Curated News: JAMA

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High drug prices as well as the excessive use of imaging and surgical procedures, and excessive administrative burdens contribute the majority to America’s health care overspending compared to Europe, argues policy expert Ezekiel J. Emanuel, MD, PhD, chair of the department of Medical Ethics and Health Policy at the Perelman School of Medicine at the University of Pennsylvania, in an editorial in this week’s JAMA.

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A new study from University of Michigan Kellogg Eye Center links familial relationships to the likelihood older adults will get needed cataract surgery — a procedure with broad implications for health.

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Aseem R. Shukla, MD, a pediatric urologist at Children’s Hospital of Philadelphia, along with several of his colleagues from around the world, have created an innovative program to help address urological needs in India. The team is specifically addressing bladder exstrophy, a complex, rare disorder that occurs during fetal development when the bladder does not form completely and drains onto the surface of the abdomen.

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Mount Sinai researchers have shown, for the first time, the complex web of links between physical and behavioral characteristics, like age, body mass index (BMI), and substance use, and specific patterns of brain structure and function in patients with psychosis. The study is important because many of these characteristics can be targeted clinically to improve brain health in these patients.

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Medicare’s experimental mandatory bundled payment model for knee and hip replacements is more likely to yield cost savings when the surgeries are performed in larger hospitals that do more of these procedures, according to a study from the Perelman School of Medicine at the University of Pennsylvania. Non-profit and major teaching hospital status also appear to be associated with cost savings, the Penn Medicine analysis found.

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In a collaborative, multi-institutional study published by JAMA Oncology, researchers from the University of Alabama at Birmingham, University of Chicago, and National Cancer Institute determined that MRI-based prediction models can help reduce unnecessary biopsies in suspected prostate cancer patients and help improve personalized risk stratification.

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A sizable percentage of elderly patients with blood-related cancers such as leukemia and multiple myeloma are apt to show signs of diminished cognitive functioning

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Women who have one or both breasts removed to treat cancer may have unrealistic expectations about how they’ll feel after that surgery and after breast reconstruction, if they choose that option, a U.S. study suggests. Newsmax Article

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A new study debunks the “obesity paradox,” a counterintuitive finding that showed people who have been diagnosed with cardiovascular disease live longer if they are overweight or obese compared with people who are normal weight at the time of diagnosis.

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Rutgers and Stanford researchers develop new mathematical model to explain how smartphones act as “portable funhouse mirrors”

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In a national medical records analysis, researchers at Johns Hopkins Medicine say there is evidence that the number of gender affirming surgeries performed in hospitals for transgender individuals is on the rise, along with increased access made possible by Medicare, Medicaid or private insurance coverage for the procedures.

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Signing up for 5Ks and even a 10K is a feat many people with hypertrophic cardiomyopathy may not have dared to attempt a decade or two ago. Fear of tragedy leads many HCM patients to a sedentary lifestyle.

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Long-term acute care (LTAC) facilities are designed to meet the needs of older adults with severe, complex illnesses who are recovering from hospitalization, but less expensive options sometimes overlooked may also be available, population health researchers at UT Southwestern found.

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UCLA researchers found that nearly all people diagnosed with uveal melanoma had a number of unmet psychological and health information needs, particularly during the first three months after their diagnoses. The study is the first prospective, longitudinal approach to examine supportive care needs among patients with this disease, and suggested more acute needs among people with uveal melanoma than people with other cancers.

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A comprehensive evaluation by clinical researchers at the Perelman School of Medicine at the University of Pennsylvania identified a neurological syndrome that left U.S. government personnel serving in Havana, Cuba with persistent memory and thinking dysfunction, as well as vision and balance problems after hearing unusual noises in their homes or hotel rooms. The team published their findings today in JAMA.

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Family history of breast cancer continues to significantly increase chances of developing invasive breast tumors in aging women — those ages 65 and older, according to research published in JAMA Internal Medicine. The findings could impact mammography screening decisions later in life.

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Comparison of two of the most commonly prescribed drugs for infants with nonsyndromic epilepsy revealed that levetiracetam was more effective than phenobarbital, according a multicenter, observational study published in JAMA Pediatrics. After six months of single-drug treatment, 40 percent of infants who received levetiracetam met criteria for successful outcome – they did not require a second anti-epileptic drug to control their seizures and they became seizure-free within three months of starting treatment. Only 16 percent of infants treated with phenobarbital achieved the same outcome.

