JAMA最新文献

{"title":"Sibling Comparisons to Account for Confounding.","authors":"Yulin Hswen","doi":"10.1001/jama.2026.2876","DOIUrl":"https://doi.org/10.1001/jama.2026.2876","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754936","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":"The Veteran Affairs' Whole Health Approach for Chronic Pain Management: Research Summary.","authors":"","doi":"10.1001/jama.2026.5038","DOIUrl":"https://doi.org/10.1001/jama.2026.5038","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"122 1","pages":"e265038"},"PeriodicalIF":0.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754935","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":"Pigmentary Changes That Developed During Pregnancy.","authors":"Grace Rabinowitz,Arianna Strome,Avrom S Caplan","doi":"10.1001/jama.2026.2928","DOIUrl":"https://doi.org/10.1001/jama.2026.2928","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754938","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":"The Veteran Affairs' Whole Health Approach for Chronic Pain Management: The wHOPE Randomized Clinical Trial.","authors":"Karen H Seal,Benjamin J Morasco,Aaron M Martin,Kavitha P Reddy,Theresa M Van Iseghem,Rendelle E Bolton,Barbara G Bokhour,Jennifer Murphy,Lauren M Denneson,Denise Esserman,Eugenia Buta,Natalie Purcell,Daniel Bertenthal,Jacob T Painter,Linda R Abadjian,Liliana C Moore,Allan C Chan,Nicole McCamish,Shira Maguen,Thomas C Neylan,Carolyn J Gibson,William C Becker, ","doi":"10.1001/jama.2026.5006","DOIUrl":"https://doi.org/10.1001/jama.2026.5006","url":null,"abstract":"ImportanceThe US Department of Veterans Affairs (VA) Whole Health approach was congressionally mandated in 2016 for patients with chronic pain receiving care in VA hospitals, but no randomized clinical trials have tested its benefits.ObjectiveTo evaluate the effectiveness of a whole health team intervention in VA patients with chronic pain compared with cognitive behavioral therapy and with usual care, and to evaluate the effectiveness of cognitive behavioral therapy compared with usual care in reducing long-term pain interference.Design, Setting, and ParticipantsThis randomized clinical trial involving 6 VA health systems in the US enrolled participants between September 18, 2020, and January 19, 2024. Final follow-up occurred on January 27, 2025. Analyses took place between April 1, 2025, and February 3, 2026. Participants were patients with chronic pain receiving VA primary care.InterventionsPatients with chronic pain were randomized (11:11:2) to receive a whole health team intervention (n = 343), cognitive behavioral therapy for chronic pain delivered in group sessions (n = 339), or usual care (n = 82) for 12 months. The whole health team included a primary physician or nurse practitioner, a second clinician providing nonpharmacological or integrative pain care, and a coach. The team provided interdisciplinary, individualized care consistent with the VA Whole Health model to attain personal health goals aligned with patients' personal values and life goals.Main Outcomes and MeasuresThe primary outcome was the Brief Pain Inventory interference (BPI-I) subscale score (range, 0-10 points; higher scores indicate worse interference from pain; minimal clinically important difference, 1.0) at 12 months.ResultsOf 764 randomized patients (mean [SD] age, 60.5 [12.3] years; 66.5% were men), 632 (82.7%) completed 12-month follow-up. At 12 months, the whole health group had significantly improved pain interference scores (from 6.6 to 4.9) compared with the cognitive behavioral therapy (from 6.4 to 5.5) (mean difference, -0.58 [97% CI, -1.11 to -0.05]; P = .02) and usual care (from 6.4 to 5.7) (mean difference, -0.77 [99% CI, -1.40 to -0.15]; P = .002) groups. At 12 months, cognitive behavioral therapy did not improve pain interference scores significantly more than usual care (mean difference, -0.19 [99% CI, -0.89 to 0.50]; P = .46). The most common adverse event was suicidal ideation, which occurred in 15.9% of patients in the cognitive behavioral therapy group, 13.7% in the whole health team group, and 13.4% in the usual care group.Conclusions and RelevanceThese results support use of the whole health team approach to attain a statistically significant but small improvement in pain interference in VA patients with chronic pain.Trial RegistrationClinicalTrials.gov Identifier: NCT04330365.