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Новости за 18.06.2024

Stewardship Prompts to Improve Antibiotic Selection for Pneumonia

Jamanetwork.com 

This clinical trial examines the effect of an antibiotic stewardship bundle (education, feedback, and real-time multidrug-resistant organism risk-based CPOE prompts) vs routine stewardship on antibiotic selection during the first 3 hospital days in adults with pneumonia.

Harnessing the Electronic Health Record to Improve Empiric Antibiotic Prescribing

Jamanetwork.com 

Approximately half of hospitalized adults in the US receive antibiotics, with pneumonia and urinary tract infection (UTI) being the 2 most frequent indications. Estimates suggest about 30% of all antibiotics prescribed in US hospitals are either unnecessary or suboptimal, and extended-spectrum antibiotic use is common. Unnecessary antibiotic use contributes to numerous harms, including drug-related adverse effects, increased risk of drug resistance, and higher costs.

Risks of Harm in Alzheimer Disease by Amyloid Lowering

Jamanetwork.com 

This Viewpoint discusses how data gaps in published research impede clinicians’ ability to clearly discuss the risks and benefits of amyloid-lowering drugs for treating Alzheimer disease.

Blood Testing for Phosphatidylethanol

Jamanetwork.com 

A 36-year-old man with obesity and dyslipidemia presented with elevated liver enzymes following a liver transplant to treat acute-on-chronic liver failure due to alcohol-associated hepatitis. What would you do next?

Maintenance of Certification’s Value to Patients and Physicians—Reply

Jamanetwork.com 

In Reply We appreciate the Letter by Drs Stern and Hafferty about our recent Viewpoint, which gave priority to highlighting the large and growing body of evidence that patients of physicians who demonstrate more medical knowledge have better prognoses on a host of important outcomes. In doing so, we were addressing the “patient outcomes issue” often raised in conversations about certification and maintenance of certification.

Maintenance of Certification’s Value to Patients and Physicians

Jamanetwork.com 

To The Editor The American Board of Internal Medicine (ABIM) has an outsized influence as the arbiter of internal medicine physician quality, given the alternatives of minimal state regulations, spotty insurance-based estimates, and random patient-based ratings. A recent Viewpoint responded to recent challenges to board certification by highlighting the evidence for improved clinical outcomes and asserting their renewed commitment to organizational transparency. However, they did not mention the... Читать дальше...

FTC Oversight of the Pharmaceutical Industry

Jamanetwork.com 

High drug prices in the US are a serious problem for both patients and the health care system. Prices of branded drugs are driven higher by monopoly dynamics: patents and other exclusive marketing rights allow companies to increase prices and restrict supply. Firms earn extraordinary profits from exclusive rights and so have incentives to sustain or extend these rights, including in unfair and abusive ways. Firms build “thickets” of secondary patents (eg, for devices used to deliver a drug) around... Читать дальше...

Advancing Access to Cell and Gene Therapies in Medicaid

Jamanetwork.com 

This Viewpoint presents the components of the payment model and the implementation challenges among the Center for Medicare and Medicaid Innovation, state Medicaid agencies, patients, and manufacturers.

A Good Prognosis

Jamanetwork.com 

These are not the final few months of my life, not the last bowl of salad I add a few spoons of tuna and mayo to. I’m not going to die on a date printed in the calendar that hangs on my fridge with cheesy pictures of Yosemite and captions like Bike to Work Day. I can sit here at the kitchen window, watching my neighbor walk down the street with her daughter without the need to join them or to hurry someplace pretty to have a last look. According to statistics I’ve got at least five years left, or ten depending on the website. Читать дальше...

Krill Oil for Knee Osteoarthritis

Jamanetwork.com 

This randomized clinical trial assesses the effect of krill oil supplementation vs placebo on knee pain improvement in patients with knee osteoarthritis, significant knee pain, and effusion-synovitis.

Time to IVT Treatment and Functional Outcomes in Acute Ischemic Stroke—Reply

Jamanetwork.com 

In Reply We thank Drs Sedghi and Siepmann for their comments. Indeed, all trials included in our individual participant meta-analysis enrolled only patients directly presenting at thrombectomy-capable stroke centers. Hence, the data presented in our study are applicable only to this exact clinical scenario. Because the likelihood of reperfusion after IVT is highly dependent on the time between administration of IVT and assessment of reperfusion, no extrapolations should be made to scenarios in which... Читать дальше...

Time to IVT Treatment and Functional Outcomes in Acute Ischemic Stroke

Jamanetwork.com 

To the Editor A recent individual patient data meta-analysis of 6 randomized trials found that the beneficial effect of intravenous thrombolysis (IVT) before thrombectomy in patients with anterior-circulation large-vessel occlusion diminished with time from onset of stroke symptoms to administration of IVT and lost statistical significance after 2 hours and 20 minutes. However, as pointed out by the authors, all patients included in this analysis presented directly to a thrombectomy-capable center. Читать дальше...

Chronic Chagas Disease in the US

Jamanetwork.com 

This JAMA Insights provides recommendations for Chagas disease screening, diagnosis, and management in the US

Heard but Excluded: A Language Manifesto

Jamanetwork.com 

This Viewpoint discusses dismantling language barriers via multipronged approaches grounded in innovation, human-centered design, and systems thinking in 3 key areas.

The Other Side of the Curtain

Jamanetwork.com 

In this narrative medicine essay, a newly minted pediatric critical care physician learns firsthand what holistic medical care is from the love and attention she received during a hospitalization for mediastinal lymphoma.