JAMA Network Open最新文献_第4页

Are Cardiovascular Complications the Achilles' Heel of Osimertinib?

IF 10.5 1区医学

JAMA Network Open Pub Date : 2024-12-02 DOI: 10.1001/jamanetworkopen.2024.48309

Nicholas S Wilcox, Michael G Fradley

引用次数: 0

Variation in Case Exposure During Internal Medicine Residency.

IF 10.5 1区医学

JAMA Network Open Pub Date : 2024-12-02 DOI: 10.1001/jamanetworkopen.2024.50768

Andrew C L Lam, Brandon Tang, Chang Liu, Marwa F Ismail, Surain B Roberts, Matthew Wankiewicz, Anushka Lalwani, Daniel Schumacher, Benjamin Kinnear, Amol A Verma, Fahad Razak, Brian M Wong, Shiphra Ginsburg

{"title":"Variation in Case Exposure During Internal Medicine Residency.","authors":"Andrew C L Lam, Brandon Tang, Chang Liu, Marwa F Ismail, Surain B Roberts, Matthew Wankiewicz, Anushka Lalwani, Daniel Schumacher, Benjamin Kinnear, Amol A Verma, Fahad Razak, Brian M Wong, Shiphra Ginsburg","doi":"10.1001/jamanetworkopen.2024.50768","DOIUrl":"10.1001/jamanetworkopen.2024.50768","url":null,"abstract":"Importance: Variation in residency case exposure affects resident learning and readiness for future practice. Accurate reporting of case exposure for internal medicine (IM) residents is challenging because feasible and reliable methods for linking patient care to residents are lacking.Objective: To develop an integrated education-clinical database to characterize and measure case exposure variability among IM residents.Design, setting, and participants: In this cohort study, an integrated educational-clinical database was developed by linking patients admitted during overnight IM in-hospital call shifts at 5 teaching hospitals to senior on-call residents. The senior resident, who directly cares for all overnight IM admissions, was linked to their patients by the admission date, time, and hospital. The database included IM residents enrolled between July 1, 2010, and December 31, 2019, in 1 Canadian IM residency. Analysis occurred between August 1, 2023, and June 30, 2024.Main outcomes and measures: Case exposure was defined by patient demographic characteristics, discharge diagnoses, volumes, acuity (eg, critical care transfer), medical complexity (eg, Charlson Comorbidity Index), and social determinants of health (eg, from long-term care). Residents were grouped into quartiles for each exposure measure, and the top and bottom quartiles were compared using standardized mean difference (SMD). Variation between hospitals was evaluated by calculating the SMD between the hospitals with the highest and lowest proportions for each measure. Variation over time was assessed using linear and logistic regression.Results: The integrated educational-clinical database included 143 632 admissions (median [IQR] age, 71 [55-83] years; 71 340 [49.7%] female) linked to 793 residents (median [IQR] admissions per shift, 8 [6-12]). At the resident level, there was substantial variation in case exposure for demographic characteristics, diagnoses, volumes, acuity, complexity, and social determinants. For example, residents in the highest quartile had nearly 4 times more admissions requiring critical care transfer compared with the lowest quartile (3071 of 30 228 [10.2%] vs 684 of 25 578 [2.7%]; SMD, 0.31). Hospital-level variation was also significant, particularly in patient volumes (busier hospital vs less busy hospital: median [IQR] admissions per shift, 10 [8-12] vs 7 [5-9]; SMD, 0.96). Over time, residents saw more median (IQR) admissions per shift (2010 vs 2019: 7.6 [6.6-8.4] vs 9.0 [7.6-10.0]; P = .04) and more complex patients (2010 vs 2019: Charlson Comorbidity Index ≥2, 3851 of 13 762 [28.0%] vs 2862 of 8188 [35.0%]; P = .03), while working similar shifts per year (median [IQR], 11 [8-14]).Conclusions: In this cohort study of IM residents in a Canadian residency program, significant variation in case exposure was found be","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2450768"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846698","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}

引用次数: 0

Disparities and Gaps in Breast Cancer Screening for Women Aged 40 to 49 Years.

IF 10.5 1区医学

JAMA Network Open Pub Date : 2024-12-02 DOI: 10.1001/jamanetworkopen.2024.51827

Tianshu Gu, Jing Yuan, Shelley White-Means, Minghui Li

引用次数: 0

Pharmacist-Led Management Model and Medication Adherence Among Patients With Chronic Heart Failure: A Randomized Clinical Trial.

IF 10.5 1区医学

JAMA Network Open Pub Date : 2024-12-02 DOI: 10.1001/jamanetworkopen.2024.53976

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

{"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":"Importance: Poor medication adherence is associated with high morbidity and mortality among patients with chronic heart failure (CHF), which is particularly concerning in China.Objective: 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.Design, setting, and participants: 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.Intervention: 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.Main outcomes and measures: The primary outcome was the proportion of days covered (PDC) by heart failure medication at 52 weeks.Results: 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.Conclusions and relevance: 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.Trial registration: Chinese Clinical Trial Registry Identifier: ChiCTR2000040232.","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}

引用次数: 0

Daily Physical Activity, Sports Participation, and Executive Function in Children. 儿童的日常体育活动、运动参与和执行功能。

IF 10.5 1区医学

JAMA Network Open Pub Date : 2024-12-02 DOI: 10.1001/jamanetworkopen.2024.49879

Lu Yang, Eva Corpeleijn, Esther Hartman

{"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":"Importance: It is unclear whether daily physical activity and sports participation relate to executive function (EF) in children.Objective: To explore associations between early-life physical activity, sports participation, and executive function in primary school children.Design, setting, and participants: 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.Exposures: 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.Main outcomes and measures: Executive function was assessed using the Behavior Rating Inventory of Executive Function at ages 10 to 11 years.Results: 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]).Conclusions and relevance: 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.","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}

引用次数: 0

Nicotine Pouch Use Among US Military Personnel. 美国军人使用尼古丁袋的情况。

IF 10.5 1区医学

JAMA Network Open Pub Date : 2024-12-02 DOI: 10.1001/jamanetworkopen.2024.51517

Melissa A Little, Kathryn M Polaskey, Asal Pilehvari, Rebecca A Krukowski, Kurt M Ribisl, Teresa D Pearce

引用次数: 0

Supporting Pediatric Emergency Care Coordinators in All US EDs-A Moral Imperative.

