JAMA : the journal of the American Medical Association
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Advances in surgery have focused on minimizing the invasiveness of surgical procedures, such that a significant paradigm shift has occurred for some procedures in which surgeons no longer directly touch or see the structures on which they operate. Advancements in video imaging, endoscope technology, and instrumentation have made it possible to convert many procedures in many surgical specialties from open surgeries to endoscopic ones. The use of computers and robotics promises to facilitate complex endoscopic procedures by virtue of voice control over the networked operating room, enhancement of dexterity to facilitate microscale operations, and development of virtual simulator trainers to enhance the ability to learn new complex operations. Future research will focus on delivery of diagnostic and therapeutic modalities through natural orifices in which investigation is under remote control and navigation, so that truly "noninvasive" surgery will be a reality.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus.
Current evidence that breastfeeding is beneficial for infant and child health is based exclusively on observational studies. Potential sources of bias in such studies have led to doubts about the magnitude of these health benefits in industrialized countries. ⋯ Our experimental intervention increased the duration and degree (exclusivity) of breastfeeding and decreased the risk of gastrointestinal tract infection and atopic eczema in the first year of life. These results provide a solid scientific underpinning for future interventions to promote breastfeeding.
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Rising costs of medications and inequities in access have sparked calls for drug policy reform in the United States and Canada. Control of drug expenditures by prescription cost-sharing for elderly persons and poor persons is a contentious issue because little is known about the health impact in these subgroups. ⋯ In our study, increased cost-sharing for prescription drugs in elderly persons and welfare recipients was followed by reductions in use of essential drugs and a higher rate of serious adverse events and ED visits associated with these reductions.
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Randomized trials with adequate sample size offer an opportunity to assess the safety of new medications in a controlled setting; however, generalizable data on drug safety reporting are sparse. ⋯ The quality and quantity of safety reporting vary across medical areas, study designs, and settings but they are largely inadequate. Current standards for safety reporting in randomized trials should be revised to address this inadequacy.
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Racial disparities in health care delivery and outcomes may be due to differences in health care access and, therefore, may be mitigated in an equal-access health care system. Few studies have examined racial differences in health outcomes in such a system. ⋯ Black patients admitted to VA hospitals with common medical diagnoses have lower mortality rates than white patients. The survival advantage of black patients is not readily explained; however, the absence of a survival disadvantage for blacks may reflect the benefits of equal access to health care and the quality of inpatient treatment at VA medical centers.