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Journal Cover JAMA The Journal of the American Medical Association
  [SJR: 6.44]   [H-I: 549]   [1462 followers]  Follow
   Full-text available via subscription Subscription journal
   ISSN (Print) 0098-7484 - ISSN (Online) 1538-3598
   Published by American Medical Association Homepage  [13 journals]
  • Highlights for July 11, 2017
    • PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Reducing Excessive Use of Antipsychotics in Nursing Homes
    • Authors: Gurwitz JH; Bonner A, Berwick DM.
      Abstract: This Viewpoint describes the structure and outcomes of a national initiative of the Centers for Medicare & Medicaid Services to reduce the use of antipsychotics in nursing homes.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Antiplatelet Therapy, Coronary Stents, and Elective Noncardiac Surgery
    • Authors: Childers CP; Maggard-Gibbons M, Shekelle PG.
      Abstract: This Viewpoint discusses the management of antiplatelet therapy in patients with coronary stents undergoing elective noncardiac surgery.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Social Mission in Health Professions Education
    • Authors: Mullan F.
      Abstract: This Viewpoint urges all medical and health professional training programs to make social mission a central curricular focus to help evenly distribute health care and to eliminate health disparities among patients who have little means and access to health care.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Stories Doctors Tell
    • Authors: Moniz T; Lingard L, Watling C.
      Abstract: In special sections such as this one (A Piece of My Mind), leading medical journals publish physicians’ narrative anecdotes. These narratives offer a unique window onto the practice of medicine, and, in a context of current concerns about physician wellness and rising rates of burnout, they may constitute an untapped resource for understanding how physicians perceive their personal and professional challenges. Using a narrative inquiry approach, we explored the stories that physicians spontaneously chose to tell about the practice of medicine in narrative sections of medical journals, focusing on the lessons conveyed, the narrative strategies used to convey them, and the relationships between the two.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Lessons From the VAST-D Study
    • Authors: Fava M.
      Abstract: In this issue of JAMA, Mohamed and colleagues report the outcome of an important multicenter clinical trial, the Veterans Affairs Augmentation and Switching Treatments for Improving Depression Outcomes (VAST-D) Study. The study, conducted with scientific rigor and sophisticated clinical trial methodology, compared the relative effectiveness and safety of 3 commonly used treatment options for 1522 patients with major depressive disorder (MDD) with inadequate response to antidepressant therapy: switching to a different antidepressant, which was bupropion in this study (n = 511); augmenting current treatment with bupropion (n = 506); or augmenting current treatment with an atypical antipsychotic drug, which was aripiprazole in this study (n = 505). The primary outcome was remission of depression (defined as a 16-item Quick Inventory of Depressive Symptomatology-Clinician Rated [QIDS-C16] questionnaire score of ≤5 at 2 consecutive visits) after 12 weeks of acute treatment. Additional outcomes included response (≥50% reduction in QIDS-C16 score or improvement on the Clinical Global Impression [CGI] Global Improvement scale), as well as relapse, and adverse effects. Patients who achieved remission at 12 weeks (n = 396) were followed for relapse for up to 36 weeks after randomization.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Does Obstructive Sleep Apnea Treatment Reduce Cardiovascular Risk' It
           Is Far Too Soon to Say
    • Authors: Gottlieb DJ.
      Abstract: The association of obstructive sleep apnea (OSA) with vascular disease and mortality was reported in clinical case series almost 3 decades ago and has since been confirmed in numerous prospective observational studies involving both sleep clinic patients and community-based cohorts. Physiological studies in animals and humans have suggested likely mechanisms whereby the intermittent hypercapnic hypoxemia and recurrent arousal from sleep that characterize OSA might cause vascular disease. The most strongly implicated mechanism is increased sympathetic nervous system activity, with considerable evidence as well for impaired glucose homeostasis, vascular inflammation, and oxidative stress. Numerous single-site and multicenter studies have demonstrated modest but clinically significant reductions in blood pressure with OSA treatment, an effect that is substantial during sleep. This effect alone would be expected to result in a reduction in risk of myocardial infarction and stroke. Clinical cohort studies comparing patients with OSA treated with positive airway pressure (PAP) with untreated patients with OSA have consistently demonstrated lower rates of death, myocardial infarction, and stroke among the treated patients. However, such observational studies carry a substantial risk of bias due to a “healthy adherer” effect, and randomized clinical trials (RCTs) are therefore necessary to demonstrate whether treatment of OSA does reduce cardiovascular risk.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Cardiovascular Risk Factor Control for All
    • Authors: Greenland P; Fuster V.
