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JAMA The Journal of the American Medical Association
   [770 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]   [SJR: 4.843]   [H-I: 456]
  • The Case for Social Medicine
    • Authors: Kothari K.
      Abstract: The first patient I ever interviewed as a medical student was a middle-aged woman named Barbara. Wearing my crisp new white coat, the pockets yet unburdened with a physician’s paraphernalia, I walked in with only the intention of having a conversation. I discovered that Barbara had kidney failure and needed dialysis three times a week, which restricted her to working part-time. Barbara now had a systemic infection, for the third time in the past few months, which required an emergency department visit and a week-long hospitalization. She would be following up with her primary care physician and nephrologist, who are in different locations from the dialysis center she attends. A few weeks later, I met Lisa in the emergency department. She suffered from an acute exacerbation of chronic pancreatitis and was in excruciating pain. After gathering her medical history, I asked Lisa where she lived. Holding back tears, she said that she had been a nurse, but now lived in a homeless shelter with her 8-year old daughter.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Autologous Hematopoietic Stem Cell Therapy in Severe Systemic Sclerosis
           Ready for Clinical Practice'
    • Authors: Khanna D; Georges GE, Couriel DR.
      Abstract: Systemic sclerosis is a life-threatening disease that includes a subset of patients with diffuse cutaneous systemic sclerosis (defined as widespread skin involvement) and internal organ involvement and has a mortality of 30% to 50% at 5 years. Conventional-dose immunosuppressive therapy has limited efficacy in preventing disease progression, and there are few data to support survival benefit. High-dose immunosuppression is an alternative to conventional-dose immunosuppression. Despite the increased risk of toxicity, the rationale for high-dose immunosuppression is that systemic sclerosis is an autoimmune disorder that progressively damages internal organs and is associated with chronic inflammation and systemic immunological abnormalities. Studies of high-dose immunosuppression (with autologous hematopoietic stem cell transplantation [HSCT]) in patients with systemic sclerosis have demonstrated efficacy in preventing disease progression, and a single-center trial (Autologous Non-myeloablative HSCT Compared With Pulse Cyclophosphamide Once per Month for Systemic Sclerosis [ASSIST]) demonstrated superiority of autologous HSCT over conventional therapy.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Banning the Handshake From the Health Care Setting
    • Authors: Sklansky M; Nadkarni N, Ramirez-Avila L.
      Abstract: The handshake represents a deeply established social custom. In recent years, however, there has been increasing recognition of the importance of hands as vectors for infection, leading to formal recommendations and policies regarding hand hygiene in hospitals and other health care facilities. Such programs have been limited by variable compliance and efficacy. In an attempt to avoid contracting or spreading infection, many individuals have made their own efforts to avoid shaking hands in various settings but, in doing so, may face social, political, and even financial risks.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Finding the Missing Link for Big Biomedical Data
    • Authors: Weber GM; Mandl KD, Kohane IS.
      Abstract: It has been argued that big data will enable efficiencies and accountability in health care. However, to date, other industries have been far more successful at obtaining value from large-scale integration and analysis of heterogeneous data sources. What these industries have figured out is that big data becomes transformative when disparate data sets can be linked at the individual person level. In contrast, big biomedical data are scattered across institutions and intentionally isolated to protect patient privacy. Both technical and social challenges to linking these data must be addressed before big biomedical data can have their full influence on health care. It is this linkage challenge that we address in this Viewpoint.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Liberating Data to Transform Health Care New York’s Open Data
    • Authors: Martin EG; Helbig N, Shah NR.
      Abstract: The health community relies on governmental survey, surveillance, and administrative data to track epidemiologic trends, identify risk factors, and study the health care delivery system. Since 2009, a quiet “open data” revolution has occurred. Catalyzed by President Obama’s open government directive, federal, state, and local governments are releasing deidentified data meeting 4 “open” criteria: public accessibility, availability in multiple formats, free of charge, and unlimited use and distribution rights. As of February 2014,, the federal health data repository, has more than 1000 data sets, and Health Data NY, New York’s health data site, has 48 data sets with supporting charts and maps. Data range from health interview surveys to administrative transactions. The implicit logic is that making governmental data readily available will improve government transparency; increase opportunities for research, mobile health application development, and data-driven quality improvement; and make health-related information more accessible. Together, these activities have the potential to improve health care quality, reduce costs, facilitate population health planning and monitoring, and empower health care consumers to make better choices and live healthier lives.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Diagnostic Challenges of Hepatitis C
    • Authors: Konerman MA; Lok AS.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Attitudes About Mandated Coverage of Birth Control Medication and Other
           Health Benefits in a US National Sample
    • Authors: Moniz MH; Davis MM, Chang T.
