{"title":"Surrogate Markers and Clinical Outcomes.","authors":"Jeffrey Siegel, Mary Thanh Hai, Peter Stein","doi":"10.1001/jama.2024.14276","DOIUrl":"10.1001/jama.2024.14276","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":null,"pages":null},"PeriodicalIF":63.1,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019623","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}
Joshua D Wallach, Reshma Ramachandran, Joseph S Ross
{"title":"Surrogate Markers and Clinical Outcomes-Reply.","authors":"Joshua D Wallach, Reshma Ramachandran, Joseph S Ross","doi":"10.1001/jama.2024.14279","DOIUrl":"10.1001/jama.2024.14279","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":null,"pages":null},"PeriodicalIF":63.1,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019624","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}
Lawrence O Gostin, Shalini Singaravelu, Noreen Hynes
{"title":"Smallpox Readiness: Modern Strategies Against an Ancient Disease.","authors":"Lawrence O Gostin, Shalini Singaravelu, Noreen Hynes","doi":"10.1001/jama.2024.8614","DOIUrl":"10.1001/jama.2024.8614","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":null,"pages":null},"PeriodicalIF":63.1,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581557","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":"Value-Based Payment and Vanishing Small Independent Practices.","authors":"Hayden Rooke-Ley, Zirui Song, Jane M Zhu","doi":"10.1001/jama.2024.12900","DOIUrl":"10.1001/jama.2024.12900","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":null,"pages":null},"PeriodicalIF":63.1,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019627","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":"JAMA.","authors":"","doi":"10.1001/jama.2023.18401","DOIUrl":"https://doi.org/10.1001/jama.2023.18401","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":null,"pages":null},"PeriodicalIF":63.1,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301357","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":"American-ish.","authors":"Samir S Shah","doi":"10.1001/jama.2024.13552","DOIUrl":"10.1001/jama.2024.13552","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":null,"pages":null},"PeriodicalIF":63.1,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019616","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":"State Medical Boards and Interstate Telemedicine in the Courtroom.","authors":"Barak D Richman","doi":"10.1001/jama.2024.13103","DOIUrl":"10.1001/jama.2024.13103","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":null,"pages":null},"PeriodicalIF":63.1,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019621","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":"Surrogate Markers and Clinical Outcomes.","authors":"Pascal Richette, Nicola Dalbeth, Lisa K Stamp","doi":"10.1001/jama.2024.14273","DOIUrl":"10.1001/jama.2024.14273","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":null,"pages":null},"PeriodicalIF":63.1,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019622","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}
Valerie M Vaughn, Robert P Dickson, Jennifer K Horowitz, Scott A Flanders
Importance: Community-acquired pneumonia (CAP) results in approximately 1.4 million emergency department visits, 740 000 hospitalizations, and 41 000 deaths in the US annually.
Observations: Community-acquired pneumonia can be diagnosed in a patient with 2 or more signs (eg, temperature >38 °C or ≤36 °C; leukocyte count <4000/μL or >10 000/μL) or symptoms (eg, new or increased cough or dyspnea) of pneumonia in conjunction with consistent radiographic findings (eg, air space density) without an alternative explanation. Up to 10% of patients with CAP are hospitalized; of those, up to 1 in 5 require intensive care. Older adults (≥65 years) and those with underlying lung disease, smoking, or immune suppression are at highest risk for CAP and complications of CAP, including sepsis, acute respiratory distress syndrome, and death. Only 38% of patients hospitalized with CAP have a pathogen identified. Of those patients, up to 40% have viruses identified as the likely cause of CAP, with Streptococcus pneumoniae identified in approximately 15% of patients with an identified etiology of the pneumonia. All patients with CAP should be tested for COVID-19 and influenza when these viruses are common in the community because their diagnosis may affect treatment (eg, antiviral therapy) and infection prevention strategies. If test results for influenza and COVID-19 are negative or when the pathogens are not likely etiologies, patients can be treated empirically to cover the most likely bacterial pathogens. When selecting empirical antibacterial therapy, clinicians should consider disease severity and evaluate the likelihood of a bacterial infection-or resistant infection-and risk of harm from overuse of antibacterial drugs. Hospitalized patients without risk factors for resistant bacteria can be treated with β-lactam/macrolide combination therapy, such as ceftriaxone combined with azithromycin, for a minimum of 3 days. Systemic corticosteroid administration within 24 hours of development of severe CAP may reduce 28-day mortality.
Conclusions: Community-acquired pneumonia is common and may result in sepsis, acute respiratory distress syndrome, or death. First-line therapy varies by disease severity and etiology. Hospitalized patients with suspected bacterial CAP and without risk factors for resistant bacteria can be treated with β-lactam/macrolide combination therapy, such as ceftriaxone combined with azithromycin, for a minimum of 3 days.
