{"title":"Most Young Adults Who Use E-Cigarettes Have Never Smoked.","authors":"Emily Harris","doi":"10.1001/jama.2023.22357","DOIUrl":"10.1001/jama.2023.22357","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"2045"},"PeriodicalIF":120.7,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107592847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Weekly Basal Insulin May Be Equally Effective for Type 1 Diabetes.","authors":"Emily Harris","doi":"10.1001/jama.2023.22358","DOIUrl":"10.1001/jama.2023.22358","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"2045"},"PeriodicalIF":120.7,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107592850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This Viewpoint summarizes the Fifth Circuit Court of Appeals ruling on access to mifepristone, the first of 2 pills used in medication abortion.
{"title":"Explaining the Fifth Circuit Court of Appeals Ruling on Mifepristone Access.","authors":"Molly A Meegan","doi":"10.1001/jama.2023.21591","DOIUrl":"10.1001/jama.2023.21591","url":null,"abstract":"This Viewpoint summarizes the Fifth Circuit Court of Appeals ruling on access to mifepristone, the first of 2 pills used in medication abortion.","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"2047-2048"},"PeriodicalIF":120.7,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50163827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Insulin Maintains Activity While Stored Unrefrigerated.","authors":"Emily Harris","doi":"10.1001/jama.2023.22352","DOIUrl":"10.1001/jama.2023.22352","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"2044"},"PeriodicalIF":120.7,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107592845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This Arts and Medicine feature reviews The Autumn Ghost, an historical retelling of the 1952 polio epidemic in Copenhagen, Denmark, which catalyzed developments in anesthesia and respiratory support procedures that are still in use today.
{"title":"The Autumn Ghost-The Danish Polio Epidemic of 1952 and the Birth of Intensive Care Medicine.","authors":"David Oshinsky","doi":"10.1001/jama.2023.18659","DOIUrl":"10.1001/jama.2023.18659","url":null,"abstract":"This Arts and Medicine feature reviews The Autumn Ghost, an historical retelling of the 1952 polio epidemic in Copenhagen, Denmark, which catalyzed developments in anesthesia and respiratory support procedures that are still in use today.","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"1937-1938"},"PeriodicalIF":120.7,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71415361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Survey: Which Children Visit ED for Mental Health Concerns, and Why.","authors":"Emily Harris","doi":"10.1001/jama.2023.21877","DOIUrl":"10.1001/jama.2023.21877","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"1946"},"PeriodicalIF":120.7,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71523445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Revising NIH's Mission Statement to Remove Ableist Language.","authors":"Lisa I Iezzoni, Bonnielin K Swenor","doi":"10.1001/jama.2023.20123","DOIUrl":"10.1001/jama.2023.20123","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"1949-1950"},"PeriodicalIF":120.7,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41241059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this narrative medicine essay, a family medicine physician whose daughter was born with a 50% chance of having the Huntingtin gene embraces the joy of the present over the fear of the future.
{"title":"Oh Susannah.","authors":"Maura Clement Jacobi","doi":"10.1001/jama.2023.22943","DOIUrl":"10.1001/jama.2023.22943","url":null,"abstract":"In this narrative medicine essay, a family medicine physician whose daughter was born with a 50% chance of having the Huntingtin gene embraces the joy of the present over the fear of the future.","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"1953"},"PeriodicalIF":120.7,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Richard K Albert, Gregory J Jurkovich, John Connett, Erika S Helgeson, Angela Keniston, Helen Voelker, Sarah Lindberg, Jennifer L Proper, Grant Bochicchio, Deborah M Stein, Christian Cain, Ron Tesoriero, Carlos V R Brown, James Davis, Lena Napolitano, Thomas Carver, Mark Cipolle, Luis Cardenas, Joseph Minei, Raminder Nirula, Jay Doucet, Preston R Miller, Jeffrey Johnson, Kenji Inaba, Lillian Kao
Importance: Among patients receiving mechanical ventilation, tidal volumes with each breath are often constant or similar. This may lead to ventilator-induced lung injury by altering or depleting surfactant. The role of sigh breaths in reducing ventilator-induced lung injury among trauma patients at risk of poor outcomes is unknown.
