Journal Cover JAMA The Journal of the American Medical Association
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   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 August 15, 2017
    • PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • A Proposal for Dental, Vision, and Hearing Service Coverage Under Medicare
    • Authors: Willink A; Schoen C, Davis K.
      Abstract: This Viewpoint argues that Medicare coverage should be expanded to include dental, vision, and hearing services, and discusses ways to structure the benefit.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Diagnostic Stewardship to Improve Antimicrobial Use
    • Authors: Morgan DJ; Malani P, Diekema DJ.
      Abstract: This Viewpoint discusses the potential benefits and harms of diagnostic stewardship—modifying the ordering, performance, and reporting of diagnostic tests to improve treatment—as a means of reducing inappropriate antibiotic use.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Value-Based Pricing and State Reform of Prescription Drug Costs
    • Authors: Hwang TJ; Kesselheim AS, Sarpatwari A.
      Abstract: This Viewpoint discusses a New York law that allows the state to negotiate rebates with manufacturers to obtain value-based prices for drugs in its Medicaid program and assesses the potential effects of value-based pricing.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Climate Change—WWLD
    • Authors: Kaelin WG; Jr.
      Abstract: Twenty-five years as a physician-scientist have taught me a few things about science and scientists that help me when viewing the climate change debate. For example, some scientists really are, as frequently portrayed in the media, a bit eccentric. They are often curiosity-driven loners with an insatiable need to explore, to know. Scientists are skeptical of the scientific findings of others, and the best of them are equally distrustful of their own work. Most are truth seekers who know that their legacies will be determined by whether their discoveries withstand the test of time.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Trials and Tribulations
    • Authors: Brown JL.
      Abstract: Reviewing malpractice cases as a medical expert was an unexpected consequence of testifying as a defendant. I and other physicians in our group practice had been named in a medical malpractice lawsuit. My testimony was required when the case went to trial. After the legal issues were resolved, our attorney suggested that my credentials and demeanor would make me a credible expert witness. Despite having initial reservations, I accepted her offer to review cases because participating in the process seemed preferable to passively accepting any future legal intrusions.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Balancing Needs for Access and Empirical Evidence of Benefit and Risk
    • Authors: Califf RM.
      Abstract: When people use medical products, they generally expect that the benefits of doing so will outweigh the risks in terms of living longer, feeling better, or improving their functional status. However, most drugs and biologics and many medical devices that enter early evaluation in humans are found either to have no benefit or to have risks that outweigh the observed benefits when proper clinical trials are conducted. The complexity and high failure rates of medical product development have appropriately led to a regulatory system that requires compelling evidence of safety and efficacy from clinical trials for drugs, biologics, and high-risk devices before they are allowed on the market.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Shared Decision Making and Improving Health Care
    • Authors: Montori VM; Kunneman M, Brito JP.
      Abstract: Achieving health care of higher quality at lower cost has fueled policy interest in shared decision making (SDM). In SDM, clinicians and patients work together to understand the patient’s situation and determine how best to address it. Programs are in place in the United States to promote SDM using legal and financial incentives, mostly by implementing patient decision aids (PtDAs). The Cochrane review of SDM tools for people facing treatment or screening decisions is the key evidence cited in policy statements that propose to implement, distribute, and use certified PtDAs.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Characteristics of Studies Used for FDA Approval of High-Risk Device
           Supplements
    • Authors: Zheng SY; Dhruva SS, Redberg RF.
      Abstract: This study characterizes the quality of clinical studies and data used to support US Food and Drug Administration approval of modifications to high-risk medical devices.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Characteristics of Drug Trials Before and After FDA Accelerated Approval
    • Authors: Naci H; Smalley KR, Kesselheim AS.
      Abstract: This study uses public US Food and Drug Administration (FDA) data to characterize drug trials used to obtain FDA accelerated approval and to describe the existence, timing, and characteristics of postapproval trials mandated by the FDA as part of the accelerated approval decision.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Effect of a Lifestyle Intervention on Glycemic Control in Patients With
           Type 2 Diabetes
    • Authors: Johansen M; MacDonald C, Hansen K, et al.
      Abstract: This randomized clinical trial compared the effects of an intensive lifestyle intervention vs standard care on glycemic control and medication reduction among participants with non–insulin-dependent type 2 diabetes.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Celiac Disease and Nonceliac Gluten Sensitivity
    • Authors: Leonard MM; Sapone A, Catassi C, et al.
      Abstract: This review discusses the the role of a gluten-free diet in the clinical management of celiac disease and nonceliac gluten sensitivity and highlights the importance for long-term therapy of distinguishing between these conditions.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Patient Decision Aids to Engage Adults in Treatment or Screening Decisions
    • Authors: Stacey D; Légaré F, Lewis KB.
