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Journal Cover JAMA The Journal of the American Medical Association
  [SJR: 6.278]   [H-I: 491]   [1087 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 0098-7484 - ISSN (Online) 1538-3598
   Published by American Medical Association Homepage  [11 journals]
  • Defining Septic Shock
    • Authors: Jaehne A; Jayaprakash N, Langberg S.
      Abstract: To the Editor A panel of 19 experts conducted an extensive and complex analysis of current literature and sepsis databases to develop new SEPSIS-3 definitions and clinical criteria for sepsis and septic shock. Despite this effort, some concerns remain in regard to these definitions.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Defining Septic Shock—Reply
    • Authors: Shankar-Hari M; Singer M.
      Abstract: In Reply Sepsis-3 defines septic shock as a life-threatening, generalized form of acute circulatory dysfunction (represented as vasopressor-dependent hypotension) associated with inadequate oxygen utilization (represented as hyperlactatemia), but with the important caveat of adequate fluid resuscitation. This definition has strong similarities to the consensus recommendations cited by Dr Hernández and colleagues. This change in clinical criteria describing this definition will alter the epidemiology of septic shock because of reclassification but should offer greater consistency, as the current incidence varies 10-fold and mortality 4-fold.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Clinical Criteria to Identify Patients With Sepsis
    • Authors: Seymour CW; Angus DC.
      Abstract: In Reply Both letters suggest misunderstandings about the scientific goal of the task force, which was to explore the predictive validity of diagnostic criteria for sepsis. There is no gold standard for sepsis, which precludes simple measures of validity based on the presence of true positives (cases with sepsis) and true negatives (controls without sepsis). Predictive validity permits assessment of the extent to which potential criteria, applied in a population at risk of the unmeasurable condition (sepsis), predict outcomes more common in the condition.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Defining Septic Shock
    • Abstract: To the Editor The proposed new definition of septic shock, part of the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), requires the simultaneous presence of hypotension and hyperlactatemia for making the diagnosis, instead of hypotension or hyperlactatemia. In our opinion, this is a step backward compared with previous definitions.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Clinical Criteria to Identify Patients With Sepsis
    • Authors: Gerdin M; Baker T.
      Abstract: To the Editor In their study, Dr Seymour and colleagues developed a simple model for identifying ward patients at risk of sepsis. Their qSOFA score was compared with previously published criteria. We agree with the authors that there is a need for early recognition of patients with sepsis and that such systems should be based on measures of organ dysfunction, such as easily recorded vital signs, and feasible for health staff to use. The authors stated that the greater “predictive validity for in-hospital mortality” of the qSOFA supports its use.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Partnering Behavioral Modification With Bariatric Surgery
    • Authors: Minami CA; Stulberg JJ, Hungness ES.
      Abstract: This commentary discusses an observational cohort study published in JAMA Surgery that investigated postoperative eating behaviors and weight control and their effects on 3-year change in weight.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Cutaneous Necrosis of the Ears
    • Authors: Phan KM; Nguyen KH, Crum-Cianflone NF.
      Abstract: A 22-year-old woman presented with a 2-month history of fevers and pleuritic chest pain and a 2-day history of cutaneous necroses on her ears, without trauma. Evaluation revealed abnormal coagulation values and a deep vein thrombosis in one leg. What would you do next'
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Clinical Criteria to Identify Patients With Sepsis
    • Authors: Makam AN; Nguyen O.
      Abstract: To the Editor Dr Seymour and colleagues assessed the predictive validity of various clinical criteria to identify patients with sepsis. However, their conclusion that the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) scores are more clinically useful than the systemic inflammatory response syndrome (SIRS) criteria was primarily based on differences in the area under the receiver operating curve (AUROC), which has several limitations.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • USPSTF Recommendation Statement: Screening for Skin Cancer
    • Authors: ; Bibbins-Domingo K, Grossman DC, et al.
