S Claiborne Johnston

University of Texas at Austin, Austin, Texas, United States

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Publications (305)2484.35 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective. A better understanding of the manuscript peer-review process could improve the likelihood that research of the highest quality is funded and published. To this end, we aimed to assess consistency across reviewers’ recommendations; agreement between reviewers’ recommendations and editors’ final decisions; and reviewer- and editor-level factors influencing editorial decisions in STROKE Journal.Methods. We analyzed all initial original contributions submitted to STROKE from January 2004 through December 2011. All submissions were linked to the final editorial decision (accept vs. reject). We assessed the level of agreement between reviewers (intraclass correlation coefficient). We compared the initial editorial decision (accept, minor revision, major revision and reject) across reviewers’ recommendations. We performed a logistic regression analysis to identify reviewer- and editor-related factors related to acceptance as the final decision.Results. Of 12,902 original submissions to STROKE during the 8-year study period, the level of agreement between reviewers was between fair and moderate (intraclass correlation coefficient 0.55, 95%CI: 0.09-0.75). Likelihood of acceptance was less than 5% if at least one reviewer recommended a rejection. In the multivariable analysis, higher reviewer-assigned priority scores were related to greater odds of acceptance (OR 26.3, 95%CI: 23.2-29.8); while higher numbers of reviewers (OR 0.54 per additional reviewer, 95%CI: 0.50-0.59) and suggestions for reviewers by authors vs. no suggestions (OR 0.83, 95%CI: 0.73-0.94) had lesser odds of acceptance.Interpretation. This analysis of the peer-review process of STROKE identified several factors that might be targeted to improve the consistency and fairness of the overall process. ANN NEUROL 2014. © 2014 American Neurological Association
    Annals of Neurology 07/2014; · 11.19 Impact Factor
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    ABSTRACT: Clinical trials frequently spend considerable effort to collect data on patients who were assessed for eligibility but not enrolled. The Consolidated Standards of Reporting Trials (CONSORT) guidelines' recommended flow diagram for randomized clinical trials reinforces the belief that the collection of screening data is a necessary and worthwhile endeavor. The rationale for collecting screening data includes scientific, trial management, and ethno-socio-cultural reasons.
    Clinical trials (London, England). 06/2014;
  • 06/2014; 45(6):1862-8.
  • Gustavo Saposnik, S Claiborne Johnston
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    ABSTRACT: IMPORTANCE The Stroke Prognostication using Age and the NIH Stroke Scale index, created by combining age in years plus a National Institutes of Health (NIH) Stroke Scale score of 100 or higher (and hereafter referred to as the SPAN-100 index), is a simple risk score for estimating clinical outcomes for patients with acute ischemic stroke (AIS). The association between this index and response to intravenous thrombolysis for AIS has not been properly evaluated. OBJECTIVE To assess the relationship between SPAN-100 index status and outcome following treatment with intravenous thrombolysis for AIS. DESIGN, SETTING, AND PARTICIPANTS Using the Virtual International Stroke Trials Archive (VISTA) database, an international repository of clinical trials data, we assessed the SPAN-100 index among 7093 patients with AIS who participated in 4 clinical trials from 2000 to 2006. The SPAN-100 index is considered positive if the sum of the age and the NIH Stroke Scale (a 15-item neurological examination scale with scores ranging from 0 to 42, with higher scores indicating more severe strokes) score is greater than or equal to 100. Multivariable logistic regression analyses were used to determine the independent association between SPAN-100 index status and 90-day outcomes. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of severe disability or death measured 90 days after stroke, and the secondary outcomes were death alone and a composite of no disability/modest disability. RESULTS Of 7093 patients, 743 (10.5%) were SPAN-100 positive, and 2731 (38.5%) received intravenous thrombolysis. Compared with SPAN-100-negative patients, SPAN-100-positive patients were more likely to experience a catastrophic outcome (adjusted odds ratio [AOR], 9.03 [95% CI, 6.68-12.21]) or death alone (AOR, 5.03 [95% CI, 4.06-6.23]) and less likely to experience a favorable outcome (AOR, 0.08 [95% CI, 0.06-0.13]). However, there was an interaction between SPAN-100 index status and thrombolysis treatment (P < .001) revealing a reduction in the likelihood of severe disability/death with thrombolytic treatment for SPAN-100-positive (AOR, 0.46 [95% CI, 0.29-0.71]) but not SPAN-100-negative patients (AOR, 0.96 [95% CI, 0.85-1.07]). Similar interactions between SPAN-100 index status and thrombolysis treatment were observed for the 2 secondary outcomes. CONCLUSION AND RELEVANCE Compared with the SPAN-100-negative patients with AIS, the SPAN-100-positive patients with AIS seem to have poorer 3-month outcomes but may derive greater benefit when treated with intravenous thrombolysis. The SPAN-100-positive patients are often excluded from AIS clinical trials but should probably not be denied thrombolysis treatment on the basis of such a profile alone.
    JAMA neurology. 05/2014;
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    ABSTRACT: The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.
    Stroke 05/2014; · 6.16 Impact Factor
  • Annals of Neurology 12/2013; 74(6):A5-7. · 11.19 Impact Factor
  • Annals of Neurology 11/2013; 74(5):A7-9. · 11.19 Impact Factor
  • Gustavo Saposnik, S Claiborne Johnston, Bruce Ovbiagele
