JAMA Network Open最新文献

{"title":"Attention-Deficit/Hyperactivity Disorder in Medicaid-Enrolled Autistic Adults.","authors":"Benjamin E Yerys, Sha Tao, Lindsay Shea, Gregory L Wallace","doi":"10.1001/jamanetworkopen.2024.53402","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.53402","url":null,"abstract":"<p><strong>Importance: </strong>Autistic adults experience suboptimal health outcomes. Likewise, attention-deficit/hyperactivity disorder (ADHD) is linked to poor health outcomes in the general population, yet little is known about co-occurring ADHD and its links with poor health outcomes among autistic adults.</p><p><strong>Objective: </strong>To determine the prevalence of ADHD and ADHD medication prescriptions and to examine associations between health outcomes and both ADHD co-occurrence and ADHD medication prescriptions among autistic adults.</p><p><strong>Design, setting, and participants: </strong>Population-based cohort study of US Medicaid-enrolled adults aged 18 years and older, including autistic adults with and without co-occurring intellectual disability (ID), adults with ID without autism, and adults from a random sample of Medicaid-enrolled individuals from 2008 to 2019. Analyses were completed September 2023 to September 2024.</p><p><strong>Exposures: </strong>Autism, ADHD, and ID using validated algorithms from the Chronic Conditions Warehouse.</p><p><strong>Main outcomes and measures: </strong>Prevalence rates of co-occurring ADHD, ADHD medication prescriptions, substance use, cardiovascular conditions, injury in autism without ID, ID without autism, autism with ID, and the general population.</p><p><strong>Results: </strong>The study included 3 506 661 patients (mean [SD] age, 33.5 [15.6] years; 1 854 892 [52.9%] female; 702 694 [20.0%] Black, 587 048 [16.7%] Hispanic, and 1 786 703 [60.0%] White). Compared with the general Medicaid-enrolled population (1 846 102 patients), which had 49 523 patients (2.7%) with co-occurring ADHD diagnoses, this study found elevated rates of ADHD in autism without ID (280 195 patients [26.7%]; prevalence ratio [PR], 5.1; 95% CI, 4.4-5.9), autism with ID (261 061 patients [40.2%]; PR, 6.8; 95% CI, 6.0-7.7), and ID without autism (1 119 303 patients [19.0%]; PR, 4.4; 95% CI, 4.0-5.0). A total of 117 704 adults (26.6%) with ADHD received an ADHD medication prescription. The study identified that rates of substance use were higher among clinical groups with co-occurring ADHD. For example, 9886 of 74 675 autistic adults with ADHD (13.2%) had substance use disorder, compared with 11 782 of 205 520 autistic adults with no ADHD (5.7%). ADHD diagnoses were associated with higher rates of all health outcomes, regardless of group. Substance use was higher in both ID groups with ADHD diagnoses and ADHD medications, whereas injury and cardiovascular condition rates were lower in all ADHD groups who received ADHD medications.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of Medicaid-enrolled adults, autistic adults experienced high rates of co-occurring ADHD and were more likely to receive ADHD medication prescriptions than adults in the general population. Negative health outcome rates are higher among autistic people with co-occurring ADHD, although ADHD medication prescriptions are","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e2453402"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399259","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":"Age-Related Changes in Brain Structure in Pediatric Chronic Kidney Disease.","authors":"Ellen van der Plas, Eric Nelson, Brian Becknell, Anne E Dawson, Camille S Wilson, Jeffrey D Dawson, Joseph L Alge, Lyndsay A Harshman","doi":"10.1001/jamanetworkopen.2024.57601","DOIUrl":"10.1001/jamanetworkopen.2024.57601","url":null,"abstract":"<p><strong>Importance: </strong>Pediatric patients with chronic kidney disease (CKD) exhibit reduced cerebellum volume, which is associated with neurocognitive deficits and a lower estimated glomerular filtration rate (eGFR), even before dialysis or transplantation. These differences have not been examined within the context of age-related brain changes during childhood to early adulthood.</p><p><strong>Objective: </strong>To evaluate differences in age-related neurodevelopmental changes in patients with CKD compared with control participants and to investigate associations between regional neuroanatomy, functional outcomes, and disease-related variables.</p><p><strong>Design, setting, and participants: </strong>Case-control study of individuals aged 6 through 21 years with and without CKD at an academic medical center in Iowa City, Iowa, from September 2016 to August 2024.</p><p><strong>Exposures: </strong>Neurocognitive testing; 3-T magnetic resonance imaging.