JAMA Network Open最新文献

{"title":"Error in Conflict of Interest Disclosures.","authors":"","doi":"10.1001/jamanetworkopen.2024.51384","DOIUrl":"10.1001/jamanetworkopen.2024.51384","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2451384"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11584917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686975","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":"Targeted Reinnervation During Gender-Affirming Mastectomy and Restoration of Sensation.","authors":"Katya Remy, Chase Alston, Elyse Gonzales, Merel H J Hazewinkel, Katherine H Carruthers, Leslie E Cohen, Eleanor Tomczyk, Jonathan M Winograd, William G Austen, Ian L Valerio, Lisa Gfrerer","doi":"10.1001/jamanetworkopen.2024.46782","DOIUrl":"10.1001/jamanetworkopen.2024.46782","url":null,"abstract":"<p><strong>Importance: </strong>During gender-affirming mastectomy, nerves are transected, resulting in sensory loss. Nerve preservation using targeted nipple-areola complex (NAC) reinnervation (TNR) may restore sensation.</p><p><strong>Objective: </strong>To determine the quantitative and patient-reported sensory outcomes of TNR.</p><p><strong>Design, setting, and participants: </strong>Prospective matched cohort study of patients undergoing gender-affirming mastectomy from August 2021 to December 2022 at Weill Cornell Medicine and Massachusetts General Hospital. Data were analyzed from January to March 2023.</p><p><strong>Exposure: </strong>Patients who underwent TNR and matched patients who did not.</p><p><strong>Main outcomes and measures: </strong>Mechanical detection measured with monofilaments and patient-reported outcome questionnaires were completed preoperatively and at 1, 3, 6, 9, and 12 months postoperatively. Additional quantitative sensory testing was performed preoperatively and at 12 months postoperatively. The primary outcome was mechanical detection while secondary outcomes were the additional quantitative sensory testing variables and patient-reported outcomes. Exclusion criteria included peripheral nerve disorders, unmatched patients, and incomplete follow-up.</p><p><strong>Results: </strong>A total of 25 patients who underwent TNR and 25 matched patients who did not were included. The mean (SD) age was 24.9 (5.5) years, BMI was 26.6 (5.2), and mastectomy weight was 608.9 (326.5) g; 6 patients (12.0%) were Asian, 5 patients (10.0%) were Black or African American, and 33 patients (66.0%) were White. Repeated measures analysis of variance (ANOVA) showed that the outcomes of TNR on improving mechanical detection over time was significant at the NAC (F = 35.2; P < .001) and chest (F = 4.2; P = .045). At 12 months, mean quantitative sensory values in patients who underwent TNR reached baseline and were improved compared with patients who did not undergo TNR for monofilaments (mean [SD] NAC, 3.7 [0.5] vs 4.9 [0.9]; [data]; P < .001; chest, 3.3 [0.4] vs 3.6 [0.6]; [data]; P = .002), vibration (mean [SD] NAC, 7.7 [ 0.4] vs 7.3 [0.4]; t96 = 6.3; P < .001; chest, 7.8 [0.3] vs 7.5 [0.3]; t96 = 5.1; P < .001), 2-point discrimination (NAC, 40% vs 0%; r = 20; P = .02); chest, 4.1 [1.2] cm vs 5.7 [1.8] cm; P < .001), pinprick (mean [SD] NAC, 24.9 [21.2] mN vs 82.6 [96.7] mN; t98 = 4.1; P < .001; chest, 22.5 [25.6] mN vs 54.1 [45.4] mN; t98 = 4.6; P < .001), cold (mean [SD] NAC, 23.1 [4.7] °C vs 12.0 [7.6] °C; t98 = 8.8; P < .001; chest, 23.6 [3.1] °C vs 19.7 [5.6] °C; t98 = 4.4; P < .001), warm (mean [SD] NAC, 39.9 [5.0] °C vs 45.8 [4.2] °C; t98 = 6.3; P < .001; chest, 39.4 [3.1] °C vs 42.9 [4.0] °C; t98 = 4.9; P < .001), and pressure pain detection (mean [SD] NAC, 89.9 [45.6] kPa vs 130.5 [68.9] kPa; t86 = 3.9; P < .001; chest, 128.5 [38.0] kPa vs 175.5 [49.3] kPa; t96 = 4.0; P = .001). ANOVA demonstrated that TNR significantly improved pat","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2446782"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11584927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687014","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":"US Pediatric Inpatient Care Loss Before and During the COVID-19 Pandemic.","authors":"Urbano L França, Michael L McManus","doi":"10.1001/jamanetworkopen.2024.46025","DOIUrl":"10.1001/jamanetworkopen.2024.46025","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2446025"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11584919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687027","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":"Prenatal Diet and Infant Growth From Birth to Age 24 Months.","authors":"Monique M