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Journal Cover   JAMA The Journal of the American Medical Association
  [SJR: 4.843]   [H-I: 456]   [982 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]
  • Genomic Engineering and the Future of Medicine
    • Authors: Doudna JA.
      Abstract: Biology and clinical medicine are in the midst of a remarkable revolution. Technical advances in DNA sequencing have given scientists access to the molecular code governing each individual’s unique characteristics, including disease susceptibility and drug sensitivity. This remarkable knowledge could only inform researchers and clinicians because tools to act on the data by making targeted changes to the human genome were too expensive and cumbersome for widespread practical use. Nonetheless, the compelling promise of truly personalized medicine spurred the quest for methods to achieve precision genomic manipulation.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Highlights
    • PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Advance Directives
    • Authors: Thompson AE.
      Abstract: Advance directives help your family and your doctors respect your health care wishes.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • JAMA
    • PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • compline
    • Authors: Donze R.
      Abstract: may our cells alwaysknow their boundaries, our
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • The Effects of Weather on Pain, Comfort and Efficiency
    • Abstract: It is not at all uncommon to hear that a patient feels well or ill parallel to changes of the weather. There is no doubt that barometric and above all hygrometric changes produce distinct and often marked variations in sensation. Probably no information, however, is more fallacious than the vague general impressions with regard to these effects of the weather that are supposed to be common knowledge. For instance, it is a shock to most persons to learn that though dark, rainy days are supposed to produce depression, and bright, sunny weather to lift clouds of despondency, suicides are most frequent in June and least frequent in December. Cold weather is supposed to be a great source of suffering and consequent depression, especially to the working classes, and yet the cold winter months have fewest suicides and the warm summer weather the most. It is not the extremes of heat, however, which produce the despondency and ill feeling that lead up to suicide, for the climax of the curve of suicides is not reached in July or in August, when people have become run down from the persistence of hot weather, but in the pleasant month of June.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Toxic Puffer Fish Species Illegally Imported to United States
    • Abstract: Puffer fish may be a delicacy in Asian countries, but 4 people in Minnesota didn’t have a pleasant gustatory experience after buying the dried fish from a street vendor during a visit to New York City. Instead of eating Japanese puffer fish (Takifugu rubripes)—the only species that can legally be imported into the United States—a brother and sister in their early 30s and 2 friends ate Lagocephalus lunaris, an Indo-Pacific species of puffer fish that is never safe to consume because of its naturally high levels of potentially deadly tetrodotoxin.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • By the River Edward W. Redfield
    • Authors: Smith JM.
      Abstract: Something about a river seems to soothe the soul, whether the hypnotic rhythm of the hastening waters, the lyrical wandering of a waterway tracing the topography, or a subconscious sense of its life-giving properties. For painter Edward W. Redfield (1869-1965), the river and its fringe of foliage bankside provided an ever-new exhibition of color and lighting combos to convey on canvas. His optimistic, vigorously wrought landscapes appealed to Americans who saw in them a reading of their young country as surging forward with a similar strength of purpose.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Proposed Rule Seeks to Safeguard Against Phased-Out Chemicals
    • Authors: Hampton T.
      Abstract: A newly proposed rule by the US Environmental Protection Agency (EPA) seeks to ensure that certain perfluorinated chemicals do not re-enter the marketplace without review (http://1.usa.gov/1yE657R). Perfluorinated chemicals—which are used in various industrial applications as well as in goods such as cleaners, carpet, leather, paper, and paints—are useful to manufacturers because they impart properties including fire resistance, and oil, stain, and water repellency. Long-chain perfluorinated chemicals persist in the environment and are toxic to animals, producing reproductive, developmental, and systemic effects. These compounds have been detected at low levels in human blood across the world. Although the effects of these compounds on human health are unknown, they bioaccumulate in humans such that even low exposure could result in high body burden.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Cholesterol-Lowering Drugs Taken by 28% of US Population
    • Abstract: Cholesterol-lowering medication use is steadily increasing, with 27.9% of adults 40 years or older reporting that they took a prescription drug to reduce their cholesterol during 2011 to 2012. In comparison, 19.9% of adults in the United States used a cholesterol-lowering medication in 2003 to 2004.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Electric Stimulation Device Approved to Treat Obesity
    • Authors: Hampton T.
