In this narrative medicine essay, a primary care physician-psychiatrist offers a prayer to save his son who needs a heart transplant and to comfort the donor family who are still unaware that they will experience a lifetime of pain and loss.
{"title":"Match Day","authors":"Cerrone Cohen","doi":"10.1001/jama.2024.28556","DOIUrl":"https://doi.org/10.1001/jama.2024.28556","url":null,"abstract":"In this narrative medicine essay, a primary care physician-psychiatrist offers a prayer to save his son who needs a heart transplant and to comfort the donor family who are still unaware that they will experience a lifetime of pain and loss.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michail Ignatiadis, Andrew Bailey, Heather McArthur, Sarra El-abed, Evandro de Azambuja, Otto Metzger, Stephen Y. Chui, Max Dieterich, Thomas Perretti, Esther Shearer-Kang, Luciana Molinero, Günther G. Steger, Jacek Jassem, Soo Chin Lee, Michaela Higgins, Jose Zarba, Marcus Schmidt, Henry Gomez, Angel Guerrero Zotano, Luca Moscetti, Joanne Chiu, Elisabetta Munzone, Noa Efrat Ben-Baruch, Emilio Bajetta, Shinji Ohno, Seock-Ah Im, Gustavo Werutsky, Einav Nili Gal-Yam, Xavier Gonzalez Farre, Ling-Ming Tseng, William Jacot, Oleg Gluz, Zhimin Shao, Yaroslav Shparyk, Anastasia Zimina, Eric Winer, David A. Cameron, Giuseppe Viale, Shigehira Saji, Richard Gelber, Martine Piccart
ImportanceTriple-negative breast cancer is an aggressive subtype with a high incidence in young patients, a high incidence in non-Hispanic Black women, and a high risk of progression to metastatic cancer, a devastating sequela with a 12- to 18-month life expectancy. Until recently, one strategy for treating early-stage triple-negative breast cancer was chemotherapy after surgery. However, it was not known whether the addition of immune therapy to postsurgery chemotherapy would be beneficial.ObjectiveTo evaluate the addition of immune therapy in the form of atezolizumab to postoperative chemotherapy in patients with the high-risk triple-negative breast cancer subtype.Design, Setting, and ParticipantsIn this open-label international randomized phase 3 trial conducted in more than 330 centers in 31 countries, patients undergoing surgery as initial treatment for stage II or III triple-negative breast cancer were enrolled between August 2, 2018, and November 11, 2022. The last patient follow-up was on August 18, 2023.InterventionsPatients were randomized (1:1) to receive standard chemotherapy for 20 weeks with (n = 1101) or without (n = 1098) the immune therapy drug atezolizumab for up to 1 year.Main Outcomes and MeasuresThe primary end point was invasive disease-free survival (time between randomization and invasive breast cancer in the same or opposite breast, recurrence elsewhere in the body, or death from any cause).ResultsThe median age of enrolled patients was 53 years and most self-reported as being of Asian or White race and neither Latino nor Hispanic ethnicity. The study independent data monitoring committee halted enrollment at 2199 of 2300 planned patients. All patients stopped atezolizumab following a planned early interim and futility analysis. The trial continued to a premature final analysis. With invasive disease-free survival events in 141 patients (12.8%) treated with atezolizumab-chemotherapy and 125 (11.4%) with chemotherapy alone (median follow-up, 32 months), the final stratified invasive disease-free survival hazard ratio was 1.11 (95% CI, 0.87-1.42; P = .38). Compared with chemotherapy alone, the regimen of atezolizumab plus chemotherapy was associated with more treatment-related grade 3 or 4 adverse events (54% vs 44%) but similar incidences of fatal adverse events (0.8% vs 0.6%) and adverse events leading to chemotherapy discontinuation. Chemotherapy exposure was similar in the 2 treatment groups.Conclusions and RelevanceThe addition of the immune therapy drug atezolizumab to chemotherapy after surgery did not provide benefit among patients with triple-negative breast cancer who are at high risk of recurrent disease.Trial RegistrationClinicalTrials.gov Identifier: NCT03498716
