JAMA Network Open最新文献

{"title":"Global Disparities of Cancer and Its Projected Burden in 2050.","authors":"Habtamu Mellie Bizuayehu, Kedir Y Ahmed, Getiye Dejenu Kibret, Abel F Dadi, Sewunet Admasu Belachew, Tanmay Bagade, Teketo Kassaw Tegegne, Rebecca L Venchiarutti, Kelemu Tilahun Kibret, Aklilu Habte Hailegebireal, Yibeltal Assefa, Md Nuruzzaman Khan, Amanuel Abajobir, Kefyalew Addis Alene, Zelalem Mengesha, Daniel Erku, Daniel A Enquobahrie, Tsion Zewdu Minas, Eyaya Misgan, Allen G Ross","doi":"10.1001/jamanetworkopen.2024.43198","DOIUrl":"10.1001/jamanetworkopen.2024.43198","url":null,"abstract":"<p><strong>Importance: </strong>Cancer prevention and care efforts have been challenged by the COVID-19 pandemic and armed conflicts, resulting in a decline in the global Human Development Index (HDI), particularly in low- and middle-income countries. These challenges and subsequent shifts in health care priorities underscore the need to continuously monitor cancer outcome disparities and statistics globally to ensure delivery of equitable and optimal cancer prevention and care in uncertain times.</p><p><strong>Objective: </strong>To measure the global burden of 36 cancers in 2022 by sex, age, and geographic location and to project future trends by 2050.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used population-based data from 2022 in 185 countries and territories were obtained from the Global Cancer Observatory database. Data extraction and analysis were carried out in April 2024.</p><p><strong>Main outcomes and measures: </strong>Counts, rates, prevalence, mortality to incidence ratios (MIRs), and demography-based projections were used to characterize current and future cancer burden.</p><p><strong>Results: </strong>This population-based study included 36 cancer types from 185 countries and territories. By 2050, 35.3 million cancer cases worldwide are expected, a 76.6% increase from the 2022 estimate of 20 million. Similarly, 18.5 million cancer deaths are projected by 2050, an 89.7% increase from the 2022 estimate of 9.7 million. Cancer cases and deaths are projected to nearly triple in low-HDI countries by 2050, compared to a moderate increase in very high-HDI countries (142.1% vs 41.7% for cancer cases and 146.1% vs 56.8% for cancer deaths). Males had a higher incidence and greater number of deaths in 2022 than females, with this disparity projected to widen by up to 16.0% in 2050. In 2022, the MIR for all cancers was 46.6%, with higher MIRs observed for pancreatic cancer (89.4%), among males (51.7%), among those aged 75 years or older (64.3%), in low-HDI countries (69.9%), and in the African region (67.2%).</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study based on data from 2022, cancer disparities were evident across HDI, geographic regions, age, and sex, with further widening projected by 2050. These findings suggest that strengthening access to and quality of health care, including universal health insurance coverage, is key to providing evidence-based cancer prevention, diagnostics, and care.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2443198"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583170","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":"Methylphenidate and Atomoxetine in Pregnancy and Possible Adverse Fetal Outcomes: A Systematic Review and Meta-Analysis.","authors":"Ester di Giacomo, Veronica Confalonieri, Fabio Tofani, Massimo Clerici","doi":"10.1001/jamanetworkopen.2024.43648","DOIUrl":"10.1001/jamanetworkopen.2024.43648","url":null,"abstract":"<p><strong>Importance: </strong>Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders, and it afflicts about 7% of young people. As a consequence, many young women might be pregnant while taking medication for ADHD, but data about safety have not yet been strictly examined.</p><p><strong>Objective: </strong>To examine adverse effects in offspring of mothers receiving treatment with atomoxetine and methylphenidate during pregnancy.</p><p><strong>Data sources: </strong>Electronic databases (PubMed, Embase, and PsycINFO) were searched for articles published through December 31, 2023, with the following search terms: (atomoxetine OR methylphenidate) AND (pregnancy).</p><p><strong>Study selection: </strong>Observational studies (eg, cohort studies, case-control studies, case-crossover studies, cross-sectional studies, and registry-based studies) that reported offspring outcomes in pregnancy with atomoxetine and/or methylphenidate and in mothers with ADHD but unexposed to ADHD treatment during pregnancy or from the general population were included. Ten studies of 656 records satisfied criteria.