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754940","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":"Sibling Comparisons to Account for Confounding-Reply.","authors":"Viktor H Ahlqvist,Brian K Lee,Yu-Han Chiu","doi":"10.1001/jama.2026.2879","DOIUrl":"https://doi.org/10.1001/jama.2026.2879","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754937","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":"A Licensure Framework for Autonomous Clinical AI.","authors":"Alon Bergman,Robert M Wachter,Ezekiel J Emanuel","doi":"10.1001/jama.2026.5483","DOIUrl":"https://doi.org/10.1001/jama.2026.5483","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754941","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":"Artificial Intelligence Is Not the End of the Physician.","authors":"Canio Martinelli,Vincenzo Carnevale,Alfredo Ercoli,Antonio Giordano","doi":"10.1001/jama.2026.4356","DOIUrl":"https://doi.org/10.1001/jama.2026.4356","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754939","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":"Six-Month Outcomes of a Trial of Potassium Supplementation Thresholds After Cardiac Surgery.","authors":"Niall G Campbell,Elizabeth Allen,Zahra Jamal,Richard Evans,Charles Opondo,Julie Sanders,Joanna Sturgess,Hugh E Montgomery,Diana Elbourne,Ben O'Brien, ","doi":"10.1001/jama.2026.5357","DOIUrl":"https://doi.org/10.1001/jama.2026.5357","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751296","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":"Lay Health Worker-Led Symptom Intervention for Older Adults With Cancer.","authors":"Gonglin Tang,Xin Chen,Hongwei Zhao","doi":"10.1001/jama.2026.2851","DOIUrl":"https://doi.org/10.1001/jama.2026.2851","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"150 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751299","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":"Cardiac Resynchronization Therapy","authors":"Caique M. Ternes, Jitae A. Kim, Anirban Basu, Kenneth A. Ellenbogen, Mihail G. Chelu","doi":"10.1001/jama.2026.4893","DOIUrl":"https://doi.org/10.1001/jama.2026.4893","url":null,"abstract":"Importance Heart failure (HF) affects more than 64 million individuals worldwide, and acute HF is associated with 1-year mortality rates of 23.6% in North America and Europe. Cardiac dyssynchrony from conduction system disease may cause HF progression, particularly in patients with left ventricular (LV) systolic dysfunction. Observations Electrical dyssynchrony in HF most commonly presents as left bundle-branch block and affects 20% to 30% of patients with reduced LV ejection fraction (LVEF). Cardiac resynchronization therapy, which includes biventricular pacing and conduction system pacing, restores synchronous ventricular contraction and is recommended for patients with symptomatic HF despite optimal medical therapy, LVEF of 35% or less, and left bundle-branch block. Delayed referral for device therapy in this population is associated with worse clinical outcomes. Resynchronization should also be considered for patients requiring chronic ventricular pacing, typically due to symptomatic bradycardia because right ventricular pacing for atrioventricular block may result in ventricular dyssynchrony and increased risk of LV systolic dysfunction. Biventricular pacing uses 2 leads to stimulate the right ventricle and LV simultaneously; conduction system pacing uses a single lead to stimulate the His bundle or left bundle branch. An individual patient–level meta-analysis of 5 randomized clinical trials (N = 3872) reported biventricular pacing was associated with lower all-cause mortality compared with medical therapy or implantable cardioverter-defibrillator over a median follow-up of 23.7 months (13.7% vs 20.8%; hazard ratio, 0.66 [95% CI, 0.57-0.77]). A meta-analysis of 7 small randomized clinical trials, including 408 patients with HF and LVEF of 40% or less, reported that compared with biventricular pacing, conduction system pacing was associated with improvement in LVEF (mean difference, 2.06%; <jats:italic toggle=\"yes\">P</jats:italic> = .03). An observational study of 1778 patients with LVEF of 35% or less undergoing cardiac resynchronization therapy reported conduction system pacing was associated with lower rates of HF hospitalization (12% vs 19%; hazard ratio, 0.67 [95% CI, 0.52-0.86]). A trial of 249 patients without HF undergoing permanent pacing for atrioventricular block–related bradycardia reported lower rates of pacing-induced cardiomyopathy, defined as a decrease in LVEF of at least 10% to less than 50% after conduction system pacing vs right ventricular pacing (6% vs 15%; <jats:italic toggle=\"yes\">P</jats:italic> = .01). Conclusions and Relevance Cardiac dyssynchrony due to conduction system disease occurs in 20% to 30% of patients with HF and systolic dysfunction. Cardiac resynchronization therapy restores synchronous ventricular activation in patients with HF, reduced LVEF, and left bundle-branch block, or in those requiring chronic ventricular pacing, and may improve LV function, decrease HF hospitalizations, and reduce mortality.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751763","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}