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Source: JAMA
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Total 276 results found since Jan 2013.
Recovery After Stroke
Source: JAMA - December 13, 2016 Category: Journals (General) Source Type: research
Mixing Study for Evaluation of Abnormal Coagulation Testing
An 84-year-old woman with a history of chronic kidney disease, prior stroke, and hypertension but no personal or family history of bleeding disorders was admitted with a 2-week history of spontaneous subcutaneous ecchymoses and hematomas. She had normal vital signs, laboratory results showing isolated severe anemia but unremarkable for other causes of anemia, and a large soft-tissue hematoma in the left chest wall without evidence of internal hemorrhage. How do you interpret these test results?
Source: JAMA - November 22, 2016 Category: Journals (General) Source Type: research
Intensive vs Standard Blood Pressure Control for Older Adults
To the Editor We believe that the mechanisms underlying the results of SPRINT, and the analysis of patients aged 75 years or older, warrant further discussion. Untreated hypertension poses a particular risk of stroke and myocardial infarction in a short time window, which may be mitigated by blood pressure reduction. On the other hand, left ventricular hypertrophy, diastolic dysfunction, and overt heart failure secondary to hypertension tend to develop over a longer period (decades) and their prevention by lowering of blood pressure could take a longer period to manifest. It was therefore unexpected to note the statistical...
Source: JAMA - November 8, 2016 Category: Journals (General) Source Type: research
Reducing Stroke Disability
The FDA hasexpanded indications for 2 blood clot retrieval devices as first-line treatment for ischemic stroke when used with a clot-dissolving drug within 6 hours of symptom onset.
Source: JAMA - October 18, 2016 Category: Journals (General) Source Type: research
Endovascular Thrombectomy for Ischemic Stroke
In 2015, the publication of 5 clinical trials established the efficacy of endovascular thrombectomy for reducing disability from large artery ischemic stroke, with each trial demonstrating the same superiority of thrombectomy compared with standard care. Endovascular stroke therapy —most recently with the use of stent retrievers to rapidly recanalize the artery during stent deployment and complete the thrombectomy by withdrawing the stent that had engaged the clot during stent deployment—had been practiced prior to that time, despite uncertainty about its uses and benefits . After nearly 2 decades since intravenous tis...
Source: JAMA - September 27, 2016 Category: Journals (General) Source Type: research
Endovascular Thrombectomy and Outcomes in Ischemic Stroke
This meta-analysis of trials comparing treatment of acute ischemic stroke with vs without endovascular thrombectomy characterizes the threshold time after which treatment is no longer beneficial.
Source: JAMA - September 27, 2016 Category: Journals (General) Source Type: research
Improving Outcomes From Transcatheter Aortic Valve Implantation
Perioperative stroke from cardiovascular procedures is associated with increased mortality and morbidity, prolonged hospitalization, and greater cost, and it is often the procedural complication most feared by patients. In recent years, there has been increased attention to these serious adverse events and an increased acceptance that they are occurring at a higher rate than prior studies suggested. Previous estimates of stroke incidence were often derived from clinical trials in which interventionalists, surgeons, and patients were carefully screened and narrowly selected, and postprocedural assessment of nervous system i...
Source: JAMA - August 9, 2016 Category: Journals (General) Source Type: research
AHA/ASA Guidelines for Primary Prevention of Stroke
This JAMA Clinical Guidelines Synopsis summarizes the American Heart Association/American Stroke Association (AHA/ASA) 2014 guidelines on primary prevention of stroke.
Source: JAMA - August 9, 2016 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
Task-Oriented Rehabilitation Program for Stroke
To the Editor The Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) trial concluded that structured, task-oriented training is not superior to “usual and customary occupational therapy” (UCC) in moderately impaired stroke patients. Several weaknesses diminish confidence in the conclusions.
Source: JAMA - July 5, 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
Sodium Excretion and Cardiovascular Disease Risk
This cohort study investigates the association between urinary sodium excretion and heart failure, myocardial infarction, and stroke in patients with chronic kidney disease.
Source: JAMA - May 24, 2016 Category: Journals (General) Source Type: research
An Unresponsive Patient With Osborn Waves
A 79-year-old man with a history of hypertension and stroke presented to the emergency department unresponsive with an undetectable temperature. Blood pressure was 85/55 mm Hg; pulse oximetry was 100% on ambient air. An ECG revealed sinus bradycardia with Osborn waves and attenuated P waves. What would you do next?
Source: JAMA - May 3, 2016 Category: Journals (General) Source Type: research
Article Selection and Possible Risk of Bias
To the Editor The 2015 American Heart Association/American Stroke Association focused update for the early management of acute ischemic stroke recommended endovascular therapy as an adjunctive therapy to intravenous thrombolysis. Dr Badhiwala and colleagues performed a meta-analysis regarding endovascular thrombectomy for acute ischemic stroke and found that endovascular thrombectomy was associated with improved functional outcomes (odds ratio [OR], 1.56 [95% CI, 1.14-2.13]; P = .005) and no significant difference in all-cause mortality (OR, 0.87 [95% CI, 0.68-1.12]; P = .27) at 90 days compared with standard medic...
Source: JAMA - April 26, 2016 Category: Journals (General) Source Type: research