Hedderson, Holly B Schuh, Emily A Knapp, Traci A Bekelman, Diane J Catellier, Matt Westlake, Kristen Lyall, Rebecca J Schmidt, Anne L Dunlop, Sarah S Comstock, Leda Chatzi, Katherine A Sauder, Dana Dabelea, Karen M Switkowski, Pi-I Debby Lin, Lyndsay A Avalos, Yeyi Zhu, Assiamira Ferrara","doi":"10.1001/jamanetworkopen.2024.45771","DOIUrl":"10.1001/jamanetworkopen.2024.45771","url":null,"abstract":"<p><strong>Importance: </strong>Being born either small for gestational age (SGA) or large for gestational age (LGA) and experiencing rapid or slow growth after birth are associated with later-life obesity. Understanding the associations of dietary quality during pregnancy with infant growth may inform obesity prevention strategies.</p><p><strong>Objective: </strong>To evaluate the associations of prenatal dietary quality according to the Healthy Eating Index (HEI) and the Empirical Dietary Inflammatory Pattern (EDIP) with infant size at birth and infant growth from birth to age 24 months.</p><p><strong>Design, setting, and participants: </strong>This cohort study used data from birthing parent-child dyads in 8 cohorts participating in the Environmental influences on Child Health Outcomes program between 2007 and 2021. Data were analyzed from March 2021 to August 2024.</p><p><strong>Exposures: </strong>The HEI and the EDIP dietary patterns.</p><p><strong>Main outcomes and measures: </strong>Outcomes of interest were infant birth weight, categorized as SGA, reference range, or LGA, and infant growth from birth to ages 6, 12, and 24 months, categorized as slow growth (weight-for-length z score [WLZ] score difference <-0.67), within reference range (WLZ score difference -0.67 to 0.67), or rapid (WLZ score difference, >0.67).</p><p><strong>Results: </strong>The study included 2854 birthing parent-child dyads (median [IQR] maternal age, 30 [25-34] years; 1464 [51.3%] male infants). The cohort was racially and ethnically diverse, including 225 Asian or Pacific Islander infants (7.9%), 640 Black infants (22.4%), 1022 Hispanic infants (35.8%), 664 White infants (23.3%), and 224 infants (7.8%) with other race or multiple races. A high HEI score (>80), indicative of a healthier diet, was associated with lower odds of LGA (adjusted odds ratio [aOR], 0.88 [95% CI, 0.79-0.98]), rapid growth from birth to age 6 months (aOR, 0.80 [95% CI, 0.37-0.94]) and age 24 months (aOR 0.82 [95% CI, 0.70- 0.96]), and slow growth from birth to age 6 months (aOR, 0.65 [95% CI, 0.50-0.84]), 12 months (aOR, 0.74 [95% CI, 0.65-0.83]), and 24 months (OR, 0.65 [95% CI, 0.56-0.76]) compared with an HEI score 80 or lower. There was no association between high HEI and SGA (aOR, 1.14 [95% CI, 0.95-1.35]). A low EDIP score (ie, ≤63.6), indicative of a less inflammatory diet, was associated with higher odds of LGA (aOR, 1.24 [95% CI, 1.13-1.36]) and rapid infant growth from birth to age 12 months (aOR, 1.50 [95% CI, 1.18-1.91]) and lower odds of rapid growth to age 6 months (aOR, 0.77 [95% CI, 0.71-0.83]), but there was no association with SGA (aOR, 0.80 [95% CI, 0.51-1.25]) compared with an EDIP score of 63.6 or greater.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, a prenatal diet that aligned with the US Dietary Guidelines was associated with reduced patterns of rapid and slow infant growth, known risk factors associated with obesity. Future research should ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2445771"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11582932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681934","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":"Multilevel Intervention and Outreach for Colorectal Cancer Screening.","authors":"Aasma Shaukat","doi":"10.1001/jamanetworkopen.2024.46703","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.46703","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2446703"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710161","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":"A New Clue on Diffuse Brain Swelling After Pediatric TBI.","authors":"Patrick M Kochanek, Dennis W Simon, Robert S B Clark","doi":"10.1001/jamanetworkopen.2024.46707","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.46707","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2446707"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710118","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":"Heart Failure and All-Cause Hospitalizations in Patients With Heart Failure: A Meta-Analysis.","authors":"Ahmed Sayed, Mohamed ElRefaei, Kamal Awad, Husam Salah, John Mandrola, Andrew Foy","doi":"10.1001/jamanetworkopen.2024.46684","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.46684","url":null,"abstract":"<p><strong>Importance: </strong>Heart failure (HF) hospitalization is a common end point in HF trials; however, how HF hospitalization is associated with all-cause hospitalization in terms of proportionality, correlation of treatment effects, and concomitant reporting has not been studied.