      Abstract: This Recommendation Statement from the US Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adults.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Evidence Report: Screening for Skin Cancer in Adults
    • Authors: Wernli KJ; Henrikson NB, Morrison CC, et al.
      Abstract: This systematic review to support the 2016 update of the US Preventive Services Task Force Recommendation Statement on screening for skin cancer among adults summarizes published evidence about the effectiveness of and potential harms from clinical skin cancer screening.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Association of Late Preterm and Early Term Birth Rates With Obstetric
           Interventions
    • Authors: Richards JL; Kramer MS, Deb-Rinker P, et al.
      Abstract: This study analyzed national and population-based birth registry data from Canada, Denmark, Finland, Norway, Sweden, and the United States to describe recent trends in late preterm and early term birth rates and assess association with use of clinician-initiated obstetric interventions.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Survival and Surgical Interventions for Children With Trisomy 13 and 18
    • Authors: Nelson KE; Rosella LC, Mahant S, et al.
      Abstract: This cohort study used health administrative databases to examine rates of survival and utilization of surgery among children with trisomy 13 and 18.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Visual Inspection and the USPSTF on Skin Cancer Screening
    • Authors: Tsao H; Weinstock MA.
      Abstract: In this issue of JAMA, the US Preventive Services Task Force (USPSTF) provides recommendations for screening for skin cancer. Based on assessment of the available evidence in 2016, the USPSTF concludes that “the current evidence is insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adults.” Thus, skin cancer screening is classified with an I statement, ie, insufficient evidence, the same statement grade and determination made by the USPSTF 7 years ago in its 2009 recommendation. However, “insufficient evidence of benefit” is different from “evidence of no benefit”: the public, physicians, and the popular press should avoid this misinterpretation. For the scientific community, the I designation should not be viewed as an indictment but rather an invitation to the public health, medical, and scientific communities to galvanize and to work together in executing well-designed but feasible studies so future recommendations can be of greater public health benefit.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • SRS With or Without WBRT and Cognitive Function in Patients With Brain
           Metastases
    • Authors: Brown PD; Jaeckle K, Ballman KV, et al.
      Abstract: This randomized trial assessed whether patients with 1 to 3 brain metastases who received stereotactic radiosurgery (SRS) alone vs SRS combined with whole brain radiotherapy (WBRT) had less cognitive deterioration at 3 months.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Trisomy 13 and 18—Treatment Decisions in a Stable Gray Zone
    • Authors: Lantos JD.
      Abstract: Thirty years ago, pediatric residents were taught that trisomy 13 and 18 were lethal congenital anomalies. Parents were told that these conditions were incompatible with life. There was a tacit consensus that life-sustaining treatment was not medically indicated. Clinical experience usually was consistent with this self-fulfilling prophecy.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Improving Birth Outcomes Key to Improving Global Health
    • Authors: Spong CY.
      Abstract: Optimizing birth outcomes is critical to improving global health not only for children, but also for the mother and family. Children who are born small, which is common in preterm births and complicated pregnancies, have a higher risk of heart disease and diabetes later in life. Similarly, some pregnancy complications, such as preeclampsia, have been found to increase the risk of maternal cardiac disease. Improving birth outcomes by optimizing pregnancy, reducing pregnancy complications, and delivering at the appropriate time can improve lifelong health for the mother and child, thereby benefitting the family unit and the broader community.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • A Word From Our Sponsors
    • Authors: Bergl P.
      Abstract: Occasionally, the stars align in our family’s busy weekdays, and my wife and I arrive home early enough to catch the evening news. Yes, despite being millennials, we enjoy these vestiges of the pre–internet days as a primary source of the day’s headlines. If we are lucky, we can catch the national broadcast at 5:30 pm local time. Usually, we resort to listening to the 6 pm local edition blaring on the television in the other room while we arrange both the food and the children in the dining room.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Whole Brain Radiotherapy for Brain Metastases
    • Authors: Kaidar-Person O; Anders CK, Zagar TM.
