Showing 1 – 20 of 1086
Relevance | Newest | Oldest |
  • JAMA July 4, 2017

    Figure: Flow of Neonates Through a Trial of Cooling for 120 Hours vs 72 Hours and Cooling to 32.0°C vs 33.5°C for Hypoxic-Ischemic Encephalopathy

    ECMO indicates extracorporeal membrane oxygenation.aModerate or severe encephalopathy was defined as the presence of 1 or more signs in at least 3 of the following 6 categories: (1) level of consciousness (moderate is lethargic, severe is stupor or coma); (2) spontaneous activity (moderate is decreased activity, severe is no activity); (3) posture (moderate is distal flexion or complete extension, severe is decerebrate); (4) tone (moderate is hypotonia, severe is flaccid); (5) primitive reflexes (moderate is a weak suck, severe is an absent suck, or moderate is incomplete Moro reflex and severe is absent); and (6) autonomic nervous system—either pupil (moderate is constricted; severe is deviated, dilated, or nonreactive to light), heart rate (moderate is bradycardia, severe is variable heart rate), or respiration (moderate is periodic breathing, severe is apnea).
  • JAMA November 1, 2016

    Figure 3: Main and Sensitivity or Secondary Analyses According to Outcome

    Unadjusted and adjusted analyses as well as sensitivity analyses and the subgroups of pulseless patients and patients with a pulse at the beginning of the event for the primary outcome survival to hospital discharge and the secondary outcomes return of spontaneous circulation (ROSC) and favorable neurologic outcome at hospital discharge. ROSC was defined as no further need for chest compressions that was sustained for greater than 20 minutes. Neurologic outcome was determined using the pediatric cerebral performance category (PCPC) score, for which a PCPC score of 1 indicates no neurologic deficit; 2, mild cerebral disability; 3, moderate cerebral disability; 4, severe cerebral disability; 5, coma or vegetative state; and 6, brain death. A PCPC score of 1 and 2 was considered a favorable neurologic outcome, and a PCPC score of 3 to 6 or death was considered a poor neurologic outcome. The “main adjusted” analysis refers to the multivariable time-dependent propensity score–matched analysis. RR indicates risk ratio; CPB, cardiopulmonary bypass; CPR, cardiopulmonary resuscitation.
  • JAMA March 15, 2016

    Figure 1: Flow of Participants in the Study of Effect of Inhaled Xenon on Cerebral White Matter Damage in Comatose Patients Who Experienced Out-of-Hospital Cardiac Arrest

    MRI indicates magnetic resonance imaging.aPatient was first transmitted to the wrong hospital; an initiation of possible xenon treatment was not possible within 4 hours.
  • Effect of Inhaled Xenon on Cerebral White Matter Damage in Comatose Survivors of Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial

    Abstract Full Text
    free access is active quiz
    JAMA. 2016; 315(11):1120-1128. doi: 10.1001/jama.2016.1933

    This randomized clinical trial compares the effect of hypothermia with vs without xenon on magnetic resonance imaging–assessed white matter damage in comatose patients who had experienced out-of-hospital cardiac arrest in Finland.

  • JAMA February 5, 2014

    Figure 3: Effect of Antihypertensive Treatment on Death or Major Disability at 14 Days or Hospital Discharge

    Major disability was defined as a score of 3 to 6 on the modified Rankin Scale (score of 0 indicates no symptoms, score of 5 indicates severe disability, and score of 6 indicates death). Each percentage is based on the number of participants in that subgroup. Data markers indicate point estimates (with the area of the square proportional to the number of events); error bars indicate 95% CIs. Scores on the National Institutes of Health Stroke Scale (NIHSS) range from 0 (normal neurologic status) to 42 (coma with quadriplegia).
  • JAMA February 5, 2014

    Figure 4: Effect of Antihypertensive Treatment on Death or Major Disability at 3 Months

    Major disability was defined as a score of 3 to 6 on the modified Rankin Scale (score of 0 indicates no symptoms, score of 5 indicates severe disability, and score of 6 indicates death). Each percentage is based on the number of participants in that subgroup. Data markers indicate point estimates (with the area of the square proportional to the number of events); error bars indicate 95% CIs. Scores on the National Institutes of Health Stroke Scale (NIHSS) range from 0 (normal neurologic status) to 42 (coma with quadriplegia).
  • JAMA February 5, 2014

    Figure 1: Study Flow

    a Individuals with severe heart failure (New York Heart Association class III and IV), myocardial infarction, unstable angina, atrial fibrillation, aortic dissection, cerebrovascular stenosis, or in a deep coma.b Eligible at screening visit but transferred to another hospital before randomization.
  • JAMA January 1, 2014

    Figure 2: The Proportion of Comatose Patients Achieving Either Death Without Awakening or Awakening as a Function of Days After Cardiac Arrest for Enrolled Patients

    The area between the 2 curves represents the proportion of patients who remain comatose. All patients at time = 0 are comatose and over time either awaken or die without awakening. A, There were 568 patients with ventricular fibrillation (VF) and known event times (284 in intervention group and 284 in control group). For patients with initial rhythm of VF at 7 days, 157 patients died without awakening (28%), 355 had awakened (62%), and 56 were still comatose (10%). At 30 days, 34 more patients died without awakening, 14 more had awakened, and 8 patients remained comatose. B, There were 771 patients without VF but with known event times (395 in the intervention group and 376 in the control group). At 7 days, 566 patients died without awakening (73%), 138 had awakened (18%), and 67 were still comatose (9%). At 30 days, 46 more patients died without awakening, 8 more had awakened, and 13 patients remained comatose.
  • JAMA June 9, 2010

