JAMA最新文献

{"title":"The Rise of Health Care Platforms","authors":"Jonathan Kanter, Martin Gaynor","doi":"10.1001/jama.2025.3641","DOIUrl":"https://doi.org/10.1001/jama.2025.3641","url":null,"abstract":"This Viewpoint discusses how a small number of health care conglomerate platforms exhibit the same characteristics as big tech companies, which may require antitrust regulation and action.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"8 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805957","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":"Concordance of 30-Day Mortality and In-Hospital Mortality or Hospice Discharge After Sepsis","authors":"Hallie C. Prescott, Megan Heath, Namita Jayaprakash, Raymund B. Dantes, Chanu Rhee, Patricia J. Posa, Scott A. Flanders","doi":"10.1001/jama.2025.2526","DOIUrl":"https://doi.org/10.1001/jama.2025.2526","url":null,"abstract":"This study uses a multihospital cohort to evaluate 2 candidate outcome measures being considered for benchmarking by the CDC and CMS for community-onset sepsis hospitalizations: 30-day mortality after admission and composite in-hospital mortality or hospice discharge.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805956","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":"Addressing Health Literacy","authors":"Michael K. Paasche-Orlow, Michael S. Wolf","doi":"10.1001/jama.2025.2198","DOIUrl":"https://doi.org/10.1001/jama.2025.2198","url":null,"abstract":"This JAMA Insights discusses personal and organizational health literacy and offers recommendations on how clinicians and health care institutions can improve their patients’ health literacy skills.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"93 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143806008","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":"Testing the Boundaries of Presidential Powers in Health","authors":"Lawrence O. Gostin, Stephen Vladeck, Lauren E. Bateman","doi":"10.1001/jama.2025.5122","DOIUrl":"https://doi.org/10.1001/jama.2025.5122","url":null,"abstract":"This Viewpoint discusses the unprecedented assertion of presidential control over federal spending, including withholding of disbursements of appropriated funds for public health and foreign aid.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790150","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":"Management of Staphylococcus aureus Bacteremia","authors":"Steven Y. C. Tong, Vance G. Fowler, Lesley Skalla, Thomas L. Holland","doi":"10.1001/jama.2025.4288","DOIUrl":"https://doi.org/10.1001/jama.2025.4288","url":null,"abstract":"Importance<jats:italic>Staphylococcus aureus</jats:italic>, a gram-positive bacterium, is the leading cause of death from bacteremia worldwide, with a case fatality rate of 15% to 30% and an estimated 300 000 deaths per year.Observations<jats:italic>Staphylococcus aureus</jats:italic> bacteremia causes metastatic infection in more than one-third of cases, including endocarditis (≈12%), septic arthritis (7%), vertebral osteomyelitis (≈4%), spinal epidural abscess, psoas abscess, splenic abscess, septic pulmonary emboli, and seeding of implantable medical devices. Patients with <jats:italic>S aureus</jats:italic> bacteremia commonly present with fever or symptoms from metastatic infection, such as pain in the back, joints, abdomen or extremities, and/or change in mental status. Risk factors include intravascular devices such as implantable cardiac devices and dialysis vascular catheters, recent surgical procedures, injection drug use, diabetes, and previous <jats:italic>S aureus</jats:italic> infection. <jats:italic>Staphylococcus aureus</jats:italic> bacteremia is detected with blood cultures. Prolonged <jats:italic>S aureus</jats:italic> bacteremia (≥48 hours) is associated with a 90-day mortality risk of 39%. All patients with <jats:italic>S aureus</jats:italic> bacteremia should undergo transthoracic echocardiography; transesophageal echocardiography should be performed in patients at high risk for endocarditis, such as those with persistent bacteremia, persistent fever, metastatic infection foci, or implantable cardiac devices. Other imaging modalities, such as computed tomography or magnetic resonance imaging, should be performed based on symptoms and localizing signs of metastatic infection. <jats:italic>Staphylococcus aureus</jats:italic> is