      Abstract: There has been ongoing debate regarding the value of stereotactic radiosurgery (SRS) alone compared with SRS plus whole brain radiation therapy (WBRT) for patients who have limited metastatic lesions in the brain. In this issue of JAMA, Brown and colleagues report the results of a randomized clinical trial (RCT) in which 213 patients with 1 to 3 brain metastases all less than 3 cm in diameter were randomized to either SRS alone or SRS plus WBRT. Compared with SRS plus WBRT, there was less cognitive deterioration at 3 months after SRS alone (63.5% [40/63 patients] vs 91.7% [44/48]; difference, 28.2%; 90% CI, 14.%-41.9%) and better quality of life (mean change from baseline, −0.1 vs −12.0 points; mean difference, −11.9 points; 95% CI, −19 to −14.8 points). In contrast, intracranial disease control rates (local and distant) at 3 months were 93.7% (89/95) with SRS plus WBRT and 75.3% (79/105) with SRS alone, a mean difference of 18.4% (95% CI, 7.8%-29.0%). Median overall survival was similar in the 2 groups (SRS alone, 10.4 months; SRS plus WBRT, 7.4 months; hazard ratio, 1.02; 95% CI, 0.75-1.38).
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • The Potential to Advance Health Care in the US Criminal Justice System
    • Authors: Kendig NE.
      Abstract: This Viewpoint discusses potential opportunities to advance health care in the US criminal justice system based on recent developments.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Stealth Research—Reflections and Update
    • Authors: Ioannidis JA.
      Abstract: In this Viewpoint, Ioannidis discusses controversial “stealth research” and provides an update to the case of a specific diagnostics company involved in such research.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Highlights for July 26, 2016
    • PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Definitions for Sepsis and Septic Shock
    • Authors: Sprung CL; Reinhart K.
      Abstract: To the Editor Dr Singer and colleagues reevaluated and updated the definitions of sepsis and septic shock using literature reviews, Delphi surveys of experts, and studies of several large databases. Despite some improvements, such as easier-to-use terms (ie, sepsis rather than severe sepsis) and development of the quick Sequential Organ Failure Assessment (qSOFA) score, a rapid bedside score without blood tests, we have several concerns.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Definitions for Sepsis and Septic Shock
    • Authors: Schneider-Lindner V; Lindner HA, Thiel M.
      Abstract: To the Editor The new consensus definition for sepsis (Sepsis-3) relies on interpretation of a study on the performance of several scores in patients with suspected infection for mortality prediction. Although this is a commendable step forward compared with previous expert opinion-based criteria definitions, we fear unintended adverse effects. Unsurprisingly, as the SOFA score was developed for predicting mortality, it outperformed SIRS in the hospital setting. Based on this result, the authors abandoned SIRS from the sepsis definition, eliminated the first stage of the former sepsis-continuum (previously called sepsis), and reclassified it as infection.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Definitions for Sepsis and Septic Shock
    • Authors: Townsend SR; Rivers E, Tefera L.
      Abstract: To the Editor The Sepsis Definitions Task Force published a series of articles that proposed a new definition of sepsis and septic shock, including revision of the current definitions of severe sepsis and septic shock. Because the definitions of sepsis and septic shock are integral to the recently implemented Centers for Medicare & Medicaid Services (CMS) sepsis measure (SEP-1: Early Management Bundle, Severe Sepsis/Septic Shock), clinicians and hospital stakeholders have questioned how the proposed definitions may affect the SEP-1 measure specifications.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Definitions for Sepsis and Septic Shock
    • Authors: Singh S; Mohan S, Singhal R.
      Abstract: To the Editor The Sepsis-3 definition of sepsis includes the SOFA score. The SOFA scoring system has stood the test of time as a simple, readily reproducible scoring system to monitor the progress of sepsis patients, and its place in clinical evaluation is undisputed.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Definitions for Sepsis and Septic Shock
    • Authors: Deutschman CS; Singer M.
