JAMA

To the Editor Dr Ali and colleagues reported no additional analgesic benefit from adding acetaminophen (paracetamol) or hydromorphone to ibuprofen for children with acute musculoskeletal injuries. In all groups, the ibuprofen dose was 10 mg/kg and the acetaminophen dose was 15 mg/kg, with pain assessed 60 minutes after drug administration. Pain scores did not differ between ibuprofen monotherapy and either combination (ibuprofen plus acetaminophen or ibuprofen plus hydromorphone).

In Reply We thank Drs Rader and Brownstein for their thoughtful Letter about our recent publication reporting estimates of US state-level adult obesity prevalence by race and ethnicity group through 2035. They correctly point out that our forecasts were based on past trends and raise the concern that our results did not account for the potential effect of recent changes in prescribing patterns of weight-management medications such as GLP-1 RAs on the prevalence of obesity.

This Viewpoint discusses the pros and cons of artificial intelligence (AI) in physician learning and offers ways in which AI systems should be used to support rather than replace clinical judgment.

In Reply We thank Dr Morelli and colleagues for their thoughtful comments about the OPTION trial.

Among poetry’s applications in modern medicine is to reconnect clinicians to ancient healing rituals. In “After Sunstroke,” the speaker searingly recalls the Dionysian cult of ancient Greece and specifically its association with the maenads, female followers of the god of ecstasy who were believed to possess healing powers expressed in the catharsis of his worship with libation and dance. We hear the throb of music in the poem’s iambic rhythm, with the speaker also evoking the altered sensorium of sunstroke in a further reference to the madness of the maenads’ writhing and moaning. To the ancient Greeks, such rituals were community gatherings that themselves catalyzed healing; a similar impulse to (re)join in human communion is acutely felt here after the speaker recounts his isolating, hallucinatory symptoms of “I could glean/only goat bleat and the untuned bells/of a mad song…//…rereading the same/dense page about the German troops/in snow, till I would almost plead//to join them getting picked apart.” What feels like it could culminate in “certain death” is met instead by the healing physicality of the maenads, who seem to assuage not only the speaker’s, but even all humanity’s, suffering—that “piercing ring of heat”—in suffusing it with their “raised arms and wild hair.” Their frantic motion and headlong rush toward release is reminiscent, perhaps, of the hectic days of clinicians on the verge of burnout, always going beyond the possible in the quest to heal. Thus poetry aids in the timeless struggle to ease our patients’, and perhaps even our own, debasement by illness.

To the Editor Dr Williams and colleagues reported a rapid recovery with extended ultraoxygenated preservation (REUP) technique for adult donation after circulatory death (DCD) heart transplant that avoids both preimplant donor heart reanimation and ex situ machine perfusion, with encouraging early outcomes (30-day survival, 96%; severe primary graft dysfunction, 4%). In settings where thoracoabdominal normothermic regional perfusion is restricted—often reflecting deceased donor rule concerns and variable institutional policies—a cold-preservation strategy that does not require reanimation could have important practical implications.

This crossover randomized clinical trial examines the effect of symptom-based dosing vs scheduled opioid taper on time to medical readiness for discharge in infants with neonatal opioid withdrawal syndrome treated with the Eat, Sleep, Console approach.

The US Centers for Disease Control and Prevention (CDC) reported that drug overdose deaths decreased in 2025, marking the third consecutive year of decline.

Muscle loss, weaker grip strength, and slower walking pace may all be connected to a higher risk of stroke, a recent study found.

This Medical News article discusses a World Health Organization report on marketing tactics used to increase global nicotine pouch uptake.

Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA.

This Medical News article discusses a new study that found weakened heart muscle cell contractions in patients with heart failure with preserved ejection fraction and very high body mass index.

Single-pill combination therapy for hypertension remains uncommon and in fact has decreased over time, according to a study published in the Journal of the American College of Cardiology.

Certain metrics of the sleep-wake cycle, a behavioral manifestation of the circadian rhythm, may be associated with dementia, a study published in JAMA Neurology found.

