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JAMA: Journal of the American Medical Association has published a Special Communication titled "The Integration of Clinical Trials With the Practice of Medicine: Repairing a House Divided," which discusses the need to integrate clinical trials with clinical practice. The authors highlight the separate missions and infrastructures of clinical trialists and clinicians, leading to inefficiencies and limitations in trials. They propose solutions such as implementation science, novel statistical analysis approaches, and integration of trials with electronic health records. JAMA is launching a new series called "Integrating Clinical Trials and Practice" to explore innovations in trial design, funding, regulation, education, and application. The goal is to align clinical trials with clinical practice and improve patient care. [Extracted from the article]

In this Medical News article, Arvind Narayanan, PhD, a professor of computer science at Princeton University, discusses the benefits of using artificial intelligence in research and clinical settings while remaining cautious of hype, biases, and data privacy issues. [ABSTRACT FROM AUTHOR]

The article reports on a policy paper about the future of funding and care of patients with human immunodeficiency virus (HIV) in the U.S. The paper was developed by the Ryan White Medical Providers Coalition (RWMPC) and the HIV Medicine Association (HIVMA). The paper highlighted concerns about the future of HIV care and funding as health care and economic situations in the country change. The Ryan White HIV/AIDS Program has been providing HIV-related services.

A call for papers for the annual theme issue of the "Journal of the American Medical Association" on violence and human rights in 2012 is presented.

Presents an editorial concerning tuberculosis research. Statistics on TB and countries where the disease is prevalent; Indication that the medical journal will publish a theme issue on the importance of treating TB for global health; Request for authors to submit original-research manuscripts on various topics and areas of interest; Outlook for low-income countries to achieve the Millennium Development Goals; Purpose of the journal's theme issue.

Editorial. Comments on the need to target problems and achieve solutions with regard to global health. Effect of globalization on health care; Statistics from the Global Health Research Forum; Efforts to target problems on a global level.

Opinion. Presents a position paper from the Surgical Section of the National Medical Association. Financial aspects of caring for injured victims of violence; Viewing the issue from a public health perspective; Organizations which have addressed the issue of injury prevention.

Presents an editorial calling for research papers on the causes, consequences and prevention of interpersonal violence as well as the prevention and management of the health effects of violence among survivors of armed conflict, war, mass displacement, torture and other human rights abuses. Call for controlled studies of interventions for the prevention and treatment of intimate partner violence, child abuse, youth violence, effects of terrorism, sexual assault and more.

Importance: Recent discussion has focused on questions related to the repeal and replacement of portions of the Affordable Care Act (ACA). However, issues central to the future of health and health care in the United States transcend the ACA provisions receiving the greatest attention. Initiatives directed to certain strategic and infrastructure priorities are vital to achieve better health at lower cost.Objectives: To review the most salient health challenges and opportunities facing the United States, to identify practical and achievable priorities essential to health progress, and to present policy initiatives critical to the nation's health and fiscal integrity.Evidence Review: Qualitative synthesis of 19 National Academy of Medicine-commissioned white papers, with supplemental review and analysis of publicly available data and published research findings.Findings: The US health system faces major challenges. Health care costs remain high at $3.2 trillion spent annually, of which an estimated 30% is related to waste, inefficiencies, and excessive prices; health disparities are persistent and worsening; and the health and financial burdens of chronic illness and disability are straining families and communities. Concurrently, promising opportunities and knowledge to achieve change exist. Across the 19 discussion papers examined, 8 crosscutting policy directions were identified as vital to the nation's health and fiscal future, including 4 action priorities and 4 essential infrastructure needs. The action priorities-pay for value, empower people, activate communities, and connect care-recurred across the articles as direct and strategic opportunities to advance a more efficient, equitable, and patient- and community-focused health system. The essential infrastructure needs-measure what matters most, modernize skills, accelerate real-world evidence, and advance science-were the most commonly cited foundational elements to ensure progress.Conclusions and Relevance: The action priorities and essential infrastructure needs represent major opportunities to improve health outcomes and increase efficiency and value in the health system. As the new US administration and Congress chart the future of health and health care for the United States, and as health leaders across the country contemplate future directions for their programs and initiatives, their leadership and strategic investment in these priorities will be essential for achieving significant progress. [ABSTRACT FROM AUTHOR]

Editorial. Comments on the aging of the population and the implications for medical care and health care systems. How the demographic trend will affect health care and society; Specific problems that the U.S. faces which are related to aging; Invitation to authors to submit manuscripts on topics such as disease interventions, dementia, incontinence, diabetes, cancer and others.