</p><p><strong>Main outcomes and measures: </strong>Participants completed standardized neurocognitive assessments and quantitative neuroanatomical scans. Brain regions of interest (ROIs) were analyzed for volumetric differences using automated pipelines. Multivariable linear models assessed neurocognitive and neuroanatomical differences between groups, including an age × group interaction for ROI analyses.</p><p><strong>Results: </strong>The sample included 124 individuals (mean [SD] age, 12.8 [4.5] years; 74 [59.7%] male), including 87 control participants (44 [50.6%] male) and 37 participants with CKD (30 [81.1%] male). The mean (SD) eGFR was 71.3 [25.5] mL/min/1.73 m2 for the CKD group. Participants with CKD scored lower than control participants on most neurocognitive measures included in the analyses. The CKD group showed differential age-related changes in cerebellar gray matter (β = -0.10; 95% CI, -0.18 to -0.01; Cohen f = 0.22) and white matter (β = -0.09; 95% CI, -0.19 to -0.00; Cohen f = 0.19). The age × group interaction approached but did not reach significance for amygdala volume (β = 0.09; 95% CI, -0.01 to 0.19; Cohen f = 0.18; P = .06). Volumetric variation in these regions was associated with proxy ratings of executive function in patients with CKD. A significant, positive association between cerebellar gray matter and eGFR was observed in the CKD group (β = 0.04; 95% CI, 0.00 to 0.02; P = .01).</p><p><strong>Conclusions and relevance: </strong>In this case-control study, age-related neurodevelopmental differences were observed in pediatric patients with CKD compared with healthy peers. Reductions in cerebellar volume were associated with cognitive deficits and lower kidney function. These findings underscore the importance of monitoring neurodevelopmental trajectories in children with CKD, as early interventions may be necessary to mitigate cognitive impairments associated with CKD.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e2457601"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080111","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":"Error in the Byline, Abstract, and Results.","authors":"","doi":"10.1001/jamanetworkopen.2025.0680","DOIUrl":"10.1001/jamanetworkopen.2025.0680","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e250680"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364791","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":"Perioperative Factor Xa Inhibitor Discontinuation for Patients Undergoing Procedures With Minimal or Low Bleeding Risk.","authors":"So-Ryoung Lee, Kyung-Yeon Lee, Jong-Sung Park, Young Soo Lee, Yong Seog Oh, Sang-Jin Han, June Namgung, Ji Hyun Lee, Woo-Hyun Lim, Min Soo Ahn, Soonil Kwon, Hyo-Jeong Ahn, Seil Oh, Gregory Y H Lip, Eue-Keun Choi","doi":"10.1001/jamanetworkopen.2024.58742","DOIUrl":"10.1001/jamanetworkopen.2024.58742","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Discontinuation of oral anticoagulant treatment is common in clinical practice due to concerns about bleeding, even for procedures with minimal to low bleeding risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To explore whether perioperative discontinuation of factor Xa inhibitors is associated with major bleeding and thromboembolic events in patients with atrial fibrillation (AF) undergoing procedures with minimal to low bleeding risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This prospective, multicenter, single-arm cohort study conducted in Korea included patients with AF who planned to undergo a procedure with minimal to low bleeding risk between September 25, 2020, and April 5, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;The PERIXa (Perioperative Factor Xa Inhibitor Discontinuation in Patients With Atrial Fibrillation Undergoing Minimal to Low Bleed Risk Procedures) protocol recommending giving the last dose of factor Xa inhibitor (ie, apixaban, edoxaban, or rivaroxaban) 24 hours before the procedure (ie, endoscopy, dental procedure, or ocular surgery) and restarting treatment with the inhibitor the next day.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was major bleeding, and the secondary outcome included a composite of thromboembolic events 30 days after the index procedure with minimal to low bleeding risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 1902 patients were included in the modified intention-to-treat analysis set encompassing all patients who underwent the intended procedure (mean [SD] age, 70.4 [8.8] years; 1135 [59.7%] male; mean [SD] CHA2DS2-VASc [congestive heart failure, hypertension, age 75 years or older, diabetes, stroke, vascular disease, age 65-74 years, and female sex; range, 0-9, with higher scores indicating higher risk of stroke] score, 2.8 [1.3]; mean [SD] HAS-BLED [hypertension, kidney or liver disease, stroke history, prior bleeding, unstable international normalized ratio, age &gt;65 years, and drug or alcohol use; range, 0-9, with higher scores indicating higher risk of bleeding] score, 1.6 [0.7]). Among them, 921 (48.4%) were receiving apixaban, 616 (32.4%) were receiving edoxaban, and 365 (19.2%) were receiving rivaroxaban. Of the total procedures, 948 (49.8%) were endoscopy, 820 (43.1%) were dental procedures, and 120 (6.3%) were ocular surgery. The 30-day event rate of major bleeding was 0.1% (n = 2), and there were no composite thromboembolic events. The results were consistent in the per-protocol analysis, and no differences were observed by procedure category or factor Xa inhibitor type.