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  • The Pathway to Patient Data Ownership and Better Health
    JAMA (IF 44.405) Pub Date : 2017-09-25
    Katherine A. Mikk, Harry A. Sleeper, Eric J. Topol

    Digital health data are rapidly expanding to include patient-reported outcomes, patient-generated health data, and social determinants of health. Measurements collected in clinical settings are being supplemented by data collected in daily life, such as data derived from wearable sensors and smartphone apps, and access to other data, such as genomic data, is rapidly increasing. One projection suggests that a billion individuals will have their whole genome sequenced in the next several years.1 These additional sources of data, whether patient-generated, genomic, or other, are critical for a comprehensive picture of an individual’s health.

    更新日期:2017-09-25
  • Cybersecurity—A Serious Patient Care Concern
    JAMA (IF 44.405) Pub Date : 2017-09-25
    Mark P. Jarrett

    The world of paper medical records has almost disappeared, ushering in a new era of electronically stored, analyzed, and shared medical information that offers exciting opportunities for improved patient care. However, this major shift in information management has introduced unintended and unfavorable consequences, such as theft of patient-protected health information, wide-scale sequestering of medical records by ransomware (malicious software—malware—that permanently blocks the access to records unless a ransom is paid), and the ability for hackers to directly harm patients. For example, the recent global WannaCry ransomware attack resulted in more than 48 National Health Service organizations in the United Kingdom being forced to cancel surgical procedures and outpatient appointments. This virus also affected several intravenous contrast power injectors in the United States.1 In addition to health care organizations, more than 230 000 computers in 150 countries were infected.

    更新日期:2017-09-25
  • Advancing the Research Mission in a Time of Mergers and Acquisitions
    JAMA (IF 44.405) Pub Date : 2017-09-25
    Paul J. Hauptman, Richard J. Bookman, Stephen Heinig

    Academic medical centers find it increasingly necessary to pursue economies of scale by merging, partnering with, acquiring, or being acquired by nonacademic hospital networks and health systems. These arrangements may provide greater purchasing power, leverage with payers, and a reduction in the size of clinical and ancillary staff for services that are deemed to be redundant. In this environment, a new set of challenges confront the ability of academic medical centers to fulfill the mission to create new medical knowledge. Clinical research is encountering a “hyper-level of scientific and operating complexity”1 and pressures to generate clinical volume and revenue leave many academic researchers with limited ability to focus on investigative work.

    更新日期:2017-09-25
  • Talking to Machines About Personal Mental Health Problems
    JAMA (IF 44.405) Pub Date : 2017-09-21
    Adam S. Miner, Arnold Milstein, Jefferey T. Hancock

    Gabby is a “racially ambiguous female in her mid-forties.”1 A software program designed to help patients with chronic pain and depression, Gabby has many “siblings” that already converse directly with millions of patients in the United States and globally about their mental health. Advances in machine learning, digital assistants, and natural language processing support such personal health conversations between machines and patients. Conversational artificial intelligence is the term used to describe this new capability. Gabby is a conversational agent, a software program that uses conversational artificial intelligence to interact with users through voice or text. Conversational agents are different from other software programs because they converse directly with people, and some data suggest that people respond to them psychologically as though they are human.2 Clinicians have contemplated the use of conversational agents in mental health care for decades, especially to improve access for underserved populations.

    更新日期:2017-09-21
  • Is Cognitive Behavioral Therapy the Gold Standard for Psychotherapy?The Need for Plurality in Treatment and Research
    JAMA (IF 44.405) Pub Date : 2017-09-21
    Falk Leichsenring, Christiane Steinert

    Mental disorders are common and associated with severe impairments and high societal costs, thus representing a significant public health concern. About 75% of patients prefer psychotherapy over medication.1 For psychotherapy of mental disorders, several approaches are available such as cognitive behavioral therapy (CBT), interpersonal therapy, or psychodynamic therapy. Pointing to the available evidence, CBT is usually considered the gold standard for the psychotherapeutic treatment of many or even most mental disorders.2,3 For example, the American Psychological Association’s Division 12 Task Force on Psychological Interventions currently lists CBT as the only treatment with “strong research support” in almost 80% of all mental disorders included in its listing.2

