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JAMA - recientes

Highlights for February 13, 2018
13/2/2018
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Language, Science, and Politics
13/2/2018
Gostin LO.
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This Viewpoint provides historical context for advice given by the US Department of Health and Human Services in 2017 to the CDC to avoid particular words in 2019 budget requests and argues that scientific innovation can flourish only when it is protected from political interference.

Defining Outcomes for CME Activity
13/2/2018
Stevenson R, Moore DE, Jr.
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This Viewpoint proposes a framework for thinking about outcomes of continuing medical education (CME) activities, including identification of professional practice gaps and improvement of clinical competence, clinician performance, and patient and community health outcomes.

Promoting Innovation Through Regulatory Alignment for CME
13/2/2018
McMahon GT, Skochelak SE.
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This Viewpoint discusses efforts by the ACCME and AMA to develop new rules that allow physicians to collect continuing medical education credits using new technologies and in a streamlined way.

Increasing the Transparency of Conflict of Interest Disclosures in Nutrition Research
13/2/2018
Ioannidis JA, Trepanowski JF.
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In this Viewpoint, John Ioannidis argues that nutrition researchers should be required to disclose relevant dietary advocacy, activism, practices, and personal preferences given indirect financial benefits they may realize from offering dietary advice and the relative ease with which they can promote their personal beliefs in diet through science.

A Medical Student Shares Her Struggle With Depression
13/2/2018
Gupta R.
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In this essay, a young medical student describes her struggle with depression and how the experience of vulnerability has bred a deep compassion for her patients and peers.

Utility of a Clinical Prediction Rule to Exclude Pulmonary Embolism Among Low- Risk Emergency Department Patients
13/2/2018
Kline JA.
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In this issue of JAMA, Freund and colleagues report the results of the PROPER trial, a cluster-randomized clinical trial conducted at 14 centers in France that tested the effect of a clinical prediction rule, using only clinical criteria, to exclude acute pulmonary embolism (PE) at the bedside among low-risk emergency department patients. These criteria are commonly referred to as the PERC rule (pulmonary embolism rule-out criteria) and consist of 8 objective factors: arterial oxygen saturation (Sp o2) of 94% or less, unilateral leg swelling, hemoptysis, recent trauma or recent surgery, prior PE or prior deep venous thrombosis, pulse rate of at least 100 beats/minute, patient age of 50 years or older, and exogenous estrogen use. In this trial, the investigators compared patient outcomes from usual emergency care processes vs care processes that included the PERC rule. This study addresses an important clinical controversy—can the notoriously elusive and potentially fatal disease process of PE be safely excluded without laboratory testing or radiological imaging?

Improving Evidence for Implementing Guideline-Based Care in Low- and Middle-Income Countries
13/2/2018
Granger CB, Xavier D.
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Coronary heart disease is the number one cause of death and disability in India and around the world. Evidence-based approaches for prevention and treatment of coronary heart disease are widely available but are not used optimally, particularly in low- and middle-income countries. In India, like in many countries, there are major gaps between actual and ideal care, and quality of care is substantially worse for patients with low socioeconomic status. Studies of quality improvement in Brazil, China, and India have been associated with improvements in acute coronary syndrome care and in clinical outcomes. However, there is an important need to further develop approaches to improve implementation of evidence-based care in these countries.

Screening for Ovarian Cancer in Asymptomatic Women
13/2/2018
Lu KH.
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Developing an effective strategy for early detection of ovarian cancer remains one of the most significant unmet needs in the diagnosis and treatment of the disease. Approximately 22 000 cases of ovarian cancer are diagnosed each year among women in the United States. Similar to women with lung and pancreatic cancers, women with ovarian cancer are typically diagnosed in late stages, resulting in poor outcomes. For the 20% of patients with ovarian cancer diagnosed with stage I disease, 5-year survival rates are greater than 90%, whereas for the majority of women diagnosed with stage III or IV ovarian cancer, 5-year survival rates are approximately 17% to 39%.

Pulmonary Embolism Rule-Out Criteria and Subsequent Thromboembolic Events
13/2/2018
Freund Y, Cachanado M, Aubry A, et al.
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This crossover cluster–randomized clinical noninferiority trial compared the safety of using pulmonary embolism rule-out criteria (PERC) vs a conventional strategy (D-dimer and CTPA) for excluding the diagnosis of pulmonary embolism (PE) among emergency department patients with low clinical probability of PE.

Effect of a Quality Improvement Intervention on AMI Outcomes in India
13/2/2018
Huffman MD, Mohanan PP, Devarajan R, et al.
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This cluster randomized, stepped-wedge clinical trial compares the effect of a quality improvement tool kit vs usual care on 30-day major adverse cardiovascular events in patients with acute myocardial infarction (AMI) in Kerala, India.

Affordable Care Act Dependent Coverage Provision and Prenatal Care and Birth Outcomes
13/2/2018
Daw JR, Sommers BD.
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This study determines whether the dependent coverage provision of the Affordable Care Act was associated with changes in payment for birth, prenatal care, and birth outcomes among married and unmarried women.

USPSTF Recommendation: Screening for Ovarian Cancer
13/2/2018
, Grossman DC, Curry SJ, et al.
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This 2018 Recommendation Statement from the US Preventive Services Task Force recommends against screening for ovarian cancer in asymptomatic women (D recommendation).

USPSTF Evidence Report: Screening for Ovarian Cancer
13/2/2018
Henderson JT, Webber EM, Sawaya GF.
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This systematic review to support the 2018 update of the US Preventive Services Task Force Recommendation Statement on screening for ovarian cancer summarizes published evidence on the benefits and harms of ovarian cancer screening for average-risk, asymptomatic women.

The Stepped-Wedge Approach to Cluster Clinical Trial Design
13/2/2018
Ellenberg SS.
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This JAMA Guide to Statistics and Methods discusses the stepped-wedge apporach to cluster randomized clinical trial design, in which clusters are randomized to the order in which they receive the experimental regimen.

Byline Placement of Co-first Authors by Gender in Journals With High Impact Factors
13/2/2018
Aakhus E, Mitra N, Lautenbach E, et al.
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This study describes the byline order of gender-discordant co-first authors in 10 clinical and basic science journals with high impact factors.

Paid Family and Childbearing Leave Policies at Top US Medical Schools
13/2/2018
Riano NS, Linos E, Accurso EC, et al.
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This study characterizes variations in duration, salary support, policy clarity, and constraints or prerequisites for childbearing and family leave policies at 12 top-tier US medical schools.

Early Resuscitation for Adults With Sepsis in a Low-Income Country
13/2/2018
Nedel W, Deutschendorf C.
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To the Editor Dr Andrews and colleagues performed a randomized clinical trial of a sepsis protocol for early resuscitation involving intravenous fluids, vasopressors, and blood transfusion compared with usual care among adults with sepsis and hypotension in Zambia. They found that in-hospital mortality was greater in the sepsis protocol group than in the usual care group. However, the difference in mortality may not be attributed solely to the early resuscitation protocol.

Early Resuscitation for Adults With Sepsis in a Low-income Country—Reply
13/2/2018
Semler MW, Andrews B, Bernard GR.
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In Reply Drs Nedel and Deutschendorf highlight 2 key considerations for the interpretation of our trial and the management of patients with sepsis across settings: (1) timing of antibiotic administration and (2) volume of intravenous fluid.

Costs of Quality Measurement
13/2/2018
Chen J, Patel MM.
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To the Editor We agree with Dr Schuster and colleagues that measuring the cost of quality measurement is an important but often overlooked link in the quality strategy. We suggest that measure developers should estimate the contextual cost rather than the absolute cost.







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