</p><p><strong>Data extraction and synthesis: </strong>Two independent reviewers performed data extraction according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analyses were conducted based on reported odds ratios (ORs) and corresponding 95% CIs using a linear random effects model. Each study was inversely weighted by the reported variance of the estimators. Risk of publication bias and analysis of heterogeneity through univariate and multivariate metaregressions were also rated. Data were analyzed from January to March 2024.</p><p><strong>Main outcomes and measures: </strong>Study outcomes included miscarriages and congenital anomalies.</p><p><strong>Results: </strong>Ten studies involving 16 621 481 pregnant women, 30 830 of them affected by ADHD, were included. Congenital anomalies or miscarriages were not more frequent in offspring of mothers receiving treatment with methylphenidate or atomoxetine during pregnancy compared with unexposed offspring (OR, 1.14; 95% CI, 0.83-1.55; P = .41; I2 = 8% for congenital anomalies; OR, 1.01; 95% CI, 0.70-1.47; P = .96; I2 = 0% for miscarriages) or compared with the general population (OR, 1.19; 95% CI, 0.93-1.53; P = .16; I2 = 74% for congenital anomalies; OR, 1.05, 95% CI, 0.81-1.37; P = .70; I2 = 0% for miscarriage).</p><p><strong>Conclusions and relevance: </strong>Evidence from this meta-analysis, which involves a substantial sample of pregnant women with and without ADHD, suggests the maintenance of methylphenidate or atomoxetine during pregnancy is safe, given that congenital anomalies and miscarriages did not appear to significantly increase. Further studies are recommended to support and confirm these findings.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2443648"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11541644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583186","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":"Maui Wildfire and 988 Suicide and Crisis Lifeline Call Volume and Capacity.","authors":"Alexandra C Rivera-González, Jonathan Purtle, Joseph Keawe'aimoku Kaholokula, Jim P Stimpson, Alexander N Ortega","doi":"10.1001/jamanetworkopen.2024.46523","DOIUrl":"10.1001/jamanetworkopen.2024.46523","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2446523"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11579797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675832","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":"Opioids and Dementia in the Danish Population.","authors":"Nelsan Pourhadi, Janet Janbek, Christiane Gasse, Thomas Munk Laursen, Gunhild Waldemar, Christina Jensen-Dahm","doi":"10.1001/jamanetworkopen.2024.45904","DOIUrl":"10.1001/jamanetworkopen.2024.45904","url":null,"abstract":"<p><strong>Importance: </strong>Opioids have been studied as a potential risk factor for dementia, but evidence concerning long-term noncancer opioid use and exclusive use of weak opioids and associated dementia risk is sparse.</p><p><strong>Objective: </strong>To assess the association between cumulative noncancer use of opioids and risk of age-related all-cause dementia.</p><p><strong>Design, setting, and participants: </strong>This nested case-control study within a population-based cohort included 1 872 854 individuals without previous dementia, cancer, opioid addiction, or opioid use in terminal illness. Data were obtained from national Danish registers. Each individual who developed dementia during follow-up was incidence-density matched to 5 dementia-free controls. Statistical analysis was performed from August 2023 to March 2024.</p><p><strong>Exposure: </strong>Cumulative opioid exposure was based on filled prescriptions available from 1995 through 2020.</p><p><strong>Main outcomes and measures: </strong>Conditional logistic regression provided adjusted incidence rate ratios (IRRs) for associations between opioids and dementia.</p><p><strong>Results: </strong>Among 1 872 854 individuals without previous dementia, cancer, opioid addiction, or opioid use in terminal illness included in the study, 93 638 (5.0%) developed all-cause dementia during follow-up (51 469 [55.0%] female; median [IQR] age, 78.1 [73.0-82.8] years) and were matched to 468 190 control individuals (257 345 [55.0%] female; median [IQR] age, 78.0 [73.0-82.8] years). Opioid use up to 90 total standardized doses (TSDs) was not consistently associated with dementia risk. Opioid exposure above 90 TSDs yielded increased IRRs of dementia occurring before age 90 years ranging from 1.29 (95% CI, 1.17-1.42) for 91 to 200 TSDs to 1.59 (95% CI, 1.44-1.76) for greater than 500 TSDs for age-band 60 to 69 years at dementia diagnosis. Corresponding IRRs were 1.16 (95% CI, 1.11-1.22) to 1.49 (95% CI, 1.42-1.57) for age-band 70 to 79 years and 1.08 (95% CI, 1.03-1.14) to 1.21 (95% CI, 1.16-1.27) for 80 to 89 years. Sensitivity analyses corroborated associations in individuals with chronic noncancer pain and with use of weak opioids.