In this narrative medicine essay, an infectious diseases physician describes how a patient with a complex lung infection demanded that his treatment would not interfere with his life, which offered a fresh way of understanding patient-centered care.
{"title":"Against Medical Advice","authors":"Wendy Stead","doi":"10.1001/jama.2025.24090","DOIUrl":"https://doi.org/10.1001/jama.2025.24090","url":null,"abstract":"In this narrative medicine essay, an infectious diseases physician describes how a patient with a complex lung infection demanded that his treatment would not interfere with his life, which offered a fresh way of understanding patient-centered care.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145972292","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":"The Earliest Chapters in the History of Surgery and Medicine.","authors":"","doi":"10.1001/jama.2025.15689","DOIUrl":"https://doi.org/10.1001/jama.2025.15689","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986277","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 JAMA Insights discusses post–intensive care unit syndrome, including how it is assessed and diagnosed as well as suggestions for treatment and prevention.
本期JAMA Insights讨论了重症监护室后综合征，包括如何评估和诊断以及治疗和预防建议。
{"title":"Post–Intensive Care Syndrome","authors":"Brad W. Butcher","doi":"10.1001/jama.2025.23666","DOIUrl":"https://doi.org/10.1001/jama.2025.23666","url":null,"abstract":"This JAMA Insights discusses post–intensive care unit syndrome, including how it is assessed and diagnosed as well as suggestions for treatment and prevention.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145972288","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}
JAMA+ AI Associate Editor Yulin Hswen, ScD, MPH, spoke with Cecilia Lee, MD, MS, a professor of ophthalmology at Washington University in St Louis, for JAMA+ AI Conversations.
{"title":"Insights From the Eye With AI","authors":"Yulin Hswen","doi":"10.1001/jama.2025.22489","DOIUrl":"https://doi.org/10.1001/jama.2025.22489","url":null,"abstract":"JAMA+ AI Associate Editor Yulin Hswen, ScD, MPH, spoke with Cecilia Lee, MD, MS, a professor of ophthalmology at Washington University in St Louis, for JAMA+ AI Conversations.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145972291","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}
Riccardo Lombardo,Claudia Lorenti,Cosimo De Nunzio
{"title":"Biparametric vs Multiparametric MRI for Diagnosis of Prostate Cancer.","authors":"Riccardo Lombardo,Claudia Lorenti,Cosimo De Nunzio","doi":"10.1001/jama.2025.22869","DOIUrl":"https://doi.org/10.1001/jama.2025.22869","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986276","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 Perspective outlines the 2025-2030 Dietary Guidelines for Americans that were recently released by the US Department of Health and Human Services and the US Department of Agriculture.
本展望概述了美国卫生与公众服务部和美国农业部最近发布的《2025-2030年美国人膳食指南》。
{"title":"The 2025-2030 Dietary Guidelines for Americans","authors":"Dariush Mozaffarian","doi":"10.1001/jama.2026.0283","DOIUrl":"https://doi.org/10.1001/jama.2026.0283","url":null,"abstract":"This Perspective outlines the 2025-2030 Dietary Guidelines for Americans that were recently released by the US Department of Health and Human Services and the US Department of Agriculture.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968461","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":"Fever, Rash, and Dizziness in a 32-Year-Old.","authors":"Aurianna M Lajaunie,Baiju Patel,Preeti N Malani","doi":"10.1001/jama.2025.24574","DOIUrl":"https://doi.org/10.1001/jama.2025.24574","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961282","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":"Minor Papillotomy for Treatment of Idiopathic Acute Pancreatitis With Pancreas Divisum: Research Summary.","authors":"","doi":"10.1001/jama.2025.24246","DOIUrl":"https://doi.org/10.1001/jama.2025.24246","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"3 1","pages":"e2524246"},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961284","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":"Multidomain Lifestyle Interventions for Cognitive Function-Reply.","authors":"Laura D Baker,Mark A Espeland","doi":"10.1001/jama.2025.22637","DOIUrl":"https://doi.org/10.1001/jama.2025.22637","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961288","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}