{"title":"Adjuvant Atezolizumab for Early Triple-Negative Breast Cancer","authors":"Michail Ignatiadis, Andrew Bailey, Heather McArthur, Sarra El-abed, Evandro de Azambuja, Otto Metzger, Stephen Y. Chui, Max Dieterich, Thomas Perretti, Esther Shearer-Kang, Luciana Molinero, Günther G. Steger, Jacek Jassem, Soo Chin Lee, Michaela Higgins, Jose Zarba, Marcus Schmidt, Henry Gomez, Angel Guerrero Zotano, Luca Moscetti, Joanne Chiu, Elisabetta Munzone, Noa Efrat Ben-Baruch, Emilio Bajetta, Shinji Ohno, Seock-Ah Im, Gustavo Werutsky, Einav Nili Gal-Yam, Xavier Gonzalez Farre, Ling-Ming Tseng, William Jacot, Oleg Gluz, Zhimin Shao, Yaroslav Shparyk, Anastasia Zimina, Eric Winer, David A. Cameron, Giuseppe Viale, Shigehira Saji, Richard Gelber, Martine Piccart","doi":"10.1001/jama.2024.26886","DOIUrl":"https://doi.org/10.1001/jama.2024.26886","url":null,"abstract":"ImportanceTriple-negative breast cancer is an aggressive subtype with a high incidence in young patients, a high incidence in non-Hispanic Black women, and a high risk of progression to metastatic cancer, a devastating sequela with a 12- to 18-month life expectancy. Until recently, one strategy for treating early-stage triple-negative breast cancer was chemotherapy after surgery. However, it was not known whether the addition of immune therapy to postsurgery chemotherapy would be beneficial.ObjectiveTo evaluate the addition of immune therapy in the form of atezolizumab to postoperative chemotherapy in patients with the high-risk triple-negative breast cancer subtype.Design, Setting, and ParticipantsIn this open-label international randomized phase 3 trial conducted in more than 330 centers in 31 countries, patients undergoing surgery as initial treatment for stage II or III triple-negative breast cancer were enrolled between August 2, 2018, and November 11, 2022. The last patient follow-up was on August 18, 2023.InterventionsPatients were randomized (1:1) to receive standard chemotherapy for 20 weeks with (n = 1101) or without (n = 1098) the immune therapy drug atezolizumab for up to 1 year.Main Outcomes and MeasuresThe primary end point was invasive disease-free survival (time between randomization and invasive breast cancer in the same or opposite breast, recurrence elsewhere in the body, or death from any cause).ResultsThe median age of enrolled patients was 53 years and most self-reported as being of Asian or White race and neither Latino nor Hispanic ethnicity. The study independent data monitoring committee halted enrollment at 2199 of 2300 planned patients. All patients stopped atezolizumab following a planned early interim and futility analysis. The trial continued to a premature final analysis. With invasive disease-free survival events in 141 patients (12.8%) treated with atezolizumab-chemotherapy and 125 (11.4%) with chemotherapy alone (median follow-up, 32 months), the final stratified invasive disease-free survival hazard ratio was 1.11 (95% CI, 0.87-1.42; <jats:italic>P</jats:italic> = .38). Compared with chemotherapy alone, the regimen of atezolizumab plus chemotherapy was associated with more treatment-related grade 3 or 4 adverse events (54% vs 44%) but similar incidences of fatal adverse events (0.8% vs 0.6%) and adverse events leading to chemotherapy discontinuation. Chemotherapy exposure was similar in the 2 treatment groups.Conclusions and RelevanceThe addition of the immune therapy drug atezolizumab to chemotherapy after surgery did not provide benefit among patients with triple-negative breast cancer who are at high risk of recurrent disease.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT03498716\">NCT03498716</jats:ext-link>","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Devin K. Schweppe, Brian J. Beliveau, Andrew N. Hoofnagle
This JAMA Insights explores the capability of proteomics to analyze thousands of proteins in patient samples, which could improve clinicians’ understanding of and ability to treat a wide range of diseases.
