tbuckley/cabot-search huggingface dataset:
DRUG HABITS.
Journal: JAMA (2003)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Syncope.
Authors: A D Ormerod
Journal: BMJ (1984)

Transient loss of consciousness may be due to syncope, epilepsy, cardiac arrhythmia, and, rarely, transient cerebral ischaemic attack.It is important not to attribute syncope to cerebrovascular disease when-the true cause is a transient disturbance of cardiac rhythm which is amenable to therapy.The differences between epilepsy and syncope will usually be apparent from a carefully taken history and whenever possible from an eye witness account.
Osimertinib Plus Durvalumab in Patients With EGFR-Mutated, Advanced NSCLC: A Phase 1b, Open-Label, Multicenter Trial
Authors: Myung-Ju Ahn, Byoung Chul Cho, Xiaoling Ou, Andrew Walding, Angela W. Dymond, Song Ren, Mireille Cantarini, Pasi A. Jänne
Journal: Journal of Thoracic Oncology (2022)
In praise of 'letters'
Authors: S. Vaisrub
Journal: JAMA (1981)

In trying to keep up to date with the literature, the medical journal reader will turn to original articles. Here he will find reports on large-scale studies either confirming or discrediting accepted ideas and practices. If lucky, he may even strike a new observation, possibly one in the nature of a breakthrough. When in a less ambitious mood, our reader will glimpse through the letters to the editor. There he will find a mix of useful tips, whether based on anecdotal evidence or derived from modest preliminary studies. These tips may suggest improvements, however small, in diagnostic or therapeutic techniques; they may provide new or revive old clues to prognosis; occasionally they may even suggest a lifesaving maneuver. Such a mélange of tips can be found in any letters to the editor section of reputable medical journals. For instance, browsing through the letters of a randomly selected issue of the
Real-world study of chemotherapy plus immunotherapy versus chemotherapy alone as neoadjuvant treatment guided bladder-sparing therapy for localized muscle-invasive bladder cancer.
Authors: Yali Shen, Feng Wen, Peng Zhang, Tianhai Lin
Journal: Journal of Clinical Oncology (2022)

499 Background: Bladder-preserving combined-modality therapy has been a popular research field as an alternative to radical cystectomy for selected patients with localized muscle-invasive bladder cancer (MIBC). This real-world study aimed to compare the efficacy of neoadjuvant chemotherapy plus immunotherapy versus chemotherapy alone as one of bladder-sparing therapies for localized MIBC. Methods: Patients with cT2-4bN0-3M0-1a pathological and imaging diagnosed MIBC were included in the study. Either chemotherapy (gemcitabine and cisplatin/carboplatin) plus immunotherapy (PD-1 checkpoint inhibitor, including pembrolizumab，tislelizumab and toripalimab) or chemotherapy alone were given as patients’ wish. The primary endpoint was complete response rate (CR, T0/Ta/Tis), and the secondary endpoints were disease control rate (DCR), progression-free survival (PFS), bladder-intact disease-free survival (BI-DFS) and toxicity. Results: In total, 41 patients were included, 25 in combination group and 16 in chemotherapy group respectively. The baseline characteristics were well balanced in two groups. Median follow-up time was 15.3 ±4.4 months(m). No patient died. The efficacy evaluable population was consisted of 34 pts (22 in combination group; 12 in chemotherapy alone group). The CR rate for combination group was 50.0% and 0 for chemotherapy alone group. One patient suffered from disease progression in combination group and three in chemotherapy group. The DCRs for combination group and chemotherapy group were 95.5% and 66.7%, respectively ( p= 0.003). Twelve patients had radiotherapy and six patients had radical cystectomy followed by neoadjuvant treatments in combination group. And two patients had radiotherapy and three patients had radical cystectomy in chemotherapy group. The one-year PFS rates were 95.5% and 62.5% for combination group and chemotherapy group( p= 0.010), and the one-year BI-DFS were 66.1% versus 27.5% respectively( p= 0.159). The bladder-preserving combined-modality therapies used were well-tolerated with acceptable and manageable toxicities. Grade ¾ hematological system adverse events were 15.9% and 6.4% in combination group and chemotherapy group, respectively ( p= 0.021). Conclusions: Neoadjuvant chemotherapy plus immunotherapy showed better efficacy compared with chemotherapy alone as an important bladder-sparing therapy for locally advanced MIBC with acceptable and manageable toxicities.
Stammering
Authors: M RUIZ-CASTANEDA
Journal: BMJ (1965)