      Abstract: Identification and control of cardiovascular disease (CVD) risk factors are critical components in the prevention of CVD. Advantages of control of risk factors have been documented in numerous studies and have contributed substantially to national and global health policies for prevention of chronic disease. For example, Stamler et al studied 5 cohorts of young adult and middle-aged men, as well as middle-aged women, from the Chicago Heart Association Detection Project in Industry and screenees from the Multiple Risk Factor Intervention Trial. “Healthy factors” were defined as normal levels of major CVD risk factors (serum total cholesterol level less than or equal to 200 mg/dL; blood pressure less than or equal to 120/80 mm Hg; no diabetes; and no current smoking). Over 16 to 22 years of follow-up, Stamler et al observed 70% to 85% lower cardiovascular mortality, 40% to 60% lower total mortality, and 6 to 9 years’ greater predicted life expectancy among individuals having all of these healthy factors compared with those who had 1 or more elevated risk factors. Similar results were found among younger women (
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Effects of Antidepressant Switching vs Augmentation on Depression
    • Authors: Mohamed S; Johnson GR, Chen P, et al.
      Abstract: This randomized clinical trial compares the effects on symptom remission of switching to bupropion, adding bupropion, or adding aripiprazole to baseline treatment among Veterans Affairs patients with antidepressant-resistant major depressive disorder.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Alendronate and Hip Fracture in Older Patients Using Oral Prednisolone
    • Authors: Axelsson KF; Nilsson AG, Wedel H, et al.
      Abstract: This Swedish cohort study investigates whether treatment with alendronate is associated with reduced risk of hip fracture among older patients using oral glucocorticoids.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Positive Airway Pressure, Cardiovascular Events, and Death in Sleep Apnea
    • Authors: Yu J; Zhou Z, McEvoy R, et al.
      Abstract: This systematic review analyzes 10 randomized clinical trials comparing the effects of positive airway pressure (PAP) vs sham PAP in reducing cardiovascular outcomes or death among patients with sleep apnea.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • USPSTF Recommendation: Behavioral Counseling for CVD Prevention
    • Authors: ; Grossman DC, Bibbins-Domingo K, et al.
      Abstract: This Recommendation Statement from the US Preventive Services Task Force recommends that primary care professionals individualize the decision to refer adults without obesity and cardiovascular risk factors to behavioral counseling to promote healthful diet and physical activity (C recommendation).
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Behavioral Counseling for Cardiovascular Disease Prevention
    • Authors: Patnode CD; Evans CV, Senger CA, et al.
      Abstract: This Evidence Report and systematic review to support a 2017 US Preventive Services Task Force Recommendation Statement summarizes current evidence on benefits and harms of behavioral counseling for primary prevention of cardiovascular disease (CVD) in adults without known CVD risk factors.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Balancing Ischemic and Bleeding Risks of Dual Antiplatelet Therapy
    • Authors: Levine GN.
      Abstract: This commentary discusses a study published in JAMA Cardiology that assessed the prognosis of cardiovascular and bleeding events associated with dual antiplatelet therapy continued beyond a year after coronary stenting.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Overall Survival for Patient-Reported Symptom Monitoring in Routine Cancer
    • Authors: Basch E; Deal AM, Dueck AC, et al.
      Abstract: This study assesses overall survival associated with electronic patient-reported symptom monitoring vs usual care during routine cancer treatment.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Vaginal Fetal Fibronectin to Predict Spontaneous Preterm Birth
    • Authors: Evantash E.