</p><p><strong>Objective: </strong>To determine the ratio of HF to all-cause hospitalizations, whether reported treatment effects on HF hospitalization are associated with treatment effects on all-cause hospitalization, and how often all-cause hospitalization is reported alongside HF hospitalization.</p><p><strong>Data sources: </strong>PubMed was searched from inception to September 2, 2024, for randomized clinical trials (RCTs) of HF treatments using MeSH (medical subject heading) terms and keywords associated with heart failure, ventricular failure, ventricular dysfunction, and cardiac failure, as well as the names of specific journals.</p><p><strong>Study selection: </strong>RCTs of HF treatments and reporting on HF hospitalization published in 1 of 3 leading medical journals (New England Journal of Medicine, The Lancet, or JAMA).</p><p><strong>Data extraction and synthesis: </strong>The PRISMA guidelines were followed. Data extraction was performed by 2 reviewers, and disagreements were resolved by consensus. Trial baseline characteristics and outcome data on HF and all-cause hospitalizations were extracted. The ratio of HF to all-cause hospitalizations was calculated. The association of HF hospitalization effects with all-cause hospitalization effects was evaluated using hierarchical bayesian models with weak priors. The posterior distribution was used to calculate the HF hospitalization treatment effects that would need to be observed before a high probability (97.5%) of a reduction in all-cause hospitalization could be achieved. The proportion of trials reporting all-cause hospitalization was calculated.</p><p><strong>Main outcomes and measures: </strong>HF and all-cause hospitalizations.</p><p><strong>Results: </strong>Of 113 trials enrolling 261 068 patients (median proportion of female participants, 25.4% [IQR, 21.3%-34.2%]; median age, 66.2 [IQR, 62.8-70.0] years), 60 (53.1%) reported on all-cause hospitalization. The weighted median ratio of HF to all-cause hospitalizations was 45.9% (IQR, 30.7%-51.7%). This ratio was higher in trials with greater proportions of New York Heart Association class III or IV HF, with lower left ventricular ejection fractions, investigating nonpharmaceutical interventions, and that restricted recruitment to patients with HF and reduced ejection fraction. Reported effects on HF and all-cause hospitalizations were well-correlated (R2 = 90.1%; 95% credible interval, 62.3%-99.8%). In a large trial, the intervention would have to decrease the odds of HF hospitalization by 16% to ensure any reduction, 36% to ensure a 10% reduction, and 56% to ensure a 20% reduction in the odds of all-cause hospitalization with 97.5% probabilit","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2446684"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142728782","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":"Selection of Patients With Early-Stage Breast Cancer for Extended Endocrine Therapy: A Secondary Analysis of the IDEAL Randomized Clinical Trial.","authors":"Laura J van 't Veer, Elma Meershoek-Klein Kranenbarg, Marjolijn Duijm-de Carpentier, Cornelis J H Van de Velde, Miranda Kleijn, Christa Dreezen, Andrea R Menicucci, William Audeh, Gerrit-Jan Liefers","doi":"10.1001/jamanetworkopen.2024.47530","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.47530","url":null,"abstract":"<p><strong>Importance: </strong>There is a need for biomarkers that predict late recurrence risk and extended endocrine therapy (EET) benefit among patients with early-stage breast cancer (EBC). MammaPrint, a 70-gene expression risk-of-recurrence assay, has been found to project significant EET benefit in patients with assay-classified low-risk tumors.</p><p><strong>Objective: </strong>To determine the test's utility in identifying which patients with EBC in the IDEAL (Investigation on the Duration of Extended Adjuvant Letrozole) trial could benefit from 5-year vs 2.5-year letrozole treatment.