IF 10.5 1区医学

JAMA Network Open Pub Date : 2024-12-02 DOI: 10.1001/jamanetworkopen.2024.51055

Marc A Auerbach, Elizabeth Sanseau

引用次数: 0

Biased Language in Simulated Handoffs and Clinician Recall and Attitudes. 模拟交接中的偏颇语言与临床医生的回忆和态度。

IF 10.5 1区医学

JAMA Network Open Pub Date : 2024-12-02 DOI: 10.1001/jamanetworkopen.2024.50172

Austin Wesevich, Erica Langan, Ilona Fridman, Sonya Patel-Nguyen, Monica E Peek, Victoria Parente

{"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":"Importance: 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.Objective: To compare clinical information recall accuracy and attitudes toward patients among trainees in paired cases of biased vs neutral language in simulated handoffs.Design, setting, and participants: 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.Exposures: 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.Main outcomes and measures: 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.Results: 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 < .001). More positive attitudes toward patients were associated with higher clinical information recall accuracy (odds ratio, 1.12; 95% CI, 1.02-1.22).Conclusions and relevance: 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}

引用次数: 0

Depression and Suicide Risk Screening in the Veterans Health Administration.

IF 10.5 1区医学

JAMA Network Open Pub Date : 2024-12-02 DOI: 10.1001/jamanetworkopen.2024.51936

Lucinda B Leung, Karen Chu, Martin L Lee, Amy G Bonilla, Edward P Post, John C Fortney

引用次数: 0

Allostatic Load, Educational Attainment, and Risk of Cancer Mortality Among US Men.

IF 10.5 1区医学

JAMA Network Open Pub Date : 2024-12-02 DOI: 10.1001/jamanetworkopen.2024.49855

Cynthia Li, Sydney P Howard, Charles R Rogers, Sydney Andrzejak, Keon L Gilbert, Keith J Watts, Malcolm S Bevel, Myles D Moody, Marvin E Langston, Judah V Doty, Adetunji T Toriola, Darwin Conwell, Justin X Moore

{"title":"Allostatic Load, Educational Attainment, and Risk of Cancer Mortality Among US Men.","authors":"Cynthia Li, Sydney P Howard, Charles R Rogers, Sydney Andrzejak, Keon L Gilbert, Keith J Watts, Malcolm S Bevel, Myles D Moody, Marvin E Langston, Judah V Doty, Adetunji T Toriola, Darwin Conwell, Justin X Moore","doi":"10.1001/jamanetworkopen.2024.49855","DOIUrl":"10.1001/jamanetworkopen.2024.49855","url":null,"abstract":"Importance: Health disparities among racial and ethnic minoritized populations, particularly for cancer mortality rates, remain a major public health concern. Men from underrepresented backgrounds (Black and Hispanic men, specifically) face the pervasive effects of discrimination in their daily lives, which also contribute to the complex associations among allostatic load (a marker of chronic stress), educational opportunities, and elevated risks of cancer mortality.Objective: To elucidate the associations among educational attainment, allostatic load, and cancer mortality risk among men.Design, setting, and participants: This is a retrospective cohort analysis of data from the National Health and Nutrition Examination Survey, a nationally representative sample of approximately 5000 people across the US, from 1988 to 2010 linked with data from the National Death Index, which served as follow-up data for the cohort and was available through December 31, 2019. Participants included men aged 18 years and older. Data were analyzed from June to October 2024.Exposure: Allostatic load data were stratified by educational attainment levels, categorized as (1) less than high school education and (2) high school graduate and above. Allostatic load score was calculated as the sum of total abnormal biomarkers and health measures (9 total). Participants were considered to have high allostatic load if their score was 3 or more.Main outcomes and measures: The primary outcome was cancer death. Weighted Cox proportional hazards models were fitted to estimate adjusted hazard ratios (HRs) of cancer death between educational attainment and allostatic load (adjusted for age, income, and smoking status).Results: Among all 20 529 men (mean [SE] age, 41.00 [0.22] years), those with high AL and less than high school educational attainment had a greater than 4-fold increased risk of cancer mortality (unadjusted HR, 4.71; 95% CI, 3.36-6.60) compared with those with low allostatic load and a college degree or higher. Similarly, both Black men (HR, 4.19; 95% CI, 2.09-8.40) and White men (HR, 5.77; 95% CI, 4.06-8.20) with high allostatic load and less than high school educational attainment had higher risks for cancer death compared with race-specific counterparts with college education and low allostatic load. After adjustments for age, poverty-to-income ratio, smoking status, history of cancer, and ever congestive heart failure and heart attack, the associations were attenuated, but all men (HR, 1.69; 95% CI, 1.15-2.47) and White men (HR, 1.82; 95% CI, 1.16-2.85) still had greater than 50% increased risk of cancer death compared with men with college education and low allostatic load.Conclusions and relevance: This study highlights the detrimental association of not attaining a high school degree, combined with hi","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2449855"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800769","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}

引用次数: 0