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Journal Cover JAMA The Journal of the American Medical Association
  [SJR: 6.44]   [H-I: 549]   [1595 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 November 14, 2017
    • PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • The Las Vegas Shootings and Key Challenges in the US Firearm Epidemic
    • Authors: Shultz JM; Thoresen S, Galea S.
      Abstract: This Viewpoint uses the October 2017 mass shooting in Las Vegas to discuss public health imperatives in the US firearm violence epidemic, including long-term treatment of nonfatally injured survivors, management of mental health sequelae for noninjured participants and their communities, and effective responses to commercial stakeholders who benefit from firearm sales at the expense of the public’s health.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • FDA’s Plan to Address the Enormous Toll of Smoking
    • Authors: Warner KE; Schroeder SA.
      Abstract: This Viewpoint discusses a new FDA regulatory plan to reduce the burden of smoking-related disease by requiring reduction of nicotine in combustible tobacco products beneath addicting levels and by encouraging innovations in novel reduced-risk nicotine products.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • The Role of Biomedical Research in Pandemic Preparedness
    • Authors: Marston HD; Paules CI, Fauci AS.
      Abstract: In this Viewpoint, Anthony Fauci and colleagues review rapid research responses to recent infectious disease outbreaks as a way of emphasizing the strategies and collaborations necessary to prepare for a next unknown pandemic.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Global Budgets for Safety-Net Hospitals
    • Authors: Sharfstein JM; Gerovich S, Chin D.
      Abstract: This Viewpoint discusses steps necessary to develop an all-payer hospital global budgeting system as one means to incentivize health systems to emphasize preventive care that reduces health service utilization and costs.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • The Greatest Gift
    • Authors: Kaplan LI.
      Abstract: The package was in plain brown paper wrapping. The note enclosed read, “Thanks for everything you did for my father. It meant more than you can ever imagine.” I teared up, remembering the day I helped the father of a colleague die peacefully. When I opened the wrapping and saw the picture of two saplings planted side by side and a certificate saying that the family planted one in my honor next to the one in their father’s, the single tear turned to a river. Although I never thought that a patient’s death would be one of the best clinical experiences of my then young career, that day increased my love for practicing medicine significantly.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Death by Gun Violence—A Public Health Crisis
    • Authors: Bauchner H; Rivara FP, Bonow RO, et al.
      Abstract: The shooting in Las Vegas, Nevada, that left 59 people dead, 10 times that number wounded, and thousands of people with the psychological distress from being present at the scene during and after the massacre has once again raised the issue of what we as a nation can and should do about guns. The solution lies in not just focusing on Las Vegas and the hundreds of other mass shootings that have occurred in the United States in the last 14 months, but rather to underscore that on average almost 100 people die each day in the United States from gun violence. The 36 252 deaths from firearms in the United States in 2015 exceeded the number of deaths from motor vehicle traffic crashes that year (36 161). That same year, the US Centers for Disease Control and Prevention reported that 5 people died from terrorism. Since 1968, more individuals in the United States have died from gun violence than in battle during all the wars the country has fought since its inception.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Prepregnancy Obesity and Severe Maternal Morbidity
    • Authors: Caughey AB.
      Abstract: There is an obesity pandemic in the United States. In 1991, approximately 12% of the US population was obese, and no single state had an obesity rate greater than 15%. In 2014, the obesity rate was 38%, and no single state had an obesity rate less than 20%. Assuming that the prevalence of obesity was nearly zero for much of human history, it took thousands of years to reach an obesity prevalence of about 15%, but then just 25 years to more than double that rate. This pandemic is not only in the United States. Obesity rates have increased across most developed countries. Canada, for example, has had a similar increase in obesity, with prevalence reaching 24% among reproductive-aged women in 2012. Even in low-and middle-income countries, obesity rates are increasing. Health care costs associated with obesity are substantial. According to a 2013 report, obesity was estimated to add $600 per year in health care costs for a 20-year-old and $3800 per year in health care costs for a 70-year-old. According to these estimates, it is conceivable that health care costs associated with obesity could be more than $300 billion per year in the United States.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Locking Plate vs Intramedullary Nail Fixation and Disability in Tibia
           Fracture
    • Authors: Costa ML; Achten J, Griffin J, et al.
      Abstract: This randomized clinical trial compares the effects of locking plate vs intramedullary nail fixation on disability, symptoms, and quality of life among patients with an acute displaced extra-articular distal tibia fracture.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Prepregnancy Body Mass Index and Severe Maternal Morbidity
    • Authors: Lisonkova S; Muraca GM, Potts J, et al.
