JAMA Internal Medicine最新文献

{"title":"Early Screening for Latent Autoimmune Diabetes in Adults to Improve Care-Beyond the Routine.","authors":"Camryn L Keller, Ankita Yelamanchili, Bruno Álvarez Concejo","doi":"10.1001/jamainternmed.2024.6770","DOIUrl":"10.1001/jamainternmed.2024.6770","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828528","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":"Experience of Older Adults and Their Family Members in the Kidney Transplant Evaluation.","authors":"Catherine R Butler, Olivia A Gaughran, Janelle S Taylor, Patrick O Gee, Ann M O'Hare","doi":"10.1001/jamainternmed.2024.6653","DOIUrl":"10.1001/jamainternmed.2024.6653","url":null,"abstract":"<p><strong>Importance: </strong>Transplant can be a valuable treatment option for older adults with kidney failure, and recent initiatives encourage more frequent referral to transplant centers. However, the evaluation process can be challenging, and most older adults do not ultimately receive a kidney.</p><p><strong>Objective: </strong>To elucidate the perspectives and experiences of older adults with advanced kidney disease and their family members regarding the kidney transplant evaluation process.</p><p><strong>Design, setting, and participants: </strong>This qualitative study, conducted between December 19, 2022, and February 5, 2024, included adults aged 65 years or older with advanced kidney disease (estimated glomerular filtration rate ≤20 mL/min/1.73 m2, receiving dialysis, or with a functioning kidney transplant) and their family members in Seattle, Washington.</p><p><strong>Main outcomes and measures: </strong>Perspectives and experiences of patients and family members, identified through inductive thematic analysis of semi-structured interviews.</p><p><strong>Results: </strong>A total of 26 older adults (16 [61.5%] men; median age, 68 years [range, 65-74 years]) with advanced kidney disease and 7 of their family members (4 [57.1%] women; median age, 65 years [range, 36-75 years]) were interviewed. Three dominant themes pertaining to the kidney transplant evaluation process were identified: (1) committed to transplant, (2) a complex and protracted process, and (3) responsibility without power. Because receiving a kidney was such an important priority, most participants were willing to engage in what could be a demanding process of testing and treatment narrowly focused on this future goal. However, the transplant evaluation could be lengthy, demanding, opaque, and fragmented, and patients often put other aspects of their lives on hold while awaiting an uncertain result. Patients and families often felt personally responsible for navigating and completing the transplant evaluation despite having little power to shape this process. Feeling responsible for the continued progress of a high-stakes evaluation process while remaining dependent on clinical teams and family members for support could strain relationships.</p><p><strong>Conclusions and relevance: </strong>This qualitative study found that older adults with advanced kidney disease and their family members were highly motivated to receive a kidney transplant but engagement in an evaluation process, over which they had little control, could have far-reaching implications for patients and families. These findings underline the importance of making the transplant evaluation process more transparent and person centered and of helping patients and families who are contemplating or engaged in the process to understand what to expect.</p>","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828530","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":"Rethinking Palliative Interventions in Critical Care-When More Is Not Better.","authors":"Kieran L Quinn, Rebecca Rodin, James Downar","doi":"10.1001/jamainternmed.2024.6848","DOIUrl":"10.1001/jamainternmed.2024.6848","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828558","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":"Focusing on Systems and Policies to Solve the Kidney Transplant Equity Crisis.","authors":"L Ebony Boulware, Dinushika Mohottige, Tanjala S Purnell","doi":"10.1001/jamainternmed.2024.6654","DOIUrl":"https://doi.org/10.1001/jamainternmed.2024.6654","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828531","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":"Mobile App-Facilitated Collaborative Palliative Care Intervention for Critically Ill Older Adults: A Randomized Clinical Trial.","authors":"Christopher E Cox, Deepshikha C Ashana, Katelyn Dempsey, Maren K Olsen, Alice Parish, David Casarett, Kimberly S Johnson, Krista L Haines, Colleen Naglee, Jason N Katz, Mashael Al-Hegelan, Isaretta L Riley, Sharron L Docherty","doi":"10.1001/jamainternmed.2024.6838","DOIUrl":"10.1001/jamainternmed.2024.6838","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Few person-centered, scalable models of collaborative intensive care unit (ICU) clinician-palliative care specialist care exist.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the effect of a collaborative palliative care intervention compared to usual care among family members of patients in the ICU.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This parallel-group randomized clinical trial with patient-level randomization was conducted between April 2021 and September 2023. The study was set at 6 medical and surgical ICUs in 1 academic hospital and 1 community hospital. The study participants included critically ill older adult patients with 1 of 11 poor outcome phenotypes, their family members with elevated palliative care needs, and their attending ICU physicians.