JAMA

Distribuir contenido
Actualizado: hace 3 años 3 semanas

Drugs for Osteoarthritis

Mar, 09/02/2021 - 01:00
This Medical Letter review reproduces a Table summarizing key information about drugs for osteoarthritis published as part of a comprehensive review on the topic.

Algorithmic Stewardship in Health Care—Reply

Mar, 09/02/2021 - 01:00
In Reply Mr Li and Dr Wang highlight valuable examples of regulation from other industries, including banking and insurance. We agree that best practices from these industries provide lessons for health care and that health system–level algorithmic stewardship should complement clear guidance and oversight from those with regulatory authority.

Update on Blood Pressure Control Among US Adults With Hypertension—Reply

Mar, 09/02/2021 - 01:00
In Reply In response to our recent article about trends in BP control among US adults, Dr Kovell and colleagues emphasize the importance of hypertension control to reduce cardiovascular disease mortality in women and to prevent maternal morbidity and mortality. They note that women had a larger reduction in BP control between 2013-2014 and 2017-2018 compared with men.

Financing of US Graduate Medical Education—Reply

Mar, 09/02/2021 - 01:00
In Reply Teaching hospitals continue to expand the number of resident physicians, exceeding the number of government-funded residency spots, without additional government funding. This is a clear signal that the marginal benefit of employing a resident physician, even in the absence of government funding, clearly exceeds the cost—a narrative at odds with the public advocacy for more federal GME support. We applaud the work done by Dr Royce and others analyzing the distribution of GME funding as it pertains to higher revenue–generating specialties and primary care. It is important to note that there are no nationally coordinated GME performance metrics, and the few that exist are ad hoc and unvalidated. While it is important to collect validated measures of performance for benchmarking programs, they should not be used to justify the GME program, and Congress should use these GME funds, which amount to billions of dollars, for higher priorities.

Algorithmic Stewardship in Health Care

Mar, 09/02/2021 - 01:00
To the Editor The Viewpoint by Ms Eaneff and colleagues proposed the role of stewardship for predictive algorithms by benchmarking to best practices from other clinical areas of medicine. In our opinion, to ensure the equality and safety of predictive algorithms, the health system could also learn from the high standards in other industries in which quality control and supervision of predictive algorithms are well established.

Update on Blood Pressure Control Among US Adults With Hypertension

Mar, 09/02/2021 - 01:00
To the Editor In their recent article, Dr Muntner and colleagues demonstrated that despite the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guidelines recommending more intensive BP treatment, there was a striking decrease in BP control among US adults with hypertension from 2013-2014 to 2017-2018.

Financing of US Graduate Medical Education

Mar, 09/02/2021 - 01:00
To the Editor In their recent Viewpoint, Dr Grischkan and colleagues provided a synopsis of the forces behind the contemporary financing of US graduate medical education (GME). They claimed that training of residents by teaching hospitals is a profitable endeavor. Supporting their position, the authors observed that more than 15?000 resident positions have been created since 2003, despite no increase in federal funding for these positions. Two points deserve further consideration.

Prevalence and Outcomes of SARS-CoV-2 Infection Among Migrant Workers in Singapore

Mar, 09/02/2021 - 01:00
This study examines the prevalence and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among migrant workers in Singapore.

Income Tax Credit for Charity Practice of Physicians

Mar, 09/02/2021 - 01:00
The value of the services rendered annually by physicians of this country in the treatment of the indigent sick for which they receive no compensation has been estimated as in excess of $300,000,000. Recognition of this tremendous contribution made by physicians for the public good is reflected in a bill, H. R. 5296, introduced in the Congress January 30 by Representative Clare Boothe Luce of Connecticut. The measure provides that physicians, surgeons and dentists, commencing with the taxable year 1946, shall be allowed an additional credit as a deduction on their income tax equal in terms of percentages to that portion of their time each year which is devoted to charity, free clinic work and public research work. The Commissioner of Internal Revenue will prescribe by regulation, it is contemplated, the method of computing such time and the proof which shall be required in substantiation.

