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  • Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
    JAMA (IF 44.405) Pub Date : 2017-11-20
    Adam S. Cifu, Andrew M. Davis
    更新日期:2017-11-21
  • The New 2017 ACC/AHA Guidelines “Up the Pressure” on Diagnosis and Treatment of Hypertension
    JAMA (IF 44.405) Pub Date : 2017-11-20
    Philip Greenland, Eric Peterson

    Hypertension, the world’s most common and modifiable cardiovascular risk factor,1 has been the focus of multiple clinical practice guidelines dating back to the first Joint National Committee in 1977. In 2014, a writing group commissioned by the National Heart, Lung, and Blood Institute focused on a few key treatment questions and used data only from randomized clinical trials (RCTs) to inform their recommendations.2 Based on a lack of RCT evidence, the writing group recommended relaxing some of the treatment goals for several subgroups, including patients aged 60 years or older and those with diabetes or kidney disease. Even before publication, these somewhat conservative recommendations were criticized and ultimately not endorsed either by major professional societies or by some of the original guideline writing group.3

    更新日期:2017-11-21
  • The 2017 Clinical Practice Guideline for High Blood Pressure
    JAMA (IF 44.405) Pub Date : 2017-11-20
    Paul K. Whelton, Robert M. Carey

    Clinical practice guidelines (CPGs) are well suited to the management of high blood pressure (BP) because it is a condition that is common, costly for patients and society, exhibits considerable variation in practice patterns and hypertension control rates by geographic region and socioeconomic status, and has a substantial body of scientific evidence available to support recommendations.1 BP-related CPGs have long been a part of routine clinical practice, beginning with the 1977 Report of the Joint National Committee (JNC) on Detection, Evaluation, and Treatment of High Blood Pressure.2

    更新日期:2017-11-21
  • 更新日期:2017-11-17
  • Effect of Granulocyte-Macrophage Colony-Stimulating Factor With or Without Supervised Exercise on Walking Performance in Patients With Peripheral Artery DiseaseThe PROPEL Randomized Clinical Trial
    JAMA (IF 44.405) Pub Date : 2017-11-15
    Mary M. McDermott, Luigi Ferrucci, Lu Tian, Jack M. Guralnik, Donald Lloyd-Jones, Melina R. Kibbe, Tamar S. Polonsky, Kathryn Domanchuk, James H. Stein, Lihui Zhao, Doris Taylor, Christopher Skelly, William Pearce, Harris Perlman, Walter McCarthy, Lingyu Li, Ying Gao, Robert Sufit, Christina L. Bloomfield, Michael H. Criqui
    更新日期:2017-11-16
  • JAMA
    JAMA (IF 44.405) Pub Date : 2017-11-14

    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:2017-11-15
  • Acute Mountain Sickness
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Jill Jin
    更新日期:2017-11-15
  • The Method of Experiment in Medicine
    JAMA (IF 44.405) Pub Date : 2017-11-14

    “In a country rich in gold, observant wayfarers may find nuggets on their path; but only systematic mining can provide the currency of nations. In the search for natural knowledge, the experimentalists are the miners.” There is a peculiar appropriateness in these words of Gowland Hopkins of Cambridge University at a time when men’s minds are diverted by the great emergencies of war and are upset by the distorted values of every-day life. Nowadays it would require a foolhardy person to maintain that “there is nothing new under the sun,” or to prophesy what cannot be done. The progressive evolution of science is expressed in the arts exemplified daily before us. We marvel at the newest phase of the conquest of the upper air or the ocean depths, at the irresistible force of the newest explosive or the perfection of the latest motor, all too often oblivious of the great strides that experimentation in medicine has brought about.

    更新日期:2017-11-15
  • When
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Carol Snyder Halberstadt

    更新日期:2017-11-15
  • Beyond Heart Symbolism: Artistic Representation of Narratives of Congenital Heart Disease
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Giovanni Biglino, Sofie Layton, Jo Wray
    更新日期:2017-11-15
  • “Healing Bracelet” Causes Harm
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Rita Rubin
    更新日期:2017-11-15
  • Stroke Death Rate Plateaus
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Rita Rubin
    更新日期:2017-11-15
  • Functional Brain Imaging Updates on the Horizon
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Jennifer Abbasi

    Two teams of researchers are poised to bring new functional brain imaging technologies to the clinic. First, within a few years, physicians could have a way to monitor brain function at the bedside of hospitalized infants, something that is not currently possible with large functional magnetic resonance imaging (fMRI) machines. European researchers have developed a portable brain scanning technology called functional ultrasound imaging (fUSI). The fUSI system employs a flexible, noninvasive head mount and combines video-electroencephalographic recording with ultrafast Doppler (UfD) imaging of brain microvasculature.