{"title":"Molecular Phenotyping With Proteomics","authors":"Devin K. Schweppe, Brian J. Beliveau, Andrew N. Hoofnagle","doi":"10.1001/jama.2024.28089","DOIUrl":"https://doi.org/10.1001/jama.2024.28089","url":null,"abstract":"This JAMA Insights explores the capability of proteomics to analyze thousands of proteins in patient samples, which could improve clinicians’ understanding of and ability to treat a wide range of diseases.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This Viewpoint discusses the need for the US to foster public-private partnerships, advance convergence science, and prioritize workforce development in order to maintain its position as a global leader in biomedical research, particularly in the face of rising competition from countries around the world.
{"title":"Toward a Unified Vision for US Biomedical Research","authors":"E. Albert Reece, Victor J. Dzau","doi":"10.1001/jama.2025.0893","DOIUrl":"https://doi.org/10.1001/jama.2025.0893","url":null,"abstract":"This Viewpoint discusses the need for the US to foster public-private partnerships, advance convergence science, and prioritize workforce development in order to maintain its position as a global leader in biomedical research, particularly in the face of rising competition from countries around the world.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David B Reuben,Thomas M Gill,Alan Stevens,Jeff Williamson,Elena Volpi,Maya Lichtenstein,Lee A Jennings,Rebecca Galloway,Jenny Summapund,Katy Araujo,David Bass,Lisa Weitzman,Zaldy S Tan,Leslie Evertson,Mia Yang,Katherine Currie,Aval-Na'Ree S Green,Sybila Godoy,Sitara Abraham,Jordan Reese,Rafael Samper-Ternent,Roxana M Hirst,Pamela Borek,Peter Charpentier,Can Meng,James Dziura,Yunshan Xu,Eleni A Skokos,Zili He,Sherry Aiudi,Peter Peduzzi,Erich J Greene,
ImportanceThe effectiveness of different approaches to dementia care is unknown.ObjectiveTo determine the effectiveness of health system-based, community-based dementia care, and usual care for persons with dementia and for caregiver outcomes.Design, Setting, and ParticipantsRandomized clinical trial of community-dwelling persons living with dementia and their caregivers conducted at 4 sites in the US (enrollment June 2019-January 2023; final follow-up, August 2023).InterventionsParticipants were randomized 7:7:1 to health system-based care provided by an advanced practice dementia care specialist (n = 1016); community-based care provided by a social worker, nurse, or licensed therapist care consultant (n = 1016); or usual care (n = 144).Main Outcomes and MeasuresPrimary outcomes were caregiver-reported Neuropsychiatric Inventory Questionnaire (NPI-Q) severity score for persons living with dementia (range, 0-36; higher scores, greater behavioral symptoms severity; minimal clinically important difference [MCID], 2.8-3.2) and Modified Caregiver Strain Index for caregivers (range, 0-26; higher scores, greater strain; MCID, 1.5-2.3). Three secondary outcomes included caregiver self-efficacy (range, 4-20; higher scores, more self-efficacy).ResultsAmong 2176 dyads (individuals with dementia, mean age, 80.6 years; 58.4%, female; and 20.6%, Black or Hispanic; caregivers, mean age, 65.2 years; 75.8%, female; and 20.8% Black or Hispanic), primary outcomes were assessed for more than 99% of participants, and 1343 participants (62% of those enrolled and 91% still alive and had not withdrawn) completed the study through 18 months. No significant differences existed between the 2 treatments or between treatments vs usual care for the primary outcomes. Overall, the least squares means (LSMs) for NPI-Q scores were 9.8 for health system, 9.5 for community-based, and 10.1 for usual care. The difference between health system vs community-based care was 0.30 (97.5% CI, -0.18 to 0.78); health system vs usual care, -0.33 (97.5% CI, -1.32 to 0.67); and community-based vs usual care, -0.62 (97.5% CI, -1.61 to 0.37). The LSMs for the Modified Caregiver Strain Index were 10.7 for health system, 10.5 for community-based, and 10.6 for usual care. The difference between health system vs community-based care was 0.25 (97.5% CI, -0.16 to 0.66); health system vs usual care, 0.14 (97.5% CI, -0.70 to 0.99); and community-based vs usual care, -0.10 (97.5% CI, -0.94 to 0.74). Only the secondary outcome of caregiver self-efficacy was significantly higher for both treatments vs usual care but not between treatments: LSMs were 15.1 for health system, 15.2 for community-based, and 14.4 for usual care. The difference between health system vs community-based care was -0.16 (95% CI, -0.37 to 0.06); health system vs usual care, 0.70 (95% CI, 0.26-1.14); and community-based vs usual care, 0.85 (95% CI, 0.42 to 1.29).Conclusions and RelevanceIn this randomized trial of dementia care programs