</p><p><strong>Conclusions and relevance: </strong>This study found that opioid use of less than 90 TSDs was not significantly associated with increased dementia risk. Above 90 TSDs of opioid use was associated with an elevated dementia risk before age 90 years, which persisted in individuals with chronic noncancer pain and in individuals solely exposed to weak opioids. Further research should ascertain whether the findings denote causality between opioids and dementia risk.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2445904"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666756","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":"Asian American Representation in Medicine by Career Stage and Residency Specialty.","authors":"Patricia Mae G Santos, Carlos Irwin A Oronce, Kanan Shah, Fumiko Chino, Mylin A Torres, Reshma Jagsi, Curtiland Deville, Neha Vapiwala","doi":"10.1001/jamanetworkopen.2024.44478","DOIUrl":"10.1001/jamanetworkopen.2024.44478","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Asian American individuals are not underrepresented in medicine; however, aggregation in prior workforce analyses may mask underlying disparities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess representation by Asian race and disaggregated subgroups in the US allopathic medical school workforce.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study used Association of American Medical Colleges (AAMC) special reports, generated using the AAMC Applicant-Matriculant Data File, Student Records System, Graduate Medical Education Track Survey, and faculty roster. Participants included medical school applicants, matriculants, graduates, residents, and faculty enrolled or employed at US allopathic medical schools between 2013 and 2021. Data were analyzed between March and May 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Asian race or ethnic subgroup as per AAMC and US Census Bureau Office of Management and Budget criteria, including Bangladeshi American, Cambodian American, Chinese American, Filipino American, Indian American, Indonesian American, Japanese American, Korean American, Pakistani American, Taiwanese American, and Vietnamese American.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Representation quotients (RQ) were used to indicate representation that was equivalent (RQ of 1), higher (RQ greater than 1), or lower (RQ less than 1) than expected representation based on US population estimates. One-way analysis of variance and linear regression models assessed mean RQ differences by career stage and over time, with Bonferroni correction for multiple comparisons.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In this study, Asian American individuals accounted for 94 934 of 385 775 applicants (23%), 39 849 of 158 468 matriculants (24%), 37 579 of 152 453 graduates (24%), 229 899 of 1 035 512 residents (22%), and 297 413 of 1 351 187 faculty members (26%). The mean (SD) RQ was significantly greater among Asian American residents (3.44 [0.15]) and faculty (3.54 [0.03]) compared with Asian applicants (3.3 [0.04]), matriculants (3.37 [0.03]), or graduates (3.31 [0.06]). Upon disaggregation, RQ was significantly lower among residents and faculty in 10 of 12 subgroups. Although subgroups, such as Taiwanese American, Indian American, and Chinese American, had RQs greater than 1 (eg, Chinese American graduates: mean [SD], RQ, 3.90 [0.21]), the RQs were less than 1 for Laotian, Cambodian, and Filipino American subgroups (eg, Filipino American graduates: mean [SD], RQ, 0.93 [0.06]) at almost every career stage. No significant RQ changes were observed over time for Laotian American and Cambodian American trainees, with a resident RQ of 0 in 8 of 25 and 4 of 25 specialties, respectively. Faculty RQ increased in 9 of 12 subgroups, but Cambodian American, Filipino American, Indonesian American, Laotian American, and Vietnamese American faculty (eg, Vietnamese American faculty: mean [SD], RQ, 0.59 [0.08]) had RQs less","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2444478"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668112","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":"Medication Exposure and Mortality in Patients With Schizophrenia.","authors":"Sébastien Brodeur, Yohann M Chiu, Josiane Courteau, Marc Dorais, Dominic Oliver, Emmanuel