      Abstract: To the Editor Dr Esplin and colleagues assessed the accuracy of vaginal fetal fibronectin testing and cervical length for predicting spontaneous preterm birth in asymptomatic nulliparous women. However, the manner in which fetal fibronectin testing was performed in the study raises concerns about the authors’ conclusion that fetal fibronectin does not reliably predict spontaneous preterm birth in this population. On the contrary, when used as directed, the weight of evidence supports the use of fetal fibronectin testing both in women at risk of spontaneous preterm birth and in those who are asymptomatic.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Vaginal Fetal Fibronectin to Predict Spontaneous Preterm Birth—Reply
    • Authors: Esplin M; Elovitz M, Iams J.
      Abstract: In Reply We believe that the evidence supporting the use of fetal fibronectin to screen for the risk of preterm birth in low-risk, asymptomatic women, such as those enrolled in our study, is far from conclusive. Our results indicating a low sensitivity and positive predictive value for fetal fibronectin for the prediction of preterm birth at less than 37 weeks’ gestation are consistent with those from other studies using the same primary outcome in low-risk women. Jwala et al evaluated asymptomatic, low-risk women at 18 to 24 weeks’ gestation using a threshold of 5 ng/mL or more of fetal fibronectin and found a sensitivity of 58% and a positive predictive value of 8.75% for predicting preterm birth at less than 37 weeks. Heath et al evaluated a cohort of similar women at 23 weeks’ gestation using a threshold of greater than 50 ng/mL and found a sensitivity of 32.6% and a positive predictive value of 8.1% for the prediction of preterm birth at less than 33 weeks. We evaluated 10 000 asymptomatic, low-risk women at multiple time points (6-14 weeks, 16-22 weeks, and 22-30 weeks) using multiple thresholds (≥10 ng/mL, ≥50 ng/mL, and ≥200 ng/mL) and found sensitivities ranging from 2.9% to 34.5% and positive predictive values ranging from 6.4% to 14.0% for the prediction of preterm birth at less than 37 weeks. Our results are consistent with those from 2 other large cohorts of similar low-risk women, which suggests that our methods and conclusions regarding the clinical utility of fetal fibronectin are valid.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Hemoglobin A 1c as a Surrogate for Clinical Outcomes in Diabetes Studies
    • Authors: Venker BT.
      Abstract: To the Editor In a Viewpoint article, Drs Lipska and Krumholz discussed the role of hemoglobin A1c (HbA1c) and how its incorporation into clinical guidelines and clinical trials is evolving. There is growing evidence that using glycemic control as a surrogate for preventing adverse outcomes related to diabetes may be inappropriate. As Lipska and Krumholz pointed out, 2 studies with empagliflozin (EMPA-REG OUTCOME) and liraglutide (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results [LEADER]) compared with placebo found a decrease in cardiovascular events and mortality. However, although the level of glucose control at the end of the studies was similar, control was not equal throughout the trials and representing it as such is somewhat inaccurate.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Hemoglobin A 1c as a Surrogate for Clinical Outcomes in Diabetes
    • Authors: Lipska KJ; Krumholz HM.
      Abstract: In Reply We agree with Dr Venker that HbA1c levels were not the same in the placebo and active treatment groups of the EMPA-REG OUTCOME and LEADER trials and appreciate his careful analysis of HbA1c levels over time. However, we still characterize these differences in HbA1c levels as “small.”
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Posing Causal Questions When Analyzing Observational Data
    • Authors: Bhupathiraju SN; Stampfer MJ, Manson JE.