This Medical News article is an interview with Michael Howell, MD, MPH, about applications of large language models in medicine. [ABSTRACT FROM AUTHOR]

This article presents a list of books received by the publications. These include: "Gaucher Disease," edited by Anthony Futerman and Ari Zimran, "Inborn Metabolic Diseases: Diagnosis and Treatment," edited by John Fernandes, Jean-Marie Saudubray and John Walter, "Emerging Infections 7," edited by W. Michael Scheld, David Hooper and James Hughes, "Chronic Disease Management," edited by Jim Nuovo, "Infection: Microbiology and Management," by Barbara Bannister and "Primary Care: More Poems by Physicians," edited by Angela Bell and Jack Coulehan.

A list of books submitted to the "Journal of the American Medical Association" is presented, including: "Thieme Atlas of Anatomy: Neck and Internal Organs," by Michael Schuenke, Erik Schulte and Udo Schumacher; "A Personal History of Nuclear Medicine," by Henry N. Wagner Jr.; "The Biology of Cancer," by Robert A. Weinberg; "Crash Course: Immunology," by Robert Novak and James Griffin; "Glaucoma," edited by Franz Grehn and Robert Stamper; "On Call Pediatrics," by James J. Nocton; and many others.

Key Points: Question: Among people receiving care in opioid treatment programs, does facilitated telemedicine for hepatitis C treatment increase cure rates compared with standard-of-care referral to hepatitis specialists? Findings: Cure percentages were 90.2% in telemedicine and 39.4% in referral, with an estimated logarithmic odds ratio of the study group effect of 2.9. Among cured participants, illicit drug use decreased significantly. We observed minimal reinfections during 2 years of follow-up. Meaning: Facilitated telemedicine integrated into opioid treatment programs resulted in significantly higher cure rates, with significant reductions in illicit drug use and minimal reinfections; facilitated telemedicine increases hepatitis C treatment access for underserved populations. Importance: Facilitated telemedicine may promote hepatitis C virus elimination by mitigating geographic and temporal barriers. Objective: To compare sustained virologic responses for hepatitis C virus among persons with opioid use disorder treated through facilitated telemedicine integrated into opioid treatment programs compared with off-site hepatitis specialist referral. Design, Setting, and Participants: Prospective, cluster randomized clinical trial using a stepped wedge design. Twelve programs throughout New York State included hepatitis C–infected participants (n = 602) enrolled between March 1, 2017, and February 29, 2020. Data were analyzed from December 1, 2022, through September 1, 2023. Intervention: Hepatitis C treatment with direct-acting antivirals through comanagement with a hepatitis specialist either through facilitated telemedicine integrated into opioid treatment programs (n = 290) or standard-of-care off-site referral (n = 312). Main Outcomes and Measures: The primary outcome was hepatitis C virus cure. Twelve programs began with off-site referral, and every 9 months, 4 randomly selected sites transitioned to facilitated telemedicine during 3 steps without participant crossover. Participants completed 2-year follow-up for reinfection assessment. Inclusion criteria required 6-month enrollment in opioid treatment and insurance coverage of hepatitis C medications. Generalized linear mixed-effects models were used to test for the intervention effect, adjusted for time, clustering, and effect modification in individual-based intention-to-treat analysis. Results: Among 602 participants, 369 were male (61.3%); 296 (49.2%) were American Indian or Alaska Native, Asian, Black or African American, multiracial, or other (ie, no race category was selected, with race data collected according to the 5 standard National Institutes of Health categories); and 306 (50.8%) were White. The mean (SD) age of the enrolled participants in the telemedicine group was 47.1 (13.1) years; that of the referral group was 48.9 (12.8) years. In telemedicine, 268 of 290 participants (92.4%) initiated treatment compared with 126 of 312 participants (40.4%) in referral. Intention-to-treat cure percentages were 90.3% (262 of 290) in telemedicine and 39.4% (123 of 312) in referral, with an estimated logarithmic odds ratio of the study group effect of 2.9 (95% CI, 2.0-3.5; P <.001) with no effect modification. Observed cure percentages were 246 of 290 participants (84.8%) in telemedicine vs 106 of 312 participants (34.0%) in referral. Subgroup effects were not significant, including fibrosis stage, urban or rural participant residence location, or mental health (anxiety or depression) comorbid conditions. Illicit drug use decreased significantly (referral: 95% CI, 1.2-4.8; P =.001; telemedicine: 95% CI, 0.3-1.0; P <.001) among cured participants. Minimal reinfections (n = 13) occurred, with hepatitis C virus reinfection incidence of 2.5 per 100 person-years. Participants in both groups rated health care delivery satisfaction as high or very high. Conclusions and Relevance: Opioid treatment program–integrated facilitated telemedicine resulted in significantly higher hepatitis C virus cure rates compared with off-site referral, with high participant satisfaction. Illicit drug use declined significantly among cured participants with minimal reinfections. Trial Registration: ClinicalTrials.gov Identifier: NCT02933970 This study discusses whether facilitated telemedicine for hepatitis C treatment increases cure rates compared with standard-of-care referral to hepatitis specialists. [ABSTRACT FROM AUTHOR]

