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WHO’s Top Health Threats for 2019

Mar, 19/03/2019 - 01:00
In its list of the top 10 global health threats for 2019, the World Health Organization (WHO) identified noncommunicable diseases such as diabetes, cancer, and heart disease as a grave danger, causing more than 70% of deaths worldwide and disproportionately affecting low- and middle-income countries. The WHO noted that these illnesses sometimes exacerbate mental health issues among young people, which can lead to suicide.

Venezuela’s Infant Death Rate Rises Amid Worsening Humanitarian Crisis

Mar, 19/03/2019 - 01:00
Venezuela’s plunge into an economic crisis and the collapse of its health care system appear to have taken a toll on newborns. The country’s infant mortality rate has increased by 40% since 2008, according to a recent study.

Higher HIV Rates in Adolescent Girls Related to Drought in Lesotho

Mar, 19/03/2019 - 01:00
A recent study linked severe drought in the African country of Lesotho from 2014 to 2016 with an increased risk of HIV infection among adolescent girls.

Lessons Learned From TARV About Dispersion of Transcatheter Mitral Valve Repair Into Clinical Practice

Mar, 19/03/2019 - 01:00
This Viewpoint discusses the strategy of “rational dispersion” for new technology into clinical practice, and proposes patient and clinical selection criteria, follow-up and registry surveillance, and regionalization strategies that would guide rational staged rollout of transcatheter technology for mitral valve repair (TMVR).

JAMA

Mar, 19/03/2019 - 01:00

JAMA Peer Reviewers in 2018

Mar, 19/03/2019 - 01:00
We sincerely thank the 2704 peer reviewers who completed manuscript reviews for JAMA in 2018.

Bearing Witness and Finding Meaning in Others’ Suffering

Mar, 19/03/2019 - 01:00
In this narrative medicine essay, a palliative care physician’s experience—holding the hand of a man who was flung to a curb after miscalculating a light change as he dashed across the street causing him to be struck by truck—cured her of fainting at the sight of pain, which enabled her to choose a career in palliative care.

The War of All Against All

Mar, 19/03/2019 - 01:00

Cardiac Catheter Ablation for Heart Rhythm Abnormalities

Mar, 19/03/2019 - 01:00
This JAMA Patient Page describes why and how cardiac catheter ablation is used to correct atrial fibrillation and other heart rhythm abnormalities.

Dietary Cholesterol or Egg Consumption With Incident CVD and Mortality

Mar, 19/03/2019 - 01:00
This pooled cohort study reports that consumption of an additional 300 mg of dietary cholesterol per day or an additional half egg per day is significantly associated with higher risk of incident cardiovascular disease (CVD) events and all-cause mortality.

Levels of Evidence Supporting ACC/AHA and ESC Guidelines, 2008-2018

Mar, 19/03/2019 - 01:00
This systematic review of current and prior American College of Cardiology/American Heart Association and European Society of Cardiology guidelines summarizes the class and level of evidence (LOE) supporting guideline recommendations and changes in LOEs over time.

Catheter Ablation vs Antiarrhythmic Medication and Quality of Life in Atrial Fibrillation

Mar, 19/03/2019 - 01:00
This randomized trial compares the effects of pulmonary vein isolation using radiofrequency ablation vs antiarrhythmic medication on self-reported quality of life at 1 year in patients with atrial fibrillation and previous medication failure.

Challenges in Research on Suicide Prevention—Reply

Mar, 19/03/2019 - 01:00
In Reply We are gratified to know that the FDA is developing guidance that supports inclusion of individuals with suicidal ideation or behavior associated with serious mental illnesses, including schizophrenia and bipolar disorder, in clinical trials. We agree that trial participants with acute suicidal ideation or behavior, including those in the control groups of clinical trials evaluating suicidal ideation or behavior as an end point, be provided with standard-of-care (including emergency) interventions or with investigational approaches hypothesized to be as good as or better than the standard of care. However, mandating participant exclusion when suicidal ideation or behavior passes a predetermined threshold is a step backward: drawing conclusions about new treatments for the population most at risk would be impossible.

Reducing the Burden of Fellowship Interviews—Reply

Mar, 19/03/2019 - 01:00
In Reply Excessive interviewing between training programs and applicants is costly and time-consuming for both. Dr Miele reiterates a concern raised in our Viewpoint that candidates with strong applications will be favored over those who excel in interviews if interview matching were instituted. He suggests the use of telephone interviews to reduce the number of in-person interviews. Drs Dunkin and Gardner make a related argument that programs and candidates have difficulty discriminating because they lack good information. Therefore, candidates apply broadly and interview widely and programs interview many candidates. They argue that industrial organizational psychologists may help facilitate the exchange of information between candidates and programs. Neither of the suggestions is mutually exclusive.

Challenges in Research on Suicide Prevention

Mar, 19/03/2019 - 01:00
To the Editor In a Viewpoint, Drs Sisti and Joffe expressed concern that interventions to reduce suicide have not been well studied in clinical trials and proposed inclusion of actively suicidal individuals in trials. The US Food and Drug Administration (FDA) provides regulatory advice on clinical trials for psychiatric drug development. We wish to comment on several issues in the article.

Challenges in Research on Suicide Prevention

Mar, 19/03/2019 - 01:00
To the Editor Drs Sisti and Joffe described challenges in conducting research on suicide. We agree that such research should include individuals with suicidal behavior and that suicide attempts and death are appropriate outcomes for trials. We also agree that conceptualizing the outcome of suicide as an adverse event might trigger objections by regulatory bodies that jeopardize the feasibility of such investigations.

Reducing the Burden of Fellowship Interviews

Mar, 19/03/2019 - 01:00
To the Editor The Viewpoint by Dr Melcher and colleagues raised concerns regarding time expenditures, incurred costs, and loss of clinical coverage caused by interviewing for surgical fellowships and proposed an interview match as a way to decrease the overall amount of interviews. They referenced a survey of pediatric surgery program directors that showed the median rank at which programs matched was less than 4. There is a flaw in this justification: one cannot assume that the top 4 candidates on a rank list were all applicants who would have been granted interviews through an interview match.

Reducing the Burden of Fellowship Interviews

Mar, 19/03/2019 - 01:00
To the Editor Dr Melcher and colleagues accurately described the challenges of the current surgical fellowship application system and proposed a match within the match solution. The essence of their proposal centers on limiting the number of interviews that an applicant can participate in and that programs can conduct.

Disclosure of Religious Identity on Catholic Hospital Websites

Mar, 19/03/2019 - 01:00
This study examines whether Catholic hospitals disclose their religious identity and health care practices based on the church’s teachings on their websites.

Vesalius and Cushing: Tradition and Inspiration

Mar, 19/03/2019 - 01:00
Just as skill in perspective drawing is necessary for proficiency in painting and sculpture, a mastership in anatomy opens the door to all purposeful work in medicine. The period of Galen, emphasizing rational anatomy and physiology as a corrective to even the brightest hippocratic philosophies of form and function, significantly runs synchronously with the highest development in Greek art. Galen’s inductive school dominated practically all natural and medical science until the advent of the Renaissance, when medicine, till then a unit, burst into the cluster of component disciplines natural history, physiology, geology, chemistry, physics, astronomy and mechanics. When Vesalius in the sixteenth century instituted the teaching of anatomy by dissections of the human body, the laboratory method recorded its first victory over the didactic. No wonder, then, that the name of Andreas Vesalius took a high place in medical consciousness.

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