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AI Can’t Worry About Patients, and a Clinical Ethicist Says That Matters 人工智能不能为患者操心,临床伦理学家说这很重要
Pub Date : 2024-11-15 DOI: 10.1001/jama.2024.23525
Yulin Hswen, Jennifer Abbasi
This Medical News article is an interview with Sarah C. Hull, MD, MBE, a cardiologist and clinical ethicist at Yale School of Medicine, about appropriate boundaries for use of artificial intelligence in clinical settings.
医学新闻》的这篇文章是对耶鲁大学医学院心脏病学家、临床伦理学家莎拉-赫尔(Sarah C. Hull)医学博士的采访,内容涉及在临床环境中使用人工智能的适当界限。
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引用次数: 0
Election Night 选举之夜
Pub Date : 2024-11-15 DOI: 10.1001/jama.2024.25200
Andrew F. Beck
While watching the 2024 election night results and considering possible health care policies, a pediatrician reflects on his role in engaging in conversations about politics and policy as an advocate for patients.
在观看 2024 年大选之夜的结果并考虑可能的医疗保健政策时,一位儿科医生反思了他作为病人的代言人在参与政治和政策对话中所扮演的角色。
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引用次数: 0
The Burden of Choice 选择的负担
Pub Date : 2024-11-14 DOI: 10.1001/jama.2024.21969
Jessica Chen
In this narrative medicine essay, a family planning fellow discusses how undergoing an abortion, the procedure she specializes in performing, has deepened her perception of the concept of the difficult components of choice and helped her understand the difference in providing vs experiencing care.
在这篇医学叙事文章中,一位计划生育研究员讨论了她是如何通过人工流产(她擅长实施的手术)来加深她对选择困难这一概念的认识,并帮助她理解提供护理与体验护理之间的区别。
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引用次数: 0
The Carceral-Community Cascade and HCV Elimination 胴体-社区级联与消除丙型肝炎病毒
Pub Date : 2024-11-14 DOI: 10.1001/jama.2024.20602
Matthew J. Akiyama, Tessa Bialek, Raphael Simonson
This Viewpoint discusses a sector-wide approach to hepatitis C virus elimination, including not only jails and prisons, but also community supervision and alternatives to incarceration programs.
本观点讨论了消除丙型肝炎病毒的全部门方法,不仅包括监狱,还包括社区监督和替代监禁计划。
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引用次数: 0
Artemisinin Partial Resistance in Ugandan Children With Complicated Malaria 乌干达并发疟疾儿童对青蒿素的部分抗药性
Pub Date : 2024-11-14 DOI: 10.1001/jama.2024.22343
Ryan C. Henrici, Ruth Namazzi, Giselle Lima-Cooper, Charles Kato, Sadati Aliwuya, Jamille G. Dombrowski, Sade Pratt, Susana Campino, Andrea L. Conroy, Colin J. Sutherland, Chandy C. John, Robert O. Opoka
This study assesses artemisinin partial resistance, Pfkelch13 variations, and malaria recrudescence in Ugandan children with complicated malaria.
本研究评估了患有复杂疟疾的乌干达儿童对青蒿素的部分抗药性、Pfkelch13 变异和疟疾复发情况。
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引用次数: 0
Trends in Hospitalizations and Liver Transplants Associated With Alcohol-Induced Liver Disease 与酒精性肝病有关的住院治疗和肝移植趋势
Pub Date : 2024-11-14 DOI: 10.1001/jama.2024.21503
Vrishketan Sethi, Ramon Bataller, Hao Liu, Kristine M. Ruppert, Michele Molinari
This study investigates trends in hospitalization and liver transplant rates in the US from 2005 to 2021 associated with alcohol-induced liver disease.