      Abstract: This population-based epidemiology study uses Washington State birth and hospitalization data to assess the association between prepregnancy body mass index and severe morbidity or mortality during pregnancy.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Predicting Risk of Advanced Chronic Kidney Disease After Acute Kidney
           Injury
    • Authors: James MT; Pannu N, Hemmelgarn BR, et al.
      Abstract: This study uses data from Canadian administrative and clinical ambulatory databases to derive and validate risk prediction models for advanced chronic kidney disease in patients hosptialized with acute kidney injury.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Effect of Epicutaneous Immunotherapy vs Placebo on Peanut Protein
           Sensitivity
    • Authors: Sampson HA; Shreffler WG, Yang WH, et al.
      Abstract: This phase 2b randomized trial compares adverse events and efficacy of 3 doses of a peanut protein patch for the treatment of peanut sensitivity in patients aged 6 to 55 years.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Does This Patient Have Acute Mountain Sickness'
    • Authors: Meier D; Collet T, Locatelli I, et al.
      Abstract: This Rational Clinical Examination systematic review summarizes the accuracy of available scoring instruments for diagnosing acute mountain sickness.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • The Use of Composite Outcome Measures in Randomized Trials
    • Authors: Irony TZ.
      Abstract: This JAMA Guide to Statistics and Methods reviews the use of composite outcome measures in clinical trials and discusses how their use should influence interpretations of trial results.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Erythematous Rash Following Hematopoietic Stem Cell Transplantation
    • Authors: Shi CR; Plovanich M, Burgin S.
      Abstract: A 66-year-old man developed noninfectious fever and rash after autologous HSCT. Chest computed tomography showed ground-glass and consolidative lung opacities; skin punch biopsy showed vacuolar change and superficial perivascular mononuclear cell infiltrate. What would you do next'
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Change in Testing, Result Awareness, and Control of HbA 1c in US Adults,
           2007-2014
    • Authors: Shahraz S; Pittas AG, Saadati M, et al.
      Abstract: This cross-sectional study uses NHANES survey data to examine trends in glycemic control and patient awareness of HbA1c test results and targets between 2007 and 2014.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Insulin Analogues, Hypoglycemia, and Type 1 Diabetes
    • Authors: Zulewski H; Keller U.
      Abstract: To the Editor The SWITCH 1 randomized clinical trial compared the effect of 2 insulin analogues, insulin degludec vs insulin glargine, on the frequency of hypoglycemic events in patients with type 1 diabetes and risk factors for hypoglycemia. According to the study protocol, the insulin dose was titrated to reach fasting glucose values between 71 mg/dL and 90 mg/dL (3.9-5.0 mmol/L). Such low target values increase the risk of severe hypoglycemia. The American Diabetes Association and National Institute for Health and Care Excellence in the United Kingdom recommend fasting glucose values that range from 90 mg/dL to 130 mg/dL. Also, professional diabetes organizations suggest less-stringent hemoglobin A1c (HbA1c) targets and, thus, higher target glucose values for patients at risk of severe hypoglycemia to prevent this complication.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Insulin Analogues, Hypoglycemia, and Type 1 Diabetes
    • Authors: Lane W; Bailey TS, Gerety G.
      Abstract: In Reply The SWITCH 1 trial was the first trial, to our knowledge, to investigate hypoglycemia as a primary outcome in patients with type 1 diabetes, comparing insulin degludec with insulin glargine. Personalizing fasting blood glucose targets for patients remains important in clinical practice. However, in the trial, identical fasting blood glucose target goals and noninferior HbA1c values were imperative for analysis of the primary outcome of hypoglycemia. The protocol included algorithms for up- or down-titration of the insulin dose to achieve target fasting blood glucose levels of 71 mg/dL to 90 mg/dL; titration was conducted at the investigator’s discretion, so at no time was patient safety compromised. Targeting a higher fasting blood glucose would not facilitate achieving HbA1c values of less than 7%, as recommended by the American Diabetes Association or less than 6.5%, as recommended by the American Association of Clinical Endocrinologists. Achieving a fasting blood glucose target of less than 110 mg/dL and a HbA1c target less than 7% proved difficult in past treat-to-target trials using older insulins, and earlier landmark studies showed that intensive treatment aimed at reducing microvascular and macrovascular complications increased hypoglycemia risk. Aiming for higher blood glucose targets in the management of type 1 diabetes implies a conservative approach to avoid hypoglycemia, in part reflecting a past era of older insulins, which were shorter acting and with more variable and less-predictable time-action profiles than newer basal insulin analogues.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Antipsychotic Drug Prescribing in Nursing Homes
    • Authors: Gillick MR.
