PEEP for Postoperative Pulmonary Complications
https://jamanetwork.com/journals/jama/fullarticle/2847576
To the Editor The DESIGNATION trial compared driving pressure–guided high PEEP with standard low PEEP. We seek clarification on 2 methodological aspects of the intervention to better interpret its null result.
https://jamanetwork.com/journals/jama/fullarticle/2847576
To the Editor The DESIGNATION trial compared driving pressure–guided high PEEP with standard low PEEP. We seek clarification on 2 methodological aspects of the intervention to better interpret its null result.
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PEEP for Postoperative Pulmonary Complications
https://jamanetwork.com/journals/jama/fullarticle/2847575
To the Editor In the DESIGNATION randomized clinical trial, individualized driving pressure–guided high PEEP with recruitment maneuvers did not reduce postoperative pulmonary complications compared with standard low PEEP in adults at increased risk for postoperative pulmonary complications (Assess Respiratory Risk in Surgical Patients in Catalonia [ARISCAT] score ≥26) undergoing open abdominal surgery. As anesthesiologists frequently managing the treatment of such patients, we would like to highlight 2 aspects that may further inform bedside practice.
https://jamanetwork.com/journals/jama/fullarticle/2847575
To the Editor In the DESIGNATION randomized clinical trial, individualized driving pressure–guided high PEEP with recruitment maneuvers did not reduce postoperative pulmonary complications compared with standard low PEEP in adults at increased risk for postoperative pulmonary complications (Assess Respiratory Risk in Surgical Patients in Catalonia [ARISCAT] score ≥26) undergoing open abdominal surgery. As anesthesiologists frequently managing the treatment of such patients, we would like to highlight 2 aspects that may further inform bedside practice.
Myocardial Fibrosis and Early Intervention in Asymptomatic Patients With Severe Aortic Stenosis
https://jamanetwork.com/journals/jamacardiology/fullarticle/2847275
This study attempts to determine whether midwall myocardial fibrosis burden is associated with adverse clinical outcomes in asymptomatic patients and whether those with more fibrosis derive greater benefit from early intervention.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2847275
This study attempts to determine whether midwall myocardial fibrosis burden is associated with adverse clinical outcomes in asymptomatic patients and whether those with more fibrosis derive greater benefit from early intervention.
Cardiac Fibrosis—An Emerging Diagnostic and Therapeutic Target
https://jamanetwork.com/journals/jamacardiology/fullarticle/2847274
While cardiomyocytes account for most of a healthy heart’s mass and volume, cardiac fibroblasts are the most prevalent cell type. Cardiac fibroblasts govern the extracellular matrix, synthesizing and repairing the tissue microarchitecture, and function as crucial mediators of intercellular communication through multiple signaling mechanisms. In nearly all forms of heart disease, whether due to myocardial infarction, nonischemic cardiomyopathy, or valvular dysfunction, cardiac fibroblasts may become activated. Pathologic fibrosis ensues, with the expanded myocardial interstitium disrupting the heart’s structural integrity and promoting its dysfunction. Therefore, identifying and targeting cardiac fibroblasts before cardiac fibrosis results in irreversible injury carries strong potential clinical impact.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2847274
While cardiomyocytes account for most of a healthy heart’s mass and volume, cardiac fibroblasts are the most prevalent cell type. Cardiac fibroblasts govern the extracellular matrix, synthesizing and repairing the tissue microarchitecture, and function as crucial mediators of intercellular communication through multiple signaling mechanisms. In nearly all forms of heart disease, whether due to myocardial infarction, nonischemic cardiomyopathy, or valvular dysfunction, cardiac fibroblasts may become activated. Pathologic fibrosis ensues, with the expanded myocardial interstitium disrupting the heart’s structural integrity and promoting its dysfunction. Therefore, identifying and targeting cardiac fibroblasts before cardiac fibrosis results in irreversible injury carries strong potential clinical impact.
Myocardial Fibroblast Activation in Ischemic and Nonischemic Cardiomyopathy
https://jamanetwork.com/journals/jamacardiology/fullarticle/2847273
This case-control study compares myocardial fibroblast activation patterns between patients with heart failure with reduced ejection fraction, patients with prior myocardial infarction without heart failure, and healthy volunteers.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2847273
This case-control study compares myocardial fibroblast activation patterns between patients with heart failure with reduced ejection fraction, patients with prior myocardial infarction without heart failure, and healthy volunteers.
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A Love Letter to Clinical Trials
https://jamanetwork.com/journals/jama/fullarticle/2847669
Trials come with a multitude of tribulations. Funding for clinical trials can be elusive. Regulatory hurdles are many. Participants are hard to recruit and sometimes even harder to retain. Protocols can be unwieldy, and trial timelines can stretch endlessly. And even when completed, trials can yield results that defy expectations and challenge interpretation. As former National Institutes of Health Director Donald Fredrickson remarked more than 60 years ago, trials “strain our resources and patience, and they protract the moment of truth to excruciating limits.” And yet, clinical trials remain the bedrock of evidence-based medicine—and perhaps always will. When the stakes are highest, the medical community looks to trials to provide the certainty—or at least the clarity—needed to act.
https://jamanetwork.com/journals/jama/fullarticle/2847669
Trials come with a multitude of tribulations. Funding for clinical trials can be elusive. Regulatory hurdles are many. Participants are hard to recruit and sometimes even harder to retain. Protocols can be unwieldy, and trial timelines can stretch endlessly. And even when completed, trials can yield results that defy expectations and challenge interpretation. As former National Institutes of Health Director Donald Fredrickson remarked more than 60 years ago, trials “strain our resources and patience, and they protract the moment of truth to excruciating limits.” And yet, clinical trials remain the bedrock of evidence-based medicine—and perhaps always will. When the stakes are highest, the medical community looks to trials to provide the certainty—or at least the clarity—needed to act.
Error in Nonauthor Collaborator List
https://jamanetwork.com/journals/jama/fullarticle/2847670
The Original Investigation titled “Microultrasonography-Guided vs MRI-Guided Biopsy for Prostate Cancer Diagnosis: The OPTIMUM Randomized Clinical Trial,” published on March 23, 2025, was corrected to add Chirag Patel to the nonauthor collaborator list in Supplement 3. This article was corrected online.
https://jamanetwork.com/journals/jama/fullarticle/2847670
The Original Investigation titled “Microultrasonography-Guided vs MRI-Guided Biopsy for Prostate Cancer Diagnosis: The OPTIMUM Randomized Clinical Trial,” published on March 23, 2025, was corrected to add Chirag Patel to the nonauthor collaborator list in Supplement 3. This article was corrected online.
International Reference Pricing Across Medicare and Medicaid
https://jamanetwork.com/journals/jama/fullarticle/2847578
This Viewpoint discusses 3 US Centers for Medicare & Medicaid Services (CMS) drug pricing models and how a pivot toward international reference pricing could affect consumers, manufacturers, and drug pricing policy.
https://jamanetwork.com/journals/jama/fullarticle/2847578
This Viewpoint discusses 3 US Centers for Medicare & Medicaid Services (CMS) drug pricing models and how a pivot toward international reference pricing could affect consumers, manufacturers, and drug pricing policy.
Intrawound Tobramycin Plus Vancomycin to Prevent Surgical Site Infection in Tibial Fractures Research Summary
https://jamanetwork.com/journals/jama/fullarticle/2847579
The study compared whether applying tobramycin and vancomycin powders topically to a surgical incision during closure of definitive fixation was more effective than applying vancomycin powder alone in reducing deep surgical site infection in periarticular tibial fractures.
https://jamanetwork.com/journals/jama/fullarticle/2847579
The study compared whether applying tobramycin and vancomycin powders topically to a surgical incision during closure of definitive fixation was more effective than applying vancomycin powder alone in reducing deep surgical site infection in periarticular tibial fractures.
Fever, Rash, and Shortness of Breath
https://jamanetwork.com/journals/jama/fullarticle/2847585
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?
https://jamanetwork.com/journals/jama/fullarticle/2847585
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?
Inconsistencies Between Text and Table
https://jamanetwork.com/journals/jama/fullarticle/2847653
In the US Preventive Services Task Force Recommendation Statement titled “Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality,” published in the September 28, 2021, issue of JAMA, there were inconsistencies between Table 1 and the Practice Considerations section. Table 1 incorrectly stated, “Recommend low-dose aspirin if the patient has ≥2 moderate-risk factors. Consider low-dose aspirin if the patient has 1 of these moderate-risk factors.” Table 1 has been updated to accurately state, “Pregnant persons with 2 or more moderate-risk factors may also benefit from low-dose aspirin.” The Recognition of Risk Status section was also updated to list specific moderate risk factors more clearly and to fully align with those risk factors named in Table 1. This article was corrected online.
https://jamanetwork.com/journals/jama/fullarticle/2847653
In the US Preventive Services Task Force Recommendation Statement titled “Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality,” published in the September 28, 2021, issue of JAMA, there were inconsistencies between Table 1 and the Practice Considerations section. Table 1 incorrectly stated, “Recommend low-dose aspirin if the patient has ≥2 moderate-risk factors. Consider low-dose aspirin if the patient has 1 of these moderate-risk factors.” Table 1 has been updated to accurately state, “Pregnant persons with 2 or more moderate-risk factors may also benefit from low-dose aspirin.” The Recognition of Risk Status section was also updated to list specific moderate risk factors more clearly and to fully align with those risk factors named in Table 1. This article was corrected online.
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Saving Time in the Medical School
https://jamanetwork.com/journals/jama/fullarticle/2847651
Ray Lyman Wilbur, M.D., Stanford University, Calif.
https://jamanetwork.com/journals/jama/fullarticle/2847651
Ray Lyman Wilbur, M.D., Stanford University, Calif.
Mortality in US Immigration and Customs Enforcement Detention
https://jamanetwork.com/journals/jama/fullarticle/2847650
This study estimates annual mortality rates among individuals detained in US Immigration and Customs Enforcement facilities and summarizes age and cause of death patterns from 2004 through January 2026.
https://jamanetwork.com/journals/jama/fullarticle/2847650
This study estimates annual mortality rates among individuals detained in US Immigration and Customs Enforcement facilities and summarizes age and cause of death patterns from 2004 through January 2026.
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Audio Highlights April 17, 2026
https://jamanetwork.com/journals/jama/fullarticle/2848102
Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA.
https://jamanetwork.com/journals/jama/fullarticle/2848102
Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA.
What to Know About the Cicada SARS-CoV-2 Variant
https://jamanetwork.com/journals/jama/fullarticle/2848071
This JAMA Medical News article discusses the unusual trajectory of BA.3.2, the most recent version of SARS-CoV-2 to be designated a Variant Under Monitoring by the World Health Organization.
https://jamanetwork.com/journals/jama/fullarticle/2848071
This JAMA Medical News article discusses the unusual trajectory of BA.3.2, the most recent version of SARS-CoV-2 to be designated a Variant Under Monitoring by the World Health Organization.
FDA Approves Weekly Basal Insulin for Adults With Type 2 Diabetes
https://jamanetwork.com/journals/jama/fullarticle/2848078
The US Food and Drug Administration (FDA) approved insulin icodec-abae, marketed as Awiqli, making it the first once-weekly basal insulin treatment option for adults with type 2 diabetes.
https://jamanetwork.com/journals/jama/fullarticle/2848078
The US Food and Drug Administration (FDA) approved insulin icodec-abae, marketed as Awiqli, making it the first once-weekly basal insulin treatment option for adults with type 2 diabetes.
Metabolically Healthy Obesity in Children Still Raises Cardiometabolic Risk
https://jamanetwork.com/journals/jama/fullarticle/2848077
Some children with obesity may not have symptoms such as high blood pressure or elevated triglycerides. But recent findings suggest that even if children with obesity appear metabolically healthy, they may still benefit from treatment.
https://jamanetwork.com/journals/jama/fullarticle/2848077
Some children with obesity may not have symptoms such as high blood pressure or elevated triglycerides. But recent findings suggest that even if children with obesity appear metabolically healthy, they may still benefit from treatment.
Long-Term Neurocognitive Outcomes After Severe Malaria Infection
https://jamanetwork.com/journals/jama/fullarticle/2847974
In 1948, Salil Ghosh wrote of the near-miraculous recovery of several children with severe “malignant malaria” who had been treated with quinine. One illustrative patient, a “girl aged 9 years,” was admitted with 2 days of “unconsciousness with delirium” and found to have “rings plenty,” the classic finding of blood-stage Plasmodium falciparum infection seen on peripheral blood smear. Following administration of intramuscular, and then oral, quinine, the patient “went home in perfect health.”
https://jamanetwork.com/journals/jama/fullarticle/2847974
In 1948, Salil Ghosh wrote of the near-miraculous recovery of several children with severe “malignant malaria” who had been treated with quinine. One illustrative patient, a “girl aged 9 years,” was admitted with 2 days of “unconsciousness with delirium” and found to have “rings plenty,” the classic finding of blood-stage Plasmodium falciparum infection seen on peripheral blood smear. Following administration of intramuscular, and then oral, quinine, the patient “went home in perfect health.”
Mechanical Thrombectomy and Final Infarct Volume in Patients With Stroke
https://jamanetwork.com/journals/jamaneurology/fullarticle/2847760
This secondary analysis of a randomized clinical trial evaluates the outcomes of endovascular treatment in addition to best medical treatment compared with best medical treatment alone on the volume of brain tissue initially at risk preserved in patients with a medium or distal vessel occlusion stroke.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2847760
This secondary analysis of a randomized clinical trial evaluates the outcomes of endovascular treatment in addition to best medical treatment compared with best medical treatment alone on the volume of brain tissue initially at risk preserved in patients with a medium or distal vessel occlusion stroke.
Brain Biomarkers and a Multidomain Lifestyle Intervention
https://jamanetwork.com/journals/jamaneurology/fullarticle/2847759
This randomized clinical trial examines data for a subset of its participants to determine whether the lifestyle intervention is related to changes in brain imaging biomarkers and potential correlations with changes in cognition.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2847759
This randomized clinical trial examines data for a subset of its participants to determine whether the lifestyle intervention is related to changes in brain imaging biomarkers and potential correlations with changes in cognition.