Communities with fewer resources or less social or political power in an inequitable society often experience poor health as a consequence. Recognizing and addressing this reality is a moral and professional imperative for all committed to advancing health. But the COVID-19 pandemic and other recent infectious disease outbreaks laid bare another reality: in a global, interconnected world, the poor health of those more vulnerable has direct consequences for all.
In this Viewpoint, Richman and Schulman argue that patient satisfaction surveys may not actually reflect clinical performance or assist efforts to improve patient experience and are not useful tools to measure physician performance.
A 6-year-old boy taking no regular medications had persistent fever and cough for 15 days. Physical examination revealed eyelid swelling; vesiculobullous lesions on the palms and soles; vesicles and erosions on the face, trunk, and limbs; erosions on the lips and oral mucosa; and blisters on the anal mucosa. Laboratory testing revealed leukocytosis, and lung auscultation revealed bilateral crackles. What is the diagnosis and what would you do next?
This Viewpoint identifies several barriers to ending the HIV epidemic and urges increasing expertise in HIV medicine in underserved areas like the South challenging legislation designed to keep students ignorant.
Patients from certain racial and ethnic groups who sought outpatient care for COVID-19 were about 20% to 36% less likely to be prescribed Paxlovid (nirmatrelvir-ritonavir), a multi-institution study found.
This report, the Consolidated Standards of Reporting Trials (CONSORT)–Outcomes 2022 extension, is a consensus statement on the standards for reporting outcomes in clinical trial reports and contains recommendations to be integrated with the CONSORT 2010 statement.
This randomized clinical trial assesses the effect of a diet and exercise intervention vs an attention control condition on knee pain at 18-month follow-up among individuals aged 50 years or older with knee osteoarthritis and overweight or obesity.
This randomized clinical trial examines whether mindfulness-based stress reduction, exercise, or a combination of both interventions improves cognitive function in older adults with subjective cognitive concerns.
In Reply Dr Zeng and colleagues correctly point out that the observed effect size for ticagrelor dual antiplatelet therapy vs aspirin on the risk of saphenous vein graft failure varied across the individual randomized clinical trials (RCTs) included in our individual patient data meta-analysis. As reported in the article, the I2 for the network meta-analysis was 55.4%, suggesting that there was considerable between-trial heterogeneity despite our readjudicating and harmonizing the definition of graft failure across the trials.
In Reply In response to the OIG’s letter about our article, which concluded that there was a significant decrease in the rates of adjusted adverse events for hospital patients between 2010 and 2019, we agree that too many adverse events occurred, and efforts should be focused on lowering their frequency. However, we want to highlight important differences between their study and ours, and why we stand behind our results.
To the Editor We have several concerns about the recent systematic review and meta-analysis that found ticagrelor and aspirin vs aspirin alone reduced the risk of saphenous vein graft failure after coronary artery bypass graft surgery.
To the Editor A recent article reported a significant decline in 21 measures of hospital adverse events across 4 adverse event domains from 2010 to 2019 based on abstracted data from the Medicare Patient Safety Monitoring System (MPSMS) for patients with 4 principal diagnoses. In May 2022, the US Department of Health and Human Services, Office of Inspector General (OIG) released the results of a nationally representative medical record review with a less positive message. The OIG’s study found that 25% of Medicare patients experienced a harm event in October 2018, which was not statistically different from the rate of 27% that the OIG reported a decade ago.
The marked increase in smallpox in recent years all over the civilized world is one of a group of facts that have disquieted many observers. Smallpox is a preventable disease, the first of the infectious diseases demonstrated to be preventable by inoculation. The evidence is so clear, so unmistakable and so convincing that it is a perpetual wonder that opposition can raise its head. But indifference to the protective value of vaccination and even definite hostility to its practice are today exceedingly common.
Lifestyle interventions are the first-line therapy for weight loss, based on multiple randomized clinical trials demonstrating efficacy. However, whether these approaches can be successfully translated to community or clinical settings remains unclear. For example, the Diabetes Prevention Program (DPP) was a highly successful efficacy trial, in which patients randomized to a lifestyle intervention attained a 7% weight loss at 1 year and reduced risk of diabetes, compared with the control group, by 58% (4.8% vs 11.0% risk of diabetes), but efforts to translate this to community settings have had mixed results.
The Original Investigation titled “Effect of a Postoperative Multimodal Opioid-Sparing Protocol vs Standard Opioid Prescribing on Postoperative Opioid Consumption After Knee or Shoulder Arthroscopy: A Randomized Trial” published in the October 4, 2022, issue of JAMA included incorrect data. In the Results section, the number of patients in the opioid-sparing groups who requested more opioids was incorrect and the data points were incorrectly placed in Figure 2. This article was corrected online.
The JAMA Diagnostic Test Interpretation titled “Serum Cystatin C for Estimation of GFR,” published in the August 8, 2022, issue of JAMA, included an error in the SI conversion in Table 1. The Table has been corrected online and now indicates the correct SI conversion for creatinine to μmol/L.
A gene editing method using bacteria-derived plasmids rather than viral vectors could program patients’ own T cells to attack multiple tumor antigens specific to their cancers, a first-in-human study suggests. The study’s authors say the approach could open up thousands of unique tumor antigens as targets, potentially personalizing cancer immunotherapy and making it more effective against solid tumors. The study was presented at the Society for Immunotherapy of Cancer meeting and published in Nature.
