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Journal Cover JAMA The Journal of the American Medical Association
  [SJR: 6.44]   [H-I: 549]   [1346 followers]  Follow
   Full-text available via subscription Subscription journal  (Not entitled to full-text)
   ISSN (Print) 0098-7484 - ISSN (Online) 1538-3598
   Published by American Medical Association Homepage  [13 journals]
  • Highlights for March 21, 2017
    • PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Implementing Peanut Allergy Prevention Guidelines at a Population Level
    • Authors: Turner PJ; Campbell DE.
      Abstract: This Viewpoint summarizes the National Institute of Allergy and Infectious Diseases’ guideline for prevention of peanut allergies in US infants and argues that the complexity and narrow scope of the recommendations could prevent population-wide implementation and uptake.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Exercise During Pregnancy
    • Authors: Perales M; Artal R, Lucia A.
      Abstract: This Viewpoint summarizes the American Congress of Obstetrics and Gynecology (ACOG) guideline recommendations and more recent evidence about the benefits of exercise during pregnancy.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Non–Vitamin K Oral Anticoagulants in Atrial Fibrillation
    • Authors: Potpara TS; Lip GH.
      Abstract: This Viewpoint discusses use of non–vitamin K oral anticoagulants in treating atrial fibrillation.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • The Joint Commission’s Pain Standards and the Prescription Opioid
    • Authors: Baker DW.
      Abstract: This Viewpoint discusses the history of The Joint Commission standards for pain management and lessons learned that might inform current efforts to address the prescription opioid epidemic and prevent unintended consequences of future similar standard-setting initiatives.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Medical Care of Detainees in US Military Facilities
    • Authors: Chalela JA.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Patient-Reported Outcomes Following Treatment for Localized Prostate
    • Authors: Hamdy FC; Donovan JL.
      Abstract: When treatments are known to be successful with good oncological outcomes for specific cancers, most patients will be prepared to accept the proposed therapy and its consequences on quality of life. But when multiple, equally effective treatments are available and uncertainty about their benefits prevails with a substantial risk of overtreatment, the balance of risks between benefit and harm from adverse effects can dominate decision making. Such is the case in clinically localized prostate-specific antigen (PSA)–detected prostate cancer. Men affected by prostate cancer realize increasingly that survival and prostate cancer recurrence rates alone are insufficient to allow sound clinical decisions to be made and that there are trade-offs between cancer control and adverse treatment effects. Two articles in this issue of JAMA by Barocas and colleagues and by Chen and colleagues address this important problem.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Direct-to-Consumer Advertising of Androgen Replacement Therapy
    • Authors: Kravitz RL.
      Abstract: The Kefauver-Harris Amendment to the Food, Drug and Cosmetic Act, enacted by Congress in 1962, required pharmaceutical manufacturers to provide proof of prescription drug effectiveness as well as safety and to obtain preapproval of their marketing plans. Over the next 35 years, manufacturers promoted their products largely to physicians through ads in medical journals and in-office “detailing.” Print advertising directed toward patients was unusual and broadcast advertising was rare, owing to the US Food and Drug Administration’s (FDA’s) insistence that ads on television and radio include a brief summary of adverse reactions and contraindications—a requirement that tended to produce long, stultifying, and expensive commercials. However, 20 years ago in 1997, the FDA ruled that “adequate provision” of information about drug risks and benefits could be made by referring consumers to a toll-free telephone number, a simultaneously occurring print ad, or a website. With barriers vastly diminished, this new FDA rule unleashed a torrent of television ads. These ads promoted treatments for a wide array of conditions, from depression to toenail fungus, high cholesterol, and—beginning in the mid-2000s—male hypogonadism (otherwise known as testosterone deficiency or “low T”).
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Outcomes of Radiation, Surgery, or Observation for Localized Prostate
    • Authors: Barocas DA; Alvarez J, Resnick MJ, et al.