    更新日期:2017-09-21
  • Digital PhenotypingTechnology for a New Science of Behavior
    JAMA (IF 44.405) Pub Date : 2017-09-21
    Thomas R. Insel
    更新日期:2017-09-21
  • New Toolkits Help Physicians Detect, Diagnose, and Manage Dementia
    JAMA (IF 44.405) Pub Date : 2017-09-20
    Judith Graham
    更新日期:2017-09-20
  • FDA Approval of TisagenlecleucelPromise and Complexities of a $475 000 Cancer Drug
    JAMA (IF 44.405) Pub Date : 2017-09-20
    Peter B. Bach, Sergio A. Giralt, Leonard B. Saltz

    Approval of the drug tisagenlecleucel (Kymriah; Novartis) by the US Food and Drug Administration (FDA) for the treatment of pediatric and young adult acute lymphoblastic leukemia (ALL) in August 2017 was a landmark in oncology. The science underlying chimeric antigen receptor T cells (CAR-T) heralds a new era of treatment, and the list price of $475 000 for the new drug (delivered as a one-time infusion) definitively shattered oncology drug pricing norms.1

    更新日期:2017-09-20
  • JAMA
    JAMA (IF 44.405) Pub Date : 2017-09-19

    The JAMA Network is a consortium of peer-reviewed print and online medical publications that includes JAMA® and 11 other specialty Network journals. JAMA does not hold itself responsible for statements made by any contributor. All articles published, including opinion articles, represent the views of the authors and do not reflect the policy of JAMA, the American Medical Association, or the institution with which the author is affiliated unless otherwise indicated.

    更新日期:2017-09-19
  • Every Day Is Fish Day
    JAMA (IF 44.405) Pub Date : 2017-09-19

    In the search for new or little appreciated sources of palatable foods to meet the shortage that the war has brought to the entire civilized world, some consideration has already been given to fish. From a physiologic or nutritional standpoint, this type of animal food commends itself on account of its comparative richness in precisely those nutrients—proteins and fats—which at present command the highest prices. The fact that no special feeding or nurture is required to produce the common fish of our markets puts them into striking contrast, from an economic standpoint, to the various types of meat that are obtained as the result of the prolonged feeding of animals originally valued at a liberal price, through a period of growth and the process of finishing for the market. The cod, the mackerel and the shad, for example, require no management comparable to the methods of animal production in farm practice. The essential features of expense lie in the capture and marketing of the food.

    更新日期:2017-09-19
  • Beginning and End
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Carol Snyder Halberstadt

    更新日期:2017-09-19
  • 更新日期:2017-09-19
  • The 8-Week Cure for Hepatitis C
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Rebecca Voelker

    In less than a month, the FDA approved a second medication for hepatitis C virus (HCV) infection. The newer entry into the treatment arena is the first drug capable of suppressing viral load to undetectable levels in only 8 weeks. Marketed as Mavyret, the recently approved medication is a combination of glecaprevir and pibrentasvir. Clinical trials involving about 2300 adults with any of the 6 HCV genotypes showed that 92% or more who received the combination for 8, 12, or 16 weeks had no detectable virus in their blood 12 weeks after treatment ended, suggesting their infections were cured.

    更新日期:2017-09-19
  • Deaths Reported After Intragastric Balloon Surgery
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Rebecca Voelker
    更新日期:2017-09-19
  • Relief for Graft-vs-Host Disease
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Rebecca Voelker

    A drug previously approved for adults with certain types of lymphoma or leukemia has become the first FDA approved medication for chronic graft-vs-host disease (GVHD). Ibrutinib, marketed as Imbruvica, inhibits Bruton tyrosine kinase, a protein that plays a role in the survival and spread of malignant B cells. The medication is indicated for adults who develop chronic GVHD after a hematopoietic stem cell transplant but don’t respond to systemic therapy. An estimated 30% to 70% of patients who undergo these transplants subsequently develop chronic GVHD.

    更新日期:2017-09-19
  • Lack of Improvement in Health Care for Afghans With Disabilities
    JAMA (IF 44.405) Pub Date : 2017-09-19
    M.J. Friedrich

    In Afghanistan, people with disabilities, particularly those in remote areas, have not seen improvement in health care availability or coverage, despite investments made in health care by the international community over the last decade, report researchers in a Lancet Global Health study. The investigators from the United States and the United Kingdom used data from 2 representative household surveys conducted in 2005 and 2013 across 13 provinces in Afghanistan. The surveys, which included 334 people in 2005 and 961 people in 2013, asked questions about activity limitations and functional difficulties, socioeconomic factors, perceived availability of health care, and experience with coverage of health care needs.