      Abstract: Access to contraception improves maternal and child health. The Patient Protection and Affordable Care Act (ACA) requires most private health insurance plans to cover contraception without a shared patient cost to improve access. However, debate continues about applying the contraception coverage mandate to public corporations that object on religious grounds; the US Supreme Court is reviewing the ACA’s contraceptive coverage requirement. We assessed attitudes about mandated coverage of birth control medications.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Topical and Systemic Antimicrobial Therapy for Venous Leg Ulcers
    • Authors: O’Meara S; Richardson R, Lipsky BA.
      Abstract: Clinical QuestionIs treatment with topical or systemic antimicrobial agents associated with better venous leg ulcer healing compared with usual care (dressings and bandages without antimicrobials) or an alternative topical or systemic antimicrobial agent'Bottom LineAvailable evidence, from underpowered pooled data, neither supports nor refutes an association of systemic antibiotic therapy with improved venous leg ulcer healing. Among topical antimicrobials, cadexomer iodine may be associated with better healing compared with usual care.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Levothyroxine Prescription Not as Simple as It Seems
    • Authors: Cappola AR.
      Abstract: JAMA Internal MedicineFalling Threshold for Treatment of Borderline Elevated Thyrotropin Levels—Balancing Benefits and Risks: Evidence From a Large Community-Based StudyPeter N. Taylor, MSc, MRCP; Ahmed Iqbal, MRCP; Caroline Minassian, MSc; Adrian Sayers, MSc; Mohd S. Draman, MRCP; Rosemary Greenwood, MSc; William Hamilton, MD; Onyebuchi Okosieme, MD, FRCP; Vijay Panicker, PhD; Sara L. Thomas, PhD; Colin Dayan, PhD, FRCPImportance Rates of thyroid hormone prescribing in the United States and the United Kingdom have increased substantially. If some of the increase is due to lowering the thyrotropin threshold for treatment, this may result in less benefit and greater harm.Objective To define trends in thyrotropin levels at the initiation of levothyroxine sodium therapy and the risk of developing a suppressed thyrotropin level following treatment.Design, Setting, Participants, and Exposure Retrospective cohort study using data from the United Kingdom Clinical Practice Research Datalink. Among 52 298 individuals who received a prescription for levothyroxine between January 1, 2001, and October 30, 2009, we extracted data about the thyrotropin level before levothyroxine therapy initiation, clinical symptoms, and thyrotropin levels up to 5 years after levothyroxine was initiated. We excluded persons who had a history of hyperthyroidism, pituitary disease, or thyroid surgery; those who were taking thyroid-altering medication or if the levothyroxine prescription was related to pregnancy; and those who did not have a thyrotropin level measured within 3 months before the initiation of levothyroxine.Main Outcomes and Measures The median thyrotropin level at the time of the index levothyroxine prescription, the odds of initiation of levothyroxine therapy at thyrotropin levels of 10.0 mIU/L or less, and the age-stratified odds of developing a low or suppressed thyrotropin level after levothyroxine therapy.Results Between 2001 and 2009, the median thyrotropin level at the initiation of levothyroxine therapy fell from 8.7 to 7.9 mIU/L. The odds ratio for prescribing levothyroxine at thyrotropin levels of 10.0 mIU/L or less in 2009 compared with 2001 (adjusted for changes in population demographics) was 1.30 (95% CI, 1.19-1.42; P 
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Decline in Estimated Glomerular Filtration Rate and Subsequent Risk of
           End-Stage Renal Disease and Mortality
    • Authors: Coresh J; Turin T, Matsushita K, et al.