      Abstract: This cohort study uses SEER registry data to compare adverse functional effects of managing localized prostate cancer with radical prostatectomy, external beam radiation, and active surveillance.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Association Between Prostate Cancer Treatment and Quality of Life
    • Authors: Chen RC; Basak R, Meyer A, et al.
      Abstract: This cohort study compares quality of life among men with prostate cancer treated with radical prostatectomy, external beam radiotherapy, brachytherapy, or active surveillance.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Dabigatran vs Warfarin and Risk of Osteoporotic Fractures Among Patients
           With Nonvalvular Atrial Fibrillation
    • Authors: Lau WY; Chan EW, Cheung C, et al.
      Abstract: This cohort study uses national electronic medical record data from Hong Kong to compare risk of osteoporotic fracture among patients prescribed dabigatran or warfarin for newly diagnosed nonvalvular atrial fibrillation.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Direct-to-Consumer Advertising and Testosterone Testing and Initiation
    • Authors: Layton J; Kim Y, Alexander G, et al.
      Abstract: This ecologic study investigates associations between televised direct-to-consumer advertising and testosterone testing and initiation in the United States between 2009 and 2013.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Definitive Management of Primary Hyperparathyroidism
    • Authors: Campbell MJ.
      Abstract: This commentary discusses 2016 American Association of Endocrine Surgeons Guidelines for management of primary hyperparathyroidism published in JAMA Surgery.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • A Tender Rash on the Hand
    • Authors: Vangipuram R; Tong Y, Tyring SK.
      Abstract: A healthy 36-year-old man had 5 days of an intensely painful vesicular eruption on an erythematous base at the base of his thumb after a suspected spider bite, with no other physical signs. What would you next?
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Metformin for Prediabetes
    • Abstract: This Medical Letter review summarizes the clinical study evidence and adverse effects of metformin treatment for individuals at risk for type 2 diabetes.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Seven-Year Follow-up of Offspring of Women Taking Prenatal DHA in an RCT
    • Authors: Gould JF; Treyvaud K, Yelland LN, et al.
      Abstract: This study reports neurodevelopmental outcomes at 7 years of children whose mothers participated in a randomized trial of docosahexaenoic acid supplementation during pregnancy to improve their child’s intelligence.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Time to Endovascular Thrombectomy for Acute Stroke
    • Authors: Kansagra AP.
      Abstract: To the Editor In an individual-patient meta-analysis using data from 5 randomized clinical trials, Dr Saver and colleagues reported improved outcomes following mechanical thrombectomy initiated up to 7.3 hours after the onset of acute ischemic stroke due to large vessel occlusion. This result represents a meaningful extension of the current 6-hour treatment guideline and would expand access to life-altering treatments. However, the challenges of interpreting these data must be acknowledged. Only 3 of the 5 trials allowed intervention beyond 6 hours, and these 3 trials used more stringent imaging selection criteria that varied between and even within trials. These differences in patient selection are difficult to capture in a random-effects analysis and can confound the time dependence of treatment benefit by enriching the population treated within extended time windows compared with those treated within 6 hours.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Time to Endovascular Thrombectomy for Acute Stroke—Reply
    • Authors: Saver JL; Goyal M, Hill MD, et al.
      Abstract: In Reply We concur with Dr Kansagra that it is important to take into account that special penumbral and collateral imaging selection criteria were used in a minority of the participating trials, but we note that special imaging selection was used less often than Kansagra suggests. Of the 3 trials enrolling patients for intervention beyond 6 hours, 2 (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands [MR CLEAN] and Randomized Trial of Revascularization With Solitaire FR Device vs Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset [REVASCAT]) did not use special imaging selection at all. (The third, Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times [ESCAPE], did require presence of fair or better collaterals on computed tomography angiography.)
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Sedation vs Intubation for Patients With Acute Stroke Undergoing
    • Authors: See AP; Ducruet AF.