    更新日期:2017-09-19
  • Exposure to Lychee Orchard Pesticides Linked to AES Outbreak
    JAMA (IF 44.405) Pub Date : 2017-09-19
    M.J. Friedrich

    Exposure to pesticides and other agrochemicals sprayed on trees in lychee orchards has been linked to an outbreak of acute encephalitis syndrome (AES) in northern Bangladesh in 2012, according to a study in the American Journal of Tropical Medicine and Hygiene carried out by a collaborative team of clinicians, epidemiologists, and social scientists from Bangladesh and the United States. The leading hypothesized cause of AES among children living near lychee orchards was the ingestion of phytotoxins present in lychee seeds and pulp. However, recurrent AES outbreaks reported around lychee orchards, particularly around harvest season, and the short duration between onset of illness to death led the scientists to suspect toxic poisoning rather than infection or lychee ingestion.

    更新日期:2017-09-19
  • Progress Stalls in Improving Vaccine Coverage Rates
    JAMA (IF 44.405) Pub Date : 2017-09-19
    M.J. Friedrich
    更新日期:2017-09-19
  • Community-Based Prevention and Strategies for the Opioid Crisis
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Howard K. Koh
    更新日期:2017-09-19
  • Notice of Retraction and Replacement: Favini et al. Comparative Trends in Payment Adjustments Between Safety-Net and Other Hospitals Since the Introduction of the Hospital Readmission Reduction Program and Value-Based Purchasing. JAMA. 2017;317(15):1578-1580.
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Nathan Favini, Jason M. Hockenberry, Matlin Gilman, Sanjula Jain, Michael K. Ong, E. Kathleen Adams, Edmund R. Becker

    In the Research Letter titled “Comparative Trends in Payment Adjustments Between Safety-Net and Other Hospitals Since the Introduction of the Hospital Readmission Reduction Program and Value-Based Purchasing” published in the April 18, 2017, issue of JAMA, we reported incorrect trends in excess readmission ratios.1 This study was a retrospective analysis of public data on hospital payment adjustments levied under the Hospital Readmission Reduction Program (HRRP) and Value-Based Purchasing differentiated by safety-net vs non–safety-net hospital status. The original article also analyzed the underlying excess readmission ratios used to calculate the HRRP payment penalties.

    更新日期:2017-09-19
  • Low-Dose Desmopressin Nasal Spray and FDA Approval—Reply
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Michael Fralick, Aaron S. Kesselheim

    In Reply Drs Fein and Herschkowitz indicate that the pharmacokinetics of desmopressin nasal spray (Noctiva) mitigate the risk of hyponatremia while preserving efficacy. However, the drug was approved with a boxed warning, “Noctiva can cause hyponatremia, which may be life-threatening if severe.”1 This prominent FDA-required statement supports the contention that hyponatremia was still seen by the reviewers as an important risk from use of this medication.1 The authors also state that all 5 deaths in the desmopressin group were unrelated to the product, but this differs from the phrasing in the FDA report: “All deaths occurred among patients in the desmopressin group and none occurred in the placebo group, although 3 deaths were deemed by the FDA to be unrelated to the medication.”2

    更新日期:2017-09-19
  • Shortage or Surplus of Physicians in the United States—Reply
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Ezekiel J. Emanuel, Emily Gudbranson

    In Reply Dr Butt, Dr Kruse, and Drs Farnbach Pearson and Larson dispute our estimates on whether a physician shortage truly exists. We believe that their math is mistaken. In all of our calculations, we were quite conservative, allotting 12 half-hour primary care appointments per day (just 6 hours of patient time per day) and physician panel sizes of 1500 patients. The calculations assumed physicians worked just 40 weeks per year. These assumptions leave more than sufficient time—2 to 4 hours per day and several weeks per year—for physicians to fulfill the myriad other nonclinical responsibilities cited by Butt, such as administration, responding to emails, and teaching medical students and house staff.