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    ABSTRACT: The ischemic stroke risk score (iScore) is a validated tool developed to estimate the risk of death and functional outcomes early after an acute ischemic stroke. Our goal was to determine the ability of the iScore to estimate clinical outcomes after intravenous thrombolysis tissue-type plasminogen activator (tPA) in the Virtual International Stroke Trials Archive (VISTA). We applied the iScore (www.sorcan.ca/iscore) to patients with an acute ischemic stroke within the VISTA collaboration to examine the effect of tPA. We explored the association between the iScore (<200 and ≥200) and the primary outcome of favorable outcome at 3 months defined as a modified Rankin scale score of 0 to 2. Secondary outcomes included death at 3 months, catastrophic outcomes (modified Rankin scale, 4-6), and Barthel index >90 at 3 months. Among 7140 patients with an acute ischemic stroke, 2732 (38.5%) received tPA and 711 (10%) had an iScore ≥200. Overall, tPA treatment was associated with a significant improvement in the primary outcome among patients with an iScore <200 (38.9% non-tPA versus 47.5% tPA; P<0.001) but was not associated with a favorable outcome among patients with an iScore ≥200 (5.5% non-tPA versus 7.6% tPA; P=0.45). In the multivariable analysis after adjusting for age, baseline National Institutes of Health Stroke Scale, and onset-to-treatment time, there was a significant interaction between tPA administration and iScore; tPA administration was associated with 47% higher odds of a favorable outcome at 3 months among patients with an iScore <200 (odds ratio, 1.47; 95% confidence interval, 1.30-1.67), whereas the association between tPA and favorable outcome among those with an iScore ≥200 remained nonsignificant (odds ratio, 0.80; 95% confidence interval, 0.45-1.42). A similar pattern of benefit with tPA among patients with an iScore <200, but not ≥200, was observed for secondary outcomes including death. The iScore is a useful and validated tool that helps clinicians estimate stroke outcomes. In stroke patients participating in VISTA, an iScore <200 was associated with better outcomes at 3 months after tPA.
    Stroke 10/2013; · 6.16 Impact Factor
  • Stephen L Hauser, S Andrew Josephson, S Claiborne Johnston
    Annals of Neurology 10/2013; 74(4):A5-A25. · 11.19 Impact Factor
  • S Andrew Josephson, S Claiborne Johnston, Stephen L Hauser
    Annals of Neurology 09/2013; 74(3):A7-A8. · 11.19 Impact Factor
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    ABSTRACT: Risk factors for delirium are well-described, yet there is no widely used tool to predict the development of delirium upon admission in hospitalized medical patients. To develop and validate a tool to predict the likelihood of developing delirium during hospitalization. Prospective cohort study with derivation (May 2010-November 2010) and validation (October 2011-March 2012) cohorts. Two academic medical centers and 1 Veterans Affairs medical center. Consecutive medical inpatients (209 in the derivation and 165 in the validation cohort) over age 50 years without delirium at the time of admission. Delirium assessed daily for up to 6 days using the Confusion Assessment Method. The AWOL prediction rule was derived by assigning 1 point to each of 4 items assessed upon enrollment that were independently associated with the development of delirium (Age ≥ 80 years, failure to spell "World" backward, disOrientation to place, and higher nurse-rated iLlness severity). Higher scores were associated with higher rates of delirium in the derivation and validation cohorts (P for trend < 0.001 and 0.025, respectively). Rates of delirium according to score in the combined population were: 0(1/50, 2%), 1(5/141, 4%), 2(15/107, 14%), 3(10/50, 20%), and 4(7/11, 64%) (P for trend < 0.001). Area under the receiver operating characteristic curve for the derivation and validation cohorts was 0.81 (0.73-0.90) and 0.69 (0.54-0.83) respectively. The AWOL prediction rule characterizes medical patients' risk for delirium at the time of hospital admission and could be used for clinical stratification and in trials of delirium prevention. Journal of Hospital Medicine 2013. © 2013 Society of Hospital Medicine.
    Journal of Hospital Medicine 08/2013; · 1.40 Impact Factor
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    ABSTRACT: We measured contracts final negotiation (FN) and full execution (FE) times using shared definitions in a prospective observational study of management of contracts for clinical trials at 29 CTSA institutions. Median FN and FE times were reached in 39 and 91 days, respectively; mean times for FN and FE were 55 and 103 days, respectively. Individual site medians ranged from 3 to 116 days for FN and 34 to 197 days for FE. The use of master agreements (MAs) and previously negotiated terms (PNTs) was associated with significant reduction of FN times by a mean of 33 days (p < 0) and 22 days (p < 0.001), respectively. PNTs, but not MAs, were associated with significantly reduced FE time (22 days, p < 0.007). Gap analysis revealed a gap of 22 days between contracts negotiation and Institutional Review Board (IRB) review and intervals of 33 days (contracts) and 48 days (IRB review) during which the process steps were being conducted alone, suggesting a potential benefit with parallel processing. These baseline data support a plan to investigate root causes of prolonged study start-up time by examining causes of variation and outliers.
    Clinical and Translational Science 08/2013; 6(4):279-85. · 2.33 Impact Factor
  • Stroke 08/2013; · 6.16 Impact Factor
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    ABSTRACT: Ischemic stroke and other vascular outcomes occur in 10-20% of patients in the three-months following a transient ischemic attack or minor ischemic stroke, and many are disabling. The highest risk period for these outcomes is the early hours and days immediately following the ischemic event. Aspirin is the most common antithrombotic treatment used for these patients. The aim of POINT is to determine whether clopidogrel plus aspirin taken <12 h after transient ischemic attack or minor ischemic stroke symptom onset is more effective in preventing major ischemic vascular events at 90 days in the high-risk, and acceptably safe, compared with aspirin alone. POINT is a prospective, randomized, double-blind, multicenter trial in patients with transient ischemic attack or minor ischemic stroke. Subjects are randomized to clopidogrel (600 mg loading dose followed by 75 mg/day) or matching placebo, and all will receive open-label aspirin 50-325 mg/day, with a dose of 162 mg daily for five-days followed by 81 mg daily strongly recommended. The primary efficacy outcome is the composite of new ischemic vascular events - ischemic stroke, myocardial infarction, or ischemic vascular death - by 90 days. The primary safety outcome is major hemorrhage, which includes symptomatic intracranial hemorrhage. Aspirin is the most common antithrombotic given to patients with a stroke or transient ischemic attack, as it reduces the risk of subsequent stroke. This trial expects to determine whether more aggressive antithrombotic therapy with clopidogrel plus aspirin, initiated acutely, is more effective than aspirin alone.
    International Journal of Stroke 08/2013; 8(6):479-83. · 2.75 Impact Factor
  • Stephen L Hauser, S Claiborne Johnston
    Annals of neurology. 08/2013; 74(2):A5-6.
  • Stephen L Hauser, S Claiborne Johnston
    Annals of Neurology 07/2013; 74(1):A5-6. · 11.19 Impact Factor
  • S Claiborne Johnston, Stephen L Hauser
    Annals of Neurology 06/2013; 73(6):A5-6. · 11.19 Impact Factor
  • S Andrew Josephson, S Claiborne Johnston, Stephen L Hauser
    Annals of Neurology 05/2013; 73(5):A5-6. · 11.19 Impact Factor
  • Stephen L Hauser, S Claiborne Johnston
    Annals of Neurology 04/2013; 73(4):A5-A6. · 11.19 Impact Factor

