JAMA Network Open最新文献

{"title":"Pharmacist-Led Management Model and Medication Adherence Among Patients With Chronic Heart Failure: A Randomized Clinical Trial.","authors":"Lingjiao Wang, Yuanyuan Zhao, Liping Han, Huan Zhang, Hejun Chen, Aixia Liu, Jing Yu, Ran Fu, Liguang Duan, Feiyue An, Zhimin Guo, Yang Lun, Chaoli Chen, Fangfang Cheng, Chaohui Song, Haixia Gao, Chunhua Zhou","doi":"10.1001/jamanetworkopen.2024.53976","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.53976","url":null,"abstract":"<p><strong>Importance: </strong>Poor medication adherence is associated with high morbidity and mortality among patients with chronic heart failure (CHF), which is particularly concerning in China.</p><p><strong>Objective: </strong>To assess the effect of a pharmacist-led management model incorporating a social media platform vs usual care on medication adherence in patients with CHF.</p><p><strong>Design, setting, and participants: </strong>This prospective, multicenter randomized clinical trial was conducted from March 2021 to May 2023, with a follow-up duration of 52 weeks. The trial was conducted in the cardiology wards of 5 hospitals in China. Participants were 18 years or older, had a CHF diagnosis, and were receiving stable medication. They were randomly assigned to either the intervention group (pharmacist-led management) or the control group (usual care) in a 1:1 ratio using a computer-generated random number table with concealed allocation via opaque envelopes. Intention-to-treat data analysis was performed from June 2023 to July 2024.</p><p><strong>Intervention: </strong>The intervention group received a multimodal pharmaceutical intervention, including WeChat application-based communication and education, and a standardized follow-up visit from a pharmacist every month. The control group received the standardized follow-up visit from nurses every month.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the proportion of days covered (PDC) by heart failure medication at 52 weeks.</p><p><strong>Results: </strong>Among the 445 participants analyzed, 223 were assigned to the intervention group and 222 to the control group. These patients had a mean (SD) age of 63.2 (13.3) years and included 263 males (59.1%). A total of 333 patients (74.8%) had a New York Heart Association class III or IV heart failure, indicating severe limitations in physical activity. At 52 weeks, the intervention group had a significantly higher PDC for heart failure medication (8.1%; 95% CI, 5.5%-10.7%; P < .001) and a greater proportion of patients with PDC of 80% or greater (odds ratio, 0.34; 95% CI, 0.21-0.54; P < .001) compared with the control group.</p><p><strong>Conclusions and relevance: </strong>This randomized clinical trial found a modest improvement in medication adherence among patients with CHF who received the pharmacist-led management intervention vs usual care.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry Identifier: ChiCTR2000040232.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2453976"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864133","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":"Daily Physical Activity, Sports Participation, and Executive Function in Children.","authors":"Lu Yang, Eva Corpeleijn, Esther Hartman","doi":"10.1001/jamanetworkopen.2024.49879","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.49879","url":null,"abstract":"<p><strong>Importance: </strong>It is unclear whether daily physical activity and sports participation relate to executive function (EF) in children.</p><p><strong>Objective: </strong>To explore associations between early-life physical activity, sports participation, and executive function in primary school children.</p><p><strong>Design, setting, and participants: </strong>Data for this cohort study were collected from April 2006 to December 2017 from the Groningen Expert Center for Kids with Obesity (GECKO) Drenthe birth cohort, which includes Northern Dutch children. Preschool children aged 5 to 6 years and primary school children aged 10 to 11 years with valid EF, daily physical activity, and sports participation data were included in the analysis. Data were analyzed from May 2023 to February 2024.</p><p><strong>Exposures: </strong>At ages 5 to 6 years, daily physical activity was measured with accelerometry. At ages 10 to 11 years, sports participation data were collected using the Short Questionnaire to Assess Health-Enhancing Physical Activity.</p><p><strong>Main outcomes and measures: </strong>Executive function was assessed using the Behavior Rating Inventory of Executive Function at ages 10 to 11 years.