重要性：在美国，社区获得性肺炎（CAP）每年导致约 140 万人次急诊就诊、74 万人次住院治疗和 4.1 万人次死亡：社区获得性肺炎可在患者出现 2 个或 2 个以上肺炎体征（如体温 >38 ℃ 或 ≤36 ℃；白细胞计数 10 000/μL）或症状（如新发或加重的咳嗽或呼吸困难）并伴有一致的影像学检查结果（如气室密度）且无其他解释的情况下确诊。多达 10% 的 CAP 患者需要住院治疗；其中多达五分之一的患者需要接受重症监护。老年人（≥65 岁）和有潜在肺部疾病、吸烟或免疫抑制的人患 CAP 和 CAP 并发症（包括败血症、急性呼吸窘迫综合征和死亡）的风险最高。住院的 CAP 患者中只有 38% 能确定病原体。在这些患者中，多达 40% 的患者可能是由病毒引起的 CAP，而在已确定肺炎病因的患者中，约 15% 的患者是由肺炎链球菌引起的。当 COVID-19 和流感病毒在社区常见时，所有 CAP 患者都应接受这些病毒的检测，因为它们的诊断可能会影响治疗（如抗病毒治疗）和感染预防策略。如果流感和 COVID-19 检测结果为阴性或病原体可能不是病因，则可对患者进行经验性治疗，以覆盖最可能的细菌病原体。在选择经验性抗菌治疗时，临床医生应考虑疾病的严重程度，评估细菌感染或耐药感染的可能性，以及过度使用抗菌药物造成伤害的风险。无耐药菌风险因素的住院病人可采用β-内酰胺/大环内酯类复方疗法，如头孢曲松联合阿奇霉素，疗程至少 3 天。在重症CAP发生后24小时内全身应用皮质类固醇可降低28天的死亡率：结论：社区获得性肺炎很常见，可能导致败血症、急性呼吸窘迫综合征或死亡。一线治疗因病情严重程度和病因而异。对于疑似细菌性 CAP 且无耐药菌风险因素的住院患者，可采用β-内酰胺/大环内酯类复方疗法，如头孢曲松联合阿奇霉素，疗程至少 3 天。
{"title":"Community-Acquired Pneumonia: A Review.","authors":"Valerie M Vaughn, Robert P Dickson, Jennifer K Horowitz, Scott A Flanders","doi":"10.1001/jama.2024.14796","DOIUrl":"https://doi.org/10.1001/jama.2024.14796","url":null,"abstract":"<p><strong>Importance: </strong>Community-acquired pneumonia (CAP) results in approximately 1.4 million emergency department visits, 740 000 hospitalizations, and 41 000 deaths in the US annually.</p><p><strong>Observations: </strong>Community-acquired pneumonia can be diagnosed in a patient with 2 or more signs (eg, temperature >38 °C or ≤36 °C; leukocyte count <4000/μL or >10 000/μL) or symptoms (eg, new or increased cough or dyspnea) of pneumonia in conjunction with consistent radiographic findings (eg, air space density) without an alternative explanation. Up to 10% of patients with CAP are hospitalized; of those, up to 1 in 5 require intensive care. Older adults (≥65 years) and those with underlying lung disease, smoking, or immune suppression are at highest risk for CAP and complications of CAP, including sepsis, acute respiratory distress syndrome, and death. Only 38% of patients hospitalized with CAP have a pathogen identified. Of those patients, up to 40% have viruses identified as the likely cause of CAP, with Streptococcus pneumoniae identified in approximately 15% of patients with an identified etiology of the pneumonia. All patients with CAP should be tested for COVID-19 and influenza when these viruses are common in the community because their diagnosis may affect treatment (eg, antiviral therapy) and infection prevention strategies. If test results for influenza and COVID-19 are negative or when the pathogens are not likely etiologies, patients can be treated empirically to cover the most likely bacterial pathogens. When selecting empirical antibacterial therapy, clinicians should consider disease severity and evaluate the likelihood of a bacterial infection-or resistant infection-and risk of harm from overuse of antibacterial drugs. Hospitalized patients without risk factors for resistant bacteria can be treated with β-lactam/macrolide combination therapy, such as ceftriaxone combined with azithromycin, for a minimum of 3 days. Systemic corticosteroid administration within 24 hours of development of severe CAP may reduce 28-day mortality.</p><p><strong>Conclusions: </strong>Community-acquired pneumonia is common and may result in sepsis, acute respiratory distress syndrome, or death. First-line therapy varies by disease severity and etiology. Hospitalized patients with suspected bacterial CAP and without risk factors for resistant bacteria can be treated with β-lactam/macrolide combination therapy, such as ceftriaxone combined with azithromycin, for a minimum of 3 days.</p>","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":null,"pages":null},"PeriodicalIF":63.1,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301333","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}
Michele B Goodwin, Allison M Whelan, Lawrence O Gostin
{"title":"The Supreme Court and the Emergency Medical Treatment and Labor Act-A Dangerous Time for Us All.","authors":"Michele B Goodwin, Allison M Whelan, Lawrence O Gostin","doi":"10.1001/jama.2024.14868","DOIUrl":"https://doi.org/10.1001/jama.2024.14868","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":null,"pages":null},"PeriodicalIF":63.1,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301348","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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