Hypertension With High-Risk Features in Cryptogenic Stroke
https://jamanetwork.com/journals/jamaneurology/fullarticle/2847758
This secondary analysis of a randomized clinical trial evaluates the association between hypertension with high-risk features and treatment effect.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2847758
This secondary analysis of a randomized clinical trial evaluates the association between hypertension with high-risk features and treatment effect.
Reimagining Care Delivery for Alzheimer Disease
https://jamanetwork.com/journals/jamaneurology/fullarticle/2847757
This Viewpoint describes a system-level redesign of Alzheimer disease diagnosis and treatment where memory clinic services are differentiated by purpose to match patient needs and complexity with appropriate oversight.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2847757
This Viewpoint describes a system-level redesign of Alzheimer disease diagnosis and treatment where memory clinic services are differentiated by purpose to match patient needs and complexity with appropriate oversight.
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Eliminating Unnecessary Animal Testing
https://jamanetwork.com/journals/jama/fullarticle/2848148
This Perspective reviews the US Food and Drug Administrationâs achievements toward eliminating unnecessary animal-based testing and outlines more human-relevant changes for the future.
https://jamanetwork.com/journals/jama/fullarticle/2848148
This Perspective reviews the US Food and Drug Administrationâs achievements toward eliminating unnecessary animal-based testing and outlines more human-relevant changes for the future.
Error in Denominators
https://jamanetwork.com/journals/jama/fullarticle/2847987
In the Research Letter titled âTrends in Vitamin K Administration Among Infants,â published in the December 8, 2025, issue of JAMA, there were errors in the reported total number of newborns included in the study. It should have been noted that 15 354 of 526 341 newborns in 2017 and 37 187 of 717 402 newborns in 2024 did not receive intramuscular vitamin K. This article was corrected online.
https://jamanetwork.com/journals/jama/fullarticle/2847987
In the Research Letter titled âTrends in Vitamin K Administration Among Infants,â published in the December 8, 2025, issue of JAMA, there were errors in the reported total number of newborns included in the study. It should have been noted that 15 354 of 526 341 newborns in 2017 and 37 187 of 717 402 newborns in 2024 did not receive intramuscular vitamin K. This article was corrected online.
US State Actions Related to COVID-19 Vaccination Infrastructure and Access Amid Federal Shifts
https://jamanetwork.com/journals/jama/fullarticle/2847986
This study analyzes US state actions taken in 2025 that strengthened or weakened COVID-19 vaccination infrastructure and access.
https://jamanetwork.com/journals/jama/fullarticle/2847986
This study analyzes US state actions taken in 2025 that strengthened or weakened COVID-19 vaccination infrastructure and access.
Gestational Weight Gain and Pregnancy Outcomes After Discontinuation of GLP-1 Receptor Agonists
https://jamanetwork.com/journals/jama/fullarticle/2847985
To the Editor A recent study that used a propensity score and 1:3 matching provided valuable insight into the potential effect of glucagon-like peptide-1 receptor agonists (GLP-1RAs) during pregnancy. Nevertheless, several limitations warrant careful consideration.
https://jamanetwork.com/journals/jama/fullarticle/2847985
To the Editor A recent study that used a propensity score and 1:3 matching provided valuable insight into the potential effect of glucagon-like peptide-1 receptor agonists (GLP-1RAs) during pregnancy. Nevertheless, several limitations warrant careful consideration.
Interrupted Time Series Analysis for Policy Evaluation
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2848029
This Guide to Statistics and Methods examines the population-level associations of guidelines for the use of doxycycline postexposure prophylaxis with sexually transmitted infection incidence.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2848029
This Guide to Statistics and Methods examines the population-level associations of guidelines for the use of doxycycline postexposure prophylaxis with sexually transmitted infection incidence.