In Reply Drs Yin and Zhang query what impact clinically relevant heterogeneity of participants with severe pain scores might have on study conclusions for the No OUCH trials. Study exclusion criteria ensured children requiring intranasal or intravenous opioid analgesia for severe pain would not be included in this study of oral analgesia. Indeed, the study participants’ mean baseline pain severity score of 6.4 to 6.5 (SD, 1.7-1.9), which at its upper limits was still only at the cusp of severe pain (defined as 8-10/10), included the group in whom clinicians often consider escalation beyond ibuprofen. We agree with Yin and Zhang that all children with mild to moderately severe pain should receive oral analgesia. However, our study was specifically designed to understand the incremental benefit of adding other analgesics to ibuprofen for children with moderately severe pain, rather than those with severe pain. Stratification by injury type demonstrated no clinically or statistically significant difference between study groups and across injury types (fracture vs sprain vs dislocation) consistent with prior studies of children’s fractures and other musculoskeletal injuries that have not reported any benefit with either combination therapy or opioids alone. We plan to report functional outcomes according to injury type in a future article, in which we will consider stratification by pain severity if the data support such analysis.

Ketamine infusions may help treat major depressive episodes during the acute phase, according to a study published in JAMA Psychiatry.

This study evaluated whether addition of a locking fluid containing 4% tetrasodium EDTA (t-EDTA) reduced central venous access device (CVAD) complications compared with usual care among adults in intensive care units (ICUs).

This Medical News article discusses ongoing developments in the Ebola outbreak primarily in the Democratic Republic of the Congo and the challenges in containing the rare Bundibugyo virus, which has no vaccine or specific treatment.

In this narrative essay, an anesthesiologist and the parents of a child he treated describe the extraordinary effort to save a 6-year-old’s life.

This Medical News article is an interview with Stephen Kornfeld, MD, about his experience filling in for the ship’s ailing physician when hantavirus turned his vacation cruise into a global public health concern.

As glucagon-like peptide-1 (GLP-1) medications have become more popular, metabolic bariatric surgeries have decreased, according to a research letter published in JAMA Surgery.

Traditionally, health plans manage payment for care, while clinicians deliver care. Although these roles have typically been distinct, organizations have increasingly merged these functions, integrating care and coverage. The largest health insurers in the US now also operate extensive physician networks, while health systems are increasingly acquiring or partnering with payers. These payer-provider integrated entities, often referred to as payviders, are a variation of earlier integrated models and are driven by more contemporary features of the health care delivery landscape, including Medicare Advantage expansion, value-based care payment reforms, substantial capital investment in health care organizations, and limited federal oversight of vertical integration.

The heat of an olive grove in August staggers and stuns—cicadas drilling, the tall grass baked too dry for mulch.

This narrative review discusses the pathophysiology, epidemiology, clinical presentation, diagnosis, and treatment of male hypogonadism.

To the Editor Ms DeCleene and colleagues presented a methodologically robust analysis of obesity prevalence in the US from 1990 to 2022, with forecasts through 2035. Their analytic strategy leveraged modeling techniques from the Global Burden of Disease project, which has produced highly reliable estimates of disease burden in the US and globally. However, the current use of this approach for US obesity forecasting relies on the assumption that pre-2022 trends will continue, absent exogenous shocks. The rapid proliferation of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) represents an already demonstrated example of such a shock.

This Medical News article discusses ongoing developments in the hantavirus cruise ship outbreak and the effect of the withdrawal of the US from the World Health Organization on managing the outbreak.

This JAMA Patient Page describes risk factors for gastric cancer, ways to prevent it, and the treatment and prognosis.