    更新日期:2017-11-15
  • Laboratory-on-a-Chip Uses Acoustics to Isolate Tell-Tale Particles in Blood
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Jennifer Abbasi
    更新日期:2017-11-15
  • The High Costs of Unnecessary Care
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Aaron E. Carroll
    更新日期:2017-11-15
  • Phage Therapy’s Role in Combating Antibiotic-Resistant Pathogens
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Jeff Lyon
    更新日期:2017-11-15
  • Error in Flow Diagram
    JAMA (IF 44.405) Pub Date : 2017-11-14

    In the Original Investigation entitled “Effect of Post–Cesarean Delivery Oral Cephalexin and Metronidazole on Surgical Site Infection Among Obese Women: A Randomized Clinical Trial”1 published in the September 19, 2017, issue of JAMA, an error occurred in the Figure. In the placebo group, the figure should have stated that 198 received placebo as randomized and 3 did not receive placebo as randomized (withdrew prior to placebo administration). This article was corrected online.

    更新日期:2017-11-15
  • Incorrect Statistical Measures and Typographical Errors
    JAMA (IF 44.405) Pub Date : 2017-11-14

    In the Original Investigation article entitled “Effect of Routine Low-Dose Oxygen Supplementation on Death and Disability in Adults With Acute Stroke: The Stroke Oxygen Study Randomized Clinical Trial”1 published in the September 26, 2017, issue of JAMA, incorrect data were reported. In Table 1, the SI conversion factor should have read “To convert glucose to mmol/L, multiply values by 0.0555.” In Table 2, some values, reported as 99% CIs were actually 95% CIs. The correct 99% CIs for the Barthel ADL index should be 70.2 (68.2 to 72.2) in the continuous oxygen group, 71.1 (69.1 to 73.1) in the nocturnal oxygen group, and 70.9 (68.9 to 72.8) in the control group; for the Nottingham Extended ADL, 9.66 (9.29 to 10.02) in the continuous oxygen group, 9.54 (9.17 to 9.90) in the nocturnal oxygen group, and 9.77 (9.40 to 10.14) in the control group; for VAS for quality of life, 55.4 (53.8 to 57.1) in the continuous oxygen group, 55.7 (54.1 to 57.3) in the nocturnal oxygen group, and 55.5 (53.8 to 57.1) in the control group; for highest systolic BP within 72 hours, −1.96 (−3.48 to −0.44) in comparison 1; for highest diastolic BP within 72 hours, −1.10 (−2.06 to −0.15) in comparison 1; for highest temperature within 7 days, 0.01 (−0.03 to 0.04) in comparison 1; and for serious adverse events, 0.94 (0.78 to 1.13) in comparison 1 and 1.19 (0.96 to 1.47) in comparison 2. In Figure 3, there were 4703 patients in the continuous or nocturnal oxygen group who did not have congestive heart failure, and for patients in the continuous or nocturnal oxygen group on whom thrombolysis was performed vs not, the P value test for interaction was .40. Changes to these reported statistical measures do not affect the conclusions of this study. This article was corrected online.

    更新日期:2017-11-15
  • Personal Sound Amplification Products for Hearing Loss—Reply
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Nicholas S. Reed, Frank R. Lin

    In Reply In our study, the type of hearing loss was limited to sensorineural hearing loss, which is commonly associated with the age-related hearing loss that an over-the-counter option (ie, PSAPs) would target. In addition, our study used real-ear measures, considered an aspect of best-practice clinical hearing aid fitting, to address the customization in each individual ear. We did not include loudness discomfort level. Although loudness discomfort levels have been previously reported as a common aspect of hearing aid fitting, the most recent review revealed low and limited scientific evidence of their effectiveness in hearing aid fitting.1

    更新日期:2017-11-15
  • Personal Sound Amplification Products for Hearing Loss
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Manuele Casale, Lorenzo Sabatino, Fabrizio Salvinelli

    To the Editor Dr Reed and colleagues1 compared personal sound amplification products (PSAPs) with a conventional hearing aid for speech understanding in noise in patients affected by mild to moderate hearing loss. In an audiologist’s practice, the hearing aid gain is largely influenced by hearing loss type (transmissive, sensorineural, or mixed) or the area of abnormality in the auditory system (middle ear, inner ear, or brain), but these were not specified in the Research Letter.

