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Journal Cover JAMA The Journal of the American Medical Association
  [SJR: 6.44]   [H-I: 549]   [1129 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]
  • JAMA
    • PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Types of Pancreatic Cysts
    • Authors: Nassour I; Choti MA.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Infant Allergenic Food Introduction and Risk of Allergic/Autoimmune
           Disease
    • Authors: Ierodiakonou D; Garcia-Larsen V, Logan A, et al.
      Abstract: This meta-analysis summarizes evidence about associations between timing of allergenic food introduction during infancy and risk of allergic or autoimmune disease.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Review of Antimicrobial Resistance
    • Authors: Marston HD; Dixon DM, Knisely JM, et al.
      Abstract: In this Special Communication, Anthony Fauci and colleagues review ecological factors contributing to, mechanisms of, and novel strategies to manage antimicrobial resistance.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Pragmatic Trials
    • Authors: Sox HC; Lewis RJ.
      Abstract: This Guide to Statistics article compares pragmatic randomized controlled trials, which focus on important challenges that patients, physicians, and policy makers face in day-to-day life with explanatory trials that seek to test a hypothesis.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Performing the Wrong Procedure
    • Authors: Minnier T; Phrampus P, Waddell L.
      Abstract: This JAMA Performance Improvement uses the case of a patient given the wrong catheter to discuss appropriate clinician and health system responses to procedure errors.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Buprenorphine Prescribers’ Patient Censuses
    • Authors: Stein BD; Sorbero M, Dick AW, et al.
      Abstract: This retrospective cross-sectional analysis of pharmacy data indicates that most buprenorphine prescribers’ patient censuses are considerably below current limits.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Timing of Initiation of Renal Replacement Therapy in Patients With Severe
           AKI
    • Authors: Wang H; Li C, Hou X.
      Abstract: To the Editor Timing of initiation of renal replacement therapy (RRT) in patients with severe acute kidney injury (AKI) remains controversial. Several well-designed, randomized clinical trials have been published or are ongoing. The single-center Early vs Late Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients With Acute Kidney Injury (ELAIN) trial found an early strategy of initiating RRT compared with a delayed strategy reduced mortality in patients who were critically ill.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Timing of Initiation of Renal Replacement Therapy in Patients With Severe
           AKI
    • Authors: Besen B; Ranzani OT, Park M.
      Abstract: To the Editor In the report of the ELAIN trial, we think some issues need clarification. First, it is not clear whether the measure of effect for the primary outcome (hazard ratio for 90-day mortality from the Cox model) was presented as crude or adjusted. If it was adjusted, it is not clear what covariates were included. Following the Consolidated Standards of Reporting Trials (CONSORT) recommendations and the published ELAIN protocol, it is important to first present a crude measure of effect for the primary outcome and afterwards the adjusted result. Covariate adjustment in trials can provide additional useful information, such as an effect measure clinically closer to the patient level. Furthermore, the covariates to be adjusted for in the main analysis should be specified a priori. Nevertheless, the authors used a method (backward elimination) subject to important biases when trying to answer causal questions. Additionally, the reported adjustment was not congruent with what was specified in the published protocol, wherein the crude measure of effect would be estimated first and then the interaction between the intervention and the baseline risk of death (estimated with specific covariates).
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Timing of Initiation of Renal Replacement Therapy in Patients With Severe
           AKI
    • Authors: Young PJ; Bellomo R, Landoni G.
      Abstract: To the Editor Dr Zarbock and the authors of the ELAIN trial studied the appropriate timing of RRT in critically ill patients. However, we are concerned that clinicians may now overestimate the odds that early initiation of RRT reduces mortality in the critically ill. The ELAIN trial investigators acknowledged that the magnitude of the observed mortality reduction with early initiation of dialysis was likely to be overestimated in their trial. They powered their trial to detect an even greater difference (an 18% absolute reduction in mortality) than they actually found (a 15% absolute reduction in mortality), suggesting that the treatment effect used to inform their sample size calculations was inflated.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Autumnal Equinox
    • Authors: Halberstadt C.