Generative artificial intelligence (AI) has been touted as a potential innovation for greater diagnostic accuracy and clinical efficiency in health care, but whether generative AI will deliver on this promise or fall to the "productivity paradox" is examined in this Special Communication. Importance: Since the introduction of ChatGPT in late 2022, generative artificial intelligence (genAI) has elicited enormous enthusiasm and serious concerns. Observations: History has shown that general purpose technologies often fail to deliver their promised benefits for many years ("the productivity paradox of information technology"). Health care has several attributes that make the successful deployment of new technologies even more difficult than in other industries; these have challenged prior efforts to implement AI and electronic health records. However, genAI has unique properties that may shorten the usual lag between implementation and productivity and/or quality gains in health care. Moreover, the health care ecosystem has evolved to make it more receptive to genAI, and many health care organizations are poised to implement the complementary innovations in culture, leadership, workforce, and workflow often needed for digital innovations to flourish. Conclusions and Relevance: The ability of genAI to rapidly improve and the capacity of organizations to implement complementary innovations that allow IT tools to reach their potential are more advanced than in the past; thus, genAI is capable of delivering meaningful improvements in health care more rapidly than was the case with previous technologies. [ABSTRACT FROM AUTHOR]

Key Points: Question: Does β-blockade for up to 14 days with landiolol reduce organ failure as measured by the Sequential Organ Failure Assessment (SOFA) score for critically ill patients with tachycardia and septic shock treated with high-dose norepinephrine for more than 24 hours? Findings: In this randomized clinical trial enrolling 126 patients with tachycardia and established septic shock (treated with norepinephrine for >24 hours), the administration of landiolol intravenously to reduce heart rate to less than 95/min compared with standard care did not significantly decrease organ failure as measured by the mean SOFA score (8.8 vs 8.1, respectively) in the 14 days after randomization. Meaning: These results do not support the use of landiolol for managing patients with tachycardia treated with norepinephrine for established septic shock. Importance: Patients with septic shock undergo adrenergic stress, which affects cardiac, immune, inflammatory, and metabolic pathways. β-Blockade may attenuate the adverse effects of catecholamine exposure and has been associated with reduced mortality. Objectives: To assess the efficacy and safety of landiolol in patients with tachycardia and established septic shock requiring prolonged (>24 hours) vasopressor support. Design, Setting, and Participants: An open-label, multicenter, randomized trial involving 126 adults (≥18 years) with tachycardia (heart rate ≥95/min) and established septic shock treated for at least 24 hours with continuous norepinephrine (≥0.1 μg/kg/min) in 40 UK National Health Service intensive care units. The trial ran from April 2018 to December 2021, with early termination in December 2021 due to a signal of possible harm. Intervention: Sixty-three patients were randomized to receive standard care and 63 to receive landiolol infusion. Main Outcomes and Measures: The primary outcome was the mean Sequential Organ Failure Assessment (SOFA) score from randomization through 14 days. Secondary outcomes included mortality at days 28 and 90 and the number of adverse events in each group. Results: The trial was stopped prematurely on the advice of the independent data monitoring committee because it was unlikely to demonstrate benefit and because of possible harm. Of a planned 340 participants, 126 (37%) were enrolled (mean age, 55.6 years [95% CI, 52.7 to 58.5 years]; 58.7% male). The mean (SD) SOFA score in the landiolol group was 8.8 (3.9) compared with 8.1 (3.2) in the standard care group (mean difference [MD], 0.75 [95% CI, −0.49 to 2.0]; P =.24). Mortality at day 28 after randomization in the landiolol group was 37.1% (23 of 62) and 25.4% (16 of 63) in the standard care group (absolute difference, 11.7% [95% CI, −4.4% to 27.8%]; P =.16). Mortality at day 90 after randomization was 43.5% (27 of 62) in the landiolol group and 28.6% (18 of 63) in the standard care group (absolute difference, 15% [95% CI, −1.7% to 31.6%]; P =.08). There were no differences in the number of patients having at least one adverse event. Conclusion and Relevance: Among patients with septic shock with tachycardia and treated with norepinephrine for more than 24 hours, an infusion of landiolol did not reduce organ failure measured by the SOFA score over 14 days from randomization. These results do not support the use of landiolol for managing tachycardia among patients treated with norepinephrine for established septic shock. Trial Registration: EU Clinical Trials Register Eudra CT: 2017-001785-14; isrctn.org Identifier: ISRCTN12600919 This clinical trial assesses whether landiolol for patients with tachycardia and established septic shock requiring prolonged vasopressor support reduces the risk of organ failure. [ABSTRACT FROM AUTHOR]