    更新日期:2017-11-15
  • Antipsychotic Drug Prescribing In Nursing Homes—Reply
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Jerry H. Gurwitz, Alice Bonner, Donald M. Berwick

    In Reply We did not claim in our Viewpoint, nor do we believe, that the National Partnership to Improve Dementia Care in Nursing Homes has been the sole cause of the decline in antipsychotic use observed among nursing home residents over the past 5 years.1 What we did claim is that the evidence suggests that it played a significant role, and that, without it, progress would have been slower and less steady. In their letters, Dr Gillick and Dr Westbury raise some important contextual issues relevant to the findings reported in our Viewpoint. Gillick describes the marketing efforts of pharmaceutical manufacturers to promote non–FDA-approved (off-label) use of atypical antipsychotics and the large financial settlements that have been paid to federal and state governments for engaging in off-label promotion. Pharmaceutical marketing activities in nursing homes were quite common prior to the launch of the National Partnership to Improve Dementia Care in Nursing Homes.2 In the 2011 report of the Office of Inspector General, “Medicare Atypical Drug Claims for Elderly Nursing Home Residents,”3 the aggressive marketing efforts of the pharmaceutical industry were highlighted. However, although it is possible that large financial settlements against manufacturers and the cessation of illegal marketing practices contributed to reductions in off-label antipsychotic prescribing, evidence supporting this specific association is not available.4

    更新日期:2017-11-15
  • Antipsychotic Drug Prescribing in Nursing Homes
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Juanita L. Westbury

    To the Editor The claim in the Viewpoint by Dr Gurwitz and colleagues that the CMS National Partnership to Improve Dementia Care in Nursing Homes has led to a 33% relative reduction in the prevalence of antipsychotic use among long-term nursing home residents over the past 5 years1 is not strictly correct and requires qualification. The CMS antipsychotic prevalence figures reported actually only include approximately 90% of nursing home residents. Residents classified as having schizophrenia, who, by the end of 2015, composed nearly 9% of the nursing home population, are not included.2 Although the majority of residents with this condition would be prescribed antipsychotic treatment, this use is not factored in the CMS antipsychotic reduction calculation, nor is it included in the calculations of the publicly accessible 5-star quality scores used to rank nursing homes in the United States.3

    更新日期:2017-11-15
  • Antipsychotic Drug Prescribing in Nursing Homes
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Muriel R. Gillick

    To the Editor In their Viewpoint,1 Dr Gurwitz and colleagues drew attention to the recent success in addressing the overuse of antipsychotic medication in nursing homes. They attributed the decline in prescribing for atypical antipsychotics—drugs that have long been widely prescribed for the treatment of the behavioral symptoms of dementia despite the absence of evidence that they are effective for this indication and despite the US Food and Drug Administration (FDA) black box warning against their use—to the National Partnership to Improve Dementia Care in Nursing Homes, initiated by the Centers for Medicare & Medicaid Services (CMS). But there is another part of the story that deserves mention.

    更新日期:2017-11-15
  • Insulin Analogues and Hypoglycemia in Patients With Type 1 Diabetes—Reply
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Wendy Lane, Timothy S. Bailey, Gregg Gerety

    In Reply The SWITCH 1 trial was the first trial, to our knowledge, to investigate hypoglycemia as a primary outcome in patients with type 1 diabetes, comparing insulin degludec with insulin glargine. Personalizing fasting blood glucose targets for patients remains important in clinical practice. However, in the trial, identical fasting blood glucose target goals and noninferior HbA1c values were imperative for analysis of the primary outcome of hypoglycemia. The protocol included algorithms for up- or down-titration of the insulin dose to achieve target fasting blood glucose levels of 71 mg/dL to 90 mg/dL; titration was conducted at the investigator’s discretion, so at no time was patient safety compromised. Targeting a higher fasting blood glucose would not facilitate achieving HbA1c values of less than 7%, as recommended by the American Diabetes Association1 or less than 6.5%, as recommended by the American Association of Clinical Endocrinologists.2 Achieving a fasting blood glucose target of less than 110 mg/dL and a HbA1c target less than 7% proved difficult in past treat-to-target trials using older insulins, and earlier landmark studies showed that intensive treatment aimed at reducing microvascular and macrovascular complications increased hypoglycemia risk.3 Aiming for higher blood glucose targets in the management of type 1 diabetes implies a conservative approach to avoid hypoglycemia, in part reflecting a past era of older insulins, which were shorter acting and with more variable and less-predictable time-action profiles than newer basal insulin analogues.

