JAMA最新文献_第8页

Data Errors in Text and Table. 文本和表格中的数据错误。

JAMA Pub Date : 2024-09-26 DOI: 10.1001/jama.2024.20532

引用次数: 0

Legal Accountability for Health Crises: "Unshielding" the Sackler Family. 健康危机的法律责任：为萨克勒家庭 "解套"。

JAMA Pub Date : 2024-09-25 DOI: 10.1001/jama.2024.16200

Daniel G Aaron,Adam J Levitin,Michael S Sinha

引用次数: 0

Purdue Pharma and the Sackler Family at the Supreme Court. 最高法院的普渡制药公司和萨克勒家族。

JAMA Pub Date : 2024-09-25 DOI: 10.1001/jama.2024.16176

Elle Rothermich,Abbe R Gluck

引用次数: 0

Fever Prevention in Patients With Acute Vascular Brain Injury: The INTREPID Randomized Clinical Trial. 急性脑血管损伤患者的发热预防：INTREPID 随机临床试验。

JAMA Pub Date : 2024-09-25 DOI: 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":null,"pages":null},"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}

引用次数: 0

And Now I Turn Unto My Calling-Of Medical Oaths and Poetry. 现在，我转向我的使命--关于医学誓言和诗歌。

JAMA Pub Date : 2024-09-25 DOI: 10.1001/jama.2024.13681

Rafael Campo

引用次数: 0

Feasibility of Fever Prevention in Vascular Brain Injury. 血管性脑损伤预防发烧的可行性。

JAMA Pub Date : 2024-09-25 DOI: 10.1001/jama.2024.16415

Teresa May,Lori Shutter

引用次数: 0

N-of-1 Studies in an Era of Precision Medicine. 精准医学时代的 "N-of-1 "研究。

JAMA Pub Date : 2024-09-25 DOI: 10.1001/jama.2024.14637

Erika F Augustine,Timothy W Yu,Richard S Finkel