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Global Hunger on the Rise as Climate Extremes Increase

Mar, 20/11/2018 - 01:00
Climate change is jeopardizing goals to end hunger and malnutrition by 2030, according to a recent United Nations (UN) report that shows almost 821 million people worldwide did not have enough to eat in 2017, up from 804 million in 2016.

Guidelines for Ending Childhood and Adolescent Tuberculosis

Mar, 20/11/2018 - 01:00
Despite progress over the last 5 years in understanding the toll tuberculosis (TB) takes on young people, an important group has been largely overlooked: adolescents. In its newly revised Roadmap toward ending tuberculosis in children and adolescents, the World Health Organization (WHO) has incorporated youths aged 10 to 19 years as a group to target for disease prevention and treatment. The WHO issued the new report in September on the eve of the first-ever United Nations High-Level Meeting on Tuberculosis in New York City.

Mapping Yellow Fever Virus in Brazil

Mar, 20/11/2018 - 01:00
Scientists have shown that Brazil’s largest outbreak of yellow fever virus in decades arose in forest-dwelling, nonhuman primates and spread to humans at the end of 2016. The research reported in Science demonstrates how mapping viral incidence and spread in real time can help investigators develop better outbreak models that may help eliminate future yellow fever epidemics.

Validity of the qSOFA Score in Low- and Middle-Income Countries

Mar, 20/11/2018 - 01:00
To the Editor Dr Rudd and colleagues concluded that the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score was superior to the systemic inflammatory response syndrome (SIRS) score and a baseline risk model in predicting in-hospital mortality in low- and middle-income countries (LMICs), an issue that has been debated since its introduction in the Sepsis-3 definitions. We are concerned that the treatment of missing data may have introduced significant bias.

Validity of the qSOFA Score in Low- and Middle-Income Countries—Reply

Mar, 20/11/2018 - 01:00
In Reply We agree with Dr Lewis and colleagues that missing data can be an important limitation in clinical research, including our analysis of the predictive validity of the qSOFA score and SIRS criteria. There are 2 issues related to missing data: (1) why missing data are present and (2) the approach to missing data during analysis. First, missing data were present in all 9 cohorts included in the study. Many sites lacked electronic health record systems, had limited medical staff available to collect and record serial vital signs, and were unable to routinely perform laboratory testing for every patient with suspected infection because of limited laboratory and financial resources. Given this reality, the diagnosis of sepsis in LMICs will not always be informed by complete data. Therefore, it is useful for clinicians in low-resource settings to understand the performance of alternative scoring systems in situations in which some variables, though important predictors of clinical outcome, may be missing.

Maryland’s Hospital Global Budget Program

Mar, 20/11/2018 - 01:00
To the Editor In a Viewpoint, Dr Sharfstein and colleagues assessed the state of evidence on Maryland’s hospital global budget program. We agree with much of their synthesis, including that hospital admissions declined in Maryland following the program’s implementation, but we are not convinced that these changes can be attributed to global budgets.

Maryland’s Hospital Global Budget Program—Reply

Mar, 20/11/2018 - 01:00
In Reply Dr Roberts and colleagues are “not convinced” that Maryland’s unique approach to paying hospitals was responsible for changes in care and cost in the state. We cited the studies by Roberts and colleagues because they contributed to understanding this question. We also cited other research, including analyses with a similar methodology but with a greater quantity of more recent data that did find significant associations.

Odds Ratios vs Risk Ratios

Mar, 20/11/2018 - 01:00
To the Editor Dr Norton and colleagues described significant limitations of odds ratios (ORs) but they did not report one important advantage of ORs compared with risk ratios (RRs): the magnitude of the association between an exposure and a dichotomous outcome is invariant to whether the outcome is defined as event occurrence (eg, death) or nonoccurrence (eg, no death; ie, survival).

Odds Ratios vs Risk Ratios—Reply

Mar, 20/11/2018 - 01:00
In Reply We agree with Dr Sonis that ORs have one distinct advantage over RRs when reporting the association between a binary outcome and a risk factor. If the original OR was computed for the occurrence of an outcome, then the OR for the nonoccurrence of the outcome is the inverse of the original OR. There is no such convenient transformation for RRs. He illustrates this point with a simple example and explains that this is important because for many outcomes it is arbitrary whether to report the outcome as the event occurrence or nonoccurrence.

Breakthrough Therapy Designation for New Drugs

Mar, 20/11/2018 - 01:00
To the Editor Mr Puthumana and colleagues cataloged the trial characteristics of drugs granted Breakthrough Therapy designation by the US Food and Drug Administration (FDA), noting that pivotal trials supporting these approvals commonly lacked randomization, double blinding, and control groups; used surrogate markers; and enrolled small numbers of patients. The Breakthrough Therapy designation was developed with the explicit intent of enabling use of efficient trial designs incorporating the aforementioned elements if early evidence warranted it. When a drug shows a substantial improvement over available therapy early in development, optimizing further study to ensure timely patient access prevents patients from having to wait unnecessarily long for new treatment.

Breakthrough Therapy Designation for New Drugs—Reply

Mar, 20/11/2018 - 01:00
In Reply We agree with Dr Benz that clinicians must use their best judgment to determine whether to prescribe newly approved drugs granted Breakthrough Therapy designation. Furthermore, we applaud the FDA’s efforts, directed by US Congress, to make more efficient determinations of drug safety and efficacy to allow promising new drugs to enter the market as quickly as the agency can responsibly do so. The purpose of our investigation was to provide a systematic evaluation of the program to ensure that clinicians and their patients understand the clinical trial evidence being generated to secure FDA approval for drugs granted Breakthrough Therapy designation, thereby allowing them to make better informed decisions about whether to use these medications.

I Pray

Mar, 20/11/2018 - 01:00
I praythough I do not believeanything will change.

Current Comment

Mar, 20/11/2018 - 01:00

Endoscopic Retrograde Cholangiopancreatography

Mar, 20/11/2018 - 01:00
This JAMA Patient Page describes the endoscopic retrograde cholangiopancreatography procedure and its purposes.

JAMA

Mar, 20/11/2018 - 01:00