</p><p><strong>Design, setting, and participants: </strong>This secondary analysis of the IDEAL randomized clinical trial evaluated postmenopausal women with hormone receptor-positive EBC who were assigned to either 2.5 or 5 years of EET, with 10 years of follow-up after randomization. A 70-gene assay was used to classify tumors as high, low, or ultralow risk. Adverse event (AE) frequency and treatment compliance were evaluated. Statistical analyses were performed from April 2022 to September 2024.</p><p><strong>Interventions: </strong>After 5 years of endocrine therapy, patients were randomized to 2.5 or 5 years of EET with letrozole.</p><p><strong>Main outcomes and measures: </strong>Primary end point was distant recurrence (DR). Cox proportional hazard regression models and likelihood ratios tested the interaction between treatment and gene expression assay.</p><p><strong>Results: </strong>Among 515 women included (mean [SD] age at randomization, 59.9 [9.5] years), 265 were in the 2.5-year treatment arm and 250 in the 5-year treatment arm. Of these patients, 223 (43.3%) patients with 70-gene assay-classified low-risk tumors had a significant absolute benefit of 10.1% for DR (hazard ratio, 0.32; 95% CI, 0.12-0.87; P = .03). Treatment interaction was not significant for DR. Of patients with either 70-gene assay-classified high-risk tumors (259 [50.3%]) or ultralow risk tumors (33 [6.4%]), 5 years vs 2.5 years of EET was not associated with improved benefit for DR. As expected, rates of AEs and treatment discontinuation were comparable among the different 70-gene assay risk groups in each treatment arm.</p><p><strong>Conclusions and relevance: </strong>This secondary analysis of the IDEAL trial found that the 70-gene assay identified patients with low-risk tumors who could benefit from 5-year vs 2.5-year EET. These findings suggest that this gene expression assay could go beyond guiding neoadjuvant and adjuvant chemotherapy decisions to informing the optimal duration of adjuvant endocrine therapy.</p><p><strong>Trial registration: </strong>EU Clinical Trials Register Eudra CT: 2006-003958-16.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2447530"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142728844","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":"Patient, Caregiver, and Clinician Perspectives on the Time Burdens of Cancer Care.","authors":"Arjun Gupta, Whitney V Johnson, Nicole L Henderson, Obafemi O Ogunleye, Preethiya Sekar, Manju George, Allison Breininger, Michael Anne Kyle, Christopher M Booth, Timothy P Hanna, Gabrielle B Rocque, Helen M Parsons, Rachel I Vogel, Anne H Blaes","doi":"10.1001/jamanetworkopen.2024.47649","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.47649","url":null,"abstract":"<p><strong>Importance: </strong>Cancer and its care impose significant time commitments on patients and care partners. The oncology community has only recently conceptualized these commitments and the associated burden as the \"time toxicity\" of cancer care. As the concept gains traction, there is a critical need to fundamentally understand the perspectives of multiple stakeholders on the time burdens of cancer care.</p><p><strong>Objectives: </strong>To explore time-consuming aspects of cancer care that were perceived as burdensome, identify the individuals most affected by time burdens of cancer care, and evaluate the consequences of these time burdens.</p><p><strong>Design, setting, and participants: </strong>Participants in this qualitative analysis were recruited from a National Cancer Institute-designated cancer center in Minnesota, where semistructured qualitative interviews were conducted from February 1 to October 31, 2023. Purposive and criterion sampling methods were used to recruit patients (adults with advanced stage gastrointestinal cancer receiving systemic cancer-directed treatment), care partners (patient-identified informal [unpaid] partners), and clinicians (physicians, physician assistants, nurse practitioners, nurses, social workers, and schedulers). Data were analyzed from February 2023 to February 2024.</p><p><strong>Main outcomes and measures: </strong>Thematic analysis was conducted with a hybrid (inductive and deductive methods) approach. Themes, subthemes, and illustrative quotations are presented.