Social Isolation and Loneliness: Imperatives for Health Care in a Post-COVID World

Mar, 09/02/2021 - 01:00
The importance of social determinants of health has been gaining traction in the health care sector during the last decade. Social determinants of health have been found to be responsible for 80% to 90% of health outcomes, and an abundance of research has demonstrated that no matter the advancements in medicine and health care, the health of individuals and communities will not improve if these root-cause social factors are not addressed. The coronavirus disease 2019 (COVID-19) pandemic is highlighting one of these factors: social isolation.

Audio Highlights

Mar, 09/02/2021 - 01:00
Listen to the JAMA Editor’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA.

Bicuspid Aortic Valve—A Common Form of Structural Heart Disease

Mar, 09/02/2021 - 01:00
By the ninth week of human embryonic development, many of the unique anatomical structures of the heart have appeared, including the semilunar valves. The aortic valve is derived from an endocardial outflow tract cushion, and in most instances the valve consists of 3 nearly identical leaflets, or cusps.

Searching for the Optimal Exercise Training Regimen in Heart Failure With Preserved Ejection Fraction

Mar, 09/02/2021 - 01:00
Heart failure with preserved ejection fraction (HFpEF) is increasing in prevalence, associated with high morbidity and mortality, and continues to be refractory to available pharmacotherapies. HFpEF is a multiorgan disease with complex pathophysiology that culminates in debilitating exercise intolerance as its essential clinical manifestation. Exercise intolerance is preceded by an accelerated decline in exercise capacity, measured objectively as peak exercise oxygen consumption (peak V?o2), and manifests clinically as dyspnea, fatigue, and reduced quality of life (QoL). Accordingly, there is an increasing emphasis on developing therapeutic approaches to improve exercise capacity and QoL in patients with HFpEF.

Phone Apps and Wearable Trackers Modestly Improve Activity

Mar, 09/02/2021 - 01:00
Smartphone fitness applications and wearable activity trackers seem to have a small to moderate positive effect on physical activity, a systematic review and meta-analysis of randomized trials found. The improvements, reported in the British Journal of Sports Medicine, corresponded to an additional 1850 steps per day.

CRISPR-Based COVID-19 Smartphone Test in Development

Mar, 09/02/2021 - 01:00
A simplified point-of-care assay that turns a smartphone into a fluorescence microscope could expand coronavirus disease 2019 (COVID-19) testing capability, researchers reported in a study in Cell.

Model Predicts Emergency Department Patients’ COVID-19 Outcomes

Mar, 09/02/2021 - 01:00
A new artificial intelligence algorithm uses chest x-ray severity scores and clinical variables collected during emergency department (ED) visits to predict whether patients with coronavirus disease 2019 (COVID-19) will be intubated or will die. If further validated in larger studies with additional patient populations, the proof-of-concept model, described in Radiology: Artificial Intelligence, could be used to appropriately triage ED patients before they become seriously ill with COVID-19.

Death by Massive Hemorrhage in Robert Frost’s “Out, Out–”

Mar, 09/02/2021 - 01:00
This Arts and Medicine feature uses poet Robert Frost’s poem “Out, Out–”, about the tragic death of a boy in the premodern era from a work injury and hemorrhagic shock, to discuss the stakes of developing a more effective public health response to traumatic injury.

Helping People Who Are Homeless Stay Healthy During the Pandemic

Mar, 09/02/2021 - 01:00
This Medical News story profiles Harvard dermatologist Jennifer Tan, MD, who helps care for people experiencing homelessness.

Dorsal Foot Lesions In a Nigerian Woman With a Transfusion History

Mar, 09/02/2021 - 01:00
A 32-year-old Nigerian woman with a childhood transfusion history developed scaly plaques with cobblestone surfaces on the dorsum of the forefoot and midfoot bilaterally; serologic testing was negative for HIV and positive for hepatitis C virus. What is the diagnosis and what would you do next?

Genetic Variants of SARS-CoV-2—What Do They Mean?

Mar, 09/02/2021 - 01:00
This Viewpoint discusses emerging genetic variants of SARS-CoV-2, including new “UK” and “mink” variants and the significance of the new variants to coronavirus transmissibility, spread, virulence, and efforts to vaccinate the population against COVID-19.