JAMA Internal Medicine最新文献

{"title":"Red Blood Cell Exchange Transfusion for Severe Babesiosis.","authors":"David E Leaf, Audrey E Monson, Julie-Alexia Dias, Luis A Marcos, Ulysses Wu, Michael Rossi, Jia H Ng, Rushad Patell, Joshua Hundert, Marc Y El Khoury, James Higgs, Robert P Smith, Vishali Ramsaroop, Adam Green, Ahmed Abdul Azim, Scott Weisenberg, Laura A Kirkman, David Ingram, Caroline M Hsu, Kevin Dieckhaus, Peter Hyson, Zoe Burger, Tayoot Chengsupanimit, Tammy Stalmack, Rachel Aber, Marjorie Golden, Maria Koshy, Kendall Wright, Grace Cortezzo, Gavin McLeod, Rebecca Wenzel-Rideout, Julio Javier Baigorri, Aranya Bagchi, Ahmad Jaser, Guillermo Socorro Matos, Daniel Sanchez-Almanzar, Steven T Hoge, Tushar Shenoy, Shobana Krishnamurthy, Sarah A Kaunfer, Jack A Blau, Ann Woolley, Rudline Zamor, Brigitte Maczaj, David Kenison, Arthur Totten, Victoria Bateman, Sabrina Mohsin, Eun Sun Lee, Joseph Garner, Payal Rath, Quinlan Wu, Dorra Guermazi, Abby London, Panos Arvanitis, Philip S Yune, Mahie Abdullah, Angela Kim, Juby Roy, Reshma George, Simon Kashfi, Susana Hong, Pratap Upadrista, Jamie S Hirsch, Alexander Bulteel, Riya Sharma, Tina Guo, Daniela Garcia, Shahzad Shaefi, Joseph Yeb, George Williams, Eesha Verma, Nourelhoda Gouda, Hannah R Rosenthal, Angelica Chan, Hadeel Zainah, Seth Heithaus, Miguel A Saldivar, Emily Wood, John DiPalazzo, Susan Elias, Matthew McAuliffe, Ramsha Abbas, Abigail Orenstein, Mark A Tidswell, Peter Galiano, Sanjae Spencer, Sidharth Srinivasan, Joyce Xu, Sivani Alla, Leila Alidoost, Eliana Jacobson, Sanjay V Menghani, Priyanka Kannabran, Deborah B Ogunribido, Paddy Ssentongo, Debra Powell, Leah Meyer, Kshitij Prabhune, Bianca Griffiths, Daphne Gonzalez Aponte, Graham Dixon, Edouard Vannier, Scott C Roberts, Dimitrios Farmakiotis, Peter J Krause","doi":"10.1001/jamainternmed.2026.0244","DOIUrl":"10.1001/jamainternmed.2026.0244","url":null,"abstract":"<p><strong>Importance: </strong>Babesiosis is a worldwide emerging tick-borne disease with an expanding geographic range in the US, Europe, and Asia. Red blood cell exchange transfusion (ET) is often used as an adjunctive treatment for severe illness from babesiosis, particularly in patients with high parasitemia, acute organ injury, or severe hemolytic anemia. Data supporting its clinical effectiveness, however, are lacking.</p><p><strong>Objective: </strong>To test whether ET improves clinical outcomes among hospitalized adult patients with severe babesiosis.</p><p><strong>Design, settings, and participants: </strong>This target trial emulation used data from a multicenter cohort study of 3233 consecutive adults hospitalized with babesiosis from 2010 to 2024 at 82 sites across the northeastern US. Patients were eligible if they had parasitemia greater than 10%, or 5% to 10% with either acute organ injury or severe hemolytic anemia. Data were analyzed from April to August 2025.</p><p><strong>Exposure: </strong>Treatment with ET in the first 7 days of hospitalization.</p><p><strong>Main outcomes and measures: </strong>A composite of in-hospital death or 30-day readmission. Outcomes were compared between patients who received ET within the first 7 days of admission and those who did not. The analysis used logistic regression, with inverse probability of treatment weighting (IPTW) to adjust for potential confounders.</p><p><strong>Results: </strong>The analysis included 629 patients (median [IQR] age, 71 [63-79] years; 446 male [70.9%]), among whom 209 (33.2%) received ET in the first 7 days of hospitalization. Patients treated with ET were more severely ill at baseline than those not treated with ET (median parasitemia, 14.0% vs 7.2%); however, severity of illness characteristics were well balanced after applying IPTW. In the main analysis, the primary end point occurred in 3.6% of patients who received ET and in 9.8% who did not (adjusted odds ratio, 0.22; 95% CI, 0.09-0.51). The benefit of ET was confirmed in multiple sensitivity analyses.</p><p><strong>Conclusions and relevance: </strong>This multicenter cohort study found that among severely ill adults hospitalized with babesiosis, the adjusted risk of in-hospital death or 30-day readmission was nearly 5-fold lower in those treated with ET vs those not treated with ET. These data support ET for severely ill patients with babesiosis, although the findings may be susceptible to unmeasured confounding. Further research is needed to identify which patients are most likely to benefit.</p>","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"597-607"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574128","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":"Transesophageal Echocardiography During CPR in Patients With Out-of-Hospital Cardiac Arrest: The EXECT-CPR Randomized Clinical Trial.","authors":"Sheng-En Chu, Chiao-Yin Cheng, Chih-Jung Chang, Hua Ho, Hsuan-An Chen, Chun-Hsiang Chan, Matthew H Ma, Chin-Ho Chang, Kuang-Chau Tsai, Kuan-Ming Chiu, Lee-Wei Chen, Wen-Chu Chiang, Jen-Tang Sun","doi":"10.1001/jamainternmed.2026.0102","DOIUrl":"10.1001/jamainternmed.2026.0102","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Cardiopulmonary resuscitation (CPR) guidelines recommend chest compressions at the lower half of the sternum. This may lead to aortic valve compression, which is associated with poor outcomes, while compressions over the left ventricle are seldom achieved.