JAMA最新文献

{"title":"Social Media Use Trajectories and Cognitive Performance in Adolescents.","authors":"Jason M Nagata,Jennifer H Wong,Kristen E Kim,Racquel A Richardson,Sahana Nayak,Char Potes,Andreas M Rauschecker,Aaron Scheffler,Leo P Sugrue,Fiona C Baker,Alexander Testa","doi":"10.1001/jama.2025.16613","DOIUrl":"https://doi.org/10.1001/jama.2025.16613","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developmental Costs of Youth Social Media Require Policy Action.","authors":"Sheri Madigan,Keith Owen Yeates,Pasco Fearon","doi":"10.1001/jama.2025.18668","DOIUrl":"https://doi.org/10.1001/jama.2025.18668","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"136 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI, Health, and Health Care Today and Tomorrow: The JAMA Summit Report on Artificial Intelligence.","authors":"Derek C Angus,Rohan Khera,Tracy Lieu,Vincent Liu,Faraz S Ahmad,Brian Anderson,Sivasubramanium V Bhavani,Andrew Bindman,Troyen Brennan,Leo Anthony Celi,Frederick Chen,I Glenn Cohen,Alastair Denniston,Sanjay Desai,Peter Embí,Aldo Faisal,Kadija Ferryman,Jackie Gerhart,Marielle Gross,Tina Hernandez-Boussard,Michael Howell,Kevin Johnson,Kristine Lee,Xiaoxuan Liu,Kimberly Lomis,Alex John London,Christopher A Longhurst,Ken Mandl,Elizabeth McGlynn,Michelle M Mello,Fatima Munoz,Lucila Ohno-Machado,David Ouyang,Roy Perlis,Adam Phillips,David Rhew,Joseph S Ross,Suchi Saria,Lee Schwamm,Christopher W Seymour,Nigam H Shah,Rashmee Shah,Karandeep Singh,Matthew Solomon,Kathryn Spates,Kayte Spector-Bagdady,Tommy Wang,Judy Wawira Gichoya,James Weinstein,Jenna Wiens,Kirsten Bibbins-Domingo, ","doi":"10.1001/jama.2025.18490","DOIUrl":"https://doi.org/10.1001/jama.2025.18490","url":null,"abstract":"ImportanceArtificial intelligence (AI) is changing health and health care on an unprecedented scale. Though the potential benefits are massive, so are the risks. The JAMA Summit on AI discussed how health and health care AI should be developed, evaluated, regulated, disseminated, and monitored.ObservationsHealth and health care AI is wide-ranging, including clinical tools (eg, sepsis alerts or diabetic retinopathy screening software), technologies used by individuals with health concerns (eg, mobile health apps), tools used by health care systems to improve business operations (eg, revenue cycle management or scheduling), and hybrid tools supporting both business operations (eg, documentation and billing) and clinical activities (eg, suggesting diagnoses or treatment plans). Many AI tools are already widely adopted, especially for medical imaging, mobile health, health care business operations, and hybrid functions like scribing outpatient visits. All these tools can have important health effects (good or bad), but these effects are often not quantified because evaluations are extremely challenging or not required, in part because many are outside the US Food and Drug Administration's regulatory oversight. A major challenge in evaluation is that a tool's effects are highly dependent on the human-computer interface, user training, and setting in which the tool is used. Numerous efforts lay out standards for the responsible use of AI, but most focus on monitoring for safety (eg, detection of model hallucinations) or institutional compliance with various process measures, and do not address effectiveness (ie, demonstration of improved outcomes). Ensuring AI is deployed equitably and in a manner that improves health outcomes or, if improving efficiency of health care delivery, does so safely, requires progress in 4 areas. First, multistakeholder engagement throughout the total product life cycle is needed. This effort would include greater partnership of end users with developers in initial tool creation and greater partnership of developers, regulators, and health care systems in the evaluation of tools as they are deployed. Second, measurement tools for evaluation and monitoring should be developed and disseminated. Beyond proposed monitoring and certification initiatives, this will require new methods and expertise to allow health care systems to conduct or participate in rapid, efficient, and robust evaluations of effectiveness. The third priority is creation of a nationally representative data infrastructure and learning environment to support the