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Journal Cover JAMA The Journal of the American Medical Association
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     ISSN (Print) 0098-7484 - ISSN (Online) 1538-3598
     Published by American Medical Association Homepage  [11 journals]   [SJR: 4.843]   [H-I: 456]
  • How the Opium Habit Is Acquired
    • Abstract: Mr. Virgil G. Eaton tells the public, in the September number of the PopularScienceMonthly, how the opium habit is acquired. He is the writer that frightened the people of the country about two years ago by prophesying that they would all be bald in about a dozen centuries. He now predicts that unless people develop their muscles, rest their nerves, and send the family doctor on a vacation, the residents of our American cities will be all opium-slaves.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • JAMA
    • PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Transplant-Transmitted Encephalitis
    • Abstract: Improved surveillance systems are needed to identify rare but difficult-to-diagnose encephalitis cases resulting from pathogens transmitted during organ transplants, according to a recent report.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Tweeting Food-Borne Illness
    • Abstract: In less than a year, a Chicago Department of Public Health website launched to track Twitter traffic for food-borne illness complaints turned up 21 restaurants that failed unannounced health inspections (Harris JK et al. MMWR Morb Mortal Wkly Rep. 2014;63[32]:681-685).
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Crimson Autumn Ural Tansykbaev
    • Authors: Cole TB.
      Abstract: The Republic of Uzbekistan is a land-locked country in central Asia, bordered by Kazakhstan and the desiccated Aral Sea to the north, Kyrgyzstan to the northeast, Afghanistan to the south, Tajikistan to the southeast, and Turkmenistan to the southwest. It straddles the Silk Road, a cross-continental trade route that enriched the Uzbek cities of Tashkent and Samarkand before the fragmentation of the Mongol Empire in the 14th century. Much of the old city of Tashkent was destroyed in a 1966 earthquake, but Samarkand has been able to preserve its Islamic architecture and its folk art traditions of embroidery, weaving, engraving, ceramics, and painting on wood. In the far northwest corner of Uzbekistan is the autonomous region of Karakalpakstan, known for the archaeological site of Khorezm and the Nukus Museum, home of the Savistsky Collection of Uzbek and Russian avant-garde art.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • A Pathologist Drives Home
    • Authors: Mandavilli S.
      Abstract: I study cells in microscopic fields:armies of Kublai Khan, cannymendicant travelers that defy easy classification,like the ones that felled my grandmotherwhen I scooped her up, light as a sparrowfrom the floor, hoping that Rama mightdescend as another avatar to vanquishasuras; insatiable and pleomorphic, wearingfuchsia and magenta war paint, they line upat ramparts, holding up abnormal mitoses,as if they were a cross to bear.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • International Standards for Newborn Size and Fetal Growth
    • Authors: Friedrich MJ.
      Abstract: Two reports from the International Fetal and Newborn Growth Consortium for the 21st Century provide universal, multiethnic growth standards for fetuses and newborns that complement the World Health Organization Child Growth Standards for children from birth to age 5 years.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Mortality Rates Decreasing for South Africans Taking ART
    • Authors: Friedrich MJ.
      Abstract: Mortality rates among South African patients infected with HIV who take antiretroviral therapy (ART) for longer than 2 years are now comparable with those of North American patients, reports an international team of researchers (Boulle A et al. PLoS Med. 2014;11[9]:e1001718).
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Potential Therapies and Vaccines to Combat Ebola
    • Authors: Friedrich MJ.
      Abstract: Transfusing whole blood or purified serum from individuals who have survived an Ebola infection is the therapy with the greatest potential for widespread implementation in West Africa’s ongoing Ebola outbreak, according to an expert panel convened by the World Health Organization (WHO) (http://bit.ly/1qqSJaI). The panel met in early September to assess which experimental therapies and vaccines for Ebola should be prioritized for accelerated clinical development.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Report Focuses on Global Patterns of Violence Against Children
    • Authors: Friedrich MJ.