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cohort study, patients with AF receiving a factor Xa inhibitor and undergoing a procedure with minimal to low bleeding risk had low rates of major bleeding and thromboembolism when following the standardized PERIXa protocol for perioperative management of oral anticoagulant treatment, suggesting that this","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e2458742"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364862","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":"Firearm Type and Number of People Killed in Publicly Targeted Fatal Mass Shooting Events.","authors":"Leslie M Barnard, Erin Wright-Kelly, Ashley Brooks-Russell, Marian E Betz","doi":"10.1001/jamanetworkopen.2024.58085","DOIUrl":"10.1001/jamanetworkopen.2024.58085","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e2458085"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189329","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":"Older Adults' Attitudes Toward Deprescribing in 14 Countries.","authors":"Renata Vidonscky Lüthold, Katharina Tabea Jungo, Kristie Rebecca Weir, Limor Adler, Radost Asenova, Sara Ares-Blanco, Markus Bleckwenn, Thomas Frese, Gilles Henrard, Aisling A Jennings, Donata Kurpas, Vanja Lazic, Heidrun Lingner, Stina Mannheimer, Anabela Pereira, Ferdinando Petrazzuoli, Rosalinde K E Poortvliet, Ágnes Szélvári, Dorothea Wild, Emily Reeve, Zsofia Rozsnyai, Sven Streit","doi":"10.1001/jamanetworkopen.2024.57498","DOIUrl":"10.1001/jamanetworkopen.2024.57498","url":null,"abstract":"<p><strong>Importance: </strong>Better understanding of patients' attitudes toward deprescribing specific medications will inform future deprescribing interventions.</p><p><strong>Objective: </strong>To investigate older adults' attitudes toward deprescribing by investigating which medications they would like to have deprescribed, the reasons why, and patient factors associated with interest in deprescribing.</p><p><strong>Design, setting, and participants: </strong>This survey study was conducted from May 2022 to December 2023 in primary care settings in 14 countries. Patients aged 65 years or older taking 5 or more medications were consecutively recruited by their general practitioner (GP) and completed the questionnaire.</p><p><strong>Exposures: </strong>Patient characteristics, including gender, number of medications, GP gender, education level, financial status, confidence in completing medical forms, self-rated health, satisfaction with medications, trust in the GP, and country.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were patient attitudes toward deprescribing specific medications, as measured by responses to the question, \"Thinking about your current medication list, are there any medications that you would like to stop taking or reduce the dose of?\" Multilevel multivariable logistic regression analysis was used, adjusted for clustering effect at the country level, to investigate the association between patient characteristics and interest in deprescribing.</p><p><strong>Results: </strong>Of 1340 patients (mean [SD], 96 [47] patients per country), 736 (55%) were women, 580 (44%) had secondary school as their highest level of education, 1089 (82%) were satisfied with their medications, and 589 (44%) expressed they would like to deprescribe 1 or more of their medications. Patients expressed interest in deprescribing specific medications at varying levels, from 79% (86 of 109 patients) in Poland to 23% (21 of 96 patients) in Bulgaria. The 3 most reported medications patients would like to have deprescribed were diuretics (111 of 1002 medications [11%]), lipid-modifying agents (109 of 1002 medications [11%]), and agents acting on the renin-angiotensin system (83 of 1002 medications [8%]). The odds of naming at least 1 specific medication for deprescribing were lower for patients with higher medication satisfaction (odds ratio, 0.31; 95% CI, 0.21-0.47) and for patients with higher trust in their GP (odds ratio, 0.960; 95% CI, 0.930-0.998).</p><p><strong>Conclusions and relevance: </strong>In this survey study with primary care patients aged 65 years and older, patient attitudes toward deprescribing specific medications varied across countries, demonstrating that deprescribing interventions could be more impactful when adapted to specific settings and contexts. These findings highlight the importance of patient-practitioner communication in ensuring appropriate medication use.