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Importance: Few studies are available on informed consent (IC) among detained persons, even with ethics being a critical aspect of prison research. In IC research, audiovisual material seems to improve understanding and satisfaction compared with conventional paper-based material, but findings remain unclear., Objective: To compare audiovisual and paper-based materials for 1-time general IC for research in prisons., Design, Setting, and Participants: This cross-sectional randomized clinical trial was conducted in 2 corrections facilities in Switzerland (an adult prison and a juvenile detention center). The study was conducted from December 14, 2019, to December 2, 2020, in the adult prison and from January 15, 2020, to September 9, 2021, in the juvenile detention center. In the adult prison, study participation was offered to detained persons visiting the medical unit (response rate, 84.7%). In the juvenile detention center, all newly incarcerated adolescents were invited to participate (response rate, 98.0%)., Interventions: Participants were randomized to receive paper-based conventional material or to watch a 4-minute video. Materials included the same legal information, as required by the Swiss Federal Act on Research Involving Human Beings., Main Outcomes and Measures: The main outcome was acceptance to sign the IC form. Secondary outcomes included understanding, evaluation, and time to read or watch the IC material., Results: The study included 190 adults (mean [SD] age, 35.0 [11.8] years; 190 [100%] male) and 100 adolescents (mean [SD] age, 16.0 [1.1] years; 83 [83.0%] male). In the adult prison, no significant differences were found between groups in acceptance to sign the IC form (77 [81.1%] for paper-based material and 81 [85.3%] for audiovisual material; P = .39) and to evaluate it (mean [SD] correct responses, 5.09 [1.13] for paper-based material and 5.01 [1.07] for audiovisual material; P = .81). Understanding was significantly higher in the audiovisual material group (mean [SD] correct responses, 5.09 [1.84]) compared with the paper-based material group (mean [SD] correct responses, 4.61 [1.70]; P = .04). In the juvenile detention center, individuals in the audiovisual material group were more likely to sign the IC form (44 [89.8%]) than the paper-based material group (35 [68.6%], P = .006). No significant difference was found between groups for understanding and evaluation. Adults took a mean (SD) of 5 (2) minutes to read the paper material, and adolescents took 7 (3) minutes., Conclusions and Relevance: Given the small benefit of audiovisual material, these findings suggest that giving detained adults and prison health care staff a choice regarding IC material is best. For adolescents, audiovisual material should be provided. Future studies should focus on increasing understanding of the IC process., Trial Registration: ClinicalTrials.gov Identifier: NCT05505058.

The article focuses on calling for papers on "Health and the 2024 Elections Globally," highlighting the significant influence of governments on health policies and inviting submissions to the periodical that address healthcare issues in national, regional or global contexts during election years.

The article focuses on the bacterial aspects of dirty money and the historical concern regarding the transmission of infectious material through currency. While previous worries highlighted the potential danger of dirty paper money, bacteriological investigations failed to find significant microbial distribution on paper currency, suggesting that the composition of printed bills might inhibit bacterial growth.

The article focuses on concerns raised in response to a recent Viewpoint discussing the threats and opportunities associated with the rapid growth of mega-journals. It authors express concerns about issues not discussed in the original Viewpoint, such as the integrity of medical literature due to special issue manipulation, retraction rates, and paper-mill articles in mega-journals.

JAMA: Journal of the American Medical Association has published a Special Communication titled "The Integration of Clinical Trials With the Practice of Medicine: Repairing a House Divided," which discusses the need to integrate clinical trials with clinical practice. The authors highlight the separate missions and infrastructures of clinical trialists and clinicians, leading to inefficiencies and limitations in trials. They propose solutions such as implementation science, novel statistical analysis approaches, and integration of trials with electronic health records. JAMA is launching a new series called "Integrating Clinical Trials and Practice" to explore innovations in trial design, funding, regulation, education, and application. The goal is to align clinical trials with clinical practice and improve patient care. [Extracted from the article]

In this Medical News article, Arvind Narayanan, PhD, a professor of computer science at Princeton University, discusses the benefits of using artificial intelligence in research and clinical settings while remaining cautious of hype, biases, and data privacy issues. [ABSTRACT FROM AUTHOR]

Nonhuman animal research has contributed to human health advancements but raises questions about the extent to which humans protect nonhuman animals during such endeavors. This series of drawings explores several ethics and empirical questions from a visual point of view. [ABSTRACT FROM AUTHOR]

The article reports on the release of an Interagency Working Group on Asbestos in Consumer Products White Paper by the U.S. Food and Drug Administration (FDA) on the detection and identification of asbestos fibers in talc-containing cosmetic products.