    更新日期:2017-11-15
  • Insulin Analogues and Hypoglycemia in Patients With Type 1 Diabetes
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Henryk Zulewski, Ulrich Keller

    To the Editor The SWITCH 1 randomized clinical trial compared the effect of 2 insulin analogues, insulin degludec vs insulin glargine, on the frequency of hypoglycemic events in patients with type 1 diabetes and risk factors for hypoglycemia.1 According to the study protocol, the insulin dose was titrated to reach fasting glucose values between 71 mg/dL and 90 mg/dL (3.9-5.0 mmol/L). Such low target values increase the risk of severe hypoglycemia. The American Diabetes Association2 and National Institute for Health and Care Excellence3 in the United Kingdom recommend fasting glucose values that range from 90 mg/dL to 130 mg/dL. Also, professional diabetes organizations suggest less-stringent hemoglobin A1c (HbA1c) targets and, thus, higher target glucose values for patients at risk of severe hypoglycemia to prevent this complication.

    更新日期:2017-11-15
  • Change in Testing, Awareness of Hemoglobin A1c Result, and Glycemic Control in US Adults, 2007-2014
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Saeid Shahraz, Anastassios G. Pittas, Mojdeh Saadati, Cindy P. Thomas, Christine M. Lundquist, David M. Kent
    更新日期:2017-11-15
  • Erythematous Rash Following Hematopoietic Stem Cell Transplantation
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Connie R. Shi, Molly Plovanich, Susan Burgin
    更新日期:2017-11-15
  • The “Utility” in Composite Outcome MeasuresMeasuring What Is Important to Patients
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Telba Z. Irony

    There are many harmful manifestations of atherosclerotic cardiovascular disease (ASCVD). Because all of these manifestations are undesirable, combining the most important ones into a single study outcome measure can simplify efforts to measure the overall effect of the disease on health outcomes. For example, ASCVD can result in myocardial infarction (MI), stroke, or death. Each of these is to be avoided, and how well an intervention reduces the risk of any of these occurring can be measured by combining all of these clinical outcomes into a single composite end point. A composite end point is an outcome that is defined as occurring if 1 or more of the components occurs. For ASCVD, one of the most common composites is called major adverse cardiovascular events (MACE). Because a composite outcome occurs more frequently than its individual components, composites can reduce the number of study participants required to achieve the desired power of a study, making it easier and less expensive to conduct a clinical trial.

    更新日期:2017-11-15
  • Does This Patient Have Acute Mountain Sickness?The Rational Clinical Examination Systematic Review
    JAMA (IF 44.405) Pub Date : 2017-11-14
    David Meier, Tinh-Hai Collet, Isabella Locatelli, Jacques Cornuz, Bengt Kayser, David L. Simel, Claudio Sartori
    更新日期:2017-11-15
  • Effect of Varying Doses of Epicutaneous Immunotherapy vs Placebo on Reaction to Peanut Protein Exposure Among Patients With Peanut SensitivityA Randomized Clinical Trial
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Hugh A. Sampson, Wayne G. Shreffler, William H. Yang, Gordon L. Sussman, Terri F. Brown-Whitehorn, Kari C. Nadeau, Amarjit S. Cheema, Stephanie A. Leonard, Jacqueline A. Pongracic, Christine Sauvage-Delebarre, Amal H. Assa’ad, Frederic de Blay, J. Andrew Bird, Stephen A. Tilles, Franck Boralevi, Thierry Bourrier, Jacques Hébert, Todd D. Green, Roy Gerth van Wijk, André C. Knulst, Gisèle Kanny, Lynda C. Schneider, Marek L. Kowalski, Christophe Dupont
    更新日期:2017-11-15
  • Derivation and External Validation of Prediction Models for Advanced Chronic Kidney Disease Following Acute Kidney Injury
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Matthew T. James, Neesh Pannu, Brenda R. Hemmelgarn, Peter C. Austin, Zhi Tan, Eric McArthur, Braden J. Manns, Marcello Tonelli, Ron Wald, Robert R. Quinn, Pietro Ravani, Amit X. Garg
    更新日期:2017-11-15
  • Association Between Prepregnancy Body Mass Index and Severe Maternal Morbidity
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Sarka Lisonkova, Giulia M. Muraca, Jayson Potts, Jessica Liauw, Wee-Shian Chan, Amanda Skoll, Kenneth I. Lim
    更新日期:2017-11-15
  • Effect of Locking Plate Fixation vs Intramedullary Nail Fixation on 6-Month Disability Among Adults With Displaced Fracture of the Distal TibiaThe UK FixDT Randomized Clinical Trial
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Matthew L. Costa, Juul Achten, James Griffin, Stavros Petrou, Ian Pallister, Sarah E. Lamb, Nick R. Parsons
    更新日期:2017-11-15
  • Prepregnancy Obesity and Severe Maternal MorbidityWhat Can Be Done?
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Aaron B. Caughey