Objective: To determine whether adding sigh breaths improves clinical outcomes.
Design, setting, and participants: A pragmatic, randomized trial of sigh breaths plus usual care conducted from 2016 to 2022 with 28-day follow-up in 15 academic trauma centers in the US. Inclusion criteria were age older than 18 years, mechanical ventilation because of trauma for less than 24 hours, 1 or more of 5 risk factors for developing acute respiratory distress syndrome, expected duration of ventilation longer than 24 hours, and predicted survival longer than 48 hours.
Interventions: Sigh volumes producing plateau pressures of 35 cm H2O (or 40 cm H2O for inpatients with body mass indexes >35) delivered once every 6 minutes. Usual care was defined as the patient's physician(s) treating the patient as they wished.
Main outcomes and measures: The primary outcome was ventilator-free days. Prespecified secondary outcomes included all-cause 28-day mortality.
Results: Of 5753 patients screened, 524 were enrolled (mean [SD] age, 43.9 [19.2] years; 394 [75.2%] were male). The median ventilator-free days was 18.4 (IQR, 7.0-25.2) in patients randomized to sighs and 16.1 (IQR, 1.1-24.4) in those receiving usual care alone (P = .08). The unadjusted mean difference in ventilator-free days between groups was 1.9 days (95% CI, 0.1 to 3.6) and the prespecified adjusted mean difference was 1.4 days (95% CI, -0.2 to 3.0). For the prespecified secondary outcome, patients randomized to sighs had 28-day mortality of 11.6% (30/259) vs 17.6% (46/261) in those receiving usual care (P = .05). No differences were observed in nonfatal adverse events comparing patients with sighs (80/259 [30.9%]) vs those without (80/261 [30.7%]).
Conclusions and relevance: In a pragmatic, randomized trial among trauma patients receiving mechanical ventilation with risk factors for developing acute respiratory distress syndrome, the addition of sigh breaths did not significantly increase ventilator-free days. Prespecified secondary outcome data suggest that sighs are well-tolerated and may improve clinical outcomes.
重要性：在接受机械通气的患者中，每次呼吸的潮气量通常是恒定的或相似的。这可能通过改变或消耗表面活性剂而导致呼吸机诱导的肺损伤。在有不良预后风险的创伤患者中，叹息在减少呼吸机引起的肺损伤方面的作用尚不清楚。目的：确定增加叹气是否能改善临床效果。设计、设置和参与者：2016年至2022年在美国15个学术创伤中心进行的一项实用、随机的叹息加常规护理试验，随访28天。纳入标准为年龄超过18岁、因创伤而进行的机械通气时间少于24小时、患急性呼吸窘迫综合征的5个风险因素中的1个或更多，预期通气持续时间超过24小时，预测存活时间超过48小时。干预措施：每6分钟输送一次叹息量，产生35 cm H2O的平台压力（或体重指数>35的住院患者为40 cm H2O）。常规护理被定义为患者的医生按照他们的意愿治疗患者。主要结果和指标：主要结果是无呼吸机天数。预先指定的次要结果包括全因28天死亡率。结果：在5753名筛查患者中，524名入选（平均[SD]年龄43.9[19.2]岁；394名[75.2%]为男性）。随机接受叹息治疗的患者的中位无呼吸机天数为18.4天（IQR，7.0-25.2），单独接受常规护理的患者为16.1天（IQR，1.1-24.4）（P = .08）。两组之间无呼吸机天数的未调整平均差异为1.9天（95%CI，0.1-3.6），预先指定的调整平均差异是1.4天（95%CI，-0.2-3.0）。对于预先指定的次要结果，随机接受叹息治疗的患者28天死亡率为11.6%（30/259），而接受常规护理的患者为17.6%（46/261）（P = .05）。在非致命性不良事件方面，有叹息的患者（80/259[309%]）与没有叹息的患者相比（80/261[307%]）没有观察到差异。结论和相关性：在一项针对接受机械通气的创伤患者的实用随机试验中，添加叹气并没有显著增加无呼吸机的天数。预先指定的次要结果数据表明，叹息具有良好的耐受性，并可能改善临床结果。试验注册：ClinicalTrials.gov标识符：NCT02582957。