Gregory A Coté,Valerie Durkalski-Mauldin,Evan L Fogel,Dana C Moffatt,Andrew Y Wang,Luis F Lara,Paul R Tarnasky,James L Buxbaum,Sun-Chuan Dai,Sreeni Jonnalagadda,Field F Willingham,Andrew Ross,Rajesh N Keswani,Sumant Inamdar,Truptesh H Kothari,Timothy B Gardner,Priya A Jamidar,Srinivas Gaddam,Douglas K Pleskow,Jeffrey J Easler,B Joseph Elmunzer,John Gerard Coneys,J Shawn Mallery,Daniel S Strand,Georgios I Papachristou,Adam Slivka,Prashant Kedia,Ara B Sahakian,Abdul Kouanda,Anh Phan,April Williams,Dana K Andersen,Jose Serrano,Dhiraj Yadav,
ImportancePancreas divisum is implicated as an obstructive cause for acute pancreatitis. Observational data suggest endoscopic retrograde cholangiopancreatography (ERCP) with minor papillotomy reduces the risk of pancreatitis episodes. Even though this endoscopic procedure is widely used in practice, clinical trials are lacking.ObjectiveTo determine whether ERCP with minor papillotomy reduces the risk of acute pancreatitis among adults with unexplained acute recurrent pancreatitis and pancreas divisum.Design, Setting, and ParticipantsThis multicenter, sham-controlled, double-blind randomized clinical trial enrolled adults with 2 or more episodes of acute pancreatitis and pancreas divisum. Adults with other etiologies for acute pancreatitis or concomitant chronic calcific pancreatitis were excluded. The trial was conducted between September 1, 2018, and August 30, 2024, at 21 referral centers in the US and Canada. Last follow-up occurred on February 15, 2025.InterventionParticipants were randomized in a 1:1 ratio to ERCP with minor papillotomy or sham ERCP.Main Outcomes and MeasuresThe primary outcome was development of acute pancreatitis more than 30 days after randomization as a time-to-event outcome. The secondary outcomes included acute pancreatitis episode frequency and development of chronic calcific pancreatitis, diabetes, and exocrine pancreatic dysfunction.ResultsA total of 148 participants were randomized (mean age, 54 [SD, 19.5] years; 68.2% female; 95.3% non-Hispanic or Latino and 87.2% White; mean lifetime acute pancreatitis episodes, 3 [SD, 2]; mean duct diameter, 2.2 [SD, 1.3] mm) and followed up for a median of 34 months (IQR, 21.7-45.7 months). Of the 75 participants in the ERCP with minor papillotomy group, 26 (34.7%) developed acute pancreatitis compared with 32 of 73 participants (43.8%) in the sham ERCP group (adjusted hazard ratio, 0.83 [95% CI, 0.49 to 1.41]). The incidence rate ratio for acute recurrent pancreatitis episode frequency was 0.25 (95% CI, 0.18 to 0.34) in the ERCP with minor papillotomy group vs 0.30 (95% CI, 0.23 to 0.41) in the sham ERCP group. There were no between-group differences in frequency and incidence of chronic calcific pancreatitis (4.0% in the ERCP with minor papillotomy group vs 2.7% in the sham ERCP group; risk difference [RD], 0.01 [95% CI, -0.05 to 0.07]), diabetes (15.8% vs 12.8%, respectively; RD, 0.03 [95% CI, -0.13 to 0.19]), and exocrine pancreatic dysfunction (7.7% vs 17.2%; RD, -0.10 [95% CI, -0.27 to 0.08]). The adverse event of acute pancreatitis within 30 days of randomization occurred more frequently in the ERCP with minor papillotomy group (14.7%) vs the sham ERCP group (8.2%) (RD, 0.06 [95% CI, -0.04 to 0.17]).Conclusions and RelevanceAmong patients with unexplained acute recurrent pancreatitis and pancreas divisum, ERCP with minor papillotomy does not reduce the risk of another episode of acute pancreatitis or related sequelae.Trial RegistrationClinicalTrials.gov Identifier: NCT0