categorized as methicillin-susceptible (MSSA) or methicillin-resistant (MRSA) based on susceptibility to β-lactam antibiotics. Initial treatment for <jats:italic>S aureus</jats:italic> bacteremia typically includes antibiotics active against MRSA such as vancomycin or daptomycin. Once antibiotic susceptibility results are available, antibiotics should be adjusted. Cefazolin or antistaphylococcal penicillins should be used for MSSA and vancomycin, daptomycin, or ceftobiprole for MRSA. Phase 3 trials for <jats:italic>S aureus</jats:italic> bacteremia demonstrated noninferiority of daptomycin to standard of care (treatment success, 53/120 [44%] vs 48/115 [42%]) and noninferiority of ceftobiprole to daptomycin (treatment success, 132/189 [70%] vs 136/198 [69%]). Source control is a critical component of treating <jats:italic>S aureus</jats:italic> bacteremia and may include removal of infected intravascular or implanted devices, drainage of abscesses, and surgical debridement.Conclusions and relevance<jats:italic>Staphylococcus aureus</jats:italic> bacteremia has a case fatality rate of 15% to 30% and causes 300 000 deaths per year worldwide. Empirical antibiotic treatment should include vancomycin or dapto","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797605","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":"Invasive Group A Streptococcal Infections in 10 US States","authors":"Christopher J. Gregory, Jennifer Onukwube Okaro, Arthur Reingold, Shua Chai, Rachel Herlihy, Susan Petit, Monica M. Farley, Lee H. Harrison, Kathy Como-Sabetti, Ruth Lynfield, Paula Snippes Vagnone, Daniel Sosin, Bridget J. Anderson, Kari Burzlaff, Tasha Martin, Ann Thomas, William Schaffner, H. Keipp Talbot, Bernard Beall, Sopio Chochua, Yunmi Chung, Soyoun Park, Chris Van Beneden, Yuan Li, Stephanie J. Schrag","doi":"10.1001/jama.2025.0910","DOIUrl":"https://doi.org/10.1001/jama.2025.0910","url":null,"abstract":"ImportanceInvasive group A <jats:italic>Streptococcus</jats:italic> (GAS) infections are associated with substantial morbidity, mortality, and economic burden.ObjectiveTo update trends in invasive GAS disease incidence rates in 10 US states between 2013 and 2022.Design, Setting, and ParticipantsClinical, demographic, and laboratory data for invasive GAS cases were collected as part of population-based surveillance in the Active Bacterial Core surveillance network covering 34.9 million persons across 10 US states. A case was defined as isolation of GAS from a normally sterile site or from a wound in a patient with necrotizing fasciitis or streptococcal toxic shock syndrome between January 1, 2013, and December 31, 2022. Demographic and clinical data were collected from medical record review. From 2013 to 2014, available isolates were <jats:italic>emm</jats:italic> typed and antimicrobial susceptibilities determined using conventional methods; from 2015 onward, whole-genome sequencing was used.Main Outcomes and MeasuresIncidence rates by sex, age, race, and selected risk factors; clinical syndromes, outcomes, and underlying patient conditions; and isolate characteristics, including antimicrobial susceptibility.ResultsSurveillance in 10 US states identified 21 312 cases of invasive GAS from 2013 through 2022, including 1981 deaths. The majority of cases (57.5%) were in males. Among case-patients, 1272 (6.0%) were aged 0 to 17 years, 13 565 (63.7%) were aged 18 to 64 years, and 6474 (30.4%) were 65 years or older; 5.5% were American Indian or Alaska Native, 14.3% were Black, and 67.1% were White. Incidence rose from 3.6 per 100 000 persons in 2013 to 8.2 per 100 000 persons in 2022 (<jats:italic>P</jats:italic> &amp;amp;lt; .001 for trend). Incidence was highest among persons 65 years or older; however, the relative increase over time was greatest among adults aged 18 to 64 years (3.2 to 8.7 per 100 000 persons). Incidence was higher among American Indian or Alaska Native persons than in other racial and ethnic groups. People experiencing homelessness, people who inject drugs, and residents of long-term care facilities had substantially elevated GAS incidence rates. Among tested isolates, those nonsusceptible to macrolides and clindamycin increased from 12.7% in 2013 to 33.1% in 2022.ConclusionsInvasive GAS infections increased substantially in 10 US states during a surveillance period from 2013 to 2022. Accelerated efforts to prevent and control GAS are needed, especially among groups at highest risk of infection.