JAMA neurology最新文献

{"title":"Quality Improvement Intervention for Reducing Acute Treatment Times in Ischemic Stroke: A Cluster Randomized Clinical Trial.","authors":"Daniël Hansen, Sanne J den Hartog, Nikki van Leeuwen, Jelis Boiten, Wouter Dinkelaar, Pieter J van Doormaal, Frank Eijkenaar, Bart J Emmer, Adriaan C G M van Es, H Zwenneke Flach, Rob Gons, M Heleen den Hertog, Farshad Imani, Paula M Janssen, Hans Kortman, Nyika D Kruyt, Laurien S Kuhrij, Christiaan van der Leij, T H Rob Lo, Aad van der Lugt, Geert Lycklama À Nijeholt, Jasper M M Martens, Paul J Nederkoorn, Jurgen Piet, Michel J M Remmers, Yvo B W E M Roos, Suzanne M Silvis, Lotte J Stolze, Wouter Stomp, Julia H van Tuijl, Martine T B Truijman, Sarah E Vermeer, Marianne A A van Walderveen, Ido R van den Wijngaard, H Bart Van der Worp, Lonneke Yo, Diederik W J Dippel, Hester F Lingsma, Bob Roozenbeek","doi":"10.1001/jamaneurol.2024.4304","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4304","url":null,"abstract":"<p><strong>Importance: </strong>Efficient care processes are crucial to minimize treatment delays and improve outcome after endovascular thrombectomy (EVT) in patients with ischemic stroke. A potential means to improve care processes is performance feedback.</p><p><strong>Objective: </strong>To evaluate the effect of performance feedback to hospitals on treatment times for EVT.</p><p><strong>Design, setting, and participants: </strong>This cluster randomized clinical trial was conducted from January 1, 2020, to June 30, 2022. Participants were consecutive adult patients with ischemic stroke who underwent EVT in 13 Dutch hospitals. No patients were excluded. Data analysis took place from March to May 2023.</p><p><strong>Intervention: </strong>The intervention consisted of feedback on hospital performance using structure, process, and outcome indicators. Indicator scores were based on data from a national quality registry and compared with a benchmark. Performance feedback was provided through a dashboard for local quality improvement teams who developed and implemented improvement plans based on the feedback. Every 6 months, 3 to 4 randomly selected hospitals switched to the intervention condition.</p><p><strong>Main outcome and measures: </strong>The primary outcome was time from door to groin puncture for all patients treated with EVT. Secondary outcomes included door-to-needle time, National Institutes of Health Stroke Scale (NIHSS) score at day 2, expanded Treatment in Cerebral Infarction (eTICI) score, and modified Rankin Scale (mRS) score at 3 months. The effect of the intervention was estimated with multivariable linear mixed models.</p><p><strong>Results: </strong>A total of 4747 patients were included (intervention: 2431; control: 2316). Their mean (SD) age was 72 (13) years; 2337 (49.2%) were female and 2410 (50.8%) were male. The median (IQR) baseline NIHSS score was 14 (8-19). Median (IQR) door-to-groin puncture time under the intervention condition was 47 (25-71) minutes, compared with 52 (29-75) minutes under the control condition. The adjusted absolute reduction was 5 minutes (β = -4.8; 95% CI, -9.5 to -0.1; P = .04), corresponding to a relative reduction of 9.2% (95% CI, -18.3% to -0.2%).</p><p><strong>Conclusion and relevance: </strong>This study found that performance feedback provided through a dashboard used by local quality improvement teams reduced door-to-groin puncture time for EVT. Implementation of performance feedback in hospitals providing EVT can improve the quality of care for ischemic stroke.</p><p><strong>Trial registration: </strong>The Netherlands Trial Register: NL9090.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heatwaves and Neurodegenerative Disease.","authors":"Indu Subramanian, Ali Saad","doi":"10.1001/jamaneurol.2024.4319","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4319","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Cerebrospinal Fluid Leak Mimicking a Cerebellopontine Angle Tumor.","authors":"Wouter I Schievink, Ferdinand K Hui","doi":"10.1001/jamaneurol.2024.4322","DOIUrl":"10.1001/jamaneurol.2024.4322","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurological Pupil Index and Intracranial Hypertension in Patients With Acute Brain Injury: A Secondary Analysis of the ORANGE Study.","authors":"Matteo Petrosino, Elisa Gouvêa Bogossian, Paola Rebora, Stefania Galimberti, Randall Chesnut, Pierre Bouzat, Mauro Oddo, Fabio Silvio Taccone, Giuseppe Citerio","doi":"10.1001/jamaneurol.2024.4189","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4189","url":null,"abstract":"<p><strong>Importance: </strong>Invasive intracranial pressure (ICP) is the standard of care in patients with acute brain injury (ABI) with impaired consciousness. The Neurological Pupil Index (NPi) obtained by automated pupillometry is promising for noninvasively estimating ICP.</p><p><strong>Objectives: </strong>To evaluate the association between repeated NPi and invasive ICP values.