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Highlights

from JAMA - 27 Jan 15



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Digital Medical Tools and Sensors

from JAMA - 27 Jan 15

In this Viewpoint, Eric Topol and colleagues discuss the effect that mobile devices as biomedical sensors could have on health care.



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Sharing and Reporting the Results of Clinical Trials

from JAMA - 27 Jan 15

This Viewpoint advocates initiating greater transparency in reporting results of clinical trials as a responsibility that will benefit the health of many.



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Focusing to Achieve a World Without AIDS

from JAMA - 27 Jan 15

This Viewpoint discusses essential steps to attaining a world without AIDS.



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Maximizing Antiretroviral Therapy in Developing Countries The Dual Challenge of Efficiency and Quality

from JAMA - 27 Jan 15

This Viewpoint discusses the need for improvement in both efficiency and quality of antiretroviral therapy programs in developing countries.



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What I Learned About Adverse Events From Captain Sully It’s Not What You Think

from JAMA - 27 Jan 15

This is not a piece about how medicine should take a cue from aviation and incorporate simulations into training. It is not about how medicine should learn from aviation and develop emergency checklists and algorithms. It is not about how medicine should learn from aviation and promote blame-free error reporting. No, it is not even about how medicine should learn from aviation and incorporate briefings, debriefings, and safety language models. Medicine safety culture is experiencing a bit of “av



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Protocolized Sedation in Critically Ill Children

from JAMA - 27 Jan 15

Light sedation or no sedation has become the therapeutic goal in critically ill adults. Large randomized trials and systematic reviews have demonstrated that this goal is feasible, safe, and beneficial. The benefits include shorter durations of mechanical ventilation and stay in the intensive care unit (ICU). However, prospective data supporting the benefits of minimizing sedation in children are lacking, with only 1 randomized trial of 102 children showing shorter durations of mechanical ventil



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Daily Chlorhexidine Bathing for Critically Ill Patients A Note of Caution

from JAMA - 27 Jan 15

With increasing concern about health care–associated infections and transmission of multidrug-resistant organisms (MDROs), there has been substantial support for universal decolonization strategies, especially for high-risk patients, such as those in the intensive care unit (ICU). One such strategy that is being adopted widely is the use of daily chlorhexidine bathing. However, the findings of Noto and colleagues in this issue of JAMA challenge this approach.



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MR/Ultrasound Fusion–Guided Biopsy in Prostate Cancer What Is the Evidentiary Standard?

from JAMA - 27 Jan 15

Although the benefits of prostate cancer screening have come into question recently, for men who are screened and have elevated prostate-specific antigen (PSA) levels, or those who present with symptoms, prostate biopsy remains the next step in the diagnostic workup. The objective of biopsy is first to determine whether any cancer is present and then to determine tumor grade (ie, Gleason score) because it predicts clinical outcomes. Lower-grade localized tumors are generally felt to be amenable



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Chlorhexidine Bathing and Health Care–Associated Infections A Randomized Clinical Trial

from JAMA - 27 Jan 15

ImportanceDaily bathing of critically ill patients with the broad-spectrum, topical antimicrobial agent chlorhexidine is widely performed and may reduce health care–associated infections.ObjectiveTo determine if daily bathing of critically ill patients with chlorhexidine decreases the incidence of health care–associated infections.Design, Setting, and ParticipantsA pragmatic cluster randomized, crossover study of 9340 patients admitted to 5 adult intensive care units of a tertiary medical center



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Protocolized Sedation vs Usual Care in Pediatric Patients Mechanically Ventilated for Acute Respiratory Failure A Randomized Clinical Trial

from JAMA - 27 Jan 15

ImportanceProtocolized sedation improves clinical outcomes in critically ill adults, but its effect in children is unknown.ObjectiveTo determine whether critically ill children managed with a nurse-implemented, goal-directed sedation protocol experience fewer days of mechanical ventilation than patients receiving usual care.Design, Setting, and ParticipantsCluster randomized trial conducted in 31 US pediatric intensive care units (PICUs). A total of 2449 children (mean age, 4.7 years; range, 2 w



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Comparison of MR/Ultrasound Fusion–Guided Biopsy With Ultrasound-Guided Biopsy for the Diagnosis of Prostate Cancer

from JAMA - 27 Jan 15

ImportanceTargeted magnetic resonance (MR)/ultrasound fusion prostate biopsy has been shown to detect prostate cancer. The implications of targeted biopsy alone vs standard extended-sextant biopsy or the 2 modalities combined are not well understood.ObjectiveTo assess targeted vs standard biopsy and the 2 approaches combined for the diagnosis of intermediate- to high-risk prostate cancer.Design, Setting, and ParticipantsProspective cohort study of 1003 men undergoing both targeted and standard b



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Diagnosis and Treatment of Clostridium difficile in Adults A Systematic Review

from JAMA - 27 Jan 15

ImportanceSince 2000, the incidence and severity of Clostridium difficile infection (CDI) have increased.ObjectiveTo review current evidence regarding best practices for the diagnosis and treatment of CDI in adults (age =18 years).Evidence ReviewOvid MEDLINE and Cochrane databases were searched using keywords relevant to the diagnosis and treatment of CDI in adults. Articles published between January 1978 and October 31, 2014, were selected for inclusion based on targeted keyword searches, manua



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Decision Curve Analysis

from JAMA - 27 Jan 15

This Guide to Statistics and Methods describes how a decision curve analysis can be used to evaluate the benefits of a diagnostic test, such as 3 prostate biopsy strategies.



