Main Points:
Patients with arteriovenous malformations (abnormal connection between arteries and veins) in the brain that have not ruptured had a lower risk of stroke or death for up to 12 years if they received conservative management of the condition compared to an interventional treatment, according to a study in the April 23/30 issue of JAMA, a neurology theme issue.
Published in:
JAMA
Study Further:
Interventional treatment for brain arteriovenous malformations (bAVMs) with procedures such as neurosurgical excision, endovascular embolization, or stereotactic radiosurgery can be used alone or in combination to attempt to obliterate bAVMs. Because interventions may have complications and the untreated clinical course of unruptured bAVMs can be benign, some patients choose conservative management (no intervention). Guidelines have endorsed both intervention and conservative management for unruptured bAVMs. Whether conservative management is superior to interventional treatment for unruptured bAVMs is uncertain because of the lack of long-term experience, according to background information in the article.
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Main Points:
The majority of adults surveyed indicated they would want administration of clot-dissolving medications if incapacitated by a stroke, a finding that supports clinicians’ use of this treatment if patient surrogates are not available to provide consent, according to a study in the April 23/30 issue of JAMA, a neurology theme issue.
Published in:
JAMA
Study Further:
“In life-threatening emergencies involving incapacitated patients without surrogates, clinicians may intervene without obtaining informed consent, applying the presumption that reasonable people would consent to treatment in such circumstances. Whether this rationale applies to the treatment of acute ischemic stroke with intravenous thrombolysis [administration of clot-busting agent] is controversial because this intervention improves functional outcomes but is not life preserving. Nonetheless, the presumption of consent to thrombolysis for ischemic stroke has recently been endorsed by professional societies,” according to background information in the study.
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Main Points:
In a study that included more than 71,000 stroke patients, implementation of a quality initiative was associated with improvement in the time to treatment and a lower risk of in-hospital death, intracranial hemorrhage (bleeding in the brain), and an increase in the portion of patients discharged to their home, according to the study appearing in the April 23/30 issue of JAMA, a neurology theme issue.
Published in:
JAMA
Study Further:
Intravenous tissue plasminogen activator (tPA; an enzyme that helps dissolve clots) reduces long-term disability when administered early to eligible patients with acute ischemic stroke. These benefits, however, are highly time dependent. Because of the importance of rapid treatment, national guidelines recommend that hospitals complete the evaluation of patients with acute ischemic stroke and begin intravenous tPA therapy for eligible patients within 60 minutes of hospital arrival. However, prior studies demonstrate that less than one-third of patients are treated within the recommended time frame, and that this measure has improved minimally over time, according to background information in the article.
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Images of a small fraction of the galaxies analyzed in the new study. The galaxies are ordered by total mass of stars (rising from bottom to top) and by ‘bulge to total stellar mass ratio’ (rising from left to right). Galaxies that appear redder have high values for both of these measurements, meaning that the mass of the bulge — and central black hole — determines their color. (Credit: A. Bluck)
Main Points:
The universe we can see is made up of billions of galaxies, each containing anywhere from hundreds of thousands to hundreds of billions of stars. Large numbers of galaxies are elliptical in shape, red and mostly made up of old stars. Another (more familiar) type is the spiral, where arms wind out in a blue thin disk from a central red bulge. On average stars in spiral galaxies tend to be much younger than those in ellipticals. Read more…
Main Points:
Mammograms with false-positive results were associated with increased short-term anxiety for women, and more women with false-positive results reported that they were more likely to undergo future breast cancer screening.
Published in:
JAMA Internal Medicine
Author:
Anna N.A. Tosteson, Sc.D., of the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, N.H., and colleagues.
Background:
A portion of women who undergo routine mammogram screening will experience false-positive results and require further evaluation to rule out breast cancer.
How the Study Was Conducted:
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