    Figure: Explanation of Additional Symptoms of Intracerebral Hemorrhage

    In the top panel, a small hemorrhage in the right basal ganglia causes left hemiparesis and a clinical presentation indistinguishable from ischemic stroke. As intracerebral bleeding continues (middle panel), expansion of the hemorrhage exerts a mass effect on the brain, increasing intracranial pressure and causing a midline shift. Clinical findings characteristic of hemorrhagic stroke manifest, such as progressive neurological deficits, headache, and vomiting. Eventually, blood may dissect into the ventricles and extend into the subarachnoid space via the median and lateral apertures of the fourth ventricle (bottom panel), leading to neck stiffness. In severe hemorrhagic stroke, intracerebral expansion of the hemorrhage may result in coma from bilateral cerebral dysfunction or uncal herniation.
  • Consciousness, Coma, and Brain Death—2009

    Abstract Full Text
    JAMA. 2009; 301(11):1172-1174. doi: 10.1001/jama.2009.224
  • JAMA December 12, 2007

    Figure 2: Delirium-Free and Coma-Free Days During Study

    Horizontal bars indicate median; error bars indicate the most extreme data point (no more than 1.5 × the interquartile range [IQR]); upper and lower limits of the boxes indicate IQR; upper and lower limits of the notches indicate (1.58 × IQR)/square root of n; side notches allow assessment of significance in difference between the 2 medians. If the notches do not overlap, the 2 groups' medians are significantly different at the α = .05 level. Calculations are based on the formula given in Chambers et al. Delirium-free and coma-free days is a composite score to assess duration of being alive and without delirium or coma over a 12-day evaluation period (1 week beyond the maximum 120-hour study drug protocol).
  • Effect of Sedation With Dexmedetomidine vs Lorazepam on Acute Brain Dysfunction in Mechanically Ventilated Patients: The MENDS Randomized Controlled Trial

    Abstract Full Text
    free access
    JAMA. 2007; 298(22):2644-2653. doi: 10.1001/jama.298.22.2644
  • Is This Patient Dead, Vegetative, or Severely Neurologically Impaired? Assessing Outcome for Comatose Survivors of Cardiac Arrest

    Abstract Full Text
    is expired quiz
    JAMA. 2004; 291(7):870-879. doi: 10.1001/jama.291.7.870
  • JAMA September 10, 2003

    Figure 2: Studies With a Higher Proportion of Patients With Central Nervous System Symptoms (Coma, Seizures, or Stroke)

    These studies had a higher proportion of patients with death or permanent end-stage renal disease (ESRD) at follow-up, explaining 44% of the between-study variability (P = .01). The area of each circle is proportional to the number of patients in each study. Curve is best-fit line from meta-regression. See "Methods" section.
  • JAMA March 7, 2001

    Figure 5: Association Between Adjusted Relative Odds of Death and Trauma Center Volume in Patients Admitted With Multisystem Blunt Trauma

    Relative odds of death compared with the lowest-volume institution are shown for patients (A) without and (B) with coma. These estimates are adjusted for New Injury Severity Score, age, Glasgow Coma Scale score, and presence of shock on admission. Dashed lines represent 95% confidence intervals for estimated odds ratios.
  • Factors Associated With Use of Cardiopulmonary Resuscitation in Seriously Ill Hospitalized Adults

    Abstract Full Text
    free access
    JAMA. 1999; 282(24):2333-2339. doi: 10.1001/jama.282.24.2333
  • JAMA April 4, 2017

    Figure 3: Percentage of Patients With Well-Controlled Sedation and Delirium- and Coma-Free Days During ICU Stay Among the Dexmedetomidine and Control Groups

    To examine the effect of dexmedetomidine on sedation control and the occurrence of delirium and coma, a generalized linear model was used accounting for repeated measurements in the same patient. Well-controlled sedation was defined as a Richmond Agitation-Sedation Scale (RASS) score between −3 and +1 throughout 1 day spent in the intensive care unit (ICU) and was defined as (rate of controlled sedation) = (patient’s number of days with well-controlled sedation)/(total number of patients in the ICU), calculated for each day. Coma was defined as an RASS score between −4 and −5 throughout 1 day in the ICU. Day 1 is defined as the first day of randomization into the trial.
  • JAMA January 17, 2017

    Figure 2: Rural and Urban Mortality Rates for Diabetic Ketoacidosis or Coma (Definite or Probable) and Chronic Kidney Disease Among People With Diabetes by Age at Risk

    The mortality rates by risk in the 4 age groups were standardized for sex, using the total population with diabetes in the China Kadoorie Biobank as the standard. The age at risk was calculated according to baseline age and length of follow-up, with a censoring date of January 1, 2014, or age of death if earlier. The analyses were restricted to those who died between the ages of 35 and 79 years, excluding 0 deaths at ages younger than 35 years and 5 deaths for diabetic ketoacidosis or coma and 8 deaths for chronic kidney disease at ages of 80 years or older. The size of each box is proportional to the number of deaths in each group and the error bars indicate the 95% CI. To avoid overlap of 95% CI lines, the boxes and their 95% CIs for rural and urban areas were moved apart slightly from the actual positions. An individual could contribute person-time to more than 1 age category.
  • Hospital Quality Reporting by US News & World Report: Why, How, and What's Ahead

    Abstract Full Text
    JAMA. 2015; 313(19):1903-1904. doi: 10.1001/jama.2015.4566

    This Viewpoint discusses why US News & World Report reports on hospital quality, how performance is evaluated, and what evolution in data sources and methods may be anticipated.