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Highlights for October 3, 2017
3/10/2017
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Digital Phenotyping
3/10/2017
Insel TR.
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In this Viewpoint, Thomas Insel discusses the possibility that sensor, keyboard, and voice and speech data from smartphones might be used as a digital phenotype to improve patient-specific measurement-based behavioral care.

Talking to Machines About Personal Mental Health Problems
3/10/2017
Miner AS, Milstein A, Hancock JT.
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This Viewpoint describes trends in the use of conversational artificial intelligence in mental health care and discusses potential advantages and risks to patients and the public.

Measuring the Cost of Quality Measurement
3/10/2017
Schuster MA, Onorato SE, Meltzer DO.
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This Viewpoint discusses the importance of accounting for the cost of measurement in establishing the value of hospital quality measures.

Author and Nonauthor Contributions in Scholarly Publications
3/10/2017
Mentzelopoulos SD, Zakynthinos SG.
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This Viewpoint discusses the importance of research authorship for academic promotion and proposes revision of research integrity codes to define nonauthor contributions and distinguish nonauthor from author contributions to discourage awarding of authorship to nonauthor collaborators.

An OB/GYN’s Personal Story of Pregnancy Loss
3/10/2017
Kelley AS.
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It had been 1 week since I learned that our baby, at 8 weeks’ gestation, no longer had a heartbeat.

Trying to Improve Sepsis Care in Low-Resource Settings
3/10/2017
Machado FR, Angus DC.
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Earlier this year, the World Health Organization recognized sepsis as a global health problem, responsible for millions of preventable deaths every year, and adopted a resolution targeting the prevention, diagnosis, and treatment of sepsis, especially in low- and middle-income countries. Although most sepsis cases are assumed to occur in low- and middle-income countries, nearly all research on both the epidemiology of sepsis and optimal treatment comes from high-income countries.

Counting Sepsis, an Imprecise but Improving Science
3/10/2017
Rudd KE, Delaney A, Finfer S.
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Sepsis, most succinctly defined as organ dysfunction due to infection, is estimated to account for more than 5 million deaths around the world each year and to cause or contribute to approximately half of all deaths occurring in hospitals in the United States. A 2016 report from the Healthcare Cost and Utilization Project estimated the cost of treating sepsis in US hospitals in 2013 at $24 billion, making it the most expensive condition treated in US hospitals among all payers. In recent years, the substantial burden of sepsis at the individual, health system, and societal levels has become increasingly recognized by the medical community and the public, culminating in the World Health Organization (WHO) adopting the Improving the Prevention, Diagnosis, and Management of Sepsis resolution at the World Health Assembly in May 2017.

Announcing JAMA Network Open —A New Journal From The JAMA Network
3/10/2017
Rivara FP, Easley TJ, Flanagin A, et al.
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We are pleased to announce that in early 2018, The JAMA Network will launch a new journal—JAMA Network Open. Our editorial goal is to publish the very best clinical research across all disciplines, serving the worldwide community of investigators and clinicians and meeting the evolving needs and requirements of authors and funders. With the launch of JAMA Network Open, we simultaneously assert our editorial commitment to excellence and to the authorship community regardless of requirements of funders. This will be a fully open access journal and follows the launch of JAMA Oncology in 2015 and JAMA Cardiology in 2016, which are hybrid journals offering open access options for research articles. Frederick P. Rivara, MD, MPH, current editor in chief of JAMA Pediatrics, will be the editor in chief of JAMA Network Open.

Effects of an Early Resuscitation Protocol on Sepsis Mortality in Zambia
3/10/2017
Andrews B, Semler MW, Muchemwa L, et al.
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This randomized clinical trial compares the effects of an early resuscitation sepsis protocol (administration of intravenous fluids, vasopressors, and blood transfusion) vs usual care for prevention of in-hospital mortality among adults with sepsis and hypotension in Zambia.

Incidence and Trends of Sepsis in US Hospitals, 2009-2014
3/10/2017
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.