      Abstract: The US Food and Drug Administration (FDA) has approved a first-of-its-kind weight loss treatment device that electronically suppresses hunger signals traveling between the stomach and the brain (http://1.usa.gov/1yAbICk). The Maestro Rechargeable System, which is manufactured by EnteroMedics of St Paul, Minnesota, consists of an electrical pulse generator, wire leads, and electrodes that are implanted into the abdomen and intermittently send electrical pulses to the vagus nerve.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Officials Strive to Help Consumers Shop for Health Insurance Benefits
    • Authors: Hampton T.
      Abstract: The Departments of Health and Human Services, Labor, and the Treasury have issued proposed rules to clarify options for individuals seeking health insurance coverage (http://go.cms.gov/1B8QP29). The proposal would require all health plans and issuers to provide a standardized brief summary of what a particular health insurance policy or employer plan covers—a Summary of Benefits and Coverage—so that consumers can make meaningful comparisons of different plans and can easily understand what they cover.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Progesterone Offers No Benefits in Traumatic Brain Injury
    • Authors: Slomski A.
      Abstract: Despite promising results from preclinical studies and 2 clinical trials, the neuroprotective properties of progesterone did not improve functional outcomes or decrease mortality after traumatic brain injury (TBI) in 2 large, parallel, placebo-controlled phase 3 trials.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Trials Will Assess Effect of Flexible Hours for Trainees
    • Authors: Slomski A.
      Abstract: Starting in July, some internal medicine residents and interns will have fewer limitations on their work hours as participants in a forthcoming randomized trial, the Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) trial. Last July, general surgery residents also began working a more flexible schedule with fewer duty-hour restrictions as part of the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial. Both trials are aimed at investigating the effect of the most recent regulations instituted in 2011 limiting trainee duty hours, with the goal of informing policies to optimize the quality and safety of patient care and the education of residents.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Efforts Seek to Develop Systematic Ways to Objectively Assess
           Surgeons’ Skills
    • Authors: Hampton T.
      Abstract: Imagine a surgeon is hired based on strong professional recommendations and qualifications, yet subsequent to being hired, many of the surgeon’s patients are readmitted to the clinic with serious postoperative complications. It is later discovered that the surgeon lacks sufficient manual dexterity and was therefore making critical technical errors during surgery that compromised surgical success and patient health. Such an occurrence, though surprising, is not unheard of.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • On Fear, Distrust, and Ebola
    • Authors: Sharfstein JM.
      Abstract: Soon after the first US case of Ebola was diagnosed in Dallas, I decided that Maryland’s Department of Health and Mental Hygiene should have a press conference (http://bit.ly/1Ajy09F). With leading infectious disease experts from the University of Maryland and Johns Hopkins, we answered questions from virtually every news outlet in the area for about 45 minutes.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Glaucoma Drug Significantly Slows the Progression of Vision Loss
    • Authors: Slomski A.
      Abstract: The prostaglandin analogue latanoprost, the most commonly prescribed treatment for glaucoma, can greatly reduce risk of vision loss in people with open-angle glaucoma, found a placebo-controlled trial of 516 patients (Garway-Heath DF et al. Lancet.doi:10.1016/S0140-6736(14)62111-5 [published online December 18, 2014]).
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Alternative Pricing Strategies for Cancer Drugs
    • Authors: Messori A; De Rosa M, Pani L.
      Abstract: To the Editor Dr Bach, in discussing indication-specific pricing for cancer drugs, examined the practical aspects of linking the price of a drug to its benefits. However, he did not mention the Italian experience in this area, which extends more than 5 years and involves a total of 162 agents, most of which are oncological drugs.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Alternative Pricing Strategies for Cancer Drugs—Reply
    • Authors: Bach PB.
