JAMA Network Open最新文献

{"title":"Early Cardiac Rehabilitation for Critically Ill Patients With Acute Decompensated Heart Failure: A Randomized Clinical Trial.","authors":"Linjing Wu, Jiahua Li, Yamin Zheng, Mengmeng Xue, Wei Yan, Yongbin Sun, Meiling Zhang, Qiaoyan Li, Jiahong Zhang, Ying Jia, Yuli Wang, Yuan Chen, Guangyu Sun, Binbin Liu, Cuilian Dai","doi":"10.1001/jamanetworkopen.2025.24141","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.24141","url":null,"abstract":"<p><strong>Importance: </strong>The optimal timing and approach for initiating cardiac rehabilitation (CR) in critically ill patients during the acute phase of acute decompensated heart failure (ADHF) remains uncertain.</p><p><strong>Objective: </strong>To evaluate the effects of CR on physical function and rehospitalization for critically ill patients with ADHF admitted to the cardiac intensive care unit (CICU).</p><p><strong>Design, setting, and participants: </strong>In this single-center, single-blind randomized clinical trial conducted in China, critically ill patients with severe ADHF admitted to the CICU were recruited between March 26, 2021, and September 1, 2022. All patients were followed up for 6 months, and investigators were blinded to the group assignment.</p><p><strong>Interventions: </strong>After short-term therapy, participants were randomized 1:1 to an early progressive and personalized CR program for patients with ADHF (AHF-CR program) that was administered exclusively during the patients' CICU stay or to usual care.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were Short Physical Performance Battery (SPPB) score at hospital discharge and 6-month all-cause rehospitalization rates. These outcomes were analyzed using an intention-to-treat approach including all patients after randomization. The Perme Intensive Care Unit Mobility (PERME) score was incorporated as an exploratory outcome during analysis to assess mobility status in critically ill patients.</p><p><strong>Results: </strong>This study included 120 patients (mean [SD] age, 68.6 [12.3] years; 80 [66.7%] male). At randomization, pulmonary crackles were observed in 49 patients in the control group (81.7%) and 43 patients in the intervention group (71.7%). Additionally, 62 patients (51.7%) had an arterial partial pressure of oxygen to fraction of inspired oxygen ratio below 300 mm Hg. A total of 40 patients (33.3%) received intravenous vasoactive medications, and 87 (72.5%) received intravenous loop diuretics. The median difference in SPPB scores between groups was 1.0 (95% CI, 0-2.0; P = .16), which was not significant. Six-month rehospitalization rates were comparable between the control and intervention groups (16 [26.6%] vs 17 [28.3%]; hazard ratio, 1.00 [95% CI, 0.51-1.99]; P = .99). Exploratory analysis revealed that the intervention group had higher PERME scores, with a median between-group difference of 2.76 (95% CI, 0.77-4.74; adjusted P = .04).</p><p><strong>Conclusions and relevance: </strong>In this randomized clinical trial of critically ill patients with ADHF, the AHF-CR program did not significantly improve SPPB scores or rehospitalization rates. However, it may offer potential physical benefits, including enhanced mobility.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry Identifier: ChiCTR2100050151.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2524141"},"PeriodicalIF":9.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarker Testing in Advanced Cancer.","authors":"Kenneth L Kehl","doi":"10.1001/jamanetworkopen.2025.19972","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.19972","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2519972"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incorporating Ethics in Clinical Guidelines in Infectious Diseases: A Scoping Review.","authors":"Dafna Yahav, Asma Nasim, Neta Shirin, Maddalena Armellini, Chiara Zanchi, Varol Tunali, Massimo Mirandola, Aleksandra Barac, Luigia Scudeller, Blin Nagavci, José Ramón Paño-Pardo, Jesús Rodríguez-Baño, Euzebiusz Jamrozik, Murat Akova, Elda Righi","doi":"10.1001/jamanetworkopen.2025.19826","DOIUrl":"10.1001/jamanetworkopen.2025.19826","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2519826"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Kidney Health Through Environmental Epidemiology-California Teachers Earn an A.","authors":"Simon John Christoph Soerensen, Glenn Matthew Chertow","doi":"10.1001/jamanetworkopen.2025.18522","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.18522","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2518522"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Error in Statistical Analysis Section.","authors":"","doi":"10.1001/jamanetworkopen.2025.25559","DOIUrl":"10.1001/jamanetworkopen.2025.25559","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2525559"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Veterans' Donations of Research Incentives to Fellow Veterans.","authors":"Donna M Zulman, Mayuree Rao, Cindie Slightam, Liberty Greene, Matthew L Maciejewski","doi":"10.1001/jamanetworkopen.2025.20307","DOIUrl":"10.1001/jamanetworkopen.2025.20307","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2520307"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public Perception of Physicians Who Use Artificial Intelligence.","authors":"Moritz Reis, Florian Reis, Wilfried Kunde","doi":"10.1001/jamanetworkopen.2025.21643","DOIUrl":"10.1001/jamanetworkopen.2025.21643","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2521643"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12272287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Passive Smartphone Sensors for Detecting Psychopathology.","authors":"Whitney R Ringwald, Grant King, Colin E Vize, Aidan G C Wright","doi":"10.1001/jamanetworkopen.2025.19047","DOIUrl":"10.1001/jamanetworkopen.2025.19047","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Smartphone sensors can continuously and unobtrusively collect clinically relevant behavioral data, allowing for more precise symptom monitoring in clinical and research settings. However, progress in identifying unique behavioral markers of psychopathology from smartphone sensors has been stalled by research on diagnostic categories that are heterogenous and have many nonspecific symptoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine which domains of psychopathology are detectable with smartphone sensors and identify passively sensed markers for general impairment (the p-factor) and specific transdiagnostic domains.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study collected data from the Intensive Longitudinal Investigation of Alternative Diagnostic Dimensions study from January 1 to December 31, 2023, including a baseline survey and 15 days of smartphone monitoring. Participants were recruited from the community via a clinical research registry. A volunteer sample was selected for mental health treatment status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Transdiagnostic psychopathology dimensions of internalizing, detachment, disinhibition, antagonism, thought disorder, somatoform, and the p-factor; 27 behavior markers derived from a global positioning system, accelerometer, motion, call logs, screen on or off, and battery status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 557 participants were included in the study (463 [83%] female; mean [SD] age, 30.7 [8.8] years). The coefficient of multiple correlation (R) showed that the domain most strongly correlated with sensed behavior was detachment (R = 0.42; 95% CI, 0.29-0.54) followed by somatoform (R = 0.41; 95% CI, 0.30-0.53), internalizing (R = 0.37), disinhibition (R = 0.35; 95% CI, 0.19-0.51), antagonism (R = 0.33; 95% CI, 0.6-0.59), and thought disorder (R = 0.28; 95% CI, -0.19 to 0.75). Each psychopathology domain was associated with 4 to 10 smartphone sensor variables. Detachment, somatoform, and internalizing had the most behavioral markers. Of the 27 smartphone sensor variables, 14 (52%) had associations with psychopathology domains. After adjusting for shared variance between psychopathology dimensions, all domains except thought disorder retained significant, incremental associations with sensor variables, reflecting unique behavioral signatures (eg, antagonism and number of calls [standardized β = -0.11; 95% CI, -0.20 to -0.02] and disinhibition and battery charge level [standardized β = -0.24; 95% CI, -0.40 to -0.08]). The p-factor was associated with lower mobility (standardized β = -0.22; 95% CI, -0.32 to -0.12), more time at home (standardized β = 0.23; 95% CI, 0.14 to 0.32), later bed time (standardized β = 0.25; 95% CI, 0.11 to 0.38), and less phone charge (standardized β = -0.16; 95% CI, -0.30 to -0.01]). The p-factor was modeled as a latent factor estimated from common variance of the 6 psychopathology ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2519047"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hurdles for the Delivery of Multinational Randomized Clinical Trials.","authors":"Denise van Hout, Paul Mouncey, David Harrison, Marc Bonten, Lennie Derde, Derek C Angus, Aisha Anjum, Djillali Annane, Janis Best-Lane, Frank Brunkhorst, Maurizio Cecconi, Stephan Ehrmann, Anthony Gordon, Leanne Marie Hays, Esmee Kester, Niamh Mahon, Colin McArthur, Alistair Nichol, Svenja Peters, Sara Pugliese, Kathryn Rowan, Julian Torre-Cisneros, Sebastian Weis","doi":"10.1001/jamanetworkopen.2025.18503","DOIUrl":"10.1001/jamanetworkopen.2025.18503","url":null,"abstract":"<p><strong>Importance: </strong>Ethical, administrative, regulatory, and logistical (EARL) procedures can hamper clinical trial delivery. Quantification of these hurdles is rare, prohibiting identification of areas for improvement.</p><p><strong>Objective: </strong>To identify and quantify EARL hurdles in trial delivery before and during the COVID-19 pandemic.</p><p><strong>Design, setting, and participants: </strong>This cohort study used data from the ongoing Randomized Embedded Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia to enable comparison of EARL procedures for multiple protocols across 19 European countries in the pre-COVID-19 pandemic (February 19, 2016 to March 10, 2020) and COVID-19 pandemic (March 11, 2020, to May 4, 2023) periods. Data were analyzed from November 2024 to March 2025 with contracts and protocol submissions as the units of analysis.