This Medical News article is an interview with Marzyeh Ghassemi, a machine learning expert at the Massachusetts Institute of Technology who focuses on health care applications, and JAMA Editor in Chief Kirsten Bibbins-Domingo. [ABSTRACT FROM AUTHOR]

In this Medical News interview, Stanford Health Care's chief data scientist Nigam Shah, MBBS, PhD, discusses ways to train and evaluate artificial intelligence models for use in health care. [ABSTRACT FROM AUTHOR]

In this Medical News article, Andrew Bindman, MD, executive vice president and chief medical officer for Kaiser Permanente, discusses how AI can alert clinicians when patients are falling through the health care system's cracks. [ABSTRACT FROM AUTHOR]

Presents a book received by 'The Journal of the American Medical Association' called 'An Illustrated Pocketbook of Prostatic Diseases' by Roger S. Kirby.

Presents a list of books related to medical topics. "Human Embryology and Developmental Biology," by Bruce M. Carlson; "Hormonal Carcinogenesis IV," edited by Jonathan J. Li, Sara A. Li, and Antonio Llombart-Bosch; "Cardiology Explained," by Euan A. Ashley and Josef Neibauer; "Frontiers in Health Policy Research," edited by David M. Cutler and Alan M. Garber; "Post Mortem Technique Handbook," by Michael T. Sheaff and Deborah J. Hopster; "Accounts of Innocence: Sexual Abuse, Trauma, and the Self," by Joseph E. Davis; "The Neurobiology of Autism," edited by Margaret L. Bauman and Thomas L. Kemper; "Sexual Metamorphosis: An Anthology of Transsexual Memoirs," edited by Jonathan Ames; "Current Therapy in Colon and Rectal Surgery," by Victor W. Fazio, James M. Church, and Conor P. Delaney; "Endourooncology: New Horizons in Endourology," edited by Hiromi Kumon, Masaru Murai, and Shiro Baba.

The article presents a call for papers to be published in a special October, 2008 issue devoted to the health of the U.S. Preference will be given to papers describing original research that presents new scientific understanding backed by solid data. Any topic related to the nation's health is eligible, including national health status, the composition of the health care work force, econometric analysis of health care reform, and comparative analyses with health care systems in other countries.

A list of books received by the "Journal of the American Medical Association" for review is presented. Titles include "Prostate Cancer: Principles and Practice," "Pain: New Essays on Its Nature and the Methodology of Its Study," "Faces of Osteoporosis and the Stories Behind Them," 'Frantz Fanon: A Portrait" and "AJCC Cancer Staging Atlas." Books on medical topics such as immunology, infectious diseases, otolaryngology, pediatrics, pathology and sports exercise are also listed.

The article discusses the health care crisis in the United States and invites those who are serious scholars in the field of medical care to submit manuscripts on topics dealing with health care for a March 2007 special thematic issue of the "Journal of the American Medical Association." The article encourages papers to focus on access to health care as well as the economic ramifications associated with potential solutions. The author writes that the amount of people in the U.S. who are unable to receive adequate medical care is on the rise.

The article presents schedule of Dina E. El-Metwally, MD, PhD, who is themedical director of the level 4 neonatal intensive care unit (NICU)at University of Maryland Children's Hospital (UMCH) in Baltimore, Maryland. She mentions about her taking up texts and emails and daily briefings and meetings and interactions with patients and their families.

The author reflects on the achievements as well as the possible future of the Affordable Care Act (ACA) legislation. The author referred to the challenges faced by the legislation prior to implementation including that from the Supreme Court as well as the U.S. Congress with the slim majority Senate approval. The author applauded the innovative thrusts of ACA despite the shortcomings on truly making health care more affordable with mention of the accountable care organization (ACO) system.