{"title":"Minor Papillotomy for Treatment of Idiopathic Acute Pancreatitis With Pancreas Divisum: A Randomized Clinical Trial.","authors":"Gregory A Coté,Valerie Durkalski-Mauldin,Evan L Fogel,Dana C Moffatt,Andrew Y Wang,Luis F Lara,Paul R Tarnasky,James L Buxbaum,Sun-Chuan Dai,Sreeni Jonnalagadda,Field F Willingham,Andrew Ross,Rajesh N Keswani,Sumant Inamdar,Truptesh H Kothari,Timothy B Gardner,Priya A Jamidar,Srinivas Gaddam,Douglas K Pleskow,Jeffrey J Easler,B Joseph Elmunzer,John Gerard Coneys,J Shawn Mallery,Daniel S Strand,Georgios I Papachristou,Adam Slivka,Prashant Kedia,Ara B Sahakian,Abdul Kouanda,Anh Phan,April Williams,Dana K Andersen,Jose Serrano,Dhiraj Yadav, ","doi":"10.1001/jama.2025.23988","DOIUrl":"https://doi.org/10.1001/jama.2025.23988","url":null,"abstract":"ImportancePancreas divisum is implicated as an obstructive cause for acute pancreatitis. Observational data suggest endoscopic retrograde cholangiopancreatography (ERCP) with minor papillotomy reduces the risk of pancreatitis episodes. Even though this endoscopic procedure is widely used in practice, clinical trials are lacking.ObjectiveTo determine whether ERCP with minor papillotomy reduces the risk of acute pancreatitis among adults with unexplained acute recurrent pancreatitis and pancreas divisum.Design, Setting, and ParticipantsThis multicenter, sham-controlled, double-blind randomized clinical trial enrolled adults with 2 or more episodes of acute pancreatitis and pancreas divisum. Adults with other etiologies for acute pancreatitis or concomitant chronic calcific pancreatitis were excluded. The trial was conducted between September 1, 2018, and August 30, 2024, at 21 referral centers in the US and Canada. Last follow-up occurred on February 15, 2025.InterventionParticipants were randomized in a 1:1 ratio to ERCP with minor papillotomy or sham ERCP.Main Outcomes and MeasuresThe primary outcome was development of acute pancreatitis more than 30 days after randomization as a time-to-event outcome. The secondary outcomes included acute pancreatitis episode frequency and development of chronic calcific pancreatitis, diabetes, and exocrine pancreatic dysfunction.ResultsA total of 148 participants were randomized (mean age, 54 [SD, 19.5] years; 68.2% female; 95.3% non-Hispanic or Latino and 87.2% White; mean lifetime acute pancreatitis episodes, 3 [SD, 2]; mean duct diameter, 2.2 [SD, 1.3] mm) and followed up for a median of 34 months (IQR, 21.7-45.7 months). Of the 75 participants in the ERCP with minor papillotomy group, 26 (34.7%) developed acute pancreatitis compared with 32 of 73 participants (43.8%) in the sham ERCP group (adjusted hazard ratio, 0.83 [95% CI, 0.49 to 1.41]). The incidence rate ratio for acute recurrent pancreatitis episode frequency was 0.25 (95% CI, 0.18 to 0.34) in the ERCP with minor papillotomy group vs 0.30 (95% CI, 0.23 to 0.41) in the sham ERCP group. There were no between-group differences in frequency and incidence of chronic calcific pancreatitis (4.0% in the ERCP with minor papillotomy group vs 2.7% in the sham ERCP group; risk difference [RD], 0.01 [95% CI, -0.05 to 0.07]), diabetes (15.8% vs 12.8%, respectively; RD, 0.03 [95% CI, -0.13 to 0.19]), and exocrine pancreatic dysfunction (7.7% vs 17.2%; RD, -0.10 [95% CI, -0.27 to 0.08]). The adverse event of acute pancreatitis within 30 days of randomization occurred more frequently in the ERCP with minor papillotomy group (14.7%) vs the sham ERCP group (8.2%) (RD, 0.06 [95% CI, -0.04 to 0.17]).Conclusions and RelevanceAmong patients with unexplained acute recurrent pancreatitis and pancreas divisum, ERCP with minor papillotomy does not reduce the risk of another episode of acute pancreatitis or related sequelae.Trial RegistrationClinicalTrials.gov Identifier: NCT0","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961285","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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