</p><p><strong>Results: </strong>A total of 880 children (470 female [53.4%]; mean [SD] age at EF measurement, 11.1 [0.4] years) were included. Moderate to vigorous physical activity at ages 5 to 6 years did not correlate with EF at ages 10 to 11 years (eg, Global Executive Composite [GEC]: β, 0.16; 95% CI, -0.21 to 0.53). Higher levels of light physical activity at ages 5 to 6 years were associated with poorer inhibitory control (β, 0.86; 95% CI, 0.24-1.47) and self-monitoring (β, 0.79; 95% CI, 0.09-1.48) at ages 10 to 11 years, while greater sedentary time was associated with better inhibitory control (β, -0.62; 95% CI, -1.08 to -0.16) and self-monitoring (β, -0.57; 95% CI, -1.09 to -0.06). Compared with children engaged in individual sports, team sports participants exhibited better overall EF (mean difference [SE], -3.03 [0.81]), behavior regulation (mean difference [SE], -3.39 [0.77]), and metacognition (mean difference [SE], -2.55 [0.81]). Children involved in both types of sports vs only individual sports had better EF (GEC: mean difference [SE], -2.66 [0.93]).</p><p><strong>Conclusions and relevance: </strong>In this cohort study of Dutch children, early-life moderate to vigorous physical activity was not associated with EF in middle childhood. Children participating in team sports at ages 10 to 11 years consistently exhibited superior EF compared with participants in individual sports.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2449879"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142836437","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":"Nicotine Pouch Use Among US Military Personnel.","authors":"Melissa A Little, Kathryn M Polaskey, Asal Pilehvari, Rebecca A Krukowski, Kurt M Ribisl, Teresa D Pearce","doi":"10.1001/jamanetworkopen.2024.51517","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.51517","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2451517"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142836441","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":"Supporting Pediatric Emergency Care Coordinators in All US EDs-A Moral Imperative.","authors":"Marc A Auerbach, Elizabeth Sanseau","doi":"10.1001/jamanetworkopen.2024.51055","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.51055","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2451055"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846645","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":"Biased Language in Simulated Handoffs and Clinician Recall and Attitudes.","authors":"Austin Wesevich, Erica Langan, Ilona Fridman, Sonya Patel-Nguyen, Monica E Peek, Victoria Parente","doi":"10.1001/jamanetworkopen.2024.50172","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.50172","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Poor-quality handoffs can lead to medical errors when transitioning patient care. Biased language within handoffs may contribute to errors and lead to disparities in health care delivery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare clinical information recall accuracy and attitudes toward patients among trainees in paired cases of biased vs neutral language in simulated handoffs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;Surveys administered from April 29 to June 15 and from July 20 to October 10, 2023, included 3 simulated verbal handoffs, randomized between biased and neutral, and measured clinical information recall, attitudes toward patients, and key takeaways after each handoff. Participants included residents in internal medicine, pediatrics, and internal medicine-pediatrics and senior medical students at 2 academic medical centers in different geographic regions of the US. Data were analyzed from November 2023 to June 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Each participant received 3 handoffs that were based on real handoffs about Black patients at 1 academic center. These handoffs were each randomized to either a biased or neutral version. Biased handoffs had 1 of 3 types of bias: stereotype, blame, or doubt. The order of handoff presentation was also randomized. Internal medicine and pediatrics residents received slightly different surveys, tailored for their specialty. Internal medicine-pediatrics residents received the pediatric survey. Medical students were randomly assigned the survey type.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Each handoff was followed by a clinical information recall question, an adapted version of the Provider Attitudes Toward Sickle Cell Patients Scale (PASS), and 3 free-response takeaways.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 748 trainees contacted, 169 participants (142 residents and 27 medical students) completed the survey (23% overall response rate), distributed across institutions, residency programs, and years of training (95 female [56%]; mean [SD] age, 28.6 [2.3] years). Participants who received handoffs with blame-based bias had less accurate information recall than those who received neutral handoffs (77% vs 93%; P = .005). Those who reported bias as a key takeaway of the handoff had lower clinical information recall accuracy than those who did not (85% vs 93%; P = .01). Participants had less positive attitudes toward patients per PASS scores after receiving biased compared with neutral handoffs (mean scores, 22.9 [3.3] vs 25.2 [2.7]; P &lt; .001). More positive attitudes toward patients were associated with higher clinical information recall accuracy (odds ratio, 1.12; 95% CI, 1.02-1.22).