Fecal Microbiota Transplant for Multidrug Resistance
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2848028
Fecal microbiota transplant (FMT) has transformed the medical treatment of recurrent Clostridium difficile infection (R-CDI). An explosion of randomized clinical trials during the 2010s demonstrated the effectiveness of FMT in treating patients with R-CDI, which has become the archetypal disorder of dysbiosis that is characterized by a collapsed microbiome with low bacterial community diversity and depleted microbial metabolites. FMT, delivered enterally across multiple formulations, cured greater than 90% of patients with R-CDI in some trials, prompting medical societies to recommend FMT for R-CDI and spurring efforts to design more scalable alternatives to FMT that were manufactured with either bacterial consortia from homogenized human gut communities or a consortia of cultured bacteria. There are currently 2 fecal microbiota products (FMPs) approved by the US Food and Drug Administration for preventing R-CDI, and a consortium of cultured gut bacteria, termed a live biotherapeutic product (LBP), is currently in phase 3 trials. FMPs and LBPs, which work by shaping gut microbial ecology, represent an entirely new approach to treating infectious diseases.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2848028
Fecal microbiota transplant (FMT) has transformed the medical treatment of recurrent Clostridium difficile infection (R-CDI). An explosion of randomized clinical trials during the 2010s demonstrated the effectiveness of FMT in treating patients with R-CDI, which has become the archetypal disorder of dysbiosis that is characterized by a collapsed microbiome with low bacterial community diversity and depleted microbial metabolites. FMT, delivered enterally across multiple formulations, cured greater than 90% of patients with R-CDI in some trials, prompting medical societies to recommend FMT for R-CDI and spurring efforts to design more scalable alternatives to FMT that were manufactured with either bacterial consortia from homogenized human gut communities or a consortia of cultured bacteria. There are currently 2 fecal microbiota products (FMPs) approved by the US Food and Drug Administration for preventing R-CDI, and a consortium of cultured gut bacteria, termed a live biotherapeutic product (LBP), is currently in phase 3 trials. FMPs and LBPs, which work by shaping gut microbial ecology, represent an entirely new approach to treating infectious diseases.
Preventing Pregnancy-Related Cardiovascular Disease Burden: A Report From the National Academies of Sciences, Engineering, and Medicine
https://jamanetwork.com/journals/jama/fullarticle/2848128
This Perspective discusses prevention of pregnancy-related cardiovascular morbidity and mortality before, during, after, and between pregnancies.
https://jamanetwork.com/journals/jama/fullarticle/2848128
This Perspective discusses prevention of pregnancy-related cardiovascular morbidity and mortality before, during, after, and between pregnancies.
Early Rule Out With a Refreshed Troponin Assay
https://jamanetwork.com/journals/jamacardiology/fullarticle/2847712
In 2008, Roche Diagnostics introduced a high-sensitivity version of their cardiac troponin T assay (hs-cTnT), a fifth-generation assay. Researchers quickly deduced that by using the assayâs limit of detection (LoD) of 5 ng/L (to convert to micrograms per liter, multiply by 0.001) as a cutoff, many patients could safely be classified as very low-risk for myocardial infarction (MI). Researchers gathered data across multiple institutions, and a 9241-patient meta-analysis demonstrated a pooled sensitivity for the LoD of 98.7%. Outside the US, on presentation (0-hour) concentrations less than LoD became guideline recommended, reassuring patients quickly and reducing time spent in busy emergency departments (EDs). Once US Food and Drug Administration (FDA) approval was obtained in the US, a similar risk-stratification approach became possible, though using a threshold of 6 ng/L because the FDA mandated that exact concentrations below the limit of quantitation (LoQ) be not reported. In the meantime, troponin I assay manufacturers brought to market high-sensitivity cardiac troponin I (hs-cTnI) assays. Low-risk thresholds were derived for these that were above the LoD and LoQ by identifying the concentration that gave a minimum prespecified statistical performance. Most often these minimums are greater than or equal to 99% sensitivity and greater than or equal to 99.5% negative predictive value (NPV). Roche Diagnostics has now placed in the hands of researchers a sixth-generation cTnT assay. Already this has been established as high sensitivity, with very low LoD and LoQ and well-defined sex-specific upper-reference levels. This will allow, for the first time with hs-cTnT, the derivation of single-sample, very low-risk thresholds likely usable across institutions. In this issue of JAMA Cardiology, Thurston and colleagues present the first such derivation of a single-sample, very low-risk threshold for the Roche sixth-generation hs-cTnT assay.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2847712
In 2008, Roche Diagnostics introduced a high-sensitivity version of their cardiac troponin T assay (hs-cTnT), a fifth-generation assay. Researchers quickly deduced that by using the assayâs limit of detection (LoD) of 5 ng/L (to convert to micrograms per liter, multiply by 0.001) as a cutoff, many patients could safely be classified as very low-risk for myocardial infarction (MI). Researchers gathered data across multiple institutions, and a 9241-patient meta-analysis demonstrated a pooled sensitivity for the LoD of 98.7%. Outside the US, on presentation (0-hour) concentrations less than LoD became guideline recommended, reassuring patients quickly and reducing time spent in busy emergency departments (EDs). Once US Food and Drug Administration (FDA) approval was obtained in the US, a similar risk-stratification approach became possible, though using a threshold of 6 ng/L because the FDA mandated that exact concentrations below the limit of quantitation (LoQ) be not reported. In the meantime, troponin I assay manufacturers brought to market high-sensitivity cardiac troponin I (hs-cTnI) assays. Low-risk thresholds were derived for these that were above the LoD and LoQ by identifying the concentration that gave a minimum prespecified statistical performance. Most often these minimums are greater than or equal to 99% sensitivity and greater than or equal to 99.5% negative predictive value (NPV). Roche Diagnostics has now placed in the hands of researchers a sixth-generation cTnT assay. Already this has been established as high sensitivity, with very low LoD and LoQ and well-defined sex-specific upper-reference levels. This will allow, for the first time with hs-cTnT, the derivation of single-sample, very low-risk thresholds likely usable across institutions. In this issue of JAMA Cardiology, Thurston and colleagues present the first such derivation of a single-sample, very low-risk threshold for the Roche sixth-generation hs-cTnT assay.
