JAMA Network Open最新文献

{"title":"Errors in Results and Table 1.","authors":"","doi":"10.1001/jamanetworkopen.2025.6345","DOIUrl":"10.1001/jamanetworkopen.2025.6345","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e256345"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657293","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":"Treatment and Attrition Trends for Metastatic Clear Cell Renal Cell Carcinoma in the US.","authors":"Zeynep Irem Ozay, Yeonjung Jo, Gliceida Galarza Fortuna, Chadi Hage Chehade, Georges Gebrael, Micah Ostrowski, Nicolas Sayegh, Ethan Anderson, Salvador Jaime-Casas, Miguel Zugman, Vinay Mathew Thomas, Benjamin L Maughan, Neeraj Agarwal, Sumanta K Pal, Umang Swami","doi":"10.1001/jamanetworkopen.2025.1201","DOIUrl":"10.1001/jamanetworkopen.2025.1201","url":null,"abstract":"<p><strong>Importance: </strong>The treatment landscape of metastatic clear cell renal cell carcinoma (ccRCC) has rapidly evolved with the approval of multiple immune checkpoint inhibitor (ICI)-based combinations. However, clinical data on changes in treatment patterns and attrition before and after ICI-based combinations approval are lacking.</p><p><strong>Objective: </strong>To assess treatment patterns and attrition rates in patients with metastatic ccRCC before and after the approval of ICI-based combinations.</p><p><strong>Design, setting, and participants: </strong>This cohort study used patient-level data from a nationwide deidentified electronic health record-derived database, originating from around 280 cancer clinics in the US. Patients diagnosed with metastatic ccRCC who received first-line therapy between January 1, 2011, and January 20, 2023, were included. Those treated for 2 or more malignant neoplasms or enrolled in clinical trials were excluded.</p><p><strong>Exposures: </strong>Line of therapy initiation before and after April 16, 2018.</p><p><strong>Main outcomes measures: </strong>Treatments received in each line of therapy and attrition rate were summarized using frequencies and percentages.</p><p><strong>Results: </strong>Of 12 707 patients with metastatic ccRCC within the database, 8534 were eligible and included (median [IQR] age, 66 [59-74] years; 6032 male [70.7%]; 629 Black [8.1%], 697 Hispanic [9.0%], 5493 White [71.0%]). Before April 16, 2018, the most common first-line therapy was tyrosine kinase inhibitor (TKI) monotherapy (3595 of 4561 patients [78.8%]). Following the approval of ICI-based combinations in 2018, most patients (2392 of 3973 patients [60.2%]) received ICI-based combinations as first-line therapy for metastatic ccRCC. TKI monotherapy remained the most common second- and third-line therapy in patients treated before and after April 16, 2018. Before 2018, 2639 patients (57.9%) and 1458 patients (31.9%) received second-line and third-line therapies, respectively, compared with 1494 (37.6%) and 562 (14.1%) after 2018.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of 8534 patients with metastatic ccRCC, although ICI-based combinations are the preferred first-line therapy due to their proven superiority over TKI monotherapy, many patients were not receiving them; high attrition rates were observed in subsequent lines. These findings highlight the need to optimize treatment selection by implementing current guidelines in clinical practice.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e251201"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663585","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":"Pulmonary Embolism in Patients with End-Stage Kidney Disease Starting Dialysis.","authors":"Kunal N Patel, Wan-Chi Chan, Vivek Bhat, Monil M Majmundar, Harsh Mehta, Cyrus Munguti, Kartik Munshi, Sri G Yarlagadda, Gaurav M Parmar, Aditya M Sharma, Daniella Kadian-Dodov, Lewis G Satterwhite, Jinxiang Hu, Jordan Baker Ms, Kamal Gupta","doi":"10.1001/jamanetworkopen.2025.0848","DOIUrl":"10.1001/jamanetworkopen.2025.0848","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250848"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648614","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":"Unmasking Racial and Ethnic Disparities in Prehospital Sedation and Restraint Practices-Beyond the Straps.","authors":"Utsha G Khatri, Samuel E Sondheim","doi":"10.1001/jamanetworkopen.2025.1289","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.1289","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e251289"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663586","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":"The Achilles' Heel of Midline Catheters.","authors":"David Paje","doi":"10.1001/jamanetworkopen.2025.1268","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.1268","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e251268"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663506","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":"Alcohol Use Disorder Medication Coverage and Utilization Management in Medicaid Managed Care Plans.","authors":"Maureen T Stewart, Sage R Feltus, Christina M Andrews, Andrea Acevedo, Cindy Parks Thomas, Jeffrey Bratberg, Constance M Horgan, Dominic Hodgkin, Rachel Sayko Adams","doi":"10.1001/jamanetworkopen.2025.0695","DOIUrl":"10.1001/jamanetworkopen.2025.0695","url":null,"abstract":"<p><strong>Importance: </strong>Evidence-based, patient-centered treatment for alcohol use disorder (AUD) can include pharmacotherapy with naltrexone, acamprosate, or disulfiram; however, these medications are rarely used. Medicaid managed care plans (MCPs) manage health services for nearly 80% of Medicaid enrollees and are the largest payer for addiction treatment services. Little is known about Medicaid MCP policies for AUD medications.