Curated News: JAMA

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Among patients with oral anticoagulation-associated intracerebral hemorrhage (bleeding within the brain), reversal of international normalized ratio below a certain level within 4 hours and systolic blood pressure less than 160 mm Hg at 4 hours were associated with lower rates of hematoma (a localized swelling filled with blood) enlargement, and resumption of anticoagulant therapy was associated with a lower risk of ischemic events without increased bleeding complications, according to a study in the February 24 issue of JAMA.

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A decline in smoking rates may mean that many people who could have benefited from early detection of lung cancer are dying because they don’t qualify for low-dose CT scans, according to a group of Mayo Clinic researchers. Their research appears in the Feb. 24 issue of JAMA, the journal of the American Medical Association.

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Researchers have identified the first genetic variation that is associated with increased risk and severity of peripheral neuropathy following treatment with a widely used anti-cancer drug. Investigators also found evidence of how it may be possible to protect young leukemia patients without jeopardizing cures. St. Jude Children’s Research Hospital scientists led the study, which appears today in the Journal of the American Medical Association.

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UCLA researchers have found that radiation therapy is the most common treatment for men with prostate cancer regardless of the aggressiveness of the tumor, risk to the patient and overall patient prognosis. These findings lay the groundwork for improved treatment assessment by physicians and to better inform men fighting the disease.

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A study of more than 1,500 cigarette smokers who were not ready to quit smoking but were willing to cut back on cigarette consumption and combine their approach with varenicline (Chantix) increased their long-term success of quitting smoking. The multinational study is published in the February issue of the Journal of the American Medical Association.

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Among cigarette smokers not willing or able to quit smoking in the next month but willing to reduce with the goal of quitting in the next 3 months, use of the nicotine addiction medication varenicline for 24 weeks compared with placebo produced greater reductions in smoking prior to quitting and increased smoking cessation rates at the end of treatment and at 1 year, according to a study in the February 17 issue of JAMA.

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Patients who experienced a certain type of heart attack who received the anticoagulant fondaparinux had a lower risk of major bleeding events and death both in the hospital and after six months compared to patients who received low-molecular-weight heparin (LMWH), although both groups had similar rates of subsequent heart attack or stroke, according to a study in the February 17 issue of JAMA.

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Among patients with severe community-acquired pneumonia and high initial inflammatory response, the use of the corticosteroid methylprednisolone decreased treatment failure, compared with placebo, according to a study in the February 17 issue of JAMA.

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Although some public health organizations advise against the use of electric fans in severe heat, a new study published in the February 17 issue of JAMA demonstrated that electric fans prevent heat-related elevations in heart rate and core body temperature.

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Among previously untreated adults with Gaucher disease type 1, a genetic disease in which there is improper metabolism due to a defect in an enzyme, treatment with the drug eliglustat resulted in significant improvements in liver and spleen size hemoglobin level, and platelet count, according to a study in the February 17 issue of JAMA.

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Many mental health therapists use treatments that have little evidence to support them. A new multi-institution study led by Penn Medicine has found that an organization’s culture and climate are better predictors of the use of evidence-based practices than an individual therapist’s characteristics in the treatment of children and adolescents with psychiatric disorders.

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Physicians often blame patient demands for contributing to high medical costs, however, a new Penn Medicine study involving more than 5,000 patient-clinician visits indicates that cancer patients rarely push for unnecessary tests and treatments from their health care providers.

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Blood pressure-lowering treatment among patients with type 2 diabetes is associated with a lower risk of cardiovascular disease (CVD) and heart disease events and improved mortality, according to a study in the February 10 issue of JAMA.

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Among blood donors with normal hemoglobin levels, low-dose oral iron supplementation, compared with no supplementation, reduced the time to recovery of the postdonation decrease in hemoglobin concentration in donors with low or higher levels of a marker of overall iron storage (ferritin), according to a study in the February 10 issue of JAMA.

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The testing of 10 smartphone applications and wearable devices intended to track physical activity found that most were accurate in tracking step counts, according to a study in the February 10 issue of JAMA.

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Treatment with creatine monohydrate for at least 5 years for patients with early and treated Parkinson disease failed to slow clinical progression of the disease, compared with placebo, according to a study in the February 10 issue of JAMA.

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Among patients with severe aplastic anemia who received stem cell transplant from an unrelated donor, longer leukocyte (white blood cells) telomere length (a structure at the end of a chromosome) was associated with increased overall survival at 5 years, according to a study in the February 10 issue of JAMA.

