JAMA Internal Medicine最新文献

{"title":"The Importance of Care for People Coming Home-Mass Incarceration and Human Frailty.","authors":"Margaret Hayden, Leo Gordon Eisenstein, Sanjay Kishore","doi":"10.1001/jamainternmed.2024.5069","DOIUrl":"https://doi.org/10.1001/jamainternmed.2024.5069","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620609","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":"Midline vs Peripherally Inserted Central Catheter for Outpatient Parenteral Antimicrobial Therapy.","authors":"David Paje, Emily Walzl, Megan Heath, Elizabeth McLaughlin, Jennifer K Horowitz, Caitlin Tatarcuk, Lakshmi Swaminathan, Scott Kaatz, Anurag N Malani, Valerie M Vaughn, Steven J Bernstein, Scott A Flanders, Vineet Chopra","doi":"10.1001/jamainternmed.2024.5984","DOIUrl":"10.1001/jamainternmed.2024.5984","url":null,"abstract":"<p><strong>Importance: </strong>Little is known about the safety of midline catheters vs peripherally inserted central catheters (PICCs) for outpatient parenteral antimicrobial therapy (OPAT).</p><p><strong>Objective: </strong>To compare outcomes from midline catheters vs PICCs for OPAT.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included patients who received antimicrobial therapy through a midline catheter or PICC between January 2017 and November 2023 across 69 Michigan hospitals. Because peripherally compatible OPAT was the indication of interest, vancomycin therapy was excluded. Data were analyzed from April to June 2024.</p><p><strong>Exposures: </strong>Insertion of a midline catheter or PICC for OPAT following hospitalization.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was major device complications (ie, catheter-related bloodstream infection or catheter-related venous thromboembolism). Secondary outcomes included minor device complications (eg, catheter dislodgement, occlusion, tip migration, infiltration, superficial thrombophlebitis, or exit site concerns) and device failure, defined as catheter removal following device complication. Cox proportional hazards regression models were fit to device type and outcomes, adjusting for patient and device confounders and device dwell.</p><p><strong>Results: </strong>Of 2824 included patients, 1487 (53.5%) were male, and the median (IQR) age was 66.8 (55.9-77.1) years. Of 2824 devices placed for OPAT, 1999 (70.8%) were midline catheters and 825 (29.2%) were PICCs. The median (IQR) dwell time was 12 (8-17) days for midline catheters and 19 (12-27) days for PICCs (P < .001). A major device complication occurred in 44 patients (1.6%) overall, including 16 (0.8%) with midline catheters and 28 (3.4%) with PICCs (P < .001). OPAT delivered via midline catheters was associated with a lower risk of major complications vs PICCs (adjusted hazard ratio [aHR], 0.46; 95% CI, 0.23-0.91). Risks of minor complications and device failure were similar across device types (minor complications: 206 of 1999 [10.3%] vs 114 of 825 [13.8%]; aHR, 1.07; 95% CI, 0.83-1.38; device failure: 191 of 1999 [9.6%] vs 100 of 825 [12.1%]; aHR, 1.26; 95% CI, 0.96-1.65). For device dwell of 14 or fewer days, midline catheters were associated with a lower risk of major complications (12 of 1324 [0.9%] vs 16 of 304 [5.3%]; aHR, 0.29; 95% CI, 0.12-0.68) and similar risk of failure (151 of 1324 [11.4%] vs 52 of 304 [17.1%]; aHR, 0.79; 95% CI, 0.56-1.12) vs PICCs. For dwell longer than 14 days, no significant difference in rates of major complications (4 of 675 [0.6%] vs 12 of 521 [2.3%]; aHR, 0.42; 95% CI, 0.13-1.40) or device failure (40 of 675 [5.9%] vs 48 of 521 [9.2%]; aHR, 1.02; 95% CI, 0.64-1.61) were observed.</p><p><strong>Conclusions and relevance: </strong>In this study, midline catheters appeared to be safe alternatives to PICCs for OPAT, particularly if","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620589","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":"Do Not Wait to Consider Life Expectancy Until After a Prostate Cancer Diagnosis.","authors":"Nancy Li Schoenborn, Louise C Walter","doi":"10.1001/jamainternmed.2024.6020","DOIUrl":"https://doi.org/10.1001/jamainternmed.2024.6020","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620537","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":"Overtreatment of Prostate Cancer Among Men With Limited Longevity in the Active Surveillance Era.","authors":"Timothy J Daskivich, Michael Luu, John Heard, I-Chun Thomas, John T Leppert","doi":"10.1001/jamainternmed.2024.5994","DOIUrl":"10.1001/jamainternmed.2024.5994","url":null,"abstract":"<p><strong>Importance: </strong>Men with limited life expectancy (LE) have historically been overtreated for prostate cancer despite clear guideline recommendations. With increasing use of active surveillance, it is unclear if overtreatment of men with limited LE has persisted and how overtreatment varies by tumor risk and treatment type.