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Journal Cover   JAMA The Journal of the American Medical Association
  [SJR: 6.278]   [H-I: 491]   [911 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]
  • JAMA
    • PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Cannabinoids for Medical Use
    • Authors: Whiting PF; Wolff RF, Deshpande S, et al.
      Abstract: This meta-analysis summarizes the effectiveness of cannabis and cannabinoids for managing medical and psychotic disorders, including chemotherapy-induced nausea and vomiting, chronic pain, and mood and sleep disorders.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Clinician Training Reduces Cesarean Rates in Low-Risk Pregnancies
    • Authors: Slomski A.
      Abstract: An intervention that promoted clinical audits, feedback, and best labor and delivery practices led to a significant reduction in the rate of cesarean deliveries among women with low-risk pregnancies giving birth at public hospitals in Quebec, Canada, according to a cluster randomized clinical trial (Chaillet N et al. N Engl J Med. 2015;372[18]:1710-1721).
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Mindfulness Therapy Is Not Superior to Maintenance Antidepressants
    • Authors: Slomski A.
      Abstract: Mindfulness-based cognitive therapy (MBCT) is as effective as maintenance antidepressant treatment in preventing depression relapse, suggest results from a recent randomized trial (Kuyken W et al. Lancet. doi:10.1016/S0140-6736(14)62222-4 [published online April 20, 2015]).
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Osteoporosis Drug May Benefit the Frail Elderly in Nursing Homes
    • Authors: Slomski A.
      Abstract: A single intravenous dose of the potent osteoporosis drug zoledronic acid significantly improved bone mineral density (BMD) in frail elderly women living in long-term care facilities. Positive findings from the proof-of-concept randomized trial paves the way for an “essential” larger trial to study fracture reduction with bisphosphonate treatment in a frail elderly population. (Greenspan SL et al. JAMA Intern Med. doi:10.1001/jamainternmed.2015.0747 [published online April 13, 2015]).
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • IOM Cognitive Aging Guidelines for Health Care Professionals
    • Authors: Jacob J.
      Abstract: The Institute of Medicine (IOM) in April released a report on cognitive aging that includes an action guide for clinicians caring for elderly patients; a summary of core competencies for health care professionals who treat older adults; and a list of assessment, practice guideline, and patient education resources (http://bit.ly/1A6Q78R).
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Novel Programs and Discoveries Combat Antibiotic Resistance
    • Authors: Hampton T.
      Abstract: In the wake of increasing antimicrobial resistance threats, this article discusses some recent government initiatives and efforts by scientists, physicians, and public health officials to combat drug-resistant bacteria.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Medical Marijuana
    • Authors: D'Souza D; Ranganathan M.
      Abstract: This Editorial discusses some of the medical and legal considerations surrounding use of medical marijuana and cannabinoid drugs.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • ICD Use Among Medicare Patients After Acute MI
    • Authors: Pokorney SD; Miller AL, Chen AY, et al.
      Abstract: This cohort study uses registry and Medicare claims data to assess the frequency of ICD implantation within 1 year of myocardial infarction and to compare mortality in patients with vs without ICDs.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Screening for Patent Ductus Arteriosus Among Preterm Infants
    • Authors: Rozé J; Cambonie G, Marchand-Martin L, et al.
      Abstract: This population-based cohort study reports that screening echocardiography before day 3 of life to identify patent ductus arteriosus among extremely preterm infants was associated with lower in-hospital mortality and likelihood of pulmonary hemorrhage.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • I’m Sorry
    • Authors: Kahn JS.
      Abstract: The resident arrived in the team room reading a text page—Mr Smith was not feeling well. Mr Smith had been admitted five days earlier with recurrence of congestive heart failure. He had multiple problems that were exacerbated by his desire to eat salty foods and foods with high sugar content. He would often decide that he did not need the medications necessary to control his CHF or his diabetes. These decisions routinely led him to the emergency department and from there to the medical floor or even the intensive care unit. This time he was admitted to my medical service. After admission and over the next five days, Mr Smith progressively improved through careful adherence to his medications and a reasonable diet. We restarted his home medications, including a β-blocker, and simplified his medication regimen to try to maintain his improving health. He seemed ready to return home. He made a commitment to improve his dietary habits and his medication adherence, and we had a plan for his discharge. On the morning of his planned discharge, I saw him walking the halls and he looked weak, fatigued, and even short of breath. He did not look like he was ready to go home.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Underutilization of ICDs in Older Patients
    • Authors: Hauser RG.
