JAMAPub Date : 2024-09-25DOI: 10.1001/jama.2024.14745
David M Greer,Raimund Helbok,Neeraj Badjatia,Sang-Bae Ko,Mary McKenna Guanci,Kevin N Sheth
{"title":"Fever Prevention in Patients With Acute Vascular Brain Injury: The INTREPID Randomized Clinical Trial.","authors":"David M Greer,Raimund Helbok,Neeraj Badjatia,Sang-Bae Ko,Mary McKenna Guanci,Kevin N Sheth","doi":"10.1001/jama.2024.14745","DOIUrl":"https://doi.org/10.1001/jama.2024.14745","url":null,"abstract":"ImportanceFever is associated with worse outcomes in patients with stroke, but whether preventing fever improves outcomes is unclear.ObjectiveTo determine whether fever prevention after acute vascular brain injury is achievable and impacts functional outcome.Design, Setting, and ParticipantsOpen-label randomized clinical trial with blinded outcome assessment that enrolled 686 of 1176 planned critically ill patients with stroke at 43 intensive care units in 7 countries from March 2017 to April 2021 (last date of follow-up was May 12, 2022).InterventionPatients randomized to fever prevention (n = 339) were targeted to 37.0 °C for 14 days or intensive care unit discharge using an automated surface temperature management device. Standard care patients (n = 338) received standardized tiered fever treatment on occurrence of temperature of 38 °C or greater.Main Outcomes and MeasuresPrimary outcome was daily mean fever burden: the area under the temperature curve above 37.9 °C (total fever burden) divided by the total number of hours in the acute phase, multiplied by 24 hours (°C-hour). The principal secondary outcome was 3-month functional recovery by shift analysis of the 6-category modified Rankin Scale, which is scored from 0 (no symptoms) to 6 (death). Major adverse events included death, pneumonia, sepsis, and malignant cerebral edema.ResultsEnrollment was stopped after a planned interim analysis demonstrated futility of the principal secondary end point. In total, 686 patients were enrolled, and 9 were consented but not randomized, leaving a primary analysis population of 677 patients (254 ischemic stroke, 223 intracerebral hemorrhage, 200 subarachnoid hemorrhage; 345 were female [51%]; median age, 62 years) with 433 (64%) completing the study through 12 months. Daily mean (SD) fever burden was significantly lower in the fever prevention group (0.37 [1.0] °C-hour; range, 0.0-8.0 °C-hour) compared with the standard care group (0.73 [1.1] °C-hour; range, 0.0-10.3 °C-hour) (difference, -0.35 [95% CI, -0.51 to -0.20]; P < .001). Between-group differences for the primary outcome by stroke subtype were -0.10 (95% CI, -0.35 to 0.15) for ischemic stroke, -0.50 (95% CI, -0.78 to -0.22) for intracerebral hemorrhage, and -0.52 (95% CI, -0.81 to -0.23) for subarachnoid hemorrhage (all P < .001 by Wilcoxon rank-sum test). There was no significant difference in functional recovery at 3 months (median modified Rankin Scale score, 4.0 vs 4.0, respectively; odds ratio for a favorable shift in functional outcome, 1.09 [95% CI, 0.81 to 1.46]; P = .54). Major adverse events occurred in 82.2% of participants in the fever prevention group vs 75.9% in the standard care group, including 33.8% vs 34.5% for infections, 14.5% vs 14.0% for cardiac disorders, and 24.5% vs 20.5% for respiratory disorders.Conclusions and RelevanceIn patients with acute vascular brain injury, preventive normothermia using an automated surface temperature management device effectively reduced fev","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142321175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMAPub Date : 2024-09-25DOI: 10.1001/jama.2024.13681
Rafael Campo
{"title":"And Now I Turn Unto My Calling-Of Medical Oaths and Poetry.","authors":"Rafael Campo","doi":"10.1001/jama.2024.13681","DOIUrl":"https://doi.org/10.1001/jama.2024.13681","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMAPub Date : 2024-09-25DOI: 10.1001/jama.2024.14637
Erika F Augustine,Timothy W Yu,Richard S Finkel
{"title":"N-of-1 Studies in an Era of Precision Medicine.","authors":"Erika F Augustine,Timothy W Yu,Richard S Finkel","doi":"10.1001/jama.2024.14637","DOIUrl":"https://doi.org/10.1001/jama.2024.14637","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMAPub Date : 2024-09-23DOI: 10.1001/jama.2024.17961
Hilary Ong, Cassandra L. Thiel, Hardeep Singh
{"title":"Health Care Actions for Reducing Plastic Use and Pollution","authors":"Hilary Ong, Cassandra L. Thiel, Hardeep Singh","doi":"10.1001/jama.2024.17961","DOIUrl":"https://doi.org/10.1001/jama.2024.17961","url":null,"abstract":"This Viewpoint proposes a comprehensive sociotechnical approach spanning the entire plastics life cycle to reduce plastic use and pollution in health care.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142276956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMAPub Date : 2024-09-20DOI: 10.1001/jama.2024.19131
Samantha Anderer
{"title":"Study: Heat-Related Deaths on the Rise in US Since 2016.","authors":"Samantha Anderer","doi":"10.1001/jama.2024.19131","DOIUrl":"https://doi.org/10.1001/jama.2024.19131","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142273437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMAPub Date : 2024-09-20DOI: 10.1001/jama.2024.16009
Rebecca K Metcalfe,Jay J H Park
{"title":"Diversity Action Plans in Clinical Trials.","authors":"Rebecca K Metcalfe,Jay J H Park","doi":"10.1001/jama.2024.16009","DOIUrl":"https://doi.org/10.1001/jama.2024.16009","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142275311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMAPub Date : 2024-09-20DOI: 10.1001/jama.2024.19129
Samantha Anderer
{"title":"FDA Approves First Automated Insulin Device for Type 2 Diabetes.","authors":"Samantha Anderer","doi":"10.1001/jama.2024.19129","DOIUrl":"https://doi.org/10.1001/jama.2024.19129","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142273439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMAPub Date : 2024-09-20DOI: 10.1001/jama.2024.19132
Samantha Anderer
{"title":"HHS Dedicates Millions to Expand Prenatal, Postpartum Home Visits.","authors":"Samantha Anderer","doi":"10.1001/jama.2024.19132","DOIUrl":"https://doi.org/10.1001/jama.2024.19132","url":null,"abstract":"","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142273434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}