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this survey study of residents and medical students, biased handoffs impeded accurate transfer of key clinical information and decreased empathy, potentially endangering patients and worsening health dispar","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2450172"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142836431","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":"Depression and Suicide Risk Screening in the Veterans Health Administration.","authors":"Lucinda B Leung, Karen Chu, Martin L Lee, Amy G Bonilla, Edward P Post, John C Fortney","doi":"10.1001/jamanetworkopen.2024.51936","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.51936","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2451936"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877282","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":"Patterns of Social Connection Among Older Adults in England.","authors":"Feifei Bu, Daisy Fancourt","doi":"10.1001/jamanetworkopen.2024.51580","DOIUrl":"10.1001/jamanetworkopen.2024.51580","url":null,"abstract":"<p><strong>Importance: </strong>Issues related to social connection are increasingly recognized as a global public health priority. However, there is a lack of a holistic understanding of social connection and its health impacts given that most empirical research focuses on a single or few individual concepts of social connection.</p><p><strong>Objective: </strong>To explore patterns of social connection and their associations with health and well-being outcomes.</p><p><strong>Design, setting, and participants: </strong>This cohort study included participants aged 50 years and older from the fourth wave of the English Longitudinal Study of Aging (2008-2009). Machine learning cluster analysis and regression analysis were used. The analyses were performed from January to July 2024.</p><p><strong>Exposure: </strong>Social connection clusters informed by the cluster analysis.</p><p><strong>Main outcomes and measures: </strong>This study considered outcomes related to mental health (depression), hedonic (life satisfaction, pleasure) and eudaimonic (self-realization) well-being, general health (self-reported health), and health behavior (moderate or vigorous physical activity). Key confounders, identified using directed acyclic graphs, including age, sex, ethnicity, education, social class, and wealth, were controlled for.</p><p><strong>Results: </strong>Among 7706 participants aged 50 years and older (mean [SD] age, 64.7 [9.6] years; 4248 [55.1%] female; 7536 [97.8%] White), 5 clusters were identified, including disconnected (974 [12.6%]), gapped structure/poor function (1109 [14.4%]), gapped structure/high function (1582 [20.5%]), poor function/mixed quality (1501 [19.5%]), and highly connected (2540 [33.0%]). All clusters had poorer outcomes compared with the highly connected cluster (eg, depression among individuals in disconnected vs highly connected clusters: odds ratio [OR], 2.73; 95% CI, 2.24 to 3.33), many of which persisted after controlling for baseline outcome (eg, depression among individuals in disconnected vs highly connected clusters: OR, 1.95; 95% CI, 1.57 to 2.43). The difference was smallest between the highly connected and gapped structure/high function clusters across most outcomes (eg, depression among individuals in gapped structure/high function vs highly connected: OR, 1.34; 95% CI, 1.10-1.64; after controlling for baseline outcome: OR, 1.28; 95% CI, 1.03-1.59).</p><p><strong>Conclusions and relevance: </strong>This cohort study highlights the importance of considering multidimensional measures of social connection and understanding the nuance of its heterogenous patterns. Understanding the typologies of social connection has substantial implications for exploring modifiable risk factors for social disconnection and for understanding the mechanisms linking social connection to health-related outcomes.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2451580"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877307","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":"Ticagrelor vs Prasugrel for Acute Coronary Syndrome in Routine Care.","authors":"Nils Krüger, Johannes Krefting, Thorsten Kessler, Raphael Schmieder, Fabian Starnecker, Alexander Dutsch, Christian Graesser, Ulrike Meyer-Lindemann, Theresa Storz, Irina Pugach, Christian Frieß, Zhifen Chen, Dario Bongiovanni, Iulian Manea, Tobias Dreischulte, Frank Offenborn, Peter Krase, Hendrik B Sager, Jens Wiebe, Sebastian Kufner, Erion Xhepa, Michael Joner, Teresa Trenkwalder, Ulrich Gueldener, Adnan Kastrati, Salvatore Cassese, Heribert Schunkert, Moritz von Scheidt","doi":"10.1001/jamanetworkopen.2024.48389","DOIUrl":"10.1001/jamanetworkopen.2024.48389","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;In patients with acute coronary