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Sky-High Mortality Rates From Cesarean Delivery in Africa

Mar, 21/05/2019 - 02:00
Women in Africa are 50 times more likely to die as a result of a cesarean delivery as women in high-income countries, a team of investigators from several African countries has reported. Neonates fare poorly, too. Their mortality rate after cesarean delivery is high—44 per 1000 live births.

Water and Sanitation Deficits Take a Toll in Armed Conflict Regions

Mar, 21/05/2019 - 02:00
Diarrheal diseases resulting from scarce clean water and sanitation in countries with protracted armed conflicts take more children’s lives than the violence itself, according to a recent United Nations Children’s Fund (UNICEF) report.

Huge Swath of North Korea Faces the Threat of Hunger

Mar, 21/05/2019 - 02:00
A recent United Nations report lays out a grim scenario in North Korea, formally the Democratic People’s Republic of Korea: An estimated 11 million people—almost 44% of the population—are undernourished and millions lack clean drinking water, access to basic health services, and sanitation.

JAMA

Mar, 21/05/2019 - 02:00

Systole and Diastole: A Metaphor for Living

Mar, 21/05/2019 - 02:00
In this narrative medicine essay, a physician finds in the motion of diastole, the process of letting go and filling up, an apt metaphor for how to handle the burnout, anxiety, and depression of medical training.

One Syllable

Mar, 21/05/2019 - 02:00
Write light. Watch how the air quickens.A gentle humming begins.

Epiglottitis

Mar, 21/05/2019 - 02:00
This JAMA Patient Page describes the symptoms, diagnosis, and treatment of epiglottitis in children.

Association of Changes in Air Quality With Incident Asthma in Children in California, 1993-2014

Mar, 21/05/2019 - 02:00
This study uses Southern California Children’s Health Study data to examine associations between changes in regional air pollution (ozone, nitrogen dioxide, and particulate matter <10 ?m and <2.5 ?m) and changes in childhood asthma incidence across 3 child cohorts.

Trends in Levels of Lipids and Apolipoprotein B in US Youths Aged 6 to 19 Years, 1999-2016

Mar, 21/05/2019 - 02:00
This national survey study uses National Health and Nutrition Examination Survey data from 1999-2016 to characterize trends in levels of lipids and apolipoprotein B in US youths aged 6 to 19 years.

Meta-analysis of Opioids for Chronic Pain—Reply

Mar, 21/05/2019 - 02:00
In Reply Average effects have limitations, which is why we modeled the proportion of patients that achieved the minimally important difference for all continuous outcomes. Pooling the proportion of patients achieving 30% and 50% improvement from baseline scores for pain relief requires that trialists report this information, which the large majority did not.

Need for Randomized Trials to Support Procedural Interventions—Reply

Mar, 21/05/2019 - 02:00
In Reply As Ms Sharma and colleagues highlight, RCTs have gained a dominant role in medical research due to their ability to generate an unbiased estimate of treatment effect in the study sample. However, as discussed in our Viewpoint and elsewhere, there are significant barriers to the conduct of RCTs for devices and procedures. To rely on intrinsic motivation among physicians to conduct these trials as Sharma and colleagues suggest seems unrealistic, albeit optimistic, given the self-interest of those who develop and promote new health technologies. We believe that in the absence of a regulatory environment that mandates RCTs for procedures, these trials will continue to be relatively uncommon. Important evidence in support of this prediction lies in the 21st Century Cures Act that has enabled the US Food and Drug Administration to promulgate the use of so-called real-world data (eg, observational data from insurance databases, disease registries) in the approval of new indications for pharmaceutical agents.

Self-medication as Part of Self-management Plans for Patients With COPD—Reply

Mar, 21/05/2019 - 02:00
In Reply We agree with Dr Steurer-Stey that the use of action plans with adequate instructions for self-medication can be helpful for the management of some patients with COPD. However, this approach needs to be individualized and consider patient factors such as comorbidities, cognitive status, and knowledge. As Fan et al pointed out, self-medication may not be helpful for all patients, and the authors of the recent Cochrane review recommended taking into account comorbidities in self-management action plans.

Meta-analysis of Opioids for Chronic Pain

Mar, 21/05/2019 - 02:00
To the Editor Following the discussion by Serghiou and Goodman, a closer examination of the application and reporting of the random-effects meta-analyses by Dr Busse and colleagues suggests additional caveats and questions.

Meta-analysis of Opioids for Chronic Pain

Mar, 21/05/2019 - 02:00
To the Editor Dr Busse and colleagues analyzed the weighted mean differences of pain intensity and physical function after treatment with opioids vs placebo for chronic noncancer pain from 69 trials. However, their outcomes did not meet best practices in the reporting of systematic reviews of chronic pain trials and are not helpful for clinical practice.

Self-medication as Part of Self-management Plans for Patients With COPD

Mar, 21/05/2019 - 02:00
To the Editor The randomized clinical trial by Dr Aboumatar and colleagues demonstrated that the combination of transitional care support and long-term self-management resulted in fewer hospitalizations and emergency department visits for patients with chronic obstructive pulmonary disease (COPD). One statement in the article deserves a comment.

Need for Randomized Trials to Support Procedural Interventions

Mar, 21/05/2019 - 02:00
To the Editor Dr Wallis and colleagues highlighted the many issues surrounding the testing and approval of procedures and devices, which include questions of ethics (values) and epistemology (knowledge) about the need for RCTs. Although RCTs are valuable in medical research, they are not always scientifically required or ethically permissible, so how should the need for an RCT to assess a procedure or device be determined? To help adjudicate when RCTs should be performed, we have proposed 3 universal conditions: demonstrated uncertainty (ie, nonredundancy), scientific plausibility of any treatment (ie, no known inferiority), and methodological rigor.

Need for Randomized Trials to Support Procedural Interventions

Mar, 21/05/2019 - 02:00
To the Editor The Viewpoint by Dr Wallis and colleagues suggested that there is a limited role for randomized trials in establishing the effectiveness of procedural interventions. Instead the authors suggested that patients, physicians, and payers might need to take a “leap of faith” regarding robotic surgery and other procedural interventions. We are concerned by the implications of this message and believe there are better ways for science to keep up with innovation.

Trends in Incidence and Stage at Diagnosis of Colorectal Cancer in Middle-aged Adults

Mar, 21/05/2019 - 02:00
This cancer epidemiology study uses SEER program data to describe trends in stage of incident colorectal cancer in adults aged 40-49 years between 1975 and 2015 to understand if apparent increases in incidence are due to earlier detection or true increases in risk.

Minor Comments

Mar, 21/05/2019 - 02:00

Highlights for May 21, 2019

Mar, 21/05/2019 - 02:00