本研究调查了 2005 年至 2021 年美国与酒精引起的肝病有关的住院率和肝移植率的趋势。
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引用次数: 0
Tenofovir and Hepatitis B Virus Transmission During Pregnancy 替诺福韦与孕期乙肝病毒传播
Pub Date : 2024-11-14 DOI: 10.1001/jama.2024.22952
Calvin Q. Pan, Erhei Dai, Zhongfu Mo, Hua Zhang, Thomas Q. Zheng, Yuming Wang, Yingxia Liu, Tianyan Chen, Suwen Li, Cuili Yang, Jinjuan Wu, Xiuli Chen, Huaibin Zou, Shanshan Mei, Lin Zhu
ImportanceStandard care for preventing mother-to-child transmission (MTCT) of hepatitis B virus (HBV) in highly viremic mothers consists of maternal antiviral prophylaxis beginning at gestational week 28 combined with an HBV vaccine series and HBV immune globulin (HBIG) at birth. However, HBIG is unavailable in some resource-limited areas.ObjectiveTo determine whether initiating tenofovir disoproxil fumarate (TDF) at gestational week 16 combined with HBV vaccinations for infants is noninferior to the standard care of TDF at gestational week 28 combined with HBV vaccinations and HBIG for infants in preventing MTCT in mothers with HBV and high levels of viremia.Design, Setting, and ParticipantsAn unblinded, 2-group, randomized, noninferiority clinical trial was conducted in 7 tertiary care hospitals in China. A total of 280 pregnant individuals (who all identified as women) with HBV DNA levels greater than 200 000 IU/mL were enrolled between June 4, 2018, and February 8, 2021. The final follow-up occurred on March 1, 2022.InterventionsPregnant individuals were randomly assigned to receive either TDF starting at gestational week 16 with HBV vaccinations for the infant or TDF starting at gestational week 28 with HBV vaccinations and HBIG administered to the infant.Main Outcomes and MeasuresThe primary outcome was the MTCT rate, defined as detectable HBV DNA greater than 20 IU/mL or hepatitis B surface antigen positivity in infants at age 28 weeks. Noninferiority was established if the MTCT rate in the experimental group did not increase by more than an absolute difference of 3% compared with the standard care group, as measured by the upper limit of the 2-sided 90% CI.ResultsAmong 280 pregnant individuals who enrolled in the trial (mean age, 28 years; mean gestational age at enrollment, 16 weeks), 265 (95%) completed the study. Among all live-born infants, using the last observation carried forward, the MTCT rate was 0.76% (1/131) in the experimental group and 0% (0/142) in the standard care group. In the per-protocol analysis, the MTCT rate was 0% (0/124) in the experimental group and 0% (0/141) in the standard care group. The between-group difference was 0.76% (upper limit of the 2-sided 90% CI, 1.74%) in all live-born infants and 0% (upper limit of the 2-sided 90% CI, 1.43%) in the per-protocol analysis. Both comparisons met the criterion for noninferiority. Rates of congenital defects and malformations were 2.3% (3/131) in the experimental group and 6.3% (9/142) in the standard care group (difference, 4% [2-sided 95% CI, −8.8% to 0.7%]).Conclusions and RelevanceAmong pregnant women with HBV and high levels of viremia, TDF beginning at gestational week 16 combined with HBV vaccination for infants was noninferior to the standard care of TDF beginning at gestational week 28 combined with HBIG and HBV vaccination for infants. These results support beginning TDF at gestational week 16 combined with infant HBV vaccine to prevent MTCT of HBV in geograph