Bleeding Risk in Nonvalvular AF on NOACs With vs Without Other Medications
3/10/2017
Chang S, Chou I, Yeh Y, et al.
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This cohort study uses data from the Taiwan National Health Insurance database to assess the association between use of non–vitamin K oral anticoagulants with vs without concurrent medications and risk of major bleeding in patients with nonvalvular atrial fibrillation.

Antithrombotic Medication Use and Hematuria-Related Complications
3/10/2017
Wallis CD, Juvet T, Lee Y, et al.
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This population-based study characterize rates of hematuria-related complications among patients taking antithrombotic medications.

Cancer DNA in the Circulation
3/10/2017
Husain H, Velculescu VE.
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This JAMA Insights article explains cell-free circulating tumor DNA and its utility in noninvasive cancer detection and characterization, prediction of treatment response, monitoring of disease relapse, and identification of mechanisms of resistance to targeted therapies.

LABA Combination Treatment for Patients With Stable Chronic Obstructive Pulmonary Disease
3/10/2017
Horita N, Nagashima A, Kaneko T.
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This Clinical Evidence Synopsis summarizes a Cochrane review on the efficacy of long-acting β-agonists (LABAs) combined with long-acting muscarinic antagonists vs LABAs combined with inhaled corticosteroids for patients with stable chronic obstructive pulmonary disease.

Urinalysis in the Evaluation of Proliferative Glomerulonephritis
3/10/2017
Harel Z, Simel DL, Wald R.
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A 62-year-old woman with hypertension and who had a urinary tract infection with hematuria 1 year ago presented with elevated serum creatinine. Her urinalysis was positive for hematuria, red blood cell casts, and proteinuria. How do you interpret the test results?

Incidence of Measles in the United States, 2001-2015
3/10/2017
Clemmons NS, Wallace GS, Patel M, et al.
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This study uses Centers for Disease Control and Prevention data to characterize trends in the incidence of measles among US residents from 2001 to 2015.

Ferric Carboxymaltose to Treat Isovolemic Anemia
3/10/2017
Yu Z, Li T.
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To the Editor In a randomized clinical trial, Dr Kim and colleagues found that among adults with isovolemic anemia following radical gastrectomy, ferric carboxymaltose compared with placebo resulted in improved hemoglobin response at 12 weeks. We are concerned about the uncertain internal validity and selective outcome reporting in the article.

Ferric Carboxymaltose to Treat Isovolemic Anemia—Reply
3/10/2017
Kim Y, Yang H.
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In Reply Drs Yu and Li were concerned that the results of the Ferric Carboxymaltose for Acute Isovolemic Anemia Following Gastrectomy (FAIRY) trial may have been skewed because patients with other causes of anemia were not excluded. Limited data on the reversal of certain types of anemia (such as sickle cell and HIV/AIDS-induced anemias) with intravenous iron demonstrate the importance of excluding such patient populations. However, 3 points ameliorate this concern. First, the exclusion criteria did eliminate patients with anemia induced by chronic, inherited, or severe conditions. Among other specifications, patients with concurrent medical conditions that jeopardized health, active infection or inflammation, or an American Society of Anesthesiologist (ASA) score greater than 3 were excluded from the study. Second, the prevalence of other anemia types that may have been overlooked by the exclusion criteria is small and should have been distributed equally in both groups. A study that evaluated the incidence and etiology of postgastrectomy anemia in 161 patients with gastric cancer found that non–iron-related causes of anemia—such as megaloblastic and vitamin B12 deficiency anemias—were rare.

Different Iron Preparations for Young Children With Iron-Deficiency Anemia
3/10/2017
Fujita T.
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To the Editor In a randomized clinical trial comparing the efficacy of different iron drops containing the same amounts of essential iron for infants and young children (aged 9-48 months) with nutritional iron-deficiency anemia (IDA), ferrous sulfate drops increased mean hemoglobin concentration by 4.0 g/dL during the study period of 12 weeks compared with 3.4 g/dL with iron polysaccharide complex drops (difference, 1.0 g/dL; 95% CI, 0.4-1.6 g/dL). Consequently, Dr Powers and colleagues recommended ferrous sulfate as the first-line treatment for IDA among infants and young children.







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