{"title":"Health System, Community-Based, or Usual Dementia Care for Persons With Dementia and Caregivers: The D-CARE Randomized Clinical Trial.","authors":"David B Reuben,Thomas M Gill,Alan Stevens,Jeff Williamson,Elena Volpi,Maya Lichtenstein,Lee A Jennings,Rebecca Galloway,Jenny Summapund,Katy Araujo,David Bass,Lisa Weitzman,Zaldy S Tan,Leslie Evertson,Mia Yang,Katherine Currie,Aval-Na'Ree S Green,Sybila Godoy,Sitara Abraham,Jordan Reese,Rafael Samper-Ternent,Roxana M Hirst,Pamela Borek,Peter Charpentier,Can Meng,James Dziura,Yunshan Xu,Eleni A Skokos,Zili He,Sherry Aiudi,Peter Peduzzi,Erich J Greene,","doi":"10.1001/jama.2024.25056","DOIUrl":"https://doi.org/10.1001/jama.2024.25056","url":null,"abstract":"ImportanceThe effectiveness of different approaches to dementia care is unknown.ObjectiveTo determine the effectiveness of health system-based, community-based dementia care, and usual care for persons with dementia and for caregiver outcomes.Design, Setting, and ParticipantsRandomized clinical trial of community-dwelling persons living with dementia and their caregivers conducted at 4 sites in the US (enrollment June 2019-January 2023; final follow-up, August 2023).InterventionsParticipants were randomized 7:7:1 to health system-based care provided by an advanced practice dementia care specialist (n = 1016); community-based care provided by a social worker, nurse, or licensed therapist care consultant (n = 1016); or usual care (n = 144).Main Outcomes and MeasuresPrimary outcomes were caregiver-reported Neuropsychiatric Inventory Questionnaire (NPI-Q) severity score for persons living with dementia (range, 0-36; higher scores, greater behavioral symptoms severity; minimal clinically important difference [MCID], 2.8-3.2) and Modified Caregiver Strain Index for caregivers (range, 0-26; higher scores, greater strain; MCID, 1.5-2.3). Three secondary outcomes included caregiver self-efficacy (range, 4-20; higher scores, more self-efficacy).ResultsAmong 2176 dyads (individuals with dementia, mean age, 80.6 years; 58.4%, female; and 20.6%, Black or Hispanic; caregivers, mean age, 65.2 years; 75.8%, female; and 20.8% Black or Hispanic), primary outcomes were assessed for more than 99% of participants, and 1343 participants (62% of those enrolled and 91% still alive and had not withdrawn) completed the study through 18 months. No significant differences existed between the 2 treatments or between treatments vs usual care for the primary outcomes. Overall, the least squares means (LSMs) for NPI-Q scores were 9.8 for health system, 9.5 for community-based, and 10.1 for usual care. The difference between health system vs community-based care was 0.30 (97.5% CI, -0.18 to 0.78); health system vs usual care, -0.33 (97.5% CI, -1.32 to 0.67); and community-based vs usual care, -0.62 (97.5% CI, -1.61 to 0.37). The LSMs for the Modified Caregiver Strain Index were 10.7 for health system, 10.5 for community-based, and 10.6 for usual care. The difference between health system vs community-based care was 0.25 (97.5% CI, -0.16 to 0.66); health system vs usual care, 0.14 (97.5% CI, -0.70 to 0.99); and community-based vs usual care, -0.10 (97.5% CI, -0.94 to 0.74). Only the secondary outcome of caregiver self-efficacy was significantly higher for both treatments vs usual care but not between treatments: LSMs were 15.1 for health system, 15.2 for community-based, and 14.4 for usual care. The difference between health system vs community-based care was -0.16 (95% CI, -0.37 to 0.06); health system vs usual care, 0.70 (95% CI, 0.26-1.14); and community-based vs usual care, 0.85 (95% CI, 0.42 to 1.29).Conclusions and RelevanceIn this randomized trial of dementia care programs","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"130 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 58-year-old woman with no allergies or rheumatic disease had a 2-year history of spontaneous wheals that occurred daily, accompanied by pruritus, arthralgia, and intermittent fevers; the wheals resolved after several hours without residual hyperpigmentation or bruising. C-reactive protein level was elevated, and skin biopsy showed dermal neutrophilic infiltration. What is the diagnosis and what would you do next?
