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Journal Cover   JAMA The Journal of the American Medical Association
  [SJR: 6.278]   [H-I: 491]   [922 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]
  • IOM Report on Core Metrics for Health and Health Care
    • Authors: Blumenthal D; McGinnis J.
      Abstract: This Viewpoint discusses an Institute of Medicine report that identifies 15 measures as core metrics for better health at lower cost.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Highlights for May 19, 2015
    • PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Hospital Quality Reporting by US News & World Report
    • Authors: Harder B; Comarow A.
      Abstract: This Viewpoint discusses why US News & World Report reports on hospital quality, how performance is evaluated, and what evolution in data sources and methods may be anticipated.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Visit Frequency and the Accountable Care Organization
    • Authors: Ganguli I; Wasfy JH, Ferris TG.
      Abstract: This Viewpoint discusses how physicians and health care organizations could work together to achieve the optimal number of patient office visits.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Including Physicians in Bundled Hospital Care Payments
    • Authors: Mehrotra A; Hussey P.
      Abstract: This Viewpoint discusses benefits of and barriers to including physicians in Medicare’s bundled hospital care payment system.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • A Silent Curriculum
    • Authors: Brooks KC.
      Abstract: During my medical training thus far, Trayvon Martin lost his life, Michael Brown was left to die in the streets of Ferguson, Missouri, and Eric Garner was choked by officers as he repeated 11 times that he could not breathe. But these events were rarely mentioned in the lecture hall, my small-group sessions, or morning rounds. Was I supposed to ignore their implications for the lives of my patients, and for my role as their caregiver'
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Hospital Ratings
    • Authors: Zuger A.
      Abstract: From the first days of their training, physicians are enjoined to remember that the patient is more than the disease. Good clinicians look past the diagnoses to focus on the unique individual whose illness must be interpreted and treated in its human context.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Amyloid Pathology in Persons With and Without Dementia Syndromes
    • Authors: Rosenberg RN.
      Abstract: In this issue of JAMA, 2 articles from the Netherlands report findings from meta-analyses that assess the prevalence of amyloid pathology as determined by biomarkers in persons with normal cognition, subjective cognitive impairment (SCI), or mild cognitive impairment (MCI) and estimate the prevalence of amyloid positivity on amyloid-β positron emission tomography (PET) in a wide variety of dementia syndromes. These reports are the largest and most detailed to date and are critical assessments that help define the role of amyloid in the causation of cognitive impairment and dementia.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Expression of Concern
    • Authors: Bauchner H; Fontanarosa PB.
      Abstract: Several concerns have been raised about the study conduct, integrity, and scientific validity involving an article published in JAMA by Dr Sato et al. After communicating these concerns to the author and evaluating his response, we have contacted administrative officials at the author’s institution and requested that they conduct an investigation to evaluate the scientific integrity of the research and the validity of the reported study results. This notice of concern is to inform readers about these possible issues related to this article. After additional information from this investigation becomes available, we will determine whether additional action is warranted.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Oral Steroids for Acute Sciatica Due to Herniated Lumbar Disk
    • Authors: Goldberg H; Firtch W, Tyburski M, et al.
      Abstract: This randomized trial reports that among patients with acute sciatica due to a herniated lumbar disk, a short course of oral steroids resulted in modestly improved function and no improvement in pain compared with placebo.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Prevalence of Cerebral Amyloid Pathology in Persons Without Dementia
    • Authors: Jansen WJ; Ossenkoppele R, Knol DL, et al.
      Abstract: This meta-analysis explores the association of amyloid pathology with age, APOE genotype, sex, education, and presence of cognitive impairment among persons without dementia.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Prevalence of Positive Amyloid PET Scans in People With Dementia
    • Authors: Ossenkoppele R; Jansen WJ, Rabinovici GD, et al.
      Abstract: This participant-level meta-analysis estimates the prevalence of PET scan–measured amyloid in Alzheimer disease participants and its associations with age, sex, education, cognitive function, and APOE genotype.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Stroke Prevention in Atrial Fibrillation
    • Authors: Lip GH; Lane DA.
