This Viewpoint discusses the importance of developing national data systems for the study of firearm violence, and calls for investments in infrastructure and regulations to promote data availability and accessibility as an essential means to reduce the adverse public health effects of gun-related injury and mortality.
A 59-year-old man taking warfarin for recurrent VTE has a point-of-care (POC) international normalized ratio (INR) value of 3.7 (target 2.0 to 3.0). What would you do next?
In this Viewpoint, co-chairs of the US Department of Health and Human Services (HHS) workgroup on patient-centered reduction or discontinuation of long-term opioid analgesics summarize their 2019 guidance, including criteria for and approaches to opioid tapering; behavioral health support; and management of withdrawal symptoms, pain, and other complications.
This JAMA Insights Clinical Update reviews evidence-based use of opioids to manage noncancer pain, proposing opioid-sparing pain management strategies for patients with chronic pain not yet prescribed opioids, those with chronic pain receiving opioids, and those with acute pain and not currently receiving opioid therapy.
This Viewpoint discusses details of the Radiation Oncology Model, a 90-day episode-based alternative payment model proposed by the Centers for Medicare & Medicaid Services (CMS) intended to reduce inappropriate overuse of proton beam therapy, intensity-modulated radiation therapy (IMRT), and other expensive radiation oncology services.
In the context of limited evidence to date that national health care quality improvement (QI) initiatives are effective, this Viewpoint proposes shifting the focus of QI efforts to high-need, high-cost individuals, such as frail older patients and those at the end of life, because they are especially vulnerable to adverse consequences of low-value, high-cost care.
This Special Communication uses a systematic literature review to update previous dollar estimates of waste in the US health care system attributable to failure of care delivery and coordination, low-value care, price inflation, fraud, and administrative complexity.
This Viewpoint proposes a template for thinking about physician malpractice liability arising from use of artificial intelligence (AI) in clinical practice, and identifies scenarios with and without injury and liability vs based on alignment of AI recommendations with standards of care, AI accuracy, and physician decisions in response.
This JAMA Clinical Guidelines Synopsis summarizes the 2019 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines on primary prevention of cardiovascular disease.
This Medical News feature discusses how placebo pills, hostility, and insomnia can affect health.
This Medical News article discusses recent findings linking subconcussive football hits to midbrain white matter damage.
This phase 2b/3 randomized clinical trial compares the effects of selepressin, a selective vasopressin V1a receptor agonist and noncatecholaminergic vasopressor, vs placebo on ventilator- and vasopressor-free days within 30 days among adult patients with septic shock receiving norepinephrine.
This randomized clinical trial compares the effect of high-flow nasal oxygen with prophylactic noninvasive ventilation applied immediately after extubation vs high-flow nasal oxygen alone on the rate of reintubation in patients at high risk of extubation failure in the intensive care unit (ICU).
This study compares changes in end-of-life practices (withholding or withdrawing of life-prolonging therapy, active shortening of the dying process, failed CPR, documentation of brain death) in 22 European ICUs between 1999-2000 and 2015-2016.
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