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This Week in JAMA
December 10, 2008

This Week in JAMA

JAMA. 2008;300(22):2579. doi:10.1001/jama.2008.806

Deaths from unintentional prescription drug overdose have increased recently. To evaluate the characteristics of individuals dying of unintentional pharmaceutical overdose, the role of drug abuse, and the drugs involved, Hall and colleagues Article analyzed population-based data from West Virginia, where substantial increases in unintentional drug overdose mortality have been documented. The authors found that a majority of overdose deaths in West Virginia in 2006 involved men aged 18 to 54 years and were associated with nonmedical use and diversion of pharmaceuticals, particularly opioid analgesics. In an editorial, McLellan and Turner Article discuss opioid prescribing practices and the prevention of opioid addiction and prescription diversion.

Dexamethasone is widely used to prevent postoperative nausea and vomiting in pediatric tonsillectomy, although questions remain regarding the dose response and adverse event profile. In a randomized placebo-controlled trial involving 215 children undergoing elective tonsillectomy, Czarnetzki and colleagues found that dexamethasone administered after induction of anesthesia was associated with a dose-dependent decreased risk of postoperative nausea and vomiting but an increased risk of postoperative bleeding.

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Developing effective treatment for obesity is a public health priority. In a randomized, 16-week trial that involved 57 overweight and obese adults, Volpp and colleagues assessed the effect of financial incentives for meeting weight loss goals on overall weight loss. The study incentives were either dollar-for-dollar investments matched to a participant's daily contribution (which was lost if they failed to achieve weight goals) or eligibility for a daily lottery prize. The authors found that compared with usual care, which included monthly weigh-ins, the addition of either economic incentive was associated with significantly greater weight loss during the 16-week intervention. However, this weight loss was not sustained beyond the intervention period.

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A 34-year-old woman with sickle cell disease and a history of relatively severe hemolysis, chronic leg ulcers, and mild pulmonary hypertension presented with signs of an ischemic stroke, and magnetic resonance imaging revealed evidence of old cerebral infarcts. Kato and Gladwin review the pathophysiology of sickle cell vasculopathy—a subphenotype of sickle cell disease that includes these clinical features—and summarize preliminary data from clinical trials of small-molecule therapeutic strategies directed at the abnormal vascular biology.

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Many treatments are promoted for pressure ulcers, but their relative efficacy is unclear. In a systematic review of 103 randomized clinical trials of treatments for pressure ulcers, Reddy and colleagues found little evidence that one specialized support surface or wound-care product is superior to another and little evidence that routine nutritional supplementation or adjunctive therapies offer more benefit than standard care.

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“Before I got sick I thought people could choose how to confront serious illness. One could either wallow in self-pity or buck up and move that rubber tree plant.” From “Legacy: A Conversation.”

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Scientists are seeking a better understanding of factors that give rise to Alzheimer disease and are investigating how to detect the disorder in its earliest stages.

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Acceptance of quality assurance: the French experience

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Socioeconomic status and coronary heart disease risk prediction

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Personal genome testing: raiding the medical commons

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Join Brett D. Thombs, PhD, and Roy Ziegelstein, MD, December 17 from 2 to 3 PM eastern time to discuss depression screening for patients with cardiovascular disease. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 41-year-old woman with recurrent uterine fibroids? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is December 31.

For your patients: Information about sickle cell vasculopathy.

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