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e2457498"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382507","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":"Long-Term Survival by Number of Immune Checkpoint Inhibitors in PD-L1-Negative Metastatic NSCLC: A Systematic Review and Meta-Analysis.","authors":"Ben Ponvilawan, Dhruv Bansal, Nagla Abdel Karim, Rahul Ramakrishnan, Janakiraman Subramanian","doi":"10.1001/jamanetworkopen.2024.57357","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.57357","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e2457357"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398986","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":"Stress About Eviction or Loss of Housing and Child Mental Health.","authors":"Jamie L Hanson","doi":"10.1001/jamanetworkopen.2024.58984","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.58984","url":null,"abstract":"<p><strong>Importance: </strong>Eviction and housing loss are pressing public health concerns. Understanding how caregivers' stress about eviction or loss of housing is associated with specific childhood psychiatric issues across development is important.</p><p><strong>Objective: </strong>To examine associations between stress about eviction or loss of housing and caregiver-reported child depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and behavioral problems, while adjusting for sociodemographic factors.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study analyzed data from the 2022 National Survey of Children's Health, a nationally representative survey of caregivers and children in the US. Data were collected between July 2022 and January 2023.</p><p><strong>Exposure: </strong>Eviction or loss of housing.</p><p><strong>Main outcomes and measures: </strong>Caregiver-reported child depression, anxiety, ADHD, and behavioral problems. Generalized linear mixed models were used to test associations with stress about eviction or loss of housing.</p><p><strong>Results: </strong>From a sample of 54 103 families, 36 638 were included in the analytic sample (analytic sample mean [SD] age: 9.91 [4.62] years; sex assigned at birth, 18 901 male [52%]). In this study, stress about eviction or loss of housing was associated with depression in children (adjusted odds ratio [aOR], 1.10; 95% CI, 1.02-1.18). Stress about eviction or loss of housing was significantly associated with higher odds of reported anxiety in the base model (aOR, 1.26 (95% CI, 1.22-1.31) but not in the stringently adjusted model (aOR, 1.04; 95% CI, 1.00-1.08]). Associations were sometimes moderated by age, with stronger associations for younger children. Stress about eviction or loss of housing was not associated with ADHD or behavioral problems after adjustment.</p><p><strong>Conclusions and relevance: </strong>This study found that stress about eviction or loss of housing was associated with increased odds of internalizing issues, such as depression and anxiety, among children. Prospective longitudinal research is still needed to fully understand these complex associations over time. These findings underscore the importance of policies and interventions to address housing instability and its mental health consequences for children.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e2458984"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399007","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":"Extracorporeal Blood Purification in European Pediatric Intensive Care Units: A Consensus Statement.","authors":"Gabriella Bottari, Emanuele Buccione, Benan Bayrakci, George Briassoulis, Michael J Carter, Demet Demirkol, Stavroula Ilia, Luc Morin, Karl Reiter, Maria-Jose Santiago, Luregn J Schlapbach, Maria Slocker-Barrio, Pierre Tissieres, Tomás Zaoral, Stefania Bianzina, Akash Deep","doi":"10.1001/jamanetworkopen.2024.57657","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.57657","url":null,"abstract":"<p><strong>Importance: </strong>Important advances have been made in extracorporeal blood purification therapies (EBPTs) due to new technologies and biomaterials; however, the lack of established guidelines is a factor in great variability in clinical practice. This aspect is accentuated in pediatric intensive care given the small number of patients with diverse diagnoses treated with EBPT and the technical challenges in treating small children, potentiating the risk of adverse events.</p><p><strong>Objective: </strong>To understand what experienced users of EBPT think about its relevant issues, insight that may have implications for the design of future studies, and the application of EBPTs in patient care.