重要性预防高病毒血症母亲乙型肝炎病毒(HBV)母婴传播(MTCT)的标准护理包括从妊娠第 28 周开始的母体抗病毒预防以及 HBV 疫苗系列和出生时的 HBV 免疫球蛋白(HBIG)。目的 确定在妊娠第 16 周开始服用富马酸替诺福韦二吡呋酯(TDF)并为婴儿接种 HBV 疫苗,在预防感染 HBV 和高病毒血症母亲的 MTCT 方面是否不劣于在妊娠第 28 周开始服用 TDF 并为婴儿接种 HBV 疫苗和 HBIG 的标准疗法。在中国的 7 家三甲医院开展了一项非盲、两组、随机、非劣效性临床试验。2018年6月4日至2021年2月8日期间,共有280名HBV DNA水平大于200 000 IU/mL的孕妇(均为女性)入组。干预措施孕妇被随机分配接受TDF治疗,从孕16周开始,为婴儿接种HBV疫苗;或从孕28周开始接受TDF治疗,为婴儿接种HBV疫苗和HBIG。主要结果和测量指标主要结果是母婴传播率,定义为28周时婴儿体内检测到的HBV DNA大于20 IU/mL或乙肝表面抗原阳性。如果实验组的母婴传播率与标准护理组相比增加的绝对差值不超过 3%,则确定为非劣效性,以双侧 90% CI 的上限来衡量。结果在 280 名参加试验的孕妇中(平均年龄 28 岁;参加试验时的平均胎龄 16 周),有 265 人(95%)完成了研究。在所有活产婴儿中,以最后一次观察结果为准,实验组的母婴传播率为 0.76%(1/131),标准护理组为 0%(0/142)。在按协议分析中,实验组的母婴传播率为 0%(0/124),标准护理组为 0%(0/141)。在所有活产婴儿中,组间差异为 0.76%(双侧 90% CI 上限,1.74%),在按方案分析中,组间差异为 0%(双侧 90% CI 上限,1.43%)。两项比较均符合非劣效性标准。实验组先天缺陷和畸形发生率为 2.3% (3/131),标准治疗组为 6.3% (9/142)(差异为 4% [双侧 95% CI,-8.8% 至 0.7%])。结论和相关性在感染 HBV 且病毒血症水平较高的孕妇中,从孕 16 周开始服用 TDF 并为婴儿接种 HBV 疫苗的效果不优于从孕 28 周开始服用 TDF 并为婴儿接种 HBIG 和 HBV 疫苗的标准治疗方法。这些结果支持在没有 HBIG 的地区从孕 16 周开始 TDF 与婴儿 HBV 疫苗接种相结合来预防 HBV 的 MTCT:NCT03476083
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引用次数: 0
Discontinuation of Glucagon-Like Peptide-1 Receptor Agonists 停用胰高血糖素样肽-1 受体激动剂
Pub Date : 2024-11-13 DOI: 10.1001/jama.2024.22284
Sadiya S. Khan, Chiadi E. Ndumele, Dhruv S. Kazi
This Viewpoint discusses the health benefits of glucagon-like peptide-1 receptor agonists (GLP-1 RAs); summarizes the clinical, policy, and equity implications of GLP-1 RA discontinuation; and calls for the identification and implementation of strategies to improve long-term adherence to GLP-1 RA therapy.
本观点讨论了胰高血糖素样肽-1 受体激动剂(GLP-1 RA)对健康的益处;总结了停用 GLP-1 RA 对临床、政策和公平的影响;并呼吁确定和实施改善长期坚持 GLP-1 RA 治疗的策略。
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引用次数: 0
Representativeness of Studies Required Under Medicare’s Coverage With Evidence Development Program 医疗保险 "证据开发覆盖计划 "所要求的研究的代表性
Pub Date : 2024-11-13 DOI: 10.1001/jama.2024.20493
Maryam Mooghali, Sanket S. Dhruva, Joseph S. Ross, Reshma Ramachandran
This study evaluates representation of older adults, women, and people of Black race and Hispanic ethnicity in Centers for Medicare &amp;amp; Medicaid Services national coverage determination (NCD) and coverage with evidence development (CED)–approved studies.
本研究评估了老年人、妇女、黑人和西班牙裔在联邦医疗保险和医疗补助服务中心(Centers for Medicare &amp;amp; Medicaid Services)批准的国家承保范围确定(NCD)和证据开发承保范围确定(CED)研究中的代表性。
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引用次数: 0
Symptom Screening Linked to Care Pathways for Pediatric Patients With Cancer 症状筛查与儿科癌症患者的护理路径有关
Pub Date : 2024-11-13 DOI: 10.1001/jama.2024.19585
L. Lee Dupuis, Emily Vettese, Allison C. Grimes, Melissa P. Beauchemin, Lisa M. Klesges, Christina Baggott, Jenna Demedis, Catherine Aftandilian, David R. Freyer, Nicole Crellin-Parsons, Etan Orgel, David Dickens, Kara M. Kelly, Wade Kyono, Alexandra Walsh, Farha Sherani, Daniel Cannone, Andrea D. Orsey, Allison A. King, Lolie Yu, Wendy Woods-Swafford, Scott M. Bradfield, Michael E. Roth, Adam J. Esbenshade, Emi H. Caywood, Vibhuti Agarwal, Ramamoorthy Nagasubramanian, George A. Tomlinson, Lillian Sung