Pointers Intrathoracic SarcoidosisFifty-two cases occurred among 54,239 participants in an M.R.C. trial of tuberculosis vaccines.Dr. I. Sutherland and colleagues conclude that the vaccines neither protected against, nor promoted, the disease.Initial tuberculin status did not affect incidence (p.497).Safety of Sabin Vaccine: Dr. D. L. Miller and Dr. N. S. Galbraith have investigated the safety of oral polio vaccines.It is unlikely, they consider, that disease was caused by virus spread- ing to contacts of those vaccinated (p.504).Exophthalmos in Thyrotoxicosis: Dr. W. R. Greig and colleagues report that a rapid return to the euthyroid state has no adverse effects on the degree of exophthalmos in thyrotoxic patients (p.509).
Association of TMB and PD-L1 with efficacy of first-line pembrolizumab (pembro) or pembro + chemotherapy (chemo) versus chemo in patients (pts) with advanced urothelial carcinoma (UC) from KEYNOTE-361.
Authors: Rafael Morales-Barrera, Thomas Powles, Mustafa Ozguroglu, Tibor Csoszi, Yohann Loriot, Aude Flechon, Nobuaki Matsubara, Alejo Rodriguez-Vida, Lajos Geczi, Susanna Y. Cheng, Yves Fradet, Stephane Oudard, Seyda Gunduz, Junshui Ma, Mohini Rajasagi, Amir Vajdi, Razvan Cristescu, Kentaro Imai, Blanca Homet Moreno, Ajjai Shivaram Alva
Journal: Journal of Clinical Oncology (2022)

540 Background: The 3-arm, open-label, phase 3 KEYNOTE-361 study (NCT02853305) evaluated first-line pembro ± chemo vs chemo in advanced UC regardless of PD-L1 status. The trial did not meet its primary end points of superior PFS and OS with pembro + chemo vs chemo and thus analysis of pembro monotherapy (mono) vs chemo was exploratory. We explored the association of TMB status and PD-L1 combined positive score (CPS) with clinical outcomes in KEYNOTE-361. Methods: In pts with TMB and/or PD-L1 data, the association between TMB (via whole exome sequencing) and PD-L1 (via PD-L1 IHC 22C3 pharmDx) and clinical outcomes (ORR, PFS, and OS) was evaluated. In each treatment arm, the hypotheses regarding the associations were evaluated using logistic regression (ORR) and Cox proportional hazards regression (PFS; OS), and 1-sided (pembro; pembro + chemo) and 2-sided (chemo) P values were calculated; significance was prespecified at α = 0.05 without multiplicity adjustment. Clinical utility was assessed using prespecified cutoffs of 175 mut/exome (TMB) and CPS 10 (PD-L1). Clinical data cutoff was April 29, 2020. Results: 820/993 pts (82.6%) had evaluable TMB data (pembro, 252; pembro + chemo, 282; chemo, 286). TMB (log 10 ) was significantly positively associated with ORR, PFS, and OS for pembro ( P &lt; 0.001, &lt; 0.001, and 0.007, respectively) and PFS and OS for pembro + chemo ( P= 0.007 and 0.010, respectively). The area under the receiver operating characteristics (AUROC) curve (95% CI) for discriminating response was 0.64 (0.56-0.71) for pembro, 0.53 (0.46-0.60) for pembro + chemo, and 0.52 (0.45-0.59) for chemo. Efficacy by TMB cutoff is reported in the Table. All 993 pts had PD-L1 data (pembro, 302; pembro + chemo, 349; chemo, 342). PD-L1 was significantly positively associated with PFS for pembro ( P= 0.006) and ORR for pembro + chemo ( P= 0.042) but not chemo. Efficacy by PD-L1 CPS is reported in the Table. Conclusions: Strong associations were observed between TMB and all 3 clinical outcomes (ORR, PFS, and OS) with pembro mono in the first-line setting and a reduced association was observed between TMB and clinical outcomes with pembro + chemo. No consistent associations were observed between PD-L1 and clinical outcomes with pembro mono or pembro + chemo. Clinical trial information: NCT02853305. [Table: see text]
Hypoxia‐driven immunosuppression by Treg and type‐2 conventional dendritic cells in HCC
Authors: Sheena Suthen, Chun Jye Lim, Phuong H. D. Nguyen, Charles‐Antoine Dutertre, Hannah L. H. Lai, Martin Wasser, Camillus Chua, Tony K. H. Lim, Wei Qiang Leow, Tracy Jiezhen Loh, Wei Keat Wan, Yin Huei Pang, Gwyneth Soon, Peng Chung Cheow, Juinn Huar Kam, Shridhar Iyer, Alfred Kow, Wai Leong Tam, Timothy W. H. Shuen, Han Chong Toh, Yock Young Dan, Glenn K. Bonney, Chung Yip Chan, Alexander Chung, Brian K. P. Goh, Weiwei Zhai, Florent Ginhoux, Pierce K. H. Chow, Salvatore Albani, Valerie Chew
Journal: Hepatology (2022)