      Abstract: In Reply Dr Messori and colleagues describe an approach to paying for cancer therapies in Italy that shares some essential features with indication-specific pricing as I discussed in a Viewpoint, but it is not the same. What the approaches share is the premise that payment should not be associated with the drug but instead with its use. Likewise, both approaches ultimately reward pharmaceutical companies more when their drugs are more effective.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Inconsistent Units of Measure
    • Abstract: In the Diagnostic Test Interpretation entitled “Lactate in Sepsis” published in the January 13, 2015, issue of JAMA (2015;313[2]:194-195. doi:10.1001/jama.2014.13811), lactate levels were inserted in both SI and conventional units of measure. In the first paragraph, the second sentence should read “He was found to be tachycardic, hypotensive, in severe respiratory distress, and oliguric, and he had peripheral cyanosis and a lactate level of 3.1 mmol/L (reference range, 0.6-1.7 mmol/L) (27.9 mg/dL; reference range, 5.0-15 mg/dL).” The fourth sentence should read “Following admission, the patient’s lactate level decreased to 1.2 mmol/L (10.8 mg/dL).” The sixth and seventh sentences should read “The following morning, his central venous pressure was 13, stroke volume variation was 7%, and lactate was 3.0 mmol/L (27.0 mg/dL). Mean arterial pressure of 60 to 65 mm Hg was achieved but lactate continued to increase to 4.2 mmol/L (37.8 mg/dL).” In the Test Characteristics section, the first sentence in the first paragraph should read “Studies in hypoxia, low flow states, and early septic shock1 have provided grounds to conceptualize hyperlactatemia (arterial or venous blood lactate >2 mmol/L [>18.0 mg/dL]), as the manifestation of inadequate oxygen delivery and anaerobic metabolism.” The first sentence in the second paragraph should read “Lactate testing is inexpensive (mean Medicare reimbursement, $13.92) and predicts hospital mortality (likelihood ratio, 1.4-2 for ≥2.5 mmol/L [≥22.5 mg/dL]-cutoff; or 2.6-6.3 for 4 mmol/L [36.0 mg/dL]-cutoff).3,4” In the Application of Test Results to This Patient section, the first sentence should read “On admission, a lactate level of 3.1 mmol/L (27.9 mg/dL) should alert the clinician to the high severity of illness.” This article was corrected online.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Assessing the Benefit of Vascular Closure Devices After Femoral Artery
           Puncture—Reply
    • Authors: Schulz-Schüpke S; Kastrati A, .
      Abstract: In Reply Dr Hoffer questions whether the advantage of a 9-minute reduction in time to hemostasis observed with vascular closure devices (VCDs) compared with manual compression in our trial was real. In his opinion, the reduction in time to hemostasis may not have been observed had the time needed for angiographic evaluation of the punctured artery been taken into account in the VCD group.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Male Body Image and Weight-Related Disorders
    • Authors: Nguyen GT; Margo KL.
      Abstract: To the Editor The article by Drs Neumark-Sztainer and Eisenberg discussed important issues concerning body image, muscle building, and disordered eating among men, but it did not mention the implications of body image on the behaviors of males who are gay or bisexual.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Male Body Image and Weight-Related Disorders—Reply
    • Authors: Eisenberg ME; Neumark-Sztainer D.
      Abstract: In Reply Drs Nguyen and Margo raise an important point that issues of muscularity and body dissatisfaction may be heightened in certain subpopulations of men, particularly those who are gay or bisexual. We agree with the concern they raise about media images targeting gay audiences as a potential influence.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Assessing the Benefit of Vascular Closure Devices After Femoral Artery
           Puncture
    • Authors: Hoffer EK.
      Abstract: To the Editor Arterial closure devices have demonstrated benefits with regard to a decrease in complications and recovery time in the setting of therapeutic arterial procedures. A meta-analysis left a question regarding increased complication risk vs the rapid, reliable, inexpensive, and safe alternative of manual compression. The Instrumental Sealing of Arterial Puncture Site–CLOSURE Device vs Manual Compression (ISAR-CLOSURE) randomized clinical trial was an adequately powered study that provides assurance that the studied arterial closure devices were noninferior to manual compression with regard to efficacy and complications.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Elevated Lactate Levels in a Non–Critically Ill Patient
    • Authors: Chen M; Kim TY, Pessegueiro AM.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Trends in the Proportion of Patients With Lung Cancer Meeting Screening
           Criteria
    • Authors: Wang Y; Midthun DE, Wampfler JA, et al.
      Abstract: Lung cancer screening using low-dose computed tomography is recommended for high-risk individuals by professional associations, including the US Preventive Services Task Force (USPSTF). The implications of the USPSTF screening criteria were investigated in a well-defined population retrospectively over 28 years to demonstrate trends in the proportion of patients with lung cancer meeting the criteria.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Hydroxychloroquine and the Retina
    • Authors: Marmor MF; Melles RB.
