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Highlights

from JAMA - 26 Nov 14



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Ending the Cycle of Blame in US Health Care

from JAMA - 26 Nov 14

This Viewpoint discusses how simplistic narratives have shaped views about cause, blame, and responsibility in the challenges facing the US health care system.



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Accountable Health Communities Getting There From Here

from JAMA - 26 Nov 14

This Viewpoint discusses approaches to overcoming 2 major challenges facing efforts to establish accountable health communities.



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Critiquing US Health Care

from JAMA - 26 Nov 14

This Viewpoint discusses the economics of the US health care system.



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Engaging to No Avail

from JAMA - 26 Nov 14

It was about 5 am when I gave up trying to sleep through a queasy stomach. I wondered about that as I headed for the shower because stomachaches are unusual for me, and nausea even more so.



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Reshaping US Health Care From Competition and Confiscation to Cooperation and Mobilization

from JAMA - 26 Nov 14

This Editorial discusses 3 approaches to reshaping US health care.



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The Value of High-Quality Full-Day Preschool

from JAMA - 26 Nov 14

Unlike established K-12 public schooling, preschool programs have had to justify their claim for public funding by demonstrating their effectiveness. In the 1960s, longitudinal studies of the Early Training Program, the HighScope Perry Preschool Program, and others showed improvements in intellectual performance that promised to be permanent, but then disappeared a few years later, leading to the perception that the effects of preschool programs were transient. In the 1980s, the Consortium for L



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Medical Malpractice Reform When Is It About Money? Why Is It About Time?

from JAMA - 26 Nov 14

Crisis, it is said, means both danger and opportunity. In medical liability reform, however, greater opportunity may lie in noncrisis. In this issue of JAMA, Mello and colleagues offer data suggesting that no crisis of the conventional sort currently exists in the medical malpractice system.



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Levofloxacin for BK Virus Prophylaxis Following Kidney Transplantation A Randomized Clinical Trial

from JAMA - 26 Nov 14

ImportanceBK virus infection is a significant complication of modern immunosuppression used in kidney transplantation. Viral reactivation occurs first in the urine (BK viruria) and is associated with a high risk of transplant failure. There are currently no therapies to prevent or treat BK virus infection. Quinolone antibiotics have antiviral properties against BK virus but efficacy at preventing this infection has not been shown in prospective controlled studies.ObjectiveTo determine if levoflo



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Association of Sickle Cell Trait With Chronic Kidney Disease and Albuminuria in African Americans

from JAMA - 26 Nov 14

ImportanceThe association between sickle cell trait (SCT) and chronic kidney disease (CKD) is uncertain.ObjectiveTo describe the relationship between SCT and CKD and albuminuria in self-identified African Americans.Design, Setting, and ParticipantsUsing 5 large, prospective, US population-based studies (the Atherosclerosis Risk in Communities Study [ARIC, 1987-2013; n?=?3402], Jackson Heart Study [JHS, 2000-2012; n?=?2105], Coronary Artery Risk Development in Young Adults [CARDIA, 1985-2006; n?=



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Association of a Full-Day vs Part-Day Preschool Intervention With School Readiness, Attendance, and Parent Involvement

from JAMA - 26 Nov 14

ImportanceEarly childhood interventions have demonstrated positive effects on well-being. Whether full-day vs part-day attendance improves outcomes is unknown.ObjectiveTo evaluate the association between a full- vs part-day early childhood program and school readiness, attendance, and parent involvement.Design, Setting, and ParticipantsEnd-of-preschool follow-up of a nonrandomized, matched-group cohort of predominantly low-income, ethnic minority children enrolled in the Child-Parent Centers (CP



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Cost-effectiveness of Dalteparin vs Unfractionated Heparin for the Prevention of Venous Thromboembolism in Critically Ill Patients

from JAMA - 26 Nov 14

ImportanceVenous thromboembolism (VTE) is a common complication of acute illness, and its prevention is a ubiquitous aspect of inpatient care. A multicenter blinded, randomized trial compared the effectiveness of the most common pharmocoprevention strategies, unfractionated heparin (UFH) and the low-molecular-weight heparin (LMWH) dalteparin, finding no difference in the primary end point of leg deep-vein thrombosis but a reduced rate of pulmonary embolus and heparin-induced thrombocytopenia amo



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The Medical Liability Climate and Prospects for Reform

from JAMA - 26 Nov 14

For many physicians, the prospect of being sued for medical malpractice is a singularly disturbing aspect of modern clinical practice. State legislatures have enacted tort reforms, such as caps on damages, in an effort to reduce the volume and costs of malpractice litigation. Attempts to introduce similar traditional reform measures at the federal level have so far failed. Much less prominent, but potentially more important, are proposed alternative approaches for resolving medical injuries; a n