generation of generalizable knowledge about health effects of AI tools across different settings. Fourth, an incentive structure should be promoted, using market forces and policy levers, to drive these changes.Conclusions and RelevanceAI will disrupt every part of health and health care delivery in the coming years. Given the many long-standing problems in health care, this disruption represents an in","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145284019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-Arterial Thrombolysis After Thrombectomy-Does the Story Have an Epilogue?","authors":"Alison Seitz,Thabele M Leslie-Mazwi","doi":"10.1001/jama.2025.19441","DOIUrl":"https://doi.org/10.1001/jama.2025.19441","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145283980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualized Perioperative Blood Pressure Management in Patients Undergoing Major Abdominal Surgery: The IMPROVE-multi Randomized Clinical Trial.","authors":"Bernd Saugel,Agnes S Meidert,Frank M Brunkhorst,Robert Bischoff,Joseph Esser,Minca Mattis,Pauline Naue,Katharina Vogel,Alina Bergholz,Moritz Flick,Alina Kröker,Dominik X Müller,Kristen K Thomsen,Christina Vokuhl,Mirja Wegge,Sebastian Bratke,Martin Graeßner,Bettina Jungwirth,Sebastian Schmid,Carla D Grundmann,Jan M Wischermann,Patrick Kellner,Moritz Steinhaus,Linda Grüßer,Sina M Coldewey,Kai Zacharowski,Patrick Meybohm,Marit Habicher,Alexander Zarbock,Amelie Zitzmann,Svenja Letz,Claudia Neumann,Jan Larmann,Thomas Renné,Linda Krause,Eik Vettorazzi,Antonia Zapf,Annemarie Carlstedt,Daniel I Sessler,Karim Kouz, ","doi":"10.1001/jama.2025.17235","DOIUrl":"https://doi.org/10.1001/jama.2025.17235","url":null,"abstract":"ImportanceIntraoperative hypotension is associated with organ injury. However, it remains unknown if targeted blood pressure management during surgery can improve clinical outcomes.ObjectiveTo evaluate whether individualized vs routine perioperative blood pressure management during major abdominal surgery improves clinical outcomes in patients considered at high risk of postoperative complications.Design, Setting, and ParticipantsThis randomized single-blind clinical trial enrolled patients 45 years or older undergoing elective major abdominal surgery with general anesthesia expected to last 90 minutes or longer who had at least 1 additional high-risk criterion between February 26, 2023, and April 25, 2024, at 15 German university hospitals. The date of last follow-up was July 25, 2024.InterventionPatients were randomized in a 1:1 ratio to individualized perioperative blood pressure management (with mean arterial pressure [MAP] targets based on preoperative mean nighttime MAP assessed using automated blood pressure monitoring) or routine blood pressure management with a MAP target of 65 mm Hg or higher.Main Outcomes and MeasuresThe primary outcome was the incidence of a composite outcome of acute kidney injury, acute myocardial injury, nonfatal cardiac arrest, or death within the first 7 postoperative days. There were 22 secondary outcomes, including infectious complications within the first 7 postoperative days and a composite outcome of need for kidney replacement therapy, myocardial infarction, nonfatal cardiac arrest, or death within 90 days after surgery.ResultsOf the 1272 patients enrolled, 1142 were randomized (571 patients to each group), and 1134 were included in the primary analysis (median age, 66 years [IQR, 59-73 years]; 34.1% female). The primary outcome occurred in 190 of 567 patients (33.5%) assigned to individualized blood pressure management and 173 of 567 patients (30.5%) assigned to routine blood pressure management (relative risk, 1.10 [95% CI, 0.93-1.30]; P = .31). None of the 22 secondary outcomes were significantly different, including infectious complications within the first 7 postoperative days (90/567 [15.9%] vs 97/567 [17.1%]; P = .63) and a composite outcome of need for kidney replacement therapy, myocardial infarction, nonfatal cardiac arrest, or death within 90 days after surgery (32/566 [5.7%] vs 20/567 [3.5%]; P = .12).Conclusions and RelevanceAmong patients at high risk of postoperative complications undergoing major abdominal surgery, individualized perioperative blood pressure management with MAP targets based on preoperative mean nighttime MAP did not decrease the composite outcome of acute kidney injury, acute myocardial injury, nonfatal cardiac arrest, or death within the first 7 postoperative days compared with routine blood pressure management with a MAP target of 65 mm Hg or higher.Trial RegistrationClinicalTrials.gov Identifier: NCT05416944.