      Abstract: Today, calm and sunny, dry,the sun slips equal to the coming night.The birds are gone, not even sparrows here,just a single mourning dove—so much uprooted, dug away, and paved.I watch my wild drought-stressed patchbeyond the equinox—a blip three-quarters gone,my body’s winter, and no turning back.But at these moments of the sunnot yet settled in the westI write, I read, and draw my breathsfrom life within and still around me.The day and dark descendwhile white clouds rise as birds and stars,and I am blessed.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Scientific Inquisitiveness—An Anecdote
    • Abstract: In describing the characteristics of a scientific investigator, Liebig once pointed out that certain disciplines, like mathematics, are merely an indispensable instrument for the attainment of scientific ends. He remarked that it is not the mere instrument which plans and executes the work, but the human intellect. It is obvious that without the power of observation, without sagacity, all mathematical knowledge is useless. We may imagine a man who, favored by a good memory, has rendered himself intimately acquainted with every theorem of mathematics and has obtained an eminent degree of skilfulness in handling this instrument, but is altogether unable to invent a problem for solution. If we propose to him a problem, and thus give him the conditions for its solution, he will succeed in obtaining an answer by performing the current operations with which he is familiar, and express it in a formula consisting of certain symbols, the meaning of which, however, is perfectly unintelligible to him, because he is deficient in other attainments essential for judging of its truth. Such a man is a mere calculating machine. But as soon as he possesses the capacity and the talent of proposing a question to himself and testing the truth of his calculations by experiment, he becomes qualified to investigate nature. For whence should he derive his problems, if not from nature or from life?
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Introducing JAMA Performance Improvement
    • Authors: Livingston EH.
      Abstract: Somewhat sensationalized claims are still made that there is a crisis in health care, with many patients needlessly dying due to medical errors. It is unlikely that medical care is as bad as is sometimes portrayed in the media, but because the prospect of poor-quality care and anecdotal reports of unacceptable patient outcomes receive so much public attention, there must be greater transparency and open discussion about the quality of health care delivery and how to improve it. Public discussion is dominated by statistically aggregated data and many quality improvement efforts relying on assessment of those data.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Monitoring and Feedback for Long-term Weight Loss
    • Authors: Jakicic JM; Davis KK, Rogers RJ, et al.
      Abstract: This randomized clinical trial compares the effects of a technology-enhanced vs a standard behavioral weight loss intervention on achieving weight loss over 24 months among adults.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Non-TNF vs Anti-TNF Treatment of Rheumatoid Arthritis After Failure of a
           First Anti-TNF Agent
    • Authors: Gottenberg J; Brocq O, Perdriger A, et al.
      Abstract: This pragmatic randomized trial compares the effects of a second anti–tumor necrosis factor (TNF) drug vs non–TNF-targeted biologic therapy among patients with rheumatoid arthritis for whom a first anti-TNF drug had failed.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Early Allergen Introduction for Preventing Development of Food Allergy
    • Authors: Greenhawt M.
      Abstract: In 2000, the American Academy of Pediatrics (AAP) recommended that “solid foods should not be introduced into the diet of high-risk infants until 6 months of age, with dairy products delayed until 1 year, eggs until 2 years, and peanuts, nuts, and fish until 3 years of age” in “infants at high risk for developing allergy, identified by a strong (biparental, parent, and sibling) family history of allergy” to help prevent food allergy from developing. In 2008, the AAP revised this guidance, stating that new evidence raised “serious questions about the benefit of delaying the introduction of solid foods that are thought to be highly allergic.” A recommendation to not delay solid food introduction beyond 4 to 6 months of life was issued but offered no guidance regarding an optimal timing of introduction. However, the estimated prevalence of food allergy in the United States nearly doubled (from 3.4% to 5.1%) between 1999 and 2009, and the estimated prevalence of peanut allergy tripled (from 0.4% to 1.4%) between 1999 and 2011, although it is unclear if guidance regarding delayed introduction of allergenic foods contributed to these increases or how well the 2008 guidance has been followed.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • WHO Declares India Free of Yaws and Maternal and Neonatal Tetanus
    • Authors: Friedrich MJ.
      Abstract: India was recognized by the World Health Organization in July with official certificates of elimination for 2 neglected tropical diseases—yaws and maternal and neonatal tetanus http://bit.ly/29VXMeD. These achievements, which were carried out through the existing health system and health workforce in India, illustrate the nation’s commitment to their elimination and serve as an example to other countries.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • FDA Enlists Physicians’ Aid
    • Authors: Voelker R.