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790139","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":"Care of Patients With Chronic Venous Disease of the Legs","authors":"Emily A. Goodman, Jason T. Alexander, Trissa A. Babrowski","doi":"10.1001/jama.2025.1704","DOIUrl":"https://doi.org/10.1001/jama.2025.1704","url":null,"abstract":"This JAMA Clinical Guidelines Synopsis summarizes the 2022-2023 recommendations on evaluation and management of chronic venous disease of the lower extremities from the Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"5 10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143758007","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":"Small Cell Lung Cancer","authors":"So Yeon Kim, Henry S. Park, Anne C. Chiang","doi":"10.1001/jama.2025.0560","DOIUrl":"https://doi.org/10.1001/jama.2025.0560","url":null,"abstract":"ImportanceSmall cell lung cancer (SCLC) is a high-grade neuroendocrine carcinoma with an incidence of 4.7 cases per 100 000 individuals in 2021 in the US and a 5-year overall survival of 12% to 30%.ObservationsCigarette smoking is the primary risk factor for development of SCLC, as 95% of patients diagnosed with SCLC have a history of tobacco use. Patients with SCLC may present with respiratory symptoms such as cough (40%), shortness of breath (34%), hemoptysis (10%), or metastases with corresponding local symptoms (30%) such as pleuritis or bone pain; approximately 60% of patients with SCLC may be asymptomatic at diagnosis. Chest imaging may demonstrate central hilar (85%) or mediastinal lymphadenopathy (75%). At diagnosis, approximately 15% of patients have brain metastases, which may present as headache or focal weakness. Diagnosis is confirmed by biopsy of a primary lung mass, thoracic lymph node, or metastatic lesion. Small cell lung cancer is classified into limited stage (LS-SCLC; 30%) vs extensive stage (ES-SCLC; 70%) based on whether the disease can be treated within a radiation field that is typically confined to 1 hemithorax but may include contralateral mediastinal and supraclavicular nodes. For patients with LS-SCLC, surgery or concurrent chemotherapy with platinum-etoposide and radiotherapy is potentially curative in 30% of patients. More recently, median survival for LS-SCLC has reached up to 55.9 months with the addition of durvalumab, an immunotherapy. First-line treatment for ES-SCLC is combined treatment with platinum-etoposide chemotherapy and immunotherapy with the programmed cell death 1 ligand 1 (PD-L1) inhibitors durvalumab or atezolizumab followed by maintenance immunotherapy until disease progression or toxicity. Although initial rates of tumor shrinkage are 60% to 70% with platinum-etoposide and immunotherapy treatment, the median overall survival of patients treated for ES-SCLC is approximately 12 to 13 months, with 60% of patients relapsing within 3 months. Second-line therapy for patients with ES-SCLC includes the DNA-alkylating agent lurbinectedin (35% overall response rate; median progression-free survival, 3.7 months) and a bispecific T-cell engager against delta-like ligand 3, tarlatamab (40% overall response rate; median progression-free survival, 4.9 months).Conclusions and RelevanceSmall cell lung cancer is a smoking-related malignancy that presents at an advanced stage in 70% of patients. Three-year overall survival is approximately 56.5% for LS-SCLC and 17.6% for ES-SCLC. First-line treatment for LS-SCLC is radiation targeting the tumor given concurrently with chemotherapy and followed by consolidation immunotherapy. For ES-SCLC, first-line treatment is chemotherapy and immunotherapy followed by maintenance immunotherapy.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736955","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":"Trade Tariffs on Canadian Pharmaceuticals—Implications for US Drug Supply and Costs","authors":"Mina Tadrous, Shanzeh Chaudhry, Jan Panhuysen, Ioannis Konstantinidis, Katie J. Suda","doi":"10.1001/jama.2025.4583","DOIUrl":"https://doi.org/10.1001/jama.2025.4583","url":null,"abstract":"This cross-sectional study analyzes data from the National Institutes of Health, IQVIA, and the US Food and Drug Administration on pharmaceutical drugs manufactured in Canada and exported to the US.