</p><p><strong>Objective: </strong>To determine if rates of overtreatment of men with limited LE have persisted in the active surveillance era and whether overtreatment varies by tumor risk or treatment type.</p><p><strong>Design, setting, and participants: </strong>This cohort study included men with clinically localized prostate cancer in the Veterans Affairs health system who received a diagnosis between January 1, 2000, and December 31, 2019.</p><p><strong>Main outcomes and measures: </strong>LE was estimated using the validated age-adjusted Prostate Cancer Comorbidity Index (PCCI). Treatment trends among men with limited LE were assessed using a stratified linear and log-linear Poisson regression in aggregate and across PCCI and tumor risk subgroups.</p><p><strong>Results: </strong>The mean (SD) age for the study population of 243 928 men was 66.8 (8.0) years. A total of 50 045 (20.5%) and 11 366 (4.7%) men had an LE of less than 10 years and LE of less than 5 years based on PCCI scores of 5 or greater and 10 or greater, respectively. Among men with an LE of less than 10 years, the proportion of men treated with definitive treatment (surgery or radiotherapy) for low-risk disease decreased from 37.4% to 14.7% (absolute change, -22.7%; 95% CI, -30.0% to -15.4%) but increased for intermediate-risk disease from 37.6% to 59.8% (22.1%; 95% CI, 14.8%-29.4%) from 2000 to 2019, with increases observed for favorable (32.8%-57.8%) unfavorable intermediate-risk disease (46.1%-65.2%). Among men with an LE of less than 10 years who were receiving definitive therapy, the predominant treatment was radiotherapy (78%). Among men with an LE of less than 10 years, use of radiotherapy increased from 31.3% to 44.9% (13.6%; 95% CI, 8.5%-18.7%) for intermediate-risk disease from 2000 to 2019, with increases observed for favorable and unfavorable intermediate-risk disease. Among men with an LE of less than 5 years, the proportion of men treated with definitive treatment for high-risk disease increased from 17.3% to 46.5% (29.3%; 95% CI, 21.9%-36.6%) from 2000 to 2019. Among men with an LE of less than 5 years who were receiving definitive therapy, the predominant treatment was radiotherapy (85%). Among men with an LE of less than 5 years, use of radiotherapy increased from 16.3% to 39.0% (22.6%; 95% CI, 16.5%-28.8%) from 2000 to 2019.</p><p><strong>Conclusions and relevance: </strong>The results of this cohort study suggest that, in the active surveillance era, overtreatment of men with limited LE and intermediate-risk and high-risk prostate cancer has increased in the VA, mainly with radiotherapy.</p>","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620595","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":"Kidney Transplantation Among Presumed Undocumented Immigrants After Changes in US State Policies.","authors":"Gayathri Menon, Garyn T Metoyer, Yiting Li, Yusi Chen, Sunjae Bae, Brian P Lee, Pablo C Loarte-Campos, Babak J Orandi, Dorry L Segev, Mara A McAdams-DeMarco","doi":"10.1001/jamainternmed.2024.5953","DOIUrl":"10.1001/jamainternmed.2024.5953","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620567","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":"Clarifying Causes of Increasing Cannabis-Related ED Visits in Older Adults-Reply.","authors":"Nathan M Stall, Michael P Hillmer, Jonathan S Zipursky","doi":"10.1001/jamainternmed.2024.5498","DOIUrl":"https://doi.org/10.1001/jamainternmed.2024.5498","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620349","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":"Risk of Liver Injury With Potentially Hepatotoxic Drugs-Reply.","authors":"Vincent Lo Re, Jessie Torgersen, Amy C