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To test the hypothesis that transesophageal echocardiography (TEE) guidance during CPR to avoid aortic valve compression and target the left ventricle would improve outcomes in patients with nontraumatic out-of-hospital cardiac arrest compared with conventional CPR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cluster-randomized clinical trial (the EXECT-CPR study) was conducted from June 26 to November 19, 2023, at 1 tertiary medical center in Taiwan. Participants were adults who consecutively presented to the emergency department (ED) with nontraumatic out-of-hospital cardiac arrest. Exclusion criteria were prehospital return of spontaneous circulation, extracorporeal CPR, contraindications to TEE, prior do-not-resuscitate orders, and obvious signs of death. Complete blinding was not feasible; the allocation schedule was disclosed only to the principal investigator.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Post-ED arrival CPR at TEE-guided (avoid aortic-valve compression and target the left ventricle) or guideline-recommended (the lower half of the sternum) site.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was a sustained return of spontaneous circulation (≥20 minutes). Secondary outcomes were any return of spontaneous circulation, survival to intensive care unit admission, survival to hospital discharge, cerebral performance category of 2 or lower at discharge, and intra-CPR end-tidal carbon dioxide levels.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 132 patients underwent randomization (66 in each group; median [IQR] age, 68 [55-74] years; 87 [66%] male). The primary outcome was similar between groups (TEE-guided group, 29 [44%]; conventional group, 26 [39%]; cluster-adjusted odds ratio, 1.21; 95% CI, 0.64-2.29). The secondary outcomes also did not significantly differ, except for higher intra-CPR end-tidal carbon dioxide levels in the TEE-guided group during the 11th to 20th minutes after arrival. Adverse event rates related to TEE and CPR were comparable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this randomized clinical trial among adults transported to the emergency department with ongoing CPR for nontraumatic out-of-hospital cardiac arrest, TEE-guided CPR with an adjusted compression site after arrival did not significantly improve clinical outcomes compared with conventional CPR, although it produced potential hemodynamic benefits without increasing adverse events. Given that the trial was underpowered due to optimistic effect size assumptions, these neutral findings should be interpreted with caution.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;ClinicalTrials.gov Identi","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"557-566"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147498829","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 Visual Abstract.","authors":"","doi":"10.1001/jamainternmed.2026.1710","DOIUrl":"10.1001/jamainternmed.2026.1710","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":"186 5","pages":"646"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815531","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":"Extended-Release vs Sublingual Buprenorphine in Pregnancy Through 12 Months Post Partum: A Randomized Clinical Trial.","authors":"T John Winhusen, Michelle R Lofwall, Frankie Kropp, Daniel Lewis, Marcela C Smid, Jessica L Young, Candace Hodgkins, Elizabeth E Krans, Zachary Hansen, Elisha M Wachman, Davida M Schiff, Constance Guille, Vania Rudolf, Tara Chowdhury, Lawrence Leeman, Mitra Lewis, Abigail G Matthews, Gerald Cochran, Jacquie King, Christine Wilder, Carmen Rosa","doi":"10.1001/jamainternmed.2026.0057","DOIUrl":"10.1001/jamainternmed.2026.0057","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Treating opioid use disorder (OUD) in pregnancy with sublingual buprenorphine is an evidence-based practice, but it has disadvantages that could be addressed with an extended-release formulation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the effectiveness and safety of extended-release buprenorphine vs sublingual buprenorphine for OUD in pregnancy through 12 months post partum.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This 2-group, open-label, noninferiority, randomized clinical trial was conducted between July 2, 2020, and October 30, 2024, among adults with OUD and a singleton pregnancy of 6 to 30 weeks' gestational age at 13 outpatient cross-disciplinary peripartum OUD treatment sites.