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Factors Associated With Variation in Outcomes in Bariatric Surgery Centers of Excellence—Reply

Mar, 02/10/2018 - 02:00
In Reply Dr Gallagher and colleagues raise an important and legitimate point about the role of surgical skills potentially explaining the variation in complication rates within bariatric surgery COEs. More importantly, they question the lack of objective assessment of surgical skills as part of the accreditation process.

Corrected Data for Survey Results in Viewpoint

Mar, 02/10/2018 - 02:00
The Viewpoint entitled “Building on #MeToo to Enhance the Learning Environment for US Medical Schools,” published in the May 1, 2018, issue of JAMA, reported incomplete survey results. In the first paragraph, the data from the AAMC questionnaire should have been as follows: “39% reported personally experiencing sexist, racist, or other offensive comments or humiliation.” This article was corrected online.

Incorrect Data or Information

Mar, 02/10/2018 - 02:00
In the Original Contribution entitled “Association Between Baseline LDL-C Level and Total and Cardiovascular Mortality After LDL-C Lowering: A Systematic Review and Meta-analysis” published in the April 17, 2018, issue of JAMA, incorrect data or information appeared in the Abstract, Results, Table 2, Figures 4 and 5, and the online Supplement. This article was corrected online.

Incorrect Information in Patient Page

Mar, 02/10/2018 - 02:00
In the JAMA Patient Page entitled “Screening for Cervical Cancer,” published in the August 21, 2018, issue of JAMA, incorrect and incomplete information was published regarding the USPSTF screening recommendations. In the illustration, the second sentence under “USPSTF recommendation” should have read “For women aged 21 to 29, screening should be done by a Pap test every 3 years.” The third sentence should have read “For women aged 30 to 65, screening can be done by a Pap test every 3 years, a high-risk HPV test every 5 years, or a Pap test plus a high-risk HPV test every 5 years.” This article was corrected online.

Incorrect Units

Mar, 02/10/2018 - 02:00
In the JAMA Clinical Challenge entitled “Progressive Weakness and Memory Impairment in a Middle-Aged Man” published in the July 10, 2018, issue of JAMA, some units were incorrectly reported. The third and fourth sentences of the second paragraph of the Patient Outcome section should have read, “The patient was treated with intramuscular vitamin B12 (1000 ?g daily) for 5 days, followed by weekly injections to complete an 8-mg load. This was followed by monthly 1000-?g injections.” This article was corrected online.

Vitreous

Mar, 02/10/2018 - 02:00
From eight until three, she teaches Shakespearehalf-lit, her eye melting wax from the candle,the flame burning the hole of her pupil.Her vision is Morse code, spy code, a barcode, a bush of mosquitoes with Zika,sluggish, misted from too far with Naled.A soliloquy of flaws, like Hamletthe membrane chooses to be or not to be,detaches an arrow at a time, on pace,before the shaft’s lasered back into itsquiver. Like crackers broken in packetsbut still constrained by shape. Leaded stained glass.Her eye is the poet; no one else seesthe world around her fall into pieces.

The Book Forum

Mar, 02/10/2018 - 02:00

Tinea Versicolor

Mar, 02/10/2018 - 02:00
This JAMA Patient Page describes tinea versicolor and its symptoms, diagnosis, and treatment.

JAMA

Mar, 02/10/2018 - 02:00

Highlights for September 25, 2018

Mar, 25/09/2018 - 02:00

Genetics, Biochemistry and “Simple” Organisms Converge to Unlock Secrets in Histone Biology

Mar, 25/09/2018 - 02:00
In this Viewpoint, 2018 Albert Lasker Basic Medical Research Award winners Michael Grunstein and C. David Allis discuss the discovery and influence of histones on human genetic expression.

The Discovery and Development of Propofol Anesthesia

Mar, 25/09/2018 - 02:00
In this Viewpoint, 2018 Lasker-DeBakey Clinical Medical Research Award winner John B. Glen discusses the discovery and development of propofol, one of the most widely used anesthetics for patient care.

Reducing Maternal Mortality in the United States

Mar, 25/09/2018 - 02:00
This Viewpoint suggests strategies for reducing maternal mortality in the United States, including creation of a national maternal mortality surveillance system, use of maternal safety bundles within health systems, and improving access to quality health care for all women.

