National network television news coverage of contraception - a content analysis.

Objective: The objective was to describe and analyze national network television news framing of contraception, recognizing that onscreen news can influence the public's knowledge and beliefs.

Study Design: We used the Vanderbilt Television News Archives and LexisNexis Database to obtain video and print transcripts of all relevant national network television news segments covering contraception from January 2010 to June 2014. We conducted a content analysis of 116 TV news segments covering contraception during the rollout of the Affordable Care Act.

Care Received by Elderly US Stroke Survivors May Be Underestimated.

Background And Purpose: Previous studies exploring stroke-related caregiving focused solely on informal caregiving and a relatively limited set of activities. We sought to determine whether, and at what cost, stroke survivors receive more care than matched controls using an expanded definition of caregiving and inclusion of paid caregivers.

Methods: Data were drawn from the National Health and Aging Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries.

Three simple rules to ensure reasonably credible subgroup analyses.

The limitations of subgroup analyses are well established—false positives due to multiple comparisons, false negatives due to inadequate power, and limited ability to inform individual treatment decisions because patients have multiple characteristics that vary simultaneously. In this article, we apply Bayes’s rule to determine the probability that a positive subgroup analysis is a true positive. From this framework, we derive simple rules to determine when subgroup analyses can be performed as hypothesis testing analyses and thus inform when subgroup analyses should influence how we practice medicine.

Traumatic brain injury in later life increases risk for Parkinson disease.

Objective: Traumatic brain injury (TBI) is thought to be a risk factor for Parkinson disease (PD), but results are conflicting. Many studies do not account for confounding or reverse causation. We sought to address these concerns by quantifying risk of PD after TBI compared to non-TBI trauma (NTT; defined as fractures).

National trends in stroke after acute myocardial infarction among Medicare patients in the United States: 1999 to 2010.

Background: Stroke is a common and important adverse event after acute myocardial infarction (AMI) in the elderly. It is unclear whether the risk of stroke after AMI has changed with improvements in treatments and outcomes for AMI in the last decade.

Methods: To assess trends in risk of stroke after AMI, we used a national sample of Medicare data to identify Fee-for-Service patients (n = 2,305,441) aged ≥65 years who were discharged alive after hospitalization for AMI from 1999 to 2010.

Use of a heart team in decision-making for patients with complex coronary disease at hospitals in Michigan prior to guideline endorsement.

Background: Revascularization decisions can profoundly impact patient survival, quality of life, and procedural risk. Although use of Heart Teams to make revascularization decisions is growing, data on their implementation in the real-world are limited. Our objective was to assess the prevalence of Heart Teams and their association with collaboration in routine practice.

Dementia risk after traumatic brain injury vs nonbrain trauma: the role of age and severity.

Importance: Epidemiologic evidence regarding the importance of traumatic brain injury (TBI) as a risk factor for dementia is conflicting. Few previous studies have used patients with non-TBI trauma (NTT) as controls to investigate the influence of age and TBI severity.

Objective: To quantify the risk of dementia among adults with recent TBI compared with adults with NTT.

Fertility-preserving management of a uterine arteriovenous malformation: a case report of uterine artery embolization (UAE) followed by laparoscopic resection.

Herein is presented a fertility-preserving approach in the management of a uterine arteriovenous malformation (AVM) resistant to endovascular management. The patient had a documented AVM and underwent 2 uterine artery embolization procedures, with subsequent recurrence of symptoms. Doppler ultrasound demonstrated recanalization of the AVM.

Quality of life assessment for acute heart failure patients from emergency department presentation through 30 days after discharge: A pilot study with the Kansas City Cardiomyopathy Questionnaire.

Background: There are no well validated patient-reported disease status instruments for acute heart failure(HF). We assessed the feasibility of using the Kansas City Cardiomyopathy Questionnaire (KCCQ)during acute heart failure hospitalization, and the association of acute changes with 30-day readmission.Methods and Results: A convenience sample of acute HF patients were administered the KCCQ on presentation,discharge, and 30 days after discharge.

Hospital variation in thrombolysis times among patients with acute ischemic stroke: the contributions of door-to-imaging time and imaging-to-needle time.

Importance: Given the limited time window available for treatment with tissue plasminogen activator (tPA) in patients with acute ischemic stroke, guidelines recommend door-to-imaging time (DIT) within 25 minutes of hospital arrival and door-to-needle (DTN) time within 60 minutes for patients with acute ischemic stroke. Despite improvements in DITs, DTN times for tPA treatment in patients with acute ischemic stroke remain suboptimal.

Objectives: To examine the contributions of DIT and imaging-to-needle (ITN) time to delays in timely delivery of tPA to patients with acute ischemic stroke and to assess between-hospital variation in DTN times.

Influence of hospital-level practices on readmission after ischemic stroke.