      Abstract: This Clinical Evidence Synopsis summarizes a Cochrane review of clinical trials evaluating patient decision aids designed to help patients understand their treatment options.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Bezlotoxumab (Zinplava) for Prevention of Recurrent Clostridium Difficile
           Infection
    • Abstract: This Medical Letter review summarizes the indications, risks, and benefits of bezlotoxumab, a monoclonal antibody to be used with antibacterial drug treatment to reduce recurrence of Clostridium difficile infection in adults at high risk.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Public Response to a Field Trial of Genetically Engineered Mosquitoes
    • Authors: Bloss CS; Stoler J, Brouwer KC, et al.
      Abstract: This study assesses public response to a proposed field trial in the United States of genetically engineered mosquito (OX513A) designed to suppress wild-type Aedes aegypti mosquitoes, which can transmit diseases such as Zika, dengue, and chikungunya.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Prenatal Antidepressant Use and Autism Spectrum Disorder
    • Authors: Singal D; Chateau D, Brownell M.
      Abstract: To the Editor The study by Dr Brown and colleagues concluded that in utero serotonergic antidepressant exposure was not associated with the development of autism spectrum disorder in children. However, we conclude that the opposite may be true.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Prenatal Antidepressant Use and Autism Spectrum Disorder—Reply
    • Authors: Vigod SN; Gomes T, Ray JG.
      Abstract: In Reply Ms Singal and colleagues raise some points about analysis and interpretation of epidemiological research and our study. The relationship between antenatal serotonergic reuptake inhibitor antidepressant use and child autism spectrum disorder is a complex area about which there is ongoing need for high-quality research.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Maternal Antidepressant Use and Pregnancy Outcomes
    • Authors: Yonkers K; Forray A, Smith MV.
      Abstract: To the Editor Maternal antidepressant use has become a commonly explored pregnancy exposure, with investigators using large registry databases to investigate associations with a variety of pregnancy outcomes. Ms Sujan and colleagues investigated outcomes previously associated with maternal antidepressant use, including preterm birth, small for gestational age, autism spectrum disorder, and attention-deficit/hyperactivity disorder, using Swedish registries. A sibling design controlled for confounding and reduced estimates associating maternal antidepressant use with all exposures. The authors performed additional analyses designating as exposures antidepressant use prior to pregnancy and paternal use of antidepressants; these models resulted in similar estimates of association with those that used antidepressants in the first trimester as the exposure. The sibling design supports inferences showing a role for familial and stable socioeconomic and environmental factors. The additional analyses support a role for maternal psychiatric illness.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Maternal Antidepressant Use and Pregnancy Outcomes
    • Authors: D’Onofrio BM; Sujan AC.
      Abstract: In Reply We examined the associations between maternal antidepressant use during the first trimester and offspring birth and neurodevelopmental problems. We explored whether the observed associations were consistent with a causal influence or due to alternative processes, such as confounding by indication, genetic factors, environmental factors, or some combination.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Alveolar Recruitment Strategies After Cardiac Surgery
    • Authors: Li G; Shi X.
      Abstract: To the Editor Dr Costa Leme and colleagues reported that an intensive alveolar recruitment strategy resulted in less-severe pulmonary complications than a moderate alveolar recruitment strategy among patients with hypoxemia after cardiac surgery. However, we have several concerns about the study.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Alveolar Recruitment Strategies After Cardiac Surgery
    • Authors: Patel JJ; Pfeifer K.
      Abstract: To the Editor The study by Dr Costa Leme and colleagues evaluated the effect of intensive (PEEP, 13 cm H2O) vs moderate (PEEP, 8 cm H2O) alveolar recruitment on reducing postoperative pulmonary complications in patients who had undergone cardiac surgery. The use of an intensive alveolar recruitment strategy compared with a moderate recruitment strategy resulted in less-severe postoperative pulmonary complications. We have some concerns about the research methods in this study.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Alveolar Recruitment Strategies After Cardiac Surgery
    • Authors: Amato MP; Volpe MS, Hajjar LA.
      Abstract: In Reply Drs Li and Shi raised concerns about which of our study groups actually provided intensive alveolar recruitment. In Supplement 2, eFigure 4 and eTable 1 showed that the intensive maneuver resulted in better reversal of atelectasis (our main target). At arrival in the intensive care unit, electrical impedance tomography maps showed reduced ventilation and compliance of dependent lung regions for all patients (upper:lower ventilation ratio above 1:1), but a larger improvement occurred after the intensive maneuvers (upper:lower ventilation ratio decreased to 0.6 vs 1.2 in the moderate strategy group), leading to higher respiratory-system compliance (65 vs 50 mL/cm H2O) and better oxygenation (arterial partial pressure of oxygen [Pao2]/Fio2 ratio = 344 vs 236). The comparison between study groups was significant for all parameters.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Incomplete Financial Disclosure
    • Abstract: The A Piece of My Mind article entitled “No Perfect Choice” published in the July 4, 2017, issue of JAMA, published an incomplete financial disclosure. The full statement should read as follows: “All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Dossett reports that she is on the advisory board for Sage Pharmaceuticals. Dr Burt reports that she is a consultant, advisor, and speaker for Takeda Pharmaceuticals, Lundbeck Pharmaceuticals, Otsuka Pharmaceuticals, and Sunovion. No other disclosures were reported.” This article was corrected online.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Half-century After “Summer of Love,” Free Clinics Still Play
           Vital Role
    • Authors: Rubin R.