      Abstract: ImportanceThe established chronic kidney disease (CKD) progression end point of end-stage renal disease (ESRD) or a doubling of serum creatinine concentration (corresponding to a change in estimated glomerular filtration rate [GFR] of −57% or greater) is a late event.ObjectiveTo characterize the association of decline in estimated GFR with subsequent progression to ESRD with implications for using lesser declines in estimated GFR as potential alternative end points for CKD progression. Because most people with CKD die before reaching ESRD, mortality risk also was investigated.Data Sources and Study SelectionIndividual meta-analysis of 1.7 million participants with 12 344 ESRD events and 223 944 deaths from 35 cohorts in the CKD Prognosis Consortium with a repeated measure of serum creatinine concentration over 1 to 3 years and outcome data.Data Extraction and SynthesisTransfer of individual participant data or standardized analysis of outputs for random-effects meta-analysis conducted between July 2012 and September 2013, with baseline estimated GFR values collected from 1975 through 2012.Main Outcomes and MeasuresEnd-stage renal disease (initiation of dialysis or transplantation) or all-cause mortality risk related to percentage change in estimated GFR over 2 years, adjusted for potential confounders and first estimated GFR.ResultsThe adjusted hazard ratios (HRs) of ESRD and mortality were higher with larger estimated GFR decline. Among participants with baseline estimated GFR of less than 60 mL/min/1.73 m2, the adjusted HRs for ESRD were 32.1 (95% CI, 22.3-46.3) for changes of −57% in estimated GFR and 5.4 (95% CI, 4.5-6.4) for changes of −30%. However, changes of −30% or greater (6.9% [95% CI, 6.4%-7.4%] of the entire consortium) were more common than changes of −57% (0.79% [95% CI, 0.52%-1.06%]). This association was strong and consistent across the length of the baseline period (1 to 3 years), baseline estimated GFR, age, diabetes status, or albuminuria. Average adjusted 10-year risk of ESRD (in patients with a baseline estimated GFR of 35 mL/min/1.73 m2) was 99% (95% CI, 95%-100%) for estimated GFR change of −57%, was 83% (95% CI, 71%-93%) for estimated GFR change of −40%, and was 64% (95% CI, 52%-77%) for estimated GFR change of −30% vs 18% (95% CI, 15%-22%) for estimated GFR change of 0%. Corresponding mortality risks were 77% (95% CI, 71%-82%), 60% (95% CI, 56%-63%), and 50% (95% CI, 47%-52%) vs 32% (95% CI, 31%-33%), showing a similar but weaker pattern.Conclusions and RelevanceDeclines in estimated GFR smaller than a doubling of serum creatinine concentration occurred more commonly and were strongly and consistently associated with the risk of ESRD and mortality, supporting consideration of lesser declines in estimated GFR (such as a 30% reduction over 2 years) as an alternative end point for CKD progression.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Anesthesia Technique, Mortality, and Length of Stay After Hip Fracture
    • Authors: Neuman MD; Rosenbaum PR, Ludwig JM, et al.
      Abstract: ImportanceMore than 300 000 hip fractures occur each year in the United States. Recent practice guidelines have advocated greater use of regional anesthesia for hip fracture surgery.ObjectiveTo test the association of regional (ie, spinal or epidural) anesthesia vs general anesthesia with 30-day mortality and hospital length of stay after hip fracture.Design, Setting, and PatientsWe conducted a matched retrospective cohort study involving patients 50 years or older who were undergoing surgery for hip fracture at general acute care hospitals in New York State between July 1, 2004, and December 31, 2011. Our main analysis was a near-far instrumental variable match that paired patients who lived at different distances from hospitals that specialized in regional or general anesthesia. Supplementary analyses included a within-hospital match that paired patients within the same hospital and an across-hospital match that paired patients at different hospitals.ExposuresSpinal or epidural anesthesia; general anesthesia.Main Outcomes and MeasuresThirty-day mortality and hospital length of stay. Because the distribution of length of stay had long tails, we characterized this outcome using the Huber M estimate with Huber weights, a robust estimator similar to a trimmed mean.ResultsOf 56 729 patients, 15 904 (28%) received regional anesthesia and 40 825 (72%) received general anesthesia. Overall, 3032 patients (5.3%) died. The M estimate of the length of stay was 6.2 days (95% CI, 6.2 to 6.2). The near-far matched analysis showed no significant difference in 30-day mortality by anesthesia type among the 21 514 patients included in this match: 583 of 10 757 matched patients (5.4%) who lived near a regional anesthesia–specialized hospital died vs 629 of 10 757 matched patients (5.8%) who lived near a general anesthesia–specialized hospital (instrumental variable estimate of risk difference, −1.1%; 95% CI, −2.8 to 0.5; P = .20). Supplementary analyses of within and across hospital patient matches yielded mortality findings to be similar to the main analysis. In the near-far match, regional anesthesia was associated with a 0.6-day shorter length of stay than general anesthesia (95% CI, −0.8 to −0.4, P 
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Breast Cancer Screening Using Tomosynthesis in Combination With Digital
    • Authors: Friedewald SM; Rafferty EA, Rose SL, et al.