Trauma-informed care is a transdisciplinary framework that existed well before 2020, but it is now more imperative to teach it and incorporate it into medical education. This paper describes a novel interprofessional curriculum and its focus on trauma-informed care—notably, including institutional and racial trauma—that was implemented by Yale University for medical, physician associate, and advanced practice registered nursing students. [ABSTRACT FROM AUTHOR]

The article focuses on concerns related to the rapid growth of mega-journals. It authors raise issues such as special issue manipulation, retraction rates, and paper-mill articles in mega-journals that threaten the integrity of the medical literature. It also discuss the need for differentiation between mega-journals with rigorous peer review processes and those susceptible to manipulation, and they highlight the concern of potentially predatory behavior in some mega-journals.

The poem "Aftermath" by Stacy R. Nigliazzo is presented. First line: Asters reach from paper cups across the nurses' desk. ; Last Line: Some of us cry. All of us get back to work.

The article reports on the discussion paper issued by the U.S. Food and Drug Administration (FDA) as of February 2022 to discuss its regulation of 3-dimensional (3D) printing of medical devices at the point of care like health care facilities.

This Medical News article is an interview with University of Michigan computer scientist Jenna Wiens, whose research interests lie at the intersection of AI and health care, and JAMA Editor in Chief Kirsten Bibbins-Domingo. [ABSTRACT FROM AUTHOR]

Bodily imagery elicits strong affective responses and is highly salient, potentially altering viewers' decision making. When clinicians engage surrogates in video calls showing the patient's body, several competing ethical issues must be considered. On the one hand, surrogates may require visual information to make informed decisions, and video technology closes crucial information gaps. On the other, video technology puts an increased amount of control in the hands of clinicians over how the patient's condition is perceived. This article explores some situations that can result in manipulation due to the affective impact of bodily images and the potential for selectivity and framing. Focusing on goals of care, the paper outlines the foremost ethical considerations for clinicians and provides recommendations for clinicians on how to reduce possible manipulation when making these video calls. [ABSTRACT FROM AUTHOR]

The popularity of portraits of clinicians during the COVID-19 pandemic suggested the importance of visual representation of what mass illness demands of us all--and particularly those on the front lines of health care. In addition to surges in variants of the SARS-CoV-2 virus, persons of Asian descent have endured waves of bigotry and violence. With the myriad of natural and man-made threats confronting the world today, an ancient Confucian proverb on the common good prompts us to recognize humanity's shared future. Although text-based, calligraphy is visually engaging and reminds us of the importance and poignancy of words that are well chosen and beautifully rendered. This article displays and describes Chinese calligraphies by Terry Zhizhong Yuan, commissioned by the AMA Journal of Ethics, to commemorate the American Medical Association's 175th anniversary and the extraordinary times in which we live. [ABSTRACT FROM AUTHOR]

Chatbots, ChatGPT, and scholarly manuscripts: WAME recommendations on ChatGPT and chatbots in relation to scholarly publications. According to I Nature, i that article's inclusion of ChatGPT in the author byline was an "error that will soon be corrected."[6] However, these articles and their nonhuman "authors" have already been indexed in PubMed and Google Scholar. If these models or tools are used to create content or assist with writing or manuscript preparation, authors must take responsibility for the integrity of the content generated by these tools. Editorial Artificial intelligence (AI) technologies to help authors improve the preparation and quality of their manuscripts and published articles are rapidly increasing in number and sophistication. [Extracted from the article]

This article describes how size-based health and beauty ideals made their way into the medical field through the eugenics movement of the 19th to 20th centuries and were validated using so-called "standard weight" tables. They became even more mainstream with the 20th- century tool to replace standard weight tables: body mass index (BMI). BMI, then, is a continuation of white supremacist embodiment norms, racializing fat phobia under the guise of clinical authority. This article describes the key players in the legacy of size-based mandates, which fall under what I have labeled the "white bannerol of health and beauty." This pseudoscientific bannerol has helped forge oppressive conceptions of fatness as an indicator of ill health and "low" racial quality. [ABSTRACT FROM AUTHOR]

This Viewpoint explores Centers for Medicare & Medicaid Services guidance on the collection of sexual orientation and gender identity data and how these data could be used to advance health equity for LGBTQI+ people. [ABSTRACT FROM AUTHOR]

