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This Week in JAMA
May 21, 2008

This Week in JAMA

JAMA. 2008;299(19):2241. doi:10.1001/jama.299.19.2241

To help meet the demand for blood components, some states allow blood donation by 16- and 17-year-olds. However, some data suggest that complications of donation are highest among young donors. Eder and colleagues analyzed data from 9 American Red Cross blood services regions to evaluate adverse reactions to whole blood donation among 16- and 17-year-olds vs older donors. The authors report an overall complication rate of 3.8%. Complications were recorded after 10.7% of donations by 16- and 17-year-olds, 8.3% by 18- and 19- year-olds, and 2.8% by donors 20 years and older. Young age was the strongest correlate of major complications, and 16- and 17-year olds were significantly more likely than older donors to experience syncopal-type complications.

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Levels of oxidized low-density lipoprotein (LDL)—a minor fraction of circulating LDL—are elevated in persons with metabolic syndrome, but the relationship of oxidized LDL to incident metabolic syndrome is not clear. Holvoet and colleagues examined this question in an analysis of data from a longitudinal study of cardiovascular risk development in young adults. The authors found that higher concentration of oxidized LDL was associated with an increased incidence of metabolic syndrome, as well as the individual risk factors of abdominal obesity, hyperglycemia, and hypertriglyceridemia.

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In a multicenter study, Ferrer and colleagues Article assessed processes of care for patients with severe sepsis and tested the hypothesis that greater adherence to international guidelines for sepsis care would be associated with reductions in hospital mortality. The authors measured adherence to the guidelines before and after an educational program that focused on early recognition and treatment of sepsis. The authors report improved guideline adherence and lower hospital mortality rates following the educational intervention. In an editorial, Kahn and Bates Article discuss the study findings and implications for population-level quality improvement initiatives.

Cell-free hemoglobin-based blood substitutes (HBBSs)—infusible, oxygen-carrying liquids with a long shelf life and no need for refrigeration or cross-matching—could be lifesaving for patients with hemorrhagic shock who are treated in remote settings. However, some clinical trials of HBBSs have raised questions about their safety and efficacy. In a review of the literature, US Food and Drug Administration advisory committee meeting materials, and company press releases to assess the safety of HBBSs, Natanson and colleagues Article identified 16 randomized clinical trials involving 5 different HBBSs. In a meta-analysis of the data, the authors found that compared with controls, patients who received HBBSs had significantly increased risks of death and myocardial infarction (MI). In an editorial, Fergusson and McIntyre Article discuss the responsibilities of investigators, sponsors, regulatory agencies, and research ethics boards in the planning, review, and conduct of future trials of blood substitutes.

“Can we decipher how the telling of a story contributes in a meaningful way to the making of a physician?” From “Brew.”

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Studies and adverse event reports suggest that botulinum toxin may migrate from the site of the injection and have unanticipated adverse effects beyond the injection site.

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Preemption of tort claims against device manufacturers

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Tracing human biological collections

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Road map to transform health care

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Join Wendie Berg, MD, PhD, June 18 from 2 to 3 PM eastern time to discuss screening women at high risk of breast cancer with mammography plus ultrasound vs mammography alone. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

How would you manage a 40-year-old woman with type 2 diabetes, chronic hypertension, and a history of gastric bypass surgery who is planning to conceive? Go to www.jama.com to read the case and submit your response. Your response may be selected for online publication. Submission deadline is May 28.

For your patients: Information about blood donation.

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