      Abstract: ImportanceMammography plays a key role in early breast cancer detection. Single-institution studies have shown that adding tomosynthesis to mammography increases cancer detection and reduces false-positive results.ObjectiveTo determine if mammography combined with tomosynthesis is associated with better performance of breast screening programs in the United States.Design, Setting, and ParticipantsRetrospective analysis of screening performance metrics from 13 academic and nonacademic breast centers using mixed models adjusting for site as a random effect.ExposuresPeriod 1: digital mammography screening examinations 1 year before tomosynthesis implementation (start dates ranged from March 2010 to October 2011 through the date of tomosynthesis implementation); period 2: digital mammography plus tomosynthesis examinations from initiation of tomosynthesis screening (March 2011 to October 2012) through December 31, 2012.Main Outcomes and MeasuresRecall rate for additional imaging, cancer detection rate, and positive predictive values for recall and for biopsy.ResultsA total of 454 850 examinations (n=281 187 digital mammography; n=173 663 digital mammography + tomosynthesis) were evaluated. With digital mammography, 29 726 patients were recalled and 5056 biopsies resulted in cancer diagnosis in 1207 patients (n=815 invasive; n=392 in situ). With digital mammography + tomosynthesis, 15 541 patients were recalled and 3285 biopsies resulted in cancer diagnosis in 950 patients (n=707 invasive; n=243 in situ). Model-adjusted rates per 1000 screens were as follows: for recall rate, 107 (95% CI, 89-124) with digital mammography vs 91 (95% CI, 73-108) with digital mammography + tomosynthesis; difference, –16 (95% CI, –18 to –14; P 
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Autologous Hematopoietic Stem Cell Transplantation vs Intravenous Pulse
           Cyclophosphamide in Diffuse Cutaneous Systemic Sclerosis A Randomized
           Clinical Trial
    • Authors: van Laar JM; Farge D, Sont JK, et al.
      Abstract: ImportanceHigh-dose immunosuppressive therapy and autologous hematopoietic stem cell transplantation (HSCT) have shown efficacy in systemic sclerosis in phase 1 and small phase 2 trials.ObjectiveTo compare efficacy and safety of HSCT vs 12 successive monthly intravenous pulses of cyclophosphamide.Design, Setting, and ParticipantsThe Autologous Stem Cell Transplantation International Scleroderma (ASTIS) trial, a phase 3, multicenter, randomized (1:1), open-label, parallel-group, clinical trial conducted in 10 countries at 29 centers with access to a European Group for Blood and Marrow Transplantation–registered transplant facility. From March 2001 to October 2009, 156 patients with early diffuse cutaneous systemic sclerosis were recruited and followed up until October 31, 2013.InterventionsHSCT vs intravenous pulse cyclophosphamide.Main Outcomes and MeasuresThe primary end point was event-free survival, defined as time from randomization until the occurrence of death or persistent major organ failure.ResultsA total of 156 patients were randomly assigned to receive HSCT (n = 79) or cyclophosphamide (n = 77). During a median follow-up of 5.8 years, 53 events occurred: 22 in the HSCT group (19 deaths and 3 irreversible organ failures) and 31 in the control group (23 deaths and 8 irreversible organ failures). During the first year, there were more events in the HSCT group (13 events [16.5%], including 8 treatment-related deaths) than in the control group (8 events [10.4%], with no treatment-related deaths). At 2 years, 14 events (17.7%) had occurred cumulatively in the HSCT group vs 14 events (18.2%) in the control group; at 4 years, 15 events (19%) had occurred cumulatively in the HSCT group vs 20 events (26%) in the control group. Time-varying hazard ratios (modeled with treatment × time interaction) for event-free survival were 0.35 (95% CI, 0.16-0.74) at 2 years and 0.34 (95% CI, 0.16-0.74) at 4 years.Conclusions and RelevanceAmong patients with early diffuse cutaneous systemic sclerosis, HSCT was associated with increased treatment-related mortality in the first year after treatment. However, HCST conferred a significant long-term event-free survival benefit.Trial Identifier: ISRCTN54371254
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Breast Cancer Screening Should Tomosynthesis Replace Digital
    • Authors: Pisano ED; Yaffe MJ.
