groups, supporting clinical consideration of left bundle-branch area pacing for patients expected to require frequent ventricular pacing.

📊 Research Summary: For patients with #AtrioventricularBlock and high ventricular pacing burden, left bundle-branch area pacing was associated with fewer heart failure events than right ventricular pacing, with similar device-related complications.

🔖 This trial is featured in @JAMAplusTrials, a platform that highlights the implications and innovations of #ClinicalTrial research from across the JAMA Network to advance evidence-based #medicine and public #health. This October's Trial Theme of the Month focuses on extension studies in #ClinicalTrials, where long-term findings depend on how comparison groups are defined and how attrition and selection bias are handled. Read the latest editorial: 📫 Learn more and subscribe to the email newsletter:

How should extension studies to clinical trials be interpreted? Some see them as an important source of evidence on long-term safety and treatment durability. Others question their validity and whether they should be considered trials at all. 💭 Where do you stand? Cast your vote in the latest @JAMAplusTrials poll and share your perspective. 📊 Take the poll:

#MedNews: Which diet has the greatest benefits on metabolic health: Mediterranean, low-fat, or ketogenic? A head-to-head trial compared the diets in participants with metabolically unhealthy #obesity. At the same level of weight loss, the ketogenic diet improved liver fat and other metabolic measures the most. But how will that translate in the real world?

📌 Editor’s Choice from this week's issue of JAMA: ➡️ Review on Progress in #Cancer #Vaccine Development, ➡️ Medications for #AlcoholUseDisorder, ➡️ Controlling Pain for #IUD Placement, and more.

🧵 In nulliparous individuals receiving an #intrauterine device with a smaller-diameter placement tube, intrauterine mepivacaine was associated with lower pain scores, fewer reports of severe pain, and fewer vasovagal reactions vs placebo. These findings support a patient-centered option for pain management during outpatient #gynecology procedures.

📊 Research Summary: Among nulliparous individuals undergoing #intrauterine device placement, intrauterine mepivacaine reduced pain and improved tolerability vs placebo.

🧵 In patients with severe asymptomatic #carotid artery stenosis, carotid revascularization with carotid artery stenting or carotid endarterectomy plus intensive medical management did not improve cognition vs intensive medical management alone over up to 4 years. These findings indicate that cognitive benefit should not be presented as an expected outcome when discussing treatment options for this population.

💬 Editorial by Eric E. Smith, MD, MPH, and Aravind Ganesh, MD, DPhil: In patients with asymptomatic #carotid artery stenosis, carotid revascularization did not improve cognition or prevent cognitive decline compared with medical therapy alone in the CREST-2 cognitive analyses. The findings indicate that clinicians should not counsel patients that cognition will improve after revascularization and should instead focus discussions on stroke prevention.

As #AI enters clinical care, women #physicians may face greater risk of adverse effects if these tools amplify inequities already present in #medicine. 🎙️ In the latest episode of JAMA+ AI Conversations, @JAMAplusAI Editor in Chief Roy Perlis, MD, MSc, spoke with Rochelle P. Walensky, MD, MPH, about how differences in administrative burden, electronic health record use, and patient messaging could shape who benefits from artificial intelligence in practice.

🧵 Among patients with asymptomatic high-grade internal #carotid artery stenosis and reduced cognition at baseline, carotid revascularization plus intensive medical management did not improve cognitive outcomes vs intensive medical management alone over 1 year. Baseline cerebral hemodynamic impairment did not modify this result, indicating that restoring flow to the brain should not be expected to improve cognition in chronic asymptomatic carotid stenosis.

📊 Research Summary: Baseline hemodynamic impairment did not identify a cognitive benefit of carotid revascularization in asymptomatic high-grade internal #carotid artery stenosis.

🔖 This trial is featured in @JAMAplusTrials, a platform that highlights the implications and innovations of #ClinicalTrial research from across the JAMA Network to advance evidence-based #medicine and public #health. This October's Trial Theme of the Month focuses on extension studies in #ClinicalTrials, where long-term findings depend on how comparison groups are defined and how attrition and selection bias are handled. Read the latest editorial: 📫 Learn more and subscribe to the email newsletter:

Among patients with acute ischemic #Stroke who underwent successful #EndovascularTherapy for anterior circulation large vessel occlusion, adjunctive intra-arterial tenecteplase was associated with a higher rate of excellent functional outcome at 1 year vs standard medical treatment. Mortality at 1 year was similar between groups.

📄 JAMA Patient Page: #HipFracture is a break in the upper part of the thigh bone near the hip joint and usually occurs after a fall. This JAMA Patient Page describes common symptoms, diagnosis with x-ray, and treatment with #surgery followed by early mobilization, physical therapy, and rehabilitation.

US #PrescriptionDrugs launch prices increased faster than inflation from 2008 to 2025, with no evidence of a higher postpassage trend after the #InflationReductionAct. Launch prices were higher for #CellGeneTherapy, drugs for chronic use, and drugs with rare disease designations, and increased across all subgroups over time.

🧵 Among critically ill children with hypotension receiving invasive ventilation and vasoactive drugs, a permissive #BloodPressure target of the fifth percentile for age did not significantly change the composite outcome of mortality and duration of invasive ventilation at 30 days vs usual care. The permissive target was associated with lower exposure to vasoactive drugs without a signal for harm.

📊 Research Summary: A permissive #BloodPressure target in pediatric critical care was associated with lower vasoactive drug exposure without increased adverse events or kidney replacement therapy vs usual care.

🔖 This trial is featured in @JAMAplusTrials, a platform that highlights the implications and innovations of #ClinicalTrial research from across the JAMA Network to advance evidence-based #medicine and public #health. This October's Trial Theme of the Month focuses on extension studies in #ClinicalTrials, where long-term findings depend on how comparison groups are defined and how attrition and selection bias are handled. Read the latest editorial: 📫 Learn more and subscribe to the email newsletter: