JAMA Network Open最新文献

{"title":"Veterans at High Risk for Post-COVID-19 Suicide Attempts or Other Self-Directed Violence.","authors":"David P Bui, Meike Niederhausen, Alex W Hickok, Diana J Govier, Mazhgan Rowneki, Jennifer C Naylor, Eric Hawkins, Edward J Boyko, Theodore J Iwashyna, Elizabeth M Viglianti, George N Ioannou, Jason I Chen, Denise M Hynes","doi":"10.1001/jamanetworkopen.2025.0061","DOIUrl":"10.1001/jamanetworkopen.2025.0061","url":null,"abstract":"<p><strong>Importance: </strong>US veterans have a higher risk of suicide than the general civilian population. Research suggests that COVID-19 infection is associated with increased risk of suicide attempts or other forms of self-directed violence (SDV) among veterans.</p><p><strong>Objective: </strong>To identify subgroups of veterans with high risk of post-COVID-19 suicide attempts or SDV.</p><p><strong>Design, setting, and participants: </strong>This is a retrospective cohort study conducted using data from the Veteran Health Administration (VHA). Participants included VHA enrollees with a first case of COVID-19 between May 1, 2021, and April 30, 2022, residing in the 50 states or Washington, DC.</p><p><strong>Exposure: </strong>COVID-19 infection.</p><p><strong>Main outcomes and measures: </strong>The main outcome was a suicide attempt or SDV 12 months after COVID-19 infection. Latent class analysis was used to identify subgroups. Outcome rates and 95% CIs per 10 000 veterans were calculated. Multinomial regressions were used to model outcome risk and marginal risk ratios with 99.5% CIs to compare outcome risk across latent classes.</p><p><strong>Results: </strong>The cohort included 285 235 veterans with COVID-19 and was predominantly male (248 118 veterans [87.0%]) and younger than 65 years (171 636 veterans [60.2%]). Chronic pain (152 788 veterans [53.6%]), depression (98 093 veterans [34.4%]), and posttraumatic stress disorder (79 462 veterans [27.9%]) diagnoses were common. The 12-month outcome rate was 73.8 events per 10 000 (95% CI, 70.7-77.0 events per 10 000). Two latent classes with high rates of suicide attempt or SDV were identified. The first high-risk subgroup (46 693 veterans [16.4%]) was older (34 472 veterans [73.8%] aged ≥65 years) and had a high prevalence of physical conditions (43 329 veterans [92.8%] had hypertension, and 36 824 veterans [78.9%] had chronic pain); the 12-month outcome rate was 103.7 events per 10 000 (95% CI, 94.7-113.3 events per 10 000). The second high-risk subgroup (82 309 veterans [28.9%]) was generally younger (68 822 veterans [83.6%] aged <65 years) with a lower prevalence of physical conditions but high prevalence of mental health conditions (61 367 veterans [74.6%] had depression, and 50 073 veterans [60.8%] had posttraumatic stress disorder); the 12-month outcome rate was 162.9 events per 10 000 (95% CI, 154.5-171.8 events per 10 000), and compared with the lowest risk subgroup, the 12-month risk of suicide attempts or SDV was 14 times higher in this subgroup (risk ratio, 14.23; 99.5% CI, 10.22-19.80).</p><p><strong>Conclusions and relevance: </strong>In this cohort study of veterans with COVID-19, 2 veteran subgroups with distinct health profiles had high rates of suicide attempts and SDV, suggesting that different groups may require different approaches to suicide prevention after COVID-19.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250061"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542176","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":"Hospital Security Searches Among Patients With Substance-Related Encounters.","authors":"Sarah J Nessen, Ashish Thakrar, Jeanmarie Perrone, Lin Xu, Rachel McFadden, Margaret Lowenstein","doi":"10.1001/jamanetworkopen.2025.1068","DOIUrl":"10.1001/jamanetworkopen.2025.1068","url":null,"abstract":"<p><strong>Importance: </strong>Hospital clinicians may request that security personnel search patients' rooms and belongings in response to suspected possession or use of illicit substances. Although searches are intended to protect patient and employee safety, little is known about search outcomes or consequences for clinical care.</p><p><strong>Objective: </strong>To investigate the clinical context and outcomes of room searches among patients with substance-related hospital encounters.</p><p><strong>Design, setting, and participants: </strong>Retrospective cohort study of security incident reports and electronic health record data for patients with substance-related hospital encounters between July 2021 and July 2023 at an urban, academic hospital with approximately 1000 beds in Philadelphia, Pennsylvania. Participants were adults with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes consistent with substance use disorders, chief concerns of drug overdose or withdrawal, and/or positive verbal screenings for opioid use who had emergency department visits or inpatient hospitalizations.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes were search requests, items confiscated, and patient-directed discharges (PDDs). Secondary measures centered on the clinical context of searches, including location and receipt of medications for opioid use disorder.</p><p><strong>Results: </strong>There were 13 827 total substance-related hospital encounters over the study period involving 6985 unique patients (median [IQR] age, 47 [34-58] years; 3863 [55.3%] male; 3688 [52.7%] Black; 302 [4.3%] Hispanic; 2597 [37.2%] White). Over this time, security reported 576 room search requests, among which 457 (79.3%) were requests for searches among patients with substance-related hospital encounters. Nurses requested most searches (376 searches [82.3%]), and 195 searches (43.6%) resulted in no items confiscated. Confiscated items included syringes and unspecified paraphernalia (129 searches [28.9%]), confirmed or suspected drugs and alcohol (102 searches [22.8%]), tobacco products (54 searches [12.1%]), and pipes and smoking materials (53 searches [11.9%]). Patients who had 1 or more search requests during a substance-related hospital encounter had a statistically significant odds ratio (OR) of having a PDD compared with patients who did not undergo searches (OR, 2.99; 95% CI, 2.32-3.86).</p><p><strong>Conclusions and relevance: </strong>In this cohort study of patients with substance-related hospital encounters, most searches did not result in the confiscation of illicit substances, and searches were associated with PDDs. There is an overall need for clear, patient-centered hospital search protocols that support both staff and patient well-being.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e251068"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657309","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":"Errors in Results and Table 1.","authors":"","doi":"10.1001/jamanetworkopen.2025.6345","DOIUrl":"10.1001/jamanetworkopen.2025.6345","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e256345"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657293","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":"Treatment and Attrition Trends for Metastatic Clear Cell Renal Cell Carcinoma in the US.","authors":"Zeynep Irem Ozay, Yeonjung Jo, Gliceida Galarza Fortuna, Chadi Hage Chehade, Georges Gebrael, Micah Ostrowski, Nicolas Sayegh, Ethan Anderson, Salvador Jaime-Casas, Miguel Zugman, Vinay Mathew Thomas, Benjamin L Maughan, Neeraj Agarwal, Sumanta K Pal, Umang Swami","doi":"10.1001/jamanetworkopen.2025.1201","DOIUrl":"10.1001/jamanetworkopen.2025.1201","url":null,"abstract":"<p><strong>Importance: </strong>The treatment landscape of metastatic clear cell renal cell carcinoma (ccRCC) has rapidly evolved with the approval of multiple immune checkpoint inhibitor (ICI)-based combinations. However, clinical data on changes in treatment patterns and attrition before and after ICI-based combinations approval are lacking.</p><p><strong>Objective: </strong>To assess treatment patterns and attrition rates in patients with metastatic ccRCC before and after the approval of ICI-based combinations.</p><p><strong>Design, setting, and participants: </strong>This cohort study used patient-level data from a nationwide deidentified electronic health record-derived database, originating from around 280 cancer clinics in the US. Patients diagnosed with metastatic ccRCC who received first-line therapy between January 1, 2011, and January 20, 2023, were included. Those treated for 2 or more malignant neoplasms or enrolled in clinical trials were excluded.</p><p><strong>Exposures: </strong>Line of therapy initiation before and after April 16, 2018.</p><p><strong>Main outcomes measures: </strong>Treatments received in each line of therapy and attrition rate were summarized using frequencies and percentages.</p><p><strong>Results: </strong>Of 12 707 patients with metastatic ccRCC within the database, 8534 were eligible and included (median [IQR] age, 66 [59-74] years; 6032 male [70.7%]; 629 Black [8.1%], 697 Hispanic [9.0%], 5493 White [71.0%]). Before April 16, 2018, the most common first-line therapy was tyrosine kinase inhibitor (TKI) monotherapy (3595 of 4561 patients [78.8%]). Following the approval of ICI-based combinations in 2018, most patients (2392 of 3973 patients [60.2%]) received ICI-based combinations as first-line therapy for metastatic ccRCC. TKI monotherapy remained the most common second- and third-line therapy in patients treated before and after April 16, 2018. Before 2018, 2639 patients (57.9%) and 1458 patients (31.9%) received second-line and third-line therapies, respectively, compared with 1494 (37.6%) and 562 (14.1%) after 2018.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of 8534 patients with metastatic ccRCC, although ICI-based combinations are the preferred first-line therapy due to their proven superiority over TKI monotherapy, many patients were not receiving them; high attrition rates were observed in subsequent lines. These findings highlight the need to optimize treatment selection by implementing current guidelines in clinical practice.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e251201"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663585","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":"Pulmonary Embolism in Patients with End-Stage Kidney Disease Starting Dialysis.","authors":"Kunal N Patel, Wan-Chi Chan, Vivek Bhat, Monil M Majmundar, Harsh Mehta, Cyrus Munguti, Kartik Munshi, Sri G Yarlagadda, Gaurav M Parmar, Aditya M Sharma, Daniella Kadian-Dodov, Lewis G Satterwhite, Jinxiang Hu, Jordan Baker Ms, Kamal Gupta","doi":"10.1001/jamanetworkopen.2025.0848","DOIUrl":"10.1001/jamanetworkopen.2025.0848","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250848"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648614","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":"Unmasking Racial and Ethnic Disparities in Prehospital Sedation and Restraint Practices-Beyond the Straps.","authors":"Utsha G Khatri, Samuel E Sondheim","doi":"10.1001/jamanetworkopen.2025.1289","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.1289","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e251289"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663586","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":"The Achilles' Heel of Midline Catheters.","authors":"David Paje","doi":"10.1001/jamanetworkopen.2025.1268","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.1268","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e251268"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663506","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":"Probiotics and Fever Duration in Children With Upper Respiratory Tract Infections: A Randomized Clinical Trial.","authors":"Silvia Bettocchi, Anna Comotti, Marina Elli, Valentina De Cosmi, Cristiana Berti, Ilaria Alberti, Alessandra Mazzocchi, Chiara Rosazza, Carlo Agostoni, Gregorio Paolo Milani","doi":"10.1001/jamanetworkopen.2025.0669","DOIUrl":"10.1001/jamanetworkopen.2025.0669","url":null,"abstract":"<p><strong>Importance: </strong>Upper respiratory tract infections (URTIs) are prevalent in children, prompting frequent health care consultations, especially among those with fever. Probiotics show potential as an adjuvant treatment for URTIs, but evidence in children is limited.</p><p><strong>Objective: </strong>To evaluate the efficacy of a probiotic mixture containing Bifidobacterium breve M-16V, Bifidobacterium lactis HN019, and Lactobacillus rhamnosus HN001 in shortening fever duration among children with URTIs.</p><p><strong>Design, setting, and participants: </strong>This randomized clinical trial was conducted between November 19, 2021, and June 20, 2023, at the pediatric emergency department of the Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy. Patients between 28 days and 4 years of age with a fever (≥38.5 °C) and URTI were eligible. Exclusion criteria included recent probiotic use, chronic autoimmune diseases, immunosuppressive treatment, and requirement for hospitalization. Randomization was computer generated and assigned participants to either the intervention (probiotics) or control (placebo) group. Participants, parents or caregivers, and investigators were masked to the group assignments. The primary analysis followed the intention-to-treat approach.</p><p><strong>Interventions: </strong>The probiotic group received daily single dose of 0.5 mL probiotic mixture containing Bifidobacterium breve M-16V, Bifidobacterium lactis HN019, and Lactobacillus rhamnosus HN001 for 14 days. The placebo group received daily single dose of 0.5 mL placebo for 14 days.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was fever duration, defined as the number of days between the first and the last days with fever.</p><p><strong>Results: </strong>Of the 128 patients enrolled (69 males [54%]; mean [SD] age 2.5 [1.3] years), 65 (51%) were randomly assigned to receive placebo and 63 (49%) to receive probiotics. The median (IQR) fever duration was shorter in the probiotic group than the placebo group (median [IQR], 3 [2-4] days vs 5 [4-6] days; adjusted risk ratio, 0.64; 95% CI, 0.51-0.80). Few mild adverse events were reported and did not significantly differ between the probiotic and placebo groups, including constipation (6 [16%] and 6 [12%]; P = .80) and abdominal pain (3 [8%] and 2 [4%]; P = .65).