The Acute Stroke Care Revolution

Mar, 25/09/2018 - 02:00
This Viewpoint reviews evidence of the benefits of thrombectomy for patients with ischemic stroke due to large vessel occlusion, and details the systems of care that need to be developed to ensure that all patients who might benefit from the procedure can be rapidly identified, transported, imaged, and treated under the care of qualified specialists.

Supporting a Family Member’s Treatment Decision You Disagree With

Mar, 25/09/2018 - 02:00
In this narrative medicine essay, a physician and her family struggle with their mother’s intention to continue chemotherapy when treatment will cause more harm than good.

Treatment Algorithms for Staphylococcal Bacteremia

Mar, 25/09/2018 - 02:00
Antimicrobial resistance is among the most important threats to human health. Lost in the episodic outbreaks of emerging pathogens such as 2009 H1N1 influenza, Ebola, and Zika virus has been the steady increase in resistance to commonly used antibiotics in frequently seen bacterial infections. Confronting antimicrobial resistance requires investment in 3 critical areas including (1) antimicrobial discovery, (2) rapid diagnostics, and (3) infection prevention and antimicrobial stewardship. In particular, algorithms based on clinical practice guidelines, that promote appropriate antibiotics and durations of therapy and limit unnecessary treatment, have the potential to enhance care for individual patients and improve public health more broadly.

Antibiotic Treatment for Uncomplicated Appendicitis

Mar, 25/09/2018 - 02:00
Following publication of the Appendicitis Acuta (APPAC) trial in 2015, some were quick to criticize the report. APPAC compared outcomes for open appendectomy with antibiotic therapy for acute uncomplicated appendicitis, finding that antibiotics were a reasonable alternative to appendectomy. The study failed to meet its prespecified noninferiority margin to demonstrate that antibiotic treatment resulted in clinical outcomes that were “no worse than” outcomes with surgery, the operations were open and not laparoscopic, expensive broad-spectrum antibiotics were used, and the hospital lengths of stay were too long in each group (median, 3 days in the antibiotic group and in the surgery group). Despite the study limitations, of the 257 patients in the antibiotic group, 186 (73%) initially treated with antibiotics did not require surgery at the 1-year end point. However, concerns were raised that these patients would eventually require surgery, and various experts recommended that the APPAC results for clinical decision making not be used until the long-term outcomes were known for the patients who received antibiotic treatment. Wait, they advised.

Questions About Genomic Reclassification for Hereditary Cancer Remain

Mar, 25/09/2018 - 02:00
DNA sequence information has become increasingly easier and less expensive to obtain, but interpretation remains a challenge. The vast amount of variation present in the human genome reveals the scope of the problem. For instance, analysis of all protein-coding regions of the genome (an exome analysis) in 50?726 individuals found a median of more than 20?000 gene variants per person, most of them rare and hundreds not previously identified. Because most genomic variation has little or no observable effect on human health, laboratories must undertake careful evaluation to determine the pathogenicity of variants identified by genomic testing. Standards promulgated in 2015 call for the consideration of several different types of evidence, including clinical observation, family segregation, population prevalence, and computational and functional data. However, the evidence for most variants is limited, so results regarding pathogenicity are often uncertain. One common outcome is a gene variant of unknown clinical significance. Other variants are classified as likely pathogenic or benign (defined as ?90% likelihood), yielding a 5-point classification scheme: pathogenic; likely pathogenic; variant of unknown significance; likely benign; and benign. Over time, a gene variant may be reclassified, changing, for example, from variants of unknown significance to likely pathogenic or vice versa. But how often does this happen and under what time frame? The report by Mersch et al in this issue of JAMA offers some answers to these critical questions.

Algorithm-Based Therapy vs Usual Care for Patients with Staphylococcal Bacteremia

Mar, 25/09/2018 - 02:00
This noninferiority trial compares the effects on clinical success and adverse events of an algorithm that defines diagnostic evaluation, antibiotic selection, and duration of therapy for staphylococcal bacteremia vs standard clinical care.

Five-Year Follow-up of Antibiotic Therapy for Uncomplicated Acute Appendicitis

Mar, 25/09/2018 - 02:00
During a 5-year follow-up of patients initially treated with antibiotics for uncomplicated acute appendicitis, this observational study assesses the rate of late recurrence.