Importance: Cardiogenic shock affects between 40 000 and 50 000 people in the US per year and is the leading cause of in-hospital mortality following acute myocardial infarction.Observations: Thirty-day mortality for patients with cardiogenic shock due to myocardial infarction is approximately 40%, and 1-year mortality approaches 50%. Immediate revascularization of the infarct-related coronary artery remains the only treatment for cardiogenic shock associated with acute myocardial infarction supported by randomized clinical trials. The Percutaneous Coronary Intervention Strategies with Acute Myocardial Infarction and Cardiogenic Shock (CULPRIT-SHOCK) clinical trial demonstrated a reduction in the primary outcome of 30-day death or kidney replacement therapy; 158 of 344 patients (45.9%) in the culprit lesion revascularization-only group compared with 189 of 341 patients (55.4%) in the multivessel percutaneous coronary intervention group (relative risk, 0.83 [95% CI, 0.71-0.96]; P = .01). Despite a lack of randomized trials demonstrating benefit, percutaneous mechanical circulatory support devices are frequently used to manage cardiogenic shock following acute myocardial infarction.Conclusions and Relevance: Cardiogenic shock occurs in up to 10% of patients immediately following acute myocardial infarction and is associated with mortality rates of nearly 40% at 30 days and 50% at 1 year. Current evidence and clinical practice guidelines support immediate revascularization of the infarct-related coronary artery as the primary therapy for cardiogenic shock following acute myocardial infarction. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor in response to a study of computerized physician order entry systems and medication errors, published in the March 10, 2005 edition of the "Journal of American Medical Association."

Presents a letter to the editor in response to a study of computerized physician order entry systems and medication errors, published in the March 10, 2005 edition of the "Journal of American Medical Association."

Presents the author's response to letters to the editor regarding a study of computerized physician order entry systems and medication errors, published in the March 10, 2005 edition of the "Journal of American Medical Association."

Importance: Evidence-based guidance is limited on how clinicians should screen for social risk factors and which interventions related to these risk factors improve health outcomes.Objective: To describe research on screening and interventions for social risk factors to inform US Preventive Services Task Force considerations of the implications for its portfolio of recommendations.Data Sources: Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Sociological Abstracts, and Social Services Abstracts (through 2018); Social Interventions Research and Evaluation Network evidence library (January 2019 through May 2021); surveillance through May 21, 2021; interviews with 17 key informants.Study Selection: Individual-level and health care system-level interventions with a link to the health care system that addressed at least 1 of 7 social risk domains: housing instability, food insecurity, transportation difficulties, utility needs, interpersonal safety, education, and financial strain.Data Extraction and Synthesis: One investigator abstracted data from studies and a second investigator evaluated data abstractions for completeness and accuracy; key informant interviews were recorded, transcribed, summarized, and integrated with evidence from the literature; narrative synthesis with supporting tables and figures.Main Outcomes and Measures: Validity of multidomain social risk screening tools; all outcomes reported for social risk-related interventions; challenges or unintended consequences of screening and interventions.Results: Many multidomain social risk screening tools have been developed, but they vary widely in their assessment of social risk and few have been validated. This technical brief identified 106 social risk intervention studies (N = 5 978 596). Of the interventions studied, 73 (69%; n = 127 598) addressed multiple social risk domains. The most frequently addressed domains were food insecurity (67/106 studies [63%], n = 141 797), financial strain (52/106 studies [49%], n = 111 962), and housing instability (63/106 studies [59%], n = 5 881 222). Food insecurity, housing instability, and transportation difficulties were identified by key informants as the most important social risk factors to identify in health care. Thirty-eight studies (36%, n = 5 850 669) used an observational design with no comparator, and 19 studies (18%, n = 15 205) were randomized clinical trials. Health care utilization measures were the most commonly reported outcomes in the 68 studies with a comparator (38 studies [56%], n = 111 102). The literature and key informants described many perceived or potential challenges to implementation of social risk screening and interventions in health care.Conclusions and Relevance: Many interventions to address food insecurity, financial strain, and housing instability have been studied, but more randomized clinical trials that report health outcomes from social risk screening and intervention are needed to guide widespread implementation in health care. [ABSTRACT FROM AUTHOR]

Assesses the concerns raised regarding the launching of a federal program to vaccinate a half million U.S. health care workers with the smallpox vaccine. Who will receive the vaccination; Mandatory immunization of 500,000 military personnel; Questions about compensation raised by an expert panel convened by the Institute of Medicine; Lack of compensation provisions for those individuals who are harmed by the vaccine; Expert panel urges more deliberation, analysis and evaluation by the government; Report that a number of hospitals across the country are declining to participate in the program because of concerns such as the vaccine's potential adverse effects, worker's compensation issues, and the possibility of inadvertant exposure of vulnerable individuals to vaccinia shed by vaccinated volunteers.

Presents a study to examine the relationship between patents and antiretroviral drug access in Africa and determine whether patents are a barrier to widespread AIDS treatment. Methods; Results; Conclusion that patent protection for antiretroviral drugs in Africa is not extensive and that patents are not responsible for lack of access to antiretroviral drug treatment.