      Abstract: JAMA OphthalmologyRegular Examinations for Toxic Maculopathy in Long-term Chloroquine or Hydroxychloroquine UsersMelisa Nika, MD; Taylor S. Blachley, MS; Paul Edwards, MD; Paul P. Lee, MD, JD; Joshua D. Stein, MD, MSImportance According to evidence-based, expert recommendations, long-term users of chloroquine or hydroxychloroquine sulfate should undergo regular visits to eye care providers and diagnostic testing to check for maculopathy.Objective To determine whether patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) taking chloroquine or hydroxychloroquine are regularly visiting eye care providers and being screened for maculopathy.Design, Setting, and Participants Patients with RA or SLE who were continuously enrolled in a particular managed care network for at least 5 years between January 1, 2001, and December 31, 2011, were studied. Patients’ amount of chloroquine or hydroxychloroquine use in the 5 years since the initial RA or SLE diagnosis was calculated, along with their number of eye care visits and diagnostic tests for maculopathy. Those at high risk for maculopathy were identified. Logistic regression was performed to assess potential factors associated with regular eye care visits (annual visits in ≥3 of 5 years) among chloroquine or hydroxychloroquine users, including those at highest risk for maculopathy.Main Outcomes and Measures Among chloroquine or hydroxychloroquine users and those at high risk for toxic maculopathy, the proportions with regular eye care visits and diagnostic testing, as well as the likelihood of regular eye care visits.Results Among 18 051 beneficiaries with RA or SLE, 6339 (35.1%) had at least 1 record of chloroquine or hydroxychloroquine use, and 1409 (7.8%) had used chloroquine or hydroxychloroquine for at least 4 years. Among those at high risk for maculopathy, 27.9% lacked regular eye care visits, 6.1% had no visits to eye care providers, and 34.5% had no diagnostic testing for maculopathy during the 5-year period. Among high-risk patients, each additional month of chloroquine or hydroxychloroquine use was associated with a 2.0% increased likelihood of regular eye care (adjusted odds ratio, 1.02; 95% CI, 1.01-1.03). High-risk patients whose SLE or RA was managed by rheumatologists had a 77.4% increased likelihood of regular eye care (adjusted odds ratio, 1.77; 95% CI, 1.27-2.47) relative to other patients.Conclusions and Relevance In this insured population, many patients at high risk for maculopathy associated with the use of chloroquine or hydroxychloroquine are not undergoing routine monitoring for this serious adverse effect. Future studies should explore factors contributing to suboptimal adherence to expert guidelines and the potential effect on patients’ vision-related outcomes.JAMA Ophthalmol. 2014;132(10):1199-1208. doi:10.1001/jamaophthalmol.2014.1720.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Glomerular Filtration Rate and Albuminuria for Detection and Staging of
           Acute and Chronic Kidney Disease in Adults A Systematic Review
    • Authors: Levey AS; Becker C, Inker LA.
      Abstract: ImportanceBecause early-stage kidney disease is asymptomatic and is associated with both morbidity and mortality, laboratory measurements are required for its detection.ObjectiveTo summarize evidence supporting the use of laboratory tests for glomerular filtration rate (GFR) and albuminuria to detect and stage acute kidney injury, acute kidney diseases and disorders, and chronic kidney disease in adults.Evidence ReviewWe reviewed recent guidelines from various professional groups identified via the National Guideline Clearing House and author knowledge, and systematically searched MEDLINE for other sources of evidence for selected topics.FindingsThe KDIGO (Kidney Disease Improving Global Outcomes) guidelines define and stage acute and chronic kidney diseases by GFR and albuminuria. For initial assessment of GFR, measuring serum creatinine and reporting estimated GFR based on serum creatinine (eGFRcr) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009 equation is recommended. If confirmation of GFR is required because of conditions that affect serum creatinine independent of GFR (eg, extremes of muscle mass or diet), or interference with the assay, cystatin C should be measured and estimated GFR should be calculated and reported using cystatin C (eGFRcys) and serum creatinine (eGFRcr-cys) or GFR should be measured directly using a clearance procedure. Initial assessment of albuminuria includes measuring urine albumin and creatinine in an untimed spot urine collection and reporting albumin-to-creatinine ratio. If confirmation of albuminuria is required because of diurnal variation or conditions affecting creatinine excretion, such as extremes of muscle mass or diet, the albumin excretion rate should be measured from a timed urine collection.Conclusions and RelevanceDetection and staging of acute and chronic kidney diseases can be relatively simple. Because of the morbidity and mortality associated with kidney disease, early diagnosis is important and should be pursued in at-risk populations.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Anticoagulant Reversal, Blood Pressure Levels, and Anticoagulant
           Resumption in Patients With Anticoagulation-Related Intracerebral
           Hemorrhage
    • Authors: Kuramatsu JB; Gerner ST, Schellinger PD, et al.
