JAMA最新文献

{"title":"AI Can’t Worry About Patients, and a Clinical Ethicist Says That Matters","authors":"Yulin Hswen, Jennifer Abbasi","doi":"10.1001/jama.2024.23525","DOIUrl":"https://doi.org/10.1001/jama.2024.23525","url":null,"abstract":"This Medical News article is an interview with Sarah C. Hull, MD, MBE, a cardiologist and clinical ethicist at Yale School of Medicine, about appropriate boundaries for use of artificial intelligence in clinical settings.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637214","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":"Election Night","authors":"Andrew F. Beck","doi":"10.1001/jama.2024.25200","DOIUrl":"https://doi.org/10.1001/jama.2024.25200","url":null,"abstract":"While watching the 2024 election night results and considering possible health care policies, a pediatrician reflects on his role in engaging in conversations about politics and policy as an advocate for patients.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637197","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 Burden of Choice","authors":"Jessica Chen","doi":"10.1001/jama.2024.21969","DOIUrl":"https://doi.org/10.1001/jama.2024.21969","url":null,"abstract":"In this narrative medicine essay, a family planning fellow discusses how undergoing an abortion, the procedure she specializes in performing, has deepened her perception of the concept of the difficult components of choice and helped her understand the difference in providing vs experiencing care.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610462","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 Carceral-Community Cascade and HCV Elimination","authors":"Matthew J. Akiyama, Tessa Bialek, Raphael Simonson","doi":"10.1001/jama.2024.20602","DOIUrl":"https://doi.org/10.1001/jama.2024.20602","url":null,"abstract":"This Viewpoint discusses a sector-wide approach to hepatitis C virus elimination, including not only jails and prisons, but also community supervision and alternatives to incarceration programs.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610056","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":"Artemisinin Partial Resistance in Ugandan Children With Complicated Malaria","authors":"Ryan C. Henrici, Ruth Namazzi, Giselle Lima-Cooper, Charles Kato, Sadati Aliwuya, Jamille G. Dombrowski, Sade Pratt, Susana Campino, Andrea L. Conroy, Colin J. Sutherland, Chandy C. John, Robert O. Opoka","doi":"10.1001/jama.2024.22343","DOIUrl":"https://doi.org/10.1001/jama.2024.22343","url":null,"abstract":"This study assesses artemisinin partial resistance, <jats:italic>Pfkelch13</jats:italic> variations, and malaria recrudescence in Ugandan children with complicated malaria.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610470","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":"Trends in Hospitalizations and Liver Transplants Associated With Alcohol-Induced Liver Disease","authors":"Vrishketan Sethi, Ramon Bataller, Hao Liu, Kristine M. Ruppert, Michele Molinari","doi":"10.1001/jama.2024.21503","DOIUrl":"https://doi.org/10.1001/jama.2024.21503","url":null,"abstract":"This study investigates trends in hospitalization and liver transplant rates in the US from 2005 to 2021 associated with alcohol-induced liver disease.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610464","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":"Tenofovir and Hepatitis B Virus Transmission During Pregnancy","authors":"Calvin Q. Pan, Erhei Dai, Zhongfu Mo, Hua Zhang, Thomas Q. Zheng, Yuming Wang, Yingxia Liu, Tianyan Chen, Suwen Li, Cuili Yang, Jinjuan Wu, Xiuli Chen, Huaibin Zou, Shanshan Mei, Lin Zhu","doi":"10.1001/jama.2024.22952","DOIUrl":"https://doi.org/10.1001/jama.2024.22952","url":null,"abstract":"ImportanceStandard care for preventing mother-to-child transmission (MTCT) of hepatitis B virus (HBV) in highly viremic mothers consists of maternal antiviral prophylaxis beginning at gestational week 28 combined with an HBV vaccine series and HBV immune globulin (HBIG) at birth. However, HBIG is unavailable in some resource-limited areas.ObjectiveTo determine whether initiating tenofovir disoproxil fumarate (TDF) at gestational week 16 combined with HBV vaccinations for infants is noninferior to the standard care of TDF at gestational week 28 combined with HBV vaccinations and HBIG for infants in preventing MTCT in mothers with HBV and high levels of viremia.Design, Setting, and ParticipantsAn unblinded, 2-group, randomized, noninferiority clinical trial was conducted in 7 tertiary care hospitals in China. A total of 280 pregnant individuals (who all identified as women) with HBV DNA levels greater than 200 000 IU/mL were enrolled between June 4, 2018, and February 8, 2021. The final follow-up occurred on March 1, 2022.InterventionsPregnant individuals were randomly assigned to receive either TDF starting at gestational week 16 with HBV vaccinations for the infant or TDF starting at gestational week 28 with HBV vaccinations and HBIG administered to the infant.Main Outcomes and MeasuresThe primary outcome was the MTCT rate, defined as detectable HBV DNA greater than 20 IU/mL or hepatitis B surface antigen positivity in infants at age 28 weeks. Noninferiority was established if the MTCT rate in the experimental group did not increase by more than an absolute difference of 3% compared with the standard care group, as measured by the upper limit of the 2-sided 90% CI.ResultsAmong 280 pregnant individuals who enrolled in the trial (mean age, 28 years; mean gestational age at enrollment, 16 weeks), 265 (95%) completed the study. Among all live-born infants, using the last observation carried forward, the MTCT rate was 0.76% (1/131) in the experimental group and 0% (0/142) in the standard care group. In the per-protocol analysis, the MTCT rate was 0% (0/124) in the experimental group and 0% (0/141) in the standard care group. The between-group difference was 0.76% (upper