JAMA Network Open

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EISSN : 2574-3805
Published by: American Medical Association (AMA) (10.1001)
Total articles ≅ 5,998
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, Erinn M. Hade, Lindsay A. Gil, Gregory A. Metzger, Jacqueline M. Saito, Grace Z. Mak, Ronald B. Hirschl, Samir Gadepalli, Michael A. Helmrath, Charles M. Leys, et al.
Between 60 000 and 80 000 children undergo surgery for the treatment of appendicitis each year, making it the most common indication for emergency intra-abdominal surgery in the pediatric patient population.1,2 Despite an increase in the use of laparoscopy for surgical treatment of appendicitis, between 5% and 15% of patients undergoing an appendectomy for uncomplicated appendicitis will experience at least 1 complication, with serious complications occurring for 1% to 7% of patients.3-6 Evidence from several large trials of adults, both in the United States and Europe, has shown that treatment with antibiotics alone is a reasonable alternative to an appendectomy for select patients.7-10 A recent multi-institutional interventional study that included more than 1000 pediatric patients demonstrated that nonoperative management with antibiotics alone is an effective strategy for treating children with uncomplicated acute appendicitis, with a 1-year success rate of 67%, no increase in complications, and fewer days lost to disability compared with surgery.11
, Ming-Sum Lee, John L. Adams, Adam L. Sharp, Jason N. Doctor
The US is in the middle of an opioid crisis.1 Most people with opioid addiction or dependency were first exposed through a pain management prescription.2 Despite ongoing efforts to curb the crisis, fatal overdoses continue to increase.3 Government officials, health care practitioners, and investigators have been searching for methods to better regulate opioid prescriptions.4,5 The State of California passed Assembly Bill (AB) 2760, effective January 1, 2019, to address the opioid crisis. This law mandates prescribers to offer naloxone, an opioid antagonist,6,7 or another comparable drug approved by the US Food and Drug Administration, with the opioid prescription8 to patients who are at high risk for opioid overdose (eMethods in the Supplement). The law further requires prescribers to educate these patients and their caregivers about overdose prevention and the use of naloxone. By encouraging greater knowledge and accessibility of naloxone among patients at high risk of overdose, AB 2760 serves as an overdose prevention strategy.
Laurie C. Yousman, Walter R. Hsiang, Akshay Khunte, Michael Najem, Grace Jin, Alison Mosier-Mills, Siddharth Jain,
Musculoskeletal urgent care centers (MUCCs), alongside general urgent care centers, have rapidly emerged across the US, ostensibly as an alternative to emergency departments (EDs) and general urgent care centers. Although these orthopedic-specific urgent care centers have had increased use, their effect on access to musculoskeletal care is unclear. There is conflicting research on the benefits and drawbacks of MUCCs, with some literature demonstrating a potential reduction in both cost of care and wait times and other studies questioning long-term savings associated with use of MUCCs.1,2 Regardless, the increased access to orthopedic specialists that an MUCC provides is not equally available to all patients. In a recent study of 29 MUCCs in Connecticut, most clinics either denied patients with Medicaid insurance or implemented barriers to care that were not experienced by their privately insured counterparts.3 In a comprehensive national survey of all MUCCs in the US, half of all centers surveyed did not accept Medicaid insurance.4 Given the large number of uninsured patients in the US, it is important to characterize the charges that patients without insurance coverage would incur if they were to seek urgent orthopedic care at these centers. Furthermore, freestanding EDs providing urgent care services have been established in areas with a more profitable payer mix.5 To our knowledge, no studies have characterized the payment practices of MUCCs for uninsured patients. In addition, identifying the factors associated with charges for care is imperative to understanding how the relatively new and largely unexplored MUCCs fit into the broader system of health care in the US. In conducting this survey, we assessed out-of-pocket costs and factors associated with these costs at MUCCs. We hypothesized that Medicaid acceptance would be associated with a reduction in out-of-pocket charges.
, Ithan D. Peltan, R. J. Bunnell, Samuel M. Brown, Al Jephson, Danielle Groat, Nicholas M. Levin, Emily Wilson, Jon Newbold, Gabriel V. Fontaine, et al.
Intravenous fluids are the most commonly prescribed medical therapy in the US, with an estimated 200 million liters of crystalloid administered annually.1,2 Emerging evidence suggests that normal saline (NS; 0.9% sodium chloride) solution is associated with hyperchloremic metabolic acidosis, increases in proinflammatory cytokines, decreased kidney perfusion, acute kidney injury, and mortality.3-10 Nevertheless, outcomes associated with different crystalloid formulations have historically been sparsely studied.
Ben Li, Naomi Eisenberg, Miranda Witheford, Thomas F. Lindsay, Thomas L. Forbes,
Sex-related differences play an important role in the natural history, diagnosis, and management of abdominal aortic aneurysm (AAA).1 Although the prevalence of AAA is higher in men (7.6% vs 1.3%),2 women experience more rapid AAA growth and a 4-fold higher risk of rupture.3,4 Despite the more aggressive nature of aneurysm progression in women, there are major sex disparities in AAA management.5,6 This difference is partly because women are underrepresented in clinical studies, limiting our understanding of the screening and treatment strategies in this population.7-9 In the event of ruptured AAA (rAAA), women are less likely to be admitted to the hospital and receive operative intervention.10-12 Overall, these factors contribute to higher AAA mortality rates among women compared with men.13 As a result, the Society for Vascular Surgery (SVS) recommends a lower diameter threshold for elective repair in women compared with men (5.0 vs 5.5 cm).14
, Gloria Aggrey, Meghan B. Brennan, Brent Footer, Graeme Forrest, Fergus Hamilton, Emi Minejima, Jessica Moore, Jaimo Ahn, Michael Angarone, et al.
An important limitation of traditional clinical guidelines is the frequent dissociation between quality of evidence and strength of recommendations.1-6 As a result, some past guideline recommendations have endorsed harmful care, which was only subsequently recognized when high-quality, prospective controlled trials were conducted.7 To overcome this limitation, we developed a novel approach, called WikiGuidelines, to establish clear recommendations only when high-quality, hypothesis-confirming evidence is available (see group charter in Supplement 1).
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