Diagnostic utility of brain MRI in spontaneous intracerebral hemorrhage: A retrospective cohort study and meta-analysis.

INTRODUCTION: The diagnostic yield of brain Magnetic Resonance Imaging (MRI) in spontaneous intracerebral hemorrhage (ICH) is unclear. We performed both an independent single-center retrospective cohort study and a meta-analysis to assess the detection rate of secondary lesions on MRI in patients with spontaneous ICH. PATIENTS AND METHODS: In the retrospective cohort study, we examined 856 consecutive patients with spontaneous ICH. Brain MRI scans on admission and follow-up were assessed for secondary lesions. We also examined clinical and CT radiographic variables associated with secondary lesions in univariable analysis. In the meta-analysis we searched PubMed and EMBASE for articles investigating the secondary lesion detection rate on brain MRI in spontaneous ICH. RESULTS: Of the 856 patients with ICH, 481 (56%) had at least one brain BRI performed [70 ± 14 years, 270 (56% male)]. 462 (54%) had an admission MRI and 138 (16%) had both admission and follow-up MRIs. The detection rate of secondary lesions on admission MRIs was 24/462 (5.2%). 4/127 (3.1%) patients with a negative admission MRI had a lesion identified on follow-up MRI. No clinical or radiographic variables were associated with a secondary lesion on MRI using univariable analysis. The meta-analysis included five studies total (four identified in the PubMed and EMBASE searches and our cohort study) comprising 1147 patients with spontaneous ICH who underwent brain MRI. The pooled detection rate of secondary lesions was 11% (95% CI: 7-16). DISCUSSION AND CONCLUSION: No predictors of secondary lesion detection were identified in our cohort study. Prospective studies are required to better understand the diagnostic utility of MRI in spontaneous ICH.

Diagnostic Utility of Brain MRI in Spontaneous Intracerebral Hemorrhage: A Retrospective Cohort Study and Meta-Analysis.

Background: The diagnostic yield of brain Magnetic Resonance Imaging (MRI) in spontaneous intracerebral hemorrhage (ICH) is unclear. We performed both an independent single-center retrospective cohort study and a meta-analysis to assess the detection rate of secondary lesions on MRI in patients with spontaneous ICH. Methods: In the retrospective cohort study, we examined 856 consecutive patients with spontaneous ICH. Brain MRI scans on admission and follow-up were assessed for secondary lesions. We also examined clinical and CT radiographic variables associated with secondary lesions in univariable analysis. In the meta-analysis we searched PubMed and EMBASE for articles investigating the secondary lesion detection rate on brain MRI in spontaneous ICH. Random-effects models were used to calculate the pooled estimate of secondary lesion detection rate. The meta-analysis used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Of the 856 patients with ICH, 481 (56%) had at least one brain BRI performed [70±14 years, 270(56% male)]. 462(54%) had an admission MRI and 138(16%) had both admission and follow-up MRIs. The detection rate of secondary lesions on admission MRIs was 24/462(5.2%). 4/127(3.1%) patients with a negative admission MRI had a lesion identified on follow-up MRI. No clinical or radiographic variables were associated with a secondary lesion on MRI using univariable analysis. The meta-analysis included 5 studies total (4 identified in the PubMed and EMBASE searches as well as our own cohort study) comprising 1147 patients with spontaneous ICH who underwent brain MRI. The pooled detection rate of secondary lesions was 11% (95%CI: 7-16%). Conclusions: No predictors of secondary lesion detection were identified in our cohort study. Prospective studies are required to better understand the diagnostic utility of MRI in spontaneous ICH.

A Bibliometric Analysis of Publication Patterns in Pediatric Neurology.

Purpose: To examine the publication patterns of pediatric neurology articles in general pediatric, general neurology, and neurology subspecialty journals using a bibliometric approach. Methods: The top 5 journals in general pediatrics, general neurology and neurology subspecialties were identified using the 2017 Journal Citations Report (JCR). For general pediatric journals, we selected 4 pediatric subspecialties for comparison of publication patterns with neurology: immunology, endocrinology, gastroenterology, and respirology. For general neurology and neurology subspecialty journals, we searched both the top 5 neurology and neurology subspecialty journals for pediatric articles. Using Ovid Medline, we identified articles published between 2009-2017. Results: With regards to child neurology-based articles, 1501 were published in general pediatrics journals, 643 in general neurology journals and 685 in neurology subspecialty journals. Examination of the top pediatric journals revealed that Pediatrics published the most neurology-based articles. Neurology-based studies were published more frequently than other pediatric subspecialty studies. Of the top general neurology Neurology published the most child neurology-based articles, while Epilepsia published the most child neurology-based articles out of neurology subspecialty journals. Cohort studies were the most frequent study type across all journals. Conclusion: Our study revealed that child neurology articles are published more often in pediatric journals as opposed to general neurology and neurology subspecialty journals. We also found that in general pediatric journals, neurology-based articles are published more frequently compared to other specialties. Our results provide guidance to authors when considering submission of their pediatric neurology research.

Stages and Processes of Change for Weight Loss in Acute Stroke or TIA Patients Living with Obesity.