Hypoxia is one of the central players in shaping the immune context of the tumor microenvironment (TME). However, the complex interplay between immune cell infiltrates within the hypoxic TME of HCC remains to be elucidated.We analyzed the immune landscapes of hypoxia-low and hypoxia-high tumor regions using cytometry by time of light, immunohistochemistry, and transcriptomic analyses. The mechanisms of immunosuppression in immune subsets of interest were further explored using in vitro hypoxia assays. Regulatory T cells (Tregs) and a number of immunosuppressive myeloid subsets, including M2 macrophages and human leukocyte antigen-DR isotype (HLA-DRlo ) type 2 conventional dendritic cell (cDC2), were found to be significantly enriched in hypoxia-high tumor regions. On the other hand, the abundance of active granzyme Bhi PD-1lo CD8+ T cells in hypoxia-low tumor regions implied a relatively active immune landscape compared with hypoxia-high regions. The up-regulation of cancer-associated genes in the tumor tissues and immunosuppressive genes in the tumor-infiltrating leukocytes supported a highly pro-tumorigenic network in hypoxic HCC. Chemokine genes such as CCL20 (C-C motif chemokine ligand 20) and CXCL5 (C-X-C motif chemokine ligand 5) were associated with recruitment of both Tregs and HLA-DRlo cDC2 to hypoxia-high microenvironments. The interaction between Tregs and cDC2 under a hypoxic TME resulted in a loss of antigen-presenting HLA-DR on cDC2.We uncovered the unique immunosuppressive landscapes and identified key immune subsets enriched in hypoxic HCC. In particular, we identified a potential Treg-mediated immunosuppression through interaction with a cDC2 subset in HCC that could be exploited for immunotherapies.
Abortion.
Authors: B Johnson
Journal: BMJ (1979)

Having read Professor Peter Huntingford's letter (25 August, p 496), I am more convinced than ever that reduction to the simplest possible terms will always clarify an issue, and I am at one with him in deploring the terms "serious," "grave," and "substantial." His last paragraph approximates to such clarify when he says "the right of women to choose freely whether or not they bear a child"--but I fear that the phrase is slanted and ignores an essential ingredient in the abortive act. Whereas the secondary effect of abortion is certainly that the woman will not bear a child, the primary effect is the killing of that child, admittedly small and defenceless. Maybe there are many who will seek to justify the killing of their fellow members of the human race on the grounds that they are not wanted, or might be handicapped; if so, let them proclaim these views "in good set terms." But if the principle of getting rid of the unwanted by killing them is to expand its application further, who among us will be safe when someone else can decide our fate? Even the advocates of euthanasia usually insist that it be voluntary. Who yet has asked a fetus whether it wants to live or be killed?
Epigenomic reprogramming via HRP2-MINA dictates response to proteasome inhibitors in multiple myeloma with t(4;14) translocation
Authors: Jingjing Wang, Xu Zhu, Lin Dang, Hongmei Jiang, Ying Xie, Xin Li, Jing Guo, Yixuan Wang, Ziyi Peng, Mengqi Wang, Jingya Wang, Sheng Wang, Qian Li, Yafei Wang, Qiang Wang, Lingqun Ye, Lirong Zhang, Zhiqiang Liu
Journal: Journal of Clinical Investigation (2022)

