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This Week in JAMA
April 22/29, 1998

This Week in JAMA

JAMA. 1998;279(16):1237. doi:10.1001/jama.279.16.1237
Molecular Weight Heparinoid for Acute Ischemic Stroke

Most treatments for acute ischemic stroke have focused on dissolving or preventing clots. The TOAST investigators conducted a randomized controlled trial to determine whether one of the low molecular weight heparinoids, which cause less bleeding and thrombocytopenia than heparin, improves outcomes of patients with acute ischemic stroke.

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Identifying Patients With Atrial Fibrillation at Low Risk for Stroke

Warfarin substantially reduces the risk of stroke in patients with atrial fibrillation but also increases the risk of hemorrhage. The Stroke Prevention in Atrial Fibrillation (SPAF) investigators previously identified risk factors for stroke among patients with atrial fibrillation. In this study, they use their criteria to define a low-risk population and treat them with aspirin to determine the risk of stroke during 2 years of follow-up.

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Variation in Carotid Endarterectomy Mortality

How should physicians apply clinical trial results in daily practice? Cautiously, Dr Wennberg and colleagues suggest. Compared with perioperative mortality rates reported in the trials, perioperative mortality of nontrial patients who were treated in trial hospitals was substantially higher than mortality among trial patients, and mortality at nontrial hospitals was even higher.

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Risk of Stroke and Death Following Carotid Endarterectomy

The risks of stroke and death from carotid endarterectomy in the community differ from those reported in clinical trials. Dr Cebul and colleagues identify factors associated with reduced risk of stroke and death, including having surgery at a hospital at which a high volume of carotid endarterectomies is performed.

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Public Perception of Stroke Warning Signs and Risk Factors

Patients with symptoms and signs of acute stroke often delay seeking medical attention. Dr Pancioli and colleagues provide information that may help to explain why, documenting substantial gaps in public awareness of stroke warning signs and risk factors. Of nearly 2000 adults surveyed, slightly more than half could identify at least 1 common warning sign of stroke and only two thirds could list at least 1 established stroke risk factor.

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Cranial CT Interpretation and Decisions About Thrombolytic Therapy

Accurate interpretation of cranial CT scans is essential for diagnosing acute stroke and deciding whether to administer thrombolytic therapy. Dr Schriger and colleagues asked a small sample of emergency physicians, neurologists, and general radiologists to interpret CT scans regarding thrombolytic therapy. Overall, nearly a quarter of decisions for thrombolytic therapy administration were incorrect; intracranial hemorrhage was not identified in nearly one fifth of cases.

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The Cover

". . . time's corrugations have not annihilated beauty; their thick encasement has only disguised it . . ." Ivan Albright, Self-portrait (No. 20), 1983, American.

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Medical News & Perspectives

Fifty Years of Framingham: An interview with Heart Study director William P. Castelli, MD, and a retrospective look at research and clinical findings from a unique half-century of data collection.

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Policy Perspectives

"Increasing pressures for cost control and the spread of managed care throughout the country create an urgent, shared need for information on health care quality among all health care stakeholders."

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New Feature: The JAMA Patient Page

In this issue, we launch a new feature that will provide patient-friendly information related to 1 or more articles in each week's JOURNAL. Physicians are encouraged to make copies of these pages and share them with their patients. This week's topic: stroke.

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