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Although wearable devices have received significant attention for their ability to track an individual’s physical activity, most smartphone applications are just as accurate, according to a new research letter in JAMA. The study tested 10 of the top-selling smartphone apps and devices in the United States by having 14 participants walk on a treadmill for 500 and 1,500 steps, each twice (for a total of 56 trials), and then recording their step counts. Led by researchers at the University of Pennsylvania, this study is a follow-up to a recent JAMA viewpoint suggesting that there’s little evidence that wearable devices alone can change behavior and improve health for those that need it most.

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David A. Etzioni, M.D., M.S.H.S., of Mayo Clinic Arizona, Phoenix, and colleagues compared rates of any complications, serious complications, and death during a hospitalization for elective general/vascular surgery at hospitals that did vs did not participate in the American College of Surgeons National Surgical Quality Improvement Program.

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In a study that included readmission information from nearly 350 hospitals, readmissions the first 30 days after surgery were associated with new postdischarge complications related to the surgical procedure and not a worsening of any medical conditions the patient already had while hospitalized for surgery, according to a study in the February 3 issue of JAMA.

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An examination of process measures endorsed by the National Quality Forum finds that these measures focus predominantly on management of patients with established diagnoses, and that quality measures for patient presenting symptoms often do not reflect the most common reasons patients seek care, according to a study in the February 3 issue of JAMA.

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Among patients with severe trauma and major bleeding, those who received a transfusion of a balanced ratio of plasma, platelets, and red blood cells (RBCs) were more likely to have their bleeding stopped and less likely to die due to loss of blood by 24 hours compared to patients who received a transfusion with a higher ratio of RBCs, according to a study in the February 3 issue of JAMA.

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If you’re an older person having a major operation these days, it is very likely that your hospital is receiving a “report card” on their performance. These reports are designed to prompt hospitals to improve in areas where they perform poorly. That’s the good news. The not-so-good news: Those “report cards” do not seem to be making things better for patients.

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An international clinical trial led by faculty at The University of Texas Health Science Center at Houston (UTHealth) supports the use of a blood transfusion protocol developed by military doctors. Findings appear in JAMA.

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Two issues emerged: Conversations about death and dying need to be normalized so that people can be more comfortable having advance care planning discussions within families before there’s a crisis. And, clinicians need more training to be highly skilled and sensitive communicators.

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Among men undergoing biopsy for suspected prostate cancer, targeted magnetic resonance/ultrasound fusion biopsy, compared with a standard biopsy technique, was associated with increased detection of high-risk prostate cancer and decreased detection of low-risk prostate cancer, according to a study in the January 27 issue of JAMA.

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A survey of nearly 1,600 individuals found that the majority were willing to donate tissue samples and medical information to a biobank for research and that most were willing to donate using a blanket consent, according to a study in the January 27 issue of JAMA.

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Targeted biopsy using new fusion technology that combines magnetic resonance imaging (MRI) with ultrasound is more effective than standard biopsy in detecting high-risk prostate cancer, according to a large-scale study published today in JAMA.

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Incisional hernia repairs among men age 65 years and older rose 24.2 percent in the United States from 2001 to 2010, according to a study by researchers from RTI International and the University of North Carolina at Chapel Hill.

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How can states and federal government provide adequate health care to poor people, without overburdening taxpayers or leaving health care providers with billions in unpaid bills? That thorny problem is especially challenging in the aftermath of a recession and congressional mandates expanding Medicaid eligibility.

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Sometimes patients with coclear implants need to have a second or "revision" implantation surgery because of device failure. A new study finds that adults age 65 and older do just as well in speech perception after revision cochlear implantation as those younger than 65.

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It’s very difficult to understand the retinal structure of children because they are known to be uncooperative during eye examinations designed for adults. Baylor research, published in JAMA Ophthalmology, explores a new non-invasive technology that’s kind of like a handheld CT scanner for the eye.

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As the United States population has doubled since 1955, the number of inpatient psychiatric beds in the United States has been cut by nearly 95 percent to just 45,000, a wholly inadequate equation when considering that there are currently 10 million U.S. residents with serious mental illness. A new viewpoint in JAMA looks at the evolution away from inpatient psychiatric beds, evaluates the current system for housing and treating the mentally ill, and then suggests a modern approach to institutionalized mental health care as a solution.