Stip, Marie-Josée Fleury, Marc-André Roy, Alain Vanasse, Alain Lesage, Jacinthe Leclerc","doi":"10.1001/jamanetworkopen.2024.47137","DOIUrl":"10.1001/jamanetworkopen.2024.47137","url":null,"abstract":"<p><strong>Importance: </strong>The use of antipsychotics, antidepressants, and benzodiazepines may influence the risk of mortality in people with schizophrenia. However, many observational studies have not accounted for immortal time bias (ITB), which occurs when there is a period during which patients in the exposed group are necessarily alive and misclassified as exposed (the period between start of follow-up and initiation of drug). Ignoring ITB may lead to misinterpretation of the association between these drugs and mortality.</p><p><strong>Objectives: </strong>To examine whether the cumulative dose of antipsychotics, antidepressants, and benzodiazepines is associated with mortality risk in patients with schizophrenia and discuss the potential impacts of ignoring ITB.</p><p><strong>Design, setting, and participants: </strong>This cohort study used administrative data from Québec, Canada, including patients aged 17 to 64 years diagnosed with schizophrenia between January 1, 2002, and December 31, 2012. Data analysis was performed from June 22, 2022, to September 30, 2024.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was all-cause mortality, with follow-up from January 1, 2013, to December 31, 2017, or until death. Mortality risk was assessed for low, moderate, and high exposure to antipsychotics, antidepressants, and benzodiazepines. Cox proportional hazards regression models with time-fixed exposure (not controlling for ITB) and time-dependent exposure (controlling for ITB) were performed.</p><p><strong>Results: </strong>The cohort included 32 240 patients (mean [SD] age, 46.1 [11.6] years; 19 776 [61.3%] men), of whom 1941 (6.0%) died during follow-up. No dose-response association was found for antipsychotics with mortality using the time-fixed method. However, high-dose antipsychotic use was associated with increased mortality after correcting for ITB (adjusted hazard ratio [AHR], 1.28; 95% CI, 1.07-1.55; P = .008). Antidepressants showed a reduced mortality risk using the time-fixed method, but only at high doses when correcting for ITB (AHR, 0.86; 95% CI, 0.74-1.00; P = .047). Benzodiazepines were associated with increased mortality risk regardless of the method.</p><p><strong>Conclusions and relevance: </strong>The findings of this study do not dispute the known efficacy of antipsychotics in schizophrenia, but they call into question the magnitude of long-term mortality benefits.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2447137"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11584925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686979","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":"Artificial Intelligence and Radiologist Burnout.","authors":"Hui Liu, Ning Ding, Xinying Li, Yunli Chen, Hao Sun, Yuanyuan Huang, Chen Liu, Pengpeng Ye, Zhengyu Jin, Heling Bao, Huadan Xue","doi":"10.1001/jamanetworkopen.2024.48714","DOIUrl":"10.1001/jamanetworkopen.2024.48714","url":null,"abstract":"<p><strong>Importance: </strong>Understanding the association of artificial intelligence (AI) with physician burnout is crucial for fostering a collaborative interactive environment between physicians and AI.</p><p><strong>Objective: </strong>To estimate the association between AI use in radiology and radiologist burnout.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study conducted a questionnaire survey between May and October 2023, using the national quality control system of radiology in China. Participants included radiologists from 1143 hospitals. Radiologists reporting regular or consistent AI use were categorized as the AI group. Statistical analysis was performed from October 2023 to May 2024.</p><p><strong>Exposure: </strong>AI use in radiology practice.</p><p><strong>Main outcomes and measures: </strong>Burnout was defined by emotional exhaustion (EE) or depersonalization according to the Maslach Burnout Inventory. Workload was assessed based on working hours, number of image interpretations, hospital level, device type, and role in the workflow. AI acceptance was determined via latent class analysis considering AI-related knowledge, attitude, confidence, and intention. Propensity score-based mixed-effect generalized linear logistic regression was used to estimate the associations between AI use and burnout and its components. Interactions of AI use, workload, and AI acceptance were assessed on additive and multiplicative scales.