JAMA is an international peer-reviewed general medical journal published weekly online and in print, and a member of the @JAMANetwork family of journals.
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📌 Editor’s Choice from this week's issue of JAMA:
➡️ Review on Progress in #Cancer #Vaccine Development,
➡️ Medications for #AlcoholUseDisorder,
➡️ Controlling Pain for #IUD Placement, and more.
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🧵 In nulliparous individuals receiving an #intrauterine device with a smaller-diameter placement tube, intrauterine mepivacaine was associated with lower pain scores, fewer reports of severe pain, and fewer vasovagal reactions vs placebo.
These findings support a patient-centered option for pain management during outpatient #gynecology procedures.
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📊 Research Summary: Among nulliparous individuals undergoing #intrauterine device placement, intrauterine mepivacaine reduced pain and improved tolerability vs placebo.
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🧵 In patients with severe asymptomatic #carotid artery stenosis, carotid revascularization with carotid artery stenting or carotid endarterectomy plus intensive medical management did not improve cognition vs intensive medical management alone over up to 4 years.
These findings indicate that cognitive benefit should not be presented as an expected outcome when discussing treatment options for this population.
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💬 Editorial by Eric E. Smith, MD, MPH, and Aravind Ganesh, MD, DPhil: In patients with asymptomatic #carotid artery stenosis, carotid revascularization did not improve cognition or prevent cognitive decline compared with medical therapy alone in the CREST-2 cognitive analyses.
The findings indicate that clinicians should not counsel patients that cognition will improve after revascularization and should instead focus discussions on stroke prevention.
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As #AI enters clinical care, women #physicians may face greater risk of adverse effects if these tools amplify inequities already present in #medicine.
🎙️ In the latest episode of JAMA+ AI Conversations, @JAMAplusAI Editor in Chief Roy Perlis, MD, MSc, spoke with Rochelle P. Walensky, MD, MPH, about how differences in administrative burden, electronic health record use, and patient messaging could shape who benefits from artificial intelligence in practice.
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🧵 Among patients with asymptomatic high-grade internal #carotid artery stenosis and reduced cognition at baseline, carotid revascularization plus intensive medical management did not improve cognitive outcomes vs intensive medical management alone over 1 year.
Baseline cerebral hemodynamic impairment did not modify this result, indicating that restoring flow to the brain should not be expected to improve cognition in chronic asymptomatic carotid stenosis.
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📊 Research Summary: Baseline hemodynamic impairment did not identify a cognitive benefit of carotid revascularization in asymptomatic high-grade internal #carotid artery stenosis.
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🔖 This trial is featured in @JAMAplusTrials, a platform that highlights the implications and innovations of #ClinicalTrial research from across the JAMA Network to advance evidence-based #medicine and public #health.
This October's Trial Theme of the Month focuses on extension studies in #ClinicalTrials, where long-term findings depend on how comparison groups are defined and how attrition and selection bias are handled. Read the latest editorial: ja.ma/4j8Jop4
📫 Learn more and subscribe to the email newsletter: ja.ma/4jOy4yD
Among patients with acute ischemic #Stroke who underwent successful #EndovascularTherapy for anterior circulation large vessel occlusion, adjunctive intra-arterial tenecteplase was associated with a higher rate of excellent functional outcome at 1 year vs standard medical treatment.
Mortality at 1 year was similar between groups.
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📄 JAMA Patient Page: #HipFracture is a break in the upper part of the thigh bone near the hip joint and usually occurs after a fall.
This JAMA Patient Page describes common symptoms, diagnosis with x-ray, and treatment with #surgery followed by early mobilization, physical therapy, and rehabilitation.
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US #PrescriptionDrugs launch prices increased faster than inflation from 2008 to 2025, with no evidence of a higher postpassage trend after the #InflationReductionAct.
Launch prices were higher for #CellGeneTherapy, drugs for chronic use, and drugs with rare disease designations, and increased across all subgroups over time.
