A 1995-1996 epidemic of acute renal failure among Haitian children was
traced to locally produced acetaminophen syrups tainted with diethylene glycol.
A public health warning and product recall resolved the problem, but only
after 88 children had died. Dr O'Brien and colleaguesArticle conducted both a case-control
study and prospective cohort study to investigate toxic doses of this contaminant
and other risk factors for development of poisoning. Their work underscores
the need for strict quality control by all pharmaceutical makers and for low-cost
methods of adequate safety testing.
See related editorial Article
The US Food and Drug Administration recently approved the first in a
new class of asthma medications, leukotriene inhibitors. In this randomized,
double-blind study, Dr Knorr and colleagues evaluated another such agent,
montelukast, among 6- to 14-year-olds with mild to moderate asthma. After
8 weeks, the predefined primary outcome measure, forced expiratory volume
in 1 second (FEV1), improved significantly in the montelukast group,
as did several secondary outcomes.
Functional status is a powerful predictor of survival in older adults.
However, several burdens of illness indices often used to predict mortality
in populations of hospitalized patients, such as APACHE and the Charlson index,
do not include functional status. Dr Inouye and colleagues add functional
status to these indices to determine how well they predict 90-day and 2-year
mortality in 2 populations of elderly patients.
Medications, potentially life-saving when used against illness, also
can be dangerous and sometimes lethal. In this meta-analysis, Dr Lazarou and
colleaguesArticle determine the proportion of patients hospitalized in the United
States who are affected by serious or fatal drug reactions defined as a noxious,
unintended, or undesired effect of a drug that occurs at therapeutic doses.
Given the severity of invasive group A streptococcal infection, health
professionals often face difficult questions about patient management and
protection of the public. In this consensus statement, a national multidisciplinary
working group critically examines the existing data on the risk of transmission
of invasive group A streptococcal infection to personal contacts of affected
patients. The group also tries to determine whether antimicrobial prophylaxis
should be recommended to reduce that risk for household contacts of patients.
Patients recovering from alcohol abuse or other substance abuse disorders
face daily challenges in remaining substance free. Dr Friedmann and colleagues
emphasize the importance of a supportive relationship between the recovering
patient and the primary care physician. Their report also presents practical
strategies for helping patients decrease susceptibility to relapse, manage
situations at high risk for relapse, and use available self-help and specialty
". . . it also extends a sympathetic and human view of city dwellers
as they negotiate the city's canyons." Paul Cornoyer, The
Plaza After Rain, c1910, American.
The first report from the group Physician Leadership on National Drug
Policy says addiction can be treated as successfully as other chronic diseases
and costs less than incarceration.
"Jinx put on no airs and suffered none either. He clearly was not a
doctor for the faint of heart, delicate of virtue, pompous, pious, or humorless.
. . . He was a blue collar doc, a presence with an attitude." From "Remembering
Spam, bread crumbs, and cookies. Lunch leftovers? No, just some of the
terms used in discussing privacy issues on the Internet. In our guide to interactive
This Week in JAMA. JAMA. 1998;279(15):1145. doi:10.1001/jama.279.15.1145