    更新日期:2017-09-19
  • Low-Dose Desmopressin Nasal Spray and FDA Approval
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Seymour Fein, Samuel Herschkowitz

    To the Editor Drs Fralick and Kesselheim1 raised concerns about desmopressin nasal spray (Noctiva, Serenity Pharmaceuticals), its approval by the US Food and Drug Administration (FDA) for nocturia, potential safety issues, and clinical effectiveness. Their Viewpoint contains misstatements involving the clinical data, the program, and the basis for FDA approval.

    更新日期:2017-09-19
  • Shortage or Surplus of Physicians in the United States
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Amy W. Farnbach Pearson, Richard S. Larson

    To the Editor Ms Gudbranson and colleagues offered a provocative reexamination of the adequacy of the US primary care physician workforce.1 We have several concerns regarding their analysis. They estimated demand for primary care using the total number of US primary care visits per year. This is not a measure of demand but another way of measuring supply; that is, the number of appointment slots available to patients. To our knowledge, there is no available measure of the more pertinent value: the number of visits sought. How many patients, when faced with a 20-day wait time, forgo care or make a costly emergency department or urgent care visit? This is particularly pertinent in rural areas, where clinicians may be lacking.

    更新日期:2017-09-19
  • Shortage or Surplus of Physicians in the United States
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Jerry Kruse

    To the Editor The determination of physician supply is fraught with difficulty. With relative ease, overestimates, underestimates, and miscategorizations occur, particularly for the differentiation between primary care and specialty physicians. Reports often ignore the definition of primary care, articulated in 1978 and reaffirmed in 1996 by the Institute of Medicine1: Primary care is the provision of integrated, accessible health services by clinicians who are accountable for addressing a large majority of health care needs, who develop sustained relationships with patients, and who practice within the context of family and community. In short, primary care physicians are usual sources of comprehensive, longitudinal medical care. In this light, the article by Ms Gudbranson and colleagues deserves comment.2

    更新日期:2017-09-19
  • Shortage or Surplus of Physicians in the United States
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Adeel Ajwad Butt

    To the Editor The Viewpoint by Ms Gudbranson and colleagues calculating the number of physicians needed in the United States did not consider the numerous roles that physicians play in the health care sector.1 If administrative workload, teaching of trainees (medical students, residents, and fellows), and research are included, the estimates may be quite different. The administrative burden of billing, coding, and entering data in electronic medical records requires several extra hours of work per week. No physician can be expected to assign 100% of their time to clinical care, and although some previously published models account for clinical full-time equivalents,2 it is unclear whether Gudbranson and colleagues took this into consideration. Furthermore, models accounting for clinical full-time equivalents project a serious shortage of physicians over the next decade. A report prepared for the Association of American Medical Colleges notes that the demand for physicians in 2025 will exceed supply by 46 100 to 90 400.2 Physicians in the United States (excluding residents) work an average of 49.6 hours per week compared with 44.9 hours for lawyers, 43.0 hours for engineers, and 37.3 hours for registered nurses.3 This estimate does not take into account being on call when physicians need to be immediately available but not present on-site.

    更新日期:2017-09-19
  • Characteristics of Novel Therapeutics and Postmarket Safety Events—Reply
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Nicholas S. Downing, Nilay D. Shah, Joseph S. Ross

    In Reply Dr Tanimoto and colleagues suggest that 3 additional characteristics of novel therapeutics or features of their regulatory approval should be considered when examining potential predictors of postmarket safety events after approval by the FDA: expected length of treatment, first approval by a peer regulator, such as the EMA, and total number of patients participating in the manufacturer’s pivotal trial program. We appreciate these suggestions and in response have examined whether postmarket safety event risk was associated with either expected length of treatment or relative number of patients participating in premarket clinical studies. However, we did not examine first approval by a peer regulator because new drug application submission occurs more or less simultaneously to the FDA and EMA, with approval within a few months.1

    更新日期:2017-09-19
  • Characteristics of Novel Therapeutics and Postmarket Safety Events
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Tetsuya Tanimoto, Jinichi Mori, Yasuo Oshima

    To the Editor Dr Downing and colleagues1 analyzed the frequency of postmarket safety events among 222 novel therapeutics approved by the US Food and Drug Administration (FDA) between 2001 and 2010 and found that 32% had a postmarket safety event during a median 11.7 years after approval. The authors prespecified 7 features to assess for differences in events over time: (1) class, (2) therapeutic area, (3) priority review, (4) accelerated approval, (5) orphan product, (6) near–regulatory deadline approval, and (7) total review time. However, we would like to raise additional features that need further consideration to interpret the study results.

