About 13% of US adults reported using sleep aids most days in 2024, according to the US Centers for Disease Control and Prevention (CDC).

To the Editor A recent study of 10-year follow-up results from the Appendicitis Acuta (APPAC) trial reported a 37.8% true appendicitis recurrence rate and a 44.3% cumulative appendectomy rate among patients initially treated with antibiotics for uncomplicated acute appendicitis. While the authors concluded that antibiotics remain a viable treatment option for uncomplicated appendicitis, we wish to highlight several concerns about the generalizability, safety, and practicality of this approach.

To the Editor Dr Coté and colleagues conducted a multicenter, sham-controlled, double-blind randomized clinical trial to address a long-standing practice question in patients with unexplained acute recurrent pancreatitis and pancreas divisum. The primary time-to-event outcome (acute pancreatitis >30 days after randomization) was not significantly reduced with the use of ERCP with minor papillotomy (adjusted hazard ratio, 0.83 [95% CI, 0.49-1.41]).

This cross-sectional cohort study examines inhaler use among US adults with asthma and how demographic, socioeconomic, clinical, and heath care access factors may affect treatment disparities in this population.

This Viewpoint discusses opportunities for policymakers and practitioners to make progress in the public health challenge of obesity while avoiding unintended consequences.

Describing pain is challenging, as it's a deeply personal experience often inadequately captured by standard scales and adjectives. Patients frequently turn to creative outlets like poetry to articulate their pain. Clinicians can enhance patient care by validating and actively listening to these artistic expressions of pain. The poem "Pain" offers a unique personification of pain. It is depicted humorously and bitingly as a "clown" that is both annoying and comical. This personification portrays pain not as an enemy, but as something to engage with. The speaker's pain is described as "parading" and "screeching," persistently present. Expressing pain through novel metaphors can lead to a sense of empowerment for the patient. This is particularly true when pain is framed as an unruly companion rather than a malignant force. Ultimately, the way pain is named can provide a sense of control for those experiencing it.

To the Editor A recent Review provided a comprehensive overview of the management of squamous cell carcinoma of the head and neck. From a medical oncologist’s perspective, the role of cisplatin and several important clinical considerations should have been highlighted because cisplatin remains the most important cytotoxic agent in both curative and palliative settings for patients with head and neck cancer.

JAMA Senior Editor Derek C. Angus, MD, MPH, spoke with Gil Rabinovici, MD, a neurologist and director of the University of California San Francisco Alzheimer Disease Research Center, about the latest developments in dementia and Alzheimer disease research.

This Medical News article discusses the life and legacy of legendary cardiologist Eugene Braunwald, MD, who died on April 22, 2026.

C. D. Spivak, M.D., President Colorado Medical Library Association; Editor Medical Libraries, Denver, Colo.

Glucagon-like peptide-1 (GLP-1) receptor agonists may benefit people with psoriasis, a review published in JAMA Dermatology suggests.

In Reply We thank Mr Liu and Mr Chen and colleagues for their comments regarding our randomized clinical trial evaluating ERCP with minor papillotomy in patients with pancreas divisum and unexplained acute recurrent pancreatitis. Liu asks whether anatomical features of impaired dorsal duct outflow modified the treatment effect. In prespecified subgroup analyses stratified by duct diameter or a santorinicele (Figure 4 of the article), we did not find significant treatment × subgroup interactions for the primary outcome. As stated in the article’s Discussion section, the study was not powered for these subgroups. Notably, the prevalence of a santorinicele was 12% using a mix of standard and secretin-enhanced magnetic resonance cholangiopancreatography prior to randomization, which is consistent with the radiology literature. In small santorinicele cohorts, outcomes of minor papillotomy for acute pancreatitis and divisum suggest persistent acute pancreatitis clinically, biochemically, or both in 20% to 30% of patients. Therefore, even though a dilated duct or santorinicele is suggestive of a stenotic orifice, it is unlikely that they are sufficient to ensure a clinically significant benefit of minor papillotomy.

Moderate protein restriction was associated with favorable outcomes for patients with chronic kidney disease, according to research published in JAMA Network Open.

