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  [13 journals]
  • Highlights for February 13, 2018
    • PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Language, Science, and Politics
    • Authors: Gostin LO.
      Abstract: This Viewpoint provides historical context for advice given by the US Department of Health and Human Services in 2017 to the CDC to avoid particular words in 2019 budget requests and argues that scientific innovation can flourish only when it is protected from political interference.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Defining Outcomes for CME Activity
    • Authors: Stevenson R; Moore DE, Jr.
      Abstract: This Viewpoint proposes a framework for thinking about outcomes of continuing medical education (CME) activities, including identification of professional practice gaps and improvement of clinical competence, clinician performance, and patient and community health outcomes.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Promoting Innovation Through Regulatory Alignment for CME
    • Authors: McMahon GT; Skochelak SE.
      Abstract: This Viewpoint discusses efforts by the ACCME and AMA to develop new rules that allow physicians to collect continuing medical education credits using new technologies and in a streamlined way.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Increasing the Transparency of Conflict of Interest Disclosures in
           Nutrition Research
    • Authors: Ioannidis JA; Trepanowski JF.
      Abstract: In this Viewpoint, John Ioannidis argues that nutrition researchers should be required to disclose relevant dietary advocacy, activism, practices, and personal preferences given indirect financial benefits they may realize from offering dietary advice and the relative ease with which they can promote their personal beliefs in diet through science.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • A Medical Student Shares Her Struggle With Depression
    • Authors: Gupta R.
      Abstract: In this essay, a young medical student describes her struggle with depression and how the experience of vulnerability has bred a deep compassion for her patients and peers.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Utility of a Clinical Prediction Rule to Exclude Pulmonary Embolism Among
           Low- Risk Emergency Department Patients
    • Authors: Kline JA.
      Abstract: In this issue of JAMA, Freund and colleagues report the results of the PROPER trial, a cluster-randomized clinical trial conducted at 14 centers in France that tested the effect of a clinical prediction rule, using only clinical criteria, to exclude acute pulmonary embolism (PE) at the bedside among low-risk emergency department patients. These criteria are commonly referred to as the PERC rule (pulmonary embolism rule-out criteria) and consist of 8 objective factors: arterial oxygen saturation (Sp o2) of 94% or less, unilateral leg swelling, hemoptysis, recent trauma or recent surgery, prior PE or prior deep venous thrombosis, pulse rate of at least 100 beats/minute, patient age of 50 years or older, and exogenous estrogen use. In this trial, the investigators compared patient outcomes from usual emergency care processes vs care processes that included the PERC rule. This study addresses an important clinical controversy—can the notoriously elusive and potentially fatal disease process of PE be safely excluded without laboratory testing or radiological imaging'
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Improving Evidence for Implementing Guideline-Based Care in Low- and
           Middle-Income Countries
    • Authors: Granger CB; Xavier D.
      Abstract: Coronary heart disease is the number one cause of death and disability in India and around the world. Evidence-based approaches for prevention and treatment of coronary heart disease are widely available but are not used optimally, particularly in low- and middle-income countries. In India, like in many countries, there are major gaps between actual and ideal care, and quality of care is substantially worse for patients with low socioeconomic status. Studies of quality improvement in Brazil, China, and India have been associated with improvements in acute coronary syndrome care and in clinical outcomes. However, there is an important need to further develop approaches to improve implementation of evidence-based care in these countries.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Screening for Ovarian Cancer in Asymptomatic Women
    • Authors: Lu KH.
      Abstract: Developing an effective strategy for early detection of ovarian cancer remains one of the most significant unmet needs in the diagnosis and treatment of the disease. Approximately 22 000 cases of ovarian cancer are diagnosed each year among women in the United States. Similar to women with lung and pancreatic cancers, women with ovarian cancer are typically diagnosed in late stages, resulting in poor outcomes. For the 20% of patients with ovarian cancer diagnosed with stage I disease, 5-year survival rates are greater than 90%, whereas for the majority of women diagnosed with stage III or IV ovarian cancer, 5-year survival rates are approximately 17% to 39%.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Pulmonary Embolism Rule-Out Criteria and Subsequent Thromboembolic Events
    • Authors: Freund Y; Cachanado M, Aubry A, et al.
      Abstract: This crossover cluster–randomized clinical noninferiority trial compared the safety of using pulmonary embolism rule-out criteria (PERC) vs a conventional strategy (D-dimer and CTPA) for excluding the diagnosis of pulmonary embolism (PE) among emergency department patients with low clinical probability of PE.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Effect of a Quality Improvement Intervention on AMI Outcomes in India
    • Authors: Huffman MD; Mohanan PP, Devarajan R, et al.