    There is an obesity pandemic in the United States. In 1991, approximately 12% of the US population was obese,1 and no single state had an obesity rate greater than 15%. In 2014, the obesity rate was 38%,2 and no single state had an obesity rate less than 20%. Assuming that the prevalence of obesity was nearly zero for much of human history, it took thousands of years to reach an obesity prevalence of about 15%, but then just 25 years to more than double that rate. This pandemic is not only in the United States. Obesity rates have increased across most developed countries. Canada, for example, has had a similar increase in obesity, with prevalence reaching 24% among reproductive-aged women in 2012.3 Even in low-and middle-income countries, obesity rates are increasing.4 Health care costs associated with obesity are substantial. According to a 2013 report, obesity was estimated to add $600 per year in health care costs for a 20-year-old and $3800 per year in health care costs for a 70-year-old.5 According to these estimates, it is conceivable that health care costs associated with obesity could be more than $300 billion per year in the United States.

    更新日期:2017-11-15
  • Death by Gun Violence—A Public Health Crisis
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Howard Bauchner, Frederick P. Rivara, Robert O. Bonow, Neil M. Bressler, Mary L. (Nora) Disis, Stephan Heckers, S. Andrew Josephson, Melina R. Kibbe, Jay F. Piccirillo, Rita F. Redberg, John S. Rhee, June K. Robinson

    The shooting in Las Vegas, Nevada, that left 59 people dead, 10 times that number wounded, and thousands of people with the psychological distress from being present at the scene during and after the massacre has once again raised the issue of what we as a nation can and should do about guns. The solution lies in not just focusing on Las Vegas and the hundreds of other mass shootings that have occurred in the United States in the last 14 months, but rather to underscore that on average almost 100 people die each day in the United States from gun violence. The 36 252 deaths from firearms in the United States in 20151 exceeded the number of deaths from motor vehicle traffic crashes that year (36 161).1 That same year, the US Centers for Disease Control and Prevention reported that 5 people died from terrorism. Since 1968, more individuals in the United States have died from gun violence than in battle during all the wars the country has fought since its inception.2

    更新日期:2017-11-15
  • The Greatest GiftHow a Patient’s Death Taught Me to Be a Physician
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Lawrence I. Kaplan

    The package was in plain brown paper wrapping. The note enclosed read, “Thanks for everything you did for my father. It meant more than you can ever imagine.” I teared up, remembering the day I helped the father of a colleague die peacefully. When I opened the wrapping and saw the picture of two saplings planted side by side and a certificate saying that the family planted one in my honor next to the one in their father’s, the single tear turned to a river. Although I never thought that a patient’s death would be one of the best clinical experiences of my then young career, that day increased my love for practicing medicine significantly.

    更新日期:2017-11-15
  • Global Budgets for Safety-Net Hospitals
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Joshua M. Sharfstein, Sule Gerovich, David Chin

    Investing in outpatient and community-based services can improve health and lower cost in the United States. Opportunities include enhancing primary care, expanding evidence-based behavioral health services, improving the coordination of care for patients with complex health needs, and linking patients to critical social resources. Yet because there is limited direct reimbursement for such efforts, major expansions depend on capturing savings. As a committee of the National Academy of Medicine recently noted: “In terms of sustainability, interventions that improve health and quality of care or reduce utilization and cost are only feasible to maintain if the provider is paid in such a way that profits (revenues minus costs) are higher with the intervention than without.”1

    更新日期:2017-11-15
  • The Critical Role of Biomedical Research in Pandemic Preparedness
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Hilary D. Marston, Catharine I. Paules, Anthony S. Fauci

    Unusual reports of Kaposi sarcoma and Pneumocystis carinii (now P jiroveci) pneumonia in previously healthy gay men in 1981 alerted the world to a new infectious disease threat, heralding the HIV/AIDS pandemic. The medical and public health communities faced a steep learning curve in coordinating public health and biomedical research efforts as the pandemic evolved. Since then, international partners in academia, government, and industry have devoted substantial efforts to pandemic preparedness, building on lessons learned from HIV and other outbreaks ranging from the abrupt onset of the severe acute respiratory syndrome coronavirus (SARS-CoV) to the spread of Zika in the Americas to the devastating outbreak of Ebola in West Africa.