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736956","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":"Intravenous Ferric Carboxymaltose in Heart Failure With Iron Deficiency","authors":"Stefan D. Anker, Tim Friede, Javed Butler, Khawaja M. Talha, Marius Placzek, Monika Diek, Anna Nosko, Adriane Stas, Stefan Kluge, Dominik Jarczak, Geraldine deHeer, Meike Rybczynski, Antoni Bayés-Genís, Michael Böhm, Andrew J. S. Coats, Frank Edelmann, Gerasimos Filippatos, Gerd Hasenfuß, Wilhelm Haverkamp, Mitja Lainscak, Ulf Landmesser, Iain C. Macdougall, Bela Merkely, Burkert M. Pieske, Fausto J. Pinto, Tienush Rassaf, Jennifer K. Visser-Rogers, Giuseppe Rosano, Maurizio Volterrani, Stephan von Haehling, Markus S. Anker, Wolfram Doehner, Hüseyin Ince, Friedrich Koehler, Gianluigi Savarese, Muhammad Shahzeb Khan, Ursula Rauch-Kröhnert, Tommaso Gori, Teresa Trenkwalder, Ibrahim Akin, Christina Paitazoglou, Iwona Kobielusz-Gembala, Luca Kuthi, Norbert Frey, Manuela Licka, Stefan Kääb, Karl-Ludwig Laugwitz, Piotr Ponikowski, Mahir Karakas","doi":"10.1001/jama.2025.3833","DOIUrl":"https://doi.org/10.1001/jama.2025.3833","url":null,"abstract":"ImportanceUncertainty remains about the efficacy of intravenous iron in patients with heart failure and iron deficiency.ObjectiveTo assess the efficacy and safety of ferric carboxymaltose in patients with heart failure and iron deficiency.Design, Setting, and ParticipantsThis multicenter, randomized clinical trial enrolled 1105 patients with heart failure (defined as having a left ventricular ejection fraction of ≤45%) and iron deficiency (serum ferritin level &amp;amp;lt;100 ng/mL; or if transferrin saturation was &amp;amp;lt;20%, a serum ferritin level between 100 ng/mL and 299 ng/mL) at 70 clinic sites in 6 European countries from March 2017 to November 2023. The median follow-up was 16.6 months (IQR, 7.9-29.9 months).InterventionAdministration of ferric carboxymaltose (n = 558) initially given at an intravenous dose of up to 2000 mg that was followed by 500 mg every 4 months (unless stopping criteria were met) vs a saline placebo (n = 547).Main Outcomes and MeasuresThe primary end point events were (1) time to cardiovascular death or first heart failure hospitalization, (2) total heart failure hospitalizations, and (3) time to cardiovascular death or first heart failure hospitalization in patients with a transferrin saturation less than 20%. All end point events were measured through follow-up. The end points would be considered statistically significant if they fulfilled at least 1 of the following conditions: (1) &lt;jats:italic&gt;P&lt;/jats:italic&gt; ≤ .05 for all 3 of the end point comparisons, (2) &lt;jats:italic&gt;P&lt;/jats:italic&gt; ≤ .025 for 2 of the end point comparisons, or (3) &lt;jats:italic&gt;P&lt;/jats:italic&gt; ≤ .0167 for any of the 3 end point comparisons (Hochberg procedure).ResultsOf the 1105 participants (mean age, 70 years [SD, 12 years]; 33% were women), cardiovascular death or first heart failure hospitalization (first primary outcome) occurred in 141 in the ferric carboxymaltose group vs 166 in the placebo group (hazard ratio, 0.79 [95% CI, 0.63-0.99]; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .04). The second primary outcome (total heart failure hospitalizations) occurred 264 times in the ferric carboxymaltose group vs 320 times in the placebo group (rate ratio, 0.80 [95% CI, 0.60-1.06]; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .12). The third primary outcome (cardiovascular death or first heart failure hospitalization in patients with a transferrin saturation &amp;amp;lt;20%) occurred in 103 patients in the ferric carboxymaltose group vs 128 patients in the placebo group (hazard ratio, 0.79 [95% CI, 0.61-1.02], &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .07). A similar amount of patients had at least 1 serious adverse event in the ferric carboxymaltose group (269; 48.2%) vs in the placebo group (273; 49.9%) (&lt;jats:italic&gt;P&lt;/jats:italic&gt; = .61).Conclusions and RelevanceIn patients with heart failure and iron deficiency, ferric carboxymaltose did not significantly reduce the time to first heart failure hospitalization or cardiovascular death in the overall cohort or in patients ","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736491","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}