      Abstract: The FDA has asked for help from clinicians—particularly dermatologists—as it investigates the largest number of adverse effects the agency has ever received for a hair care product.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Injectable Diabetes Drug Approved
    • Authors: Voelker R.
      Abstract: A new medication that’s injected daily at mealtime has received FDA approval to help improve glycemic control, along with diet and exercise, in adults with type 2 diabetes.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Kratom Products Seized
    • Authors: Voelker R.
      Abstract: Federal marshals seized more than 100 cases of a potentially addictive botanical supplement that has been linked with respiratory depression, vomiting, nervousness, weight loss, and constipation.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Portrait of Virginia
    • Authors: Cole TB.
      Abstract: Portrait of Virginia was painted in the naturalistic style favored by the Mexican painter Frida Kahlo (1907-1954) (JAMA cover, October 7, 1993) at the time of her marriage to the muralist Diego Rivera. The subject is conventional—a girl sitting in a chair, thinking her private thoughts—with no forewarning of the confrontational imagery of Kahlo’s later work. The background in this vertically oriented composition is divided into horizontal panels of lavender and terra-cotta, offering transitional contrasts for the girl’s green dress with red polka dots. In Mexico, where exterior walls and doorways of shops and cantinas are painted in broad washes of dry color, bright articles of clothing worn by people on the street create spontaneous contrasts of hue and tone, especially on market days (The Art of JAMA, May 3, 2016). Folk dress and traditional themes were foundational elements of Mexico’s cultural revolution in the early decades of the 20th century. To create a new art for Mexico that was distinct from the traditions of Europe and the United States, Kahlo, Rivera, and their contemporaries integrated the colors and symbols of folk culture with the forms of fine art. Many of Kahlo’s paintings allude to remembrance pictures by local craftsmen found in churches and homes throughout the country. Her best-known art works are intensely personal and can be disturbing, because they dwell on the physical consequences of her illnesses and injuries and the darkness of her inner life; what viewers find so compelling in them is Kahlo’s willingness to bare her soul.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Errors in the Text and Supplement
    • Abstract: In the Original Investigation entitled “Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients With Acute Kidney Injury: the ELAIN Randomized Clinical Trial” published in the May 24/31, 2016, issue of JAMA, there were a few errors in the text. During a revision, an adjusted analysis was removed but the description remained in the Methods; therefore, 2 sentences were removed: “A multivariable statistical analysis of the primary outcome was performed using Cox regression. After including all documented baseline characteristics of the patients in the model, backward elimination of variables was applied and a final model was established that included significant factors associated with the primary outcome.” Three changes were made to correct a number: (1) in the Results, a sentence was changed to "… 18 patients in the delayed group (15.1%), 17 of whom received RRT before reaching KDIGO stage 3 criteria"; (2) in the legend of Figure 2, a sentence was changed to “In the delayed group, 18 patients had an absolute indication for RRT”; (3) and in eTable 2 of Supplement 2, the column head was changed to “Absolute indication (n=17).” This article was corrected online.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • HIV/AIDS in 2016 and Beyond
    • Authors: Steinbrook R.
      Abstract: This Medical News feature discusses the progress and challenges in HIV/AIDS treatement and research highlighted by the 2016 International AIDS conference in Durban, South Africa.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • El Niño’s Impact on Children
    • Authors: Friedrich MJ.
      Abstract: Although the 2015-2016 El Niño climate event—one of the strongest on record—has ended, this far-reaching weather pattern spawned severe droughts and flooding in many parts of world. The fallout from the latest El Niño ramped up rates of malnutrition and created conditions conducive to the spread of many diseases, a situation that is inordinately impacting children, according to a new report, It’s not over—El Niño’s impact on children–from the United Nations Children’s Fund (UNICEF) http://bit.ly/2a83tGQ.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Psychological Scars From Confilct in South Sudan
    • Authors: Friedrich MJ.
      Abstract: Numerous human rights and humanitarian law abuses have been carried out during the decades of conflict and civil war in South Sudan and have led to an increase in mental illness in the civilian population, a situation documented by researchers from Amnesty International in the report, “Our Hearts Have Gone Dark”: The Mental Health Impact of South Sudan’s Conflicthttp://bit.ly/2aG4gzP.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Timing of Initiation of Renal Replacement Therapy in Patients With Severe
           AKI
    • Authors: Zarbock A; Kellum JA.