    更新日期:2017-09-19
  • Contribution of Opioid-Involved Poisoning to the Change in Life Expectancy in the United States, 2000-2015
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Deborah Dowell, Elizabeth Arias, Kenneth Kochanek, Robert Anderson, Gery P. Guy, Jan L. Losby, Grant Baldwin
    更新日期:2017-09-19
  • Urine Drug Screens to Monitor Opioid Use for Managing Chronic Pain
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Shannon Haymond, Geeta Nagpal, Heather Heiman
    更新日期:2017-09-19
  • A Pink Nodule on a Boy's Left Cheek
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Wei Liu, Jia-Wei Liu, Dong-Lai Ma
    更新日期:2017-09-19
  • Antipsychotics to Treat Agitation or Psychosis in Patients With Dementia
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Daniel Yohanna, Adam S. Cifu
    更新日期:2017-09-19
  • Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative CareA Randomized Clinical Trial
    JAMA (IF 44.405) Pub Date : 2017-09-19
    David Hui, Susan Frisbee-Hume, Annie Wilson, Seyedeh S. Dibaj, Thuc Nguyen, Maxine De La Cruz, Paul Walker, Donna S. Zhukovsky, Marvin Delgado-Guay, Marieberta Vidal, Daniel Epner, Akhila Reddy, Kimerson Tanco, Janet Williams, Stacy Hall, Diane Liu, Kenneth Hess, Sapna Amin, William Breitbart, Eduardo Bruera
    更新日期:2017-09-19
  • Carotid Endarterectomy and Carotid Artery Stenting in the US Medicare Population, 1999-2014
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Judith H. Lichtman, Michael R. Jones, Erica C. Leifheit, Alice J. Sheffet, George Howard, Brajesh K. Lal, Virginia J. Howard, Yun Wang, Jeptha Curtis, Thomas G. Brott
    更新日期:2017-09-19
  • Effect of Post–Cesarean Delivery Oral Cephalexin and Metronidazole on Surgical Site Infection Among Obese WomenA Randomized Clinical Trial
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Amy M. Valent, Chris DeArmond, Judy M. Houston, Srinidhi Reddy, Heather R. Masters, Alison Gold, Michael Boldt, Emily DeFranco, Arthur T. Evans, Carri R. Warshak
    更新日期:2017-09-19
  • Effect of a Community Health Worker–Led Multicomponent Intervention on Blood Pressure Control in Low-Income Patients in ArgentinaA Randomized Clinical Trial
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Jiang He, Vilma Irazola, Katherine T. Mills, Rosana Poggio, Andrea Beratarrechea, Jacquelyn Dolan, Chung-Shiuan Chen, Luz Gibbons, Marie Krousel-Wood, Lydia A. Bazzano, Analia Nejamis, Pablo Gulayin, Marilina Santero, Federico Augustovski, Jing Chen, Adolfo Rubinstein
    更新日期:2017-09-19
  • Humanizing the Treatment of Hyperactive Delirium in the Last Days of Life
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Pratik P. Pandharipande, E. Wesley Ely

    When patients with advanced cancer near the end of their life, it is important for physicians, nurses, and other health care personnel to respect and dignify the dying process of the patient. This requires a shift in focus from medical intervention to personalization of care to meet the subjective needs of patients and families, including coordination of care, symptom management, communication, and education; emotional and spiritual support; and support of patients’ social relationships and decision making.1 Pain, dyspnea, and hyperactive (ie, agitated) delirium are often experienced by dying patients and witnessed by caregivers. In a study, for example, 51% of 236 patients in palliative care units toward the end of their life had the distressing symptoms of hyperactive delirium.2 Limited evidence is available to guide the clinician in managing these symptoms. Although administration of psychoactive medications can sedate patients and reduce outward symptoms of hyperactive delirium, these drugs do so at the cost of precious time that dying patients and families have to communicate with each other, and they also have important adverse effects.