      Abstract: Another spirited debate has ensued over the benefits of breast cancer screening, freshly stimulated by the recent publication of the 25-year follow-up results of the Canadian National Breast Screening Study (CNBSS) that showed no difference in breast cancer–related mortality in screened women vs controls. This latest controversy developed even though the CNBSS is the only one of 8 randomized clinical trials of screening mammography that failed to find a reduction in mortality, and despite substantial and well-described limitations in the CNBSS methods, including poor image quality and problems in the randomization schema that created a screened cohort with more large palpable cancers than the control group. Fourteen more recent studies published between 2001 and 2010 using more modern technology have shown a 25% to 50% reduction in breast cancer–related mortality for women aged 40 to 74 years. In the interval since the randomized trials of screening and with the demonstration of improved diagnostic accuracy for women with dense breasts, digital mammography has supplanted film mammography as the screening technology of choice, and treatment of breast cancer has improved substantially.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Highlights
    • PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Healthy People 2020: A Report Card on the Health of the Nation
    • Authors: Koh HK; Blakey CR, Roper AY.
      Abstract: For 4 decades, Healthy People has represented the United States’ vision for a healthier future. Each decade, it serves as a public health road map and compass for the nation by establishing a broad set of overarching health goals while specifying actions to improve length and quality of life. For the current decade, this comprehensive national health promotion and disease prevention agenda encompasses more than a thousand specific objectives organized into 42 topic areas.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • The Alleged Presence of Bile Salts in Blood
    • Abstract: Formerly the occurrence of either bile pigments or bile salts in the blood would have been regarded as indicative of abnormal conditions. The bile pigments were assumed to be formed almost exclusively in the liver from hemoglobin liberated on disintegration of red blood cells and then discharged in the bile. Bile pigments in the blood thus became an index of some interference with the normal secretion and discharge of the hepatic secretion in which they are present. Today, thanks to the work of several investigators, it seems assured that bile pigments may have an extrahepatogenous origin. They can be formed in the body even under conditions in which the liver is excluded from participation. The occurrence of bile pigment in the blood in some quantity thus becomes an inevitable consequence; abnormality consists in an excessive content in the circulating medium.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • JAMA
    • PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Understanding the Effect of Medicaid Expansion Decisions in the South
    • PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • FDA Reviews Safety of Newer Anticoagulant
    • Authors: Kuehn BM.
      Abstract: As part of an ongoing investigation of the safety of blood thinners, the US Food and Drug Administration (FDA) has released results from a large study comparing the relative risks of warfarin with those of dabigatran, a newer product. Analyses of adverse event reports submitted to the FDA have found unexpectedly high rates of bleeding and other adverse events as dabigatran prescribing has increased.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Fogarty Targets Global Chronic Disease Challenges
    • Authors: Kuehn BM.
      Abstract: Addressing the growing burden of chronic diseases globally has become a priority for the National Institutes of Health Fogarty International Center, according to its new strategic plan (, released in May.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Use of Immunotherapy for Gastrointestinal Cancers
    • Authors: Kuehn BM.
      Abstract: Evidence from a case study of a single patient suggests that an immunotherapy technique may help shrink epithelial cell cancers. The work was funded by the National Cancer Institute.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Warnings, Lower Dose for Sleep Drug
    • Authors: Kuehn BM.
      Abstract: In its latest step to mitigate the risks of residual drowsiness associated with sleeping pills, the US Food and Drug Administration (FDA) has required the maker of the hypnotic eszopiclone to reduce the recommended starting dose.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Two Decades of Vaccination Success
    • Abstract: New models estimate that since 1994, when the Vaccines for Children (VFC) program was implemented, immunizations have prevented hundreds of millions of illnesses while saving society more than $1 trillion.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Why Do Viruses in Bats Rarely Make Them Sick'
    • Abstract: Bats pose an infectious disease paradox: they often harbor a multitude of viruses capable of killing other mammals, including humans, but the viruses rarely sicken or kill bats. The question is why.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Dido, Queen of Carthage Léonard Limosin
    • Authors: Cole TB.