Importance: Nearly 10 million US adults experience stable angina, which occurs when myocardial oxygen supply does not meet demand, resulting in myocardial ischemia. Stable angina is associated with an average annual risk of 3% to 4% for myocardial infarction or death. Diagnostic tests and medical therapies for stable angina have evolved over the last decade with a better understanding of the optimal use of coronary revascularization.Observations: Coronary computed tomographic angiography is a first-line diagnostic test in the evaluation of patients with stable angina due to higher sensitivity and comparable specificity compared with imaging-based stress testing. Moreover, coronary computed tomographic angiography allows detection of nonobstructive atherosclerosis that would not be identified with other noninvasive imaging modalities, improving risk assessment and potentially triggering more appropriate allocation of preventive therapies. Novel therapies treating lipids (proprotein convertase subtilisin/kexin type 9 inhibitors, ezetimibe, and icosapent ethyl) and type 2 diabetes (sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists) have improved cardiovascular outcomes in patients with stable ischemic heart disease when added to usual care. Randomized clinical trials showed no improvement in the rates of mortality or myocardial infarction with revascularization (largely by percutaneous coronary intervention) compared with optimal medical therapy alone, even in the setting of moderate to severe ischemia. In contrast, revascularization provides a meaningful benefit on angina and quality of life compared with antianginal therapies. Measures of the effect of angina on a patient's quality of life should be integrated into the clinic encounter to assist with the decision to proceed with revascularization.Conclusions and Relevance: For patients with stable angina, emphasis should be placed on optimizing lifestyle factors and preventive medications such as lipid-lowering and antiplatelet agents to reduce the risk for cardiovascular events and death. Antianginal medications, such as β-blockers, nitrates, or calcium channel blockers, should be initiated to improve angina symptoms. Revascularization with percutaneous coronary intervention should be reserved for patients in whom angina symptoms negatively influence quality of life, generally after a trial of antianginal medical therapy. Shared decision-making with an informed patient is important for effective treatment of stable angina. [ABSTRACT FROM AUTHOR]

In the article, the author discusses the need for medical practitioners to determine what is best for their practice rather than follow the trends in medicine as of November 1895. He claims that the trends where physicians and surgeons allow reporters during their operations and daily bulletins of cases should not be the focus of rational or state medicine. He also talks about the importance of preventive medicine in health care.

Presents an account of a physician in trying to find a research project to pursue. How the physician has yet to define a research interest; Decision of the physician to write about his volunteer work at a refugee center for patients who lack access to medical care; Response from colleagues; Experience with a refugee patient; Claim that there is nothing pedestrian about the day-to-day care of patients.

Importance: Mental health comorbidities are increasing worldwide and worsen outcomes for people with diabetes, especially when care is fragmented.Objective: To assess whether collaborative care vs usual care lowers depressive symptoms and improves cardiometabolic indices among adults with diabetes and depression.Design, Setting, and Participants: Parallel, open-label, pragmatic randomized clinical trial conducted at 4 socioeconomically diverse clinics in India that recruited patients with type 2 diabetes; a Patient Health Questionnaire-9 score of at least 10 (range, 0-27); and hemoglobin A1c (HbA1c) of at least 8%, systolic blood pressure (SBP) of at least 140 mm Hg, or low-density lipoprotein (LDL) cholesterol of at least 130 mg/dL. The first patient was enrolled on March 9, 2015, and the last was enrolled on May 31, 2016; the final follow-up visit was July 14, 2018.Interventions: Patients randomized to the intervention group (n = 196) received 12 months of self-management support from nonphysician care coordinators, decision support electronic health records facilitating physician treatment adjustments, and specialist case reviews; they were followed up for an additional 12 months without intervention. Patients in the control group (n = 208) received usual care over 24 months.Main Outcomes and Measures: The primary outcome was the between-group difference in the percentage of patients at 24 months who had at least a 50% reduction in Symptom Checklist Depression Scale (SCL-20) scores (range, 0-4; higher scores indicate worse symptoms) and a reduction of at least 0.5 percentage points in HbA1c, 5 mm Hg in SBP, or 10 mg/dL in LDL cholesterol. Prespecified secondary outcomes were percentage of patients at 12 and 24 months who met treatment targets (HbA1c <7.0%, SBP <130 mm Hg, LDL cholesterol <100 mg/dL [<70 mg/dL if prior cardiovascular disease]) or had improvements in individual outcomes (≥50% reduction in SCL-20 score, ≥0.5-percentage point reduction in HbA1c, ≥5-mm Hg reduction in SBP, ≥10-mg/dL reduction in LDL cholesterol); percentage of patients who met all HbA1c, SBP, and LDL cholesterol targets; and mean reductions in SCL-20 score, Patient Health Questionnaire-9 score, HbA1c, SBP, and LDL cholesterol.Results: Among 404 patients randomized (mean [SD] age, 53 [8.6] years; 165 [40.8%] men), 378 (93.5%) completed the trial. A significantly greater percentage of patients in the intervention group vs the usual care group met the primary outcome (71.6% vs 57.4%; risk difference, 16.9% [95% CI, 8.5%-25.2%]). Of 16 prespecified secondary outcomes, there were no statistically significant between-group differences in improvements in 10 outcomes at 12 months and in 13 outcomes at 24 months. Serious adverse events in the intervention and usual care groups included cardiovascular events or hospitalizations (4 [2.0%] vs 7 [3.4%]), stroke (0 vs 3 [1.4%]), death (2 [1.0%] vs 7 [3.4%]), and severe hypoglycemia (8 [4.1%] vs 0).Conclusions and Relevance: Among patients with diabetes and depression in India, a 12-month collaborative care intervention, compared with usual care, resulted in statistically significant improvements in a composite measure of depressive symptoms and cardiometabolic indices at 24 months. Further research is needed to understand the generalizability of the findings to other low- and middle-income health care settings.Trial Registration: ClinicalTrials.gov Identifier: NCT02022111. [ABSTRACT FROM AUTHOR]