      Abstract: This narrative review summarizes stroke risk prediction tools and strategies to prevent stroke in patients with atrial fibrillation.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Blood Pressure Control and Cognitive Performance
    • Authors: DeCarli C.
      Abstract: JAMA NeurologyMidlife Hypertension and 20-Year Cognitive Change: The Atherosclerosis Risk in Communities Neurocognitive StudyRebecca F. Gottesman, MD, PhD; Andrea L. C. Schneider, MD, PhD; Marilyn Albert, PhD; Alvaro Alonso, MD, PhD; Karen Bandeen-Roche, PhD; Laura Coker, PhD; Josef Coresh, MD, PhD; David Knopman, MD; Melinda C. Power, ScD; Andreea Rawlings, MS; A. Richey Sharrett, MD, DrPH; Lisa M. Wruck, PhD; Thomas H. Mosley, PhDImportance Hypertension is a treatable potential cause of cognitive decline and dementia, but its greatest influence on cognition may occur in middle age.Objective To evaluate the association between midlife (48-67 years of age) hypertension and the 20-year change in cognitive performance.Design, Setting, and Participants The Atherosclerosis Risk in Communities cohort (1990-1992 through 2011-2013) underwent evaluation at field centers in Washington County, Maryland, Forsyth County, North Carolina, Jackson, Mississippi, and the Minneapolis, Minnesota, suburbs. Of 13 476 African American and white participants with baseline cognitive data, 58.0% of living participants completed the 20-year cognitive follow-up.Exposures Hypertension, prehypertension, or normal blood pressure (BP) at visit 2 (1990-1992) constituted the primary exposure. Systolic BP at visit 2 or 5 (2011-2013) and indication for treatment at visit 2 based on the Eighth Joint National Committee (JNC-8) hypertension guidelines constituted the secondary exposures.Main Outcomes and Measures Prespecified outcomes included the 20-year change in scores on the Delayed Word Recall Test, Digit Symbol Substitution Test, and Word Fluency Test and in global cognition.Results During 20 years, baseline hypertension was associated with an additional decline of 0.056 global z score points (95% CI, −0.100 to −0.012) and prehypertension was associated nonsignificantly with 0.040 more global z score points of decline (95% CI, −0.085 to 0.005) compared with normal BP. Individuals with hypertension who used antihypertensives had less decline during the 20 years than untreated individuals with hypertension (−0.050 [95% CI, −0.003 to −0.097] vs −0.079 [95% CI, −0.156 to −0.002] global z score points). Having a JNC-8–specified indication for initiating antihypertensive treatment at baseline was associated with a greater 20-year decline (−0.044 [95% CI, −0.085 to −0.003] global z score points) than not having an indication. We observed effect modification by race for the continuous systolic BP analyses (P = .01), with each 20–mm Hg increment at baseline associated with an additional decline of 0.048 (95% CI, −0.074 to −0.022) points in global cognitive z score in whites but not in African Americans (decline, −0.020 [95% CI, −0.026 to 0.066] points). Systolic BP at the end of follow-up was not associated with the preceding 20 years of cognitive change in either group. Methods to account for bias owing to attrition strengthened the magnitude of some associations.Conclusions and Relevance Midlife hypertension and elevated midlife but not late-life systolic BP was associated with more cognitive decline during the 20 years of the study. Greater decline is found with higher midlife BP in whites than in African Americans.JAMA Neurol. 2014;71(10):1218-1227. doi:10.1001/jamaneurol.2014.1646
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Antidepressant Treatment for Postnatal Depression
    • Authors: Molyneaux E; Trevillion K, Howard LM.
      Abstract: This JAMA Clinical Evidence Synopsis summarizes an updated Cochrane review evaluating antidepressant treatment for postnatal depression.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Iris Heterochromia and Eyelash Hypertrichosis
    • Authors: Rao RC; Ballard TS, Chen TC.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Prevalence of the Metabolic Syndrome in the United States, 2003-2012
    • Authors: Aguilar M; Bhuket T, Torres S, et al.