</p><p><strong>Results: </strong>Interviews included 47 participants (16 patients [8 aged ≤60 years; 12 women (75.0%)], 15 care partners [12 aged ≤60 years; 9 women (60.0%)], and 16 clinicians [11 women (68.7%)]). A total of 31 subthemes were identified that were grouped into 5 themes. Theme 1 captured time burdens due to health care outside the home (eg, travel, parking, and waiting time), while theme 2 identified the often invisible tasks performed at home (eg, handling insurance and medical bills, receiving formal home-based care). Theme 3 explored how care partners are affected alongside patients (eg, burdens extending to the wider network of family, friends, and community) and theme 4 represented the consequences of time burdens (eg, demoralization, seemingly short visits turned into all-day affairs). Finally, theme 5 referenced positive time spent in clinical interactions and hope for change (eg, patients value meaningful care, the \"time toxicity\" label is a spark for change).</p><p><strong>Conclusions and relevance: </strong>This qualitative analysis identifies key sources and effects of time toxicity, as well as the populations affected. The results of this study will guide the oncology community to map, measure, and address future time burdens.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2447649"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142728838","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":"Health Care Perceptions and a Concierge-Based Transplant Evaluation for Patients With Kidney Disease.","authors":"Miriam Vélez-Bermúdez, Yuridia Leyva, Jamie M Loor, Mary Amanda Dew, Yiliang Zhu, Mark L Unruh, L Ebony Boulware, Amit Tevar, Larissa Myaskovsky","doi":"10.1001/jamanetworkopen.2024.47335","DOIUrl":"10.1001/jamanetworkopen.2024.47335","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;The kidney transplant (KT) evaluation process is particularly time consuming and burdensome for Black patients, who report more discrimination, racism, and mistrust in health care than White patients. Whether alleviating patient burden in the KT evaluation process may improve perceptions of health care and enhance patients' experiences is important to understand.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate whether Black and White participants would experience improvements in perceptions of health care after undergoing a streamlined, concierge-based approach to KT evaluation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This prospective cohort study from a single urban transplant center included Black and White English-speaking adults who were referred for KT and deemed eligible to proceed with the KT evaluation process. The patients responded to baseline and follow-up questionnaires. The study was conducted from May 2015 to June 2018. Questionnaires were collected before KT evaluation initiation (baseline) and after KT evaluation completion (follow-up). Data were analyzed from October 2022 to January 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Data were stratified by race (Black compared with White) and time (baseline compared with follow-up).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The main outcomes were experiences of discrimination in health care, perceived racism in health care, medical mistrust of health care systems, and trust in physician. Repeated-measures regression was used to assess race, time, and the race-by-time interaction as factors associated with each outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study included 820 participants (mean [SD] age, 56.50 [12.93] years; 514 [63%] male), of whom 205 (25%) were Black and 615 (75%) were White. At baseline and follow-up, Black participants reported higher discrimination (119 [58%]; χ21 = 121.89; P &lt; .001 and 77 [38%]; χ21 = 96.09; P &lt; .001, respectively), racism (mean [SD], 2.73 [0.91]; t290.46 = 7.77; P &lt; .001 and mean [SD], 2.63 [0.85]; t296.90 = 7.52; P &lt; .001, respectively), and mistrust (mean [SD], 3.32 [0.68]; t816.00 = 7.29; P &lt; .001 and mean [SD], 3.18 [0.71]; t805.00 = 6.43; P &lt; .001, respectively) scores but lower trust in physician scores (mean [SD], 3.93 [0.65]; t818.00 = -2.01; P = .04 and mean [SD], 3.78 [0.65]; t811.00 = -5.42; P &lt; .001, respectively) compared with White participants. All participants experienced statistically significant reductions in discrimination (Black participants: odds ratio, 0.27 [95% CI, 0.16-0.45]; P &lt; .001; White participants: odds ratio, 0.37 [95% CI, 0.25-0.55]; P &lt; .001) and medical mistrust in health care (Black participants: β [SE], -0.16 [0.05]; P &lt; .001; White participants: β [SE], -0.09 [0.03]; P &lt; .001), and Black participants reported lower perceived racism at follow-up (β [SE], -0.11 [0.05]; P = .04). There was a statistically significant race-by-time interaction outcome in which B","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2447335"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716192","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}