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Income, Poverty, and Health Inequality

Mar, 03/04/2018 - 02:00
The health of people with low incomes historically has been a driver of public health advances in the United States. For example, in New York City, cholera deaths during outbreaks in 1832 and 1854 concentrated among the poor helped push forward the Metropolitan Health Law, which allowed for regulation of sanitary conditions in the city. The law was an exemplar for other municipalities across the United States, saving countless lives during subsequent cholera epidemics as well as from typhus, dysentery, and smallpox.

Another Caution for Clarithromycin

Mar, 03/04/2018 - 02:00
Prescribing the antibiotic clarithromycin for patients with stable coronary heart disease could increase their risk of dying of cardiovascular disease or developing cerebrovascular disease, the FDA has warned.

New Stent for Small Vessels

Mar, 03/04/2018 - 02:00
The smallest drug-eluting stent (DES) available in the United States has received FDA approval. At 2.0 mm, the new stent is intended to help interventional cardiologists treat patients with coronary artery disease whose small vessels often can’t be treated with larger stents during percutaneous coronary intervention.

Reducing Lung Cancer Progression

Mar, 03/04/2018 - 02:00
The FDA has expanded its approval of durvalumab to include treating patients with unresectable stage III non–small cell lung cancer (NSCLC) whose tumors haven’t progressed following chemoradiation.

Artistic Renaissance in Frontotemporal Dementia

Mar, 03/04/2018 - 02:00
This Arts and Medicine essay uses case descriptions of 2 patients who experienced a sudden increase in artistic creativity with the onset of frontotemporal dementia to discuss the mechanism of paradoxical functional facilitation, in which loss of activity in one part of the brain leads to release of activity in another.

Preparation

Mar, 03/04/2018 - 02:00
First, we learned a heartbeatby taking it apart and naming it.We studied valves as if they were pipes:what makes them rust, or clog.And then we marveled—how intricatethe machinery, how precise the clockwork,as if we had built it ourselves.

The Ethics of Surgery

Mar, 03/04/2018 - 02:00
The evolution of surgery during the past century has kept pace with the development of science along other lines, wonderful as this has been, and we have reason for just pride in the contributions made by the surgeons of our own land during this period. If, however, none other had been made than the discovery of the use of ether in producing anesthesia, America would still be entitled to the highest mark of honor. No other discovery yet made in surgery has been so great a boon to suffering humanity….

JAMA Peer Reviewers in 2017

Mar, 03/04/2018 - 02:00
We sincerely thank the 2707 peer reviewers who completed manuscript reviews for JAMA in 2017.

Skin Abscess

Mar, 03/04/2018 - 02:00
This JAMA Patient Page describes skin abscess—its symptoms, treatment, and warning signs.

JAMA

Mar, 03/04/2018 - 02:00

Highlights for March 27, 2018

Mar, 27/03/2018 - 02:00

Global Payments To Rural Hospitals As a Path to Sustainability

Mar, 27/03/2018 - 02:00
This Viewpoint discusses the rationale and policy objectives of the Pennsylvania Rural Health Model, a program launched by CMS and the Commonwealth of Pennsylvania in 2017 to transition rural hospitals from fee-for-service reimbursement to a multipayer global budget payment method intended to improve population health outcomes and quality of care while lowering costs.

Potential Zika-Related Birth Defects in the United States

Mar, 27/03/2018 - 02:00
This Viewpoint summarizes findings from a population-based birth defect surveillance report from the Centers for Disease Control and Prevention estimating the prevalence of birth defects potentially related to Zika virus infection in US areas with documented local Zika virus transmission in 2016.

Preventing the Malignant Transformation of Bipolar Disorder

Mar, 27/03/2018 - 02:00
This Viewpoint argues that the therapeutic approach to bipolar disorder should mimic that for cancer, with immediate aggressive treatment and vigilant monitoring and follow-up to prevent long-term sequelae of disability, cognitive deficits, and suicide.

Mentoring in the #MeToo Era

Mar, 27/03/2018 - 02:00
In this narrative essay, the author wonders what effect the #metoo phenomenon will have on mentoring between male mentors and junior female trainees and faculty and recalls male mentors who were supportive of her and other women colleagues’ professional development in a plea for diversity and inclusion among leaders in medicine that supports the entire academic medical community.

Measurements of 24-Hour Urinary Sodium and Potassium Excretion

Mar, 27/03/2018 - 02:00
Almost 50 years ago, sodium reduction was identified as a national priority at the 1969 White House Conference on Food Nutrition and Health, yet adherence to recommended sodium levels remains an elusive public health goal. Similarly, underconsumption of potassium has been a public health concern for decades. Excessive sodium intake is etiologically related to hypertension and cardiovascular diseases, and these conditions contribute significantly to morbidity, mortality, and health care costs. Furthermore, estimates of the health and financial benefits of sodium reduction are substantial. Physiologically, the actions of sodium and potassium are inter-related and low potassium intake is also etiologically related to high blood pressure.

Eroding Access and Quality of Childbirth Care in Rural US Counties

Mar, 27/03/2018 - 02:00
Although it is difficult to imagine a health care service that is more valuable to society than childbirth, US hospitals often lose money when they provide local childbirth services for healthy mothers. This discrepancy is a major flaw in the design of the maternal health system that may be the basis for lagging birth outcomes in the United States compared with other high-income nations.

Infectious Diseases Mortality in the United States

Mar, 27/03/2018 - 02:00
Infectious disease is distinguished from most other fields of medicine by constant and rapid change. As microorganisms emerge, new treatment and prevention strategies also evolve. Although much progress has been made, infections remain a major and often preventable cause of death worldwide.

From Guideline to Order Set to Patient Harm

Mar, 27/03/2018 - 02:00
Clinical guidelines and standardized order sets are as integral to the practice of medicine in the digital age as the stethoscope and the chest x-ray. Rigorously developed guidelines and order sets aim to bring the most current, evidence-based medicine to the bedside and decrease unwanted variability in health care delivery. The JAMA Performance Improvement article in this issue of JAMA by Gupta and colleagues, however, illustrates the potential risks inherent in the incorporation of these tools into practice. In this case, a 58-year-old man with acute ST-segment elevation myocardial infarction (STEMI) was successfully treated with percutaneous coronary intervention (PCI) involving the right coronary artery but had bradycardia and complete heart block following the procedure. The patient was admitted to the coronary care unit, and the admitting physician placed orders via the electronic medical record using the “STEMI admission order set.” Within an hour of admission, the patient received medications, including atorvastatin and carvedilol, based on the order set. Over the next few hours, he developed dyspnea, bradycardia, and hypotension. This case demonstrates how a flawed guideline, incorporated into an inadequately updated order set, can undermine a physician’s intention and lead to patient harm.

Estimated 24-Hour Urinary Sodium and Potassium Excretion in US Adults

Mar, 27/03/2018 - 02:00
This study uses NHANES data to estimate the mean population sodium intake and describe urinary potassium excretion among US adults aged 20 to 69 years.

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