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Door-in-Door-out Times for Transfer of Patients With Stroke
This retrospective study involving patients with acute stroke requiring transfers from hospitals in the Get With the Guidelines –Stroke registry assesses patient and hospital factors associated with door-in-door-out times.
Source: JAMA - August 15, 2023 Category: General Medicine Source Type: research

Remote Ischemic Conditioning vs Usual Care and Neurologic Function in Acute Moderate Ischemic Stroke —Reply
In Reply We appreciate the interest shown by Dr Pico and colleagues about our trial that investigated the effect of RIC on neurologic function in patients with acute moderate ischemic stroke. A dose-response relationship between the number of days of RIC (or the number of RICs delivered) and excellent outcomes is important information to determine the best protocol for in-hospital RIC. These data will be investigated in our secondary analysis of the RICAMIS study.
Source: JAMA - December 20, 2022 Category: General Medicine Source Type: research

Strategic Opportunities to Improve Stroke Systems of Care
Restoring reperfusion to the brain as quickly as possible during acute ischemic stroke is important to reduce long-term disability and optimize clinical outcomes for patients, although hospital and resource availability are frequently not well matched with patient location. Accordingly, many patients who may have large-vessel occlusion (LVO) lack rapid access to endovascular thrombectomy (EVT), a highly efficacious procedure with a number needed to treat of approximately 3 to 7 for regaining independence among carefully selected patients. Therefore, accurate out-of-hospital diagnosis and ensuring that the patient and the n...
Source: JAMA - May 10, 2022 Category: General Medicine Source Type: research

Recent Use of NOACs and Intracranial Hemorrhage in Patients With Stroke Treated With Alteplase
This retrospective cohort study uses data from hospitals participating in the Get With The Guidelines –Stroke registry on patients with acute ischemic stroke and compares the safety and functional outcomes of intravenous alteplase among patients who were taking non–vitamin K antagonist oral anticoagulants (NOACs) prior to stroke vs patients who were not taking long-term anticoagulants.
Source: JAMA - February 22, 2022 Category: General Medicine Source Type: research

Association Between Dispatch of Mobile Stroke Units and Functional Outcomes Among Stroke Patients in Berlin
This cohort study compares global disability at 3 months among Berlin patients with out-of-hospital ischemic stroke brought to care via a mobile stroke unit ambulance (with prehospital CT scanning with or without angiography, point-of-care laboratory testing, prehospital thrombolysis) vs conventional ambulance alone.
Source: JAMA - February 2, 2021 Category: General Medicine Source Type: research

Door-to-Needle Time and Long-term Outcomes in Patients With Stroke —Reply
In Reply Although factors other than faster door-to-needle times may have contributed to the associations between door-to-needle times and 1-year mortality and readmission in our study, there are multiple lines of evidence to suggest that door-to-needle times contributed to improved clinical outcomes and were not just an index for generic stroke care quality. The hospitals providing data for our study were participating in Get With The Guidelines (GWTG) –Stroke, a national quality improvement initiative. Prior studies have analyzed conformity of GWTG-Stroke hospitals with standard stroke care measures, including 7 perfor...
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

Glucose Control in the Perioperative Period
To the Editor Drs Simha and Shah provided a Clinical Update on perioperative glucose control in patients with diabetes undergoing elective surgery. They stated that “limited evidence suggests that good glucose control is likely to be beneficial in reducing postoperative mortality, length of hospital stay, and cardiovascular complications such as stroke.” In support, they cited a Cochrane Review.
Source: JAMA - July 2, 2019 Category: General Medicine Source Type: research

Antithrombotic Treatment and Stroke Severity and Outcomes
This cohort study of patients with atrial fibrillation and acute ischemic stroke examines the prevalence of preceding antithrombotic treatment and its association with stroke severity and in-hospital outcomes.
Source: JAMA - March 14, 2017 Category: Journals (General) Source Type: research

Changing the Narrative
“During the first week of my third year of medical school, I diagnosed an acute stroke. Ms Lau had been admitted to the hospital with right hemiparesis from an acute pontine infarct. I was the first member of the neurology team to see Ms Lau on her third morning in the hospital, or at least the first to notice that she had also developed new left-sided weakness. I ran down the hall to find my resident. As he worked to confirm my findings, his pager went off. New to his role as well, he looked uncomfortable for a moment before announcing, ‘It’s time for rounds. I can’t handle this right now. She needs a stat CT scan...
Source: JAMA - July 19, 2016 Category: Journals (General) Source Type: research

Measuring and Improving Quality
To the Editor In the Viewpoint by Drs McGlynn and Kerr, they stated that “The Joint Commission focuses on 3 major types of admission: myocardial infarction, pneumonia, and heart failure,” leaving most other conditions “largely unmeasured.” In fact, the Joint Commission’s measure sets have also addressed surgical care, perinatal care (the most common reason for hospital admission in the United States), children’s asthma, psychiatric care, venous thromboembolism, stroke, immunization, and tobacco and substance use. The Joint Commission is currently developing new performance measures for blood management and tota...
Source: JAMA - June 28, 2016 Category: Journals (General) Source Type: research

ED Visits for Strokes Decline While Imaging Rates Increase
As mortality rates for stroke have declined, so too have emergency department (ED) visits for ischemic strokes or transient ischemic strokes (TIAs). At the same time, however, more stroke patients in the ED undergo advanced imaging or are transferred to another hospital than are patients with other diagnoses.
Source: JAMA - May 12, 2015 Category: Journals (General) Source Type: research

Clinical Outcomes at 1 Year Following Transcatheter Aortic Valve Replacement
ImportanceIntroducing new medical devices into routine practice raises concerns because patients and outcomes may differ from those in randomized trials.ObjectiveTo update the previous report of 30-day outcomes and present 1-year outcomes following transcatheter aortic valve replacement (TAVR) in the United States.Design, Setting, and ParticipantsData from the Society of Thoracic Surgeons/American College of Cardiology (STS/ACC) Transcatheter Valve Therapies Registry were linked with patient-specific Centers for Medicare & Medicaid Services (CMS) administrative claims data. At 299 US hospitals, 12 182 patients linked wit...
Source: JAMA - March 10, 2015 Category: Journals (General) Source Type: research

Inconsistent Units of Measure
This article was corrected online.
Source: JAMA - February 24, 2015 Category: Journals (General) Source Type: research

Cause-Specific Risk of Hospital Admission Related to Extreme Heat in Older Adults
ImportanceHeat exposure is known to have a complex set of physiological effects on multiple organ systems, but current understanding of the health effects is mostly based on studies investigating a small number of prespecified health outcomes such as cardiovascular and respiratory diseases.ObjectivesTo identify possible causes of hospital admissions during extreme heat events and to estimate their risks using historical data.Design, Setting, and PopulationMatched analysis of time series data describing daily hospital admissions of Medicare enrollees (23.7 million fee-for-service beneficiaries [aged ≥65 years] per year; 8...
Source: JAMA - December 24, 2014 Category: Journals (General) Source Type: research