Новости за 09.07.2024

This Special Communication discusses the need for better integration of clinical trials and health care delivery enterprises.

This prospective observational study investigates mortality rates and predictive risk factors for rheumatic heart disease in 24 endemic low- and middle-income countries and evaluates interventions like corrective valve surgery and valvuloplasty.

In Reply Our recent analysis reported no association between preoperative use of GLP-1 RAs and postoperative respiratory complications in a cohort of patients who underwent emergency surgery. We thank Dr Milder and colleagues, Dr Levi, and Dr Hobai for their comments, all of which raise similar points regarding the study’s focus on patients who underwent emergency surgery.

To the Editor I have some concerns about a recent Research Letter that make the conclusions seem inaccurate and premature. In the opening paragraph, the authors incorrectly referenced the 2023 American Society of Anesthesiologists (ASA) guidance recommending preoperative withholding of GLP-1 RAs as guidelines. Although the words “guidelines” and “guidance” are similar and are often used interchangeably, there is a distinct difference in their meaning and intent.

This JAMA Patient Page describes Lynch syndrome, its risk factors and diagnosis, and its association with colorectal cancer and other specific cancers.

This Viewpoint from the FDA discusses how pragmatic clinical research—assessment that uses real-world data, often in combination with research data, after initial marketing approval—can help in evaluation of new technologies, benefit research sites in underresourced settings, and better inform regulatory decisions and clinical practice.

Randomized clinical trials remain the cornerstone of evidence-based medicine. As a leading medical journal publishing the science that advances the clinical care of patients and the health of the public, JAMA is committed to the publication of clinical trials, as well as promoting the discourse on how clinical trial evidence can best serve the needs of patients and clinicians.

This Viewpoint examines the possible legal consequences of pregnancy loss following the Alabama Supreme Court’s decision to extend personhood to laboratory-conceived embryos.

This narrative review uses data from network meta-analyses and systematic reviews to explore the prevalence, diagnosis, and treatment of major depression in US adults, including specific forms of psychotherapy and more than 20 antidepressant medications.

This randomized clinical trial examines whether electroencephalogram -guided anesthesia decreases the incidence of delirium after cardiac surgery among adults 60 years or older.

This population-based retrospective study uses data from the National Vital Statistics System to evaluate trends in risk factors for preeclampsia in the US between 2010 and 2021.

In this issue of JAMA, Deschamps and colleagues report results of the Electroencephalographic Guidance of Anesthesia to Alleviate Geriatric Syndromes-Canada (ENGAGES-Canada) trial. ENGAGES-Canada compared rates of postoperative delirium among 1140 patients 60 years or older undergoing cardiac surgery who were randomly assigned to 1 of 2 strategies to prevent excessive dosing of inhaled general anesthetics: electroencephalogram (EEG)-guided dosing vs usual care, in which anesthesia dose was guided... Читать дальше...

A defining characteristic of poetry is its ability to express what might seem to defy words. Hence its indispensability in the medical realm, where clinicians and patients alike so often encounter such ineffable moments as the birth of a child, the end of life, or, as in “Radiance,” the uncertainties of a cancer diagnosis. The poem brilliantly intermingles the wonder of medical technologies that allow us to see inside our bodies with the faith that for many illuminates our inner selves. Juxtaposition works here in several additional ways... Читать дальше...

There are wondrous ways to reveal what’s inside our bodies. I learned this as sickness bloomed and I feared the scythe shimmering for my mother.

In Reply In the AGENT IDE trial, treatment of in-stent restenosis with a coronary paclitaxel-coated balloon significantly reduced the rate of the primary end point of 1-year target lesion failure compared with conventional balloon angioplasty. Among the components of the primary end point, target lesion revascularization was required to be adjudicated as ischemia-driven by an independent clinical events committee. Absolute rates of this end point may potentially be influenced by operator practice patterns; however... Читать дальше...

To the Editor We write to express our concern with the conclusion of the AGENT IDE (A Clinical Trial to Assess the Agent Paclitaxel Coated PTCA Balloon Catheter for the Treatment of Subjects With In-Stent Restenosis) study, which reported drug-coated balloons to be superior to uncoated balloons based on a composite end point of 1-year target lesion failure—defined as the composite of ischemia-driven target lesion revascularization, target vessel–related myocardial infarction, or cardiac death. This... Читать дальше...

This JAMA Guide to Statistics and Methods article explains the test-negative study design, an observational study design routinely used to estimate vaccine effectiveness, and examines its use in a study that estimated the performance of messenger RNA boosters against the Omicron variant.

In the Original Investigation titled “Identifying Children Likely to Benefit From Antibiotics for Acute Sinusitis: A Randomized Clinical Trial,” published on July 25, 2023, a Conflict of Interest Disclosure was mistakenly included. The disclosure for Dr Shaikh has been removed. This article was corrected online.

This Viewpoint discusses ways to ensure the proficiency of bilingual communication among health care staff in patient-clinician encounters, such as language testing and use of professional interpreters.

In this narrative medicine essay, when a physician’s mother begins experiencing postmenopausal bleeding, the author wonders what it would be like to hear someone’s signs and symptoms and not automatically begin to build a differential.

This study evaluates the association between cost sharing and naloxone prescription abandonment (nondispensing of naloxone prescriptions) in commercial insurance and Medicare plans.

This cross-sectional study examines trends in naloxone dispensing by US retail pharmacies from 2019 to 2023, including prescriber specialty and product brand.

If persons who are engaged in the promotion of preventive medicine ever waver in their faith that progress will attend the effort, their courage and persistence should be further sustained by the recent records of the continued campaigns against yellow fever. The success of Gorgas in eradicating this disease by mosquito control in Havana, in Cuba and in the Panama Canal Zone, has been widely proclaimed as an outstanding, monumental achievement of modern hygiene and sanitation. Less known, though similarly gratifying... Читать дальше...

Since the turn of this century, fatal drug overdoses involving opioids have continued to mount. Despite rhetorical assertions to the contrary, too little investment has been made in the science-based responses to this crisis and progress has been stymied by systems-level factors.

In the Research Letter titled “Global Production of Active Pharmaceutical Ingredients for US Generic Drugs Experiencing Shortages,” published online April 29, 2024, and in print on May 28, 2024, in Table 2, the number and percentage of facilities with and without active pharmaceutical ingredient shortages in Spain were changed to 15 (5.5%) and 12 (4.1%), respectively; in Germany, to 9 (3.3%) and 14 (4.8%), respectively; in Japan, to 7 (2.6%) and 14 (4.8%), respectively; and in France, to 8 (2.9%) and 13 (4.4%)... Читать дальше...