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Outside the hospital, use of methadone to treat pain carries a 46 percent increased risk of death when compared to the equally effective but more costly alternative, morphine SR (sustained release). That’s according to a study from Vanderbilt University Medical Center, appearing online this week in JAMA Internal Medicine.

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Over a 12-year period, the prevalence of falls among older adults appeared to be on the rise, a new nationally representative study says.

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With the dawn of the modern era of new chemotherapeutic and biologic agents available for managing their disease, patients with metastatic colorectal cancer are undergoing less surgery for the removal of their primary tumors, according to research from The University of Texas MD Anderson Cancer Center.

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Substantial improvements were seen in control of hypertension and cholesterol, and smoking cessation, according to a study in the January 13 issue of JAMA.

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In a rural Maine county, sustained, community-wide programs targeting cardiovascular risk factors and behavior changes were associated with reductions in hospitalization and death rates over a 40 year period (1970-2010) compared with the rest of the state, with substantial improvements seen for hypertension and cholesterol control and smoking cessation, according to a study in the January 13 issue of JAMA.

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From 2004 to 2012, the rate of investment in medical research in the U.S. declined, while there has been an increase in research investment globally, particularly in Asia, according to a study in the January 13 issue of JAMA.

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Among nearly 375,000 U.S. women diagnosed with invasive breast cancer, the likelihood of diagnosis at an early stage, and survival after stage I diagnosis, varied by race and ethnicity, with much of the difference accounted for by biological differences, according to a study in the January 13 issue of JAMA.

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Participants in a sleep study who had asthma had an increased risk for developing obstructive sleep apnea, with this association stronger with having had asthma longer, according to a study in the January 13 issue of JAMA.

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Between 2006 and 2012 in the U.S., there was a decline in rates of episiotomy, a surgical procedure for widening the outlet of the birth canal to make it easier for the mother to give birth, according to a study in the January 13 issue of JAMA.

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Transcatheter aortic valve replacement, or TAVR, has been called one of the biggest advances in cardiac surgery in recent years. The procedure delivers a new, collapsible aortic valve through a catheter to the valve site within the heart - a repair that otherwise requires open heart surgery. While a boon for many patients who would not have been a candidate for conventional surgery, Penn Medicine researchers have discovered that marketing for TAVR does not accurately portray the risks associated with undergoing the procedure. Their analysis is available in the January 12 issue of JAMA Internal Medicine.

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New Year’s weight loss resolutions are in full swing, but despite all the hype about the latest wearable tracking devices, there’s little evidence that this technology alone can change behavior and improve health for those that need it most, according to a new online-first viewpoint piece in JAMA. The paper, written by researchers at the University of Pennsylvania, points out that even though several large technology companies are entering this expanding market, there may be a disconnect between the assumed benefits and actual outcomes.

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Many patients with type 2 diabetes in the United States may be discouraged from taking metformin—a proven, oral diabetes medicine—because the U.S. Food and Drug Administration inappropriately labels the drug unsafe for some patients also suffering from kidney problems, researchers from Penn Medicine and Weill Cornel Medical College report this week in a research letter published in JAMA Internal Medicine.

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A multivitamin given daily to pregnant women in rural Bangladesh reduced pre-term births, increased infant birth weight and resulted in healthier babies overall, according to the large randomized trial conducted by Johns Hopkins Bloomberg School of Public Health researchers.

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Among patients in England with gout, only a minority of those with indications to receive urate-lowering therapy were treated according to guideline recommendations, according to a study in the December 24/31 issue of JAMA.

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High-risk children with chronic illness who received care at a clinic that provided both primary and specialty care and features to promote prompt effective care had an increase in access to care and parent satisfaction and a reduction in serious illnesses and costs, according to a study in the December 24/31 issue of JAMA.

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Between 1999 and 2010, periods of extreme heat in the U.S. were associated with an increased risk of hospitalization for older adults for fluid and electrolyte disorders, kidney failure, urinary tract infections, septicemia and heat stroke, according to a study in the December 24/31 issue of JAMA. The authors note that the absolute risk increase was small and of uncertain clinical importance.

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Among full-term newborns with moderate or severe hypoxic ischemic encephalopathy (damage to cells in the central nervous system from inadequate oxygen), receiving deeper or longer duration cooling did not reduce risk of neonatal intensive care unit death, compared to usual care, according to a study in the December 24/31 issue of JAMA.