US Trends in Prescribing Nonstatin Lipid-Lowering Therapy, 2019-2024
https://jamanetwork.com/journals/jamacardiology/fullarticle/2847711
This cross-sectional study examines trends in prescribing nonstatin lipid-lowering therapy in the US from 2019 to 2024 vs statin prescribing.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2847711
This cross-sectional study examines trends in prescribing nonstatin lipid-lowering therapy in the US from 2019 to 2024 vs statin prescribing.
Early Rule Out of MI With Cardiac Troponin T Assay
https://jamanetwork.com/journals/jamacardiology/fullarticle/2847710
This cohort study investigates if a novel high-sensitivity cardiac troponin T assay with enhanced precision at very low concentrations is associated with an improvement in the ruling out of myocardial infarction (MI) with a single test.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2847710
This cohort study investigates if a novel high-sensitivity cardiac troponin T assay with enhanced precision at very low concentrations is associated with an improvement in the ruling out of myocardial infarction (MI) with a single test.
Antiplatelet Therapy After CABGâToward a Mechanistic Approach
https://jamanetwork.com/journals/jamacardiology/fullarticle/2847709
This Viewpoint discusses a novel, biology-driven concept aligning antiplatelet therapy with evolving thrombotic risk after coronary artery bypass graft (CABG) surgery.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2847709
This Viewpoint discusses a novel, biology-driven concept aligning antiplatelet therapy with evolving thrombotic risk after coronary artery bypass graft (CABG) surgery.
Histone Deactylase Inhibition and R-CHOP Treatment
https://jamanetwork.com/journals/jama/fullarticle/2848067
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, with an estimated 150 000 new cases annually worldwide. Patients with DLBCL typically require treatment at the time of diagnosis, and more than 60% of patients are currently cured with front-line immunochemotherapy such as R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). However, DLBCL is highly heterogeneous, and subsets of patients who progress after front-line treatment have a substantially poorer clinical outcome. Therapeutic progress to improve the outcome of the patients with lymphoma destined to progress after initial chemotherapy has proven very difficult, with very few trials showing superiority of an experimental group over standard R-CHOP.
https://jamanetwork.com/journals/jama/fullarticle/2848067
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, with an estimated 150 000 new cases annually worldwide. Patients with DLBCL typically require treatment at the time of diagnosis, and more than 60% of patients are currently cured with front-line immunochemotherapy such as R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). However, DLBCL is highly heterogeneous, and subsets of patients who progress after front-line treatment have a substantially poorer clinical outcome. Therapeutic progress to improve the outcome of the patients with lymphoma destined to progress after initial chemotherapy has proven very difficult, with very few trials showing superiority of an experimental group over standard R-CHOP.
Suicide Mortality Among Adolescents and Young Adults After Launch of a Suicide and Crisis Lifeline
https://jamanetwork.com/journals/jama/fullarticle/2848066
This study uses data from the National Vital Statistics System to examine quarterly suicide mortality among individuals aged 15 to 34 years.
https://jamanetwork.com/journals/jama/fullarticle/2848066
This study uses data from the National Vital Statistics System to examine quarterly suicide mortality among individuals aged 15 to 34 years.