</p><p><strong>Main outcome and measures: </strong>Time to (1) site contract completion, (2) regulatory and ethical approval (TTA), and (3) first patient in (FPI). The UK was compared with non-UK countries because of its distinct research infrastructure.</p><p><strong>Results: </strong>There were 257 fully signed first contracts with study sites for analysis. In the UK, contract completion times decreased by 97% (95% CI, 95% to 98%), from a median (IQR) of 196 (154 to 250) days in the pre-COVID-19 pandemic period to 5 (1 to 11) days during the COVID-19 pandemic. In non-UK countries, median (IQR) contract completion times were 224 (119 to 412) days and 183 (62 to 291) days before and during the COVID-19 pandemic, respectively (relative difference, -18%; 95% CI, -43% to 52%). In total, 44 interventions in 16 domains were submitted, yielding 232 protocol approvals for analysis. During the COVID-19 pandemic, median (IQR) TTA was 8 (5 to 31) days in the UK and 115 (47 to 103) days in non-UK countries (median difference, 107 days; 95% CI, 76 to 123 days), with large variation across non-UK countries. Time between approval and FPI during the COVID-19 pandemic was, on average, 3 months faster in the UK compared with non-UK countries (median difference, 90 days; 95% CI, 42 to 141 days).</p><p><strong>Conclusions and relevance: </strong>This study found that EARL procedures were lengthy and variable between countries, reflecting different interpretations of trial regulations, with faster processes in the UK. These findings underscore the need to streamline processes across European countries to improve trial efficiency, in particular during future public health emergencies such as pandemics.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2518503"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12223866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Nonindividual Patient Features in Machine Learning Models of Hospital-Onset Bacteremia.","authors":"M Cristina Vazquez-Guillamet, Jingwen Zhang, Alice Bewley, Andrew Atkinson, Heidi Holtz, Ziqian Wang, Nicole Brougham, Chenyang Lu, Marin H Kollef, Philip Payne, David Warren, Victoria J Fraser","doi":"10.1001/jamanetworkopen.2025.18815","DOIUrl":"10.1001/jamanetworkopen.2025.18815","url":null,"abstract":"<p><strong>Importance: </strong>Hospital-onset bacteremia and fungemia (HOB) are common and potentially preventable complications of hospital care.</p><p><strong>Objective: </strong>To assess whether nonindividual patient features, which summarize interactions with other patients and health care workers (HCWs), can contribute to predictive and causal machine learning models for HOB.</p><p><strong>Design, setting, and participants: </strong>This prognostic study included adult patients admitted to Barnes-Jewish Hospital, an academic hospital in St Louis, Missouri, in 2021. Analyses were developed between October 2023 and August 2024 and in April 2025.</p><p><strong>Exposure: </strong>Individual patient features were extracted from electronic health records and used to engineer nonpatient features, including interactions with HCWs and direct or indirect (consecutive room occupancy) patient contact.</p><p><strong>Main outcomes and measures: </strong>HOB was defined as a positive blood culture after the third day of hospitalization. Patients who were hospitalized for more than 3 days were considered at risk for the outcome. We developed 3 gradient boosting models: 2 predictive (with patient features only and with both patient and nonpatient features to predict the occurrence of HOB) and 1 causal to test the association of nonpatient features and HOB. Predictive performance is reported using area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC), and the results of the causal model are reported as difference in average effects. Sensitivity analyses separated intensive care unit-onset and ward-onset HOB and included a methicillin-resistant Staphylococcus aureus-specific model to adjust for colonization pressure.</p><p><strong>Results: </strong>Among the 52 442 patients, 34 855 (66.5%) had admissions longer than 72 hours and were included for analysis; of these, 556 (1.6%) developed HOB. The median age for the included patients was 60 (IQR, 44-70) years, 50.5% were female, and obesity was the most frequent comorbidity (25.0%). Nonpatient features, such as a prior occupant of the same room receiving antipseudomonal beta-lactams and the mean number of HCWs per day for the 7 days preceding HOB, improved the model's performance (AUROC, 0.88 [95% CI, 0.88-0.89]; AUPRC, 0.20 [95% CI, 0.20-0.22]) compared with the patient-only model (AUROC, 0.85 [95% CI, 0.85-0.86]; AUPRC, 0.13 [95% CI, 0.12-0.14]) (P < .001). These 2 features were also associated with a higher likelihood of HOB in the causal gradient boosting model.</p><p><strong>Conclusions and relevance: </strong>These findings suggest that nonindividual patient features may contribute to a comprehensive analysis of HOB when integrated with individual patient features in a machine learning model.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2518815"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12223889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}