Control of herpes simplex virus type 2 (HSV-2) infection is of major
public health importance in view of the increasing prevalence of HSV-2 infection
in adults associated with an increase in reported cases of neonatal herpes.
In 2 multicenter trials of a recombinant subunit HSV-2 vaccine in at-risk
HSV-2–seronegative adults, Corey and coworkers found that the rate of
HSV-2 acquisition was significantly lower among vaccine recipients than among
subjects who received placebo during the initial 5 months of follow-up, but
after 1 year of follow-up, rates of HSV acquisition were similar in the 2
groups. In an editorial, Mascola discusses possible explanations for the failure
of this subunit vaccine to protect against acquisition of HSV-2 and implications
for future HSV-2 vaccine research.
See Article and editorial Article
To determine optimal reperfusion therapy after acute myocardial infarction
(AMI) specifically in elderly patients, Berger and colleagues analyzed clinical
outcome data from 20,683 Medicare beneficiaries older than 65 years enrolled
in the Cooperative Cardiovascular Project. Study subjects presented at a hospital
with AMI within 12 hours of symptom onset, had no contraindications to thrombolysis,
and received either primary percutaneous transluminal coronary angioplasty
(PTCA) or thrombolysis therapy within 6 hours of hospital arrival. Primary
PTCA was associated with significantly lower 30-day and 1-year mortality rates
than was thrombolysis. However, in a subgroup analysis of subjects considered
to be ideal for reperfusion therapy, 1-year mortality rates were similar after
primary PTCA or thrombolysis.
Hospitals are required to report actions that limit medical staff privileges
for 31 days or more and all denials of clinical privileges when peer review
actions are involved to the National Practitioner Data Bank (NPDB). In this
retrospective analysis of privileges action reports by 4743 short-term, nonfederal,
general medical/surgical hospitals, Baldwin and colleagues found that the
rate of privileges actions decreased from 2.61 per 100,000 admissions to 2.19
between 1991 and 1995 and the proportion of hospitals reporting 1 or more
privileges actions decreased from 11.6% to 10.0%. In an editorial, Brennan
considers several options for maintaining oversight of health care quality
and asserts that anonymous reporting may be necessary to achieve full reporting.
The pathogenesis of preeclampsia may involve decreased production of
vasodilating eicosanoids early in pregnancy and increased vasoconstricting
effects relative to vasodilating effects before the onset of clinical disease.
Among women enrolled in the control arm of the Calcium for Preeclampsia Prevention
Trial who developed preeclampsia, Mills and colleagues found that levels of
urinary metabolites of the vasodilating eicosanoid prostacyclin (PGI2) were significantly lower throughout pregnancy compared with matched
controls. Overall, levels of urinary metabolites of the vasoconstrictor eicosanoid
thromboxane A2 (TxA2) were not significantly different
between cases and controls and the ratio of TxA2 to PGI2
urinary metabolites was significantly higher throughout pregnancy in women
Mrs K is a 43-year-old woman with metastatic breast cancer who uses
stress reduction techniques to help her cope with having cancer. She practices
qi gong, participates in a cancer support group, and acts as a peer counselor
for others with cancer. Spiegel discusses coping strategies and social support
for individuals with life-threatening illness and the evidence that such strategies
affect clinical outcomes.
"This beautiful little girl, serene and mostly somnolent, pale but princess-like,
lying still in bed, was close to death." From "Can an Amulet Cure Leukemia?"
Advances in the understanding of the paradoxical thrombosis that may
be induced by anticoagulant therapy.
At least half of all "failures" to normalize high blood pressure may
be traced to unrecognized lapses in taking prescribed drugs, says a new study.
Electronic pillboxes that record each time a patient takes a dose may help
unmask the problem.
From the National Vaccine Advisory Committee: An update on progress
in improving childhood immunization coverage since the Childhood Immunization
Initiative of 1991 and recommendations on measures to achieve a sustainable
childhood immunization delivery system.
For your patients: Treatment for heart attack.
This Week in JAMA. JAMA. 1999;282(4):303. doi:10.1001/jama.282.4.303