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Researchers at University of California San Diego School of Medicine found a significant number of children across four regions in the United States were determined to have fetal alcohol spectrum disorders (FASD). The new findings may represent more accurate prevalence estimates of FASD among the general population than prior research.

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In 1987, National Football League players went on strike. As a response, NFL teams scrambled to fill their rosters with “replacement players,” individuals who had some experience with college or professional football, but who weren’t part of NFL rosters that year. The replacement players themselves became a footnote in sports history. It turns out these players may actually play a critical role in football today - by helping us understand how playing in the NFL affects long-term health. In our recent study, published in JAMA, we compared the life expectancies of professional NFL players who debuted between 1982 and 1992 to the life expectancies of replacement players from the 1987 strike.

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In a study, 80 percent of participants completed an advance directive after meeting with a chaplain as part of a doctor’s appointment

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When it comes to the physical scars surgery leaves behind, a new study shows patients and doctors often don’t assess their severity the same way. Researchers from the Perelman School of Medicine at the University of Pennsylvania found patients and physicians disagreed in their scar evaluations 28 percent of the time, with patients more likely to focus on the depth of the scar while physicians were more likely to emphasize coloration and texture.

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In an analysis of more than 120,000 women diagnosed with and treated for early-stage breast cancer, researchers from The University of Texas MD Anderson Cancer Center determined the rate of additional breast biopsies needed for these patients during their follow-up care. The findings, reported in JAMA Surgery, are the first comprehensive nationwide population-based study regarding the need for breast biopsies performed during follow up after treatment for invasive breast cancer.

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A study of 30,000 children with earaches, strep throat and other common infections found that narrow-spectrum antibiotics had fewer adverse effects than broad-spectrum antibiotics. A more selective approach is better, said researchers.

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People with Alzheimer’s disease have disturbances in their internal body clocks that affect the sleep/wake cycle and may increase risk of developing the disorder. Researchers at Washington University School of Medicine in St. Louis have found that such circadian rhythm disruptions also occur much earlier in people whose memories are intact but whose brain scans show early, preclinical evidence of Alzheimer’s.

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Although the incidence of appendicitis in the United States has been in decline for many years, the condition still affects approximately seven percent of Americans annually.

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Yale Cancer Center investigators have demonstrated in a new study that more sophisticated models to assess patient risk for cancer can result in better clinical trials with more definitive results.

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Symptoms of Post-Traumatic Stress Disorder (PTSD) can be debilitating and standard treatment can take months, often leaving those affected unable to work or care for their families. But, a new study demonstrated that many PTSD sufferers can benefit from an expedited course of treatment. In the first study of its kind, Prolonged Exposure (PE) therapy was found to be as effective when administered over two weeks as when it is provided over eight weeks for treating PTSD in active-duty military personnel.

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Obese, middle-age men and women who had bariatric surgery have half the death rate of those who had traditional medical treatment over a 10-year period, reports a study that answers questions about the long-term risk of the surgery. 

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A new, multicenter study that included Washington University School of Medicine in St. Louis has found that most NIH grants awarded to researchers in pediatrics during the past five years have been limited to physicians in senior positions at a small number of institutions. The findings indicate an overall downward trend in funding for pediatric research, particularly among early-career physician-scientists.

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A longtime blood test that measures the likelihood of a cardiac event has become more sensitive and more precise. Why doctors and patients should be cautiously optimistic.

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Nonsmoking adolescents who use e-cigarettes, smokeless tobacco or tobacco water pipes are more likely to start smoking conventional cigarettes within a year, according to new research by UC San Francisco.

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Compared to younger adults, older people have higher rates of complications from surgery. But many problems can be avoided by intervening with assessments and risk-reduction strategies before, during and after procedures.

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Despite decades of clinical research establishing chemotherapy with thoracic radiation as the standard-of-care for the initial management of non-metastatic small-cell lung cancer (SCLC), a large percentage of U.S. patients do not receive these treatments and in turn have lower overall survival, according to research from The University of Texas MD Anderson Cancer Center.