      Abstract: Violence against children is prevalent throughout the world but often goes unrecognized because of social acceptance, shame, or the voicelessness of children. A new report from the United Nations Children’s Fund based on administrative records, surveys, and qualitative studies collected from 190 countries over the last 2 decades (http://uni.cf/1Cut8CO) sheds light on this largely undocumented issue so that efforts can be made to bring an end to such violence.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Clarification
    • Abstract: In the Brief Report entitled “Medical Communication Companies and Industry Grants” published in the December 18, 2013, issue of JAMA (2013;310[23]:2554-2558. doi:10.1001/jama.2013.281638), the last sentence of the first paragraph in the article requires clarification. It should read: “Known best for arranging continuing medical education (CME) programs, they also may develop prelaunch and branding campaigns and produce digital and print publications.” This article was corrected online.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Errors in Clinical Crossroads
    • Abstract: In the Clinical Crossroads article entitled “Assessment and Lifestyle Management of Patients With Obesity: Clinical Recommendations From Systematic Reviews,” published in the September 3, 2014, issue of JAMA (2014;312[9]:943-952. doi:10.1001/jama.2014.10432), several errors occurred. On page 944, in the third paragraph of the left column, the second sentence should have read “Her only medication is paroxetine, 50 mg/d.” On page 945, the second-to-last sentence of the second paragraph under “Taking an Obesity-Focused History” also should have stated that Ms T is taking paroxetine, not fluoxetine. On page 950, in the paragraph under “Recommendations for Ms T,” the third sentence should have stated that Ms T should try to accumulate at least 150 minutes of moderately vigorous physical activity on a weekly basis [not a daily basis] and discuss with her physician the substitution of paroxetine [not fluoxetine] with an alternative antidepressant. This article was corrected online.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Researchers Ponder Aspirin’s Potential in Preventing Cancer
    • Authors: Rubin R.
      Abstract: A review article published online August 5 might leave some readers wondering whether it’s time to start adding aspirin to the drinking water.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Recurrence of Stevens-Johnson Syndrome and Toxic Epidermal
           Necrolysis—Reply
    • Authors: Finkelstein Y; Macdonald EM, Juurlink DN.
      Abstract: In Reply Stevens-Johnson syndrome and toxic epidermal necrolysis are rare disorders. To study their recurrence over time, large data sets are needed. This precludes a case-by-case examination of medical records.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Commitment Devices to Improve Unhealthy Behaviors
    • Authors: Blondon K.
      Abstract: To the Editor A Viewpoint by Dr Rogers and colleagues discussed the underuse of commitment devices to improve unhealthy behaviors. The authors underlined 2 basic features of these devices: their voluntary use by patients who want to change behaviors and their reinforcement of consequences related to failed goal achievement by patients.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Commitment Devices to Improve Unhealthy Behaviors—Reply
    • Authors: Rogers T; Milkman KL, Volpp KG.
      Abstract: In Reply Our Viewpoint described commitment devices and argued that they should be more widely used in health care. Commitment devices enforce voluntarily imposed restrictions on people until they have accomplished their goals or enforce voluntarily imposed penalties if they do not accomplish their goals.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Clarification of Inaccurate Statement
    • Abstract: The editors would like to clarify the last sentence of the first paragraph of the Brief Report entitled “Medical Communication Companies and Industry Grants” published in the December 18, 2013, issue of JAMA, as we believe the sentence could be read as suggesting that all medical communication companies participate in certain marketing activities, which is not accurate. The authors disagree with this interpretation and the need for a clarification. The sentence has been modified online to read: “Known best for arranging continuing medical education (CME) programs, they also may develop prelaunch and branding campaigns and produce digital and print publications.”
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Benefits and Risks Associated With Thrombolysis for Pulmonary Embolism
    • Authors: Bradford MA; Adhikari NJ, Friedrich JO.
      Abstract: To the Editor Dr Chatterjee and colleagues performed a meta-analysis comparing thrombolysis with anticoagulation for pulmonary embolism using the Peto method to determine pooled odds ratios (ORs) because of low expected event rates among included trials. We suggest that this method is flawed for several reasons.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Benefits and Risks Associated With Thrombolysis for Pulmonary Embolism
    • Authors: Bova C.
      Abstract: To the Editor The optimal treatment of intermediate-risk patients with pulmonary embolism (hemodynamically stable patients with right ventricular dysfunction or increased cardiac biomarkers) is an important issue, and the meta-analysis by Dr Chatterjee and colleagues showed a reduction in mortality with the use of thrombolysis compared with anticoagulation in this group of patients. However, in my opinion caution is due in interpreting these results.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Benefits and Risks Associated With Thrombolysis for Pulmonary
           Embolism—Reply
    • Authors: Chatterjee S; Giri J.
