This JAMA Patient Page describes the tick-borne infection Lyme disease and its signs, symptoms, and complications; diagnosis and treatment; and prevention measures.
This randomized clinical trial examines the effect of fractional flow reserve–guided complete coronary revascularization of nonculprit lesions vs culprit-only revascularization in patients with non–ST-segment elevation myocardial infarction and multivessel disease.
This Viewpoint discusses new reimbursement codes and the potential effects of these changes on primary care revenue.
This Viewpoint discusses the implications of the current administration’s policy on homelessness, which treats people experiencing homelessness as criminals instead of focusing on providing housing and care, and suggests that state and local governments should work together to provide community-based care.
This study examines the extent and nature of payments made to health care professionals and teaching hospitals by manufacturers of FDA-authorized AI- and machine learning–enabled devices.
In this narrative medicine essay, a gastroenterologist who is an international medical graduate reviews how the various interpretations of a handy icebreaker has morphed over the years.
This Viewpoint discusses lessons learned from the first negotiation cycle of the Centers for Medicare & Medicaid Services’ Cell and Gene Therapy Access Model.
This Viewpoint examines variations in US commercial health plan coverage restrictions for cell and gene therapies.
This Perspective discusses the evidence presented in a recent report from the National Academies of Sciences, Engineering, and Medicine on alcohol consumption and health.
Few technologies have generated enthusiasm in medicine as rapidly and intensely as artificial intelligence (AI), often outstripping the research community’s capacity to study its impact. The explosion in interest in both research and implementation of AI in medicine is driven by a leap in the ability of these tools to analyze and synthesize data derived from written text, wearable technology, and images. For example, deep learning–based image analysis has enabled the prediction of pathologic gene... Читать дальше...
In Reply The type I error (false-positive rate) is a fixed value chosen by researchers before a study begins and does not change with the number of cases actually enrolled. In our study, analysis of the primary outcome was only performed once, which would not increase the type I error. Although a reduced event count could decrease statistical power and increase the risk of a false-negative result (type II error), it does not increase the likelihood of a false-positive result. We calculated the statistical... Читать дальше...
To the Editor Dr Feng and colleagues compared robotic vs laparoscopic surgery for middle and low rectal cancer. Although the study addresses an important clinical question, we have significant methodological concerns regarding the interpretation of its primary outcome (3-year locoregional recurrence rate).
This cross-sectional study estimates greenhouse gas emissions from all inhalers approved for asthma or chronic obstructive pulmonary disease (COPD) using aggregated dispensing data across the US outpatient pharmaceutical market.
In Reply We thank Drs Choi and O’Keefe for recognizing the value of our proposed taxonomy and the feasibility of collecting the data to support it through passive sensing techniques. We fully agree that total screen time is only one possible indicator of problematic media use and that factors such as distraction and interruptions may be equally or more important. Both usage patterns share a critical feature: they interfere with real-world engagement and may, in similar or distinct ways, contribute to worsening cognitive... Читать дальше...
To the Editor Drs Christakis and Hale propose taxonomy regarding problematic digital media use; their nomenclature is informed by the results of their recently published study on teenage recreational smartphone use. They categorize individuals by duration of smartphone use relative to their peers. Because duration of use can be passively measured by smartphone apps that are free of charge, this is a clever and relatively reliable method for categorization.
This study uses data from the Veterans Health Administration (VA) Corporate Data Warehouse to analyze trends in annual inhaler-related emissions by inhaler type (metered-dose, dry powder, soft mist) in the VA from 2008 to 2023.
Portable, fast-acting, and highly effective, metered-dose inhalers have transformed the treatment of asthma and chronic obstructive pulmonary disease (COPD) over the past 70 years. But alongside their clinical benefits lies a largely overlooked environmental cost. Metered-dose inhalers rely on hydrofluorocarbon propellants—greenhouse gases also used in refrigeration and air conditioning—that trap heat in the atmosphere thousands of times more powerfully than carbon dioxide. Although each device contains only a small volume of propellant... Читать дальше...
In Reply We thank Ms Berris and Dr Elango for their comments. We agree that comparator groups should represent usual care. In Australia and New Zealand, usual care consisted of providing less protein than recommended in international clinical guidelines. Within our previous patient-randomized feasibility trial that used the identical enteral formulas to TARGET Protein, mean daily protein delivery recorded until day 28 in the intervention and control groups was 1.52 (SD, 0.52) g/kg and 0.99 (SD, 0.27) g/kg of ideal body weight per day... Читать дальше...
To the Editor In the recent TARGET Protein randomized clinical trial, Mr Summers and colleagues reported on 2 formulas—100 g of protein/L (augmented) vs 63 g of protein/L (usual protein)—used in adults in intensive care units for 90 days. The interventions resulted in an actual protein delivery of a median of 1.04 (IQR, 0.63-1.38) g/kg vs 0.64 (IQR, 0.40-0.88) g/kg of actual body weight per day in the augmented and usual protein groups, respectively. Both of these interventions are below current guidelines for critical illness... Читать дальше...
Although most readers encounter poetry now as written text, it is fundamentally an oral and aural art form, meant to be spoken and heard. In ancient Greece, poetry was typically recited, accompanied by the strains of a lyre; in many Indigenous cultures, poetry and storytelling is incantatory, often with the specific intent of healing psychic injury. Such means of sharing poetry summon its visceral power, with rhythmic language mimicking our heartbeats and forging both physical and spiritual communion. Читать дальше...
On the page that pictures a nested dove my voice snags on the twig of hope. Just a wrinkle under a flannel blanket, you listen, ear pressed to my heart, to the hymnal cadence of her words. I lick a thumb to turn the page, then use it to smooth your fine brows. Together we make a cove to abide in the dim unit, where we two survive.
In Reply We thank Drs Mannucci and Goel for their comments on our recent study validating the performance of a colorectal cancer screening blood test (PREEMPT CRC).
To the Editor The PREEMPT CRC study closely echoes the results of the ECLIPSE trial. These 2 studies evaluated different circulating tumor DNA–based blood tests for colorectal cancer screening in average-risk individuals and reported high sensitivity for colorectal cancer but lower sensitivity for advanced precancerous lesions (12.5% and 13.2%, respectively).
In Reply We thank Dr Xu and colleagues for their constructive and supportive critique of the UK-ROX trial. We agree with their assertion that routine implementation of conservative oxygen therapy may not yield universal survival benefit, but we question whether stratification will provide the answer. The distinction between stratified interventions, in which participants are grouped into strata (subgroups), and individualization, for which the intervention is tailored to the particular characteristics of the individual, is important. Читать дальше...
