JAMA

Distribuir contenido
Actualizado: hace 1 día 10 horas

Breastfeeding Report Card

Mar, 09/10/2018 - 02:00
More than 80% of US infants start out life breastfeeding, but many still stop earlier than recommended, the CDC’s 2018 Breastfeeding Report Card found.

More Youth Vaccinated for HPV

Mar, 09/10/2018 - 02:00
About two-thirds of adolescents had received their first dose of the human papillomavirus (HPV) vaccine in 2017 and 48.6% completed all recommended doses, according to a CDC report. This represents a 5-percentage point increase in youth who’ve completed the HPV vaccine series since 2016.

In-home Robots Improve Social Skills in Children With Autism

Mar, 09/10/2018 - 02:00
In a recent open-label pilot study, Yale University researchers demonstrated that children with autism have improved social skills after a month of daily 30-minute interactions at home with an autonomous socially assistive robot.

Researchers Test New Techniques to Rule Out and Predict Heart Attacks

Mar, 09/10/2018 - 02:00
A new protocol to rule out myocardial infarctions (MIs), or heart attacks, in emergency departments using a recently approved high-sensitivity troponin t test was found to be safe and accurate in a study published in Circulation.

Meta-analysis of LDL-C Lowering and Mortality

Mar, 09/10/2018 - 02:00
To The Editor In a meta-analysis by Dr Navarese and colleagues concerning low-density lipoprotein cholesterol (LDL-C) levels and mortality after LDL-C lowering, we identified several potential errors related to trials conducted by our research group.

Meta-analysis of LDL-C Lowering and Mortality—Reply

Mar, 09/10/2018 - 02:00
In Reply Dr Duran and colleagues suggest there were errors in data extracted from 3 trials for our meta-analyses and that the “errors do not reflect differences between RRs and HRs.” Hazard ratios were inconsistently reported for the cardiovascular and all-cause mortality end points in trials included in our meta-analyses. Although often similar, RRs are not the same as HRs. In the absence of a reported HR, there are several possible analytic approaches: (1) omit the study from the analysis, producing selection bias; (2) calculate the risk ratio, ignoring follow-up duration and creating heterogeneity and imprecision, particularly when there is a large variation in trial duration across studies, as is the case with lipid-lowering trials; or (3) calculate the RR, thereby considering different follow-up durations and ensuring a uniform approach to estimation of effect size across all trials.

Biological, Legal, and Moral Definitions of Brain Death

Mar, 09/10/2018 - 02:00
To the Editor Brain death, as Dr Truog argued in a Viewpoint, is a concept that blends both medical and legal information. He pointed out that while the law often requires drawing bright-line distinctions between categories—guilty and innocent, dead and alive—biological domains tend to be more continuous and less discrete. We would like to suggest that there is a relevant moral component as well, in that different communities and cultures may have views of personhood that diverge from those contained in legal statutes or medical guidelines. Without the necessary moral assumptions, there is no direct inference from brain death to person death: in other words, stakeholders need to agree a priori that brain death equates to person death for it to carry the medical and legal meanings implied in the Uniform Declaration of Death Act (UDDA). As shown in the unfortunate case of Jahi McMath, this is not always a given.

Biological, Legal, and Moral Definitions of Brain Death—Reply

Mar, 09/10/2018 - 02:00
In Reply The perspective presented by Mr Dewar and colleagues raises many interesting philosophical questions about the relationship among science, morality, and law in society. The definition of death intersects with all 3. Scientifically, it depends on the capacity of an organism to maintain an internal homeostatic environment. Morally, it hinges on aspects of neurologic function, such as consciousness and the capacity to relate to others. Legally, it defines the point of transition for many social practices, such as the permissibility of embalming, cremation, burial, the procurement of organs for transplantation, the implementation of wills, or the transfer of wealth through inheritance.

Using Big Data to Determine Reference Values for Laboratory Tests

Mar, 09/10/2018 - 02:00
To the Editor Dr Manrai and colleagues advocated for changes in the way reference intervals are calculated for common laboratory tests. They championed leveraging data sets collected from aggregated large-scale databases of pooled electronic health records to statistically define reference intervals tailored to an individual based on demographic and possibly genetic attributes. In addition to the challenges outlined in the article, we note an additional consideration that calls into question the likelihood of success of this approach.

Using Big Data to Determine Reference Values for Laboratory Tests—Reply

Mar, 09/10/2018 - 02:00
In Reply We agree with Dr Obstfeld and colleagues that harmonizing measurements across laboratory test platforms is critical to the success of personalized laboratory medicine. The efforts cited by the authors will contribute to reducing technical variation and measurement error across test platforms. However, the fact that large-scale data sets often contain data from multiple test platforms is not reason to avoid using them altogether, but is a cogent argument for using them to understand test variation simultaneously across test platforms and demographic strata, especially as such test variation relates to clinical outcomes. Improving the derivation and collection of meta-data will enable such systematic comparisons. As we argued, electronic health records are one possible data modality that can be used for these purposes (along with research cohorts, insurance claims data sets, and other data types), but the generalizability of findings from such observational data sets across different clinical settings is unclear. In the absence of systematic analyses of new large-scale data, the status quo, in which convenience samples from a few dozen individuals often validate monolithic reference ranges used across millions of individuals in some laboratories, will likely remain. This data-limited approach is likely to be inferior to almost any data-rich solution, but we acknowledge the current heterogeneity inherent to available big data.