      Abstract: In Reply Drs Sprung and Reinhart and Dr Schneider-Lindner and colleagues believe that Sepsis-3 recommends abandoning SIRS. That is not the case. Rather, SIRS may be useful in the presumptive diagnosis of infection. However, SIRS is not specific nor particularly sensitive for infection. As an example, Churpek and colleagues reported that 50% of hospital inpatients have SIRS at least once in their hospital stay, and many of these patients will not have infection nor require antibiotic therapy. Conversely, 64% of the 66 522 non–intensive care unit (ICU) patients in the University of Pittsburgh Medical Center validation cohort had 0 or 1 SIRS criteria at the time they were cultured and treated for suspected infection. The article also did not suggest that what was previously called “sepsis” be eliminated from the diagnostic spectrum. Rather, it should be simply and correctly identified as “infection.”
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Composition of the Sepsis Definitions Task Force
    • Authors: Shrestha GS.
      Abstract: To the Editor Dr Singer and colleagues, in the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), focused on organ dysfunction as an integral component of the pathobiology of sepsis. Incorporation of the Sequential [Sepsis-Related] Organ Failure Assessment (SOFA) score to identify organ dysfunction makes the definition more objective for clinicians and researchers.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Composition of the Sepsis Definitions Task Force
    • Authors: Wira CR; III, Swenson KE.
      Abstract: To the Editor We wish to underscore several points related to the early identification of sepsis in patients who are in the emergency medicine phase of care to complement and enhance the recommendations by the Sepsis-3 authors. Under the new definitions, sepsis requires a suspected infection and evidence of organ dysfunction.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Composition of the Sepsis Definitions Task Force
    • Authors: Burnham EL; Roman J.
      Abstract: To the Editor We were disappointed to see that the Sepsis-3 consensus panel, convened with the support of major US and international critical care societies to formulate new definitions for sepsis and septic shock, included no women, no underrepresented minority members, and no members from developing countries. This panel followed another invited consensus group convened a few years ago to address the definition of the acute respiratory distress syndrome that included only 1 woman out of 15 task force members and lacked representation from countries beyond North America and western Europe.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Composition of the Sepsis Definitions Task Force
    • Authors: Deutschman CS; Singer M.
      Abstract: In Reply The letters from Dr Shrestha, Drs Wira and Swenson, and Drs Burnham and Roman raise valid and important critiques about a process that is inherently complex and imperfect.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Composition of the Sepsis Definitions Task Force
    • Authors: Dorman T; De Backer D.
      Abstract: In Reply The Society of Critical Care Medicine and the European Society of Intensive Care Medicine convened an expert panel on sepsis for the purpose of reexamining definitions of sepsis and sepsis shock. The task force comprised recognized world leaders with expertise in sepsis pathophysiology, clinical trials, and epidemiology. It included leaders from 8 countries. The task force’s subsequent work was endorsed by 31 additional societies around the world.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Neighborhood Walkability Gains Attention
    • Authors: Abbasi J.
      Abstract: This Medical News article discusses new research linking walking, enhanced built environments, and improved health outcomes.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Weight Gain Not an Issue With Mediterranean Diet
    • Authors: Slomski A.
      Abstract: Eating a Mediterranean diet high in vegetable fats such as olive oil or nuts with no calorie restrictions had little effect on body weight or waist circumference compared with a low-fat diet, which increased central adiposity, according to recent findings (Estruch R et al. Lancet Diabetes Endocrinol. doi:10.1016/S2213-8587(16)30085-7 [published online June 6, 2016]). This study was a secondary outcomes analysis of the previously published randomized PREDIMED trial, which studied 3 diets for the prevention of cardiovascular disease (Estruch R et al. N Engl J Med. 2013;368[14]:1279-1290).
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Weight Loss and Birth Rate in Obese Women
    • Authors: Slomski A.