    更新日期:2017-11-15
  • FDA’s Innovative Plan to Address the Enormous Toll of Smoking
    JAMA (IF 44.405) Pub Date : 2017-11-14
    Kenneth E. Warner, Steven A. Schroeder

    On July 28, 2017, US Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, announced a comprehensive regulatory plan to expedite reducing the toll of more than 480 000 annual tobacco-related deaths in the United States.1 The plan is predicated on recognition that “nicotine—while highly addictive—is delivered through products that represent a continuum of risk and is most harmful when delivered through smoke particles in combustible cigarettes.”1

    更新日期:2017-11-15
  • The Las Vegas Shootings—Underscoring Key Features of the Firearm Epidemic
    JAMA (IF 44.405) Pub Date : 2017-11-14
    James M. Shultz, Siri Thoresen, Sandro Galea

    On the evening of October 1, 2017, at the close of the 3-day Route 91 Harvest Festival in Las Vegas, Nevada, a shooter, who had transported an arsenal of 23 firearms to his 32nd-floor suite at the Mandalay Bay hotel overlooking the venue, smashed out 2 windows and repeatedly raked the concertgoers below with indiscriminate bursts of semiautomatic weapons fire. The death toll from this rampage shooting climbed to 59 gunshot fatalities (58 gunshot victims and 1 shooter suicide), the highest single-shooter incident in US history and second only to the 2011 shooting massacre that resulted in 69 deaths in Utøya Island, Norway.

    更新日期:2017-11-15
  • Highlights
    JAMA (IF 44.405) Pub Date : 2017-11-14
    更新日期:2017-11-15
  • High Costs of FDA Approval for Formerly Unapproved Marketed Drugs
    JAMA (IF 44.405) Pub Date : 2017-11-13
    Aaron Hakim, Ravi Gupta, Joseph S. Ross

    In May 2017, the US Food and Drug Administration (FDA) announced a Drug Competition Action Plan, designed to address competition and pricing in the generic market and improve access to prescription drugs.1 One of FDA’s stated goals is to reexamine “places where its rules—including standards and procedures related to generic drug approvals—are being used in ways that may create obstacles to generic access,”1 instead of ensuring the vigorous competition Congress intended. In this Viewpoint, we examine FDA’s 2006 Unapproved Drugs Initiative (UDI), designed to strengthen the agency’s regulatory oversight related to unapproved marketed drugs. Using an illustrative example, we discuss this initiative’s unintended consequences, as it appears to have created obstacles to generic drug access, likely increasing prescription drug costs.

    更新日期:2017-11-13
  • Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome
    JAMA (IF 44.405) Pub Date : 2017-11-11
    Andrew R. Chapman, Kuan Ken Lee, David A. McAllister, Louise Cullen, Jaimi H. Greenslade, William Parsonage, Andrew Worster, Peter A. Kavsak, Stefan Blankenberg, Johannes Neumann, Nils A. Söerensen, Dirk Westermann, Madelon M. Buijs, Gerard J. E. Verdel, John W. Pickering, Martin P. Than, Raphael Twerenbold, Patrick Badertscher, Zaid Sabti, Christian Mueller, Atul Anand, Philip Adamson, Fiona E. Strachan, Amy Ferry, Dennis Sandeman, Alasdair Gray, Richard Body, Brian Keevil, Edward Carlton, Kim Greaves, Frederick K. Korley, Thomas S. Metkus, Yader Sandoval, Fred S. Apple, David E. Newby, Anoop S. V. Shah, Nicholas L. Mills
    更新日期:2017-11-13
  • Bioethics Panels Open Door Slightly to Germline Gene Editing
    JAMA (IF 44.405) Pub Date : 2017-11-07
    Jeff Lyon
    更新日期:2017-11-10
  • Vaccination Challenges in Confronting the Resurgent Threat From Yellow Fever
    JAMA (IF 44.405) Pub Date : 2017-11-07
    Lin H. Chen, Davidson H. Hamer

    Yellow fever (YF) virus in humans causes a spectrum of illness ranging from subclinical to mild, self-limited infections to severe, life-threatening disease. Approximately 200 000 cases of YF occur worldwide during each nonepidemic year, with a case-fatality rate (CFR) of approximately 20% in Africa and 40% to 60% in South America.1- 3 The most common symptoms of YF include fever, nausea, vomiting, abdominal pain, and hepatitis; and approximately 15% of infected patients will have a second phase of illness characterized by high fever, jaundice, renal failure, and bleeding, which frequently results in a fatal infection.1,2 This flavivirus is primarily transmitted by mosquitoes of the Aedes and Haemogogus genera in sylvatic (jungle) cycles between mosquitoes and monkeys with incidental transmission to humans. Urban outbreaks can develop when YF virus is introduced into locations where Ae aegypti are widespread.1 There is no approved antiviral against YF; therefore, treatment is supportive.