      Abstract: In Reply Dr Bradford and colleagues suggest that the Peto method of determination of pooled ORs may be flawed because the event rates for mortality in pulmonary embolism trials were approximately 3%. However, at event rates less than 5%, the Peto method provides the least biased estimates of treatment effect when compared with the corrected Mantel-Haenszel, DerSimonian-Laird, and inverse-variance ORs.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Recurrence of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
    • Authors: Stern RS.
      Abstract: To the Editor Dr Finkelstein and colleagues used hospital discharge data to determine the incidence and risk of recurrence of Stevens-Johnson syndrome and toxic epidermal necrolysis, which are rare serious conditions. The authors did not review medical records.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Emergency Department Visits by Children, Adolescents, and Young Adults in
           California by Insurance Status, 2005-2010
    • Authors: Hsia RY; Nath J, Baker LC.
      Abstract: Concerns regarding cost, continuity of care, and crowding continue to bring emergency department (ED) use under nationwide scrutiny. Although many hope that increasing insurance coverage through the Affordable Care Act will lead to decreases in ED visits, recent evidence in adults suggests that increasing access to specifically Medicaid insurance may actually be associated with increased ED use. This ongoing discussion regarding the association between insurance coverage and ED use, however, has focused primarily on adults.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Facial Droop, Left-Sided Weakness, and Cystic Brain Lesions
    • Authors: Beaird OE; Northway C, Malani PN.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Drugs for MRSA Skin and Soft-Tissue Infections
    • Abstract: Methicillin-resistant Staphylococcus aureus (MRSA), which was traditionally a nosocomially-acquired organism but now frequently occurs in the absence of health care exposure, is the predominant cause of suppurative skin and soft-tissue infections in many parts of the US. Community-associated MRSA usually causes furunculosis, purulent cellulitis, and abscesses, but necrotizing fasciitis, necrotizing pneumonia, and sepsis can also occur.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Climate Change Challenges and Opportunities for Global Health
    • Authors: Patz JA; Frumkin H, Holloway T, et al.
      Abstract: ImportanceHealth is inextricably linked to climate change. It is important for clinicians to understand this relationship in order to discuss associated health risks with their patients and to inform public policy.ObjectivesTo provide new US-based temperature projections from downscaled climate modeling and to review recent studies on health risks related to climate change and the cobenefits of efforts to mitigate greenhouse gas emissions.Data Sources, Study Selection, and Data SynthesisWe searched PubMed and Google Scholar from 2009 to 2014 for articles related to climate change and health, focused on governmental reports, predictive models, and empirical epidemiological studies. Of the more than 250 abstracts reviewed, 56 articles were selected. In addition, we analyzed climate data averaged over 13 climate models and based future projections on downscaled probability distributions of the daily maximum temperature for 2046-2065. We also compared maximum daily 8-hour average ozone with air temperature data taken from the National Oceanic and Atmospheric Administration, National Climate Data Center.ResultsBy 2050, many US cities may experience more frequent extreme heat days. For example, New York and Milwaukee may have 3 times their current average number of days hotter than 32°C (90°F). High temperatures are also strongly associated with ozone exceedance days, for example, in Chicago, Illinois. The adverse health aspects related to climate change may include heat-related disorders, such as heat stress and economic consequences of reduced work capacity; respiratory disorders, including those exacerbated by air pollution and aeroallergens, such as asthma; infectious diseases, including vectorborne diseases and waterborne diseases, such as childhood gastrointestinal diseases; food insecurity, including reduced crop yields and an increase in plant diseases; and mental health disorders, such as posttraumatic stress disorder and depression, that are associated with natural disasters. Substantial health and economic cobenefits could be associated with reductions in fossil fuel combustion. For example, greenhouse gas emission policies may yield net economic benefit, with health benefits from air quality improvements potentially offsetting the cost of US and international carbon policies.Conclusions and RelevanceEvidence over the past 20 years indicates that climate change can be associated with adverse health outcomes. Health care professionals have an important role in understanding and communicating the related potential health concerns and the cobenefits from policies to reduce greenhouse gas emissions.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Association Between Vancomycin Minimum Inhibitory Concentration and
           Mortality Among Patients With Staphylococcus aureus Bloodstream Infections
           A Systematic Review and Meta-analysis
    • Authors: Kalil AC; Van Schooneveld TC, Fey PD, et al.