</p><p><strong>Objectives: </strong>To describe Medicaid MCPs' coverage and management of acamprosate, naltrexone, and disulfiram for AUD and examine associations of plan characteristics and state policies with medication coverage.</p><p><strong>Design, setting, and participants: </strong>In this cross-sectional study, a content analysis was performed of 2021 insurance benefit data for 241 comprehensive Medicaid MCPs in states using Medicaid managed care, as well as secondary sources. Data were analyzed from May to August 2024.</p><p><strong>Main outcomes and measures: </strong>Medicaid MCP-reported medication coverage and utilization management requirements (eg, prior authorization, quantity limit requirements) for acamprosate, disulfiram, and oral and injectable naltrexone together and for each medication separately. Independent variables included plan characteristics (profit status, market share) and the state policy environment in which plans are embedded (Section 1115 substance use disorder waiver, state-defined preferred drug list). Regressions examined associations of plan characteristics and state policies with medication coverage.</p><p><strong>Results: </strong>In this cross-sectional content analysis of 241 comprehensive Medicaid MCPs in 2021, 217 (90.0%) covered at least 1 medication for AUD: 132 (54.7%) covered acamprosate, 203 (84.2%) covered oral naltrexone, 175 (72.6%) covered injectable naltrexone, 152 (63.0%) covered disulfiram, and 103 (42.7%) covered all 4 medications. Prior authorization and quantity limits were rarely applied, except for injectable naltrexone, for which 75 plans (42.8%) imposed at least 1 of these utilization management requirements.</p><p><strong>Conclusions and relevance: </strong>This study suggests that efforts to expand AUD medication prescribing may be limited by gaps in health insurance coverage. Medicaid MCPs and states can support AUD medication utilization by covering these medications without applying utilization management strategies.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250695"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624639","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":"Probiotics and Fever Duration in Children With Upper Respiratory Tract Infections: A Randomized Clinical Trial.","authors":"Silvia Bettocchi, Anna Comotti, Marina Elli, Valentina De Cosmi, Cristiana Berti, Ilaria Alberti, Alessandra Mazzocchi, Chiara Rosazza, Carlo Agostoni, Gregorio Paolo Milani","doi":"10.1001/jamanetworkopen.2025.0669","DOIUrl":"10.1001/jamanetworkopen.2025.0669","url":null,"abstract":"<p><strong>Importance: </strong>Upper respiratory tract infections (URTIs) are prevalent in children, prompting frequent health care consultations, especially among those with fever. Probiotics show potential as an adjuvant treatment for URTIs, but evidence in children is limited.</p><p><strong>Objective: </strong>To evaluate the efficacy of a probiotic mixture containing Bifidobacterium breve M-16V, Bifidobacterium lactis HN019, and Lactobacillus rhamnosus HN001 in shortening fever duration among children with URTIs.</p><p><strong>Design, setting, and participants: </strong>This randomized clinical trial was conducted between November 19, 2021, and June 20, 2023, at the pediatric emergency department of the Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy. Patients between 28 days and 4 years of age with a fever (≥38.5 °C) and URTI were eligible. Exclusion criteria included recent probiotic use, chronic autoimmune diseases, immunosuppressive treatment, and requirement for hospitalization. Randomization was computer generated and assigned participants to either the intervention (probiotics) or control (placebo) group. Participants, parents or caregivers, and investigators were masked to the group assignments. The primary analysis followed the intention-to-treat approach.</p><p><strong>Interventions: </strong>The probiotic group received daily single dose of 0.5 mL probiotic mixture containing Bifidobacterium breve M-16V, Bifidobacterium lactis HN019, and Lactobacillus rhamnosus HN001 for 14 days. The placebo group received daily single dose of 0.5 mL placebo for 14 days.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was fever duration, defined as the number of days between the first and the last days with fever.