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JAMA - más leídos

Medical Students Fail Blood Pressure Check
Abbasi J.
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This Medical News article discusses the importance of correctly prepping patients for blood pressure measurement.

Is Cognitive Behavioral Therapy the Gold Standard for Psychotherapy?
Leichsenring F, Steinert C.
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This Viewpoint reviews recent research findings questioning the status of cognitive behavioral therapy as the gold standard for treating mental disorders.

Misuse of Meta-analysis in Nutrition Research
Barnard ND, Willett WC, Ding EL.
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In this Viewpoint, Walter Willett and colleagues discuss the methodological challenges of conducting meta-analyses of observational nutrition studies and propose a set of standards to reduce confusion about conflicting recommendations from nutrition reviews that come to different conclusions.

Nutrition Counseling in Clinical Practice
Kahan S, Manson JE.
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This Viewpoint notes that nutrition and health behavior change should become a core competency for all physicians and other health professionals working with patients at risk for nutrition-related chronic disease.

Acid Suppressor Use in Infants Scrutinized
Lyon J.
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This Medical News article examines the use of stomach acid suppressors to treat mild gastric reflux in infants.

Consensus Definitions for Sepsis and Septic Shock
Singer M, Deutschman CS, Seymour C, et al.
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This article presents updated definitions of and clinical criteria for diagnosing sepsis and septic shock based on recommendations from an expert task force.

2014 Guideline for Management of High Blood Pressure
James PA, Oparil S, Carter BL, et al.
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In the report from the panel members appointed to the Eighth Joint National Committee (JNC 8), the guideline authors provide evidence-based recommendations for the management of hypertension including specific goals by age, race, and comorbidities.

What Should I Do When I Hear the Call for Medical Assistance in a Plane?
Eastwood GL.
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“If there is a doctor on board, would you please make yourself known to a member of the cabin crew?” Reflexively, my hand shoots up to press the button. Seven times I have responded to such requests. Mostly it has worked out well. Twice I thought the passenger had had too much alcohol. Once I comforted an anxious woman. Another time a young army recruit heading for basic training had unexplained arm pain. Sometimes it was more serious. A man with abdominal pain told me he had cancer and he needed my attention and reassurances. A woman had a cardiac emergency, and I had to request an unscheduled landing. Another emergency on a trans-Pacific flight required the extended care of several physicians.

Effect of Titrated vs Low Positive End-Expiratory Pressure (PEEP) on Mortality in ARDS
, Cavalcanti A, Suzumura É, et al.
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This randomized trial compares the effects of ventilator lung recruitment using PEEP titration vs a conventional low-PEEP strategy on 28-day mortality in patients with moderate to severe acute respiratory distress syndrome (ARDS).

Gun Law Reforms and Firearm Deaths in Australia
Chapman S, Alpers P, Jones M.
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This population epidemiology study uses government statistics to compare the number of mass fatal shootings, firearm deaths, and firearm-related and all-cause homicide and suicides before and after enactment of gun law reforms in Australia in 1996.

Imran JB, Eastman AL.
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Going With the Flow: The Promise and Challenge of Liquid Biopsies
Friedrich MJ.
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This Medical News article discusses recent advances and challenges in the development of liquid biopsies for cancer management.

Endovascular Thrombectomy and Outcomes in Ischemic Stroke
Saver JL, Goyal M, van der Lugt A, et al.
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This meta-analysis of trials comparing treatment of acute ischemic stroke with vs without endovascular thrombectomy characterizes the threshold time after which treatment is no longer beneficial.

Infant Allergenic Food Introduction and Risk of Allergic/Autoimmune Disease
Ierodiakonou D, Garcia-Larsen V, Logan A, et al.
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This meta-analysis summarizes evidence about associations between timing of allergenic food introduction during infancy and risk of allergic or autoimmune disease.

FDA Approval of Tisagenlecleucel as CAR-T Therapy for Leukemia
Bach PB, Giralt SA, Saltz LB.
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This Viewpoint uses FDA approval of tisagenlecleucel, the first chimeric antigen receptor T-cell (CAR-T) agent approved for human use, to discuss escalating drug prices for oncology therapies and the complex considerations of outcomes and value that should justify the pricing.

Medicine Residents' Understanding of the Biostatistics and Results in the Medical Literature
Windish DM, Huot SJ, Green ML.
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ContextPhysicians depend on the medical literature to keep current with clinical information. Little is known about residents' ability to understand statistical methods or how to appropriately interpret research outcomes.ObjectiveTo evaluate residents' understanding of biostatistics and interpretation of research results.Design, Setting, and ParticipantsMultiprogram cross-sectional survey of internal medicine residents.Main Outcome MeasurePercentage of questions correct on a biostatistics/study design multiple-choice knowledge test.ResultsThe survey was completed by 277 of 367 residents (75.5%) in 11 residency programs. The overall mean percentage correct on statistical knowledge and interpretation of results was 41.4% (95% confidence interval [CI], 39.7%-43.3%) vs 71.5% (95% CI, 57.5%-85.5%) for fellows and general medicine faculty with research training (P < .001). Higher scores in residents were associated with additional advanced degrees (50.0% [95% CI, 44.5%-55.5%] vs 40.1% [95% CI, 38.3%-42.0%]; P < .001); prior biostatistics training (45.2% [95% CI, 42.7%-47.8%] vs 37.9% [95% CI, 35.4%-40.3%]; P = .001); enrollment in a university-based training program (43.0% [95% CI, 41.0%-45.1%] vs 36.3% [95% CI, 32.6%-40.0%]; P = .002); and male sex (44.0% [95% CI, 41.4%-46.7%] vs 38.8% [95% CI, 36.4%-41.1%]; P = .004). On individual knowledge questions, 81.6% correctly interpreted a relative risk. Residents were less likely to know how to interpret an adjusted odds ratio from a multivariate regression analysis (37.4%) or the results of a Kaplan-Meier analysis (10.5%). Seventy-five percent indicated they did not understand all of the statistics they encountered in journal articles, but 95% felt it was important to understand these concepts to be an intelligent reader of the literature.ConclusionsMost residents in this study lacked the knowledge in biostatistics needed to interpret many of the results in published clinical research. Residency programs should include more effective biostatistics training in their curricula to successfully prepare residents for this important lifelong learning skill.

Antipsychotics for Agitation or Psychosis in Dementia
Yohanna D, Cifu AS.
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This JAMA Clinical Guidelines Synopsis summarizes the 2016 American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia.

MRI for Neonates
Voelker R.
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The FDA has approved the first magnetic resonance imaging (MRI) device developed specifically for neonatal brain and head imaging in the neonatal intensive care unit (NICU).

Preparing to Attend on the Inpatient Medical Wards
Chopra V, Saint S.
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Transitions are a way of life in academic medicine. While much has been written about these changes, less attention has been devoted to a more common shift: the move between academic work and clinical ward time. This gap has important consequences. For example, some faculty dread upcoming ward blocks. When on clinical rotations, they struggle to juggle patient and academic activities—often doing neither well. The resulting perceived lack of efficiency and effectiveness leads to weariness, fatigue, frustration, and symptoms of burnout. Regardless of clinical effort, most faculty will face this problem. Unfortunately, limited guidance on how best to overcome this common challenge exists.

Incidence and Trends of Sepsis in US Hospitals, 2009-2014
Rhee C, Dantes R, Epstein L, et al.
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This cohort study compares estimates of sepsis incidence, outcomes, and trends based on clinical data from US hospital electronic health record systems vs claims-based ICD-9 data.

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