      Abstract: Clinical trials have demonstrated that sudden cardiac death after an acute myocardial infarction (MI) can be prevented in patients at high risk by inserting an implantable cardioverter-defibrillator (ICD). Guidelines from the American Heart Association (AHA), American College of Cardiology (ACC), and the Heart Rhythm Society (HRS) state that ICD therapy is indicated for patients with left ventricular ejection fraction (EF) less than or equal to 35% due to prior MI who are at least 40 days after MI and are in New York Heart Association Class (NYHA) II or III or in patients who have an EF less than or equal to 30% and are in NYHA Class I. These indications are supported by the highest levels of evidence (Level A) and based in part on major clinical trials like the Multicenter Automatic Defibrillator Implantation Trial II and Sudden Cardiac Death in Heart Failure Trial, which showed that ICD therapy in high-risk individuals with coronary artery disease results in a relative risk reduction for total mortality of between 20% and 30%. In a subsequent article published by the AHA, ACC, and HRS and endorsed by the American Geriatrics Society, the only age-specific comorbidity that would make a primary prevention ICD “rarely appropriate” was if a patient 90 years or older was in NYHA Class I.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Regulating Indoor Tanning Devices and Preventing Skin Cancer
    • Authors: Mays D; Kraemer J.
      Abstract: This Viewpoint describes the current regulation of indoor tanning equipment and the need for a broader public health approach to prevent and reduce skin cancer caused by indoor tanning.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Broadly Neutralizing Antibodies and the Development of Vaccines
    • Authors: Haynes BF; Bradley T.
      Abstract: This Viewpoint discusses the importance and progress of neutralizing human immunodeficiency virus through efforts to induce broadly reactive neutralizing antibodies.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Highlights for June 23/30, 2015
    • PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • US Dietary Guidelines and Lifting the Total Dietary Fat Ban
    • Authors: Mozaffarian D; Ludwig DS.
      Abstract: Based on the Dietary Guidelines Advisory Committee’s recent recommendations, this Viewpoint urges the US Department of Agriculture and US Department of Health and Human Services to remove limits on total fat consumption in their 2015 Dietary Guideline to promote consumption of healthful fat.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Medical Marijuana
    • Authors: Thompson AE.
      Abstract: Twenty-three states and Washington, DC, allow the use of marijuana to treat certain medical conditions.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Winter Solstice
    • Authors: Halberstadt C.
      Abstract: How many dendritic treetops—these unmoving axons in a windless sky may I see?Clear and cold outside this placeless windowa pale and shallow greying sun awaits the planet’s tilt to winterand the shortest light of day.What do the trees think within their stillnessstirring as my brain shifts into mindeach moment I breathe in as they breathe outand we are joined.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Ben Franklin’s Views
    • Abstract: To the Editor:—The extract from the “Autobiography of Benjamin Franklin” (Miscellany, The Journal, June 5, 1915, p. 1933) gives a mistaken idea of the habits of our first American philosopher as regards his use of alcohol. Early in life as an impecunious printer’s devil he may have been as abstemious as is asserted, but with the access of fortune and fame he certainly indulged more freely in “that muddling liquor” which he condemns. This is only an example of the not uncommon failing which he shared with less famous mortals in not always squaring his practice with his preaching.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • New HIV Test May Improve Point-of-Care Medicine in Remote Regions
    • Authors: Jacob J.
      Abstract: In a project partially funded by grants from the National Institutes of Health, scientists at Stanford University School of Medicine developed new methods for quickly and easily testing for HIV, CD4+ T lymphocytes, and common bacteria (Shafiee H et al. Sci Rep. doi:10.1038/srep08719 [published online March 6, 2015]). The simple tests, which use new paper and flexible polymer substrates with special sensing devices, may improve point-of-care medical treatment in remote areas in developing countries.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • NIH Study Demonstrates Metabolism Affects Ease of Weight Loss
    • Authors: Jacob J.
      Abstract: National Institutes of Health (NIH) researchers have demonstrated that individuals with a slow (“thrifty”) metabolism lose less weight when their caloric intake decreases than individuals with a fast (“spendthrift”) metabolism (Reinhardt et al. Diabetes. doi:10.2337/db14-1881 [published online May 11, 2015]).
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Gauging Hispanic Health
    • Abstract: Hispanic and white populations share 13 of the 15 leading causes of death, but their rates of chronic diseases and health risks vary considerably, according to the first national study on Hispanic health risks and access to health services in the United States.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Improving Triglyceride Levels
    • Abstract: A quarter of adults in the United States have elevated triglyceride levels (≥150 mg/dL)—an improvement from a decade ago.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Health Care Coverage and Access for Men, 2013-2015
    • Authors: Kurani N; Ranji U, Salganicoff A, et al.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • The Church Supper
    • Authors: Smith JM.