      Abstract: ImportanceStaphylococcus aureus bacteremia (SAB) is a worldwide problem. It is unclear whether higher-vancomycin minimum inhibitory concentration (MIC) is associated with mortality. This potential association has direct consequences for patients and public health.Data SourcesPubMed, Embase, the Cochrane Library, Evidence-based Medicine BMJ, and the American College of Physicians Journal Club were searched from inception through April 2014.Study SelectionStudies reporting mortality and vancomycin MIC in patients with SAB were included.Data Extraction and SynthesisTwo authors performed the literature search and the study selection separately. Random-effects modeling was used for all analyses.Main Outcomes and MeasuresAll-cause mortality.FindingsAmong 38 included studies that involved 8291 episodes of SAB, overall mortality was 26.1%. The estimated mortality was 26.8% among SAB episodes (n = 2740) in patients with high-vancomycin MIC (≥1.5 mg/L) compared with 25.8% mortality among SAB episodes (n = 5551) in patients with low-vancomycin MIC (
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Association Between Skilled Nursing Facility Quality Indicators and
           Hospital Readmissions
    • Authors: Neuman MD; Wirtalla C, Werner RM.
      Abstract: ImportanceHospital readmissions are common, costly, and potentially preventable. Little is known about the association between available skilled nursing facility (SNF) performance measures and the risk of hospital readmission.ObjectiveTo measure the association between SNF performance measures and hospital readmissions among Medicare beneficiaries receiving postacute care at SNFs in the United States.Design and ParticipantsUsing national Medicare data on fee-for-service Medicare beneficiaries discharged to a SNF after an acute care hospitalization between September 1, 2009, and August 31, 2010, we examined the association between SNF performance on publicly available metrics (SNF staffing intensity, health deficiencies identified through site inspections, and the percentages of SNF patients with delirium, moderate to severe pain, and new or worsening pressure ulcers) and the risk of readmission or death 30 days after discharge to a SNF. Adjusted analyses controlled for patient case mix, SNF facility factors, and the discharging hospital.Main Outcomes and MeasuresReadmission to an acute care hospital or death within 30 days of the index hospital discharge.ResultsOf 1 530 824 patients discharged, 357 752 (23.3%; 99% CI, 23.3%-23.5%) were readmitted or died within 30 days; 72 472 died within 30 days (4.7%; 99% CI, 4.7%-4.8%), and 321 709 were readmitted (21.0%; 99% CI, 20.9%-21.1%). The unadjusted risk of readmission or death was lower at SNFs with better staffing ratings. SNFs ranked lowest (19.2% of all SNFs) had a 30-day risk of readmission or death of 25.5% (99% CI, 25.3%-25.8%) vs 19.8% (99% CI, 19.5%-20.1%) among those ranked highest. SNFs with better facility inspection ratings also had a lower risk of readmission or death. SNFs ranked lowest (20.1% of all SNFs) had a risk of 24.9% (99% CI, 24.7%-25.1%) vs 21.5% (99% CI, 21.2%-21.7%) among those ranked highest . Adjustment for patient factors, SNF facility factors, and the discharging hospital attenuated these associations; we observed small differences in the adjusted risk of readmission or death according to SNF facility inspection ratings (lowest vs highest rating: 23.7%; 99% CI: 23.7%, 23.7%; vs 23.0%; 99% CI: 23.0%, 23.1%). Other measures did not predict clinically meaningful differences in the adjusted risk of readmission or death.Conclusions and RelevanceAmong fee-for-service Medicare beneficiaries discharged to a SNF after an acute care hospitalization, available performance measures were not consistently associated with differences in the adjusted risk of readmission or death.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Association Between Hospital-Level Obstetric Quality Indicators and
           Maternal and Neonatal Morbidity
    • Authors: Howell EA; Zeitlin J, Hebert PL, et al.