</p><p><strong>Conclusions and relevance: </strong>In this randomized clinical trial, administering a probiotic mixture reduced fever duration by 2 days compared with placebo, with no meaningful safety concerns. The probiotic mixture under investigation could be an effective adjuvant for shortening fever duration in children with URTIs.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT06052540.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250669"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624687","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":"The Delicate Balancing Act of Accelerated Approval for Cancer Medicines-Speed, Certainty, and Benefit.","authors":"Kristina Jenei, Christopher M Booth","doi":"10.1001/jamanetworkopen.2025.2040","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.2040","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e252040"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709399","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":"Physician Perspectives on Ambient AI Scribes.","authors":"Shreya J Shah, Trevor Crowell, Yejin Jeong, Anna Devon-Sand, Margaret Smith, Betsy Yang, Stephen P Ma, April S Liang, Clarissa Delahaie, Caroline Hsia, Tait Shanafelt, Michael A Pfeffer, Christopher Sharp, Steven Lin, Patricia Garcia","doi":"10.1001/jamanetworkopen.2025.1904","DOIUrl":"10.1001/jamanetworkopen.2025.1904","url":null,"abstract":"<p><strong>Importance: </strong>Limited qualitative studies exist evaluating ambient artificial intelligence (AI) scribe tools. Such studies can provide deeper insights into ambient AI implementations by capturing lived experiences.</p><p><strong>Objective: </strong>To evaluate physician perspectives on ambient AI scribes.</p><p><strong>Design, setting, and participants: </strong>A qualitative study using semistructured interviews guided by the Reach, Efficacy, Adoption, Implementation, Maintenance/Practical, Robust Implementation, and Sustainability Model (RE-AIM/PRISM) framework, with thematic analysis using both inductive and deductive approaches. Physicians participating in an AI scribe pilot that included community and faculty practices, across primary care and ambulatory specialties, were invited to participate in interviews. This ambient AI scribe pilot at a health care organization in California was conducted from November 2023 to January 2024.</p><p><strong>Main outcome and measures: </strong>Facilitators and barriers to adoption, practical effectiveness, and suggestions for improvement to enhance sustainability.</p><p><strong>Results: </strong>Twenty-two semistructured interviews were conducted with AI pilot physicians from primary care (13 [59%]) and ambulatory specialties (9 [41%]), including physicians from community practices (12 [55%]) and faculty practices (10 [45%]). Facilitators to adoption included ease of use, ease of editing, and generally positive perspectives of tool quality. Physicians expressed positive sentiments about the impact of the ambient AI scribe tool on cognitive demand (16 of 16 comments [100%]), temporal demand (28 comments [62%]), work-life integration (10 of 11 comments [91%]), and overall workload (8 of 9 comments [89%]). Physician perspectives of the impact of the ambient AI scribe tool on their engagement with patients were mostly positive (38 of 56 comments [68%]). Barriers to adoption included limited functionality with non-English speaking patients and lack of access for physicians without a specific device. Physician perspectives on accuracy and style were largely negative, particularly regarding note length and editing requirements. Several specific suggestions for tool improvement were identified, and physicians were optimistic regarding the potential for long-term use of ambient AI scribes.</p><p><strong>Conclusion and relevance: </strong>In this qualitative study, ambient AI scribes were found to positively impact physician workload, work-life integration, and patient engagement. Key facilitators and barriers to adoption were identified, along with specific suggestions for tool improvement. These findings suggest the potential for ambient AI scribes to reduce clinician burden, with user-centered recommendations offering practical guidance on ways to improve future iterations and improve adoption.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e251904"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692193","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}