ObjectiveTinnitus is a condition that causes distress and impairment across cognitive, functional, and psychiatric spectra. In the psychiatric realm, tinnitus has long been associated with depression. To better characterize the co-occurrence of depression and tinnitus, we performed a systematic review of the prevalence of depression among patients with tinnitus.Data SourcesWe comprehensively examined original studies reporting the prevalence of depression in adult populations with tinnitus, as indexed in the PubMed and Web of Science databases and published from January 2006 to August 2016.Review MethodsAll identified articles were reviewed independently by 2 researchers, with a third reviewer for adjudication. Included studies were evaluated for threats to validity across 3 domains—representativeness, response rate, and ascertainment of outcome—on a 4-point modified Newcastle-Ottawa Quality Assessment Scale.ResultsTwenty-eight studies were included, representing 15 countries and 9979 patients with tinnitus. Among the included studies, the median prevalence of depression was 33%, with an interquartile range of 19% to 49% and an overall range of 6% to 84%. Studies were high quality overall, with a mean score of 3.3 (SD = 0.76), and 89% utilized a validated tool to ascertain depression.ConclusionsWe conducted one of the largest contemporary comprehensive reviews, which suggests a 33% prevalence of depression among patients with tinnitus. Our review reaffirms that a substantial proportion of patients with tinnitus have depression, and we recommend that all who treat tinnitus should screen and treat their patients for depression, if present.

IMPORTANCE QT-prolonging medications (QTPMs) are a reported risk factor for sudden cardiac death (SCD) when defined by consensus criteria that presume an arrhythmic cause. The effect of QTPM on autopsy-defined sudden arrhythmic death (SAD) is unknown.OBJECTIVE To evaluate the association between QTPM and autopsy-defined SAD vs nonarrhythmic cause of sudden death. DESIGN, SETTING, AND PARTICIPANTS This prospective countywide case-control study included World Health Organization-defined (presumed) SCD cases who underwent autopsy as part of the San Francisco Postmortem Systematic Investigation of Sudden Cardiac Death Study (POST SCD) to determine arrhythmic or nonarrhythmic cause, and control deaths due to trauma (hereinafter referred to as trauma controls) in San Francisco County, California, from February 1, 2011, to March 1, 2014. Multivariate regression was used to evaluate the association of QTPM with the risk of presumed SCD, autopsy-defined SAD, and non-SAD compared with trauma controls. Medication exposure, determined by prescription lists and postmortem toxicologic findings, was used to calculate a summative QTPM exposure score (range, 0-20). Data were analyzed from September 1, 2018, to June 15, 2019. EXPOSURE QT-prolonging medication exposure, as measured by QTPM score (1 indicated low; 2-4, moderate; and >4, high). MAIN OUTCOMES AND MEASURES Death due to trauma, presumed SCD, and autopsy-defined non-SAD and SAD with no postmortem findings of extracardiac cause. RESULTS A total of 629 patients (mean [SD] age, 61.4 [15.7] years; 439 men [69.8%]) were included, 525 with presumed SCDs and 104 traumatic death controls. Individuals with presumed SCDs had higher exposure and were more likely to be taking any QTPM (291 [55.4%] vs 28 [26.9%]; P < .001) than trauma controls. Use of QTPMs was associated with increased risk of presumed SCD in low (odds ratio [OR], 2.25 [95% CI, 1.03-4.96]; P = .04) and high (OR, 6.70 [95% CI,]; P = .01) exposure groups. After autopsy adjudication, use of QTPMs was associated with increased risk of non-SAD (low-risk OR, 2.88 [95% CI, 1.18-6.99; P = .02]; moderate-risk OR, 2.62 [95% CI, 1.20-5.73; P = .02]; and high-risk OR, 14.22 [95% CI, 2.91-69.30; P = .001]) but not SAD in all exposure groups. This association was attenuated by the exclusion of occult overdose non-SADs in the highest exposure group. CONCLUSIONS AND RELEVANCEThese findings confirm the association between QTPMs and presumed SCD; however, after autopsy, this risk was specific for nonarrhythmic causes of sudden death. Studies using consensus SCD criteria may overestimate the association of QTPMs with the risk of SAD.