</p><p><strong>Design, setting, and participants: </strong>This study is a secondary analysis of the Outcome Prognostication of Acute Brain Injury With the Neurological Pupil Index (ORANGE), a multicenter, prospective, observational study of patients with ABI performed from October 1, 2020, to May 31, 2022, with follow-up at 6 months after ABI. The ORANGE study was performed at neurologic intensive care units of tertiary hospitals in Europe and North America. In ORANGE, 514 adult patients receiving mechanical ventilatory support were admitted to the intensive care unit after ABI.</p><p><strong>Exposure: </strong>Invasive ICP monitoring and automated pupillometry assessment every 4 hours during the first 7 days, considered as a standard of care.</p><p><strong>Main outcomes and measures: </strong>Association between ICP and NPi values over time, using bayesian joint models, with linear and logistic mixed-effects longitudinal submodels.</p><p><strong>Results: </strong>The study included 318 adult patients (median [IQR] age, 58 [43-69] years; 187 [58.8%] male) who required intensive care unit admission, intubation, and mechanical ventilatory support due to acute traumatic brain injury (n = 133 [41.8%]), intracerebral hemorrhage (n = 104 [32.7%]), or aneurysmal subarachnoid hemorrhage (n = 81 [25.5%]) and had automatic infrared pupillometry used as part of the standard evaluation practice and ICP monitoring. A total of 8692 ICP measurements were collected, with a median (IQR) of 31 (18-37) evaluations per patient. The median (IQR) NPi and ICP for the study population were 4.1 (3.5-4.5) and 10 (5-14) mm Hg, respectively. In a linear mixed model, the mean change in the NPi value, as a continuous variable, was -0.003 (95% credible interval [CrI], -0.006 to 0.000) for each 1-mm Hg ICP increase. No significant association between ICP and abnormal NPi (<3; odds ratio, 1.01; 95% CrI, 0.99-1.03) or absent NPi (0; odds ratio, 1.03; 95% CrI, 0.99-1.06) was observed.</p><p><strong>Conclusions and relevance: </strong>Although an abnormal NPi could indicate brainstem dysfunction, in this large and heterogeneous population of patients, NPi values were not significantly associated overall with ICP values. Repeated NPi measurements may not be a sufficient replacement for invasive monitoring.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT04490005.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Patient Portal Messaging Crisis.","authors":"Carrie K Grouse, Gregory J Esper","doi":"10.1001/jamaneurol.2024.4153","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4153","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discontinuation of First-Line Disease-Modifying Therapy in Patients With Stable Multiple Sclerosis","authors":"Eline M. E. Coerver, Wing Hee Fung, Janet de Beukelaar, Willem H. Bouvy, Leo R. Canta, Oliver H. H. Gerlach, Elske Hoitsma, Erwin L. J. Hoogervorst, Brigit A. de Jong, Nynke F. Kalkers, Zoé L. E. van Kempen, Harry Lövenich, Caspar E. P. van Munster, Bob W. van Oosten, Joost Smolders, Anke Vennegoor, Esther M. P. E. Zeinstra, Mar Barrantes-Cepas, Gijs Kooij, Menno M. Schoonheim, Birgit I. Lissenberg-Witte, Charlotte E. Teunissen, Bastiaan Moraal, Frederik Barkhof, Bernard M. J. Uitdehaag, Jop Mostert, Joep Killestein, Eva M. M. Strijbis","doi":"10.1001/jamaneurol.2024.4164","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4164","url":null,"abstract":"ImportanceIncreasing numbers of people with multiple sclerosis (MS) use disease-modifying therapy (DMT). Long-term stable disease while taking such medications provides a rationale for considering DMT discontinuation given patient burden, costs, and potential adverse effects of immunomodulating therapy.ObjectiveTo investigate whether first-line DMT can be safely discontinued in patients with long-term stable MS.Design, Setting, and ParticipantsThis multicenter, rater-blinded, noninferiority randomized clinical trial was conducted between July 1, 2020, and March 20, 2023, at 14 Dutch centers. Data analysis was performed between July 2023 and January 2024. Key inclusion criteria were relapse-onset MS, aged 18 years or older, without relapses, and without substantial magnetic resonance imaging (MRI) activity in the previous 5 years under first-line DMT. Participants were randomized 1:1 to discontinue or continue first-line DMT.InterventionDiscontinuation of first-line DMT.Main Outcome and MeasureThe primary outcome was significant inflammatory disease activity, defined as relapse and/or 3 or more new T2 lesions or 2 or more contrast-enhancing lesions on brain MRI.ResultsOf 163 potentially eligible participants, 89 participants were included in the trial at the moment of early termination. Forty-four participants (49.4%) were assigned to the continue group and 45 participants (50.6%) were assigned to the discontinue group. Median (IQR) age was 54.0 (49.0-59.0) years, and 60 participants (67.4%) were female. Two participants in the continue group were lost to follow-up. After a median (IQR) follow-up time of 15.3 (11.4-23.9) months, the trial was prematurely terminated because of inflammatory disease activity recurrence above the predefined limit. In total, 8 of 45 participants in the discontinue group (17.8%) vs 0 of 44 participants in the continue group reached the primary end point and had recurrent, mostly radiological inflammation. Two of these 8 participants had a clinical