syndrome (ACS) undergoing invasive treatment, ticagrelor and prasugrel are guideline-recommended P2Y12 receptor inhibitors. The ISAR-REACT5 randomized clinical trial demonstrated superiority for prasugrel, although concerns were raised about the generalizability of some underpowered subgroup analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To emulate a randomized clinical trial evaluating the safety and effectiveness of ticagrelor vs prasugrel under the conditions of routine care in individuals with ACS planned to undergo an invasive treatment strategy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This new-user cohort study included secondary data from a German statutory health insurance claims database between January 2012 and December 2021, using 1:1 propensity score nearest-neighbor matching to emulate ISAR-REACT5. Individuals with ACS receiving either ticagrelor or prasugrel treatment after hospital discharge were followed up for 1 year. Eligibility criteria closely emulated those of ISAR-REACT5 and included age of 18 years or older and cardiovascular risk factors. Data were analyzed from May 2023 to May 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Outpatient prescription of ticagrelor or prasugrel.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary end point was the composite of all-cause mortality, myocardial infarction (MI), or stroke within 1 year of outpatient treatment initiation. Secondary end points included individual components of the primary end point and stent thrombosis. The safety end point was major bleeding. A Cox proportional hazards regression model was fitted to the overall cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 17 642 propensity score-matched individuals (mean [SD] age, 63.1 [10.9] years; 73.9% male), 8821 received ticagrelor and 8821 received prasugrel. Agreement was met in 11 of 12 predefined agreement metrics when comparing the results with ISAR-REACT5. The primary composite end point of all-cause mortality, MI, or stroke occurred in 815 individuals (9.2%) receiving ticagrelor and 663 (7.5%) receiving prasugrel (hazard ratio [HR], 1.24; 95% CI, 1.12-1.37). Myocardial infarction (HR, 1.20; 95% CI, 1.06-1.36) and stroke (HR, 1.33; 95% CI, 1.02-1.74) each occurred significantly more often in the ticagrelor group. Analysis of all-cause mortality (HR, 1.27; 95% CI, 0.99-1.64), stent thrombosis (HR, 1.11; 95% CI, 0.89-1.30), and major bleeding (HR, 1.12; 95% CI, 0.96-1.32) revealed no significant differences between treatment groups. Subgroup analysis showed that prasugrel was associated with the primary composite end point in fewer individuals with ST-segment elevation MI (338 of 4941 [6.8%] vs 451 of 4852 [9.3%]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This cohort study found that prasugrel was associated with lower rates of all-cause mortality, MI, or stroke compared with ticagrelor in individuals with ACS undergoing an invasive t","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2448389"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11612834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768940","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":"Challenges of Surveillance in Implementing Nonoperative Management for Rectal Cancer.","authors":"Bailey K Hilty Chu, Anthony Loria, Totadri Dhimal, Xueya Cai, Shan Gao, Yue Li, Larissa K Temple, Fernando Colugnati, Paula Cupertino, Erika E Ramsdale, Fergal J Fleming","doi":"10.1001/jamanetworkopen.2024.48682","DOIUrl":"10.1001/jamanetworkopen.2024.48682","url":null,"abstract":"<p><strong>Importance: </strong>Close surveillance for detection of local tumor regrowth is critical for patients opting for nonoperative management after neoadjuvant therapy for rectal cancer. However, there are minimal data regarding the feasibility and adherence to National Comprehensive Cancer Network (NCCN) surveillance guidelines for these patients.</p><p><strong>Objective: </strong>To determine adherence rates to NCCN-recommended surveillance in patients undergoing nonoperative management for rectal cancer.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included patients treated at a single academic center (University of Rochester, Rochester, New York) from 2012 to 2023, with analysis completed from March through May 2024. Patients with clinical stage I to III rectal cancer who underwent treatment with neoadjuvant therapy, achieved a clinical complete response (or initially near complete clinical response), and elected for nonoperative management were enrolled.</p><p><strong>Exposure: </strong>Achievement of recommended surveillance.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was adherence to surveillance guidelines for patients undergoing nonoperative management for rectal cancer. Secondary outcomes included assessment of oncologic outcomes stratified by adherence to surveillance.