JAMA Internal Medicine最新文献

Tackling the Hard Part of Gun Violence Prevention in Medical Schools.

IF 22.5 1区医学

JAMA Internal Medicine Pub Date : 2025-03-10 DOI: 10.1001/jamainternmed.2024.8210

Amelia Mercado

引用次数: 0

Awake Prone Positioning in COVID-19-Is There a New Standard of Care?

IF 22.5 1区医学

JAMA Internal Medicine Pub Date : 2025-03-10 DOI: 10.1001/jamainternmed.2025.0021

Michael A Matthay, Katherine D Wick, Narges Alipanah-Lechner

引用次数: 0

Tackling the Hard Part of Gun Violence Prevention in Medical Schools-Reply.

IF 22.5 1区医学

JAMA Internal Medicine Pub Date : 2025-03-10 DOI: 10.1001/jamainternmed.2024.8213

Samuel E Okum, Jordyn A Hurly, Joseph V Sakran

引用次数: 0

Awake Prone Positioning in Adults With COVID-19: An Individual Participant Data Meta-Analysis.

IF 22.5 1区医学

JAMA Internal Medicine Pub Date : 2025-03-10 DOI: 10.1001/jamainternmed.2025.0011

Jian Luo, Ivan Pavlov, Elsa Tavernier, Yonatan Perez, Aileen Kharat, Bairbre McNicholas, Oriol Roca, David L Vines, Miguel Ibarra-Estrada, Waleed Alhazzani, Kimberley Lewis, Steven Q Simpson, Garrett Rampon, Ling Liu, Qin Sun, Haibo Qiu, Yi Yang, Giuseppe Lapadula, Edward Tang Qian, Cheryl L Gatto, Todd W Rice, Ken Kuljit S Parhar, Jason Weatherald, Allan J Walkey, Nicholas A Bosch, Mai-Anh Nay, Thierry Boulain, Guillaume Fossat, Tim R E Harris, C Louise Thwaites, Nguyen Thanh Phong, Paolo Bonfanti, Sajad Yarahmadi, Seyed Mohammadreza Hashemian, Devachandran Jayakumar, Stephanie Parks Taylor, Stacy A Johnson, Claude Guerin, John G Laffey, Stephan Ehrmann, Jie Li

{"title":"Awake Prone Positioning in Adults With COVID-19: An Individual Participant Data Meta-Analysis.","authors":"Jian Luo, Ivan Pavlov, Elsa Tavernier, Yonatan Perez, Aileen Kharat, Bairbre McNicholas, Oriol Roca, David L Vines, Miguel Ibarra-Estrada, Waleed Alhazzani, Kimberley Lewis, Steven Q Simpson, Garrett Rampon, Ling Liu, Qin Sun, Haibo Qiu, Yi Yang, Giuseppe Lapadula, Edward Tang Qian, Cheryl L Gatto, Todd W Rice, Ken Kuljit S Parhar, Jason Weatherald, Allan J Walkey, Nicholas A Bosch, Mai-Anh Nay, Thierry Boulain, Guillaume Fossat, Tim R E Harris, C Louise Thwaites, Nguyen Thanh Phong, Paolo Bonfanti, Sajad Yarahmadi, Seyed Mohammadreza Hashemian, Devachandran Jayakumar, Stephanie Parks Taylor, Stacy A Johnson, Claude Guerin, John G Laffey, Stephan Ehrmann, Jie Li","doi":"10.1001/jamainternmed.2025.0011","DOIUrl":"10.1001/jamainternmed.2025.0011","url":null,"abstract":"Importance: The impact of awake prone positioning (APP) on clinical outcomes in patients with COVID-19 and acute hypoxemic respiratory failure (AHRF) remains uncertain.Objective: To assess the association of APP with improved clinical outcomes among patients with COVID-19 and AHRF, and to identify potential effect modifiers.Data sources: PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched through August 1, 2024.Study selection: Randomized clinical trials (RCTs) examining APP in adults with COVID-19 and AHRF that reported intubation rate or mortality were included.Data extraction and synthesis: Individual participant data (IPD) were extracted according to PRISMA-IPD guidelines. For binary outcomes, logistic regression was used and odds ratio (OR) and 95% CIs were reported, while for continuous outcomes, linear regression was used and mean difference (MD) and 95% CIs were reported.Main outcomes and measures: The primary outcome was survival without intubation. Secondary outcomes included intubation, mortality, death without intubation, death after intubation, escalation of respiratory support, intensive care unit (ICU) admission, time from enrollment to intubation and death, duration of invasive mechanical ventilation, and hospital and ICU lengths of stay.Results: A total of 14 RCTs involving 3019 patients were included; 1542 patients in the APP group (mean [SD] age, 59.3 [14.1] years; 1048 male [68.0%]) and 1477 in the control group (mean [SD] age, 59.9 [14.1] years; 979 male [66.3%]). APP improved survival without intubation (OR, 1.42; 95% CI, 1.20-1.68), and it reduced the risk of intubation (OR, 0.70; 95% CI, 0.59-0.84) and hospital mortality (OR, 0.77; 95% CI, 0.63-0.95). APP also extended the time from enrollment to intubation (MD, 0.93 days; 95% CI, 0.43 to 1.42 days). In exploratory subgroup analyses, improved survival without intubation was observed in patients younger than age 68 years, as well as in patients with a body mass index of 26 to 30, early implementation of APP (ie, less than 1 day from hospitalization), a pulse saturation to inhaled oxygen fraction ratio of 155 to 232, respiratory rate of 20 to 26 breaths per minute (bpm), and those receiving advanced respiratory support at enrollment. However, none of the subgroups had significant interaction with APP treatment. APP duration 10 or more hours/d within the first 3 days was associated with increased survival without intubation (OR, 1.85; 95% CI, 1.37-2.49).Conclusions and relevance: This IPD meta-analysis found that in adults with COVID-19 and AHRF, APP was associated with increased survival without intubation and with reduced risks of intubation and mortality, including death after intubation. Prolonged APP duration (10 or more hours/d) was associated with better outcome","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Change to Add Nonauthor Collaborators Supplement and Fix Errors in Table 1.