    更新日期:2017-09-19
  • Postoperative Antimicrobial Prophylaxis Following Cesarean Delivery in Obese WomenAn Exception to the Rule?
    JAMA (IF 44.405) Pub Date : 2017-09-19
    David P. Calfee, Amos Grünebaum

    Cesarean delivery is one of the most commonly performed surgical procedures. In 2015, 1.27 million infants born in the United States, representing 32% of all US births, were born by cesarean delivery.1 Cesarean delivery is the most important risk factor for infection in the postpartum period. Surveillance for postcesarean surgical site infection (SSI) conducted in the United States between 2006 and 2008 demonstrated an overall SSI rate of approximately 2%,2 but infection rates of up to 20% have been observed in some clinical studies.3 Several factors have been associated with the development of postcesarean SSI, including emergency surgery, onset of labor prior to delivery, membrane rupture prior to surgery, surgical wound class, procedure duration, and obesity.2,4 Among these, obesity is one of the most commonly encountered risk factors. In 2014, 24.8% of women who gave birth in the United States were obese (body mass index >29.9).5 Thus, an estimated 315 000 infants are born to obese women by cesarean delivery in the United States each year.

    更新日期:2017-09-19
  • Improving Blood Pressure Control and Health Systems With Community Health Workers
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Mark D. Huffman, Dike Ojji, Donald M. Lloyd-Jones

    In this issue of JAMA, He and colleagues1 report the results of the Hypertension Control Program in Argentina, a community health worker–led, home-based intervention that aimed to lower blood pressure among 1432 low-income adults with uncontrolled hypertension in Argentina. Compared with usual care, the intervention lowered systolic blood pressure by 6.6 mm Hg (95% CI, 4.6-8.6 mm Hg) and diastolic blood pressure by 5.4 mm Hg (95% CI, 4.0-6.8 mm Hg). This program led to a remarkable 21% absolute difference in the proportion of individuals with controlled blood pressure, defined as a systolic and diastolic blood pressure less than 140/90 mm Hg (73% in the intervention group vs 52% in the usual care group). After 18 months, the mean-adjusted total cost related to the intervention and to health care was $103 (95% CI, $61-$144) higher per participant in the intervention group than in the control group ($178.6 vs $67.6 in total costs, respectively), which was approximately 5% of Argentina’s annual per capita health spending of $1322 in 2015.2

    更新日期:2017-09-19
  • “The Tunnel at the End of the Light”Preparing to Attend on the Inpatient Medical Wards
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Vineet Chopra, Sanjay Saint
    更新日期:2017-09-19
  • The Lower Seven-Eighths
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Joseph Gascho

    I ate only one meal in a restaurant during my five-day visit to Paris in the fall of 2011: lunch at Les Deux Magots. It took an hour. Not because I am a slow eater and not because I was in awe of the ambience but because I had tic douloureux, better known as trigeminal neuralgia. I’d take a bite, and excruciating pain would shoot up above my right eye. I thinned my sandwich by removing the top piece of bread so the bite would be smaller. I found that I could best eat by taking food to my hotel room, chewing slowly and gingerly, thinned as much as possible, while lying on my back.

    更新日期:2017-09-19
  • The United Kingdom Sets Limits on Experimental TreatmentsThe Case of Charlie Gard
    JAMA (IF 44.405) Pub Date : 2017-09-19
    Robert D. Truog

    The case of Charlie Gard in London, England, has been the focus of international attention, generating polarized views about the use of experimental treatments. On one side are those who hold that patients should be able to purchase whatever treatments they desire and can afford; on the other are those who maintain that governments must play a regulatory role in protecting patients from harm and that unproven therapies must meet a threshold of scientific validity before they are offered, regardless of the ability of the patient to pay.

    更新日期:2017-09-19
  • Highlights
    JAMA (IF 44.405) Pub Date : 2017-09-19
    更新日期:2017-09-19
  • The Misuse of Meta-analysis in Nutrition Research
    JAMA (IF 44.405) Pub Date : 2017-09-18
    Neal D. Barnard, Walter C. Willett, Eric L. Ding

    Controversial conclusions from meta-analyses in nutrition are of tremendous interest to the public and can influence policies on diet and health. When the results of meta-analyses are the product of faulty methods, they can be misleading and can also be exploited by economic interests seeking to counteract unflattering scientific findings about commercial products. The term meta-analysis was coined by Glass in the mid-1970s for a set of techniques designed to characterize and combine the findings of prior studies in order to increase statistical power, provide quantitative summary estimates, and identify data gaps and biases. When applied to studies conducted with similar populations and methods, meta-analyses can be useful. However, many published meta-analyses have combined the findings of studies that differ in important ways, prompting Eysenck to complain that they have mixed apples and oranges—and sometimes “apples, lice, and killer whales”—yielding meaningless conclusions.1