Editors of medical and scientific journals select and develop the research and opinion articles that are published, with important implications for research, patient care, and policy.Despite widespread stated commitments to promote diversity among editorial staff, there is little information about the composition of editorial teams. We developed and administered a survey to assess the diversity of editors at leading medical and scientific journals.Methods | The survey, based on prior studies 1 and input from content experts, had questions about demographics and professional characteristics (eAppendix in the Supplement).Beginning in June of 2020, we used the Web of Science 2020 Journal Citation Reports 2 and expert opinion to select 25 medical and scientific journals (17 based in the US and 8 in Europe) with impact factors greater than 10; namely, the Ameri-

Background - Sudden cardiac death (SCD) studies report higher incidence in men and Blacks but presume cardiac cause. We sought to identify sex and race differences in rates and causes of presumed SCDs in a prospective postmortem study in San Francisco County. Methods - All incident presumed SCDs meeting World Health Organization definition ages 18-90 were autopsied via active surveillance of consecutive out-of-hospital deaths in the PO stmortem S ystematic Inves T igation of S udden C ardiac D eath (POST SCD) Study (2/1/2011 - 3/1/2014). Autopsy-defined sudden arrhythmic deaths (SADs) had no extra-cardiac cause or acute heart failure. Results - Among 541 presumed SCDs, 525 (97%) were autopsied; 362 (69%) were male, 110 Asian (21%), 81 Black (15%), 40 Hispanic (8%), 279 White (53%), and 15 Other Race (3%). Adjusted for age and race, women had more non-cardiac causes of presumed SCD, including pulmonary emboli (8% vs. 2%) and neurologic causes (10% vs. 3%, both p<0.01). Of autopsy-defined SAD, men had 3-fold higher rates while women had more primary electrical disease (4% vs. 2%, p=0.02) and non-ischemic causes (53% vs. 39%, p<0.01). Age-adjusted incidence rate ratios were higher for Black women (2.55, p<0.01), and lower for Asian and Hispanic men (0.51 for both, p<0.05) than their White counterparts. Myocardial infarction without obstructive coronary arteries was more common among SADs in Asians than Whites (7% vs. 1%; adjusted p<0.05). Sudden neurologic deaths were more common in Asians, endocrine causes more common in Blacks, and gastrointestinal causes more common in Hispanics than Whites (adjusted p all <0.05). Conclusions - In this countywide postmortem study of presumed SCDs, women had more non-ischemic and non-cardiac causes. Black women had higher rates of autopsy-defined SAD than White women while Asian and Hispanic men had lower rates than White men. These findings have implications for risk stratification and prevention of sudden mortality in women and minority populations.

An ideal surveillance system for medical device safety would comprehensively collect data on adverse events across the life span of a device. Preferably, the system would be integrated into electronic health records to allow seamless identification, tracking, and real-time reporting of device-associated adverse events. Moreover, it would parse adverse events to detect substantial safety signals and underperforming devices. Such a system would also allow implementation of corrective actions in a swift and commensurate manner.In this issue of JAMA Internal Medicine, 2 reports 1,2 illustrate the importance of an improved surveillance system, particularly for life-sustaining medical devices. In one report, Davidsson et al 1 present the nationwide experience of Iceland with the Riata defibrillator lead (St Jude Medical), which was recalled in 2011 because of the risk of serious injury or death. The study adds to prior experience about adverse events with the Riata lead. 3 Davidsson et al 1 used a proactive protocol to detect events, which ranged from externalization of the conductor to death, and compared these outcomes in patients with a control group of patients with other defibrillator leads. The report effectively illustrates the extent to which Riata leads underperformed; the lead failure rate was 37% (19 of 52), including 1 instance that resulted in death, compared with the 8% failure rate (4 of 50) for other defibrillator leads (hazard ratio, 4.67; 95% CI, 1.18-18.50). It is noteworthy that Iceland has exemplary record keeping; all adverse event data were captured and are available in a national registry.In another study, Sengupta et al 2 characterize the high burden of serious adverse events (including death) with another cardiac device, the InSync III model 8042 heart failure pacemaker (Medtronic). The report demonstrates considerable deficits in both the swiftness (19 months from first notice of pacemaker failure to recall) and the appropriateness of the response (the US Food and Drug Administration [FDA] classifying the recall as class II-a low probability of serious adverse events). This long unexplained delay before the recall and the inappropriate recall classification raise concerns about patient harms that could have been prevented by speedier and stronger regulatory actions.Although the characteristics of an ideal surveillance system for medical device safety are easy to state, these 2 reports demonstrate the practical challenges. The reports add to a 2015 study by Tseng et al 4 that used systematic interrogation and autopsy of sudden cardiac deaths in patients with cardiac implantable electronic devices and found that passive surveillance efforts may inaccurately estimate device malfunction. Unfortunately, cardiac devices represent the tip of