      Abstract: ImportanceAlthough use of oral anticoagulants (OACs) is increasing, there is a substantial lack of data on how to treat OAC-associated intracerebral hemorrhage (ICH).ObjectiveTo assess the association of anticoagulation reversal and blood pressure (BP) with hematoma enlargement and the effects of OAC resumption.Design, Setting, and ParticipantsRetrospective cohort study at 19 German tertiary care centers (2006-2012) including 1176 individuals for analysis of long-term functional outcome, 853 for analysis of hematoma enlargement, and 719 for analysis of OAC resumption.ExposuresReversal of anticoagulation during acute phase, systolic BP at 4 hours, and reinitiation of OAC for long-term treatment.Main Outcomes and MeasuresFrequency of hematoma enlargement in relation to international normalized ratio (INR) and BP. Incidence analysis of ischemic and hemorrhagic events with or without OAC resumption. Factors associated with favorable (modified Rankin Scale score, 0-3) vs unfavorable functional outcome.ResultsHemorrhage enlargement occurred in 307 of 853 patients (36.0%). Reduced rates of hematoma enlargement were associated with reversal of INR levels
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Association of an Inherited Genetic Variant With Vincristine-Related
           Peripheral Neuropathy in Children With Acute Lymphoblastic Leukemia
    • Authors: Diouf B; Crews KR, Lew G, et al.
      Abstract: ImportanceWith cure rates of childhood acute lymphoblastic leukemia (ALL) exceeding 85%, there is a need to mitigate treatment toxicities that can compromise quality of life, including peripheral neuropathy from vincristine treatment.ObjectiveTo identify genetic germline variants associated with the occurrence or severity of vincristine-induced peripheral neuropathy in children with ALL.Design, Setting, and ParticipantsGenome-wide association study of patients in 1 of 2 prospective clinical trials for childhood ALL that included treatment with 36 to 39 doses of vincristine. Genome-wide single-nucleotide polymorphism (SNP) analysis and vincristine-induced peripheral neuropathy were assessed in 321 patients from whom DNA was available: 222 patients (median age, 6.0 years; range, 0.1-18.8 years) enrolled in 1994-1998 in the St Jude Children’s Research Hospital protocol Total XIIIB with toxic effects follow-up through January 2001, and 99 patients (median age, 11.4 years; range, 3.0-23.8 years) enrolled in 2007-2010 in the Children’s Oncology Group (COG) protocol AALL0433 with toxic effects follow-up through May 2011. Human leukemia cells and induced pluripotent stem cell neurons were used to assess the effects of lower CEP72 expression on vincristine sensitivity.ExposureTreatment with vincristine at a dose of 1.5 or 2.0 mg/m2.Main Outcomes and MeasuresVincristine-induced peripheral neuropathy was assessed at clinic visits using National Cancer Institute criteria and prospectively graded as mild (grade 1), moderate (grade 2), serious/disabling (grade 3), or life threatening (grade 4).ResultsGrade 2 to 4 vincristine-induced neuropathy during continuation therapy occurred in 28.8% of patients (64/222) in the St Jude cohort and in 22.2% (22/99) in the COG cohort. A SNP in the promoter region of the CEP72 gene, which encodes a centrosomal protein involved in microtubule formation, had a significant association with vincristine neuropathy (meta-analysis P = 6.3×10−9). This SNP had a minor allele frequency of 37% (235/642), with 50 of 321 patients (16%; 95% CI, 11.6%-19.5%) homozygous for the risk allele (TT at rs924607). Among patients with the high-risk CEP72 genotype (TT at rs924607), 28 of 50 (56%; 95% CI, 41.2%-70.0%) developed at least 1 episode of grade 2 to 4 neuropathy, a higher rate than in patients with the CEP72 CC or CT genotypes (58/271 patients [21.4%; 95% CI, 16.9%-26.7%]; P = 2.4×10−6). The severity of neuropathy was greater in patients homozygous for the TT genotype compared with patients with the CC or CT genotype (2.4-fold by Poisson regression [P
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Precision Medicine to Improve the Risk and Benefit of Cancer Care Genetic
           Factors in Vincristine-Related Neuropathy
    • Authors: McLeod HL.
      Abstract: The past decade has seen important advances in the treatment of many cancers, with curative therapies for a few and extension of quantity and quality of life for others. For example, clarifying the role of both growth factor cell signaling and immunologic checkpoints in advanced melanoma has produced kinase inhibitors and immunotherapy drugs that each produce longer patient survival than any previous treatments. These improvements reflect efforts in pharmacology and cancer biology and the success of translating the biochemical, pharmacological, immunological, and molecular findings into treatments. This has allowed the practical emergence of personalized medicine for cancer management, whereby genetic variants, gene expression, and other patient factors allow for more objective selection of therapeutic regimens, individualized dosing of drugs, and the possibility of avoiding drug toxicity.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Association of NSAID Use With Risk of Bleeding and Cardiovascular Events
           in Patients Receiving Antithrombotic Therapy After Myocardial Infarction
    • Authors: Schjerning Olsen A; Gislason GH, McGettigan P, et al.