    更新日期:2017-09-18
  • Flawed Theories to Explain Child Physical AbuseWhat Are the Medical-Legal Consequences?
    JAMA (IF 44.405) Pub Date : 2017-09-18
    John M. Leventhal, George A. Edwards

    Over the last 2 decades, a small number of pediatricians, radiologists, neurosurgeons, pathologists, attorneys, and journalists have advanced scientifically unsupported theories both in publications and in the courtroom to explain the findings of physical abuse of children. These individuals have not only obscured facts about child abuse but also generated controversy and confusion among both the public and the medical community about the diagnosis of child physical abuse and, in particular, the diagnosis of abusive head trauma.

    更新日期:2017-09-18
  • Work Progresses on Male Contraceptives, but Hurdles Remain
    JAMA (IF 44.405) Pub Date : 2017-09-14
    Rita Rubin
    更新日期:2017-09-15
  • FDA Approval of Nonadjunctive Use of Continuous Glucose Monitors for Insulin DosingA Potentially Risky Decision
    JAMA (IF 44.405) Pub Date : 2017-09-14
    Alan R. Shapiro

    On December 20, 2016, the US Food and Drug Administration (FDA) approved labeling for use of the Dexcom G5 Mobile continuous glucose monitor (CGM) for making diabetes treatment decisions without a need for confirmation of the device’s readings with fingerstick or laboratory testing (ie, nonadjunctively).1 The FDA relabeling allowed the Centers for Medicare & Medicaid Services (CMS) to reclassify the device 3 weeks later as durable medical equipment able to replace blood glucose meters and therefore eligible for reimbursement.2 The device measures interstitial fluid glucose concentrations to estimate blood glucose concentrations. To mitigate the acknowledged risk from inaccurate estimates of blood glucose values, labeling for the device previously required a confirmation with a blood glucose meter whenever the device was used for treatment decisions, including the dosing of insulin.3 This requirement has been removed.

    更新日期:2017-09-15
  • Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons
    JAMA (IF 44.405) Pub Date : 2017-09-13
    Asa Radix, Andrew M. Davis

    Transgender individuals have a gender identity that does not align with their sex assignment at birth (gender incongruence). They account for about approximately 0.4% of the US population (1 million people).1 Some transgender people experience gender dysphoria, distress caused by the discrepancy between gender identity and birth-assigned sex, linked to lifetime suicide attempt rates of 40%.2 Some may start to live or transition into their affirmed gender. This may include social or legal transition, such as changes to attire, name, and pronouns. Some may request hormones, surgery, or both to diminish the secondary sex characteristics associated with their birth sex. Children diagnosed as having GD/GI may start GnRH agonists after beginning puberty to prevent permanent changes, including facial hair, deepening of the voice, and breast growth. Thereafter, they may initiate hormones to acquire the secondary sex characteristics of their affirmed gender. Prospective studies suggest these interventions are associated with improved psychological functioning and reduction in anxiety and depression.3

    更新日期:2017-09-14
  • Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014
    JAMA (IF 44.405) Pub Date : 2017-09-13
    Chanu Rhee, Raymund Dantes, Lauren Epstein, David J. Murphy, Christopher W. Seymour, Theodore J. Iwashyna, Sameer S. Kadri, Derek C. Angus, Robert L. Danner, Anthony E. Fiore, John A. Jernigan, Greg S. Martin, Edward Septimus, David K. Warren, Anita Karcz, Christina Chan, John T. Menchaca, Rui Wang, Susan Gruber, Michael Klompas
    更新日期:2017-09-13
  • Counting Sepsis, an Imprecise but Improving Science
    JAMA (IF 44.405) Pub Date : 2017-09-13
    Kristina E. Rudd, Anthony Delaney, Simon Finfer

