To the Editor HCV screening in EDs plays a vital role in identifying undiagnosed infections. Dr Haukoos and colleagues evaluated 2 approaches, identifying HCV in 0.21% (154/73 847) of patients via nontargeted screening and in 0.16% (115/73 651) via targeted screening. These findings suggest that the majority of cases could still be identified with substantially fewer tests.

In Reply We thank Drs Fleurence and Collins, Dr Baird and colleagues, and Dr Gallo and colleagues for their interest in the DETECT Hep C randomized clinical trial. We echo the concern about the relatively low rate of linkage to care and cure among those included in this trial. This lack of linkage to care highlights a clear limitation of simple clinician referral from EDs for HCV—the current standard of care for most EDs—and emphasizes the critical importance of developing novel strategies to improve HCV care continuum outcomes. Leveraging the successes of existing linkage to care and treatment paradigms for HIV, which have shown excellent outcomes, will likely be needed in the case of HCV. We also believe use of new point-of-care HCV RNA assays will provide an important opportunity to shift the timing of direct-acting antiviral initiation, ideally to the bedside in the ED. Such rapid direct-acting antiviral initiation could accelerate treatment adherence and cure, contributing to decreased morbidity, mortality, and transmission. We are also thrilled to hear about the Senate bill introduced by Senators Cassidy and Van Hollen, and we firmly believe such policy actions intended to improve access to treatment, especially among the most difficult-to-reach populations, have the opportunity to change the trajectory of the HCV epidemic in the US.

This randomized clinical trial examines whether a personalized hemodynamic resuscitation protocol targeting capillary refill time was more effective than usual care in patients with early septic shock.

This national study evaluates the percentage of US health care professionals sponsored for H-1B visas in fiscal year 2024 across occupation groups and county characteristics.

In Reply We appreciate the Letter from Dr Krommes about our Viewpoint. However, she and Doctors for America are misinformed. No scientific reviewers were let go as part of the reduction in force at the FDA, and our ability to provide timely, accurate reviews is uncompromised. Doctors for America is not an independent organization as it claims. It was founded to support a presidential campaign, and the Letter reveals its partisan bias.

Almost 25 years ago, a landmark trial of early goal-directed therapy (EGDT) by Rivers and colleagues reshaped the care of septic shock by introducing the concept that “early” management was crucial. Although implementation has varied across high- and low-resource settings, the importance of early sepsis recognition and treatment is now nearly universally accepted. In contrast, the specific manner by which goal-directed therapy for septic shock should be provided remains highly controversial. Conceptually, goal-directed therapy is a resuscitation protocol involving a goal to be achieved, serial assessments of the patient’s physiologic status, and administration of therapies that the assessments indicate will help achieve the goal. But what are the right goals, assessments, and therapies to improve outcomes for patients with early sepsis?

The American College of Obstetricians and Gynecologists (ACOG) released a new statement seeking to improve contraception access, citing ongoing threats to reproductive health access.

This JAMA Patient Page describes lower urinary tract symptoms in men and their associated diagnoses and treatments.

Wildness and medicine might seem like 2 words that should be kept intentionally separated. However, organized clinical settings and carefully designed workflows operate to benefit physical bodies, which of course pulse with life and are never entirely controllable. The irony of solely relying on bloodless algorithms and wishfully predictable systems to care for the undeniably living can be articulated through poetry. The poem “Hidden Pictures” expresses comfort with, and even joy at, the uncontrollable, expressed as nature and disability. The kinetic, frequently enjambed natural imagery is “bending,” “drooping,” “fall[ing],” and “spilling” around a mother and her child passing through a lush garden, revisiting a still-untamed wilderness on a summer day. Interwoven is a parallel story of the relationship between the mother and her child, a person with a disability. What can this relationship, unfolding outdoors in this fraught, unconstrained yet well-tended setting, teach us? Perhaps an answer is the very paradox—in medicine, where explanation is paramount, what if some hidden beauty lies not in naming everything but in embracing differences, like “monarch wings” and a “wheelchair” coexisting equally indomitably in a paradisical garden? Perhaps our journeys do not always take us where we expected. Relationships take surprising turns, away from libraries and into gardens, abilities are diverse, medical careers or individual clinical encounters hit unexpected blocks. Through poetry, we see that there may be a time to examine, remedy, push back, or attempt control—and yet also a place to free ourselves from the need to explicate the “unbodied” wildness in us all.

The US Food and Drug Administration (FDA) recently approved Novo Nordisk’s oral semaglutide, marketed as Rybelsus, to reduce the risk of major adverse cardiac events in adults with type 2 diabetes who are at high risk of these conditions.