The chromosomal t(4;14) (p16;q32) translocation drives high expression of histone methyltransferase nuclear SET domain-containing 2 (NSD2) and plays vital roles in multiple myeloma (MM) evolution and progression. However, the mechanisms of NSD2-driven epigenomic alterations in chemoresistance to proteasome inhibitors (PIs) are not fully understood. Using a CRISPR/Cas9 sgRNA library in a bone marrow-bearing MM model, we found that hepatoma-derived growth factor 2 (HRP2) was a suppressor of chemoresistance to PIs and that its downregulation correlated with a poor response and worse outcomes in the clinic. We observed suppression of HRP2 in bortezomib-resistant MM cells, and knockdown of HRP2 induced a marked tolerance to PIs. Moreover, knockdown of HRP2 augmented H3K27me3 levels, consequentially intensifying transcriptome alterations promoting cell survival and restriction of ER stress. Mechanistically, HRP2 recognized H3K36me2 and recruited the histone demethylase MYC-induced nuclear antigen (MINA) to remove H3K27me3. Tazemetostat, a highly selective epigenetic inhibitor that reduces H3K27me3 levels, synergistically sensitized the anti-MM effects of bortezomib both in vitro and in vivo. Collectively, these results provide a better understanding of the origin of chemoresistance in patients with MM with the t(4;14) translocation and a rationale for managing patients with MM who have different genomic backgrounds.
Association between <i>TERT</i> promoter mutations and clinical outcome with immune checkpoint inhibitor therapy for advanced urothelial cancer.
Authors: Neal Shiv Chawla, Nishita Tripathi, Nicolas Sayegh, Ameish Govindarajan, Nazli Dizman, Zeynep Busra Zengin, Luis A Meza, Ramya Muddasani, Alex Chehrazi-Raffle, Sabrina Salgia, Jasnoor Malhotra, Joann Hsu, Errol James Philip, Cristiane Decat Bergerot, Yung Lyou, Umang Swami, Sumati Gupta, Benjamin L. Maughan, Neeraj Agarwal, Sumanta K. Pal
Journal: Journal of Clinical Oncology (2022)