BACKGROUND: Obesity is associated with an increased prevalence of vascular risk factors and incidence of stroke. As such weight loss is recommended for patients living with obesity in the secondary prevention of stroke. Few studies, however, have examined the stages and processes of change for weight loss in stroke patients living with obesity. OBJECTIVE: The aim of the study was to evaluate the stages and processes of change for weight loss in patients living with obesity who have had a recent stroke or TIA. METHODS: Using a validated questionnaire, we assessed each patient's stage of behavioral change according to the transtheoretical model (precontemplation, contemplation, preparation, action, and maintenance). We also examined 4 processes of behavioral change, which quantify activities and experiences that patients undergo on the way to behavioral change: emotional reevaluation (EMR), weight management action (WMA), weight consequence evaluation, and supporting relationships. Processes scores were compared between patients in the action and maintenance stages and those in the precontemplation, contemplation, and preparation stages. RESULTS: Out of 49 patients who provided informed consent, 44 met the inclusion/exclusion criteria. Of these 44 patients, 6 (14%) were in the precontemplation stage of change, 7 (16%) were in contemplation, 2 (5%) were in preparation, 13 (30%) were in action, and 16 (36%) were in maintenance. Those in the action and maintenance stages accounted for the majority of participants (n = 29, 66%). Patients in the action and maintenance stages (N = 29) had higher EMR scores (mean 79, SD 13 vs. mean 68, SD 19, t = 2.0, p = 0.03) and WMA scores (mean 69, SD 13 vs. mean 59, SD 19, t = 2.0, p = 0.03) as compared to those in the precontemplation, contemplation, and preparation stages (N = 15). CONCLUSIONS: Our results suggest that without counseling or specific intervention, approximately two-thirds of stroke/TIA patients living with obesity are in the action or maintenance stage of behavior change with respect to weight loss and therefore more likely to succeed in intensive lifestyle-based interventions targeted towards weight loss. Patients who score higher in EMR and WMA are more likely to be in the action or maintenance stage of change.

Bibliometric Analysis of Neurology Articles Published in General Medicine Journals.

Importance: A significant portion of neurology literature is published in general medicine journals. Despite this, a detailed examination of publication patterns of neurology articles in these journals has not yet been carried out. Objective: To examine the publication patterns of neurology articles in general medicine journals during a 10-year period using a bibliometric approach. Design, Setting, and Participants: This cross-sectional bibliometric analysis identified the top 5 general medicine journals using the 2017 Journal Citations Report. Four other medical subspecialties (ie, immunology, endocrinology, gastroenterology, and pulmonology) were selected for comparison of publication patterns with neurology. Using MEDLINE, the 5 journals were searched for articles published between 2009 and 2018 that were indexed with the following MeSH terms: nervous system diseases, immune system diseases, endocrine system diseases, gastrointestinal diseases, and respiratory tract diseases. Data analysis was conducted from February 2019 to December 2020. Main Outcomes and Measures: Publications were characterized by journal, specialty, and study design. These variables were used for comparison of publication numbers. Results: The general medicine journals with the 5 highest journal impact factors (JIF) were New England Journal of Medicine (NEJM; JIF 79.3), Lancet (JIF 53.3), JAMA (JIF 47.7), BMJ (JIF 23.6), and PLOS Medicine (JIF 11.7). Our bibliometric search yielded 3719 publications, of which 1098 (29.5%) were in neurology. Of these 1098 neurology publications, 317 (28.9%) were published in NEJM, 205 (18.7%) in Lancet, 284 (25.9%) in JAMA, 214 (19.5%) in BMJ, and 78 (7.1%) in PLOS Medicine. Randomized clinical trials were the most frequent neurology study type in general medicine journals (519 [47.3%]). The number of publications in each of the other specialties were as follows: immunology, 817; endocrinology, 633; gastroenterology, 353; and pulmonology, 818. Conclusions and Relevance: The results of this study provide some guidance to authors regarding where they may wish to consider submitting their neurology research. Compared with other specialties, neurology-based articles are published more frequently in general medicine journals.

The Changing Landscape of Journalology in Medicine.

In the early 1970s, when Seminars in Nuclear Medicine started publication, little was known about the quality of reporting in biomedical journals. Senior scholars were invited to become scientific editors of journals based on their research credibility and stature. Their knowledge of journalology (publication science) was not assessed. Similarly, while the use of peer review was gaining momentum, there was limited guidance on the tasks and expectations of peer reviewing. Almost 50 years later, the evidence base regarding the quality of reporting is vast. This paper highlights some of this evidence including that relevant to imaging and nuclear medicine research. In biomedical publications, there is a crisis in reproducibility; high prevalence rates of reporting biases, such as selective outcome reporting; spin; low registration rates of research protocols; and endemic poor reporting of research across biomedicine. These issues and some more immediate solutions are also discussed in the paper. The use of reporting guidelines has been shown to be associated with better reporting of clinical trials and other research articles. The use of audit and feedback tools is likely to provide an important gauge about the functions of biomedical journals. Finally, the push to better equip scientific editors and peer reviewers is taking a more concerted effort.