ImportancePediatric patients with cancer commonly experience severely bothersome symptoms. The effectiveness of routine symptom screening with symptom feedback and symptom management care pathways is unknown.ObjectiveTo determine whether thrice-weekly symptom screening with symptom feedback and management care pathways, compared with usual care, improves overall self-reported symptom scores measured by the Symptom Screening in Pediatrics Tool (SSPedi) in pediatric patients with cancer.Design, Setting, and ParticipantsThis cluster randomized trial enrolled participants between July 2021 and August 2023 from 20 pediatric cancer centers in the US. Patients newly diagnosed with cancer aged 8 to 18 years receiving any cancer treatment were included. Twenty sites were randomized to provide symptom screening (n = 10) vs usual care (n = 10); 221 participants were enrolled at intervention sites and 224 participants at control sites. The date of final follow-up was October 18, 2023.InterventionSymptom screening included providing thrice-weekly symptom screening prompts to participants, email alerts to the health care team, and locally adapted symptom management care pathway implementation.Main Outcomes and MeasuresThe primary outcome was self-reported total SSPedi score at week 8 (range, 0-60; higher scores indicate more bothersome). Secondary outcomes were Patient-Reported Outcomes Measurement Information System Fatigue score (mean [SD] score, 50 [10]; higher scores indicate more fatigue), Pediatric Quality of Life 3.0 Acute Cancer Module scores (range, 0-100; higher scores indicate better health), symptom documentation and interventions at week 8, and unplanned health care encounters.ResultsA total of 445 participants (median [range] age, 14.8 [8.1-18.9] years; 58.9% males) were enrolled. The mean (SD) 8-week SSPedi score was 7.9 (7.2) in the symptom screening group vs 11.4 (8.7) in the usual care group. Symptom screening was associated with significantly better 8-week total SSPedi scores (adjusted mean difference, −3.8 [95% CI, −6.4 to −1.2]) and less bothersome individual symptoms, with 12 of 15 symptoms being statistically significantly reduced. There was no difference in fatigue or quality of life. The mean (SD) number of emergency department visits was 0.77 (1.12) in the symptom screening group and 0.45 (0.81) in the usual care group. There were significantly more emergency department visits in the symptom screening group (rate ratio, 1.72 [95% CI, 1.03-2.87]).ConclusionsSymptom screening with symptom feedback and symptom management care pathways was associated with improved symptom scores and increased symptom-specific interventions. Future work should integrate symptom screening into routine clinical care.Trial RegistrationClinicalTrials.gov Identifier: NCT04614662
重要性儿童癌症患者通常会出现严重的症状。目标与常规护理相比,确定每周三次的症状筛查、症状反馈和症状管理护理路径是否能改善儿科癌症患者通过儿科症状筛查工具(SSPedi)测量的总体自我报告症状评分。设计、设置和参与者这项群组随机试验在 2021 年 7 月至 2023 年 8 月期间从美国 20 家儿科癌症中心招募参与者。新确诊的癌症患者年龄在 8 到 18 岁之间,接受过任何癌症治疗。20个试验点被随机分配为提供症状筛查(10人)与常规护理(10人);干预试验点有221名参与者,对照试验点有224名参与者。干预措施症状筛查包括每周三次向参与者提供症状筛查提示、向医疗团队发送电子邮件提醒,以及实施适合当地情况的症状管理护理路径。主要结果和测量指标主要结果是第8周时自我报告的SSPedi总分(范围为0-60分;分数越高表示越困扰)。次要结果为患者报告结果测量信息系统疲劳评分(平均[标度]为50[10]分;分数越高表示越疲劳)、儿科生活质量3.0急性癌症模块评分(范围为0-100分;分数越高表示健康状况越好)、第8周的症状记录和干预措施以及计划外医疗就诊情况。 结果共有445名参与者(年龄中位数[范围]为14.8[8.1-18.9]岁;58.9%为男性)参加了研究。症状筛查组的 8 周 SSPedi 平均得分(标清)为 7.9 (7.2),而常规护理组为 11.4 (8.7)。症状筛查组患者的 8 周 SSPedi 总分明显提高(调整后的平均差异为-3.8 [95% CI, -6.4 to -1.2] ),个别症状也有所减轻,15 种症状中有 12 种在统计学上明显减轻。在疲劳或生活质量方面没有差异。症状筛查组的平均(标清)急诊就诊次数为 0.77(1.12)次,常规护理组为 0.45(0.81)次。症状筛查组的急诊就诊人数明显多于常规护理组(比率比为 1.72 [95% CI, 1.03-2.87])。今后的工作应将症状筛查纳入常规临床护理中:NCT04614662
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引用次数: 0
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