      Abstract: Dido, Queen of Carthage, pictured here in an enamel portrait by the French artisan Léonard Limosin (circa 1505-circa 1575), was the founding ruler of an ancient city-state on the coast of northern Africa. According to Roman historians and the Latin poet Virgil, who embellished Dido’s biography for his epic poem The Aenead, she was born a princess of the Phoenician city of Tyre in the eighth century bce. Dido was forced to leave Tyre when the king assassinated her husband in an unsuccessful attempt to steal his fortune; she tricked the king into thinking the treasure had been cast into the sea as an offering to her husband’s spirit and escaped by ship with her companions. They landed in North Africa, purchased a small section of land from the Berber king Iarbas, and built a walled city on a headland overlooking a bay. King Iarbas asked Dido to marry him, but she declined, saying that she would never marry again.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Turmeric
    • Authors: McGuire D.
      Abstract: My friend is convinced it’s the turmerickeeping his glioblastoma in check,not the Avastin, not the -ex’s and -ides,not the expertly directed killer rays,but a hermaphroditic rhizomethe color of monks’ robes,bees’ feet in pollen.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Interrelation of Bile Pigment and Hemoglobin
    • Abstract: Until recently it was generally held that the bile pigments are formed in the liver from hemoglobin liberated on the disintegration of red blood corpuscles. Views have since been entirely changed, however, by the demonstration that cells other than those of the liver have the capacity of converting the blood pigment into bile pigment at a rapid rate. The theory of an extrahepatic origin of bile pigments has become firmly established in present-day physiology. Indeed, there is evidence that bile pigment is not necessarily related to the destruction of red blood cells and hemoglobin but may have its origin directly in the food intake. This conclusion, however, remains debated. It is not to be imagined, say the physiologists, that the destruction of blood and formation of bile occur only in certain organs. They probably take place in all organs; and in the color of a bruise there is in reality the formation of bile pigment locally.…
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Misplaced Heading and Wording Error
    • Abstract: In the Review article entitled “Treatment of Venous Thromboembolism” published in the February 19, 2014, issue of JAMA (2014;311[7]:717-728. doi:10.1001/jama.2014.65), a heading was misplaced. The heading “Vena Cava Filters” should have appeared above the paragraph that begins “Retrievable or permanent inferior vena cava filters may be used ….” Additionally, in the seventh line of the third paragraph on page 721, the word “proximal” should have been “distal” so as to read “… distal DVT patients rarely develop proximal DVT ….” This article was corrected online.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Virtual Physician Visits Venture Into Mainstream Use
    • Authors: O’Rourke K.
      Abstract: Boston—Follow-up virtual physician “visits” conducted through a web-based portal have moved into mainstream use at Massachusetts General Hospital (MGH) in Boston. This efficient mode of care delivery is receiving rave reviews from clinicians and patients, according to a presentation at the Medical Informatics World Conference held here in April.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Economist: It’s Time for Tough Choices on US Health Costs
    • Authors: Kuehn BM.
      Abstract: The time has come for the United States to confront unsustainable health spending and make some difficult choices, argued health economist Uwe Reinhardt, PhD, during a grand rounds presentation at the American Medical Association (AMA) in May.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • FDA Approves First Celecoxib Generics
    • Authors: Kuehn BM.
      Abstract: The US Food and Drug Administration (FDA) approved 2 generic versions of the popular nonsteroidal anti-inflammatory drug (NSAID) celecoxib in late May.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • From JAMA’s Daily News Site
    • PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Mindfulness-Based Intervention and Substance Abuse Relapse
    • Authors: Slomski A.
      Abstract: Mindfulness-based relapse prevention (MBRP) significantly reduced drug use and heavy drinking after 1 year in a trial of 286 participants randomized to receive 3 different aftercare interventions (Bowen S et al. JAMA Psychiatry. 2014;71[5]:547-556). Among individuals with substance abuse disorders who get treatment, 40% to 60% will relapse within 1 year.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Physical Ability at Midlife May Predict Mortality
    • Authors: Slomski A.