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Body Image Concerns, Muscle-Enhancing Behaviors, and Eating Disorders in Males

from JAMA - 26 Nov 14

JAMA PediatricsProspective Associations of Concerns About Physique and the Development of Obesity, Binge Drinking, and Drug Use Among Adolescent Boys and Young Adult MenAlison E. Field, ScD; Kendrin R. Sonneville, RD, ScD; Ross D. Crosby, PhD; Sonja A. Swanson, ScM; Kamryn T. Eddy, PhD; Carlos A. Camargo Jr, MD, DrPH; Nicholas J. Horton, ScD; Nadia Micali, MD, PhDImportance Relatively little is known about the prevalence of concerns with physique and eating disorders among males and their relat





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US Food and Drug Administration and Design of Drug Approval Studies

from JAMA - 26 Nov 14

To enhance protocol quality, federal regulations encourage but do not require meetings between pharmaceutical companies and the US Food and Drug Administration (FDA) during the design phase of pivotal studies assessing drug efficacy and safety for the proposed indication. These meetings often generate FDA recommendations for improving research, although companies are not bound to follow them.



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Genetic Factors Associated With Severe Cutaneous Adverse Reactions

from JAMA - 26 Nov 14

To the Editor The study by Dr Chung and colleagues identified CYP2C variants, which participate in drug clearance, as important genetic factors associated with phenytoin-related severe cutaneous adverse reactions. Nevertheless, their analysis did not take into account the potential influence of coadministered drugs. For this reason, I would like to comment on the importance of drug interactions in pharmacogenetic studies, which are designed to examine the influence of certain genetic variants on



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Genetic Factors Associated With Severe Cutaneous Adverse Reactions—Reply

from JAMA - 26 Nov 14

In Reply Dr Lozano comments that drug interactions can be key confounding variables in pharmacogenetic studies and wonders if the results of our study might be changed if we had considered comedications. We agree that pharmacogenomic data can be influenced by nongenetic factors (eg, coadministered medicines and drug interactions) and that such confounding factors might lead to overestimation or underestimation of an association. In fact, uncharacterized extrinsic factors or unclear phenotypes of



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Exercise to Combat Depression

from JAMA - 26 Nov 14

To the Editor Dr Cooney and colleagues provided a concise summary of their recent meta-analysis of exercise for depression, but careful examination of their data raises concerns about the validity of their analysis and interpretation of results. The Figure indicates that 13 of 16 studies favored exercise—an 81% positive rate; the overall effect size was moderate (5-point improvement on a depression scale) favoring exercise. To put this in perspective, an analysis of 74 trials of 12 antidepressan



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Exercise to Combat Depression—Reply

from JAMA - 26 Nov 14

In Reply The synopsis of our Cochrane review of exercise for depression described the key results, the summary estimates of standardized mean differences, of the larger review. These results underwent rigorous peer review prior to publication in the Cochrane Library. We are confident about the validity and interpretation of the overall effect size, which was moderate and equivalent to a difference in the Beck Depression Inventory (BDI) of about 5 points between exercise and control.



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Costs of New Treatments for Hepatitis C Infection

from JAMA - 26 Nov 14

To the Editor Drs Brennan and Shrank raised several important questions regarding the imperative of balancing individual and societal benefits of certain new medications against their large financial expense. Equitable return on investment is commonly deemed acceptable; however, defining a reasonable standard for return on investment requires appropriate and complete information.



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Costs of New Treatments for Hepatitis C Infection

from JAMA - 26 Nov 14

To the Editor In seeking to rationalize sofosbuvir pricing, Drs Brennan and Shrank assumed $11 billion in development costs. Even if this were reasonable, Gilead’s $2.27 billion first quarter revenue would suggest that the price was grossly inflated. But the development of sofosbuvir did not cost that much.



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Costs of New Treatments for Hepatitis C Infection—Reply

from JAMA - 26 Nov 14

In Reply Dr Lopert and Mr Welch and Dr Green make the point that the Gilead purchase of Pharmasset does not accurately reflect the true costs of development of sofosbuvir. We agree.



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Collaborators Omitted

from JAMA - 26 Nov 14

In the Original Investigation entitled “Effect of Self-monitoring and Medication Self-titration on Systolic Blood Pressure in Hypertensive Patients at High Risk of Cardiovascular Disease: The TASMIN-SR Randomized Clinical Trial” published in the August 27, 2014, issue of JAMA (2014;312[8]:799-808. doi:10.1001/jama.2014.10057), 4 TASMIN-SR collaborators representing West Midlands South were omitted from the end matter. The section should read: West Midlands South: Atherstone Surgery, Dr Trevor Go


 

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