      Abstract: In Reply Drs Vinsonneau and Monchi and Dr Wang and colleagues point out that the study designs of the ELAIN and AKIKI trials differ. For example, patients in the ELAIN trial were treated earlier and were more severely ill compared with patients in the AKIKI trial. We believe that the pivotal difference between ELAIN and AKIKI is the time at which RRT was initiated. This is important because AKI can result in systemic disease affecting inflammation and function of different organs. Early treatment may attenuate the levels of pro-inflammatory mediators and subsequently reduce organ dysfunction.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Guidelines for Tinnitus
    • Authors: Tunkel DE; Jones SL, Rosenfeld RM.
      Abstract: To the Editor A JAMA Clinical Guidelines Synopsis by Dr Walker and colleagues summarized a published clinical practice guideline on tinnitus. The synopsis will aid in dissemination of the recommendations contained in this guideline, which was targeted for use by clinicians of many disciplines who treat adults with bothersome tinnitus.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Guidelines for Tinnitus
    • Authors: Cifu AS; Walker DD, Gluth MB.
      Abstract: In Reply Dr Tunkel and colleagues are correct in pointing out that the AAO-HNSF tinnitus clinical practice guideline was reviewed by stakeholders from multiple specialties. The guideline also explicitly stated that it will be updated 5 years after its publication (unless new literature is published that would change the guideline). The JAMA Clinical Guidelines Synopsis on tinnitus will be corrected online, changing the rating on both of these issues to good.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Error in Figure
    • Abstract: In the Research Letter entitled “Trends in Seniors' Use of Digital Health Technology in the United States, 2011-2014,” published in the August 2, 2016, issue of JAMA, panel B of the Figure depicts the linear trend for “Handles insurance” lower than 5% of senior use when it should be just above 5%. This article was corrected online.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Errors in Ratings Table
    • Abstract: In the JAMA Clinical Guidelines Synopsis entitled “Tinnitus” published in the May 24/31, 2016, issue of JAMA, errors occurred in the Table. In both the “External review” and the “Updating” rows, the ratings should have been “Good.” This article was corrected online.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Highlights for September 20, 2016
    • PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Ensuring Respect for Human Research Participants
    • Authors: Doernberg SN; Wendler D.
      Abstract: This Viewpoint proposes that institutional review boards play a larger role in ensuring timely public reporting of clinical trial results, with the goals of promoting medical innovation, reducing publication bias, and maximizing the value of clinical trials.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Using Professional Norms to Improve the Effects of Physician Comparisons
    • Authors: Liao JM; Fleisher LA, Navathe AS.
      Abstract: This Viewpoint proposes that reminders about professional standards might prevent counterproductive responses of physicians to report card comparisons intended to improve health care quality and reduce waste.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • A National Evaluation System for Health Technology
    • Authors: Shuren J; Califf RM.
      Abstract: This Viewpoint discusses creation of a US evaluation system for health technology that could quickly identify problematic devices, accurately and transparently characterize and disseminate information about device performance in clinical practice, and efficiently generate data to support premarket clearance or approval of new devices and new uses of currently marketed devices.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
  • Does It Matter?
    • Authors: McGevna L.
      Abstract: It is easy to lose perspective of the significance of one’s profession in the rituals of daily life. I’m a physician, but I’m not the kind of doctor most people imagine when they conjure the image. I’m not a surgeon, a primary care physician, an emergency physician, or any of the storied doctors on prime time television or in paperback novels whose casual heroics serve as entertainment for the masses or inspiration for the few. I’m a dermatologist. I see skin—and lots of it—on every part of the body that has it, which is nearly everywhere, even in places that some patients show me only sheepishly. I appreciate variety, and I am fortunate to have a great deal of it in my field. I see individuals for skin cancer surveillance and treatment, young people with acne, kids with often benign but scary-looking rashes, and hospitalized patients of all ages with frightening, sinister conditions that are often given less priority when other active medical problems demand attention. “It’s just skin” is a phrase I hear frequently.
      PubDate: Tue, 20 Sep 2016 00:00:00 GMT
       
 
 
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