      Abstract: This cluster randomized, stepped-wedge clinical trial compares the effect of a quality improvement tool kit vs usual care on 30-day major adverse cardiovascular events in patients with acute myocardial infarction (AMI) in Kerala, India.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Affordable Care Act Dependent Coverage Provision and Prenatal Care and
           Birth Outcomes
    • Authors: Daw JR; Sommers BD.
      Abstract: This study determines whether the dependent coverage provision of the Affordable Care Act was associated with changes in payment for birth, prenatal care, and birth outcomes among married and unmarried women.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • USPSTF Recommendation: Screening for Ovarian Cancer
    • Authors: ; Grossman DC, Curry SJ, et al.
      Abstract: This 2018 Recommendation Statement from the US Preventive Services Task Force recommends against screening for ovarian cancer in asymptomatic women (D recommendation).
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • USPSTF Evidence Report: Screening for Ovarian Cancer
    • Authors: Henderson JT; Webber EM, Sawaya GF.
      Abstract: This systematic review to support the 2018 update of the US Preventive Services Task Force Recommendation Statement on screening for ovarian cancer summarizes published evidence on the benefits and harms of ovarian cancer screening for average-risk, asymptomatic women.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • The Stepped-Wedge Approach to Cluster Clinical Trial Design
    • Authors: Ellenberg SS.
      Abstract: This JAMA Guide to Statistics and Methods discusses the stepped-wedge apporach to cluster randomized clinical trial design, in which clusters are randomized to the order in which they receive the experimental regimen.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Byline Placement of Co-first Authors by Gender in Journals With High
           Impact Factors
    • Authors: Aakhus E; Mitra N, Lautenbach E, et al.
      Abstract: This study describes the byline order of gender-discordant co-first authors in 10 clinical and basic science journals with high impact factors.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Paid Family and Childbearing Leave Policies at Top US Medical Schools
    • Authors: Riano NS; Linos E, Accurso EC, et al.
      Abstract: This study characterizes variations in duration, salary support, policy clarity, and constraints or prerequisites for childbearing and family leave policies at 12 top-tier US medical schools.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Early Resuscitation for Adults With Sepsis in a Low-Income Country
    • Authors: Nedel W; Deutschendorf C.
      Abstract: To the Editor Dr Andrews and colleagues performed a randomized clinical trial of a sepsis protocol for early resuscitation involving intravenous fluids, vasopressors, and blood transfusion compared with usual care among adults with sepsis and hypotension in Zambia. They found that in-hospital mortality was greater in the sepsis protocol group than in the usual care group. However, the difference in mortality may not be attributed solely to the early resuscitation protocol.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Early Resuscitation for Adults With Sepsis in a Low-income
    • Authors: Semler MW; Andrews B, Bernard GR.
      Abstract: In Reply Drs Nedel and Deutschendorf highlight 2 key considerations for the interpretation of our trial and the management of patients with sepsis across settings: (1) timing of antibiotic administration and (2) volume of intravenous fluid.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Costs of Quality Measurement
    • Authors: Chen J; Patel MM.
      Abstract: To the Editor We agree with Dr Schuster and colleagues that measuring the cost of quality measurement is an important but often overlooked link in the quality strategy. We suggest that measure developers should estimate the contextual cost rather than the absolute cost.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Costs of Quality Measurement—Reply
    • Authors: Schuster MA; Onorato SE, Meltzer DO.
      Abstract: In Reply Mr Chen and Mr Patel raise a number of important issues related to understanding the cost of quality measures. We agree that there is value in considering a variety of costs and ways of conceptualizing and calculating them.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Absolute vs Additive Net Reclassification Index
    • Authors: Leening MG; Pencina MJ.
      Abstract: To the Editor Dr Alba and colleagues advocated for head-to-head comparison of clinical prediction models using a modification of the net reclassification index (NRI), termed the absolute NRI. The argument for the proposed modification to the commonly used form of the NRI, which they termed the additive NRI, is flawed.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Absolute vs Additive Net Reclassification Index—Reply
    • Authors: Alba AC; Devereaux PJ, Guyatt G.