      Abstract: Low levels of physical capability in middle age may signal poorer chances of survival over the next 13 years, according to a cohort study of 1355 men and 1411 women in the United Kingdom (Cooper R et al. BMJ. doi:10.1136/bmj.g2219 [published online April 29, 2014]).
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Two Drugs Reduce Progression of Idiopathic Pulmonary Fibrosis
    • Authors: Slomski A.
      Abstract: Phase 3 trials have shown both pirfenidone and nintedanib are significantly better than placebo in reducing the progression of idiopathic pulmonary fibrosis.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Youth, High-Dose Antidepressants, and Self-harm
    • Authors: Slomski A.
      Abstract: Children and young adults who start antidepressant therapy at higher than modal doses appear to be at greater risk for suicidal behavior during the first 90 days of treatment, found a cohort study of 162 625 people aged 10 to 64 years with depression (Miller M et al. JAMA Intern Med. 2014;174[6]:899-909). Modal doses for citalopram, sertraline, and fluoxetine were 20 mg/d, 50 mg/d, and 20 mg/d, respectively.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Influence of Chronic Kidney Disease on Warfarin Therapy for Atrial
    • Authors: Shah R; Roberts KM, Ramanathan KB.
      Abstract: To the Editor Several randomized trials and meta-analyses have shown that the risk of bleeding is significantly higher for warfarin anticoagulation therapy than for treatment with aspirin. However, in the study by Dr Carrero and colleagues, the authors concluded that warfarin use was not associated with an increased risk of bleeding, compared with no warfarin, in patients with CKD.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Influence of Chronic Kidney Disease on Warfarin Therapy for Atrial
    • Authors: Carrero J; Szummer K, Jernberg T.
      Abstract: In Reply In our observational analysis, we reported outcomes associated with warfarin exposure in consecutive patients with atrial fibrillation surviving a myocardial infarction index event. Our data reflect Swedish clinical practice patterns in 2003 to 2010, which may not be the same as those in other parts of the world, other periods, or other populations.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Therapies for Venous Thromboembolism
    • Authors: Bikdeli B.
      Abstract: To the Editor The review by Dr Wells and colleagues on the treatment of venous thromboembolism requires some clarifications. Table 1 in the article summarized new oral anticoagulants as treatment options for venous thromboembolism. However, only rivaroxaban is currently approved in both the United States and Europe, dabigatran was recently approved by the US Food and Drug Administration (FDA), and apixaban awaits approval by both the FDA and the European Medicines Agency.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Therapies for Venous Thromboembolism—Reply
    • Authors: Wells PS; Forgie MA, Rodger MA.
      Abstract: In Reply We are aware that the FDA and other agencies may not have approved all of the new oral anticoagulants for the treatment of venous thromboembolism; however, many jurisdictions have. The purpose of Table 1 was not to list drugs that have received agency approval but rather to list drugs that have evidence behind their use.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Legal and Ethical Challenges in Brain Death
    • Authors: Grodin MA.
      Abstract: To the Editor Mr Gostin in his Viewpoint argued that “All states have followed the model act, although 2 states—New Jersey and New York—require hospitals to consider the family’s religious or moral views in determining a course of action after brain death.”
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Legal and Ethical Challenges in Brain Death—Reply
    • Authors: Gostin LO.
      Abstract: In Reply Dr Grodin is correct in his assertion that the laws of both New York and New Jersey refer to the religious beliefs of the individual rather than to those of the family. Both states, however, call upon the family or other close person to determine the individual’s beliefs when they are unknown. In the absence of an advance directive, it will thus often fall to the family to interpret and communicate the patient’s wishes.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
  • Influence of Chronic Kidney Disease on Warfarin Therapy for Atrial
    • Authors: Vaduganathan M; Greene SJ.
      Abstract: To the Editor Dr Carrero and colleagues evaluated the influence of chronic kidney disease (CKD) on the efficacy and safety of warfarin therapy in a population with atrial fibrillation and recent myocardial infarction. Previous studies have found that warfarin, when added to aspirin or dual antiplatelet therapy, is associated with increased risk of major bleeding. We thus find it surprising that, in this registry-based Swedish investigation, no excess bleeding risk was observed in warfarin users across stages of CKD. Accordingly, the characteristics of the study population deserve careful examination.
      PubDate: Wed, 25 Jun 2014 00:00:00 GMT
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