      Abstract: As a time machine type of exercise, envision being transported back to a muggy summer evening in 1930s heartland America where a group is gathered at tables set up in a churchyard. Percolating through the trees in the yard is the ripple of conversation and occasional chuckle at a rib-tickler. A main attraction may have been scoops of hand-cranked vanilla ice cream, the vapors of which could mingle with a faint scent of lavender from the ladies and the soapy smell of men who had scrubbed up for the occasion. All seems peaceable in this snapshot of life in a country where the citizens are safe and free.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Flaws in Patient Safety Measures
    • Authors: Glaser JB; Wong D, Maroun R.
      Abstract: To the Editor Dr Rajaram and colleagues reviewed 4 important concerns about current use of the Agency for Healthcare Research and Quality’s (AHRQ) Patient Safety for Selected Indicators (PSI-90) metric to measure adverse events. These concerns included surveillance bias leading to increased detection of events, multiple financial penalties because of redundant measurements, inaccurate measurement of clinically relevant complications, and poor risk adjustment among hospitals with different patient demographics and comorbidities.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Flaws in Patient Safety Measures
    • Authors: Rajaram R; Barnard C, Bilimoria KY.
      Abstract: In Reply In addition to the several methodological concerns we described regarding the AHRQ’s PSI-90 composite measure, Dr Glaser and colleagues note that the PSI-90 and other administratively derived measures can also be influenced by nuances in coding. In the example they described, their hospital’s performance on the PSI-90 was worsened because their coding software precluded the entering of exclusion criteria for iatrogenic pneumothorax (PSI-6).
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Dosing Recommendations for New Oral Anticoagulants
    • Authors: Kreuzer J; Dugi K.
      Abstract: To the Editor Dr Powell advocated for individualized therapy for the new direct-acting oral anticoagulants (DOACs) based on defined therapeutic target ranges simulated from phase 3 trials.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Dosing Recommendations for New Oral Anticoagulants
    • Authors: Powell J.
      Abstract: In Reply I agree with Drs Kreuzer and Dugi that DOACs are probably better drugs than warfarin for the reasons described. However, there is a strong probability that DOACs could be significantly more efficacious and safer for all patients. For drugs with narrow therapeutic indexes in which death can result from underdosing or overdosing, a more personalized dosing scheme seems worthy to evaluate.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Wording and Data Errors in the Text and Table
    • Abstract: In the Research Letter entitled “Data Breaches of Protected Health Information in the United States” published in the April 14, 2015, issue of JAMA (2015;313[14]:1471-1473. doi:10.1001/jama.2015.2252), there were wording and data errors. In the Results section, first paragraph, the first and second sentences should be “We evaluated 949 breaches affecting 29 million records between 2010 and 2013. Six breaches involved more than 1 million records each and the number of reported breaches increased over time, although the trend using linear regression did not reach statistical significance (P = .07; Table).” In the second paragraph of the Results section, the first sentence should be “Most breaches occurred via electronic media (67.4%; 95% CI, 64.4%-70.4%; Table), frequently involving laptop computers or portable electronic devices (32.7%; 95% CI, 29.7%-35.7%).” In this same paragraph, the penultimate sentence should be “The combined frequency of breaches resulting from hacking and unauthorized access or disclosure increased during the study period (12.1% in 2010 to 27.2% in 2013; P = .003).” In the Discussion section, first paragraph, the first sentence should be “Between 2010 and 2013, data breaches reported by HIPAA-covered entities involved 29 million records.” In the Table, second column entitled “Overall,” several numbers should be changed as follows: row 2, “Total No. of records affected, in millions,” should be “29.0”; row 6, “Desktop, email, or EMR,” should be “148 (15.6) [13.4-18.0]”; row 7, “Paper,” should be “212 (22.3) [19.8-25.1]”; row 8, “Network server,” should be “101 (10.6) [8.8-12.8]”; row 9, “Other,” should be “178 (18.8) [16.4-21.4]”; row 12, “Loss or improper disposal,” should be “105 (11.1) [9.2-13.2]”; row 13, “Unauthorized access or disclosure,” should be “140 (14.8) [12.6-17.2]”; row 14, “Hacking or IT incident,” should be “67 (7.1) [5.6-8.9]”; and row 15, “Other,” should be “85 (9.0) [7.3-11.0].” Also in the Table, last column, the following P values should be changed: row 1, “Total No. of data breaches reported” should be “.07”; and row 2, “Total No. of records affected, in millions” should be “.88.” Farther down in this same column, the P value for “Data breach category, No. (%) [95% CI]” for the data in rows 11-15 should be “.003.” This article was corrected online.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Perioperative β-Blocker Therapy
    • Authors: Stern T; Cifu AS.
