Curated News: 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.

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In Bangladesh, daily maternal supplementation of multiple micronutrients compared to iron-folic acid before and after childbirth did not reduce all-cause infant mortality to age 6 months, but did result in significant reductions in preterm birth and low birth weight, according to a study in the December 24/31 issue of JAMA.

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In a study that included overweight and obese participants, those with diets with low glycemic index of dietary carbohydrate did not have improvements in insulin sensitivity, lipid levels, or systolic blood pressure, according to a study in the December 17 issue of JAMA.

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Among patients with lymphoma undergoing a certain type of chemotherapy, receiving the antiviral drug entecavir resulted in a lower incidence of hepatitis B virus (HBV)-related hepatitis and HBV reactivation, compared with the antiviral drug lamivudine, according to a study in the December 17 issue of JAMA.

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For up to one in five Americans over age 65, getting older brings memory and thinking problems. It may seem like part of getting older - but officially, it’s called mild cognitive impairment or MCI. A new definitive look at the evidence about what works and what doesn’t in MCI should help doctors and the seniors they treat.

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Two-thirds of women treated for early-stage breast cancer in the U.S. receive longer radiation therapy than necessary, according to a new study published in JAMA this week from Penn Medicine researchers Ezekiel J. Emanuel, MD, PhD, and Justin E. Bekelman, MD.

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Among primary care physicians, the spending patterns in the regions in which their residency program was located were associated with expenditures for subsequent care they provided as practicing physicians, with those trained in lower-spending regions continuing to practice in a less costly manner, even when they moved to higher-spending regions, and vice versa, according to a study in the December 10 issue of JAMA, a theme issue on medical education.

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An analysis of the non-English-language skills of U.S. medical residency applicants finds that although they are linguistically diverse, most of their languages do not match the languages spoken by the U.S. population with limited English proficiency, according to a study in the December 10 issue of JAMA, a theme issue on medical education.

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There has been a doubling during the last decade in the number of U.S. medical schools that have student-run free clinics, with more than half of medical students involved with these clinics, according to a study in the December 10 issue of JAMA, a theme issue on medical education.

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In a sample of U.S. emergency departments, compared to attending physicians alone, supervised visits (involving both resident and attending physicians) were associated with a greater likelihood of hospital admission and use of advanced imaging and with longer emergency department stays, according to a study in the December 10 issue of JAMA, a theme issue on medical education.

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In the first year after the Accreditation Council for Graduate Medical Education (ACGME) reduced the number of continuous hours that residents can work, there was no change in the rate of death or readmission among hospitalized Medicare patients, according to a new study published in JAMA. The study was led by researchers at the Perelman School of Medicine at the University of Pennsylvania and The Children’s Hospital of Philadelphia.