This randomized trial compares the effect of recombinant human soluble thrombomodulin vs placebo in patients with sepsis-associated coagulopathy on 28-day all-cause mortality.
In this study, Sepsis-3 investigators use electronic health record and trial data from patients with sepsis within 6 hours of hospital presentation to define clinical phenotypes that correlate with host-response patterns, sepsis biomarkers, mortality, and treatment effects.
Yale University scientists, with funding through the National Institutes of Health BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative, restored some cellular functions in the brains of pigs that had been slaughtered for meat 4 hours earlier, according to a recently published study in Nature.
Little is known about how untreated substance use or mental health conditions can lead to other health care costs, such as emergency care for an overdose, concluded a recent Government Accountability Office (GAO) report.
The Centers for Medicare & Medicaid Services (CMS) recently finalized a new policy that will allow Medicare Advantage plans to offer additional telehealth services beginning in 2020.
This JAMA Clinical Insights review summarizes recent cervical cancer screening guidelines from the USPSTF, ACOG, and ACS, and proposes an algorithm for responding to abnormal screening results in women at average risk in age group 25 to 29 and older than 30.
For decades, physicians, patients, and policy analysts have complained about the US health care system. Costs are too high, quality is haphazard, and engaging with the system is frustrating. It is hard to shake the feeling that this will never change.
A recent paper by Horsley on the value of biologic principles in surgical practice concluded with these words:
This study describes point-of-sale prices for orally administered anticancer drugs offered through Medicare Part D and out-of-pocket changes in spending as a result of decreasing coinsurance and price changes between 2010 and 2019.
This study compared monetary penalties and rewards among safety net vs non–safety net hospitals under Medicare’s Comprehensive Care for Joint Replacement (CJR) model, a bundled payment plan for hip and knee replacements intended to incentivize health care quality and savings, in 2016 and 2017.
To the Editor In their review of in-flight medical emergencies, Dr Martin-Gill and colleagues outlined characteristics of the aircraft cabin environment, including mild hypoxia, that might precipitate or contribute to such emergencies, and provided recommendations for how to manage them medically. However, the underlying physiology that links routine cabin hypoxia to adverse medical events was not discussed. It is important to consider how physiological responses to cabin hypoxia might actually cause... Читать дальше...
To the Editor Dr Mikolajczyk and colleagues presented a JAMA Clinical Challenge of a 55-year-old man with a single-phase computed tomography (CT) scan demonstrating multiple liver lesions suspicious for malignancy, with the remaining liver morphologically normal. An elevated α-fetoprotein level was present. A triple-phase CT scan was obtained to evaluate the small bowel, and a pancreatic tail mass was discovered. The authors stated that the next step would be to perform endoscopic ultrasound-guided fine-needle aspiration of the pancreatic mass.
In Reply In our review, we recommended supplemental oxygen for patients with dyspnea or another symptom of distress; we did not seek to restrict use of oxygen to only patients with dyspnea or hypoxia. Pulse oximetry is not commonly available aboard commercial aircraft, nor is it a required component of the emergency medical kit mandated by the Federal Aviation Administration, making clear identification of this finding infrequent. Because commercial airlines are not required to have oxygen stores to maintain passenger need for an entire flight... Читать дальше...
In Reply The patient in our case was noted to have intussusception of the small bowel on the single-phase CT scan. Enteric malignancies are a well-recognized etiology for intussusceptions in adult patients. Given the concomitant, innumerable liver lesions, there was initial concern for metastatic disease from an enteric malignancy. Thus, triple-phase CT enterography was pursued to evaluate for a primary malignancy involving the small bowel. Hypothetically, if liver biopsy had been performed first... Читать дальше...
In Reply In T-TIME, we confirmed that low-dose intracoronary alteplase administered early during primary PCI did not reduce microvascular obstruction. Drs Sezer and Umman suggest a different agent may have been more effective, based on their trial of intracoronary streptokinase vs no additional therapy administered at the end of primary PCI. They recorded improvements in some surrogate outcomes measured during coronary angiography at 2 days and left ventricular volumes and infarct size at 6 months. Читать дальше...
Transcatheter aortic valve replacement (TAVR) was as safe, effective, noninferior, and even superior to surgical aortic valve replacement in patients with severe aortic stenosis who were at low risk of death from surgery, demonstrated a pair of trials in the New England Journal of Medicine. TAVR is currently only indicated for patients at high risk of surgical complications.
In patients with Hashimoto disease whose symptoms weren’t relieved by adequate thyroid hormone replacement, thyroidectomy improved quality of life and fatigue, reported a study in Annals of Internal Medicine.
Both cognitive behavioral therapy (CBT) and psychotherapy improved symptoms of body dysmorphic disorder (BDD) in a 2-site trial, although CBT more consistently improved symptom severity across both sites, found a JAMA Psychiatrystudy that compared the treatments. Supportive psychotherapy is most commonly prescribed for BDD though its effectiveness hasn’t been tested.
Women who smoked cigarettes during pregnancy and took higher-dose folic acid supplements delivered infants with better fetal growth than smokers who took standard-dose folic acid, according to a study published in JAMA Pediatrics.
This randomized noninferiority trial compares the effect of laparoscopic distal gastrectomy with open distal gastrectomy for locally advanced gastric cancer.
This JAMA Patient Page describes use of enteral nutrition for short-term and long-term health conditions.
It’s the tiredness that comes with doing nothing.Outside, far below: a parking lot, a blindingsnow-covered field. Inside, in the waiting room:coats on chairs, three cartons of eggnog,a cactus in the corner.Sometime during the day, Meenu Mami microwaves dal and rice,and we all sit eating. She leans back in her chair:her toes protruding from the bottoms of her salwar kameezare yellow and shiny and swollen.Squares of light move slowly across the floor.I drift in and out of sleep.
In this narrative medicine essay, the tension stirred when a barista urges a homeless man out of an upscale coffee shop reminds an emergency department physician to consider the daily or weekly life cycles of homeless men and women who seek shelter and care in emergency departments.
Among adults who have never smoked, office workers in information fields, such as publishing, data processing, and those who provide administrative support had the highest rates of chronic obstructive pulmonary disease at 3.3%, the CDC reports. According to the findings, miners face a similarly high rate of COPD at 3.1%.