      Abstract: ImportanceIn an effort to improve the quality of care, several obstetric-specific quality measures are now monitored and publicly reported. The extent to which these measures are associated with maternal and neonatal morbidity is not known.ObjectiveTo examine whether 2 Joint Commission obstetric quality indicators are associated with maternal and neonatal morbidity.Design, Setting, and ParticipantsPopulation-based observational study using linked New York City discharge and birth certificate data sets from 2010. All delivery hospitalizations were identified and 2 perinatal quality measures were calculated (elective, nonmedically indicated deliveries at 37 or more weeks of gestation and before 39 weeks of gestation; cesarean delivery performed in low-risk mothers). Published algorithms were used to identify severe maternal morbidity (delivery associated with a life-threatening complication or performance of a lifesaving procedure) and morbidity in term newborns without anomalies (births associated with complications such as birth trauma, hypoxia, and prolonged length of stay). Mixed-effects logistic regression models were used to examine the association between maternal morbidity, neonatal morbidity, and hospital-level quality measures while risk-adjusting for patient sociodemographic and clinical characteristics.Main Outcomes and MeasuresIndividual- and hospital-level maternal and neonatal morbidity.ResultsSevere maternal morbidity occurred among 2372 of 115 742 deliveries (2.4%), and neonatal morbidity occurred among 8057 of 103 416 term newborns without anomalies (7.8%). Rates for elective deliveries performed before 39 weeks of gestation ranged from 15.5 to 41.9 per 100 deliveries among 41 hospitals. There were 11.7 to 39.3 cesarean deliveries per 100 deliveries performed in low-risk mothers. Maternal morbidity ranged from 0.9 to 5.7 mothers with complications per 100 deliveries and neonatal morbidity from 3.1 to 21.3 neonates with complications per 100 births. The maternal quality indicators elective delivery before 39 weeks of gestation and cesarean delivery performed in low-risk mothers were not associated with severe maternal complications (risk ratio [RR], 1.00 [95% CI, 0.98-1.02] and RR, 0.99 [95% CI, 0.96-1.01], respectively) or neonatal morbidity (RR, 0.99 [95% CI, 0.97-1.01] and RR, 1.01 [95% CI, 0.99-1.03], respectively).Conclusions and RelevanceRates for the quality indicators elective delivery before 39 weeks of gestation and cesarean delivery performed in low-risk mothers varied widely in New York City hospitals, as did rates of maternal and neonatal complications. However, there were no correlations between the quality indicator rates and maternal and neonatal morbidity. Current quality indicators may not be sufficiently comprehensive for guiding quality improvement in obstetric care.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Effect of High-Dose Vitamin D 3 on Hospital Length of Stay in Critically
           Ill Patients With Vitamin D Deficiency The VITdAL-ICU Randomized Clinical
           Trial
    • Authors: Amrein K; Schnedl C, Holl A, et al.
      Abstract: ImportanceLow vitamin D status is linked to increased mortality and morbidity in patients who are critically ill. It is unknown if this association is causal.ObjectiveTo investigate whether a vitamin D3 treatment regimen intended to restore and maintain normal vitamin D status over 6 months is of health benefit for patients in ICUs.Design, Setting, and ParticipantsA randomized double-blind, placebo-controlled, single-center trial, conducted from May 2010 through September 2012 at 5 ICUs that included a medical and surgical population of 492 critically ill adult white patients with vitamin D deficiency (≤20 ng/mL) assigned to receive either vitamin D3 (n = 249) or a placebo (n = 243).InterventionsVitamin D3 or placebo was given orally or via nasogastric tube once at a dose of 540 000 IU followed by monthly maintenance doses of 90 000 IU for 5 months.Main Outcomes and MeasuresThe primary outcome was hospital length of stay. Secondary outcomes included, among others, length of ICU stay, the percentage of patients with 25-hydroxyvitamin D levels higher than 30 ng/mL at day 7, hospital mortality, and 6-month mortality. A predefined severe vitamin D deficiency (≤12 ng/mL) subgroup analysis was specified before data unblinding and analysis.ResultsA total of 475 patients were included in the final analysis (237 in the vitamin D3 group and 238 in the placebo group). The median (IQR) length of hospital stay was not significantly different between groups (20.1 days [IQR, 11.1-33.3] for vitamin D3 vs 19.3 days [IQR, 11.1-34.9] for placebo; P = .98). Hospital mortality and 6-month mortality were also not significantly different (hospital mortality: 28.3% [95% CI, 22.6%-34.5%] for vitamin D3 vs 35.3% [95% CI, 29.2%-41.7%] for placebo; hazard ratio [HR], 0.81 [95% CI, 0.58-1.11]; P = .18; 6-month mortality: 35.0% [95% CI, 29.0%-41.5%] for vitamin D3 vs 42.9% [95% CI, 36.5%-49.4%] for placebo; HR, 0.78 [95% CI, 0.58-1.04]; P = .09). For the severe vitamin D deficiency subgroup analysis (n = 200), length of hospital stay was not significantly different between the 2 study groups: 20.1 days (IQR, 12.9-39.1) for vitamin D3 vs 19.0 days (IQR, 11.6-33.8) for placebo. Hospital mortality was significantly lower with 28 deaths among 98 patients (28.6% [95% CI, 19.9%-38.6%]) for vitamin D3 compared with 47 deaths among 102 patients (46.1% [95% CI, 36.2%-56.2%]) for placebo (HR, 0.56 [95% CI, 0.35-0.90], P for interaction = .04), but not 6-month mortality (34.7% [95% CI, 25.4%-45.0%] for vitamin D3 vs 50.0% [95% CI, 39.9%-60.1%] for placebo; HR, 0.60 [95% CI, 0.39-0.93], P for interaction = .12).Conclusions and RelevanceAmong critically ill patients with vitamin D deficiency, administration of high-dose vitamin D3 compared with placebo did not reduce hospital length of stay, hospital mortality, or 6-month mortality. Lower hospital mortality was observed in the severe vitamin D deficiency subgroup, but this finding should be considered hypothesis generating and requires further study.Trial Registrationclinicaltrials.gov Identifier: NCT01130181
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Ash Wednesday
    • Authors: Adrian C.
      Abstract: This past April, I was asked by my hospital’s Pastoral Care Department to help out with their Ash Wednesday services. Ash Wednesday is the busiest day of the year for pastoral care, a sort of spiritual Black Friday, and the office phone started ringing at 6 am, nurses and supervisors calling in states of high anxiety to make sure that the ashes were coming for the patients or employees under their care. That’s when it’s all hands on deck, getting feet and thumbs attached to those little pots of palm ashes and sending them out into the wards and waiting rooms and cafeterias. As one of the six chaplain-interns that year, I was one of about two dozen people in the department who might have distributed the ashes—it’s not actually required that one be ordained to do this.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • What Makes a Good Quality Measure'
    • Authors: McGlynn EA; Adams JL.
      Abstract: In this issue of JAMA, reports on the relationship between clinical outcomes and quality measures by Neuman and colleagues and Howell and colleagues facilitate reflection on the attributes of good quality measures. These studies raise issues that are familiar to experts in quality measurement but may not be understood by physicians and others whose performance is being assessed. Although the reports present information on a variety of types of measures, this Editorial focuses on the clinical quality measures.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Climate Change A Continuing Threat to the Health of the World’s
           Population
    • Authors: Bauchner H; Fontanarosa PB.
      Abstract: Poverty and war are among the two greatest threats to health and well-being. In virtually every study, poverty emerges as a major risk factor for most diseases. The tragedies of 9/11 and the current conflicts in the Middle East are painful reminders of the human toll and societal cost of war. Yet poverty and war are seldom addressed by most national and international medical organizations. They have generally focused on the advancement of science, public and individual health, access to care, and more recently the importance of noncommunicable diseases.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • The Historic Role of Boards of Health in Local Innovation New York
           City’s Soda Portion Case
    • Authors: Gostin LO; Reeve BH, Ashe M.
      Abstract: This Viewpoint discusses the role that boards of health have had throughout history in relation to the soda portion rule in New York City.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • The PCORI Perspective on Patient-Centered Outcomes Research
    • Authors: Frank L; Basch E, Selby JV, et al.
      Abstract: This Viewpoint discusses the meaning of patient-centeredness in research and reasons for conducting patient-centered outcomes research.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Use of Clinical Preventive Services in Infants, Children, and Adolescents
    • Authors: Boyle CA; Perrin JM, Moyer VA.
      Abstract: This Viewpoint discusses clinical preventive services in children and adolescents and provides important insights into screening practices in the United States
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Highlights
    • PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
  • Relieving Pain in America Insights From an Institute of Medicine Committee
    • Authors: Dzau VJ; Pizzo PA.
      Abstract: This Viewpoint discusses how the Institute of Medicine stands behind the estimate that 100 million Americans have chronic pain and the committee’s recommendation that better data are needed to create the cultural transformation required to reduce the effects of pain in America.
      PubDate: Wed, 15 Oct 2014 00:00:00 GMT
       
 
 
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