      Abstract: To the Editor Dr Schönenberger and colleagues investigated whether anesthetic choice influenced outcome following endovascular thrombectomy for large-vessel stroke by conducting a randomized blinded trial enrolling 150 thrombectomy patients over a 2-year period. Interpretation of the results is limited by the choice of primary outcome measure, an underpowered trial design, and the relative ineffectiveness of the intervention.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Sedation vs Intubation for Patients With Acute Stroke Undergoing
    • Authors: Buerkle H; Goebel U.
      Abstract: To the Editor The Sedation vs Intubation for Endovascular Stroke Treatment (SIESTA) trial found no difference in the primary outcome (change in the NIHSS score after 24 hours) in patients receiving general anesthesia vs conscious sedation. However, there were differences in secondary outcomes, with patients receiving general anesthesia having a 10-minute delay in the door-to-needle interval and increased postinterventional complications, including hypothermia, delayed extubation, and pneumonia.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Sedation vs Intubation for Patients With Acute Stroke Undergoing
    • Authors: Bösel J; Schöneberger S.
      Abstract: In Reply Drs See and Ducruet raise a number of concerns about our trial. The study was designed to investigate short-term clinical outcomes, whereas longer-term outcomes, which are also important, should be addressed in a multicenter trial. The MR CLEAN data that See and Ducruet cite to question our design and sample size were not published at the time of planning the SIESTA trial. We acknowledge that in settings with higher interventional speed and efficacy, the results may have been different. However, our trial population better reflected broad practice than other randomized thrombectomy studies.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Transitions in House Staff Care and Patient Mortality
    • Authors: Sadhu JS.
      Abstract: To the Editor Dr Denson and colleagues reported that patients whose hospitalizations spanned transitions in house staff care had higher mortality rates than control patients. The methods used to construct the transition and control cohorts may explain the findings. For patients admitted on a given day, only those patients who remained hospitalized until the end-of-rotation transition were eligible for inclusion in the transition group; patients who died or were discharged before the transition period were assigned to the control group. This method resulted in fundamentally unbalanced groups, whereby patients in the transition group had longer lengths of stay than those in the control group by 3 to 4 days.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Transitions in House Staff Care and Patient Mortality
    • Authors: Denson JL; Horwitz LI, Sherman SE.
      Abstract: In Reply We acknowledge that the definition of a transition patient in the main analysis could have produced immortal time bias, as Dr Sadhu discusses in his letter. Immortal time bias is typically considered a bias in favor of lower mortality in the exposed group, because it excludes patients who die before the event of interest. The direction of such a bias is therefore not necessarily toward a sicker cohort. In our study, it is also plausible that the transition cohort was affected not only by immortal time bias, as could be seen for any arbitrary transition (such as change in hospital menu), but by the choices made by resident physicians explicitly in response to the upcoming handoff. As discussed in the accompanying editorial by Drs Arora and Farnan, when a care transition is approaching, clinicians often attempt to discharge as many patients as possible to minimize the effect of the service change on a new team of physicians. Therefore, the transition in care might itself generate a patient cohort that is more complex, more ill, and at greater risk. Also, the transition may have produced longer lengths of stay after transition because of disruptions to clinical care and discharge planning.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Error in Text
    • Abstract: In the Editorial entitled “Scalp Cooling to Prevent Chemotherapy-Induced Alopecia: The Time Has Come,” published in the February 14, 2017, issue, there was an error in the text. In the ninth paragraph, the second sentence should have read, “The DigniCap scalp cooling system (used in the study by Rugo et al) is cleared by the US Food and Drug Administration (FDA) and the Paxman scalp cooling system (used in the study by Nangia et al) is under evaluation by the FDA.” This article was corrected online.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Misstated Text
    • Abstract: In the Editorial entitled “Sublingual Immunotherapy for Allergic Rhinitis: Is 2-Year Treatment Sufficient for Long-term Benefit?” published in the February 14, 2017, issue, there was an error in the text. In the first paragraph, the third sentence should have read, “The proportion of patients treated with AIT who do not maintain sustained allergen-specific tolerance varies from 0% to 55%, depending on factors including type of allergen, treatment duration, and the definition of relapse.” This article was corrected online.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Syrians Seek Care Abroad
    • Authors: Abbasi J.