    更新日期:2017-11-10
  • Knowledge for Precision MedicineMechanistic Reasoning and Methodological Pluralism
    JAMA (IF 44.405) Pub Date : 2017-11-07
    Mark R. Tonelli, Brian H. Shirts

    Precision medicine (PM) describes prevention, diagnosis, and treatment strategies that take individual variability into account.1 While PM aims to incorporate individual variability in genes, environment, and lifestyle, the emphasis in current practice is on personalized genetic profiling for diagnosis and risk assessment. As genetic testing and interpretation advance, PM stands to move medicine away from the population-based knowledge that grounds evidence-based medicine (EBM) to the treatment of patients “based on a deep understanding of health and disease attributes unique to each individual.”2(p1842) Such understanding requires a different and broader concept of medical knowledge, the development of new methods for generating such knowledge, and approaches for incorporation into clinical practice. As PM advances, for some decisions it will replace the population-based “best evidence” of EBM with specific and detailed understanding of what makes an individual patient different from others. To practice PM, clinicians should reconsider current notions regarding the relative value of evidence, as case-based reasoning and understanding of mechanisms will figure more prominently.

    更新日期:2017-11-10
  • Potential Health Implications Related to Fracking
    JAMA (IF 44.405) Pub Date : 2017-11-07
    Russell A. Wilke, Jerome W. Freeman
    更新日期:2017-11-10
  • Ketamine Minus the Trip: New Hope for Treatment-Resistant Depression
    JAMA (IF 44.405) Pub Date : 2017-11-08
    Jennifer Abbasi
    更新日期:2017-11-10
  • Pediatric Exclusivity and Regulatory AuthorityImplications of Amgen v HHS
    JAMA (IF 44.405) Pub Date : 2017-11-08
    Jeanie Kim, Joseph S. Ross, Amy Kapczynski

    In May 2017, the US Food and Drug Administration (FDA) denied a 6-month extension of market exclusivity for Sensipar (cinacalcet), a drug manufactured by Amgen to manage hypercalcemia, common among patients with end-stage renal disease who are undergoing dialysis. The FDA determined that Amgen’s pediatric studies had been conducted inadequately and had provided inconclusive safety data. Amgen brought a lawsuit, Amgen v HHS (US Department of Health and Human Services), to challenge the denial.1 If Amgen prevails, it can delay generic competition for 6 months for a drug that generated $1.24 billion of revenue in 2016.2 More broadly, a decision favoring Amgen could diminish the FDA’s ability to encourage clinically meaningful pediatric studies and thus undermine the purpose of Congress in offering patent extensions to reward pediatric research.

    更新日期:2017-11-10
  • Omitted Disclosures of Potential Conflicts of Interest
    JAMA (IF 44.405) Pub Date : 2017-11-09

    In the Viewpoint entitled “The Misuse of Meta-analysis in Nutrition Research,”1 published in the October 17, 2017, issue of JAMA, the authors omitted disclosure of potential conflicts of interest. The disclosure statement should include the following: Dr Barnard reported that he has received research funding from the National Institute of Diabetes and Digestive and Kidney Diseases (NIH), the National Science Foundation, and the Diabetes Action Research and Education Foundation; serves without financial compensation as president of the Physicians Committee for Responsible Medicine and Barnard Medical Center; provides nonprofit organizations education, research, and medical care related to nutrition; and writes books and gives lectures related to nutrition and health, for which he has received royalties and honoraria, respectively. Dr Willett reported that he receives research support from the National Institutes of Health and the Breast Cancer Research Foundation and that he has written books related to nutrition and epidemiology and teaches with the Culinary Institute of America, for which he has received royalties and honoraria, respectively. Dr Ding reported that he has received research funding from the American Heart Association, American Diabetes Association, the Robert Wood Johnson Foundation, the Qatar National Research Fund, and the Nordea Foundation; consultancy fees from the Physicians Committee for Responsible Medicine and Naturex; and honoraria from the University of Connecticut, the University of Arizona, the University of California at Berkeley, and the European Commission and reported that he is a board member of the nonprofit ToxinAlert.org, a minority shareholder in Epidemic Health and Happy Vitals, a health economist at the nonprofit Microclinic International, and a faculty lecturer at Management Center Innsbruck, Austria. This article was corrected online.

