Cells, and hence organisms, have biological memory, recording prior exposures to facilitate future responses.1 By linking this recall to gene expression, coordinated transcriptional programs are triggered that define normal function and adaptive responses. Efficient, integrated gene expression is essential, as evident with inflammatory responses to infection or tissue repair after injury. Cellular

In this issue of JAMA, Shen et al report findings from a preliminary study of 5 severely ill patients with coronavirus disease 2019 (COVID-19) who were treated in the Shenzhen Third People's Hospital, China, using plasma from recovered individuals.1 All patients had severe respiratory failure and were receiving mechanical ventilation; 1 needed extracorporeal membrane oxygenation (ECMO) and 2 had bacterial

The profound effects of sodium-glucose transporter 2 (SGLT2) inhibition on the risks of cardiovascular complications in patients with hyperglycemia have provided for rapid and substantive changes to diabetes guidelines from various countries. In this issue of JAMA, Petrie and colleagues1 report findings from a highly informative exploratory analysis of the most recent large-scale clinical trial of

As the coronavirus disease 2019 (COVID-19) pandemic intensifies, shortages of ventilators have occurred in Italy and are likely imminent in parts of the US. In ordinary clinical circumstances, all patients in need of mechanical ventilation because of potentially-reversible conditions receive it, unless they or their surrogates decline. However, there are mounting concerns in many countries that this

As the coronavirus disease 2019 (COVID-19) pandemic accelerates, global health care systems have become overwhelmed with potentially infectious patients seeking testing and care. Preventing spread of infection to and from health care workers (HCWs) and patients relies on effective use of personal protective equipment (PPE)—gloves, face masks, air-purifying respirators, goggles, face shields, respirators

As a retired consultant histopathologist with 40 years’ experience of working in the NHS, I am appalled that NHS staff are not being provided with adequate personal protective equipment …

Significant shortcomings in the care given to heart surgery patients at St George’s Hospital in London “probably, most likely, or definitely” contributed to 67 deaths between April 2013 and December 2018, an independent panel of experts has concluded.1 NHS Improvement convened the panel of 12 assessors after St George’s University Hospitals NHS Foundation Trust fell below national safety levels for

Sarah Hallett, chair of the BMA junior doctors committee, answers questions on how the covid-19 pandemic might affect trainees This is an unprecedented situation for the NHS and it’s likely that many staff, including junior doctors, will be asked to take on roles that may be unfamiliar or that they weren’t expecting. We know that this is already happening in places where the pressure is being felt

Doctors in the Royal Navy have many opportunities to build a varied and lasting career while developing additional leadership skills. This makes them highly sought after if they decide to return to civilian life. After spending three years as a general duties medical officer—using your skills either on shore, onboard a ship, on a submarine, or working with the Royal Marines—you can choose to specialise

In this feature ( BMJ 2020;368:m1174, doi: …

Extra risk is plausible on current balance of evidence Emerging evidence suggests that the most serious complications of covid-19 are sepsis and cardiovascular or respiratory complications. They occur predominantly in elderly people and those with underlying health conditions.1 Does use of non-steroidal anti-inflammatory drugs (NSAIDs) increase these risks? We don’t know for certain, but additional

I’m aware that Carrie MacEwen’s recent interview in The BMJ has been taken out of context in the tabloids, but as one of her young doctors three years out of medical school, I think her comments are likely to fall on weary ears.1 I don’t feel hopeful that we’re onto a “new phase”; …

The BMJ reports that England will move to an “opt-out” system of consent for organ donation from May 2020.1 This follows a Department of Health and Social Care consultation that received 17 000 responses, and the proposals plan to focus on decision making and public awareness.2 Given …

A lack of access to personal protective equipment (PPE) and staff testing in care homes poses a major risk of covid-19 being spread, sector leaders have warned. Care homes have been identified as one of the biggest potential risks for virus spreading, owing to the number of elderly residents with underlying health conditions. At a health select committee hearing hosted remotely on 26 March, Sarah Pickup

The absence of covid-19 testing for NHS staff is causing huge workforce shortages by forcing doctors to self-isolate even if they do not have the virus, the head of the BMA has warned. The government’s advice is for people with covid-19 symptoms to stay at home for seven days, but for all other household members who remain well to isolate for 14 days. The BMA council chairman, Chaand Nagpaul, said

The US has become the country with the most confirmed cases of covid-19 with 86 762 diagnoses on the morning of 27 March—more than China or Italy—and 1306 deaths. The rise in cases is steeper in the US than in any other large country. Almost half of US cases are in the state of New York while neighbouring New Jersey has the second most cases. Texas and some other states now require people coming from