{"title":"A 58-Year-Old Woman With Urticaria, Fever, and Joint Pain","authors":"Hanna Bonnekoh, Melba Munoz, Pavel Kolkhir","doi":"10.1001/jama.2024.28316","DOIUrl":"https://doi.org/10.1001/jama.2024.28316","url":null,"abstract":"A 58-year-old woman with no allergies or rheumatic disease had a 2-year history of spontaneous wheals that occurred daily, accompanied by pruritus, arthralgia, and intermittent fevers; the wheals resolved after several hours without residual hyperpigmentation or bruising. C-reactive protein level was elevated, and skin biopsy showed dermal neutrophilic infiltration. What is the diagnosis and what would you do next?","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"206 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"When Medicine Seems Thankless: Poetry and Gratitude.","authors":"Rafael Campo","doi":"10.1001/jama.2024.21721","DOIUrl":"https://doi.org/10.1001/jama.2024.21721","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"62 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Greg A. Sachs, Nina M. Johnson, Sujuan Gao, Alexia M. Torke, Susan E. Hickman, Amy Pemberton, Andrea Vrobel, Minmin Pan, Jennifer West, Kurt Kroenke
ImportanceCare management benefits community-dwelling patients with dementia, but studies include few patients with moderate to severe dementia or from racial and ethnic minority populations, lack palliative care, and seldom reduce health care utilization.ObjectiveTo determine whether integrated dementia palliative care reduces dementia symptoms, caregiver depression and distress, and emergency department (ED) visits and hospitalizations compared with usual care in moderate to severe dementia.Design, Setting, and ParticipantsA randomized clinical trial of community-dwelling patients with moderate to severe dementia and their caregivers enrolled from March 2019 to December 2020 from 2 sites in central Indiana (2-year follow-up completed on January 7, 2023). Electronic health record screening identified patients with dementia; caregivers confirmed eligibility, including dementia stage.InterventionThe intervention consisted of monthly calls from a trained nurse or social worker and evidence-based protocols to help caregivers manage patients’ neuropsychiatric symptoms, caregiver distress, and palliative care issues (eg, advance care planning, symptoms, and hospice) (n = 99). Usual care caregivers received written dementia resource information and patients received care from usual clinicians (n = 102).Main Outcomes and MeasuresThe primary outcome was Neuropsychiatric Inventory Questionnaire (NPI-Q) severity score (scores range from 0-36, with higher scores indicating worse patient symptoms). Secondary outcomes included Symptom Management in End-of-Life Dementia scores, caregiver depression (Patient Health Questionnaire-8) scores, caregiver distress (NPI-Q distress) scores, and combined ED and hospitalization events. Outcomes were assessed quarterly for 24 months or until patient death.ResultsA total of 201 dyads were enrolled (patients were 67.7% female; 43.3% African American; mean [SD] age, 83.6 [7.9] years); 3 dyads withdrew and 83 patients died over the course of the study, with at least 90% of eligible dyads in both groups completing each of the quarterly assessments. For the dementia palliative care vs usual care groups, mean NPI-Q severity scores were 9.92 vs 9.41 at baseline and 9.15 vs 9.39 at 24 months, respectively (between-group difference at 24 months, −0.24 [95% CI, −2.33 to 1.84]). There was no significant difference in the rate of change in NPI-Q severity from baseline between groups over time (<jats:italic>P</jats:italic> = .87 for the group and time interaction). There were no significant differences in the secondary outcomes, except that there were fewer combined ED and hospitalization events in the dementia palliative care group (mean events/patient, 1.06 in dementia palliative care vs 2.37 in usual care; between-group difference, −1.31 [95% CI, −1.93 to −0.69]; relative risk, 0.45 [95% CI, 0.31 to 0.65]).Conclusions and RelevanceAmong community-dwelling patients with moderate to severe dementia and their caregivers, dementia palli