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Randomization to sublingual or extended-release buprenorphine (weekly formulation during pregnancy, monthly formulation optional post partum if not breastfeeding).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary and key secondary outcomes were illicit opioid abstinence during pregnancy and the postpartum period, respectively, defined as the proportion of weekly collected urine samples negative for illicit opioids. If noninferiority was demonstrated at a margin of 0.15, testing for superiority was planned. Key secondary infant outcomes from medical records were opioid treatment for neonatal opioid withdrawal syndrome (NOWS; yes or no) and number of opioid treatment days for NOWS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 140 randomized participants, the mean (SD) age was 31.2 (4.6) years. There were 10 Black participants (7.1%), 10 Hispanic participants (7.1%), 116 (82.9%) White participants, and 14 participants (10.0%) who belonged to additional groups. All but 2 were already prescribed sublingual buprenorphine. Study completion was 98% through pregnancy (137 participants) and 81% through 12 months post partum (114 participants). Illicit opioid abstinence was higher during pregnancy for participants receiving extended-release vs sublingual buprenorphine (82.5% vs 72.6%; mean difference, 9.84 [95% CI, 1.72 to 17.95] percentage points; P = .009). Postpartum abstinence rates declined and were similar in both groups (60.2% vs 59.5%; mean difference, 0.65 [98% CI, -12.72 to 14.02] percentage points; P = .45). Those receiving extended-release buprenorphine experienced fewer serious adverse events during pregnancy (8.7% vs 26.8%; P = .007) and post partum (6.0% vs 18.6%; P = .04). Nonserious adverse events rates did not differ between groups, but more were deemed medication-related for extended-release participants during pregnancy (26.1% vs 7.0%; P = .003). Infants exposed to extended-release vs sublingual buprenorphine did not differ in need for opioid treatment (30.2% vs 26.5%; relative risk, 1.14 [98% CI, 0.54 to 1.99]; P = .64) or mean (SE) treatment days (10.9 [2.2] vs 14.8 [3.0] days; relative risk, 0.73 [98% CI, 0.36 to 1.51]; P = .28). At birth, extended-relea","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"533-543"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12993732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468032","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":"Electrocardiography Unmasking the Cause of Unexplained Coma.","authors":"Gunaseelan Rajendran, Sasikumar Mahalingam, Anitha Ramkumar","doi":"10.1001/jamainternmed.2025.7798","DOIUrl":"10.1001/jamainternmed.2025.7798","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"633-634"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326101","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":"Evaluating Medicare's Prior Authorization Model Design-WISeR on Waste.","authors":"Jacob T Kannarkat, Varun Thachil, Joseph T Kannarkat, Natasha Parekh","doi":"10.1001/jamainternmed.2025.7891","DOIUrl":"10.1001/jamainternmed.2025.7891","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"503-504"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377528","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":"Understanding the Health Impacts of the Rapid Shift to Drug Smoking in the US.","authors":"George Karandinos, Travis P Baggett, Daniel Ciccarone","doi":"10.1001/jamainternmed.2026.0083","DOIUrl":"10.1001/jamainternmed.2026.0083","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"639-640"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468054","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":"Commercial Price Variation for Outpatient Physical Therapy Services.","authors":"Michael D Ranando, Joshua D Wallach, Joseph S Ross, Joshua J Skydel","doi":"10.1001/jamainternmed.2025.8355","DOIUrl":"10.1001/jamainternmed.2025.8355","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"640-643"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12954591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326172","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":"Cognitive Behavioral Therapy for Insomnia in Chronic Disease.","authors":"Cagdas Türkmen, Yuki Furukawa, Elisabeth Hertenstein","doi":"10.1001/jamainternmed.2026.0045","DOIUrl":"10.1001/jamainternmed.2026.0045","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"643-644"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468001","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":"Turnover and Burnout Among Family Physicians.","authors":"Dhruv Khullar, Lawrence P Casalino, Richard G Kronick, Lars E Petersen, Ming Tai-Seale, Jiebing Wen, Manyao Zhang, Amelia M Bond","doi":"10.1001/jamainternmed.2026.0271","DOIUrl":"10.1001/jamainternmed.2026.0271","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"635-637"},"PeriodicalIF":23.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574088","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}