More than 300 Italian doctors and scientists have called on the prime minister, Giuseppe Conte, and local authorities to use their skills and facilities to ramp up RNA testing to identify mild and asymptomatic cases of covid-19, which they have said account for 80% of all cases and are helping to spread the contagion. “Given the dramatic emergency in which our country finds itself, we consider it our

The Court of Appeal has ruled unanimously that a policy of offering bevacizumab (Avastin) off label to NHS patients with wet age-related macular degeneration (AMD) as an alternative to the much more expensive drugs ranibizumab (Lucentis) and aflibercept (Eylea) is lawful.1 In a major judgment with far reaching implications for the NHS and the drug industry, the three judges rejected arguments by the

Final year medical students are to be offered early provisional registration and foundation year 1 (FY1) doctors early full registration with the General Medical Council to help staffing levels during the covid-19 pandemic, a joint statement from regulatory and training bodies released on 25 March says.1 The statement from the UK health departments, the GMC, Health Education England, NHS Education

Nearly 700 000 people signed up in the first 24 hours of the launch of an app to help track the spread of coronavirus across the UK in real time and collect information on the range of self-reported symptoms and the characteristics of those most at risk. The Covid Symptom Tracker app (covid.joinzoe.com) enables users to make a daily report of any symptoms. It is available free of charge to members

Singlehanded GPs are worried about what will happen to their practice patients if they themselves become ill with the covid-19 virus and have to self-isolate, it has emerged. The situation has been highlighted by a case of a husband and wife GP, both older than 70, who each have their own singlehanded practices in Nottingham. Doctors Noble Vinayakumar Phillips and Naomi Phillips have sought, unsuccessfully

A group of diabetes doctors and other clinicians has set up a social media account to help alleviate patients’ fears around covid-19 and provide them with “a secure base” of information. Around one in 13 people in the UK has diabetes, roughly 90% type 2 diabetes and 10% type 1. The UK government has advised that all people with diabetes—along with other at-risk groups—should be “particularly stringent”

Differentiating excessive daytime sleepiness (EDS) from symptoms of fatigue or being “tired all the time” is key to accurate diagnosis The Epworth Sleepiness Scale (ESS) score is a useful way to assess and classify EDS. An ESS >10 indicates EDS and >17 indicates severe EDS Obstructive sleep apnoea, periodic limb movement syndrome, narcolepsy, and circadian rhythms are some of the commonest causes of

The past decade has allowed the development of a multitude of digital tools. Now they can be used to remediate the COVID-19 outbreak.

Large-scale collection of data could help curb the COVID-19 pandemic, but it should not neglect privacy and public trust. Best practices should be identified to maintain responsible data-collection and data-processing standards at a global scale.

We would like to express our concern about the limited capacity of actions taken by the Spanish Government to successfully control the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak and end the exponential growth phase of new cases. The measures taken so far, consisting primarily of partial restriction mobility, are in the right direction, although some researchers have warned

“Hope for improving health and quality of life of Palestinians will exist only once people recognise that the structural and political conditions that they endure…are the key determinants of [Palestinian] population health.”

Radiologists have watched the coronavirus disease 2019 (COVID-19) pandemic unfold, wondering if and how imaging could be useful for diagnosis. Perhaps imaging could aid in screening or accelerate the speed of diagnosis, especially with shortages of RT-PCR.

As of March 25, 2020, WHO's online coronavirus disease 2019 (COVID-19) reveals that the pandemic spans 195 countries and territories with 375 498 cases. With this rapid expansion of the pandemic comes a growing need to ensure that accurate and credible information is accessible to public health authorities, researchers, and the wider public. This has prompted WHO, institutions, and individuals to develop

Two articles reported in this issue of JAMA from separate research teams in China present details of 3 neonates who may have been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in utero from mothers with coronavirus disease 2019 (COVID-19).1,2 Evidence for such transmission is based on elevated IgM antibody values in blood drawn from the neonates following birth. All infants

Guidelines are developed for various reasons, including the emergence of new, potentially practice-changing evidence or a perceived need for guidance in times of uncertainty. The COVID-19 pandemic presents an almost unparalleled example of the latter, prompting the Surviving Sepsis Campaign (SSC) Task Force to rapidly produce Guidelines on the Management of Critically Ill Adults With Coronavirus Disease

Neil Greenberg and colleagues set out measures that healthcare managers need to put in place to protect the mental health of healthcare staff having to make morally challenging decisions The covid-19 pandemic is likely to put healthcare professionals across the world in an unprecedented situation, having to make impossible decisions and work under extreme pressures. These decisions may include how

The UK is at last in near lockdown. While further measures may be needed, the government’s announcement on Monday 23 March has brought the country nearly into step with its European neighbours. If we are indeed only two weeks behind Italy, the peak of the covid-19 pandemic is on its way. There is an eerie calm, as when the sea recedes before the tsunami. Few of us can imagine what lies ahead. For some