</p><p><strong>Results: </strong>Among 6726 radiologists included in this study, 2376 (35.3%) were female and 4350 (64.7%) were male; the median (IQR) age was 41 (34-48) years; 3017 were in the AI group (1134 [37.6%] female; median [IQR] age, 40 [33-47] years) and 3709 in the non-AI group (1242 [33.5%] female; median [IQR] age, 42 [34-49] years). The weighted prevalence of burnout was significantly higher in the AI group compared with the non-AI group (40.9% vs 38.6%; P < .001). After adjusting for covariates, AI use was significantly associated with increased odds of burnout (odds ratio [OR], 1.20; 95% CI, 1.10-1.30), primarily driven by its association with EE (OR, 1.21; 95% CI, 1.10-1.34). A dose-response association was observed between the frequency of AI use and burnout (P for trend < .001). The associations were more pronounced among radiologists with high workload and lower AI acceptance. A significant negative interaction was noted between high AI acceptance and AI use.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of radiologist burnout, frequent AI use was associated with an increased risk of radiologist burnout, particularly among those with high workload or lower AI acceptance. Further longitudinal studies are needed to provide more evidence.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2448714"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11584928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687052","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":"Changing Perceptions of Health Care Among Patients With Kidney Disease.","authors":"Beatrice P Concepcion, Milda R Saunders","doi":"10.1001/jamanetworkopen.2024.47343","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.47343","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2447343"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716158","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":"Virtual Home Care for Patients With Acute Illness.","authors":"Josh Banerjee, Christopher Lynch, Hugh Gordon, Charles E Coffey, Catherine P Canamar, Soodtida Tangpraphaphorn, Karla Gonzalez, Neha Mahajan, Jan Shoenberger, Michael Menchine, Andrew Oh, Emily Johnson, Molly Grassini, Rachel Baden, Paul Holtom, Douglass Hutcheon, Brandon M Wiley, Kusha Davar, Sheila Mallet-Smith, Margaret Sanfratello, Brenda Gallardo, Meixine Song, Nikole Swain, Maria Lydia Solis, Jenny Silva, Charmaine Pablico, Eduardo Aceves, Erica Bonilla, Ria Ashley Legaspi, Deisy M Guevara, Karissa Lee, Christina Martinez, Michelle Banh, Dana Russell, Lissette Cervantes, Jacqueline Cervantes, Cesar Gonzalez, Phillip Sheth, Shadi Dowlatshahi, Alex Rosenberg, Pruthul Patel, Wei-An Lee, Tanzim Khan, Tze-Woei Tan, Michael Fong, Samuel S Gordon, Brandi Clark, Victor Pena, Steven Dohi, Beatrisa Bannister, Roman Villalta, Priya Induru, Pauline Vuong, David Lwe, Karen Stoffel, Sam Oh, Christian Voyageur, Andrew Cool, Yong Lee, Stephen Lenh, Janet Luong, Gary Hanna, Jason N Doctor, Bryan Munoz, Concepcion Castro, Edgar Solis, Nancy Blake, Roza Sakzalyan, Christopher J Rodriguez, Christina Ghaly, Jorge Orozco, Hal F Yee, Brad Spellberg","doi":"10.1001/jamanetworkopen.2024.47352","DOIUrl":"10.1001/jamanetworkopen.2024.47352","url":null,"abstract":"<p><strong>Importance: </strong>Recent evolutions in clinical care and remote monitoring suggest that some acute illnesses no longer require intravenous therapy and inpatient hospitalization.</p><p><strong>Objective: </strong>To describe outcomes of patients receiving care in a new, outpatient, virtual, home-based acute care model called Safer@Home.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort analysis, conducted from September 1, 2022, through August 31, 2023, included 2466 patients treated at a safety net hospital in Los Angeles County for 10 core illnesses and 24 other acute illnesses for which patients are commonly hospitalized.</p><p><strong>Exposure: </strong>Outpatient, home-based, acute care with virtual monitoring and clinic visits in lieu of inpatient or in-home care.</p><p><strong>Main outcomes and measures: </strong>The primary measure was hospital length of stay. Secondary measures included all-cause mortality, 30-day readmission, return urgent care visit rates, and return emergency department (ED) visit rates.