</p><p><strong>Evidence review: </strong>Literature search was conducted using the PubMed and Embase databases between January 1, 2020, and July 15, 2024, and a combination of key medical terms. A panel of experts was formed (composed of 15 authors and pediatric intensivists) to develop a consensus statement using a modified Delphi-based model between 2022 and 2024. The panel's core team drafted the initial questionnaire, which explored EBPT use in pediatric intensive care units (PICUs), including clinical indications for initiating and discontinuing use and outcomes for assessing effectiveness and safety. SurveyMonkey was used in the distribution, completion, and revision of the questionnaire, and findings were analyzed. Panelists were asked to rank answer choices. Numerical value for each ranking was translated to a percentage defining the strength of consensus (>90% agreement from panelists signifying strong consensus; <49% signifying no consensus).</p><p><strong>Findings: </strong>A total of 116 survey responses were received from panelists from 8 European countries. Strong consensus was achieved on 6 of 24 questions and consensus (75%-90% agreement) was reached on 18 of 24 questions. According to the panelists, the continuous renal replacement therapy standard or enhanced adsorption hemofilter and plasma exchange were of interest, representing the most applied EBPTs across various applications. While evidence on hemoadsorption is growing, it remains limited.</p><p><strong>Conclusions and relevance: </strong>This consensus statement on EBPTs in critically ill pediatric patients was developed by an international panel of experts in areas where clinical evidence is still limited. This consensus statement could support pediatric intensivists in bedside decision-making and guide future research on EBPTs in PICUs.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e2457657"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080123","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":"Intersection of Race and Rurality With Health Care-Associated Infections and Subsequent Outcomes.","authors":"Katelin B Nickel, Hannah Kinzer, Anne M Butler, Karen E Joynt Maddox, Victoria J Fraser, Jason P Burnham, Jennie H Kwon","doi":"10.1001/jamanetworkopen.2024.53993","DOIUrl":"10.1001/jamanetworkopen.2024.53993","url":null,"abstract":"<p><strong>Importance: </strong>Health care-associated infections (HAIs) are a major cause of morbidity and mortality, but little is known about whether structural factors impacting race and rurality are associated with HAI and subsequent outcomes.</p><p><strong>Objective: </strong>To evaluate the association of race and rurality, which are proxies for structural disadvantage, with HAI and subsequent outcomes.</p><p><strong>Design, setting, and participants: </strong>This cohort study was conducted at 3 US urban and suburban hospitals. Participants were adults aged 18 years or older admitted for 48 hours or longer from January 1, 2017, to August 31, 2020. Statistical analysis was performed from November 2022 to April 2024.</p><p><strong>Exposure: </strong>Patient race and rurality status were defined as the combination of race (Black or White) and residence (urban or rural per patient zip code).</p><p><strong>Main outcomes and measures: </strong>HAI was defined as a positive culture from a urine, blood, or respiratory specimen obtained 48 hours or longer after admission. To determine the association of race and rurality with HAIs, multivariable generalized estimating equations models were used to account for clustering of admissions by patient. Among patients with HAI admissions, similar models examined post-HAI intensive care unit admission and in-hospital death.</p><p><strong>Results: </strong>Among 214 955 patients admitted to the hospital (median [IQR] age, 63 [51-73] years; 108 679 female patients [50.6%]; 72 490 Black patients [33.7%]; 142 465 White patients [66.3%]), recognized HAIs occurred during 6699 (3.1%). Compared with White urban patients, Black urban patients had a decreased risk of HAI (adjusted relative risk [aRR], 0.81; 95% CI, 0.75-0.87), White rural patients had an increased risk of HAI (aRR, 1.12; 95% CI, 1.05-1.20), and Black rural patients (aRR, 1.08; 95% CI, 0.81-1.44) had a similar risk of HAI. Among patients with HAI admissions, Black rural patients had an increased risk of intensive care unit admission (aRR, 1.92; 95% CI, 1.16-3.17) and in-hospital death (aRR, 1.78; 95% CI, 1.26-2.50). White rural and Black urban patients had outcomes similar to those of White urban patients.</p><p><strong>Conclusions and relevance: </strong>This cohort study of hospitalized adults identified inequities related to race and rurality in HAIs and adverse outcomes from HAIs. These findings suggest that factors such as structural racism and disinvestment in rural communities may be associated with individual HAI risk and post-HAI outcomes. Future work to further understand the reasons underpinning these disparities and methods to address structural factors through policy and process changes are critical to eliminate health inequities.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e2453993"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080127","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}