This paper examines market justice health care in the United States which is based on the principles of self-interest, personal effort and voluntary behavior and compares it to social justice of medicine which stems from the principles of a shared community and offers services to all equally. The commercialization of medical care and how that changed the medical profession itself is presented along why there is little incentive to change the system despite the need.

Importance: Meta-analyses have suggested that initiating pulmonary rehabilitation after an exacerbation of chronic obstructive pulmonary disease (COPD) was associated with improved survival, although the number of patients studied was small and heterogeneity was high. Current guidelines recommend that patients enroll in pulmonary rehabilitation after hospital discharge.Objective: To determine the association between the initiation of pulmonary rehabilitation within 90 days of hospital discharge and 1-year survival.Design, Setting, and Patients: This retrospective, inception cohort study used claims data from fee-for-service Medicare beneficiaries hospitalized for COPD in 2014, at 4446 acute care hospitals in the US. The final date of follow-up was December 31, 2015.Exposures: Initiation of pulmonary rehabilitation within 90 days of hospital discharge.Main Outcomes and Measures: The primary outcome was all-cause mortality at 1 year. Time from discharge to death was modeled using Cox regression with time-varying exposure to pulmonary rehabilitation, adjusting for mortality and for unbalanced characteristics and propensity to initiate pulmonary rehabilitation. Additional analyses evaluated the association between timing of pulmonary rehabilitation and mortality and between number of sessions completed and mortality.Results: Of 197 376 patients (mean age, 76.9 years; 115 690 [58.6%] women), 2721 (1.5%) initiated pulmonary rehabilitation within 90 days of discharge. A total of 38 302 (19.4%) died within 1 year of discharge, including 7.3% of patients who initiated pulmonary rehabilitation within 90 days and 19.6% of patients who initiated pulmonary rehabilitation after 90 days or not at all. Initiation within 90 days was significantly associated with lower risk of death over 1 year (absolute risk difference [ARD], -6.7% [95% CI, -7.9% to -5.6%]; hazard ratio [HR], 0.63 [95% CI, 0.57 to 0.69]; P < .001). Initiation of pulmonary rehabilitation was significantly associated with lower mortality across start dates ranging from 30 days or less (ARD, -4.6% [95% CI, -5.9% to -3.2%]; HR, 0.74 [95% CI, 0.67 to 0.82]; P < .001) to 61 to 90 days after discharge (ARD, -11.1% [95% CI, -13.2% to -8.4%]; HR, 0.40 [95% CI, 0.30 to 0.54]; P < .001). Every 3 additional sessions was significantly associated with lower risk of death (HR, 0.91 [95% CI, 0.85 to 0.98]; P = .01).Conclusions and Relevance: Among fee-for-service Medicare beneficiaries hospitalized for COPD, initiation of pulmonary rehabilitation within 3 months of discharge was significantly associated with lower risk of mortality at 1 year. These findings support current guideline recommendations for pulmonary rehabilitation after hospitalization for COPD, although the potential for residual confounding exists and further research is needed. [ABSTRACT FROM AUTHOR]