</p><p><strong>Results: </strong>Safer@Home provided care to 876 patients (mean [SD] age, 54.0 [14.5] years; 541 men [61.8%]) during the study period, compared with a cohort of 1590 patients (mean [SD] age, 52.3 [19.6] years; 901 men [56.7%]) with matching diagnoses who received standard, hospital-based care. Safer@Home patients had significantly shorter mean (SD) lengths of inpatient stay than the comparison cohort (1.3 [2.0] vs 5.3 [10.4] days; P < .001), totaling 3505 bed-days avoided (mean [SD], 4.0 [10.6] bed-days saved per patient), with no significant difference in all-cause mortality at last follow-up (2.6% [23 of 876] vs 4.0% [64 of 1590]; P = .07). Safer@Home patients and control patients also had no significant difference in the proportion experiencing 30-day hospital readmission (19.9% [174 of 876] vs 16.7% [266 of 1590]; P = .06). As intended, more Safer@Home than control patients had at least one 30-day return urgent care visit (37.3% [327 of 876] vs 5.2% [82 of 1590]; P < .001). In contrast, the Safer@Home and control cohorts did not significantly differ in experiencing at least one 30-day return ED visit (15.2% [133 of 876] vs 12.5% [199 of 1590]; P = .06). Safer@Home patients had significantly fewer mean (SD) total 30-day return ED visits per patient than control patients (0.19 [0.50] vs 0.21 [0.85]; P < .001).</p><p><strong>Conclusions and relevance: </strong>In this cohort study, patients receiving acute, virtual, home care with remote monitoring and as-needed return urgent care visits had markedly shorter hospital stays than patients receiving standard inpatient hospital care, with no significant increase in mortality, ED revisits, or return hospitalizations. This new care model is promising for systems that cannot staff Medicare-compliant hospital-at-home visits.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2447352"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716293","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":"Outcomes in Randomized Clinical Trials Testing Changes in Daily Water Intake: A Systematic Review.","authors":"Nizar Hakam, Jose Luis Guzman Fuentes, Behnam Nabavizadeh, Architha Sudhakar, Kevin D Li, Catherine Nicholas, Jason Lui, Peggy Tahir, Charles P Jones, Stephen Bent, Benjamin N Breyer","doi":"10.1001/jamanetworkopen.2024.47621","DOIUrl":"10.1001/jamanetworkopen.2024.47621","url":null,"abstract":"<p><strong>Importance: </strong>Several public recommendations exist regarding the amount of daily water intake, yet the supporting evidence is not clear, and benefits of increasing water consumption are not well-established.</p><p><strong>Objective: </strong>To summarize evidence from randomized clinical trials (RCTs) pertaining to the health-related outcomes associated with increased or decreased daily water consumption.</p><p><strong>Evidence review: </strong>A systematic search of PubMed, Web of Science, and Embase was performed up to April 6, 2023. Studies were included if they aimed to assess the impact of daily water consumption by any defined amount on any health-related outcome.</p><p><strong>Findings: </strong>Of 1464 records screened, 18 (1%) eligible studies were included in the review. Among eligible studies, 15 (83%) were parallel group RCTs, and 3 (16%) were crossover studies. Interventions in these studies consisted of a recommendation to alter the daily amount of water intake by a specific amount for a predefined period ranging between 4 days and 5 years, while the control groups were mostly asked to maintain their usual intake habits. The studies assessed various populations. Recurring primary end points included weight loss, fasting blood glucose level, headache, urinary tract infection, and nephrolithiasis. Consuming additional water was associated with greater weight loss (range, 44%-100% more than control conditions) and fewer nephrolithiasis events (15 fewer events per 100 participants over 5 years). Single studies suggested benefits related to migraine prevention, urinary tract infection, diabetes control, and hypotension. Ten studies (55%) reported at least 1 positive result, and 8 studies (44%) reported negative results.</p><p><strong>Conclusions and relevance: </strong>This systematic review found that there is a limited number of clinical trials in the literature assessing the benefits of increasing water intake related to a large variety of health outcomes. While the quality and quantity of evidence is limited, a small number of studies suggested benefits of water intake on weight loss and nephrolithiasis, while single studies raised the possibility of benefits for patients with migraine, urinary tract infection, diabetes, and hypotension. Given the low cost and low adverse-effect profile of water, further well-designed studies should assess benefits in these specific conditions.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2447621"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11589796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710165","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}