{"title":"Sigh Ventilation in Patients With Trauma: The SiVent Randomized Clinical Trial.","authors":"Richard K Albert, Gregory J Jurkovich, John Connett, Erika S Helgeson, Angela Keniston, Helen Voelker, Sarah Lindberg, Jennifer L Proper, Grant Bochicchio, Deborah M Stein, Christian Cain, Ron Tesoriero, Carlos V R Brown, James Davis, Lena Napolitano, Thomas Carver, Mark Cipolle, Luis Cardenas, Joseph Minei, Raminder Nirula, Jay Doucet, Preston R Miller, Jeffrey Johnson, Kenji Inaba, Lillian Kao","doi":"10.1001/jama.2023.21739","DOIUrl":"10.1001/jama.2023.21739","url":null,"abstract":"<p><strong>Importance: </strong>Among patients receiving mechanical ventilation, tidal volumes with each breath are often constant or similar. This may lead to ventilator-induced lung injury by altering or depleting surfactant. The role of sigh breaths in reducing ventilator-induced lung injury among trauma patients at risk of poor outcomes is unknown.</p><p><strong>Objective: </strong>To determine whether adding sigh breaths improves clinical outcomes.</p><p><strong>Design, setting, and participants: </strong>A pragmatic, randomized trial of sigh breaths plus usual care conducted from 2016 to 2022 with 28-day follow-up in 15 academic trauma centers in the US. Inclusion criteria were age older than 18 years, mechanical ventilation because of trauma for less than 24 hours, 1 or more of 5 risk factors for developing acute respiratory distress syndrome, expected duration of ventilation longer than 24 hours, and predicted survival longer than 48 hours.</p><p><strong>Interventions: </strong>Sigh volumes producing plateau pressures of 35 cm H2O (or 40 cm H2O for inpatients with body mass indexes >35) delivered once every 6 minutes. Usual care was defined as the patient's physician(s) treating the patient as they wished.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was ventilator-free days. Prespecified secondary outcomes included all-cause 28-day mortality.</p><p><strong>Results: </strong>Of 5753 patients screened, 524 were enrolled (mean [SD] age, 43.9 [19.2] years; 394 [75.2%] were male). The median ventilator-free days was 18.4 (IQR, 7.0-25.2) in patients randomized to sighs and 16.1 (IQR, 1.1-24.4) in those receiving usual care alone (P = .08). The unadjusted mean difference in ventilator-free days between groups was 1.9 days (95% CI, 0.1 to 3.6) and the prespecified adjusted mean difference was 1.4 days (95% CI, -0.2 to 3.0). For the prespecified secondary outcome, patients randomized to sighs had 28-day mortality of 11.6% (30/259) vs 17.6% (46/261) in those receiving usual care (P = .05). No differences were observed in nonfatal adverse events comparing patients with sighs (80/259 [30.9%]) vs those without (80/261 [30.7%]).</p><p><strong>Conclusions and relevance: </strong>In a pragmatic, randomized trial among trauma patients receiving mechanical ventilation with risk factors for developing acute respiratory distress syndrome, the addition of sigh breaths did not significantly increase ventilator-free days. Prespecified secondary outcome data suggest that sighs are well-tolerated and may improve clinical outcomes.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT02582957.</p>","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"1982-1990"},"PeriodicalIF":120.7,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10600720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"CDC Report: Health Worker Mental Health Crisis Continued in 2022.","authors":"Emily Harris","doi":"10.1001/jama.2023.21869","DOIUrl":"10.1001/jama.2023.21869","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"1945"},"PeriodicalIF":120.7,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71523434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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