In this narrative medicine essay, when a physician's mother begins experiencing postmenopausal bleeding, the author wonders what it would be like to hear someone's signs and symptoms and not automatically begin to build a differential. [ABSTRACT FROM AUTHOR]

This Medical News article is an interview with Michael Howell, MD, MPH, about applications of large language models in medicine. [ABSTRACT FROM AUTHOR]

2 Levine, M.: The Value of Boric Acid Canning Compound in Food Preservation, J. Home Econom. When treated clothes are brushed, the arsenic compound may pollute the air more than was the case with the now forbidden arsenic-bearing wall paper. JAMA Revisited JAMA. [Extracted from the article]

The article focuses on concerns related to the rapid growth of mega-journals. It authors raise issues such as special issue manipulation, retraction rates, and paper-mill articles in mega-journals that threaten the integrity of the medical literature. It also discuss the need for differentiation between mega-journals with rigorous peer review processes and those susceptible to manipulation, and they highlight the concern of potentially predatory behavior in some mega-journals.

The article reflects on the changes in the field of pediatrics over the past 25 years. In 1898, pediatrics was primarily a clinical discipline with only one laboratory investigation presented at a meeting. Today, it has evolved significantly, with a greater emphasis on laboratory research and specialized pediatric care. The author anticipates the need for three types of pediatricians in the future emphasizing the importance of mental hygiene and prevention in pediatric medicine.

The poem "Memorial Day " by Adrian M. Schnall is presented. First line: I hold it, feel its weight— ; Last Line: to move past it, or keep trying.

Discussions of nonhuman research ethics tend to focus on what we owe nonhuman research subjects in laboratory settings only. But humans make critical decisions about these animals outside the lab, too, during breeding, transportation, and end-of-study protocols. This article reviews extra-lab risks and harms to nonhuman research subjects, focusing on the most commonly and intensively used animals like rodents and fishes, and argues that extra-lab risks and harms merit ethical consideration by researchers and institutional review. [ABSTRACT FROM AUTHOR]

The Fourteenth Amendment to the US Constitution prohibits states from depriving any person "equal protection of the laws," and the Constitution's Fifth Amendment has been interpreted as applying this prohibition to the federal government. This article considers whether constitutional equal protection should apply to some nonhuman animals in light of corporations having gained such protection and concludes that expanding equal protection personhood to nonhuman animals is improbable in the present legal landscape. [ABSTRACT FROM AUTHOR]

Importance: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors improve outcomes in patients with type 2 diabetes, heart failure, and chronic kidney disease, but their effect on outcomes of critically ill patients with organ failure is unknown. Objective: To determine whether the addition of dapagliflozin, an SGLT-2 inhibitor, to standard intensive care unit (ICU) care improves outcomes in a critically ill population with acute organ dysfunction. Design, Setting, and Participants: Multicenter, randomized, open-label, clinical trial conducted at 22 ICUs in Brazil. Participants with unplanned ICU admission and presenting with at least 1 organ dysfunction (respiratory, cardiovascular, or kidney) were enrolled between November 22, 2022, and August 30, 2023, with follow-up through September 27, 2023. Intervention: Participants were randomized to 10 mg of dapagliflozin (intervention, n = 248) plus standard care or to standard care alone (control, n = 259) for up to 14 days or until ICU discharge, whichever occurred first. Main Outcomes and Measures: The primary outcome was a hierarchical composite of hospital mortality, initiation of kidney replacement therapy, and ICU length of stay through 28 days, analyzed using the win ratio method. Secondary outcomes included the individual components of the hierarchical outcome, duration of organ support–free days, ICU, and hospital stay, assessed using bayesian regression models. Results: Among 507 randomized participants (mean age, 63.9 [SD, 15] years; 46.9%, women), 39.6% had an ICU admission due to suspected infection. The median time from ICU admission to randomization was 1 day (IQR, 0-1). The win ratio for dapagliflozin for the primary outcome was 1.01 (95% CI, 0.90 to 1.13; P =.89). Among all secondary outcomes, the highest probability of benefit found was 0.90 for dapagliflozin regarding use of kidney replacement therapy among 27 patients (10.9%) in the dapagliflozin group vs 39 (15.1%) in the control group. Conclusion and Relevance: The addition of dapagliflozin to standard care for critically ill patients and acute organ dysfunction did not improve clinical outcomes; however, confidence intervals were wide and could not exclude relevant benefits or harms for dapagliflozin. Trial Registration: ClinicalTrials.gov Identifier: NCT05558098 Key Points: Question: Does the addition of dapagliflozin to standard of care improve the hierarchical outcome of hospital mortality, initiation of kidney replacement therapy, and the length of stay in the intensive care unit (ICU) among critically ill patients with acute organ dysfunction? Findings: In this multicenter, open-label, randomized clinical trial that included 507 participants with at least 1 acute organ dysfunction (hypotension, kidney injury, or respiratory), the use of 10 mg of dapagliflozin for up to 14 days did not significantly reduce the combined outcome of hospital mortality, initiation of kidney replacement therapy, and ICU length of stay, assessed by the win ratio method (win ratio, 1.01, not significant) through 28 days after randomization. Meaning: The addition of dapagliflozin to standard care for individuals with critical illness and acute organ dysfunction did not improve clinical outcomes. This randomized clinical trial assessed whether adding dapagliflozin to standard care for patients with acute organ dysfunction could reduce the composite outcome of hospital mortality, initiation of kidney replacement therapy, and length of stay compared with standard care alone. [ABSTRACT FROM AUTHOR]