Policy makers must include migrant camps in their national plans The world has watched the growing global health crisis caused by covid-19 with alarm, fear, and desperation. One after another, governments, healthcare systems, and individuals are adopting increasingly restrictive measures, with “social distancing” now the norm in most countries. Yet for many people, and especially migrants who have

A long list is emerging from largely unadjusted analyses, with age near the top As the covid-19 pandemic accelerates, governments are warning people at high risk to be particularly stringent in observing social distancing measures because if they become ill they are more likely to need critical care including ventilation, and to die.1 Most data on covid-19 are from China, and although most confirmed

A man in his 40s presented with six months of bloodstained nasal discharge from his right nostril. Nasal endoscopy showed purulent bloodstained nasal discharge in the right nasal cavity and a mass with an irregular friable appearance in the right middle meatus of the right nasal cavity; the appearance of the septum and left nasal cavity was normal. He underwent a non-contrast computed tomography scan

Nearly a million refugees live in overcrowded conditions in the camps of south Bangladesh. Gaia Vince reports on the growing fears of an imminent, catastrophic outbreak of covid-19 Bangladesh, with its 168 million inhabitants, is one of the poorest and most densely populated countries in the world. Millions live cheek by jowl in slums, where 10 or more households share a toilet. People move around

Innovative services and collaborations are improving patients’ lives and community wellbeing, finds Matthew Limb To tackle a range of problems, the practice team took control of the list of patients who are prescribed opiates for chronic pain issues. “These included high substance misuse rates, high opioid prescribing, including a couple of patient deaths, lack of effective organisational structure

Earlier and better support are improving the lives of patients with respiratory conditions, finds Matthew Limb Community acquired pneumonia is a major cause of hospital admission. But care quality and patient outcomes are often poor, with overprescribing of antibiotics and most low severity patients remaining in hospital. A respiratory infections team, comprising three specialist nurses with consultant

Italy is in a dramatic situation owing to the spread of covid-19,1 but we could do more to protect medical doctors and all hospital workers, including nurses, therapists, technicians, and support staff. Beyond the personal risks that doctors and healthcare workers are facing directly—highlighted by the death of general practitioner and national delegate for continuous medical education Roberto Stella

McCormack and Holmes’s article clearly shows how far the practice of medicine is from an exact science, how much it is still an art dependent on the performer.1 In medical school we are taught not to treat the test but the patient, but test results, even repeated, may simply show physiological variation and not …

The loss of a valuable nurse because of an irrational decision by the Nursing and Midwifery Council (NMC) is a shameful event. I agree with Oliver that this will damage nurses’ confidence in the NMC and increase the number of inappropriate cardiopulmonary resuscitation (CPR) attempts.1 We have seen the same punitive attitude from the General Medical Council, with a similar inability to see …

The switch to an “opt-out” system for organ donation is eagerly anticipated and represents a positive change.1 But it will not solve the organ donor deficit on its own. The policy change has been effective in Wales, but a systematic review of 35 countries found that the effectiveness of an opt-out system at improving donation …

This slit lamp photograph (fig 1) shows unilateral congenital corectopia in the left eye. The patient was a 5 month old boy who was …

If a patient taking oral anticoagulants has a lower gastrointestinal bleed, it’s a mistake to think that the anticoagulant is to blame. A large Danish register study finds that there’s a substantial possibility that the bleed has nothing to do with the drug. Among 2500 people who sustained lower GI bleeds while taking anticoagulants, nearly 140 were subsequently diagnosed with colorectal cancer. The

The US Food and Drug Administration (FDA) has withdrawn orphan drug designation from a potential covid-19 treatment, after criticism that treating covid-19 as a rare disease was “disingenuous.” Pharmaceutical company Gilead requested that the FDA withdraw the designation—which was set to give the company a longer exclusivity period (seven years instead of five) and significant tax incentives—just days

The US Food and Drug Administration has approved the use of plasma from recovered patients to treat people who are critically ill with covid-19, provided that doctors get approval over the telephone.1 The method has been used in the past to treat diseases such as polio, measles, and mumps, in the 1918 flu epidemic, and in previous outbreaks of respiratory infections similar to covid-19. The FDA’s decision

The BMA has called the shortage of personal protection equipment (PPE) across the NHS “totally unacceptable” and warned the government that without proper kits some doctors treating patients with covid-19 may die. Chaand Nagpaul, the BMA’s Chair of Council, has called for the government to be transparent about the level of supplies it has. The Royal College of GPs has also raised concerns about the

The top family court judge in England and Wales has ordered a fertility clinic to hand over medical records about its use of a dead patient’s sperm to the man’s brother.1 Andrew McFarlane, president of the High Court’s family division, ruled that the unnamed clinic must release records relating to the storage and use of the patient’s sperm and any embryos created using his sperm. The highly unusual