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;An automated electronic health record-integrated, mobile application-based communication platform that displayed family-reported needs over 7 days, coached ICU attending physicians on addressing needs, and prompted palliative care consultation if needs were not reduced within 3 study days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was change in the family-reported Needs at the End-of-Life Screening Tool (NEST) score between study days 1 and 3. The 13-item NEST score is a number between 0 and 130, with higher scores indicating a greater need. Secondary outcomes included quality of communication and goal of care concordance, as well as 3-month psychological distress.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 151 family members, the mean (SD) age was 57.4 (12.9) years, and 110 (72.9%) were female. Of 151 patients, the mean (SD) age was 69.8 (9.7) years, and 86 (57.0%) were male. Thirty-five ICU physicians were male (68.6%). Seventy-six patients were randomized to the intervention group and 75 to the control group. Treatment group differences in estimated mean NEST scores were similar at 3 days between the intervention and control groups (-3.1 vs -2.0, respectively; estimated mean difference in differences, -1.3 points [95% CI, -6.0 to 3.5]) and 7 days (-2.3 vs -2.2, respectively; estimated mean difference in differences, 0 points [95% CI, -6.2 to 6.2]). Median (IQR) need scores were lower among individuals who remained in the ICU at day 3 for intervention participants vs controls (24.5 [16.5-34.5] vs 27.5 [13.0-40.0], respectively); median (IQR) need scores were also lower among those who remained in the ICU at day 7 for intervention vs controls (22.0 [11.0-35.0] vs 28.0 [14.0-35.0], respectively). Goal concordance, quality of communication, and psychological distress symptoms did not differ. Twenty-nine intervention participants (38.2%) had palliative care consultations, compared to only 3 (4.0%) among controls, (P &lt; .001); 66 intervention participants (87.0%) had a family meeting, compared to 48 (64.0%) among controls (P = .001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In t","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828556","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":"How to Increase Living Kidney Donation-A Tale of Two Donors.","authors":"Mario Macis, Elizabeth Plummer","doi":"10.1001/jamainternmed.2024.6655","DOIUrl":"10.1001/jamainternmed.2024.6655","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828553","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":"International Comparison of Underlying Disease Among Recipients of Medical Assistance in Dying.","authors":"Brandon Heidinger, Colleen Webber, Kenneth Chambaere, Eliana Close, Luc Deliens, Bregje Onwuteaka-Philipsen, Thaddeus Pope, Agnes van der Heide, Ben White, James Downar","doi":"10.1001/jamainternmed.2024.6643","DOIUrl":"https://doi.org/10.1001/jamainternmed.2024.6643","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800813","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":"Depression Treatment After a Positive Depression Screen Result.","authors":"Maria E Garcia, Lisa Ochoa-Frongia, John Neuhaus, Julian C Hong, Ladson Hinton, Jennifer Livaudais-Toman, Mitchell D Feldman, Christina Mangurian, Nicole Appelle, Leah S Karliner","doi":"10.1001/jamainternmed.2024.6211","DOIUrl":"10.1001/jamainternmed.2024.6211","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;As primary care practices increase depression screening, it is unknown whether screening is associated with appropriate and equitable treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate factors associated with initial treatment among patients who screen positive for depression and/or suicidal ideation (SI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;Cohort study using electronic health record data from September 2017 to September 2021, from a large US academic health system. Participants were adult primary care patients with elevated depressive symptoms (Patient Health Questionnaire-9 score ≥10) and/or SI, excluding patients with baseline depression, bipolar disorder, schizophrenia, schizoaffective disorder, or dementia. Data were analyzed from December 30, 2022, to February 17, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Patient characteristics including gender, age, preferred language, and race and ethnicity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Primary outcome was antidepressant or mental health referral ordered at screening. Secondary outcomes were antidepressant/referral and antidepressant/referral or follow-up visit within 8 weeks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 60 062 patients screened, 3980 (7%) reported elevated depressive symptoms or SI. The cohort was 68.1% women (2711), and the mean (SD) age was 46.5 (17.6) years; 0.8% were 12.4% African American or Black (493), American Indian or Alaska Native (30), 24.8% Asian (988), 14.6% Latino/Latina/Latinx (582), 1.5% Pacific Islander (58), and 36.9% White (1470), and 9.0% other/unknown (359); 5.6% preferred a non-English language (223). Approximately 38% (1518) received antidepressants/referrals when screened (including 44% of 461 patients [203] with SI). By 8 weeks, 2785 patients (70%) received antidepressant/referral and/or follow-up (including 75% of 783 patients with SI). In multivariable logistic regression models adjusting for site and clustered on primary care physician, there were no statistically significant differences in the primary outcome by gender, preferred language, or health insurance. African American or Black and Asian patients had lower estimated probabilities of treatment ordered when screened (34.0% [95% CI, 28.4%-39.6%] for Black patients and 35.4% [95% CI, 31.5%-39.4%] for Asian patients) than White patients (40.5% [95% CI 37.4%-43.5%]). Estimated treatment decreased with increasing age (46.4% [95% CI, 41.2%-51.5%] for patients aged 18-30 years and 17.5% [95% CI, 12.1%-22.9%] for patients aged ≥75 years). Patients with SI had greater estimated treatment than those without SI (43.5% [95% CI, 39.9%-47.1%] vs 35.2% [95% CI, 33.0%-37.5%]), although treatment was overall low for this high-risk group. Secondary outcomes were consistent, although there were no statistically significant differences in follow-up visits for African American or Black and Asian patients compared with White patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Co","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800810","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":"Care Models to Improve Pain and Reduce Opioids Among Patients Prescribed Long-Term Opioid Therapy: The VOICE Randomized Clinical Trial.","authors":"Erin E Krebs, William C Becker, David B Nelson, Beth M DeRonne, Agnes C Jensen, Allyson M Kats, Benjamin J Morasco, Joseph W Frank, Una E Makris, Kelli D Allen, Jennifer C Naylor, Amanda S Mixon, Amy Bohnert, Thomas E Reznik, Jacob T Painter, Teresa J Hudson, Hildi J Hagedorn, Jennifer K Manuel, Brian Borsari, Natalie Purcell, Patrick Hammett, Erin C Amundson, Robert D Kerns, Monica R Barbosa, Caitlin Garvey, Elzie J Jones, Maureen Y Noh, Jennifer B Okere, Sujata Bhushan, John Pinsonnault, Beth E Williams, Ellen Herbst, Pooja Lagisetty, Sara Librodo, Payal S Mapara, Elizabeth Son, Christina Tat, Rebecca A Marraffa, Randy L Seys, Catherine Baxley, Karen H Seal","doi":"10.1001/jamainternmed.2024.6683","DOIUrl":"https://doi.org/10.1001/jamainternmed.2024.6683","url":null,"abstract":"<p><strong>Importance: </strong>Patients prescribed long-term opioid therapy for chronic pain often experience unrelieved pain, poor quality of life, and serious adverse events.</p><p><strong>Objective: </strong>To compare the effects of integrated pain team (IPT) vs pharmacist collaborative management (PCM) on pain and opioid dosage.</p><p><strong>Design, setting, and participants: </strong>This study was a pragmatic multisite 12-month randomized comparative effectiveness trial with masked outcome assessment. Patients were recruited from October 2017 to March 2021; follow-up was completed June 2022. The study sites were Veterans Affairs primary care clinics. Eligible patients had moderate to severe chronic pain despite long-term opioid therapy (≥20 mg/d for at least 3 months).</p><p><strong>Interventions: </strong>IPT involved interdisciplinary pain care planning, visits throughout 12 months with medical and mental health clinicians, and emphasis on nondrug therapies and motivational interviewing. PCM was a collaborative care intervention involving visits throughout 12 months with a clinical pharmacist care manager who conducted structured monitoring and medication optimization. Both interventions provided individualized pain care and opioid tapering recommendations to patients.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was pain response (≥30% decrease in Brief Pain Inventory total score) at 12 months. The main secondary outcome was 50% or greater reduction in opioid daily dosage at 12 months.</p><p><strong>Results: </strong>A total of 820 patients were randomized to IPT (n = 411) or PCM (n = 409). Participants' mean (SD) age was 62.2 (10.6) years, and 709 (86.5%) were male. A pain response was achieved in 58/350 patients in the IPT group (16.4%) vs 54/362 patients in the PCM group (14.9%) (odds ratio, 1.11 [95% CI, 0.74-1.67]; P = .61). A 50% opioid dose reduction was achieved in 102/403 patients in the IPT group (25.3%) vs 98/399 patients in the PCM group (24.6%) (odds ratio, 1.03 [95% CI, 0.75-1.42]; P = .85). Over 12 months, the mean (SD) Brief Pain Inventory total score improved from 6.7 (1.5) points to 6.1 (1.8) points (P < .001) in IPT and from 6.6 (1.6) points to 6.0 (1.9) points (P < .001) in PCM (between-group P = .82). Over 12 months, mean (SD) opioid daily dosage decreased from 80.8 (74.2) mg/d to 54.2 (65.0) mg/d in IPT (P < .001) and from 74.5 (56.9) mg/d to 52.8 (51.9) mg/d (P < .001) in PCM (between-group P = .22).</p><p><strong>Conclusions and relevance: </strong>Outcomes in this randomized clinical trial did not differ between groups; both had small improvements in pain and substantial reductions in opioid dosage.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT03026790.</p>","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800882","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":"Concerns Regarding Cardiac Rehabilitation and Patients With Lower Socioeconomic Status.","authors":"Tieh-Cheng Fu, Chun-Pai Yang, Ching-Mao Chang","doi":"10.1001/jamainternmed.2024.6481","DOIUrl":"https://doi.org/10.1001/jamainternmed.2024.6481","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800888","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}