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🧵 Among critically ill children with hypotension receiving invasive ventilation and vasoactive drugs, a permissive #BloodPressure target of the fifth percentile for age did not significantly change the composite outcome of mortality and duration of invasive ventilation at 30 days vs usual care.
The permissive target was associated with lower exposure to vasoactive drugs without a signal for harm.
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📊 Research Summary: A permissive #BloodPressure target in pediatric critical care was associated with lower vasoactive drug exposure without increased adverse events or kidney replacement therapy vs usual care.
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🔖 This trial is featured in @JAMAplusTrials, a platform that highlights the implications and innovations of #ClinicalTrial research from across the JAMA Network to advance evidence-based #medicine and public #health.
This October's Trial Theme of the Month focuses on extension studies in #ClinicalTrials, where long-term findings depend on how comparison groups are defined and how attrition and selection bias are handled. Read the latest editorial: ja.ma/4j8Jop4
📫 Learn more and subscribe to the email newsletter: ja.ma/4jOy4yD
📝 #JAMAReview: #Cancer vaccines are being evaluated for treatment and prevention across multiple malignant neoplasms as advances in tumor immunology, antigen discovery, and vaccine delivery reshape the field.
This Review discusses how vaccines can stimulate adaptive immunity against neoantigens, nonmutated tumor proteins, or tumor-derived antigens, with current approved uses in melanoma, prostate cancer, and bladder cancer.
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💡 JAMA Insights: #AlcoholUseDisorder affects 28 million individuals in the US and is associated with cirrhosis, cancers, unintentional injuries, and heart disease.
This JAMA Insights discusses medications for alcohol use disorder, including naltrexone, acamprosate, disulfiram, and topiramate, and summarizes their efficacy, adverse effects, and practical use in inpatient and primary care settings.
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JAMA retweeted
🚨Excited to share our PELICAN Randomized Clinical Trial, just published in JAMA (D1, IF 65.4)
📄 Individualized Cardiac Index-Guided Hemodynamic Therapy in High-Risk Patients Undergoing Elective Major Abdominal Surgery: The PELICAN Randomized Clinical Trial
🌍 A large, international, multicenter RCT conducted across 12 university hospitals in Austria, the Czech Republic, Denmark, Germany, and Spain.
🔬 The clinical question: Does individualized intraoperative hemodynamic therapy targeting each patient’s preoperative resting cardiac index improve postoperative outcomes compared with routine hemodynamic management?
👥 1,095 patients included in the primary analysis.
📊 Key findings:
Major postoperative complications occurred in 44.3% of patients receiving individualized cardiac index-guided therapy versus 46.9% receiving routine care.
Relative risk: 0.94 (95.1% CI, 0.83–1.08; P=.38).
No significant differences were observed in acute kidney injury, myocardial injury, severe infectious complications, cardiac arrest, or mortality within 7 postoperative days.
💡 Clinical implications:
Despite the physiological rationale for individualized hemodynamic optimization, targeting the patient’s preoperative resting cardiac index did not significantly reduce major postoperative complications.
These findings challenge the assumption that more individualized hemodynamic targets necessarily translate into better clinical outcomes and provide important evidence to inform perioperative hemodynamic management.
🤝 Grateful to all investigators, participating centers, and collaborators for their outstanding contribution to this international research effort.
Publishing this work in JAMA, one of the world’s leading medical journals, represents an important milestone for our collaborative research. acrobat.adobe.com/id/urn:aai…
#JAMA #PELICANTrial #Anesthesiology #PerioperativeMedicine #Hemodynamics @sedar_es @SCISEDAR @MontesinosSanti @mjcolomina @DrFDamico @JG_Anestesia @FernandoRamasco @bio_critic @BadenesR @MarinaVarelaDu1 @giovannilandoni @germ_red @ClinicaNavarra @JAMA_current
JAMA retweeted
Last but not least, during late breaking sessions #kidneywk, @AmitXGarg presenting a @JAMA_current simultaneous publication and simultaneous @FreelyFiltered episode released
🥁Pregnancy Outcomes after Kidney Donation
nephjc.com/freelyfiltered/20…