      Abstract: To the Editor In their Viewpoint, Dr Gurwitz and colleagues drew attention to the recent success in addressing the overuse of antipsychotic medication in nursing homes. They attributed the decline in prescribing for atypical antipsychotics—drugs that have long been widely prescribed for the treatment of the behavioral symptoms of dementia despite the absence of evidence that they are effective for this indication and despite the US Food and Drug Administration (FDA) black box warning against their use—to the National Partnership to Improve Dementia Care in Nursing Homes, initiated by the Centers for Medicare & Medicaid Services (CMS). But there is another part of the story that deserves mention.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Antipsychotic Drug Prescribing in Nursing Homes
    • Authors: Westbury JL.
      Abstract: To the Editor The claim in the Viewpoint by Dr Gurwitz and colleagues that the CMS National Partnership to Improve Dementia Care in Nursing Homes has led to a 33% relative reduction in the prevalence of antipsychotic use among long-term nursing home residents over the past 5 years is not strictly correct and requires qualification.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Antipsychotic Drug Prescribing in Nursing Homes—Reply
    • Authors: Gurwitz JH; Bonner A, Berwick DM.
      Abstract: In Reply We did not claim in our Viewpoint, nor do we believe, that the National Partnership to Improve Dementia Care in Nursing Homes has been the sole cause of the decline in antipsychotic use observed among nursing home residents over the past 5 years. What we did claim is that the evidence suggests that it played a significant role, and that, without it, progress would have been slower and less steady. In their letters, Dr Gillick and Dr Westbury raise some important contextual issues relevant to the findings reported in our Viewpoint. Gillick describes the marketing efforts of pharmaceutical manufacturers to promote non–FDA-approved (off-label) use of atypical antipsychotics and the large financial settlements that have been paid to federal and state governments for engaging in off-label promotion. Pharmaceutical marketing activities in nursing homes were quite common prior to the launch of the National Partnership to Improve Dementia Care in Nursing Homes. In the 2011 report of the Office of Inspector General, “Medicare Atypical Drug Claims for Elderly Nursing Home Residents,” the aggressive marketing efforts of the pharmaceutical industry were highlighted. However, although it is possible that large financial settlements against manufacturers and the cessation of illegal marketing practices contributed to reductions in off-label antipsychotic prescribing, evidence supporting this specific association is not available.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Personal Sound Amplification Products for Hearing Loss
    • Authors: Casale M; Sabatino L, Salvinelli F.
      Abstract: To the Editor Dr Reed and colleagues compared personal sound amplification products (PSAPs) with a conventional hearing aid for speech understanding in noise in patients affected by mild to moderate hearing loss. In an audiologist’s practice, the hearing aid gain is largely influenced by hearing loss type (transmissive, sensorineural, or mixed) or the area of abnormality in the auditory system (middle ear, inner ear, or brain), but these were not specified in the Research Letter.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Personal Sound Amplification Products for Hearing Loss—Reply
    • Authors: Reed NS; Lin FR.
      Abstract: In Reply In our study, the type of hearing loss was limited to sensorineural hearing loss, which is commonly associated with the age-related hearing loss that an over-the-counter option (ie, PSAPs) would target. In addition, our study used real-ear measures, considered an aspect of best-practice clinical hearing aid fitting, to address the customization in each individual ear. We did not include loudness discomfort level. Although loudness discomfort levels have been previously reported as a common aspect of hearing aid fitting, the most recent review revealed low and limited scientific evidence of their effectiveness in hearing aid fitting.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Incorrect Statistical Measures and Typographical Errors
    • Abstract: In the Original Investigation article entitled “Effect of Routine Low-Dose Oxygen Supplementation on Death and Disability in Adults With Acute Stroke: The Stroke Oxygen Study Randomized Clinical Trial” published in the September 26, 2017, issue of JAMA, incorrect data were reported. In Table 1, the SI conversion factor should have read “To convert glucose to mmol/L, multiply values by 0.0555.” In Table 2, some values, reported as 99% CIs were actually 95% CIs. The correct 99% CIs for the Barthel ADL index should be 70.2 (68.2 to 72.2) in the continuous oxygen group, 71.1 (69.1 to 73.1) in the nocturnal oxygen group, and 70.9 (68.9 to 72.8) in the control group; for the Nottingham Extended ADL, 9.66 (9.29 to 10.02) in the continuous oxygen group, 9.54 (9.17 to 9.90) in the nocturnal oxygen group, and 9.77 (9.40 to 10.14) in the control group; for VAS for quality of life, 55.4 (53.8 to 57.1) in the continuous oxygen group, 55.7 (54.1 to 57.3) in the nocturnal oxygen group, and 55.5 (53.8 to 57.1) in the control group; for highest systolic BP within 72 hours, −1.96 (−3.48 to −0.44) in comparison 1; for highest diastolic BP within 72 hours, −1.10 (−2.06 to −0.15) in comparison 1; for highest temperature within 7 days, 0.01 (−0.03 to 0.04) in comparison 1; and for serious adverse events, 0.94 (0.78 to 1.13) in comparison 1 and 1.19 (0.96 to 1.47) in comparison 2. In Figure 3, there were 4703 patients in the continuous or nocturnal oxygen group who did not have congestive heart failure, and for patients in the continuous or nocturnal oxygen group on whom thrombolysis was performed vs not, the P value test for interaction was .40. Changes to these reported statistical measures do not affect the conclusions of this study. This article was corrected online.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Error in Flow Diagram
    • Abstract: In the Original Investigation entitled “Effect of Post–Cesarean Delivery Oral Cephalexin and Metronidazole on Surgical Site Infection Among Obese Women: A Randomized Clinical Trial” published in the September 19, 2017, issue of JAMA, an error occurred in the Figure. In the placebo group, the figure should have stated that 198 received placebo as randomized and 3 did not receive placebo as randomized (withdrew prior to placebo administration). This article was corrected online.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Phage Therapy for Antibiotic-Resistant Superbugs
    • Authors: Lyon J.