      Abstract: This Medical News article is an interview with an Israeli physician whose hospital staff treats sick and wounded Syrians.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Value-Based Purchasing: Time for Reboot or Time to Move on?
    • Authors: Jha AK.
      Abstract: These are difficult days for those of us who have advocated for pay-for-performance (P4P) as a policy tool to improve health care quality. The idea behind P4P has always been simple: physicians and hospitals should be financially rewarded for providing high-quality care and financially penalized for providing low-quality care. Although this idea has been around for some time, it gained national traction over the past decade, as policy makers pushed toward paying for “value” and not just volume.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Boosting Cognitive Development in Children
    • Authors: Friedrich MJ.
      Abstract: Taking prenatal maternal multiple micronutrients (MMNs) during pregnancy along with a nurturing environment during childhood have long-term benefits for a child’s cognitive development, according to a follow-up study of the Supplementation With Multiple Micronutrients Intervention Trial (SUMMIT) published recently in Lancet Global Health.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Cervicovaginal Bacteria and HIV Risk
    • Authors: Friedrich MJ.
      Abstract: Healthy South African women whose cervicovaginal (CV) microbiome is dominated by a high diversity of anaerobic bacteria but is deficient in Lactobacillus species have a higher risk of acquiring HIV than women who have CV bacterial communities of low diversity that are dominated by Lactobacillis crispatus, according to a report by researchers from the United States and South Africa.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • No Guinea Worm Disease in Mali
    • Authors: Friedrich MJ.
      Abstract: Mali reported no cases of Guinea worm disease (dracunculiasis) in 2016, according to provisional figures reported by the country’s ministry of health and tracked by the Carter Center. Worldwide, only 25 cases of the disease were reported in 2016 in 3 countries—Chad (16), Ethiopia (3), and South Sudan (6)—and these occurred in 19 isolated villages. The 2016 figure is up slightly from the 22 cases that occurred in 2015.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • First Corticosteroid Approved for Duchenne Muscular Dystrophy
    • Authors: Voelker R.
      Abstract: Deflazacort has become the first corticosteroid to receive FDA approval to treat patients aged 5 years and older who have Duchenne muscular dystrophy.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Morcellator Risk Was Known
    • Authors: Voelker R.
      Abstract: The FDA was aware that laparoscopic power morcellators could spread cancerous tissue when the agency approved the first such device in 1991, according to a recent report from the US General Accountability Office (GAO).
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • New Rare Diseases Screening Test
    • Authors: Voelker R.
      Abstract: The first screening tool to detect 4 rare lysosomal storage disorders in newborns has received FDA approval.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • The Healing Power of Paint
    • Authors: Toll E; Melfi B.
      Abstract: This Arts and Medicine essay describes the experience of an outpatient clinic's staff, patients, and families who collaborated to paint self-portrait tiles to decorate the clinical space.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Sedimentation Rate
    • Authors: Wicks I.
      Abstract: Draw blood—a thick red drop, falling, laden with erythrocytes,those journeymen made in the marrowfor their brief season, spent working the blood, streaming in pale yellow plasma through the heart and its arch of great vessels, riding the pulse down arterial arcades, branching to tissue and territory, milling in fine capillaries while holding tidal breath in the deep red pockets of hemoglobin, loaded with its cargo of agile oxygenfor the electron transport chain, without which nothing. Then returning, depletedalong reticulated veins to do it all again. Fellow travelers, in their billions, dutifully recirculating, alive one hundred days.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Why I Favor Compulsory Health Insurance
    • Abstract: To the Editor:—I favor compulsory health insurance:
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
  • Cystoscopy
    • Authors: Matulewicz RS; DeLancey JO, Meeks JJ.
      PubDate: Tue, 21 Mar 2017 00:00:00 GMT
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