Publication Stats

9k Citations
2,484.35 Total Impact Points

Top Journals


  • 2014
    • University of Texas at Austin
      Austin, Texas, United States
    • St. Michael's Hospital
      Toronto, Ontario, Canada
  • 2012–2013
    • Weill Cornell Medical College
      • Department of Neurology and Neuroscience
      New York City, NY, United States
    • University of Toronto
      • • Division of Neurology
      • • Department of Medicine
      Toronto, Ontario, Canada
    • Kaiser Permanente
      Oakland, California, United States
  • 2003–2013
    • CSU Mentor
      • Department of Neurology
      Long Beach, California, United States
  • 1998–2013
    • University of California, San Francisco
      • Department of Neurology
      San Francisco, CA, United States
  • 2006–2012
    • University of California, Los Angeles
      • • Department of Neurology
      • • Center for Neurobiology of Stress
      Los Angeles, CA, United States
    • University of Oxford
      • Nuffield Department of Clinical Neurosciences
      Oxford, ENG, United Kingdom
    • Cleveland Clinic
      Cleveland, Ohio, United States
  • 2011
    • Cornell University
      • Department of Neurology and Neuroscience
      Ithaca, NY, United States
  • 2010–2011
    • Royal Perth Hospital
      Perth City, Western Australia, Australia
    • Children's Hospital Oakland Research Institute
      Oakland, California, United States
    • Capital Medical University
      Peping, Beijing, China
  • 2009
    • University of Minnesota Twin Cities
      • Department of Neurology
      Minneapolis, MN, United States
  • 2008
    • McMaster University
      Hamilton, Ontario, Canada
    • Team Coordinating Agency
      Haverhill, Massachusetts, United States
    • Université de Montréal
      • Department of Radiology, Radiation Oncology and Nuclear Medicine
      Montréal, Quebec, Canada
    • Johns Hopkins University
      • Department of Neurology
      Baltimore, MD, United States
  • 2005–2006
    • Harbor-UCLA Medical Center
      Torrance, California, United States