Justice","doi":"10.1001/jamainternmed.2024.5489","DOIUrl":"https://doi.org/10.1001/jamainternmed.2024.5489","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568866","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":"Supplemental Nutrition Assistance Program Work Requirements and Safety-Net Program Participation.","authors":"Chima D Ndumele, Hannah Factor, Matthew Lavallee, Anthony Lollo, Jacob Wallace","doi":"10.1001/jamainternmed.2024.5932","DOIUrl":"10.1001/jamainternmed.2024.5932","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Work requirements are a controversial feature of US safety-net programs, with some policymakers seeking to expand their use. Little is known about the demographic, clinical, and socioeconomic characteristics of individuals most likely to be negatively impacted by work requirements.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine the association between work requirements and safety-net program enrollment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cohort study included Medicaid and Supplemental Nutrition Assistance Program (SNAP) enrollees in Connecticut. The impact of SNAP work requirements for able-bodied adults without dependents-the target population-was estimated using a triple-differences research design comparing outcomes before and after the policy (first difference) in affected and exempted towns (second difference) between the targeted population and untargeted parents and caregivers (third difference). SNAP and Medicaid enrollment trends were assessed for a 24-month period, and the characteristics of individuals most likely to lose coverage were examined. Data were collected from August 2015 to April 2018, and data were analyzed from August 2022 to September 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;The reintroduction of SNAP work requirements in 2016.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Proportion of enrollees disenrolled from SNAP and Medicaid.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 81 888 Medicaid enrollees in Connecticut, 46 872 (57.2%) were female, and the mean (SD) age was 36.6 (7.0) years. Of these, 38 344 were able-bodied adults without dependents, of which 19 172 were exposed to SNAP work requirements, and 43 544 were parents or caregivers exempted from SNAP work requirements. SNAP coverage declined 5.9 percentage points (95% CI, 5.1-6.7), or 25%, following work requirements. There were no statistically significant changes in Medicaid coverage (0.2 percentage points; 95% CI, -1.4 to 1.0). Work requirements disproportionately affected individuals with more chronic illnesses, targeted beneficiaries who were older, and beneficiaries with lower incomes. Individuals with diabetes were 5 percentage points (95% CI, 0.8-9.3), or 91%, likelier to lose SNAP coverage than those with no chronic conditions; older SNAP beneficiaries (aged 40 to 49 years) with multiple comorbidities were 7.3 percentage points (95% CI, 4.3-11.3), or 553%, likelier to disenroll than younger beneficiaries (aged 25 to 29 years) without chronic conditions; and households with the lowest incomes were 18.6 percentage points (95% CI, 11.8-25.4), or 204%, likelier to lose coverage than the highest income SNAP beneficiaries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cohort study, SNAP work requirements led to substantial reductions in SNAP coverage, especially for the most clinically and socioeconomically vulnerable. Work requirements had little effect on Medicaid coverage, suggesting they did no","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568895","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":"When Dysuria Is More Than Just a Urinary Tract Infection: A Teachable Moment.","authors":"Jennifer A Foster, Deborah Freeland, Melissa M Mauskar","doi":"10.1001/jamainternmed.2024.5333","DOIUrl":"https://doi.org/10.1001/jamainternmed.2024.5333","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568901","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":"Social Isolation and Mortality in Adults With Chronic Obstructive Pulmonary Disease.","authors":"Angela O Suen, Anand S Iyer, Irena Cenzer, Jonathan P Singer, Alexander Smith, Rebecca L Sudore, Ashwin Kotwal","doi":"10.1001/jamainternmed.2024.5940","DOIUrl":"10.1001/jamainternmed.2024.5940","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568870","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}