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Advances in antiretroviral treatment enable persons with human immunodeficiency virus (HIV) infection to live a normal lifespan, as long as they know that they are infected and adhere to treatment. Treatment that leads to an undetectable viral load prevents transmission of HIV to others. Since 2013, however, the rate of new HIV diagnoses in the United States has stabilized, not decreased. Continued viral transmission occurs from persons unaware of their HIV status, or not receiving effective treatment. To end the AIDS epidemic, what strategies can be used to increase the rate of early diagnosis and treatment?
In this issue of JAMA Internal Medicine, Hey and colleagues address the long-standing question of the optimum role of laboratory or surrogate end points in pivotal clinical trials. Their study raises concerns about how closely the US Food and Drug Administration (FDA) is following its own standards for applying these end points.
In this issue of JAMA Internal Medicine, Ahn et al raise the intriguing question of whether treatments covered by Medicaid should be democratically decided. Analyzing Oregon and Washington state guidance documents for proposed Medicaid coverage, and the public comments responding to these documents, Ahn et al found that 88% of commenters supported expanding coverage to include additional treatments and that at least 40% of commenters had financial ties to companies making products affected by the coverage decision. Yet the evidence cited in support of coverage was weak: almost 80% of commenters cited no studies, and even when cited, fewer than one-third of the studies that were referenced were randomized clinical trials. The authors thus do.
Could emergency medicine (EM), which often is characterized as overutilized by patients, criticized as excessive in performing tests, labeled as unjustifiably expensive, and susceptible to diagnostic error, be doing something right? Burke and colleagues found that the mortality rate declined considerably among Medicare beneficiaries who had visited an emergency department (ED) from 2009 to 2016, particularly in patients with high-severity conditions. Given the limits of observational studies, the cause of the lower mortality rate is unknown. We suspect that both EM proponents and detractors will use the study’s analysis to validate their own health care policy conclusions.
To the Editor I am writing in relation to the Editorial by Parks and Grady recently published in JAMA Internal Medicine. In this article, a clear overview is provided of the current understanding of the efficacy and safety of sodium polystyrene sulfonate. In addition, a potassium binder, patiromer, is suggested as a possible alternative option for the long-term treatment of hyperkalemia.
To the Editor Joshi et al claim that for the 3 target conditions of acute myocardial infarction, heart failure, and pneumonia, most of the decline in excess readmissions is due to regression to the mean (RTM) when applying the statistical model described by Linden and Davis to the excess readmission ratios (ERRs).
In Reply We thank Malik et al for their interest in our article and their comments. We agree with the authors regarding the difficulty of differentiating between incident and prevalent atrial fibrillation (AF) in the Nationwide Inpatient Sample (NIS) database. We noted this in the article’s Limitations section. Furthermore, we also stated in our Methods section that the reported rates of AF from the NIS assumed that all secondary discharge field disease coding was for new diagnoses of AF. We realized this assumption or approach may not be completely accurate, but it has been previously published using the NIS database. We were cognizant of the limitations with the NIS database that Malik et al highlighted, so we attempted to combat them usi.
In Reply We thank Dr Sabir for his comments on our article and for bringing attention to another recent US Food and Drug Administration–approved medication for lowering serum potassium in outpatients with nonemergent hyperkalemia. In 2 late phase trials, patients with mild hyperkalemia (serum potassium ≥5.1 mEq/L) were treated with relatively high-dose, open-label oral sodium zirconium cyclosilicate 3 times per day for 48 hours. In both trials, most patients achieved normokalemia, though the reduction in serum potassium was on average small—depending on the dose, between 0.2 and 0.7 mEq/L. In both trials, patients who achieved normokalemia were randomized to receive various once-daily doses of sodium zirconium cyclosilicate for an additiona.

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