      Abstract: Assisted reproductive techniques are less successful in obese women, who also have higher complication rates in pregnancy and labor. However, recent research suggests a lifestyle intervention designed to help obese women lose 5% to 10% of their body weight did not improve perinatal outcomes after subsequent treatment for infertility (Mutsaerts MA et al. N Engl J Med. 2016;374[20]:1942-1953). The study compared birth rates of obese women who had attempted to lose weight prior to infertility treatment with women who had infertility treatment alone.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Hyperthermia Produces Antidepressant Effect
    • Authors: Slomski A.
      Abstract: Heating the body to a state of mild hyperthermia created an antidepressant effect in people with major depressive disorder, according to a recent study (Janssen CW et al. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2016.1031 [published online May 12, 2016]). Raising participants’ core body temperature to 38.5°C significantly reduced depressive symptoms within 1 week of the intervention, and the effect was sustained for several weeks.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • NCI Launches Cancer Patient Data Repository
    • Authors: Abbasi J.
      Abstract: In June, Vice President Joe Biden visited the University of Chicago to commemorate the launch of the National Cancer Institute (NCI) Genomic Data Commons (GDC), a new system for cancer researchers to share genomic and clinical data. The system is an integral element of the National Cancer Moonshot Initiative and the President’s Precision Medicine Initiative.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • New Campaign to Focus on Physical Activity and Nutrition
    • Authors: Abbasi J.
      Abstract: Two influential organizations are teaming up on a new national public engagement campaign—#0to60—to inspire people in the United States to lead healthier, active lifestyles. The campaign is spearheaded by the President’s Council on Fitness, Sports, and Nutrition—which turns 60 this year—and the National Foundation on Fitness, Sports, and Nutrition.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Buying Fruits and Vegetables With SNAP
    • Authors: Abbasi J.
      Abstract: The US Department of Agriculture (USDA) wants Supplemental Nutrition Assistance Program (SNAP) participants to buy more fruits and vegetables. To that end, the agency has announced $16.8 million in competitive grants to 27 projects across the country.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Adults Join Kids in e-Cigarette Use
    • Abstract: Electronic cigarettes aren’t just popular among middle and high school students. Plenty of US working adults are drawn to the battery-powered devices that deliver nicotine and flavorings—along with carcinogens and toxins—in a heated aerosol.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Least Severe Flu Season in 3 Years
    • Abstract: People in the United States were blessed with a relatively mild 2015-2016 influenza season that produced fewer outpatient visits and hospitalizations as well as fewer deaths from flu or pneumonia compared with the previous 3 years, according to a recent CDC summary.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Yellow Painting (Abstraction)
    • Authors: Sefton P.
      Abstract: “Painting cannot be the only activity of a mature artist,” painter Ad Reinhardt (1913-1967) once commented, and his life as a teacher, art historian, graphic designer, commercial artist, cartoonist, polemicist, art theorist, and social activist is ample testament to his commitment to that idea.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • My Life
    • Authors: Halberstadt C.
      Abstract: I who have lived my life as a shadowwithin sounds and symbols as if they were real,who has danced and borne children—I who have lived in the world as a dreamwho has gathered and planted and fedwho protected a stone, a turtle, tree, a worm,who has a list of what is unknowntold in the wind of eternities—
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Exercise and the Heart
    • Abstract: The importance of acquiring more information than is now available with respect to the physiology of exercise has not lacked emphasis in The Journal. Many of the facts which are learned find an immediate application in the domain of practical medicine and notably in the clinic of cardiac diseases. The enlargement of the heart, for example, may be attributable either to hypertrophy of its musculature or to an increase in its blood-volume. Both of these conditions are affected by muscular activity or exercise, but the interrelations which are involved have never been fully elucidated.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • Screening for Skin Cancer
    • Authors: Livingston EH.
      PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
  • JAMA
    • PubDate: Tue, 26 Jul 2016 00:00:00 GMT
       
 
 
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