    更新日期:2017-11-10
  • Transforming the Military Health System
    JAMA (IF 44.405) Pub Date : 2017-11-09
    David J. Smith, Raquel C. Bono, Bryce J. Slinger

    The Military Health System (MHS) is one of the largest health systems in the United States, delivering health services to 9.4 million eligible patients in nearly 700 military hospitals and clinics around the world as well as through the TRICARE health plan.1 The TRICARE health plan provides care to all members of the Uniformed Forces,2 their families, and retirees, rendering TRICARE the fourth largest health plan in the United States. However, military health services are currently managed by 4 separate entities: Army, Navy, Air Force, and the Defense Health Agency (DHA), creating opportunities for variation and inefficiency. The MHS falls under the Department of Defense and is distinct from the Veterans Health Administration, which provides care to the majority of veterans and to veterans ineligible for TRICARE.3

    更新日期:2017-11-10
  • JAMA
    JAMA (IF 44.405) Pub Date : 2017-11-07

    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:2017-11-07
  • Polypharmacy
    JAMA (IF 44.405) Pub Date : 2017-11-07
    Graziano Onder, Alessandra Marengoni
    更新日期:2017-11-07
  • Care of the AgedMalford W. Thewlis, M.D., Wakefield, R. I.
    JAMA (IF 44.405) Pub Date : 2017-11-07

    Geriatrics was not spontaneously recognized as a special branch of medicine; like pediatrics, it met with slow response. When Abraham Jacobi gave the first course in pediatrics in 1859, it was coolly received; the medical profession had to wait thirty-seven years for a textbook on diseases of infancy and childhood. The word geriatrics was coined by Nascher in 1909, and five years later he completed a textbook on diseases of old age, which went through a second edition in 1916. It was then that Nascher decided to enter the Public Welfare Department of New York City and suggested that I carry on; with his help and advice, this seemed possible.

    更新日期:2017-11-07
  • Rituximab / Bendamustine
    JAMA (IF 44.405) Pub Date : 2017-11-07
    Carol Snyder Halberstadt

    更新日期:2017-11-07
  • Portraits in Health Policy
    JAMA (IF 44.405) Pub Date : 2017-11-07
    Theresa BrownGold
    更新日期:2017-11-07
  • Intravenous Lymphoma Drug Approved
    JAMA (IF 44.405) Pub Date : 2017-11-07
    Rebecca Voelker

    The FDA has granted accelerated approval to a new medication for adults with relapsed follicular lymphoma who’ve already received systemic therapy at least twice. Accelerated approvals allow drugs for serious conditions that fill an unmet medical need to be cleared for marketing based on a surrogate end point rather than measureable clinical benefit. Copanlisib, which is marketed as Aliqopa, is an intravenous phosphatidylinositol-3-kinase (PI3K) inhibitor that blocks the PI3Kα and Pl3Kδ isoforms expressed in malignant B cells. Dysregulation of the Pl3K pathway, which is involved in cell growth, survival, and metabolism, plays an important role in follicular lymphoma.

    更新日期:2017-11-07
  • Duodenoscope Design Aimed at Infection Prevention
    JAMA (IF 44.405) Pub Date : 2017-11-07
    Rebecca Voelker
    更新日期:2017-11-07
  • First Biosimilar to Treat Cancer
    JAMA (IF 44.405) Pub Date : 2017-11-07
    Rebecca Voelker

    The FDA has approved the country’s first biosimilar for adults with cancer. Bevacizumab-awwb, which will be marketed as Mvasi, has been approved to treat the same types of cancers as its reference product, bevacizumab, which is sold as Avastin. The drug is a recombinant immunoglobulin G1 monoclonal antibody that binds to vascular endothelial growth factor (VEGF). By blocking VEGF’s interaction with its receptors, bevacizumab-awwb prevents the development of new blood vessels that solid tumors need to thrive. Bevacizumab-awwb and bevacizumab are from different manufacturers that use their own unique cell line and proprietary processes. Differences between the 2 drugs aren’t clinically meaningful in terms of safety, purity, and potency.

    更新日期:2017-11-07
  • Republicans Will Own Whatever Happens to the ACA and Health Care Reform
    JAMA (IF 44.405) Pub Date : 2017-11-07
    Gail Wilensky
    更新日期:2017-11-07
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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