</p><p><strong>Results: </strong>Eighty-five patients (54 male [63.5%]; median [IQR] age, 63.0 [54.0-73.0] years) were managed nonoperatively and followed for a median of 4.04 years (95% CI, 3.17-4.58 years). The 5-year overall survival was 82.3% (95% CI, 71.8%-94.5%), the 5-year disease-specific survival was 95.1% (95% CI, 89.6%-100.0%), the rate of local regrowth was 24.7% (21 patients), and the rate of distant metastases was 12.9% (11 patients). Among the 77 patients with more than 6 months of follow-up in their first year of surveillance, only 39.0% of patients (30 patients) achieved NCCN-recommended surveillance in the first year, and this decreased to 15.0% (3 patients) by year 5. However, the time to local regrowth and distant metastasis were similar regardless of the level of surveillance.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of patients with rectal cancer undergoing surveillance after nonoperative management, most did not achieve NCCN-recommended guidelines, although outcomes were not associated with surveillance intensity. This highlights the need for prospective evaluation of a surveillance regimen that is both feasible for patients and health care systems increasingly using nonoperative management. In addition, studies are warranted to explore patient preferences in rectal cancer care and to identify barriers to optimal surveillance.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2448682"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11615709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769102","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":"Redesigning the Hospital Environment to Improve Restfulness.","authors":"Caellagh D Catley, Kayla Paynter, Kendall Jackson, Ashley Huggins, Jenny Ji, Sai Anusha Sanka, Michelle Simkins, Thomas M Maddox, Patrick G Lyons","doi":"10.1001/jamanetworkopen.2024.47790","DOIUrl":"10.1001/jamanetworkopen.2024.47790","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Hospital wards are often not conducive to patient sleep, negatively affecting patient health and experience.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess determinants of in-hospital restfulness and to design and test rest-promoting interventions on the wards in partnership with clinicians, staff, and patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This rapid-sequential mixed-methods quality improvement study was performed at a large urban academic hospital in St Louis, Missouri, from May 1, 2021, to December 31, 2022, with follow-up through hospitalization. Mixed-methods activities involved purposively selected hospitalized adults on the wards, nurses, hospitalists, and hospital staff. Interventions included all adult hospitalizations on the study wards.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Sequential stacked bundles of multimodal rest-promoting interventions (general education, focused education on light or noise, safely reducing overnight monitoring or testing, and environmental personalization).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measurements: &lt;/strong&gt;Pre-post comparisons of perceived nighttime quietness (via surveys) and sleep opportunity (coprimary outcomes) as well as clinical interruptions overnight, environmental noise, and adoption and satisfaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Nine patients (4 female) and 14 staff members (10 female; 3 nurse managers or administrators, 10 nurses, and 1 physician) were interviewed, 38 surveys were collected, and more than 100 hours of observation were performed. Interventions were evaluated for 671 patients (mean [SD] age, 60 [16] years; 336 [50%] female). Determinants of in-hospital rest included infrastructure, staff attitudes, priorities, culture, and patient experiences of anxiety, uncertainty, and loss of control. Informed by these determinants, codesign workshops yielded 39 potential interventions, from which 9 were selected for testing. Related interventions were organized into bundles, which were tested in sequential 2-week sprints. Perceived nighttime quietness improved nonsignificantly during the project (wards \"always\" quiet at night: 51% preintervention vs 86% postintervention; P = .09), with excessive noise events decreasing from 0.65 (95% CI, 0.53-0.77) to 0 per 100 patient-nights before the intervention (P = .02). Sleep opportunity improved significantly (mean, 4.94 [95% CI, 4.82-5.06] hours per patient-night before the intervention vs 5.10 [95% CI, 5.00-5.20] hours per patient-night after the intervention; P = .01).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this quality improvement study, a set of feasible, acceptable, and beneficial rest-promoting interventions were developed. After implementation of these interventions on the wards, a significant improvement in nighttime quietness and sleep opportunity was observed. These results demonstrate how human-centered design methods can generate practical and effective strategies ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2447790"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769169","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}