IF 22.5 1区医学

JAMA Internal Medicine Pub Date : 2025-03-10 DOI: 10.1001/jamainternmed.2025.0002

引用次数: 0

Post-Dobbs Decision Changes in Obstetrics and Gynecology Clinical Workforce in States With Abortion Restrictions.

IF 22.5 1区医学

JAMA Internal Medicine Pub Date : 2025-03-10 DOI: 10.1001/jamainternmed.2024.8149

Jane M Zhu, Aine Huntington, K John McConnell, Allison M Whelan, Ruby Aaron, Maria I Rodriguez

引用次数: 0

Kidney Transplant Fast Track and Likelihood of Waitlisting and Transplant: A Nonrandomized Clinical Trial.

IF 22.5 1区医学

JAMA Internal Medicine Pub Date : 2025-03-10 DOI: 10.1001/jamainternmed.2025.0043

Larissa Myaskovsky, Yuridia Leyva, Chethan Puttarajappa, Arjun Kalaria, Yue-Harn Ng, Miriam Vélez-Bermúdez, Yiliang Zhu, Cindy Bryce, Emilee Croswell, Hannah Wesselman, Kellee Kendall, Chung-Chou Chang, L Ebony Boulware, Amit Tevar, Mary Amanda Dew

{"title":"Kidney Transplant Fast Track and Likelihood of Waitlisting and Transplant: A Nonrandomized Clinical Trial.","authors":"Larissa Myaskovsky, Yuridia Leyva, Chethan Puttarajappa, Arjun Kalaria, Yue-Harn Ng, Miriam Vélez-Bermúdez, Yiliang Zhu, Cindy Bryce, Emilee Croswell, Hannah Wesselman, Kellee Kendall, Chung-Chou Chang, L Ebony Boulware, Amit Tevar, Mary Amanda Dew","doi":"10.1001/jamainternmed.2025.0043","DOIUrl":"10.1001/jamainternmed.2025.0043","url":null,"abstract":"Importance: Kidney transplant (KT) is the optimal treatment for end-stage kidney disease (ESKD). The evaluation process for KT is lengthy, time-consuming, and burdensome, and racial and ethnic disparities persist.Objective: To investigate the potential association of the Kidney Transplant Fast Track (KTFT) evaluation approach with the likelihood of waitlisting, KT, and associated disparities compared with standard care.Design, setting, and participants: This nonrandomized clinical trial was a prospective comparative cohort trial with a historical control (HC) comparison and equal follow-up duration at a single urban transplant center. Study duration was 2015 to 2018 for KTFT, with follow-up through 2022, and 2010 to 2014 for HC, with follow-up through 2018. Adult, English-speaking patients with ESKD, no history of KT, and a scheduled KT evaluation appointment were included. Among 1472 eligible patients for the KTFT group, 1288 consented and completed the baseline interview and 170 were excluded for not attending an evaluation appointment; among 1337 patients eligible for the HC group, 1152 consented and completed the baseline interview and none were excluded. Data were analyzed from August 2023 through December 2024.Exposure: Streamlined, patient-centered, coordinated-care KT evaluation process.Main outcomes and measures: Time to waitlisting for KT and receipt of KT.Results: The study included 1118 participants receiving KTFT (416 female [37.2%]; mean [SD] age, 57.2 [13.2] years; 245 non-Hispanic Black [21.9%], 790 non-Hispanic White [70.7%], and 83 other race or ethnicity [7.4%]) and 1152 participants in the HC group (447 female [38.8%]; mean [SD] age, 55.5 [13.2] years; 267 non-Hispanic Black [23.2%], 789 non-Hispanic White [68.5%], and 96 other race or ethnicity [8.3%]). After adjusting for demographic and clinical factors, the KTFT compared with the HC group had a higher likelihood of being placed on the active waitlist for KT (subdistribution hazard ratio [SHR], 1.40; 95% CI, 1.24-1.59). Among individuals who were waitlisted, patients in the KTFT vs HC group had a higher likelihood of receiving a KT (SHR, 1.21; 95% CI, 1.04-1.41). Black patients (SHR, 1.54; 95% CI, 1.11-2.14) and White patients (SHR, 1.38; 95% CI, 1.16-1.65) receiving KTFT were more likely to be waitlisted for KT than those in the HC group, but no such difference was found for patients with other race or ethnicity. Among Black patients, those with KTFT were more likely than those in the HC group to undergo KT (SHR, 1.52; 95% CI, 1.06-2.16), but no significant differences were found for White patients or those with other race or ethnicity.Conclusions and relevance: This study found that KTFT was associated with a higher likelihood of waitlisting and KT than standard care. Findings suggest that KTFT may be associate","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

First, Do No Harm-A Career-Long Struggle With Iatrogenesis.

IF 22.5 1区医学

JAMA Internal Medicine Pub Date : 2025-03-10 DOI: 10.1001/jamainternmed.2024.7839

B Joseph Elmunzer

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Kidney Transplant Evaluations-Why Put Off Until Tomorrow What You Can Do Today?

IF 22.5 1区医学

JAMA Internal Medicine Pub Date : 2025-03-10 DOI: 10.1001/jamainternmed.2025.0084

Raegan W Durant

引用次数: 0

What Is a Stepped-Wedge Cluster Randomized Trial?