      Abstract: This Medical News story discusses the founding of the first free clinics in the United States and the role free clinics continue to play in communities across the country.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Reforming Medicaid
    • Authors: Slavitt A; Wilensky G.
      Abstract: We are 2 former Administrators of the Medicare and Medicaid programs, under Presidents Barack Obama and George H. W. Bush. Although we represent different political parties, we take pride in the accomplishments of these 2 programs, which collectively help millions of US residents get the health care they need.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Effect of Malaria Initiative
    • Authors: Friedrich MJ.
      Abstract: Launched in 2005 by President George W. Bush and expanded by President Barack Obama, the US President’s Malaria Initiative (PMI) has been one of the main sources of funding for malaria prevention interventions in sub-Saharan Africa. A new report in PLoS Medicine shows that the PMI has reduced child mortality and the burden of malaria in those countries that have received its funding, primarily by increasing access to insecticide-treated nets, artemisinin-based combination therapy, and indoor residual spraying.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Global Obesity Epidemic Worsening
    • Authors: Friedrich MJ.
      Abstract: The prevalence of obesity has doubled in 73 countries around the world and steadily increased in others since 1980, and health problems resulting from being overweight or obese now affect more than 2 billion people, according to a study by an international group of researchers published in the New England Journal of Medicine.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Lethal Heat Waves Expected to Increase
    • Authors: Friedrich MJ.
      Abstract: Heat-related deaths around the world will increase as deadly heat waves become more common with rising global temperatures that are associated with climate change, according to 2 new reports.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Faster Orphan Drug Decisions
    • Authors: Voelker R.
      Abstract: The FDA has announced that it will eliminate the backlog of existing requests for orphan drug designation by September 21. Going forward, the agency also pledged to respond to all requests for the designation within 90 days of receipt.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • New Leukemia, Lymphoma Diagnostic
    • Authors: Voelker R.
      Abstract: A new test used with flow cytometry to aid in diagnosing several forms of leukemia and lymphoma has received FDA approval.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Sickle Cell Therapy Drought Ends
    • Authors: Voelker R.
      Abstract: After nearly 20 years without new treatments for sickle cell disease, the FDA has approved L-glutamine oral powder to reduce severe complications of the blood disorder in patients aged 5 years or older. It also is the first sickle cell disease treatment approved for pediatric patients.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • A Song of Hope
    • Authors: Halberstadt C.
      Abstract: I will playthe last fugue of my lifeon the melting ice and rising seasas they stroke their furythrough organs and bones,on the ivory keys of an elephant’s tuskand curl through a pangolin’s scales.They will sound in the fossil cochlea of a whale,its vertebra holding a shelletched in a lost language by expired hands.And the trees who still stand will protect useven as sea turtles drownand the ears of dolphins bleed from the noise.But the birds who still fly will sing me to restand the chords they still playwill be heard.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Politics and the Medical Profession
    • Abstract: Whatever may be one’s private opinions as to public questions, to whichever party he may have belonged in the past, it is clear to all independent intellects that there are other duties to one’s fellow-men and to the future far more imperative and binding than allegiance to any political party—so far at least as such parties are at present constituted and used. Both great parties in American politics have at times fallen away from their principles and have wallowed in such bogs of corruption that they have nauseated their best members into a condition of alienation and independence, or at least into one of irritation and half contempt. One votes as he does now-a-days not because he likes Cæsar less, but that he likes Rome more; not because he believes much in the men, their acts or principles, on the ticket, but because he believes rather less in the men and their doings whose names are on the other tickets. It is too frequently a choice between two evils, in which one has some difficulty to determine which promises or rather which will fulfil the least evil. All of this is not, perhaps, wholly to be deplored; it has many advantages, not the least of which possibly are a more intelligent conception of and participation in government affairs; a use of parties and partizanship as mere instruments and tools for purposes beyond their surmise; and a habit of independence which may come in time to control the corruptionists. When these schemers and bribers and hoodlums, “in it for what it is worth,” are dictating legislation and controlling law for their unscrupulous selfishness, men who have better purposes in life may be not only excused but encouraged to put in such delegates and lawmakers as will protest against abuses and use their offices for the public good.…
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • Eye Emergencies
    • Authors: Muth CC.
      PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
  • JAMA
    • PubDate: Tue, 15 Aug 2017 00:00:00 GMT
       
 
 
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