JAMA Insights  Genomics and Precision Health December 16, 2022 RNA Sequencing as a Diagnostic Tool Shamika Ketkar, Lindsay C. Burrage, Brendan Lee JAMA. Published online December 16, 2022. doi:10.1001/jama.2022.22843 RNA sequencing (RNA-seq) is a new tool in the genetic diagnostic laboratory made possible by the advent of low-cost, high-throughput, next-generation sequencing technology. Historically, RNA studies were limited to g...

CRT Kinetics After Fluid Infusion Peripheral tissue hypoperfusion is a strong predictor of poor outcomes in patients suffering from severe conditions, such as sepsis, cardiac arrest or cardiogenic shock. The evaluation of peripheral tissue perfusion is very important in identifying shock patients. This can be done at the bedside with either semi-quantitative tools such as the mottling score, or quantitative tools, such as skin temperature and the capillary refill t...

Editorials Awake prone positioning and covid-19 Amol A Verma, Fahad Razak, Laveena Munshi, et al BMJ 2022; 379 doi: https://doi.org/10.1136/bmj.o2888 (Published 07 December 2022)Cite this as: BMJ 2022;379:o2888 Safely reduces intubation for patients with hypoxaemia In a linked paper, Weatherald and colleagues (doi:10.1136/bmj-2022-071966) offer the most up-to-date evidence synthesis evaluating the use of awake prone positioning in adults with covid-19 ...

Understanding “No Escalation of Treatment” Designations No Escalation of Treatment (NoET) designations are used in ICUs to limit treatment for critically ill patients. However, they are the subject of much debate and have not been qualitatively studied. In this study conducted at seven hospitals in the U.S., researchers evaluate how physicians understand and perceive NoET designations with regard to their utility and associated challenges. They also explore what...

Invited Commentary  September 18, 2022 Fluoroscopic Guidance for Femoral Artery Access—Pushing Patients Out of the Plane Without a Parachute? Alexander C. Fanaroff, Jay Giri JAMA Cardiol. 2022;7(11):1118-1120. doi:10.1001/jamacardio.2022.3413 Common femoral artery (CFA) access—for diagnostic angiography, percutaneous coronary intervention (PCI), or other endovascular or structural heart procedures—is among the most ubiquitous procedures performed in th...

Invasive Mechanical Ventilation and the Pulmonary Microbiota Healthy lungs are necessary to accomplish O2/CO2 exchange between blood and external air. The pulmonary microbiota is critical for maintaining the functional balance of the lungs and is associated with the development and progression of respiratory diseases, such as asthma, chronic obstructive pulmonary disease, cystic fibrosis (CF), non-CF bronchiectasis, tuberculosis, COVID-19, lung cancer and lung...

Viewpoint  August 22, 2022 The Current Status of Next-Generation Sequencing for Diagnosis of Central Nervous System Infections Michael R. Wilson, Kenneth L. Tyler JAMA Neurol. 2022;79(11):1-2. doi:10.1001/jamaneurol.2022.2287 The prime directive in diagnosing neuroinfectious disease is to answer 3 deceptively simple questions: (1) Is the patient infected? (2) If so, with what? (3) How do we treat the infection? Our ability to answer the first 2 questio...

Role of NO Pathway in Sepsis Sepsis and septic shock are accompanied by haemodynamic, microcirculatory and metabolic changes. These changes can lead to impaired tissue oxygenation, multiorgan damage and death. A common hallmark of sepsis is reduced blood pressure. An increase in nitric oxide (NO) because of inflammation can contribute to vasodilation. On the other hand, a decrease in NO can induce microvascular dysfunction.  There is a hypothesis that ...

Editorial  November 28, 2022 Autoimmune Encephalitis—Misdiagnosis, Misconceptions, and How to Avoid Them Josep Dalmau, Francesc Graus JAMA Neurol. Published online November 28, 2022. doi:10.1001/jamaneurol.2022.4154 The autoimmune encephalitides (AEs) are a group of immune-mediated brain diseases that frequently associate with pathogenic antibodies against neuronal or glial proteins. There are now more than 20 AEs described that individually ...

Invited Commentary  November 30, 2022 Nationwide Variation of Care for Patients With Bleeding Pelvic Fracture—An Opportunity to Rescue Better? Lydia R. Maurer, Haytham M. Kaafarani JAMA Surg. Published online November 30, 2022. doi:10.1001/jamasurg.2022.5778 Most studies in the trauma literature have examined the mortality of all patients with pelvic fractures, estimating it at around 10%.1,2 In this nationwide study, Anand and colleagues3&nb...