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A 30-minute daily or alternate-day facial exercise program sustained over 20 weeks improved the facial appearance of middle-aged women, resulting in a younger appearance with fuller upper and lower cheeks, reports a new Northwestern Medicine study.

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In a surprising finding, blacks and whites have the same risk of developing diabetes when all biological factors for the disease are considered over time, reports a large new Northwestern Medicine study.

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Blacks and Hispanic very preterm infants are more likely to be born at New York City hospitals with higher risk-adjusted neonatal morbidity-mortality rates, and these differences contribute to excess morbidity and mortality among black and Hispanic infants. These differences in hospital of birth explained 39.9% of the black-white disparity and 29.5% of the Hispanic-white disparity in outcomes.

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The proteasome inhibitor carfilzomib has taken on an increasing role in the treatment of multiple myeloma, but new research from the Abramson Cancer Center of the University of Pennsylvania shows the therapy comes with the risk of cardiovascular problems in a higher than expected percentage of patients.

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In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.

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A long-term look at heart attack care and spending in America in the 21st Century shows more survival, more spending, and more variation between hospitals on both scores. And while spending on rapid angioplasty appears to be paying off, a lot of the dollars spent in the six months after a heart attack aren’t making a difference in the long-term death rate.

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A device attached to a patient’s scalp that delivers a continuous dose of low-intensity electric fields improves survival and slows the growth of a deadly brain tumor, according to a new clinical trial led by a Northwestern Medicine scientist and published Dec. 19 in the journal JAMA.

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Two Johns Hopkins prostate cancer researchers found significant disparities when they submitted identical patient samples to two different commercial liquid biopsy providers. Liquid biopsy is a new and noninvasive alternative to tumor tissue sequencing, and it is intended to specifically detect and sequence tumor DNA circulating in patients’ blood. The results are used to help guide doctors to tailor the best treatment for patients at each point of their disease.

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High-intensity exercise three times a week is safe for individuals with early-stage Parkinson’s disease and decreases worsening of motor symptoms, according to a new phase 2, multi-site trial led by Northwestern Medicine and University of Denver scientists.

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Nearly half of the people who enrolled in Medicaid after it expanded in Michigan have jobs, a new study finds. Another 11 percent can’t work, likely due to serious physical or mental health conditions. And about 1 in 4 enrollees are out of work but also are much more likely to be in poor health. The new findings may inform discussions of potential work requirements for poor and near-poor Americans who qualify for expanded Medicaid.

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Research Could Lead to New Treatment for Solar Retinopathy

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Study of Electrocardiogram Readings in National Basketball Association (NBA) Players Highlights Value of Sport-Specific Normative Data and Guidelines. The findings were published on Dec. 6 in JAMA Cardiology.

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Some surgeons might be able to prescribe a third of opioid painkiller pills that they currently give patients, and not affect their level of post-surgery pain control, a new study suggests. That would mean far fewer opioids left over to feed the ongoing national crisis of misuse, addiction and overdose.

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Substitute, for-hire physicians commonly care for hospitalized patients when doctors are sick or away. Information about outcomes is largely lacking, but a new study brings some much-needed insight. Results show no differences in 30-day mortality rates among patients treated by temporary physicians.

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Results of a national survey of more than 800 physicians suggest that their experiences with patients, family members and friends with breast cancer are linked with their recommendations for routine mammograms.

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The number of doctors and advance practitioners in the United States who focus on nursing home care rose by more than a third between 2012 and 2015, according to a new study published today in JAMA from researchers at the Perelman School of Medicine at the University of Pennsylvania. Of all physicians and advance practitioners who do any work in nursing homes, 21 percent now specialize in nursing home care. The authors say the trend suggests the rise of a significant new specialty in medical practice, though how it will affect patient outcomes and continuity of care is yet to be seen.

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More and more Americans have health insurance that requires them to open their wallets for the first few thousand dollars’ worth of care they receive every year, before the insurance coverage kicks in. But a new study suggests that despite the rise in these high-deductible health plans (HDHPs), most Americans who have them aren’t saving, shopping around for better prices, talking to their doctors about costs, or making other consumer-type moves.