      Abstract: This JAMA Clinical Guidelines Synopsis article summarizes the evidence for perioperative use of β-blockers in patients with or at risk of developing cardiovascular disease.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Dose and Label Accuracy in Edible Medical Cannabis Products
    • Authors: Vandrey R; Raber JC, Raber ME, et al.
      Abstract: This study analyzed the dose accuracy of labels from edibile medical cannabis products dispensed in 3 US cities.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Housing for Homeless Adults With Mental Illness
    • Authors: Dettling M; Anghelescu I.
      Abstract: To the Editor In a randomized trial of scattered-site housing with intensive case management for homeless adults with mental illness compared with usual access to services, Dr Stergiopoulos and colleagues found that the intervention resulted in increased housing stability during 24 months without improving generic quality of life. The modest effects are promising, but the particular distribution of psychiatric diagnoses within the study population suggests the effects may not be able to be extrapolated to the entire homeless population.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Housing for Homeless Adults With Mental Illness
    • Authors: Stergiopoulos V; Hwang SW, Gozdzik A.
      Abstract: In Reply The At Home/Chez Soi study recruited adults experiencing homelessness and mental illness and stratified them into high- and moderate-needs groups. The prevalence of depression among unselected homeless adults is reported to range from 0% to 49%. A higher prevalence among homeless individuals experiencing mental illness is therefore not surprising.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Medical Marijuana for Treatment of Chronic Pain and Other Problems
    • Authors: Hill KP.
      Abstract: This synopsis of a medicine grand rounds conference uses an example of a patient with chronic low back pain as the basis for discussing the use of medical marijuana for treating chronic pain and other disorders.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Choosing Metformin as Initial Oral Therapy in Type 2 Diabetes
    • Authors: Stern RJ; Murphy EJ.
      Abstract: JAMA Internal MedicineInitial Choice of Oral Glucose-Lowering Medication for Diabetes Mellitus: A Patient-Centered Comparative Effectiveness StudySeth A. Berkowitz, MD, MPH; Alexis A. Krumme, MS; Jerry Avorn, MD; Troyen Brennan, MD, MPH, JD; Olga S. Matlin, PhD; Claire M. Spettell, PhD; Edmund J. Pezalla, MD, MPH; Gregory Brill, MS; William H. Shrank, MD, MSHS; Niteesh K. Choudhry, MD, PhDImportance Although many classes of oral glucose-lowering medications have been approved for use, little comparative effectiveness evidence exists to guide initial selection of therapy for diabetes mellitus.Objective To determine the effect of initial oral glucose-lowering agent class on subsequent need for treatment intensification and 4 short-term adverse clinical events.Design, Setting, and Participants This study was a retrospective cohort study of patients who were fully insured members of Aetna (a large national health insurer) who had been prescribed an oral glucose-lowering medication from July 1, 2009, through June 30, 2013. Individuals newly prescribed an oral glucose-lowering agent who filled a second prescription for a medication in the same class and with a dosage at or above the World Health Organization’s defined daily dose within 90 days of the end-of-day’s supply of the first prescription were studied. Individuals with interim prescriptions for other oral glucose-lowering medications were excluded.Exposures Initiation of treatment with metformin, a sulfonylurea, a thiazolidinedione, or a dipeptidyl peptidase 4 inhibitor.Main Outcomes and Measures Time to addition of a second oral agent or insulin, each component separately, hypoglycemia, other diabetes-related emergency department visits, and cardiovascular events.Results A total of 15 516 patients met the inclusion criteria, of whom 8964 (57.8%) started therapy with metformin. In unadjusted analyses, use of medications other than metformin was significantly associated with an increased risk of adding a second oral agent only, insulin only, and a second agent or insulin (P 
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • PDE5 Inhibitors for Erectile Dysfunction and Malignant Melanoma Risk
    • Authors: Loeb S; Folkvaljon Y, Lambe M, et al.
      Abstract: This case-control study examines the association between use of phosphodiesterase type 5 (PDE5) inhibitors for erectile dysfunction and malignant melanoma risk.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
  • Unrest in Baltimore and Public Health
    • Authors: Wen LS; Sharfstein JM.
      Abstract: This Viewpoint reflects on recent events in Baltimore and the role of public health in the immediate response, in understanding the basis of unrest, and in long-term solutions to health inequities.
      PubDate: Tue, 23 Jun 2015 00:00:00 GMT
       
 
 
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