Importance: Acute myocardial infarction (AMI) complicated by cardiogenic shock is associated with substantial morbidity and mortality. Although intravascular microaxial left ventricular assist devices (LVADs) provide greater hemodynamic support as compared with intra-aortic balloon pumps (IABPs), little is known about clinical outcomes associated with intravascular microaxial LVAD use in clinical practice.Objective: To examine outcomes among patients undergoing percutaneous coronary intervention (PCI) for AMI complicated by cardiogenic shock treated with mechanical circulatory support (MCS) devices.Design, Setting, and Participants: A propensity-matched registry-based retrospective cohort study of patients with AMI complicated by cardiogenic shock undergoing PCI between October 1, 2015, and December 31, 2017, who were included in data from hospitals participating in the CathPCI and the Chest Pain-MI registries, both part of the American College of Cardiology's National Cardiovascular Data Registry. Patients receiving an intravascular microaxial LVAD were matched with those receiving IABP on demographics, clinical history, presentation, infarct location, coronary anatomy, and clinical laboratory data, with final follow-up through December 31, 2017.Exposures: Hemodynamic support, categorized as intravascular microaxial LVAD use only, IABP only, other (such as use of a percutaneous extracorporeal ventricular assist system, extracorporeal membrane oxygenation, or a combination of MCS device use), or medical therapy only.Main Outcomes and Measures: The primary outcomes were in-hospital mortality and in-hospital major bleeding.Results: Among 28 304 patients undergoing PCI for AMI complicated by cardiogenic shock, the mean (SD) age was 65.0 (12.6) years, 67.0% were men, 81.3% had an ST-elevation myocardial infarction, and 43.3% had cardiac arrest. Over the study period among patients with AMI, an intravascular microaxial LVAD was used in 6.2% of patients, and IABP was used in 29.9%. Among 1680 propensity-matched pairs, there was a significantly higher risk of in-hospital death associated with use of an intravascular microaxial LVAD (45.0%) vs with an IABP (34.1% [absolute risk difference, 10.9 percentage points {95% CI, 7.6-14.2}; P < .001) and also higher risk of in-hospital major bleeding (intravascular microaxial LVAD [31.3%] vs IABP [16.0%]; absolute risk difference, 15.4 percentage points [95% CI, 12.5-18.2]; P < .001). These associations were consistent regardless of whether patients received a device before or after initiation of PCI.Conclusions and Relevance: Among patients undergoing PCI for AMI complicated by cardiogenic shock from 2015 to 2017, use of an intravascular microaxial LVAD compared with IABP was associated with higher adjusted risk of in-hospital death and major bleeding complications, although study interpretation is limited by the observational design. Further research may be needed to understand optimal device choice for these patients. [ABSTRACT FROM AUTHOR]

The article offers medical news briefs as of June 12, 2013. Need of improvement is required by the agencies the Department of Veteran Affairs (VA) and the Indian Health Service (IHS) as per the U.S. Government Accountability Office (GAO). Federal efforts are recommended by various health care community stakeholders from waste management. As per GAO, there is need of improved understanding by the U.S. Nuclear Regulatory Commission (NRC) related to radiological incidents.

The article focuses on the role of U.S. newspapers in creating awareness among U.S. people regarding public health and medical care. It cites various medical incidents that were published in several newspapers including "Enquirer," "Ledger," and "Chronicle." It mentions that newspapers reports about various meetings on topics including perpetual eclampsia, chronic intestinal nephritis and hydrated mole.

The article discusses the problem of medical advertising in lay press and fraudulent advertising in newspapers. It reflects on the responsibility of newspapers' editors for fake medical announcement, advertisement of a fraudulent claim or worthless product. It describes clean advertising and highlights a statistical analysis of the medical advertising showing patent medicines and quack treatments in this context.

The article discusses the notion of democratizing health care in the U.S. Topics include the integration of behavioral health and social services with health care provision, the use of technology to promote the sharing of health information, and changing economic incentives to involve patients in their own health.

The article discusses transparency in health care systems regarding outcomes, health care quality, medical safety, and the costs of care. Topics include the factors causing errors in the measurement of health care outcomes, the relation of the nonprofit Financial Accounting Standards Board (FASB) in promoting transparency in financial reporting, and the need for standards for health data in the U.S.

The article discusses the role of precision medicine in U.S. health care services. Topics include the need for randomized clinical trial (RCT) evidence on the effectiveness of precision medicine, the use of genomic information as part of electronic health records (EHRs), and drug development in relation to precision medicine.

The article discusses U.S. health care access for people with mental health and substance abuse problems. Topics include problems with the fragmented delivery of medical care and social services, the use of videoconferencing for mental health care, and the possibility of improved payment models for integrating services.

Prices paid to hospitals for commercially insured patients were 31% higher for system hospitals and approximately 20% higher for system physicians compared with nonsystem hospitals and physicians. Racial and ethnic disparities in care for health system-affiliated physician organizations and non-affiliated physician organizations. Editorial For better or worse, independent medical practices and solo community hospitals are disappearing as they are acquired by hospital-based health systems. [Extracted from the article]

The article focuses on the origin of medical journals from the "Bulletin of the Johns Hopkins Hospital" in the 1890s to the Medical History Club of Washington, D.C.'s "Old Dominion Medical Journal."