      Abstract: To the Editor In their Editorial on evaluating data from observational research, Dr Goodman and colleagues mischaracterized the reasons for the apparent difference between the results of the Nurses’ Health Study (NHS) and the Women’s Health Initiative Trial (WHI) of hormone therapy (HT). The main reason for the difference was that in the observational studies, including the NHS, nearly all HT use began in early menopause (within a few years of onset), and most was estrogen alone, without progestin. Because coronary disease is uncommon in early menopause, the WHI targeted an older age group (mean age, 63 years [range, 50-79 years]) to increase statistical power. This created a deviation from the “like vs like” principle enunciated by Goodman and colleagues.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Posing Causal Questions When Analyzing Observational Data—Reply
    • Authors: Goodman SN; Schneeweiss S.
      Abstract: In Reply We agree with Dr Bhupathiraju and colleagues that debates over analytic approach are often surrogates for debating which scientific questions are of greatest interest. That said, they take issue with a sentence in our Editorial that characterized the difference between the original NHS analyses and the 2008 reanalysis as due to a design bias rather than a difference in causal question. They question whether the differences observed might be due to effects of age and estrogen type rather than the distinctions we drew between analyses of new users vs current users.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Starch-Based “Super Food” May Protect Against Variety of
    • Authors: Rubin R.
      Abstract: This Medical News article discusses research exploring the clinical potential of a chemically modified dietary starch to protect against type 1 diabetes and other diseases.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Rethinking Rural Hospitals
    • Authors: Mason DJ.
      Abstract: I spend a lot of time in the northern Catskill Mountains of New York. I’m fortunate that my local hospital, Margaretville Hospital, is in the top 100 “critical access hospitals” ranked by the National Rural Health Association, even though it has only 15 beds and all were empty a few months ago. It has an emergency department, a helicopter transport system that enables access to its affiliates in the Health Alliance system, telehealth services, and outpatient physical therapy.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Robert Califf, MD, Joins Verily
    • Authors: Abbasi J.
      Abstract: Robert Califf, MD, most recently head of the US Food and Drug Administration, is joining Verily Life Sciences in an advisory role and will sit on the company’s scientific board. The news came just days after Verily announced the departure of former National Institute of Mental Health chief Thomas Insel, MD, from its team.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Gene Therapy for Vision Loss
    • Authors: Abbasi J.
      Abstract: Spark Therapeutics is poised to bring the first gene therapy for an inherited disorder to market in the United States. In May, the company completed its rolling biologics license application submission to the US Food and Drug Administration (FDA) for voretigene neparvovec, a gene therapy for RPE65-mediated inherited retinal disease, a rare retinal dystrophy that causes blindness.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Total-Body PET In Development
    • Authors: Abbasi J.
      Abstract: Positron emission tomography (PET) imaging could get a major upgrade with completion of the first research prototype total-body PET (TB-PET) scanner anticipated for fall of 2018.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Conception Without HIV Transmission
    • Abstract: Several viable, low-risk options to conceive a child are available to HIV-discordant couples in which the man is infected but the woman is not.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Toxic Mushrooms in California
    • Authors: Voelker R.
      Abstract: Heavy rainfall that quenched California’s historic drought helped to usher in another health threat: a bounty of “death cap” mushrooms that sickened more than a dozen people, including an 18-month-old girl who sustained permanent neurological damage after developing irreversible liver failure and undergoing a liver transplant.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Ventricles
    • Authors: Mampalam T.
      Abstract: The paired lateral ventricles are archedcavities filled with crystal clear fluid.In cross section, they look like butterfly wingsheld open at the center of the brain.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Relative Values of Public Health Procedures
    • Abstract: What constitute the most effective lines of effort is the most vital question confronting every public health administrator. Money is the measure of most effort, and appropriations are limited. In what way shall the appropriation for the health department be expended so as to save the most lives and prevent the most sickness' Are our municipal health departments making the best apportionment of their funds' Are health officials devoting the most effort to that which will best conserve the health of the people' If any city is doing this, it has a model health department.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • Counseling on Healthy Living to Prevent Cardiovascular Disease in Adults
           Without Risk Factors
    • Authors: Jin J.
      PubDate: Tue, 11 Jul 2017 00:00:00 GMT
  • JAMA
    • PubDate: Tue, 11 Jul 2017 00:00:00 GMT
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