Experimental allogeneic gene-edited T cells may provide an “off-the-shelf” alternative to autologous chimeric antigen receptor (CAR) T-cell therapies for children with recurrent or refractory B–cell acute lymphoblastic leukemia, reducing treatment delays and costs, according to a study in Science Translational Medicine. In a phase 1 clinical trial, 4 of 6 children treated with the allogeneic CAR T cells achieved remission, paving the way for them to receive allogeneic hematopoietic stem cell transplants.
As respiratory syncytial virus (RSV) infections surged, a maternal vaccine was found to be 82% effective in preventing severe medically attended lower respiratory tract infections due to RSV in newborns up to 90 days after birth, and 69% effective for the first 6 months after birth, reaching 1 of 2 primary efficacy end points in a phase 3 clinical trial. The top-line results were announced by Pfizer and have not yet been published elsewhere, though the firm intends to submit them for peer review.
This randomized clinical trial compares the efficacy of frozen embryo transfer (FET) timed according to endometrial receptivity testing vs standardized frozen embryo transfer in improving live birth rate.
In Reply In response to our recent Viewpoint on air quality interventions to reduce SARS-CoV-2 transmission, Mr Srikrishna and colleagues note that a clear target for air changes per hour in non–health care settings would be helpful. Although we are not aware of COVID-19 outbreaks resulting from SARS-CoV-2 exposure in spaces ventilated with 5 to 6 air changes per hour or less, there are minimal data available on this association to date. Further study is needed to determine the effectiveness of various air changes per hour under different circumstances. For some scenarios, higher air changes per hour might be needed to prevent transmission. For example, the CDC recommends at least 12 air changes per hour for hospital airborne infection isolation rooms and for some other patient care areas in health care settings.
To the Editor A recent Research Letter described the association between COVID-19 vaccine booster doses and Omicron infection in the National Basketball Association (NBA). We agree with the authors that evaluating data regarding COVID-19 vaccine booster doses is essential as new SARS-CoV-2 variants of concern emerge.
To the Editor A recent Viewpoint made a compelling case for improving indoor air quality and provided an excellent overview of different approaches and considerations. However, an important question that remains unclear from this Viewpoint and from official recommendations from the US Centers for Disease Control and Prevention (CDC) is the frequency of air changes needed to sufficiently reduce transmission of SARS-CoV-2 and other airborne pathogens in non–health care settings. Many schools, businesses, and other indoor venues do not have even a ballpark sense about the number of air changes per hour they need to achieve, much less how much money to budget for this process, because the cost increases with more air changes per hour.
To the Editor A recent Viewpoint underscored the importance of implementing proven approaches to reducing the risk of COVID-19 in shared indoor spaces through ventilation, filtration, and upper-room germicidal UV-C light. However, we believe the authors may have understated important engineering controls. Although opening windows and doors helps improve ventilation, increasing temperatures, wildfire smoke, and air pollution driven by global climate change reduce the usefulness of these interventions.
An international group of clinicians, patients, and others with an interest in atopic eczema has issued a consensus statement that recommends instruments for physicians to use in daily practice to measure eczema control and itch intensity in patients with atopic eczema.
Older patients with hypertension who were at increased risk of cardiovascular disease reduced their cardiovascular morbidity and mortality with intensive blood pressure (BP) control during the Systolic Blood Pressure Intervention Trial (SPRINT). But once the trial ended, the benefit of intensive treatment quickly abated, according to a secondary analysis in JAMA Cardiology.
Angiotensin receptor blocker (ARB) therapy significantly reduced the occurrence of epilepsy in patients with arterial hypertension compared with other antihypertensive drugs. Epilepsy is a common comorbidity of arterial hypertension, and ARB therapy may be a novel strategy for preventing it in these patients, suggested a study published in JAMA Neurology.
Nearly a quarter of physicians do not believe that a patient’s life expectancy should be a metric for halting cancer screening, despite guidelines that recommend against routine cancer screening when life expectancy is less than 10 years. What’s more, less than half of physicians are convinced the overscreening is a major problem among older adults.
The FDA authorized a software medical device intended to help anesthetists and other health professionals identify important anatomical structures in ultrasound images before inserting needles to deliver regional anesthesia.
In 2023, the majority of Medicare beneficiaries will be enrolled in a private Medicare Advantage plan, and nearly 7 in 10 beneficiaries will be members in Medicare Advantage by 2030. Medicare Advantage plans differ from traditional Medicare as they are paid on a capitated basis to cover the health care needs of enrollees each year. Medicare Advantage plans may cover additional benefits unavailable in traditional Medicare, such as dental and fitness benefits, and face incentives to coordinate care and reduce health care spending. To lower costs, Medicare Advantage typically constrains the network of available physicians and implements prior authorization requirements. Roughly 1.5% of the nation’s gross domestic product and 5% of the federal budget is spent on payments to Medicare Advantage. With the program’s recent rapid growth, it is imperative to understand the implications of its expansion for patient outcomes and medical spending.
Over the last 20 years, Medicare has increasingly turned to pay-for-performance arrangements as a central strategy for improving care and outcomes. To date, dozens of pay-for-performance arrangements have been implemented as stand-alone programs or components of broader risk contracts. No longer demonstrations, many are now fixtures in the payment system by statute.