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Source: JAMA
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Total 276 results found since Jan 2013.
Factors Contributing to the Weekend Effect
To the Editor The Viewpoint by Dr Black discussed recent high-quality studies from the United Kingdom about emergency admissions or admissions for stroke that did not demonstrate higher mortality for weekend hospitalizations. Previous findings, based on administrative databases, could be attributed to coding errors and inadequate adjustment for disease severity and comorbidities. He acknowledged that the so-called weekend effect could affect other measures of the quality of care but does not result in an increased risk of mortality.
Source: JAMA - April 18, 2017 Category: Journals (General) Source Type: research
Time to Endovascular Thrombectomy for Acute Stroke
To the Editor In an individual-patient meta-analysis using data from 5 randomized clinical trials, Dr Saver and colleagues reported improved outcomes following mechanical thrombectomy initiated up to 7.3 hours after the onset of acute ischemic stroke due to large vessel occlusion. This result represents a meaningful extension of the current 6-hour treatment guideline and would expand access to life-altering treatments. However, the challenges of interpreting these data must be acknowledged. Only 3 of the 5 trials allowed intervention beyond 6 hours, and these 3 trials used more stringent imaging selection criteria that var...
Source: JAMA - March 21, 2017 Category: Journals (General) Source Type: research
Time to Endovascular Thrombectomy for Acute Stroke —Reply
In Reply We concur with Dr Kansagra that it is important to take into account that special penumbral and collateral imaging selection criteria were used in a minority of the participating trials, but we note that special imaging selection was used less often than Kansagra suggests. Of the 3 trials enrolling patients for intervention beyond 6 hours, 2 (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands [MR CLEAN] and Randomized Trial of Revascularization With Solitaire FR Device vs Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Larg...
Source: JAMA - March 21, 2017 Category: Journals (General) Source Type: research
Sedation vs Intubation for Patients With Acute Stroke Undergoing Thrombectomy
To the Editor Dr Sch önenberger and colleagues investigated whether anesthetic choice influenced outcome following endovascular thrombectomy for large-vessel stroke by conducting a randomized blinded trial enrolling 150 thrombectomy patients over a 2-year period. Interpretation of the results is limited by the choice o f primary outcome measure, an underpowered trial design, and the relative ineffectiveness of the intervention.
Source: JAMA - March 21, 2017 Category: Journals (General) Source Type: research
Sedation vs Intubation for Patients With Acute Stroke Undergoing Thrombectomy —Reply
In Reply Drs See and Ducruet raise a number of concerns about our trial. The study was designed to investigate short-term clinical outcomes, whereas longer-term outcomes, which are also important, should be addressed in a multicenter trial. The MR CLEAN data that See and Ducruet cite to question our design and sample size were not published at the time of planning the SIESTA trial. We acknowledge that in settings with higher interventional speed and efficacy, the results may have been different. However, our trial population better reflected broad practice than other randomized thrombectomy studies.
Source: JAMA - March 21, 2017 Category: Journals (General) 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
Adverse Effects of Statins
To the Editor In his Viewpoint, Dr Thompson wrote, “Although statins reduce total stroke, they increase the risk of hemorrhagic stroke consistent with the observation that low cholesterol levels are associated with an increase in hemorrhagic stroke.” The statement could be misleading and requires clarification.
Source: JAMA - March 14, 2017 Category: Journals (General) Source Type: research
Attributing Death to Diet
A substantial body of evidence has implicated several aspects of diet with the occurrence of cardiometabolic disease (CMD) —heart disease, stroke, and type 2 diabetes. Dietary factors studied have included individual nutrients (macronutrients, micronutrients, minerals, vitamins, electrolytes, and phytochemicals), foods, and overall dietary patterns. It is generally accepted that a suboptimal diet is causally related t o CMD, but scientists debate which factors are responsible and the relative importance of each factor given the challenges of isolating and estimating the potential effects of individual nutrients and foods...
Source: JAMA - March 7, 2017 Category: Journals (General) Source Type: research
Association Between Diet and Cardiometabolic Mortality in the United States
This nutritional epidemiology study uses NHANES data to estimate associations between dietary components and mortality due to heart disease, stroke, and type 2 diabetes among US adults between 2002 and 2012.
Source: JAMA - March 7, 2017 Category: Journals (General) Source Type: research
Incorrect Information in Table 3
This article was corrected online.
Source: JAMA - February 7, 2017 Category: Journals (General) Source Type: research
Screening for Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is highly prevalent, affecting 34% of men and 17% of women. Individuals with OSA experience recurrent cardiometabolic stress when repetitively attempting to breathe against an occluded airway during sleep, leading to nightly episodes of hypoxia, sleep disruption, and surges of the sympathetic nervous system. These physiological perturbations often cause blood pressure and heart rate elevations, endothelial dysfunction, and insulin resistance —mechanisms implicated in the pathogenesis of cardiovascular disease (CVD), diabetes, and neurologic disease. When untreated, OSA is associated with an ...
Source: JAMA - January 24, 2017 Category: Journals (General) Source Type: research
Reducing Recurrent Strokes
Adevice that reduces the risk of a second stroke in patients whose first may have resulted from a blood clot traveling through a patent foramen ovale (PFO) and on to the brain has received FDA approval.
Source: JAMA - January 3, 2017 Category: Journals (General) Source Type: research
Celecoxib ’s Cardiovascular Safety
The selective cyclooxygenase 2 (COX-2) inhibitor celecoxib is no more likely than 2 nonsteroidal anti-inflammatory drugs (NSAIDs) to cause cardiovascular death, nonfatal myocardial infarction, or stroke in patients with coronary disease or other cardiovascular risks.
Source: JAMA - December 27, 2016 Category: Journals (General) Source Type: research