    Sepsis, most succinctly defined as organ dysfunction due to infection, is estimated to account for more than 5 million deaths around the world each year and to cause or contribute to approximately half of all deaths occurring in hospitals in the United States.1,2 A 2016 report from the Healthcare Cost and Utilization Project estimated the cost of treating sepsis in US hospitals in 2013 at $24 billion, making it the most expensive condition treated in US hospitals among all payers.3 In recent years, the substantial burden of sepsis at the individual, health system, and societal levels has become increasingly recognized by the medical community and the public, culminating in the World Health Organization (WHO) adopting the Improving the Prevention, Diagnosis, and Management of Sepsis resolution at the World Health Assembly in May 2017.4

    更新日期:2017-09-13
  • JAMA
    JAMA (IF 44.405) Pub Date : 2017-09-12

    The JAMA Network is a consortium of peer-reviewed print and online medical publications that includes JAMA® and 11 other specialty Network journals. JAMA does not hold itself responsible for statements made by any contributor. All articles published, including opinion articles, represent the views of the authors and do not reflect the policy of JAMA, the American Medical Association, or the institution with which the author is affiliated unless otherwise indicated.

    更新日期:2017-09-12
  • Pneumothorax
    JAMA (IF 44.405) Pub Date : 2017-09-12
    Jonathan B. Imran, Alexander L. Eastman
    更新日期:2017-09-12
  • Progress in Teaching PsychiatryAdolf Meyer, M.D., Baltimore
    JAMA (IF 44.405) Pub Date : 2017-09-12

    The request of our secretary for a contribution to this meeting suggested to me an extension of my discussion1 on the psychobiologic level of medical facts (presented two years ago in San Francisco and published in The Journal of the American Medical Association, 1915), a consideration of my present plan of teaching psychopathology and psychiatry and of some principles characteristic of the plan. No real physician is altogether specialist and no real specialist fails to define his share as part of the great problem of helping the sick and troubled patient. The psychiatrist may at last say that he has found himself. Instead of being singled out from the rest of physicians as what used to be called an asylum man, pure and simple, he has found his sphere in the special study of the patient as a person, the special study of the total activities and total behavior, the kind of thing which cannot be singled out as merely the function of any one detachable organ, not even of the brain by itself.

    更新日期:2017-09-12
  • Michael Jackson’s Procedures
    JAMA (IF 44.405) Pub Date : 2017-09-12
    Michael Collins

    更新日期:2017-09-12
  • Challenges in HCV Elimination
    JAMA (IF 44.405) Pub Date : 2017-09-12
    更新日期:2017-09-12
  • Lax Infection Control Consequences
    JAMA (IF 44.405) Pub Date : 2017-09-12
    更新日期:2017-09-12
  • Expanded Tissue Samples Poised to Assist Pathologists
    JAMA (IF 44.405) Pub Date : 2017-09-12
    Jennifer Abbasi

    A novel method to physically expand small biopsy tissue samples could help pathologists predict and diagnose disease more accurately using light microscopy. Researchers at the Massachusetts Institute of Technology, Harvard Medical School, and the Broad Institute developed the method, called expansion pathology (ExPath). In ExPath, clinical samples are attached to a polymer that swells when wet. An enzyme called proteinase K digests parts of the samples that are not of interest before water is added, swelling the remaining tissues. Expanded to 100 times their original volume, the larger specimens enable 70-nm-resolution imaging on conventional diffraction-limited microscopes. This level of resolution is currently limited to costly electron microscopes, which are rarely used in the clinic.

    更新日期:2017-09-12
  • Lightweight Exosuit Could Help Patients Walk After Stroke
    JAMA (IF 44.405) Pub Date : 2017-09-12
    Jennifer Abbasi

    Researchers at Harvard University and Boston University have developed a lightweight, soft robotic exosuit that improves gait in patients who have experienced a stroke. In a small study of 9 patients who ranged from 9 months to more than 14 years poststroke, the exosuit worn on the partially paralyzed lower limb improved forward propulsion and ground clearance during treadmill and overground walking and reduced the energy required to walk. The research appeared in Science Translational Medicine.

    更新日期:2017-09-12
  • Nanochip Turns Skin Into a Bioreactor
    JAMA (IF 44.405) Pub Date : 2017-09-12
    Jennifer Abbasi
    更新日期:2017-09-12
  • “America’s Health First”: A Misnomer
    JAMA (IF 44.405) Pub Date : 2017-09-12
    Lawrence O. Gostin
    更新日期:2017-09-12
Some contents have been Reproduced with permission of the American Chemical Society.
Some contents have been Reproduced by permission of The Royal Society of Chemistry.
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