Spinal Manipulation and Biopsychosocial Self-Management for Back Pain
https://jamanetwork.com/journals/jama/fullarticle/2848065
To the Editor In the Spinal Manipulation and Patient Self-Management for Preventing Acute to Chronic Back Pain (PACBACK) randomized clinical trial, Dr Bronfort and colleagues reported that clinician-supported biopsychosocial self-management, alone or combined with spinal manipulation, led to statistically significant but small reductions in low back painârelated disability over 12 months vs guideline-based medical care, without differences in pain intensity. The time-averaged, adjusted between-group differences in the Roland-Morris Disability Questionnaire (RMDQ; range, 0-24) scores were â1.2 points for supported self-management and â1.1 points for supported self-management with spinal manipulation. A 2- to 3-point change on the RMDQ has been proposed as a minimally important difference, although such thresholds can vary by population and estimation approach. Even when a modest mean difference coexists with large improvements for some individuals, it remains uncertain whether the observed disability signal reflects gains in physical capacity, improved coping with symptoms, or changes in appraisal of activity limitation.
https://jamanetwork.com/journals/jama/fullarticle/2848065
To the Editor In the Spinal Manipulation and Patient Self-Management for Preventing Acute to Chronic Back Pain (PACBACK) randomized clinical trial, Dr Bronfort and colleagues reported that clinician-supported biopsychosocial self-management, alone or combined with spinal manipulation, led to statistically significant but small reductions in low back painârelated disability over 12 months vs guideline-based medical care, without differences in pain intensity. The time-averaged, adjusted between-group differences in the Roland-Morris Disability Questionnaire (RMDQ; range, 0-24) scores were â1.2 points for supported self-management and â1.1 points for supported self-management with spinal manipulation. A 2- to 3-point change on the RMDQ has been proposed as a minimally important difference, although such thresholds can vary by population and estimation approach. Even when a modest mean difference coexists with large improvements for some individuals, it remains uncertain whether the observed disability signal reflects gains in physical capacity, improved coping with symptoms, or changes in appraisal of activity limitation.
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Spinal Manipulation and Biopsychosocial Self-Management for Back Pain
https://jamanetwork.com/journals/jama/fullarticle/2848064
To the Editor The recently published PACBACK trial reported no significant differences in low back pain scores between groups randomized to undergo spinal manipulations, medical management, and self-management. This study included exclusively chiropractic and physical therapistâadministered spinal manipulations and did not evaluate manipulative treatments performed by US-trained osteopathic physicians. Although it is valuable to examine different modalities of treatment for such a common and debilitating condition, the exclusion of osteopathic physicianâperformed manipulations raises concerns about this studyâs conclusion that manipulations do not affect back pain scores.
https://jamanetwork.com/journals/jama/fullarticle/2848064
To the Editor The recently published PACBACK trial reported no significant differences in low back pain scores between groups randomized to undergo spinal manipulations, medical management, and self-management. This study included exclusively chiropractic and physical therapistâadministered spinal manipulations and did not evaluate manipulative treatments performed by US-trained osteopathic physicians. Although it is valuable to examine different modalities of treatment for such a common and debilitating condition, the exclusion of osteopathic physicianâperformed manipulations raises concerns about this studyâs conclusion that manipulations do not affect back pain scores.
Spinal Manipulation and Biopsychosocial Self-Management for Back Pain
https://jamanetwork.com/journals/jama/fullarticle/2848063
To the Editor The PACBACK randomized clinical trial by Dr Bronfort and colleagues evaluated spinal manipulation combined with clinician-supported biopsychosocial self-management for acute low back pain. Although the study addresses an important clinical question, we have some concerns.
https://jamanetwork.com/journals/jama/fullarticle/2848063
To the Editor The PACBACK randomized clinical trial by Dr Bronfort and colleagues evaluated spinal manipulation combined with clinician-supported biopsychosocial self-management for acute low back pain. Although the study addresses an important clinical question, we have some concerns.
AutismâUnderstanding Diagnosis, Prevalence, and Treatment
https://jamanetwork.com/journals/jama/fullarticle/2848061
JAMA Senior Editor Derek C. Angus, MD, MPH, spoke with Dost ĂngĂźr, MD, PhD, JAMA Psychiatry Editor, and Jeremy Veenstra-VanderWeele, MD, a professor of developmental neuropsychiatry at Columbia University, about autism spectrum disorder for the Healthy Dialogue podcast.
https://jamanetwork.com/journals/jama/fullarticle/2848061
JAMA Senior Editor Derek C. Angus, MD, MPH, spoke with Dost ĂngĂźr, MD, PhD, JAMA Psychiatry Editor, and Jeremy Veenstra-VanderWeele, MD, a professor of developmental neuropsychiatry at Columbia University, about autism spectrum disorder for the Healthy Dialogue podcast.