      Abstract: The following Medical News story describes how bacteriophage therapy might help fight antibiotic resistant infections.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • The High Costs of Unnecessary Care
    • Authors: Carroll AE.
      Abstract: In a recent study published in PLOS One, researchers surveyed physicians across the United States to ask about their perspectives on unnecessary medical care. These physicians reported that more than 20% of overall medical care was not needed. This included about a quarter of tests, more than a fifth of prescriptions, and more than a 10th of procedures.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Functional Brain Imaging Updates
    • Authors: Abbasi J.
      Abstract: Two teams of researchers are poised to bring new functional brain imaging technologies to the clinic.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Sound Waves Isolate Exosomes
    • Authors: Abbasi J.
      Abstract: Engineers at Duke University have developed a microfluidic chip that uses sound waves to separate exosomes from undiluted whole blood samples. The method is faster and could preserve more information than differential centrifugation, the standard technology for isolating the particles.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Lead Poisoning From ‘Healing Bracelet’
    • Authors: Rubin R.
      Abstract: Lead poisoning of a 9-month-old baby girl in Manchester, Connecticut, last fall has been traced back to an unexpected source—a metal bracelet. Routine screening revealed that the baby had normocytic anemia and a blood lead level of 41 μg/dL—8 times the normal limit.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Stroke Death Rate Plateaus
    • Authors: Rubin R.
      Abstract: The steady, nearly half-century decline in the US death rate from stroke appears to have stopped in the last few years, according to a recent report.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Artistic Representation of Narratives of Congenital Heart Disease
    • Authors: Biglino G; Layton S, Wray J.
      Abstract: This Arts and Medicine essay discusses Heart Narratives, an art installation in the Great Ormond Street Hospital and Institute of Child Health in London that visualizes the illness narratives of children with congenital heart disease.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • When
    • Authors: Halberstadt C.
      Abstract: When I am no moreI will not knowthat I have ceased to be.There will be nothingnessas if I’d never beenexcept as momentary memories.The stone that will be named for mewill fade—the soul who lived as mewill be forever gone.I carry many souls in metogether with all beings who have ever been.Perhaps these remnant souls who come and goare what is gathered as eternity.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • The Method of Experiment in Medicine
    • Abstract: “In a country rich in gold, observant wayfarers may find nuggets on their path; but only systematic mining can provide the currency of nations. In the search for natural knowledge, the experimentalists are the miners.” There is a peculiar appropriateness in these words of Gowland Hopkins of Cambridge University at a time when men’s minds are diverted by the great emergencies of war and are upset by the distorted values of every-day life. Nowadays it would require a foolhardy person to maintain that “there is nothing new under the sun,” or to prophesy what cannot be done. The progressive evolution of science is expressed in the arts exemplified daily before us. We marvel at the newest phase of the conquest of the upper air or the ocean depths, at the irresistible force of the newest explosive or the perfection of the latest motor, all too often oblivious of the great strides that experimentation in medicine has brought about.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • Acute Mountain Sickness
    • Authors: Jin J.
      Abstract: This JAMA Patient Page explains the symptoms, diagnosis, treatment, and prevention of acute mountain sickness.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
  • JAMA
    • PubDate: Tue, 14 Nov 2017 00:00:00 GMT
       
 
 
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