In this narrative medicine essay, a palliative care physician composes letters in her head to the mothers of aging veterans and to the physician who may one day care for her son as a way to speak for patients who have no one to speak for them.

A remarkable aspect of modern medicine is the ever-growing array of medications that fundamentally alter disease trajectories and improve quality of life. At the same time, persistent inequities in access to these medications remain a reality. Pharmacoequity, a term coined in a 2021 article in JAMA, is a specific component of health equity focused on fair and just access to appropriate medications, regardless of race, ethnicity, income, insurance coverage, and other social factors.

Type 1 diabetes is traditionally diagnosed when significant beta cell destruction leads to noticeable hyperglycemia. This late diagnosis results in substantial patient burden, high healthcare costs, and risks of complications. However, type 1 diabetes can now be detected presymptomatically through the presence of multiple islet autoantibodies. Stage 1 is defined by these antibodies and normal blood sugar levels, while Stage 2 includes abnormal glucose metabolism. Stage 3 represents the symptomatic, hyperglycemic phase of the disease. Interventions that modify the disease course and delay insulin dependence are becoming available for these earlier stages. This progress brings the prevention of clinical type 1 diabetes closer to reality. Screening for presymptomatic type 1 diabetes now aligns with established screening principles. These principles emphasize early detection, effective early intervention, and reliable testing. Furthermore, cost-effectiveness and supportive healthcare infrastructure are crucial for successful screening programs.

The management of uncomplicated acute appendicitis is now a complex assessment of various treatment strategies. The focus has shifted from a simple yes or no diagnosis to accurately assessing appendicitis severity. Accurate diagnosis is crucial as it relates to treatment success, tumor prevalence, and cost savings. The judicious use of CT scans is important to minimize radiation exposure, particularly for young adults. However, imaging remains essential for assessing appendicitis severity with high accuracy. Low-dose CT protocols can significantly reduce radiation without sacrificing diagnostic accuracy. Regarding antibiotics, ertapenem was initially used for standardized efficacy due to its broad coverage. Current evidence suggests some uncomplicated cases might resolve without any antibiotic treatment. This opens possibilities for safe discharge from the emergency department for many patients. Future research should explore optimized outpatient nonoperative treatment for uncomplicated acute appendicitis.

This study evaluated whether digoxin, when added to usual care, reduced the risk of death or new-onset or worsening heart failure in patients with symptomatic rheumatic heart disease (RHD).

This JAMA Patient Page describes the causes, risk factors, and methods for evaluating stillbirth before and after it occurs.

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

JAMA+ AI Associate Editor Yulin Hswen spoke with Emily Tat of Columbia University Irving Medical Center and NewYork-Presbyterian Hospital and Peter Brodeur of Beth Israel Deaconess Medical Center for JAMA+ AI Conversations about a research network dedicated to the evaluation of clinical AI.

A Black woman of Hispanic ethnicity with a history of hypertension, obesity, and headaches had symmetrically distributed, well-demarcated hyperpigmented lines that had developed during pregnancy and that extended from her buttocks to the lower extremities; physical examination was otherwise unremarkable. What is the diagnosis and what would you do next?

This randomized trial assesses the effect of treatment with digoxin vs placebo on a composite of all-cause death or new-onset or worsening heart failure among patients with symptomatic rheumatic heart disease.

This Special Communication explores the challenges currently facing state investment in primary care and outlines how a common fund could address these challenges and sustain primary care as a public utility and common good.

The US Food and Drug Administration (FDA) approved a new medication to treat agitation associated with dementia due to Alzheimer disease.

The Centers for Medicare & Medicaid Services (CMS) announced that it will provide access to certain glucagon-like peptide-1 (GLP-1) medications for weight loss for $50 a month through a new pilot program for Medicare beneficiaries.

This Viewpoint presents the history of the Health Resources & Services Administration (HRSA) 340B Drug Pricing Program and 340B Rebate Model Pilot Program, summarizes their controversies and limitations, and calls for action by Congress and HRSA to address these issues and strengthen support for safety-net hospitals and clinics.

