JAMA (Journal of the American Medical Association)

Neurological Manifestations of Hantavirus Infection https://jamanetwork.com/journals/jamaneurology/fullarticle/2851731 This narrative review discusses the neurological complications of hantaviruses that, although rare, carry a high mortality rate, are typically secondary to ischemic injury or metabolic dysfunction, and can affect the peripheral or central nervous system.

Recommendations for Reporting on Potential Harms in Randomized Clinical Trials in JAMA Internal Medicine https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2851381 Randomized clinical trials, when rigorously conducted, offer the highest level of evidence to evaluate health care interventions. The value of a health care intervention depends on the benefits relative to the harms, which can be physical, psychological, or social. Published reports of randomized clinical trials uniformly focus on the benefits of the intervention being studied but often provide inadequate information regarding harms. There have been documented failures to report serious adverse events related to interventions, as well as discrepancies in harms reporting that arise from different approaches to monitoring, collecting, and classifying adverse events. Beyond these notable failures, there has been a general lack of adequate information on methods, analyses, and outcomes related to harms of interventions. As a result, there is a well-recognized need to improve reporting of harms in randomized clinical trials. The Consolidated Standards of Reporting Trials (CONSORT) Harms 2022 guideline provides standards for reporting harms, and select items related to harms were included in the revision of the main CONSORT 2025 guideline on reporting clinical trials. In this Editorial, we outline 3 key expectations for reporting harms in randomized clinical trials published in JAMA Internal Medicine.

Dementia Prevalence Trends in Latin America and the Caribbean https://jamanetwork.com/journals/jamaneurology/fullarticle/2851645 This cross-sectional study examines trends in dementia prevalence over 2 decades at 5 sites across Latin America and the Caribbean.

Hantavirus on a Nature Cruise and the Risk of a Pandemic https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2851366 This Viewpoint discusses the alarm surrounding the hantavirus cases first reported in May 2026 and burgeoning threats, such as Ebola virus.

Interpreting the APERITIF Randomized Clinical Trial—Reply https://jamanetwork.com/journals/jamacardiology/fullarticle/2851275 In Reply Chen and Xiong raise important points. Given the open-label design of the trial, the selection of antiplatelet therapy was not random. As suggested, we analyzed the prevalence of left ventricular (LV) thrombus, maximal thrombus diameter, and Bleeding Academic Research Consortium (BARC) type 1 bleeding at 1 month according to the antithrombotic regimen at hospital discharge (Table). Discontinuation of antithrombotic therapy is reported in Supplement 3.

Interpreting the APERITIF Randomized Clinical Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2851276 To the Editor Puymirat and colleagues report the APERITIF randomized clinical trial evaluating rivaroxaban, 2.5 mg, twice daily for 4 weeks added to dual antiplatelet therapy (DAPT) to prevent left ventricular (LV) thrombus after anterior ST-segment elevation myocardial infarction (STEMI). The primary end point—LV thrombus on contrast-enhanced cardiac magnetic resonance (CMR) at 1 month—was neutral, while minor bleeding (Bleeding Academic Research Consortium [BARC] type 1) was increased in the rivaroxaban group.

Finerenone and Blood Pressure in Heart Failure With Mildly Reduced or Preserved Ejection Fraction https://jamanetwork.com/journals/jamacardiology/fullarticle/2851277 This randomized clinical trial analyzes whether finerenone lowers blood pressure and whether its cardiovascular benefits in patients with mildly reduced or preserved ejection fraction heart failure depend on baseline blood pressure or blood-pressure reduction.

Expansion of Civil Commitment for Substance Use Disorders https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2850883 This Viewpoint discusses the ethics of civil commitment for substance use disorders and advocates for expansion of access to voluntary treatment instead.

Respiratory Outbreak Mitigation With Point-of-Care Testing in Long-Term Care https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2850884 This cluster randomized trial examines the effect of an on-site point-of-care respiratory multiplex polymerase chain reaction instrument on outbreaks of SARS-CoV-2, influenza, and respiratory syncytial virus in nursing homes.

Potential Biases in Assessment of Smallest Worthwhile Difference for Statin Therapy—Reply https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2850885 In Reply We thank Fischer for his thoughtful comments regarding our Research Letter. First, he states that the smallest worthwhile difference (SWD) should be independent of baseline risk because benefits and harms must be weighed in absolute terms. We agree that clinical decisions should be based on absolute effects, which is why we presented participants with absolute risk reductions using graphical displays and questions framed as, “If the risk is reduced from X% to Y%, would you accept treatment?” (eMethods in Supplement 1), making confusion with relative risk reduction unlikely. However, this does not necessarily imply that SWD should be constant across baseline risks.