limit of the 2-sided 90% CI, 1.74%) in all live-born infants and 0% (upper limit of the 2-sided 90% CI, 1.43%) in the per-protocol analysis. Both comparisons met the criterion for noninferiority. Rates of congenital defects and malformations were 2.3% (3/131) in the experimental group and 6.3% (9/142) in the standard care group (difference, 4% [2-sided 95% CI, −8.8% to 0.7%]).Conclusions and RelevanceAmong pregnant women with HBV and high levels of viremia, TDF beginning at gestational week 16 combined with HBV vaccination for infants was noninferior to the standard care of TDF beginning at gestational week 28 combined with HBIG and HBV vaccination for infants. These results support beginning TDF at gestational week 16 combined with infant HBV vaccine to prevent MTCT of HBV in geograph","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610465","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":"Discontinuation of Glucagon-Like Peptide-1 Receptor Agonists","authors":"Sadiya S. Khan, Chiadi E. Ndumele, Dhruv S. Kazi","doi":"10.1001/jama.2024.22284","DOIUrl":"https://doi.org/10.1001/jama.2024.22284","url":null,"abstract":"This Viewpoint discusses the health benefits of glucagon-like peptide-1 receptor agonists (GLP-1 RAs); summarizes the clinical, policy, and equity implications of GLP-1 RA discontinuation; and calls for the identification and implementation of strategies to improve long-term adherence to GLP-1 RA therapy.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"24 17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610059","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":"Representativeness of Studies Required Under Medicare’s Coverage With Evidence Development Program","authors":"Maryam Mooghali, Sanket S. Dhruva, Joseph S. Ross, Reshma Ramachandran","doi":"10.1001/jama.2024.20493","DOIUrl":"https://doi.org/10.1001/jama.2024.20493","url":null,"abstract":"This study evaluates representation of older adults, women, and people of Black race and Hispanic ethnicity in Centers for Medicare &amp;amp;amp; Medicaid Services national coverage determination (NCD) and coverage with evidence development (CED)–approved studies.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610057","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":"Symptom Screening Linked to Care Pathways for Pediatric Patients With Cancer","authors":"L. Lee Dupuis, Emily Vettese, Allison C. Grimes, Melissa P. Beauchemin, Lisa M. Klesges, Christina Baggott, Jenna Demedis, Catherine Aftandilian, David R. Freyer, Nicole Crellin-Parsons, Etan Orgel, David Dickens, Kara M. Kelly, Wade Kyono, Alexandra Walsh, Farha Sherani, Daniel Cannone, Andrea D. Orsey, Allison A. King, Lolie Yu, Wendy Woods-Swafford, Scott M. Bradfield, Michael E. Roth, Adam J. Esbenshade, Emi H. Caywood, Vibhuti Agarwal, Ramamoorthy Nagasubramanian, George A. Tomlinson, Lillian Sung","doi":"10.1001/jama.2024.19585","DOIUrl":"https://doi.org/10.1001/jama.2024.19585","url":null,"abstract":"ImportancePediatric patients with cancer commonly experience severely bothersome symptoms. The effectiveness of routine symptom screening with symptom feedback and symptom management care pathways is unknown.ObjectiveTo determine whether thrice-weekly symptom screening with symptom feedback and management care pathways, compared with usual care, improves overall self-reported symptom scores measured by the Symptom Screening in Pediatrics Tool (SSPedi) in pediatric patients with cancer.Design, Setting, and ParticipantsThis cluster randomized trial enrolled participants between July 2021 and August 2023 from 20 pediatric cancer centers in the US. Patients newly diagnosed with cancer aged 8 to 18 years receiving any cancer treatment were included. Twenty sites were randomized to provide symptom screening (n = 10) vs usual care (n = 10); 221 participants were enrolled at intervention sites and 224 participants at control sites. The date of final follow-up was October 18, 2023.InterventionSymptom screening included providing thrice-weekly symptom screening prompts to participants, email alerts to the health care team, and locally adapted symptom management care pathway implementation.Main Outcomes and MeasuresThe primary outcome was self-reported total SSPedi score at week 8 (range, 0-60; higher scores indicate more bothersome). Secondary outcomes were Patient-Reported Outcomes Measurement Information System Fatigue score (mean [SD] score, 50 [10]; higher scores indicate more fatigue), Pediatric Quality of Life 3.0 Acute Cancer Module scores (range, 0-100; higher scores indicate better health), symptom documentation and interventions at week 8, and unplanned health care encounters.ResultsA total of 445 participants (median [range] age, 14.8 [8.1-18.9] years; 58.9% males) were enrolled. The mean (SD) 8-week SSPedi score was 7.9 (7.2) in the symptom screening group vs 11.4 (8.7) in the usual care group. Symptom screening was associated with significantly better 8-week total SSPedi scores (adjusted mean difference, −3.8 [95% CI, −6.4 to −1.2]) and less bothersome individual symptoms, with 12 of 15 symptoms being statistically significantly reduced. There was no difference in fatigue or quality of life. The mean (SD) number of emergency department visits was 0.77 (1.12) in the symptom screening group and 0.45 (0.81) in the usual care group. There were significantly more emergency department visits in the symptom screening group (rate ratio, 1.72 [95% CI, 1.03-2.87]).ConclusionsSymptom screening with symptom feedback and symptom management care pathways was associated with improved symptom scores and increased symptom-specific interventions. Future work should integrate symptom screening into routine clinical care.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT04614662\">NCT04614662</jats:ext-link>","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610058","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}