</p><p><strong>Results: </strong>Of the 128 patients enrolled (69 males [54%]; mean [SD] age 2.5 [1.3] years), 65 (51%) were randomly assigned to receive placebo and 63 (49%) to receive probiotics. The median (IQR) fever duration was shorter in the probiotic group than the placebo group (median [IQR], 3 [2-4] days vs 5 [4-6] days; adjusted risk ratio, 0.64; 95% CI, 0.51-0.80). Few mild adverse events were reported and did not significantly differ between the probiotic and placebo groups, including constipation (6 [16%] and 6 [12%]; P = .80) and abdominal pain (3 [8%] and 2 [4%]; P = .65).</p><p><strong>Conclusions and relevance: </strong>In this randomized clinical trial, administering a probiotic mixture reduced fever duration by 2 days compared with placebo, with no meaningful safety concerns. The probiotic mixture under investigation could be an effective adjuvant for shortening fever duration in children with URTIs.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT06052540.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250669"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624687","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":"The Delicate Balancing Act of Accelerated Approval for Cancer Medicines-Speed, Certainty, and Benefit.","authors":"Kristina Jenei, Christopher M Booth","doi":"10.1001/jamanetworkopen.2025.2040","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.2040","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e252040"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709399","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":"Physician Perspectives on Ambient AI Scribes.","authors":"Shreya J Shah, Trevor Crowell, Yejin Jeong, Anna Devon-Sand, Margaret Smith, Betsy Yang, Stephen P Ma, April S Liang, Clarissa Delahaie, Caroline Hsia, Tait Shanafelt, Michael A Pfeffer, Christopher Sharp, Steven Lin, Patricia Garcia","doi":"10.1001/jamanetworkopen.2025.1904","DOIUrl":"10.1001/jamanetworkopen.2025.1904","url":null,"abstract":"<p><strong>Importance: </strong>Limited qualitative studies exist evaluating ambient artificial intelligence (AI) scribe tools. Such studies can provide deeper insights into ambient AI implementations by capturing lived experiences.</p><p><strong>Objective: </strong>To evaluate physician perspectives on ambient AI scribes.</p><p><strong>Design, setting, and participants: </strong>A qualitative study using semistructured interviews guided by the Reach, Efficacy, Adoption, Implementation, Maintenance/Practical, Robust Implementation, and Sustainability Model (RE-AIM/PRISM) framework, with thematic analysis using both inductive and deductive approaches. Physicians participating in an AI scribe pilot that included community and faculty practices, across primary care and ambulatory specialties, were invited to participate in interviews. This ambient AI scribe pilot at a health care organization in California was conducted from November 2023 to January 2024.</p><p><strong>Main outcome and measures: </strong>Facilitators and barriers to adoption, practical effectiveness, and suggestions for improvement to enhance sustainability.</p><p><strong>Results: </strong>Twenty-two semistructured interviews were conducted with AI pilot physicians from primary care (13 [59%]) and ambulatory specialties (9 [41%]), including physicians from community practices (12 [55%]) and faculty practices (10 [45%]). Facilitators to adoption included ease of use, ease of editing, and generally positive perspectives of tool quality. Physicians expressed positive sentiments about the impact of the ambient AI scribe tool on cognitive demand (16 of 16 comments [100%]), temporal demand (28 comments [62%]), work-life integration (10 of 11 comments [91%]), and overall workload (8 of 9 comments [89%]). Physician perspectives of the impact of the ambient AI scribe tool on their engagement with patients were mostly positive (38 of 56 comments [68%]). Barriers to adoption included limited functionality with non-English speaking patients and lack of access for physicians without a specific device. Physician perspectives on accuracy and style were largely negative, particularly regarding note length and editing requirements. Several specific suggestions for tool improvement were identified, and physicians were optimistic regarding the potential for long-term use of ambient AI scribes.</p><p><strong>Conclusion and relevance: </strong>In this qualitative study, ambient AI scribes were found to positively impact physician workload, work-life integration, and patient engagement. Key facilitators and barriers to adoption were identified, along with specific suggestions for tool improvement. These findings suggest the potential for ambient AI scribes to reduce clinician burden, with user-centered recommendations offering practical guidance on ways to improve future iterations and improve adoption.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e251904"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692193","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":"Supply, Demand, and a Growing US Kidney Transplant Waiting List.","authors":"David C Cron, Rachel E Patzer, Joel T Adler","doi":"10.1001/jamanetworkopen.2025.1675","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.1675","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e251675"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692146","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}