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proactive vs Reactive Treatment of Hypotension During Surgery: The PRETREAT Randomized Clinical Trial.","authors":"Matthijs Kant,Wilton A van Klei,Markus W Hollmann,Eline S de Klerk,Luuk C Otterspoor,Marc G Besselink,Teus H Kappen,Denise P Veelo, ","doi":"10.1001/jama.2025.18007","DOIUrl":"https://doi.org/10.1001/jama.2025.18007","url":null,"abstract":"ImportanceIntraoperative hypotension is associated with adverse postoperative outcomes, but whether a proactive strategy to prevent intraoperative hypotension improves outcomes is uncertain.ObjectiveTo determine whether intraoperative blood pressure management stratified by risk of hypotension reduces postoperative functional disability compared with usual care in adults undergoing noncardiac surgery.Design, Setting, and ParticipantsIn this randomized clinical trial, adults undergoing elective noncardiac surgery at 2 tertiary hospitals in the Netherlands were enrolled from June 17, 2021, to February 7, 2024. The date of last follow-up was October 24, 2024.InterventionPatients were randomized 1:1 to proactive blood pressure management with mean arterial pressure targets based on risk of intraoperative hypotension (low risk, ≥70 mm Hg; intermediate risk, ≥80; high risk, ≥90) or usual management at their anesthesiologist's discretion, generally aiming to avoid a mean arterial pressure of less than 65 mm Hg without higher predefined targets.Main Outcomes and MeasuresThe primary outcome was functional disability at 6 months, assessed with the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0; scale range, 0-100; higher scores indicate more disability). A minimally clinically important difference of 5 points was prespecified. There were 23 secondary outcomes, including quality of life, complications, and mortality within 6 months.ResultsThe trial was stopped early for futility after 3247 of 5000 planned patients (median age, 59 years [IQR, 44-69]; 1738 female [53.5%]) were enrolled. A total of 677 patients (21%) were low risk; 1814 (56%), intermediate risk, and 756 (23%), high risk. Baseline median WHODAS scores were 12.5 [IQR, 4.2-29.2] in proactive group and 14.6 [IQR, 4.2-29.2] in standard group). At 6 months, mean (SD) WHODAS scores were 17.7 (20.1) in the proactive group and 18.2 (20.5) in the standard group (mean difference, -0.5; 95% credible interval, -1.9 to 0.9). There were no significant differences in any of the 23 secondary outcomes.Conclusions and RelevanceIntraoperative blood pressure management with mean arterial pressure goals stratified by risk of hypotension did not improve functional disability at 6 months postoperatively compared with standard intraoperative blood pressure management.Trial RegistrationOverview of Medical Research in the Netherlands (CCMO): NL-OMON55117.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"208 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Outcomes-The Limits of Blood Pressure-Centered Strategies.","authors":"Matthieu Legrand,François Lamontagne,Romain Pirracchio","doi":"10.1001/jama.2025.18572","DOIUrl":"https://doi.org/10.1001/jama.2025.18572","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"154 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FDA Approves Injectable Keytruda for Nearly 20 Cancers.","authors":"Shravya Pant","doi":"10.1001/jama.2025.17492","DOIUrl":"https://doi.org/10.1001/jama.2025.17492","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"102 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"As Measles Cases Climb in the Americas, Vaccination Urged.","authors":"Samantha Anderer","doi":"10.1001/jama.2025.17493","DOIUrl":"https://doi.org/10.1001/jama.2025.17493","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sugary Drinks May Influence Depression Through Gut Microbiome.","authors":"Samantha Anderer","doi":"10.1001/jama.2025.17494","DOIUrl":"https://doi.org/10.1001/jama.2025.17494","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}