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Adherence to evidence-based therapy for ischemic stroke can improve patient outcomes. Wang and colleagues for the GOLDEN BRIDGE–AIS Investigators randomized 4800 patients who were hospitalized in China with acute ischemic stroke and found that hospitals receiving a multifaceted quality improvement intervention had better adherence to clinical performance measures. In an Editorial, Hill and colleagues suggest that sustainable quality improvement must be built into the culture of hospitals, written into job descriptions, and required by employment contracts.
Hand-held communication devices deliver immediate, high-intensity stimulation in the form of social networking, videos, and texting. Ra and colleagues conducted a longitudinal cohort study of 2587 high school students and found a modest association between the frequent use of digital media and symptoms of attention-deficit/hyperactivity disorder. In an Editorial, Radesky suggests that attentional shifts triggered by frequent media notifications may reduce a teen’s ability to stay focused on tasks that require top-down executive control.
In the United States, seriously ill patients may experience burdensome health care transitions during the last days of life. Teno and colleagues conducted a retrospective cohort study of 1 361 870 Medicare beneficiaries and found that as of 2015, the proportions of US patients receiving intensive care, experiencing a health care transition, or being hospitalized at the end of life were stable or declining. In an Editorial, Emanuel discusses how far end-of-life care has come and suggests what progress is still needed.
The Framingham Risk Score and Pooled Cohort Equations are widely used for assessing the risk of cardiovascular disease (CVD). This US Preventive Services Task Force statement concludes that current evidence is insufficient to assess the balance of benefits and harms of adding ankle-brachial index, high-sensitivity C-reactive protein level, or coronary artery calcium score to traditional risk assessment tools for the prevention of CVD events in asymptomatic adults. In an Editorial, Wilkins and Lloyd-Jones suggest that a randomized clinical trial could assess the incremental benefit of the coronary artery calcium score for patients at intermediate risk of CVD.
Editorial, Related Article, and JAMA Patient Page
In a review of 43 studies with 267 244 participants, Lin and colleagues found insufficient adequately powered clinical trials evaluating the incremental benefit of the ankle-brachial index, high-sensitivity C-reactive protein level, or coronary artery calcium score for risk assessment and initiation of therapy to prevent cardiovascular disease.
This JAMA Diagnostic Test Interpretation article by Kim and colleagues presents a 78-year-old man with a carcinoembryonic antigen level obtained 1 year after surgical resection of colorectal cancer. How would you interpret this test result?
Highlights. JAMA. 2018;320(3):215–217. doi:10.1001/jama.2017.12460
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