This trial investigates the diagnostic yield of transbronchial lung biopsy with a 1.1-mm cryoprobe vs 2.0-mm forceps.

In Reply In response to the important clinical considerations regarding alternate cisplatin dosing regimens that Dr Szturz outlines, we acknowledge that concurrent weekly cisplatin is widely practiced in lieu of high-dose cisplatin for toxicity concerns in the setting of definitive (rather than adjuvant) radiation. However, there is currently insufficient evidence to adopt weekly cisplatin as the standard of care in the definitive setting for individuals eligible to receive cisplatin, pending the completion of an ongoing clinical trial comparing high-dose cisplatin with weekly cisplatin at 40 mg/m2 (NRG-HN009; NCT05050162). In the adjuvant setting, there are data to support weekly cisplatin administration. As noted, JCOG1008 found that weekly , 40 mg/m2, was noninferior in overall survival with fewer toxicities compared with cisplatin, 100 mg/m2, administered every 3 weeks with postoperative radiation.

This Perspective reviews the US Food and Drug Administration’s achievements toward eliminating unnecessary animal-based testing and outlines more human-relevant changes for the future.

This Medical News article discusses a large measles outbreak in the populous South Asian country and the global implications amid declines in vaccination.

This trial assessed whether the diagnostic yield of transbronchial lung biopsy is higher with a 1.1-mm cryoprobe compared with 2.0-mm forceps in adults needing bronchoscopy for pulmonary evaluation.

For frail older patients with non–ST-elevation myocardial infarction (NSTEMI), a conservative treatment strategy may be better than an invasive approach, new research suggests.

This population-based screening study examines early-stage (stage 1 or 2) type 1 diabetes prevalence and disease progression to clinical (stage 3) type 1 diabetes in children.

This meta-analysis assesses the association of digitalis glycosides treatment with risk of the composite outcome of cardiovascular death or first worsening heart failure events in patients with heart failure with mildly reduced ejection fraction or in those with heart failure with reduced ejection fraction.

Damp grey of a new year’s day and I’m conversing with a clown.

This study evaluated whether adjunctive intravenous tirofiban improves functional outcomes in patients with acute ischemic stroke without large or medium vessel occlusion or a cardioembolic etiology who show inadequate response to tenecteplase.

This JAMA Patient Page describes common symptoms and causes of benign paroxysmal positional vertigo, risk factors, and diagnosis and treatment.

To the Editor A recent article on PICS provided an excellent synthesis of the cognitive and emotional difficulties experienced by ICU survivors.

Graduate medical education looks very different in 2026 than it did in the early 1800s, with the many changes since that time including formalization and funding for teaching hospitals, efforts at work-hour limitations, and an emphasis on competency-based education. Yet, given the demands of the profession, graduate medical education remains a very challenging training—cognitively, physically, and emotionally.

This Perspective discusses prevention of pregnancy-related cardiovascular morbidity and mortality before, during, after, and between pregnancies.

This Medical News article discusses the US Food and Drug Administration’s plans to increase the availability of unapproved peptides for which there is little evidence of safety and efficacy.

Receiving nutrition and exercise support before surgery may help reduce postoperative complications and shorten hospital stays, a meta-analysis found.

This randomized trial assesses the effect of intravenous tirofiban vs placebo on 90-day outcome among patients with acute ischemic stroke and an inadequate clinical response to intravenous tenecteplase.

This Perspective examines a new Centers for Medicare & Medicaid Services (CMS) approach to outcome-aligned Medicare payments for technology-enabled long-term care.

This Review summarizes current evidence regarding the diagnosis and treatment of amyotrophic lateral sclerosis.

Cardiovascular-kidney-metabolic (CKM) syndrome was linked to cancer risk in a recent study, with increased risk as illness progressed.

This JAMA Insights discusses the epidemiology, clinical presentation, and diagnostic evaluation of benign paroxysmal positional vertigo.

In Reply We thank Drs Meng and Li for their thoughtful comments on our Review article and for the additional context on treatment strategies and risk factors for gastric cancer.