      Abstract: This population epidemiology study uses NHANES data to report trends in the prevalence of the metabolic syndrome in US adults between 2003 and 2012.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Treatment for Clostridium difficile Infection in Adults
    • Authors: McDonald EG; Lee TC.
      Abstract: To the EditorClostridium difficile infection is a common, serious diarrheal illness, and strains such as the virulent North American pulsed-field gel electrophoresis type 1 make treatment challenging. The meta-analysis summarizing the available treatment options for incident C difficile infection in adults recommended vancomycin with or without adjunctive therapy as the treatment of choice for severe, complicated infections and metronidazole for milder disease.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Treatment for Clostridium difficile Infection in Adults
    • Authors: Dai C; Jiang M, Sun M.
      Abstract: To the Editor Although we agree that the majority of the systematic review of best practices for the diagnosis and treatment of C difficile infection in adults was supported by evidence, we have concerns that the conclusions about fidaxomicin may not fully reflect the available clinical data.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Treatment for Clostridium difficile Infection in Adults
    • Authors: Rao K; Bagdasarian N, Malani PN.
      Abstract: In Reply We agree with Drs McDonald and Lee that PPI use has been associated with incident and recurrent C difficile infection. Even though we mentioned this association in the text, tables, and figures of our review, we chose not to include PPI or other modifiable risk factors (other than concurrent use of non–C difficile infection antibiotics), in the treatment algorithm. There are numerous reports highlighting an association with acquisition and recurrence of C difficile infection; however, to date, no one has prospectively studied whether discontinuation of PPI therapy improves outcomes from C difficile infection. Despite this, we believe discontinuation of PPI therapy is a reasonable consideration, particularly because many patients receive it unnecessarily.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Government Regulations Regarding Physician Self-referral
    • Authors: O’Gara PT.
      Abstract: To the Editor The Viewpoint from Drs Adashi and Kocher called for repealing the IOASE to the Stark law. The Viewpoint is problematic because it paints all clinicians with the same brush of overusing self-referral for ancillary testing for financial gain and sets a tone of guilt by designation.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Government Regulations Regarding Physician Self-referral
    • Authors: Kapoor DA.
      Abstract: To the Editor In their Viewpoint on physician self-referral, Drs Adashi and Kocher failed to note that the independent physician’s office is the most cost-effective site of service. Even though the Government Accountability Office (GAO) suggested that 427 000 of 2.15 million imaging studies performed by groups with in-house imaging services would have been eliminated if such groups performed these services at the rates of physicians without equipment ownership, it provided no data demonstrating that lower use rates were medically more appropriate.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Government Regulations Regarding Physician Self-referral—Reply
    • Authors: Adashi EY; Kocher RP.
      Abstract: In Reply We agree with Dr O’Gara that the majority of physicians are tirelessly working to deliver the highest quality of care for their patients. Our Viewpoint never argued otherwise.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Florida Legislation Casts a Chill Over Gun Inquiries
    • Authors: Kuehn BM.
      Abstract: Early in his career, Louis B. St. Petery Jr, MD, a pediatrician in Tallahassee, Florida, attended the funeral of a young patient from his practice who was shot and killed after the child’s sibling found a loaded gun in a bedside drawer.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Conversations About How We Die
    • Authors: Mason DJ.
      Abstract: Earlier this year, neurologist and writer Oliver Sacks disclosed in an eloquent op-ed ( in the New York Times that an ocular melanoma treated 9 years earlier had now metastasized to his liver. Sacks wrote that the diagnosis gave him a new perspective: “This does not mean I am finished with life. On the contrary, I feel intensely alive, and I want and hope in the time that remains to deepen my friendships, to say farewell to those I love, to write more, to travel if I have the strength, to achieve new levels of understanding and insight.”
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Increased Measles Risk Possible in Countries Affected by Ebola
    • Authors: Friedrich MJ.
      Abstract: The recent Ebola outbreak in West Africa has disrupted health care services, including routine vaccination programs for childhood diseases, thereby potentially increasing the risk for measles in this area, report investigators from the United States, United Kingdom, and Sweden (Takahashi S et al. Science. 2015;347[6227]:1240-1242).