Potential Biases in Assessment of Smallest Worthwhile Difference for Statin Therapy https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2850886 To the Editor In their Research Letter, Luo et al attempted to define the smallest worthwhile difference (SWD) that would justify statin therapy for primary prevention of atherosclerotic cardiovascular disease (ASCVD) from the patient perspective. Interestingly, they found that the SWD for most patients differed from current guideline recommendations. Moreover, the variability in SWD observed among individuals underscores the importance of incorporating values and preferences into evidence-based clinical decision-making.

Point-of-Care Polymerase Chain Reaction Testing for Respiratory Viruses Among Nursing Home Residents to Reduce Hospital Transfers https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2850887 In this issue of JAMA Internal Medicine, Kandel et al share the results of a cluster randomized trial leveraging point-of-care polymerase chain reaction (PCR) testing in nursing homes (NHs) to improve early detection of infections caused by SARS-CoV-2, influenza, and respiratory syncytial virus. While number or size of outbreaks and mortality did not differ, the proportion of residents transferred to acute care for confirmed and suspected viral respiratory infections decreased at intervention sites compared with control sites. The authors determined that this would result in 4 fewer transfers per 100 beds during the winter and spring respiratory virus seasons, a substantial benefit for NH residents.

The Machine Is Just as Loud https://jamanetwork.com/journals/jamaneurology/fullarticle/2850992 This essay describes the author’s experience with postseizure workups and scans and the protection that she felt was attached to professional status on both occasions.

Tofersen Distribution in the Central Nervous System of SOD1 -ALS Autopsy Tissue Donors https://jamanetwork.com/journals/jamaneurology/fullarticle/2850993 This autopsy tissue case series determines the tissue distribution of tofersen and provides estimates of SOD1 reduction in human somatic motor systems tissues among deceased patients with SOD1–amyotrophic lateral sclerosis (SOD1-ALS).

PCSK9 Inhibitor Price Reductions and Medicare Part D Utilization and Spending https://jamanetwork.com/journals/jamacardiology/fullarticle/2850829 This cross-sectional study evaluates price reductions and subsequent Medicare Part D utilization and spending for proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors.

Late Complication in Cardiac Sarcoidosis in a 40-Year-Old Female https://jamanetwork.com/journals/jamacardiology/fullarticle/2850830 This case report discusses a rare complication in a female patient in her 40s with cardiac sarcoidosis who underwent repeated ventricular tachycardia ablations.

Swinging Heart and an Intrapericardial Nodule in a 52-Year-Old Male https://jamanetwork.com/journals/jamacardiology/fullarticle/2850831 This case report discusses a rare cause of cardiac tamponade in a male patient aged 52 years who presented with progressive dyspnea, chest pain, and palpitations over 3 months.

Football-Specific On-Pitch Concussion Assessment Protocol https://jamanetwork.com/journals/jamaneurology/fullarticle/2851047 This Special Communication discusses the development of a football-specific, standardized on-pitch concussion assessment protocol informed by research evidence and expert opinion using an international consensus process and steering committee deliberation.

Health Equity: JAMA Internal Medicine Call for Papers https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2851086 Research on health differences by social class and economic status dates back to the mid-19th century. Early European publications examined differences in health by social class; then, during the next 100 years, the US produced the bulk of the evidence describing persistent and substantive differences in health across a broader range of social factors. During this descriptive period, scientists and clinicians came to realize that the differences noted in health care settings resulted from an array of structural, environmental, and social factors that spanned well beyond individual patients or the health care system. These broader factors are directly related to historical and current systemic inequities disadvantaging multiple population groups. The US is a fitting setting for this descriptive work, given its particularly stark social and economic inequities despite unparalleled national spending on research and health care. More recently, this research has evolved to explore underlying mechanisms of inequities and to test interventions to improve outcomes. This evolution has also marked a shift in nomenclature from health disparities (descriptive) to health equity (advancing health for all) research. However, despite progress during the last 75 years in the US, research in this field has continued to focus overwhelmingly on describing the number and scope of health inequities and defining the groups most adversely affected, at times relying heavily on conjectures about underlying etiology framed by the sociopolitical context.

Acetaminophen Use in Pregnancy and Neurodevelopmental Outcomes https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2850980 In September 2025, the US administration held a press conference stating that its ongoing investigation into the causes of autism had identified maternal use of acetaminophen (paracetamol) during pregnancy as a potential causal factor. This was concerning given that acetaminophen is among the most used medications in pregnancy for the management of pain and fever, in part because alternative options are limited or contraindicated (eg, nonsteroidal anti-inflammatory medications and opioids).