Approximately 116 million people in the US and 1.4 billion worldwide have hypertension. In the US, among people aged 40 to 59 years, approximately 53% have hypertension, and among people 60 years and older, 71.6% have hypertension. Hypertension is a major risk factor for cardiovascular morbidity and mortality, and lowering blood pressure in people with hypertension meaningfully reduces this risk. In a network meta-analysis of 42 randomized clinical trials and 144 220 people with hypertension, systolic blood pressure lowering by 10, 20, or 30 mm Hg to achieve a treatment goal of 120 to 124 mm Hg was associated with reductions in cardiovascular disease events of 29%, 42%, and 54%, respectively. Most people with hypertension require multiple antihypertensive medications to effectively control their blood pressure.

This JAMA Insights discusses strategies for lifestyle modifications and managing adverse effects for individuals with obesity receiving incretin-based therapies for weight loss.

B. A. Thomas, M.D., Philadelphia

To the Editor Dr Ali and colleagues reported results from 2 randomized clinical trials evaluating whether adding acetaminophen (paracetamol) or hydromorphone to ibuprofen improves analgesia for children with acute nonoperative musculoskeletal injury. In pooled analyses, pain scores at 60 minutes were similar across groups, whereas adverse events were more frequent with hydromorphone. These findings are timely given pediatric opioid stewardship policies and recent clinical guidance that encourages nonopioid-first strategies and cautious outpatient opioid prescribing for acute pain in children.

This study uses American Hospital Association Annual Survey data to examine current trends in hospital-led payvider models.

This randomized trial assesses the effect of 4% t-EDTA locking solution vs control locking fluid on composite incidence of central venous access device (CVAD)–associated bloodstream infection, catheter occlusion requiring alteplase use, and catheter removal due to occlusion among adult patients in the intensive care unit.

This network meta-analysis of short-term randomized clinical trials examines adverse effects and treatment discontinuation associated with blood pressure–lowering therapies and their combinations, by drug class and regimen.

In the Original Investigation titled “National Estimates of Pediatric Sepsis in US Hospitals Using Clinical Data,” published in the April 21, 2026, issue of JAMA, a typo occurred in the Abstract. In the Results section, the first sentence should have stated “3 926 809 pediatric hospitalizations.” This article was corrected online.

This Viewpoint discusses the US Supreme Court’s decision in Chiles v Salazar and offers suggestions for state professional regulation that protect patient safety and autonomy while respecting constitutional boundaries.

In Reply We appreciate the thoughtful comments and the opportunity to provide additional granularity regarding outcomes stratified by interval from declaration of death to flush or AWIT (<10 minutes vs ≥10 minutes) for our early experience with REUP for DCD heart recovery.

This Viewpoint discusses breaking up health care conglomerates to decrease the cost of health care insurance.

Neonatal opioid withdrawal syndrome (NOWS) remains a consequential downstream effect of the ongoing opioid epidemic in the US. Although we have improved both access and approach to medical management of opioid use disorder in pregnancy, exposure confers a risk of withdrawal to the infant, regardless of type of exposure or presence of medical supervision. Infants with opioid withdrawal syndrome continue to experience prolonged hospitalization, separation from caregivers, and significant additional opioid exposure. The burden is substantial: tens of thousands of infants are affected annually, and hospitalizations for NOWS continue to consume significant health care resources. Dozens of publications have addressed which medications should be used in the management of NOWS, but there remains a surprising dearth of comparative evidence informing how these medications should be implemented.

To the Editor We read with interest the Tenecteplase for Acute Non–Large Vessel Occlusion in the Extended Time Window (OPTION) trial, which evaluated intravenous tenecteplase administered between 4.5 hours and 24 hours after ischemic stroke onset in patients selected by computed tomographic (CT) perfusion imaging. Although the study addresses an important question in acute stroke care, its findings warrant cautious interpretation in light of safety considerations and clinical context.

This study assessed whether a symptom-based dosing strategy for opioid treatment reduces time to medical readiness for discharge compared with scheduled opioid taper in infants with neonatal opioid withdrawal syndrome (NOWS) cared for with the Eat, Sleep, Console approach (ESC) or Finnegan-based care, which focuses on detailed scoring of the signs of withdrawal.