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Highlights

from JAMA - 16 Apr 14



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Cost-Related Motivations for Conducting Research Participants Should Be Informed

from JAMA - 16 Apr 14

Many groups in the United States are concerned about the increasing cost of health services and have sought to reduce health care spending while maintaining the quality of care. A promising approach to this goal is to conduct more head-to-head clinical trials that compare the effectiveness of less expensive treatment options with that of more costly treatments. However, this type of research raises questions about how the purposes of the studies are presented to potential research participants.



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Integrating Care at the End of Life Should Medicare Advantage Include Hospice?

from JAMA - 16 Apr 14

Since its creation in 1983, the Medicare hospice benefit has been “carved out” of Medicare’s managed care program, commonly known as Medicare Advantage. When a Medicare Advantage enrollee elects hospice, payments for both hospice and other services unrelated to the individual’s terminal condition revert to fee-for-service Medicare, and health plans remain liable only for the Part D or supplemental benefits they provide. Although the initial rationale for this approach is unclear, the policy has



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Sickle Cell Trait—Neglected Opportunities in the Era of Genomic Medicine

from JAMA - 16 Apr 14

The use of genomics to prevent and treat disease is considered an important cornerstone for the future of health care. While the potential of genomics must be acknowledged, use of currently available scientific data and technical advances to reduce the burden of sickle cell disease (SCD), one of the most common serious single-gene disorders, is past due. However, any discussion of SCD must consider the historical context of race, inequalities in care, and previous concerns about authoritarian eu



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Ethics, Regulation, and Comparative Effectiveness Research Time for a Change

from JAMA - 16 Apr 14

The US health care system is poised to learn more about preventing, diagnosing, and treating illness than has ever been possible. This change is powered by the increasing commitment to comparative effectiveness research, increases in practice-based research, and the increasing availability of data arising from electronic health information systems to help patients, clinicians, and others understand who benefits from which treatments. Much can be learned by observing the outcomes of the varied de



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Miracle

from JAMA - 16 Apr 14

ECMO row is lined with bodies.



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Selection of Valves for TAVR Is the CHOICE Clear?

from JAMA - 16 Apr 14

Transcatheter aortic valve replacement (TAVR) was first performed in 2002. Since then, a tremendous amount of progress with this innovative technology has resulted in widespread adoption of this procedure for treatment of aortic valve disease. More than 10?000 TAVRs were performed in the United States alone since Food and Drug Administration (FDA) approval of the first device in 2011. Contrary to Europe, where 10 different valves have been approved by the European Union, in the United States all



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Comparison of Balloon-Expandable vs Self-expandable Valves in Patients Undergoing Transcatheter Aortic Valve Replacement The CHOICE Randomized Clinical Trial

from JAMA - 16 Apr 14

ImportanceTranscatheter aortic valve replacement (TAVR) is an effective treatment option for high-risk patients with severe aortic stenosis. Different from surgery, transcatheter deployment of valves requires either a balloon-expandable or self-expandable system. A randomized comparison of these 2 systems has not been performed.ObjectiveTo determine whether the balloon-expandable device is associated with a better success rate than the self-expandable device.Design, Setting, and PatientsThe CHO



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Effect of Aleglitazar on Cardiovascular Outcomes After Acute Coronary Syndrome in Patients With Type 2 Diabetes Mellitus The AleCardio Randomized Clinical Trial

from JAMA - 16 Apr 14

ImportanceNo therapy directed against diabetes has been shown to unequivocally reduce the excess risk of cardiovascular complications. Aleglitazar is a dual agonist of peroxisome proliferator–activated receptors with insulin-sensitizing and glucose-lowering actions and favorable effects on lipid profiles.ObjectiveTo determine whether the addition of aleglitazar to standard medical therapy reduces cardiovascular morbidity and mortality among patients with type 2 diabetes mellitus and a recent acu



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Effect of Metformin on Left Ventricular Function After Acute Myocardial Infarction in Patients Without Diabetes The GIPS-III Randomized Clinical Trial

from JAMA - 16 Apr 14

ImportanceMetformin treatment is associated with improved outcome after myocardial infarction in patients with diabetes. In animal experimental studies metformin preserves left ventricular function.ObjectiveTo evaluate the effect of metformin treatment on preservation of left ventricular function in patients without diabetes presenting with ST-segment elevation myocardial infarction (STEMI).Design, Setting, and ParticipantsDouble-blind, placebo-controlled study conducted among 380 patients who u



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Maternal Body Mass Index and the Risk of Fetal Death, Stillbirth, and Infant Death A Systematic Review and Meta-analysis

from JAMA - 16 Apr 14

ImportanceEvidence suggests that maternal obesity increases the risk of fetal death, stillbirth, and infant death; however, the optimal body mass index (BMI) for prevention is not known.ObjectiveTo conduct a systematic review and meta-analysis of cohort studies of maternal BMI and risk of fetal death, stillbirth, and infant death.Data SourcesThe PubMed and Embase databases were searched from inception to January 23, 2014.Study SelectionCohort studies reporting adjusted relative risk (RR) estimat



