JAMA Archives - Page 3 of 4 - PulmCCM
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JAMA Articles

Jun 142012
 
Most clinical trials are too small, often underpowered

The past decade has seen an explosion in the number of clinical trials; there are now more than 10,000 new trials registered each year. Although clinical trials’ quality is improving somewhat, most are still small and single-center and a large proportion do not adhere with reporting requirements, raising serious questions as to what we are [... read more]

Jun 072012
 
Inhaled hypertonic saline for young kids with cystic fibrosis: no benefit? (RCT)

(image: Bennett Gamel blog) Inhaled hypertonic saline (7% NaCl) increases clearance of mucus by airway cilia, making it an attractive treatment for cystic fibrosis. Hypertonic saline has been a cornerstone of daily therapy for CF ever since a 2006 NEJM randomized trial showed that ~80 adults and kids older than 6 using hypertonic saline for [... read more]

May 162012
 
Tattletales rain on private cardiologists' cash-grabbing parade

Did you know that about half of cardiologists’ $400,000+ average income comes from self-referring patients to undergo imaging studies on scanners owned in part or in whole by the physicians themselves? This type of arrangement violates the spirit but not the letter of the Stark Law, created in 1992 to address the inevitable economic and medical inequities that result when physicians are permitted [... read more]

May 052012
 
Fellows: This is your brain on protocols (JAMA)

(image: flickrCC) Do protocols make trainees’ brains go soft? That’s the assertion of more than a few crusty hard-liners who miss the good old days — when you got 2-liter tidal volumes for your ARDS and liked it, dad-gum-it!! Prasad et al can’t say whether critical care fellows can actually run ventilators in the post-protocol [... read more]

May 032012
 
Epinephrine in field no help after out-of-hospital cardiac arrest? (JAMA)

(image: Hospira) Akihito Hagihara et al present suggestive data in the March 21 JAMA that giving epinephrine to people with out of hospital cardiac arrest increases their chances of making it to the hospital with a pulse, but not of making it home with decent brain function or functional status. In a prospective observational analysis [... read more]

May 022012
 
Cost shifting of asthma meds to patients had little effect on adherence, outcomes (JAMA)

(image: flickrCC) Health insurance plans are shifting an increasing portion of costs for prescription medications onto patients. A recent study in JAMA concluded that such cost shifting decreased asthma medication use and increased hospitalization rates in U.S. children. But the effect, if real, was small. What They Did Pinar Karaca-Mandic et al looked back at [... read more]

Mar 252012
 

“The average length of medical training could be reduced by about 30% without compromising physician competence or quality of care,” writes Ezekiel Emanuel, Obama’s former health care advisor who’s now back at University of Pennsylvania in a big-thinker job spanning ethics, economics and medicine. In a JAMA essay with co-author Viktor Fuchs, they opine that [... read more]

Mar 192012
 

This post was featured on KevinMD.com; an excerpt follows: An essay in JAMA by Vinay Prasad (Northwestern of Chicago), Adam Cifu (U. of Chicago) and John Ioannidis (Stanford) should be required reading for every medical student, resident, and to pass every board certification exam in any specialty. In my humble opinion. John Ioannidis became one [... read more]

Feb 272012
 

“Medical identity theft” — theft of your unique identifiers to perpetrate Medicare or insurance fraud — may be on the rise, according to the Federal Trade Commission. There were 12,000 cases of medical identity theft reported by patients or doctors between 2007-2009. A JAMA article by Shantanu Agrawal and Peter Budetti describes one hapless victim’s [... read more]

Feb 212012
 
Amoxicillin speeds resolution of acute sinus infections, but imperceptibly? (RCT, JAMA)

Amoxicillin may hasten the recovery from acute sinusitis (sinus infections), with more patients feeling just a tiny bit better after a week of amoxicillin compared to placebo, according to a clinical trial published in the February 15 JAMA. After 10 days, those taking placebo felt as well as those taking antibiotics. You may have heard [... read more]

Feb 062012
 

Januel et al report findings of a systematic review and meta-analysis to estimate the total incidence of acute symptomatic venous thromboembolism (symptomatic DVT or pulmonary embolism) among patients receiving proper thromboprophylaxis after hip or knee replacements. They came up with rates of 1.1% after knee replacements, and 0.5% after hip replacements. The rate of pulmonary [... read more]

Jan 212012
 

People who survive the initial hyperinflammatory “cytokine storm” of severe sepsis regain their blood pressure, but are at high risk for secondary infection and viral reactivation. Animal models strongly suggest sepsis-induced immune suppression occurring later in the course of sepsis is to blame, but that’s never been proven in humans. Jonathan Boomer, Kathleen To, Richard [... read more]

Jan 072012
 
Sleepy cops abound; you won't like them when they're angry (JAMA, NYT)

Did you ever wonder what that police officer is really doing while you wait forever in your car for him to write you your ticket? According to new research, it’s possible he’s taking a quick nap. And you’d best save your snarky comment when he brings you the citation: sleepy cops, it turns out, tend to be [... read more]

Jan 012012
 

Numerous small (n~100), single-center randomized trials have shown a benefit of omega-3 fatty acids in acute lung injury and ARDS (reduced mortality, length of stay, and organ failure; improved oxygenation and respiratory mechanics). A meta-analysis combining these studies suggested a stat.significant benefit in mortality (risk ratio 0.67), ventilator requirement (-5 days), and ICU stay (-4 [... read more]

Jan 012012
 

The National Lung Screening Trial demonstrated annual screening with chest CT saves one life per 320 screened compared to yearly screening with chest radiography. However, there was no “usual care” group (no screening at all) to compare against. Oken et al report additional results from the PLCO Trial (Prostate, Lung, Colorectal, and Ovarian Cancer Screening [... read more]

Jan 012012
 

Severe sepsis makes the heart irritable, probably due to all the evil humors and increased cardiac demand. Between 6-20% of patients with severe sepsis develop atrial fibrillation for the first time; that’s old news. What’s been unclear is what new-onset atrial fibrillation in severe sepsis means: is it an expected, yeah-so-what marker of critical illness, [... read more]

Dec 262011
 

Medications are often stopped during transfers of care. Bell et al analyzed administrative-level data for almost 400,000 hospitalizations in Ontario, Canada, as well as 90-day follow-up outpatient prescription data. They conclude that medications were likely to be discontinued after discharge from the hospital or ICU, “potentially unintentionally.” Five medication classes were analyzed (inhalers, anticoagulant/antiplatelets, acid-suppressors, thyroxine [... read more]

Dec 262011
 

The Institute of Medicine has issued stern new guidelines on guideline development. Apparently a good portion of the 2,700 clinical practice guidelines in the Agency of Healthcare Research and Quality’s database are not based on a foundation of good evidence, do not acknowledge when the evidence is shaky, and their authors often have financial conflicts [... read more]

Dec 222011
 

Neither a large 2009 multicenter study nor a 2011 meta-analysis showed any clinical benefit from the use of ICU telemedicine. Lilly et al report the results of a large single-center study in which they progressively implemented ICU telemedicine among 6,290 patients in 7 ICUs (a stepped-wedge design), with non-telemedicine groups acting as controls at each [... read more]