{"title":"Palliative Care Program for Community-Dwelling Individuals With Dementia and Caregivers","authors":"Greg A. Sachs, Nina M. Johnson, Sujuan Gao, Alexia M. Torke, Susan E. Hickman, Amy Pemberton, Andrea Vrobel, Minmin Pan, Jennifer West, Kurt Kroenke","doi":"10.1001/jama.2024.25845","DOIUrl":"https://doi.org/10.1001/jama.2024.25845","url":null,"abstract":"ImportanceCare management benefits community-dwelling patients with dementia, but studies include few patients with moderate to severe dementia or from racial and ethnic minority populations, lack palliative care, and seldom reduce health care utilization.ObjectiveTo determine whether integrated dementia palliative care reduces dementia symptoms, caregiver depression and distress, and emergency department (ED) visits and hospitalizations compared with usual care in moderate to severe dementia.Design, Setting, and ParticipantsA randomized clinical trial of community-dwelling patients with moderate to severe dementia and their caregivers enrolled from March 2019 to December 2020 from 2 sites in central Indiana (2-year follow-up completed on January 7, 2023). Electronic health record screening identified patients with dementia; caregivers confirmed eligibility, including dementia stage.InterventionThe intervention consisted of monthly calls from a trained nurse or social worker and evidence-based protocols to help caregivers manage patients’ neuropsychiatric symptoms, caregiver distress, and palliative care issues (eg, advance care planning, symptoms, and hospice) (n = 99). Usual care caregivers received written dementia resource information and patients received care from usual clinicians (n = 102).Main Outcomes and MeasuresThe primary outcome was Neuropsychiatric Inventory Questionnaire (NPI-Q) severity score (scores range from 0-36, with higher scores indicating worse patient symptoms). Secondary outcomes included Symptom Management in End-of-Life Dementia scores, caregiver depression (Patient Health Questionnaire-8) scores, caregiver distress (NPI-Q distress) scores, and combined ED and hospitalization events. Outcomes were assessed quarterly for 24 months or until patient death.ResultsA total of 201 dyads were enrolled (patients were 67.7% female; 43.3% African American; mean [SD] age, 83.6 [7.9] years); 3 dyads withdrew and 83 patients died over the course of the study, with at least 90% of eligible dyads in both groups completing each of the quarterly assessments. For the dementia palliative care vs usual care groups, mean NPI-Q severity scores were 9.92 vs 9.41 at baseline and 9.15 vs 9.39 at 24 months, respectively (between-group difference at 24 months, −0.24 [95% CI, −2.33 to 1.84]). There was no significant difference in the rate of change in NPI-Q severity from baseline between groups over time (<jats:italic>P</jats:italic> = .87 for the group and time interaction). There were no significant differences in the secondary outcomes, except that there were fewer combined ED and hospitalization events in the dementia palliative care group (mean events/patient, 1.06 in dementia palliative care vs 2.37 in usual care; between-group difference, −1.31 [95% CI, −1.93 to −0.69]; relative risk, 0.45 [95% CI, 0.31 to 0.65]).Conclusions and RelevanceAmong community-dwelling patients with moderate to severe dementia and their caregivers, dementia palli","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"206 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Challenges and Innovations in Dementia Care-Evaluating Comprehensive Models.","authors":"Julie P W Bynum","doi":"10.1001/jama.2024.28066","DOIUrl":"https://doi.org/10.1001/jama.2024.28066","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This Medical News article discusses safety concerns around compounded semaglutide and tirzepatide, including how clinicians can help prevent dosing errors.
{"title":"Patients Are Flocking to Compounded Weight-Loss Drugs, but Are They Safe?","authors":"Kate Ruder","doi":"10.1001/jama.2024.27251","DOIUrl":"https://doi.org/10.1001/jama.2024.27251","url":null,"abstract":"This Medical News article discusses safety concerns around compounded semaglutide and tirzepatide, including how clinicians can help prevent dosing errors.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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