      Abstract: In Reply Drs Leening and Pencina discourage the use of absolute NRI when comparing the performance of 2 predictive models by stating that “the absolute NRI is mathematically improper and has no clinical interpretation.” They also argue that the absolute NRI does not consider the prevalence of the event of interest. These arguments are incorrect and the refutations are presented in our Users’ Guide.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Error in Author Degree and Surname
    • Abstract: In the Letter to the Editor entitled “Prescription Drug Monitoring Programs and Opioid Death Rates” published in the November 28, 2017, issue of JAMA, there were 2 errors in the byline. Author Peter Corcoran’s degree should have been listed as MPH. The third author’s surname was misspelled; she should have been listed as Kimberly Elliott. This article was corrected online.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Simple Models and Ice Bucket Challenge Fuel Progress in ALS Treatment
    • Authors: Kuehn BM.
      Abstract: This Medical News story discusses recent progress in ALS research fueled by work in basic model systems and funding from the Ice Bucket Challenge.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • A New Year’s Wish on Opioids
    • Authors: Sharfstein JM.
      Abstract: As overdose deaths mount, leading to a decline in US life expectancy 2 years in a row, my New Year’s wish is for more people to appreciate this statement: Not all well-intentioned approaches to addressing the opioid epidemic are good ideas. Some are based on evidence and experience, others on misunderstanding, blame, fear, or frustration. What’s needed in 2018 is the wisdom—and the courage—to tell the difference.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Hemophilia Gene Therapies Show Promise
    • Authors: Abbasi J.
      Abstract: Early results from trials of investigational hemophilia A and B gene therapies were recently published in the New England Journal of Medicine. Both ongoing trials demonstrated substantial and sustained increases in endogenous clotting factor activity and reductions in bleeding and exogenous factor use. Hemophilia A and B are caused by genetic mutations that result in blood clotting factor VIII and IX deficiency, respectively. Hemophilia A is 6 times more common than hemophilia B.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Urine Test for Tuberculosis in Development
    • Authors: Abbasi J.
      Abstract: An international team of researchers is developing a nanotechnology-based urine test for active tuberculosis (TB) infection that could allow for better diagnosis and treatment management in resource-strapped settings. According to World Health Organization estimates, there were 10.4 million new TB infections globally and more than 1.6 million deaths from TB in 2016.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Obesity Tied to Income, Education, But Not in All Populations
    • Authors: Rubin R.
      Abstract: Overall, obesity was least common among the highest-income adults and those who had graduated college, according to a recent CDC analysis of 2011-2014 data from the National Health and Nutrition Examination Survey. But this pattern was not consistent across all demographic groups
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • State Restrictions of e-Cigarette Use Has Slowed
    • Authors: Rubin R.
      Abstract: State legislative activity to restrict the use of electronic cigarettes peaked in 2015 but has slowed since then, according to a recent CDC report.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Images of Transformation Through Breast Cancer
    • Authors: Henneman JR.
      Abstract: This Arts and Medicine essay reviews Edges of Light: Images of Breast Transformation, a traveling exhibit of photographs and poetry documenting a literature and humanities professor’s journey through breast cancer treatment and reconstruction.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Now I Walk
    • Authors: Halberstadt C.
      Abstract: Only in my mindand in dreams sometimeswhen free again I climbup and down the rocks to mesa rimsor wander miles on familiar earthen pathsto sit by streams and pondswith calling frogsand watch the darting dragonfliesand red-winged blackbirdssinging in the reeds,or lie down upon a hummock of the meadow grass,half-sun, half-shade,to rest within the trees.Only my mind is not the sameas once it was.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Our Forefathers’ Knowledge
    • Abstract: A striking feature of the “History of the Medical Society of the State of New York,” which has been appearing serially in the New York State Journal of Medicine, and is now published in book form, is the fact that a great amount of medical knowledge which we are prone to think of as originating in recent years was possessed by our forbears in medicine of the early part of the nineteenth century. In the chapter on the prize essays of the society attention is called to the fact that of the first seven essays not one is without great interest at the present time. One would be apt to think that medical matters discussed almost a century ago would have very little practical significance for the physician of the present. We are prone to assume that there has been so much development in medicine that we have been set far beyond the thoughts of that earlier time, especially in matters of treatment and knowledge of the cause of disease.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • Screening for Ovarian Cancer
    • Authors: Jin J.
      Abstract: This JAMA Patient Page discusses the US Preventive Services Task Force’s recommendations on screening for ovarian cancer in asymptomatic women.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
  • JAMA
    • PubDate: Tue, 13 Feb 2018 00:00:00 GMT
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