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Fibromyalgia A Clinical Review

from JAMA - 16 Apr 14

ImportanceFibromyalgia is present in as much as 2% to 8% of the population, is characterized by widespread pain, and is often accompanied by fatigue, memory problems, and sleep disturbances.ObjectiveTo review the epidemiology, pathophysiology, diagnosis, and treatment of fibromyalgia.Evidence ReviewThe medical literature on fibromyalgia was reviewed from 1955 to March 2014 via MEDLINE and the Cochrane Central Registry of Controlled Trials, with an emphasis on meta-analyses and contemporary evide



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Parental Perspectives on Adolescent Hearing Loss

from JAMA - 16 Apr 14

JAMA Otolaryngology–Head and Neck SurgeryParental Perspectives on Adolescent Hearing Loss Risk and PreventionDeepa L. Sekhar, MD, MSc; Sarah J. Clark, MPH; Matthew M. Davis, MD, MAPP; Dianne C. Singer, MPH; Ian M. Paul, MD, MscImportance: Data indicate that 1 in 6 adolescents has high-frequency hearing loss, which is typically noise related and preventable. Parental participation improves the success of adolescent behavioral interventions, yet little is known about parental perspectives regardin




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Variation in Rates of Autoimmune Thyroid Disease by Race/Ethnicity in US Military Personnel

from JAMA - 16 Apr 14

The relationship between Graves disease and race/ethnicity is undefined. Based on thyroid antibody prevalence, the rates of Hashimoto thyroiditis may be highest in whites and lowest in blacks.



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Dopamine vs Nesiritide for Acute Heart Failure With Renal Dysfunction

from JAMA - 16 Apr 14

To the Editor Dr Chen and colleagues evaluated the role of low-dose dopamine and nesiritide as individual strategies in treating patients with acute decongested heart failure while attempting to preserve or improve renal function. The trial found no benefit from low-dose dopamine or nesiritide with standard diuretic therapy. Despite significant advances in understanding the pathophysiology of acute heart failure, contemporary therapies have failed to have an effect.



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Dopamine vs Nesiritide for Acute Heart Failure With Renal Dysfunction—Reply

from JAMA - 16 Apr 14

In Reply Dr Kumar brings up 3 relevant queries regarding the ROSE trial: (1) whether future clinical trials in acute heart failure should target heart failure with preserved ejection fraction and heart failure with reduced ejection fraction separately; (2) the relevance of cystatin C as a surrogate end point; and (3) whether the advanced renal disease in the study population makes them nonresponders to any therapeutic measure.



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Lag Time to Benefit for Preventive Therapies

from JAMA - 16 Apr 14

To the Editor: In their Viewpoint, Dr Lee and colleagues explained why clinicians and guideline panels should move beyond age as a crude marker for life expectancy and compare life expectancy with the earliest time when benefits exceed harms. They also noted that “unlike magnitude of benefit, measures of lag time to benefit are rarely reported.”



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Lag Time to Benefit for Preventive Therapies

from JAMA - 16 Apr 14

To the Editor Dr Lee and colleagues discussed using lag time to benefit along with magnitude of benefit when considering preventive therapies in older adults. However, using time-to-benefit information from randomized clinical trials (RCTs) entails a number of challenges that warrant discussion.



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Lag Time to Benefit for Preventive Therapies—Reply

from JAMA - 16 Apr 14

In Reply Dr Braithwaite notes the similarities between our proposed concept of lag time to benefit and the concept of payoff time. We absolutely agree.



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Incorrect Unit of Measure and Omitted Grant

from JAMA - 16 Apr 14

In the Original Investigation entitled “Blood Pressure Trajectories in Early Adulthood and Subclinical Atherosclerosis in Middle Age” published in the February 5, 2014, issue of JAMA (2014;311[5]:490-497. doi:10.1001/jama.2013.285122), the wrong unit was provided for measurement of coronary artery calcification. Instead of Hounsfield units (HU), the correct unit of measure is Agatston units (AU). In the accompanying Editorial entitled “Early Patterns of Blood Pressure Change and Future Coronary



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CDC: Hospital Antibiotic Use Promotes Resistance Checklist Can Improve Practices

from JAMA - 16 Apr 14

Antibiotic prescribing in hospitals is inconsistent and often inappropriate—contributing to the emergence of antibiotic resistance, according to an analysis of hospital antibiotic prescribing by the US Centers for Disease Control and Prevention (CDC). But simple steps, such as implementing checklists, could help hospitals more wisely use these vital medications, the CDC says.



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WHO: More Than 7 Million Air Pollution Deaths Each Year

from JAMA - 16 Apr 14

Exposure to air pollution results in an estimated 7 million deaths each year, said the World Health Organization (WHO), double its previous estimate. This suggests that air pollution—indoor, outdoor, or both—caused 1 in 8 deaths worldwide in 2012.



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IOM: Military Psychological Interventions Lack Evidence

from JAMA - 16 Apr 14

The casualties of the Iraq and Afghanistan wars weren’t limited to soldiers returning home with broken bodies—or in body bags. The invisible wounds from psychological disorders among active-duty military personnel are even more pervasive, increasing 62% from 2000 to 2011, according to a new Institute of Medicine (IOM) report, Preventing Psychological Disorders in Service Members and Their Families: An Assessment of Programs.



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Some Progress in Effort to Reduce Hospital-Acquired Infections

from JAMA - 16 Apr 14

Hospital-acquired infections remain a pressing public health threat, affecting 1 in 25 hospitalized patients in 2011, according to the US Centers for Disease Control and Prevention (CDC). But some progress has been made in reducing these infections.


 

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