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JAMA - recientes

Highlights for December 12, 2017
12/12/2017
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Advance Directives for Dementia
12/12/2017
Gaster B, Larson EB, Curtis J.
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This Viewpoint discusses the unique challenges of crafting meaningful advance directives for patients with dementia and proposes a framework that accounts for changes in goals of care that might occur along the continuum of cognitive decline.

The Need for Research to Improve Quality and Quantity of Transplant Organ Donation
12/12/2017
Childress JF.
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This Viewpoint discusses a 2017 National Academies of Sciences, Engineering, and Medicine report about ways to support research on pretransplantation organs to reduce organ waste, upgrade the quality and quantity of transplants, and improve patient outcomes.

Contraceptive Coverage and the Balance Between Conscience and Access
12/12/2017
Stahl RY, Lynch H.
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This Viewpoint discusses the Trump administration’s 2017 change to ACA provisions, which exempts employers with religious or moral objections to contraception from including coverage for contraceptives in their insurance plans.

High Costs of FDA Approval for Formerly Unapproved Marketed Drugs
12/12/2017
Hakim A, Gupta R, Ross JS.
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This Viewpoint describes how the US Food and Drug Administration’s 2006 Unapproved Drugs Initiative may have unintentionally made generic drugs more expensive and inaccessible and proposes policy reforms to address the harms of those price increases.

A Fair Interpretation
12/12/2017
DeForest A.
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In this essay, the author urges precision language when referring to foreign language interpreters as a recognition that words outside of medicine mean something too.

Deep Learning Algorithms for Detection of Lymph Node Metastases From Breast Cancer
12/12/2017
Golden J.
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Artificial intelligence (AI), the theory and development of computer systems able to perform tasks that normally require human intelligence, is creeping into almost every facet of modern life. Familiar examples include computer chess games, speech recognition, intelligent routing in content delivery networks, and autonomous driving cars. In the financial sector, AI is routinely used for fraud detection, algorithmic trading, and chatbots (ie, computer programs that appear to conduct conversations via auditory or textual methods, such as with online virtual assistants).

Menopausal Hormone Therapy for Primary Prevention of Chronic Disease
12/12/2017
Lewis CE, Wellons MF.
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In this issue of JAMA, the US Preventive Services Task Force (USPSTF) presents a Recommendation Statement and an accompanying Evidence Report that consider the risks and benefits of menopausal hormone therapy for primary prevention of chronic conditions and arrive at a grade D recommendation. The recommendations are based only on evidence from randomized trials and do not pertain to women considering hormone therapy for vasomotor symptoms, given the USPSTF mandate to consider specific preventive care services for patients without related signs and symptoms of illness.

Effect of Levothyroxine on Miscarriage Among Women With Normal Thyroid Function Undergoing IVF
12/12/2017
Wang H, Gao H, Chi H, et al.
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This randomized clinical trial compares the effects of levothyroxine vs placebo on pregnancy outcomes among women with normal thyroid function and positive antithyroperoxidase antibodies undergoing in vitro fertilization and embryo transfer in Beijing, China.

Machine Learning Detection of Breast Cancer Lymph Node Metastases
12/12/2017
Ehteshami Bejnordi B, Veta M, Johannes van Diest P, et al.
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This diagnostic accuracy study compares the ability of machine learning algorithms vs clinical pathologists to detect cancer metastases in whole-slide images of axillary lymph nodes dissected from women with breast cancer.

Machine Learning Screen for Diabetic Retinopathy and Other Eye Diseases
12/12/2017
Ting D, Cheung C, Lim G, et al.
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This diagnostic accuracy study compares the performance of deep learning systems vs eye professionals for detecting referable and vision-threatening diabetic retinopathy, glaucoma, and other eye diseases in retinal images from Chinese, Indian, and Malaysian patients.

USPSTF Recommendation Statement: Hormone Therapy After Menopause
12/12/2017
, Grossman DC, Curry SJ, et al.
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This Recommendation Statement from the US Preventive Services Task Force recommends against use of hormone therapy for primary prevention of chronic conditions in postmenopausal women (D recommendation).

USPSTF Evidence Review: Hormones for Chronic Disease Primary Prevention
12/12/2017
Gartlehner G, Patel SV, Feltner C, et al.
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This systematic review to support the 2017 update of the US Preventive Services Task Force Recommendation Statement on use of hormone therapy summarizes published evidence on the benefits and harms of hormone therapy for primary prevention of chronic conditions in postmenopausal women.

Free-Response Receiver Operating Characteristic Curves to Assess Machine Diagnosis Accuracy
12/12/2017
Moskowitz CS.
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This JAMA Guide to Statistics and Methods discusses the use of free-response receiver operating characteristic curves to test the accuracy of computer algorithms to detect the localization of disease on pathology slide images.

Availability of Pharmacist-Prescribed Contraception in California, 2017
12/12/2017
Gomez A.
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This survey study estimates the extent to which pharmacies in California are making pharmacist-prescribed contraception available since it was permitted, but not required, in April 2016.

Radiofrequency Denervation for Chronic Low Back Pain
12/12/2017
Vorobeychik Y, Stojanovic MP, McCormick ZL.
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To the Editor Chronic low back pain is a symptom that may originate from a variety of lumbosacral structures. Thus, identifying the correct anatomic source of pain is essential for selecting the appropriate treatment. Numerous studies including, but not limited to, investigations by MacVicar et al and Dreyfuss et al have demonstrated excellent clinical outcomes for radiofrequency denervation when rigorous selection criteria were applied to establish the correct diagnosis and specific procedural technique is used.

Radiofrequency Denervation for Chronic Low Back Pain
12/12/2017
Rimmalapudi V, Buchalter J, Calodney A.
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To the Editor The study by Dr Juch and colleagues investigated the effect of radiofrequency denervation plus an exercise program compared with the exercise program alone for patients with chronic low back pain. We note several flaws in the design of the study.

Radiofrequency Denervation for Chronic Low Back Pain
12/12/2017
Kao M, Leong MS, Mackey S.
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To the Editor Dr Juch and colleagues found that radiofrequency denervation plus exercise provided no clinically significant improvement compared with exercise alone, using a minimal clinically important difference (MCID) of at least 2.0 points on an 11-point numeric rating scale for low back pain from Ostelo et al. For example, in the facet joint trial, Juch and colleagues compared the mean numeric rating scale scores between the 2 treatment groups at the same time point of 3 months. This difference, at the adjusted level of −0.18, was less than the MCID of 2.0.

Radiofrequency Denervation for Chronic Low Back Pain—Reply
12/12/2017
Maas E, Juch J, Huygen F.
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In Reply Dr Vorobeychik and colleagues suggest that numerous studies demonstrate excellent clinical outcomes for radiofrequency denervation. A Cochrane review shows low- to very low–quality evidence for the studied procedures. Providing higher-quality evidence was the main reason for initiating the Mint trials.

Contact Precautions for Multidrug-Resistant Organisms
12/12/2017
Peterson LR.
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To the Editor The Viewpoint by Dr Morgan and colleagues raised questions regarding contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), stating that contact precautions “may pose an opportunity cost to infection control” and that “hospitals should reconsider best use of contact precautions for endemic MRSA and VRE.” Importantly, available evidence supports an opposing position.







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