Key Points: Question: Does acetaminophen (paracetamol) improve respiratory, circulatory, or kidney dysfunction in critically ill patients with sepsis, and is acetaminophen more effective in patients with higher plasma cell-free hemoglobin? Findings: In this randomized clinical trial that included 447 adults, acetaminophen was safe but the number of days alive and free of organ support was not meaningfully different in the acetaminophen arm (20.2 days) vs the placebo arm (19.6 days). There was no significant interaction between cell-free hemoglobin levels and acetaminophen. Meaning: Intravenous acetaminophen was safe but did not significantly improve days alive and free of organ support in critically ill patients with sepsis. Importance: Acetaminophen (paracetamol) has many pharmacological effects that might be beneficial in sepsis, including inhibition of cell-free hemoglobin-induced oxidation of lipids and other substrates. Objective: To determine whether acetaminophen increases days alive and free of organ dysfunction in sepsis compared with placebo. Design, Setting, and Participants: Phase 2b randomized, double-blind, clinical trial conducted from October 2021 to April 2023 with 90-day follow-up. Adults with sepsis and respiratory or circulatory organ dysfunction were enrolled in the emergency department or intensive care unit of 40 US academic hospitals within 36 hours of presentation. Intervention: Patients were randomized to 1 g of acetaminophen intravenously every 6 hours or placebo for 5 days. Main Outcome and Measures: The primary end point was days alive and free of organ support (mechanical ventilation, vasopressors, and kidney replacement therapy) to day 28. Treatment effect modification was evaluated for acetaminophen by prerandomization plasma cell-free hemoglobin level higher than 10 mg/dL. Results: Of 447 patients enrolled (mean age, 64 [SD, 15] years, 51% female, mean Sequential Organ Failure Assessment [SOFA] score, 5.4 [SD, 2.5]), 227 were randomized to acetaminophen and 220 to placebo. Acetaminophen was safe with no difference in liver enzymes, hypotension, or fluid balance between treatment arms. Days alive and free of organ support to day 28 were not meaningfully different for acetaminophen (20.2 days; 95% CI, 18.8 to 21.6) vs placebo (19.6 days; 95% CI, 18.2 to 21.0; P =.56; difference, 0.6; 95% CI, −1.4 to 2.6). Among 15 secondary outcomes, total, respiratory, and coagulation SOFA scores were significantly lower on days 2 through 4 in the acetaminophen arm as was the rate of development of acute respiratory distress syndrome within 7 days (2.2% vs 8.5% acetaminophen vs placebo; P =.01; difference, −6.3; 95% CI, −10.8 to −1.8). There was no significant interaction between cell-free hemoglobin levels and acetaminophen. Conclusions and Relevance: Intravenous acetaminophen was safe but did not significantly improve days alive and free of organ support in critically ill sepsis patients. Trial Registration: ClinicalTrials.gov Identifier: NCT04291508 This randomized trial assesses whether acetaminophen would increase the number of days alive and free of organ support to day 28 among critically ill patients with sepsis and respiratory or circulatory organ dysfunction. [ABSTRACT FROM AUTHOR]

In this Medical News interview, Sachin Kheterpal, the University of Michigan Medical School's associate dean for research information technology, joins JAMA Editor in Chief Kirsten Bibbins-Domingo to discuss AI's number-crunching potential for improving patient care. [ABSTRACT FROM AUTHOR]