relapse. Median (IQR) time to disease activity was 12.0 (6.0-12.0) months.Conclusions and RelevanceIn this randomized clinical trial, even in patients with long-term MS stable for over 5 years, first-line DMT discontinuation can lead to recurrence of inflammatory disease activity. Although this study cohort was relatively small, the recurrence of inflammation in the discontinue group was significantly higher than in the continue group and also higher than in the previously published DISCOMS trial, which only included individuals aged 55 years or older. This study provides additional data, especially in a younger population and including longitudinal biomarker measurements, for informed decision-making in cases when treatment discontinuation is considered.Trial RegistrationClinicalTrials.gov Identifier: &lt;jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://www.clinicaltrials.gov/study/NCT04260711?cond=NCT04260711&amp;amp;amp;rank=1\"&gt;N","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"212 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142797048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"β-Amyloid Positron Emission Tomography Use Across Medicare Administrative Contractor Regions","authors":"Zachary A. Marcum, Dominic Nunag, Adam P. Bress, Jeremy Pruzin","doi":"10.1001/jamaneurol.2024.4073","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4073","url":null,"abstract":"This cross-sectional study assesses variation in β-amyloid positron emission tomography (PET) use among Medicare beneficiaries with mild cognitive impairment or dementia by Medicare Administrative Contractor region.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"133 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"β-Blocker Use and Delayed Onset and Progression of Huntington Disease","authors":"Jordan L. Schultz, Amy C. Ogilvie, Lyndsay A. Harshman, Peg C. Nopoulos","doi":"10.1001/jamaneurol.2024.4108","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4108","url":null,"abstract":"ImportanceHuntington disease (HD) is characterized by motor, cognitive, and psychiatric decline. β-Blockers may play a therapeutic role by decreasing enhanced sympathetic tone in HD.ObjectiveTo evaluate the impact of β-blockers on the timing of motor diagnosis onset and progression of HD symptoms.Design, Setting, and ParticipantsThis observational, longitudinal multicenter study used the Enroll-HD platform database (initiated September 2011 to present), including propensity score–matched cohorts of patients with premanifest HD (preHD) and early motor-manifest HD (mmHD) who were either users or nonusers of β-blockers. Participants included patients with genetically confirmed preHD (n = 4683 eligible participants) or mmHD (n = 3024 eligible participants) who were taking a β-blocker and were matched to similar non–β-blocker users.ExposureUninterrupted use of a β-blocker for more than 1 year.Main Outcomes and MeasuresFor PreHD: risk of receiving a motor diagnosis of HD over time. For mmHD: progression rate of total motor score, total functional capacity score, and the symbol digit modalities test. Post hoc analyses were performed to test additional clarifying hypotheses after the primary analyses were completed.ResultsThis study included 174 preHD β-blocker users (59 males; 115 females) with a mean age of 46.4 (SD, 13.1) years and a mean cytosine-adenine guanine repeat length of 41.1 (SD, 2.4) who were well matched to 174 preHD non–β-blocker users. The preHD β-blocker users showed a statistically significant reduction in the annualized hazard of receiving a motor diagnosis compared with nonusers (n = 174) (hazard ratio, 0.66; 95% CI, 0.46-0.94; <jats:italic>P</jats:italic> = .02). There were 149 mmHD β-blocker users (86 males; 60 females) with a mean age of 58.9 (SD, 11.3) years and a mean cytosine-adenine guanine repeat length of 42.0 (SD, 2.3) matched to 149 mmHD non–β-blocker users. The β-blocker users had a slower mean annualized worsening in total motor score (mean difference [MD], −0.45; 95% CI, −0.85 to −0.06; q = 0.025), total functional capacity score (MD, 0.10; 95% CI, 0.02-0.18; q = 0.025), and symbol digit modalities test (MD, 0.33; 95% CI, 0.10-0.56; q = 0.017) compared with matched nonusers.Conclusions and RelevanceIn this study, β-blocker use was associated with delayed motor onset in preHD and reduced the rate of worsening of symptoms in mmHD. These findings demonstrated that β-blockers may have a therapeutic role in HD but further studies are required.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"50 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protecting Neural Data Privacy-First, Do No Harm.","authors":"Sean Pauzauskie, Jared Genser, Rafael Yuste","doi":"10.1001/jamaneurol.2024.4070","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4070","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Crossed Clonus Response.","authors":"Sourav Hazra, Rajinder K Dhamija, Siddharth Maheshwari","doi":"10.1001/jamaneurol.2024.3488","DOIUrl":"10.1001/jamaneurol.2024.3488","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"1314-1315"},"PeriodicalIF":20.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}