Honoring the Victims of Opioid Addiction

Mar, 09/10/2018 - 02:00
This Arts and Medicine essay reviews a traveling US exhibit created by the US National Safety Council that honors the human costs of the opioid addiction crisis and engages visitors in strategies to manage opioid use and prevent future deaths.

Return

Mar, 09/10/2018 - 02:00
It was a small hourwhen I heard the liftreturning my daughterfrom the operating room.I was informed, ‘She’s okay.’She had not been reducedto blinking as a way of speaking.She would never bungee jump,or dive again, or swim front crawl,but one day she would standand one day take first steps.When I thanked the surgeonsI put my hands togetherand my head was lowered.Six weeks later, hand-in-handwith her physiotherapist,she would climb a flight of stairs.Another milestone ten days later– she would propose a race.The two would vanishup the stair well.They would come down togetherbent with laughter.

Adequate Supply of Physicians and Educational Standards

Mar, 09/10/2018 - 02:00
According to the Census Bureau estimate for 1917, the population of the United States was 106,543,317, and according to the new American Medical Directory, the total number of physicians is 147,812. At the present time, therefore, there is one physician to every 720 people. In the various countries of Europe, just before the world war began, the proportion of physicians, according to the best available authorities, was from one to every 1,500 to one to every 2,500 people. Numerically speaking, therefore, more than half of the physicians of the United States, or actually 76,783, might be withdrawn from civil practice before the proportion to the population would be as low as the highest proportion in any country of Europe, namely, one to every 1,500 of population. One physician to every 1,500 people could readily supply all the needs in thickly populated communities, but the more sparsely settled rural communities would doubtless need a larger proportion—say one to every 1,000. On this basis for the entire country, it would require one physician for about every 1,200 people. If properly distributed, this would be a reasonable proportion considering the improved roads and other means of accessibility by which a physician can now cover a much wider territory than heretofore. Based on the number of applications now going through for commissions in the Medical Department of the Army, there will be at least 35,000 physicians who have been commissioned or will have been offered commissions in the Army and the Navy by Nov. 1, 1918. As a maximum, however, not more than 40,000 physicians could possibly be needed by the government service unless the war should continue more than two or three years longer. This would still leave in civil practice one physician to every 988 population. The annual output from the medical schools in recent years has been approximately 3,000 physicians, more than covering the annual loss from deaths.

Choledocholithiasis

Mar, 09/10/2018 - 02:00
This JAMA Patient Page describes the symptoms, diagnosis, and treatment of choledocholithiasis.

JAMA

Mar, 09/10/2018 - 02:00

Highlights for October 2, 2018

Mar, 02/10/2018 - 02:00

Addressing the Tuberculosis Epidemic—21st Century Research for an Ancient Disease

Mar, 02/10/2018 - 02:00
In this Viewpoint, Anthony Fauci summarizes the National Institute of Allergy and Infectious Diseases’ (NIAID’s) 2018 Strategic Plan for Tuberculosis (TB), which comprises investments in development of point-of-care diagnostics, vaccines, shorter-duration therapeutics, and infrastructure for systems biology and “omics” approaches to the infection.

The Importance of Pairing Universal Health Care Coverage With Global Health Care Quality

Mar, 02/10/2018 - 02:00
In this Viewpoint, Don Berwick and colleagues summarize a 2018 National Academies of Sciences, Engineering, and Medicine (NASEM) report on global health care quality emphasizing that universal access will yield improvements in population health only when paired with quality reforms characterized by systems design, transparency, collaboration, anticipatory care, evidence-based decisions, and continuous feedback and learning.

Emerging Therapeutic Strategies for Aging, Cell Senescence, and Chronic Disease

Mar, 02/10/2018 - 02:00
This Viewpoint describes the processes by which aging of cells contributes to age-related decline, chronic disease, and multimorbidity, and describes current animal research and clinical trials investigating the effects of senolytic drugs and vaccines that target senescent cell antiapoptotic pathways and remove senescent cells.

Aging as a Biological Target for Prevention and Therapy

Mar, 02/10/2018 - 02:00
This Viewpoint discusses targeting fundamental biological aging processes through nutritional, genetic, and pharmacologic interventions to delay or prevent the onset or progression of multiple chronic diseases and debilities typically observed in older humans to enhance and extend both health and longevity.