      Abstract: ImportanceAntithrombotic treatment is indicated for use in patients after myocardial infarction (MI); however, concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) could pose safety concerns.ObjectiveTo examine the risk of bleeding and cardiovascular events among patients with prior MI taking antithrombotic drugs and for whom NSAID therapy was then prescribed.Design, Setting, and ParticipantsUsing nationwide administrative registries in Denmark (2002-2011), we studied patients 30 years or older admitted with first-time MI and alive 30 days after discharge. Subsequent treatment with aspirin, clopidogrel, or oral anticoagulants and their combinations, as well as ongoing concomitant NSAID use, was determined.ExposuresUse of NSAIDs with ongoing antithrombotic treatment after first-time MI.Main Outcomes and MeasuresRisk of bleeding (requiring hospitalization) or a composite cardiovascular outcome (cardiovascular death, nonfatal recurrent MI, and stroke) according to ongoing NSAID and antithrombotic therapy, calculated using adjusted time-dependent Cox regression models.ResultsWe included 61 971 patients (mean age, 67.7 [SD, 13.6] years; 63% men); of these, 34% filled at least 1 NSAID prescription. The number of deaths during a median follow-up of 3.5 years was 18 105 (29.2%). A total of 5288 bleeding events (8.5%) and 18 568 cardiovascular events (30.0%) occurred. The crude incidence rates of bleeding (events per 100 person-years) were 4.2 (95% CI, 3.8-4.6) with concomitant NSAID treatment and 2.2 (95% CI, 2.1-2.3) without NSAID treatment, whereas the rates of cardiovascular events were 11.2 (95% CI, 10.5-11.9) and 8.3 (95% CI, 8.2-8.4). The multivariate-adjusted Cox regression analysis found increased risk of bleeding with NSAID treatment compared with no NSAID treatment (hazard ratio, 2.02 [95% CI, 1.81-2.26]), and the cardiovascular risk was also increased (hazard ratio, 1.40 [95% CI, 1.30-1.49]). An increased risk of bleeding and cardiovascular events was evident with concomitant use of NSAIDs, regardless of antithrombotic treatment, types of NSAIDs, or duration of use.Conclusions and RelevanceAmong patients receiving antithrombotic therapy after MI, the use of NSAIDs was associated with increased risk of bleeding and excess thrombotic events, even after short-term treatment. More research is needed to confirm these findings; however, physicians should exercise appropriate caution when prescribing NSAIDs for patients who have recently experienced MI.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Sharing Clinical Trial Data Maximizing Benefits, Minimizing Risk
    • Authors: Lo B.
      Abstract: This Viewpoint discusses the benefits, challenges, and risks of sharing clinical trial findings and data.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Optimizing High-Risk Care Management
    • Authors: Powers BW; Chaguturu SK, Ferris TG.
      Abstract: This Viewpoint discusses the potential of high-risk care management programs that are practice-based, payer-catalyzed, and purchaser-supported to deliver better care at lower cost.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Medicare and Care Coordination Expanding the Clinician’s Toolbox
    • Authors: Aronson L; Bautista CA, Covinsky K.
      Abstract: This Viewpoint aims at helping health care professionals understand the components involved with providing non–face-to-face chronic care management (CCM) to Medicare patients.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • For What It’s Worth
    • Authors: Humikowski CA.
      Abstract: About a year ago, I died. Just for a few minutes, but long enough that I had a round of chest compressions so deep my sternum ached for weeks. At times my ribs hurt more than the long incision running down my belly, made in haste to control the bleeding that was taking my life.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
  • Potential Hazards of Adding Nonsteroidal Anti-inflammatory Drugs to
           Antithrombotic Therapy After Myocardial Infarction Time for More Than a
           Gut Check
    • Authors: Campbell CL; Moliterno DJ.
      Abstract: This Viewpoint discusses potental hazards related to the concomitant use of nonsteroidal anti-inflammatory drugs and antithrombotic therapy after myocardial infarction.
      PubDate: Tue, 24 Feb 2015 00:00:00 GMT
       
 
 
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