561 Background: Recently published data suggests that the presence of a TERT promoter mutation is predictive of superior overall survival (OS) in patients (pts) with advanced/metastatic bladder cancer (mUC) treated with an immune checkpoint inhibitor (ICI) (Kouchkovsky et al, JITC 2021). We aim to validate the results of this study in a large independent cohort. Methods: Pts with mUC treated at two tertiary cancer centers with available genomic data collected in the course of routine clinical care were identified retrospectively. Pts that had received at least one line of ICI therapy in the metastatic setting were selected. Demographic and treatment data were collected, with pts divided into two groups based on the presence or absence of TERT mutation status ( TERTm or TERTwt, respectively). We evaluated OS from diagnosis of at least muscle invasive disease, progression free survival (PFS), and objective response rate (ORR) with ICI therapy across the two groups. OS in our cohort was compared with findings from pts with bladder cancer in The Cancer Genome Atlas (TCGA) database. Results: From our combined data sets, a total of 166 pts had available genomic data, with 64 TERTm pts (52:12 M:F) and 58 TERTwt pts (32:26 M:F) meeting criteria for inclusion. Median age at diagnosis was 67 in both groups. The site of primary disease was bladder in 54 (84%) TERTm vs. 41 (71%) in TERTwt; 10 (16%) and 17 (29%) had upper tract disease, respectively. 47 (73%) TERTm pts and 40 (69%) TERTwt pts had pure urothelial disease; 17 (27%) and 18 (31%) pts had mixed/pure variant histology, respectively. 37 (58%) and 42 (72%) pts received first-line ICI therapy whereas 27 (42%) and 16 (28%) received subsequent-line therapy in TERTm and TERTwt, respectively. At the time of analysis, there were 24 (38%) patients alive in TERTm, and 23 (40%) patients alive in TERTwt. OS was 35 vs. 36 mos (95% CI 0.62-1.51, P=0.66) in TERTm and TERTwt, respectively. PFS on ICI therapy was 4.6 vs. 5.3 mos (95% CI 0.58-1.34, P≥0.99) in TERTm and TERTwt, respectively. ORR was 75% in TERTm and 50% in TERTwt (P=.004). OS in the TCGA database was 35 mos in TERTm and 47 in TERTwt (P=0.19) from a total of 311 and 127 pts, respectively. Conclusions: In contrast to previously published data, our data show no difference in OS and PFS on the basis of TERT mutational status in pts with mUC treated with ICI therapy. Further analysis from larger datasets is needed to reconcile the role of TERT mutations within this patient population.
RADIOLOGY
Authors: J. Murray, E. Braly, H. Head, D. Donahue, S. Rush, N. Stence, A. Liu, J. Kleinhenz, B. Bison, T. Pietsch, K. von Hoff, A. von Bueren, S. Rutkowski, M. Warmuth-Metz, T. Jaspan, H. Brisse, P. Potepan, M. Warmuth-Metz, F. Berg, B. Bison, T. Pietsch, N. Gerber, S. Rutkowski, M. Warmuth-Metz, K. Sugiyama, K. Kurisu, Y. Kajiwara, T. Takayasu, T. Saito, R. Hanaya, F. Yamasaki, J. Vicente, E. Fuster-Garcia, S. Tortajada, J. M. Garcia-Gomez, N. Davies, K. Natarajan, M. Wilson, R. G. Grundy, P. Wesseling, D. Monleon, B. Celda, M. Robles, A. C. Peet, C. Perret, E. Boltshauser, I. Scheer, C. Kellenberger, M. Grotzer, E. Steffen-Smith, D. Venzon, R. Bent, E. Baker, S. Shandilya, K. Warren, C.-S. Shih, J. West, C. Ho, D. Porter, Y. Wang, A. Saykin, B. McDonald, K. Arfanakis, K. Warren, G. Vezina, D. Hargrave, T. Y. Poussaint, S. Goldman, R. Packer, P. Wen, I. Pollack, D. Zurakowski, L. Kun, M. Prados, M. Kieran, L. Eckel, G. Keating, C. Giannini, N. Wetjen, A. Patton, E. Steffen-Smith, J. Sarlls, C. Pierpaoli, L. Walker, D. Venzon, R. Bent, K. Warren, S. Perreault, R. Lober, K. Yeom, A.-S. Carret, H. Vogel, S. Partap, P. Fisher, S. K. Gill, M. Wilson, N. P. Davies, L. MacPherson, T. N. Arvanitis, A. C. Peet, N. Davies, S. Gill, M. Wilson, L. MacPherson, T. Arvanitis, A. Peet, L. Hayes, R. Jones, C. Mazewski, D. Aguilera, S. Palasis, A. Bendel, R. Patterson, J. Petronio, L. Meijer, T. Jaspan, R. G. G. Grundy, D. A. Walker, N. Robison, F. Grant, S. T. Treves, P. Bandopadhayay, P. Manley, S. Chi, M. A. Zimmerman, C. Chordas, L. Goumnerova, E. Smith, M. Scott, N. J. Ullrich, T. Poussaint, M. Kieran, J. C. Yang, D. D. Lightner, Y. Khakoo, S. L. Wolden, R. Smee, C. Zhao, B. Spencer-Trotter, A. Hallock, A. Konski, K. Bhambani, A. Mahajan, J. Jones, L. Ketonen, A. Paulino, J. Ater, D. Grosshans, R. Dauser, J. Weinberg, M. Chintagumpala, R. Dvir, R. Elhasid, B. Corn, H. Tempelhoff, D. Matceyevsky, V. Makrin, N. Shtraus, D. Yavetz, S. Constantini, E. Gez, E.-S. Yu, Y.-J. Kim, H. J. Park, H. J. Kim, S. H. Shin, J.-H. Kim, J.-Y. Kim, Y. K. Lee, M. R. Fiore, C. Sanne, H. C. Mandeville, F. H. Saran, J. Greenspoon, J. Duckworth, S. Singh, K. Scheinemann, A. Whitton, K. Gauvain, T. Geller, S. Elbabaa, J. Dombrowski, K. Wong, A. Olch, T. B. Davidson, R. Venkatramani, K. Haley, W. Zaky, G. Dhall, J. Finlay, M. W. Bishop, T. R. Hummel, J. Leach, J. Minturn, J. Breneman, C. Stevenson, L. Wagner, M. Sutton, L. Miles, M. Fouladi, S. Goldman
Journal: Neuro-Oncology (2012)
A New Medico-Legal Question
Journal: JAMA (2021)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Tobacco: for consenting adults in private only
Authors: G. D. Lundberg
Journal: JAMA (1986)

The health hazards of tobacco have been on the American Medical Association's (AMA) agenda at least since the very first issue ofThe Journal, on July 14, 1883, which included an anecdotal account of the harmful effects of smoking by children.<sup>1</sup>The AMA's official policies on tobacco have been developing steadily, along with our advancing knowledge of what has been proved to be one of the most damaging substances freely available in our society. Landmark scientific articles linking smoking with lung cancer<sup>2</sup>and many other diseases<sup>3</sup>were published inThe Journal; evidence mounted in many other places as well. In June 1963, the AMA House of Delegates formally recognized the deleterious effect of various toxic substances, including tobacco, on health<sup>4</sup>; a year later, the House called smoking itself "a serious health hazard."<sup>5</sup> <h3>AMA's Efforts in the 1980s</h3> The AMA has continued over the years to attempt
Reporting Device-Associated Death Events to the FDA—Reply
Authors: Christina Lalani, Madris Kinard, Rita F. Redberg
Journal: JAMA Internal Medicine (2022)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Journals JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal