Why It Is Unethical Not to Conduct Randomized Trials in Pregnancy
https://jamanetwork.com/journals/jama/fullarticle/2844769

This Viewpoint discusses the need to develop systematic review processes for medications during pregnancy, including routine randomized clinical trials (RCTs), rather than relying on observational study data.

Smartwatch and Hypertension Notification
https://jamanetwork.com/journals/jama/fullarticle/2844767

This cross-sectional study assesses the potential impact of a smartwatch hypertension notification feature for US adults who have not been diagnosed with hypertension.

Error in the Funding/Support Statement
https://jamanetwork.com/journals/jamaneurology/fullarticle/2844931

In the Original Investigation titled “Concurrent Changes in Plasma Phosphorylated Tau 217, Tau PET, and Cognition in Preclinical Alzheimer Disease,” published online on August 25, 2025, and in the October 2025 issue, a mention was missing from the Funding/Support acknowledgment in the Article Information. The work was also funded by a grant from the Foundation for the National Institutes of Health in support of the Alzheimer’s Therapeutic Research Institute (USC ATRI) A4 Trial of the National Institute on Aging. This article has been corrected online.

Brivaracetam, Cenobamate, Lacosamide, and Perampanel in Focal Epilepsy
https://jamanetwork.com/journals/jamaneurology/fullarticle/2844930

This comparative effectiveness research study evaluates the effectiveness and safety of brivaracetam, cenobamate, lacosamide, and perampanel as adjunctive therapies in adults with drug-resistant focal epilepsy.

Glucocorticoids for Preventing Migraine Recurrence in the ED
https://jamanetwork.com/journals/jamaneurology/fullarticle/2844929

This Viewpoint discusses glucocorticoid recommendations for treating migraine in the emergency department (ED), describing the potential for harm that means it should not be a reflexive first-line choice for either children or adults.

Reducing Potentially Inappropriate Medication Use for Older Adults in the Emergency Department
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2844492

Adverse drug events in older adults are pervasive, often harmful, and potentially preventable. There are many reasons for adverse drug events in older adults, including multiple medications, pharmacodynamic changes, pharmacokinetic changes, and age-related issues in various organ systems. The American Geriatrics Society developed the Beers Criteria, a list of potentially inappropriate medications (PIMs) to guide clinicians in their prescribing practices. For these medications, potential risks may outweigh the benefits. A recent meta-analysis reported a worldwide prevalence of PIM use of 37%. As older adults often receive care in the emergency department (ED), an ED-specific guideline, the Geriatric Emergency Medication Safety Recommendations (GEMS-Rx) were developed to identify high-risk, potentially avoidable medications commonly prescribed at ED discharge. In contrast to the Beers Criteria, the GEMS-Rx criteria focus on 8 medication classes commonly prescribed in the ED that may cause harm to older adults discharged to the community.

Unproven Rules and the Need for Rigorous Policy Evaluation
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2844491

Health Care Policy

Urinary Incontinence—If Clinicians Would Only Ask
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2844490

Urinary incontinence (UI) is a common condition affecting 1 in 3 adult women worldwide. Women with UI experience a lower quality of life, poorer sexual function, and are at higher risk for depression and anxiety. The condition is dramatically underreported and undertreated, despite the availability of effective conservative treatments. The major take-home message of the study of Collins et al, published in this issue of JAMA Internal Medicine, is that asking a single question about UI to all women before a visit can change this.

High-Risk Prescriptions Among Older Adults Discharged from the ED
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2844489

This cross-sectional study identifies the prescribing rate and most commonly prescribed classes of potentially inappropriate medications for older patients at emergency department discharge.

Device-Assisted vs Standard Valsalva Maneuver for Terminating Supraventricular Tachycardia
https://jamanetwork.com/journals/jamacardiology/fullarticle/2844870

This randomized clinical trial assesses the efficacy of a handheld Valsalva maneuver assist device in improving sinus rhythm restoration rates in patients with supraventricular tachycardia.

Ticagrelor vs Prasugrel in Patients With Diabetes and Multivessel CAD
https://jamanetwork.com/journals/jamacardiology/fullarticle/2844869

This randomized clinical trial investigates if ticagrelor is noninferior to prasugrel after percutaneous coronary intervention in patients with diabetes and multivessel coronary artery disease (CAD).