Objective: To inform stroke quality improvement initiatives by determining the relationship between hospital-level stroke practices and readmission after accounting for patient-level factors.

Methods: Retrospective cohort study of adult patients hospitalized for ischemic stroke (principal ICD-9-CM codes 433.x1, 434.

Consumer Demand for Online Dizziness Information: If You Build it, They may Come.

Objective: Dizziness is a common reason patients present to doctors, but effective diagnostic tests and treatments for dizziness are underused. The internet is a way to disseminate medical information and is emerging as an intervention platform. The objective of this study was to describe internet searches for dizziness terms to assess the possible consumer demand for internet-based dizziness diagnostic and treatment tools.

A systematic review and critical appraisal of quality measures for the emergency care of acute ischemic stroke.

Acute stroke is an important focus of quality improvement efforts. There are many organizations involved in quality measurement for acute stroke, and a complex landscape of quality measures exists. Our objective is to describe and evaluate existing US quality measures for the emergency care of acute ischemic stroke patients in the emergency department (ED) setting.

Public interest in medical research participation: differences by volunteer status and study type.

Purpose: We assessed national levels of public interest in medical research participation (MRP) and factors associated with interest as a healthy volunteer; as a diagnosed volunteer; and in seven study types.

Method: Cross-sectional, Web-based survey of the US population in June 2012. Descriptive statistics estimated interest in MRP and multivariable logistic regression determined associations between respondent-level predictors and interest in MRP.

Quality of life assessment for acute heart failure patients from emergency department presentation through 30 days after discharge: a pilot study with the Kansas City Cardiomyopathy Questionnaire.

Background: There are no well validated patient-reported disease status instruments for acute heart failure (HF). We assessed the feasibility of using the Kansas City Cardiomyopathy Questionnaire (KCCQ) during acute heart failure hospitalization, and the association of acute changes with 30-day readmission.

Methods And Results: A convenience sample of acute HF patients were administered the KCCQ on presentation, discharge, and 30 days after discharge.

Understanding stroke survivorship: expanding the concept of poststroke disability.

Background And Purpose: Limitations in essential daily activities are common among older adults after stroke, but little is known about restrictions in their ability to participate in valued social activities. We sought to broaden our understanding of disability after stroke by characterizing poststroke participation restrictions and investigating the extent to which they are accounted for by differences in physical and cognitive capacity, aphasia/dysarthria, depressive, and anxiety symptoms.

Methods: Data from the 2011 National Health and Aging Trends Study (NHATS) were used to identify 892 self-reported stroke survivors aged≥65 years.

Persistent ischemic stroke disparities despite declining incidence in Mexican Americans.

Objective: To determine trends in ischemic stroke incidence among Mexican Americans and non-Hispanic whites.

Methods: We performed population-based stroke surveillance from January 1, 2000 to December 31, 2010 in Corpus Christi, Texas. Ischemic stroke patients 45 years and older were ascertained from potential sources, and charts were abstracted.

Traumatic brain injury may be an independent risk factor for stroke.

Objective: To explore whether traumatic brain injury (TBI) may be a risk factor for subsequent ischemic stroke.

Methods: Patients with any emergency department visit or hospitalization for TBI (exposed group) or non-TBI trauma (control) based on statewide emergency department and inpatient databases in California from 2005 to 2009 were included in a retrospective cohort. TBI was defined using the Centers for Disease Control definition.

Choosing Wisely: highest-cost tests in outpatient neurology.

Identifying the tests/procedures ordered by neurologists that contribute most to health care expenditures is a critical step in the process of creating the neurology top 5 list for the Choosing Wisely initiative. Using data from the 2007-2010 National Ambulatory Care Medical Survey, we found that $13.3 billion (95% confidence interval = $10.

Comparison of clinical interpretation with visual assessment and quantitative coronary angiography in patients undergoing percutaneous coronary intervention in contemporary practice: the Assessing Angiography (A2) project.

Background: Studies conducted decades ago described substantial disagreement and errors in physicians' angiographic interpretation of coronary stenosis severity. Despite the potential implications of such findings, no large-scale efforts to measure or improve clinical interpretation were subsequently undertaken.

Methods And Results: We compared clinical interpretation of stenosis severity in coronary lesions with an independent assessment using quantitative coronary angiography (QCA) in 175 randomly selected patients undergoing elective percutaneous coronary intervention at 7 US hospitals in 2011.

The impact of MRI on stroke management and outcomes: a systematic review.

Rationale, Aims And Objectives: Magnetic resonance imaging (MRI) is widely used in stroke evaluation and is superior to computed tomography for the detection of acute ischaemia. We sought to evaluate the evidence that conventional MRI influences doctor management or patient outcomes in routine care.

Methods: We systematically searched PubMED, EMBASE and proceedings of the International Stroke Conference.