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Nonleg Venous Thrombosis in Critically Ill Adults

from JAMA - 27 Jan 15

JAMA Internal MedicineNonleg Venous Thrombosis in Critically Ill Adults: A Nested Prospective Cohort StudyFrancois Lamontagne, MD, MSc; Lauralyn McIntyre, MD, MSc; Peter Dodek, MD, MHSc; Diane Heels-Ansdell, MS; Maureen Meade, MD, MSc; Julia Pemberton, MSc; Yoanna Skrobik, MD; Ian Seppelt, MBBS; Nicholas E. Vlahakis, MBBS; John Muscedere, MD; Graham Reece, MD; Marlies Ostermann, MBBS; Soundrie Padayachee, PhD, CSci; Jamal Alhashemi, MBBS, MSc; Michael Walsh, MD, PhD; Bradley Lewis, MD; David Sch



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Antiviral Drugs for Seasonal Influenza 2014-2015

from JAMA - 27 Jan 15

This article reviews the antiviral drugs available to treat influenza this season—including oseltamivir and zanamivir—as well as their indications and possible adverse effects.



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Moral Concerns and the Willingness to Donate to a Research Biobank

from JAMA - 27 Jan 15

Research biobanks are increasing in number and importance, with great potential for advancing knowledge of human health, disease, and treatment. Recruitment of donors is vital to their success and relies largely on blanket consent, in which donors give one-time permission for any future research uses of their coded specimen. This approach to consent has been endorsed recently in proposed changes to federal regulations.



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Heterogeneity in Meta-analysis of FDG-PET Studies to Diagnose Lung Cancer

from JAMA - 27 Jan 15

To the Editor Dr Deppen and colleagues conducted a large meta-analysis that showed the limitations of lung cancer diagnosis using fludeoxyglucose F 18 combined with positron emission tomography (FDG-PET) in areas with endemic infectious lung disease. Although the sensitivity and specificity of FDG-PET diagnosis was heterogeneous across the included studies, thereby compromising interpretation of the pooled results, the relevance of presenting an I2 statistic to underscore and interpret the exten



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Heterogeneity in Meta-analysis of FDG-PET Studies to Diagnose Lung Cancer—Reply

from JAMA - 27 Jan 15

In Reply Dr Mills and colleagues wish to deemphasize I2 statistics. We agree that I2 statistics can be problematic and that the naive pooled model (ie, the model assuming no study-to-study heterogeneity) is often inappropriate for meta-analyses. This is why, in our study, I2 statistics were only reported for completeness and never factored into our analysis.



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Diagnosing Endocarditis in Patients With Staphylococcus aureus Bacteremia

from JAMA - 27 Jan 15

To the Editor Dr Holland and colleagues performed a systematic review of the clinical management of patients with Staphylococcus aureus bacteremia and concluded that for those with certain low-risk characteristics, transesophageal echocardiography can be safely deferred. Our objection to this assertion is 2-fold.



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Diagnosing Endocarditis in Patients With Staphylococcus aureus Bacteremia—Reply

from JAMA - 27 Jan 15

In Reply Dr Schoenfeld and colleagues emphasize the low quality of the available evidence regarding the use of transesophageal echocardiography in patients with S aureus bacteremia and the possibility that cases of endocarditis may have been missed in the relevant studies. We agree with this point and would welcome definitive high-quality studies to address this possibility.



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Ethical Testing of Experimental Ebola Treatments

from JAMA - 27 Jan 15

To the Editor In his Viewpoint, Dr Joffe sought to justify the need for randomization of experimental drugs used for the management of the Ebola crisis due to the need for scientific information. He explicitly argued against the compassionate use of experimental interventions.



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Ethical Testing of Experimental Ebola Treatments

from JAMA - 27 Jan 15

To the Editor Dr Joffe argued for the importance of randomized study designs to ensure the acquisition of scientific knowledge required for the response to the Ebola epidemic to progress, as well as to ensure ethical treatment of patients. Many calls for RCTs have culminated with the establishment, by the Wellcome Trust, of an international consortium to conduct clinical trials of experimental therapeutics for Ebola virus disease in West Africa.



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Ethical Testing of Experimental Ebola Treatments—Reply

from JAMA - 27 Jan 15

In Reply Dr Folayan and colleagues and Mr Kanters and colleagues offer thoughtful responses to my Viewpoint, which advocated for RCTs of therapies against Ebola virus disease and cautioned against compassionate use. Their contrasting criticisms of and support for the use of RCTs demonstrate that consensus on this controversial and emotionally charged question is far off.



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Incorrect Footnote Order

from JAMA - 27 Jan 15

In the Original Investigation entitled “Association of the 2011 ACGME Resident Duty Hour Reform With General Surgery Patient Outcomes and With Resident Examination Performance” in the December 10, 2014, issue of JAMA (2014;312[22]:2374-2384. doi:10.1001/jama.2014.15277), the footnote order of a and b in the notes below Table 4 should be reversed. This article was corrected online.


 

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