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Simplified Antibiotic Regimens for Infants With Severe Infections
    • Authors: Friedrich MJ.
      Abstract: Two large recently published trials demonstrate that alternative antibiotic regimens given outside the hospital in developing countries can be used effectively to treat newborns and young infants who have severe infections and whose parents refused hospital referral or admission.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Study Evaluates Shortened TB Drug Regimen
    • Authors: Friedrich MJ.
      Abstract: A shortened drug regimen to treat tuberculosis (TB) works faster and is more effective than the current standard treatment in patients with drug-susceptible and multidrug resistant (MDR) TB, according to a study by researchers from South Africa, Tanzania, and the United States (Dawson R et al. Lancet. doi:10.1016/S0140-6736(14)62002-X [published online March 17, 2015]).
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Diagnosing Gastroparesis Without Radioactive Material
    • Authors: Rubin R.
      Abstract: A new breath test eliminates the need for radioactive material or imaging equipment to diagnose delayed gastric emptying, or gastroparesis.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • New Type of Drug for Heart Failure
    • Authors: Rubin R.
      Abstract: A newly approved heart failure drug that was fast-tracked by the FDA is the first in its class.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Temporary Heart Pump Approved
    • Authors: Rubin R.
      Abstract: The FDA recently approved a mini heart pump that can be placed in the left ventricle without open chest surgery.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Warning for e-Cigarette Makers
    • Authors: Rubin R.
      Abstract: The FDA has issued the first warning letters to e-cigarette companies for illegal claims on their websites.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Bird’s Nest and Ferns
    • Authors: Smith JM.
      Abstract: A flash of color or a snippet of birdsong brightens the landscape in grove or grassy meadow, and watching or listening to members of the myriad bird families can be entertaining and inspiring. A robin’s peppy roundelay at dawn may render the alarm clock irrelevant for a late sleeper, but it provides a note of cheer and a sense that all is well. The airy, expressive scenes of songsters and their environs painted by Fidelia Bridges (1834-1923) have appeal for both armchair wildlife enthusiasts and birders in their Wellies with binoculars in hand.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • On Dealing With Our Mother’s Health Crisis, Day 3
    • Authors: Kern A.
      Abstract: A quaking aspen high abovethe meadow here, but not so faras the sea. Clustering leaves at a right angle to earth, appear precarious holding on for life at the summer peak of their strength.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • The Humors
    • Authors: Draper JW.
      Abstract: For more than a thousand years, the humoral theory, derived from Aristotle and Galen, dominated medical and psychological thought. The body and mind were supposed to be ruled by four humors which, in equilibrium, brought perfect health; but the predominance of any one, whether from birth or age or circumstances, produced a certain type of physique and a cast of mind appropriate to certain activities and to a certain social status. The wrong humor in a given situation invited tragedy, for each humor belonged with certain stars and planets. The sanguine humor (blood) was under the astral influence of the planet Jupiter, and was thought proper to princes, to accepted lovers, and to the jovial and the fortunate; but ill-chance could easily sour it to melancholy. The phlegmatic humor under Venus was thought proper to women, children, and voluptuaries, and under the moon (which was regarded as a planet in the old geocentric astronomy) belonged to simpletons and fools. The choleric (yellow bile) under the sun was proper to rulers and self-willed women, and under Mars to soldiers, roisterers, and drunkards. It was considered unlucky. Even more unlucky was saturnine melancholy (black bile), proper to the sick, the frustrated, and the senile; indeed, it might even bring on a manic-depressive psychosis. This system, though it sometimes used absurd analogies as evidence, rested in part on sound clinical observation.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • Childhood Vaccines
    • Authors: Thompson AE.
      Abstract: Vaccines provide immunity (protection) against severe diseases caused by certain viruses and bacteria.
      PubDate: Tue, 19 May 2015 00:00:00 GMT
  • JAMA
    • PubDate: Tue, 19 May 2015 00:00:00 GMT
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