What’s My Name?
https://jamanetwork.com/journals/jamacardiology/fullarticle/2844867

This essay describes differences in the author’s level of care within the health care system as a patient when identifying himself using his first name vs his professional title and surname.

Plaque Volume in Patients With Coronary Artery Disease
https://jamanetwork.com/journals/jamacardiology/fullarticle/2844868

This secondary analysis of a randomized clinical trial examines plaque measures from coronary computed tomographic angiography to assess the incremental prognostic value of quantitative coronary artery disease measures among symptomatic patients.

Buprenorphine in the ED—Balancing Access, Safety, and Autonomy
https://jamanetwork.com/journals/jama/fullarticle/2845046

In the context of an ongoing public health emergency related to drug toxicity deaths, emergency department (ED) visits are undeniably important opportunities to identify individuals with high-risk opioid use and to engage them in care. Emergency departments are available every hour of the day, every day of the year in many communities and provide low-barrier touchpoints for individuals with high-risk opioid use, many of whom have concurrent social vulnerabilities. Increasing access to evidence-based harm reduction and treatment options for people with opioid use disorder in EDs is a crucial aspect of the response to the ongoing drug toxicity crisis. In this issue of JAMA, D’Onofrio and colleagues report a study conducted across 29 sites (with both federal funding and in-kind pharmaceutical support) that importantly pushes existing boundaries of ED-based care. D’Onofrio and colleagues tested a novel approach to initiate an extended-release formulation of buprenorphine for patients with opioid use disorder. The authors found no difference in treatment engagement at 7 days or 30 days among patients who received 7-day extended-release injectable buprenorphine compared with those who received sublingual buprenorphine. Additionally, they reported low rates of precipitated withdrawal in both groups.

Medications for Opioid Use Disorder, Withdrawal, and Overdose
https://jamanetwork.com/journals/jama/fullarticle/2845037

This review discusses the efficacy, safety, and practical considerations of treating patients with medications for opioid use disorder, opioid withdrawal, and opioid overdose.

Food Ingredients, State Actions, and Federal Preemption
https://jamanetwork.com/journals/jama/fullarticle/2845035

This Viewpoint discusses the US Food and Drug Administration’s authority over food safety, including prior regulations surrounding ingredients, preemption, and federal vs state laws.

Individualized Perioperative Blood Pressure Management in Major Abdominal Surgery
https://jamanetwork.com/journals/jama/fullarticle/2845044

To the Editor Dr Saugel and colleagues reported that matching intraoperative MAP to preoperative mean nighttime MAP did not reduce major postoperative complications compared with routine care (MAP ≥65 mm Hg).

Individualized Perioperative Blood Pressure Management in Major Abdominal Surgery—Reply
https://jamanetwork.com/journals/jama/fullarticle/2845043

In Reply In a comment on the IMPROVE-multi trial—which reported that individualized perioperative blood pressure management based on preoperative mean nighttime MAP did not improve outcomes compared with maintaining MAP at 65 mm Hg or greater—Dr Miyazaki correctly notes that maintaining intraoperative blood pressure using vasopressors (which themselves may be associated with acute kidney injury) does not necessarily ensure adequate end-organ perfusion. In our trial, interventions to maintain blood pressure targets were left to the discretion of treating anesthesiologists skilled in identifying underlying causes of hypotension and intervening appropriately. Intraoperative hypotension can be caused by vasodilation, hypovolemia, bradycardia, and myocardial depression. From a pathophysiologic perspective, hypotension should thus be specifically treated with vasopressors, fluids, chronotropic agents, or inotropes to directly address the underlying cause(s)—and not always with vasopressors. However, it still needs to be investigated in clinical trials whether blood pressure management based on distinct hypotension endotypes helps avoid organ injury. The IMPROVE-multi trial focused on blood pressure (which must be monitored in every patient during surgery) and did not include systematically monitoring blood flow variables such as stroke volume and cardiac output.

Emergency Department–Initiated Buprenorphine for Opioid Use Disorder
https://jamanetwork.com/journals/jama/fullarticle/2845042

This randomized clinical trial assesses the effect of emergency department (ED)–initiated 7-day extended-release injectable buprenorphine vs sublingual buprenorphine on treatment engagement at 7 days among patients with opioid use disorder.

Adaptations
https://jamanetwork.com/journals/jama/fullarticle/2845040

The one-eyed hawk circles overhead surveying the grassland.