Ancrod is a protease derived from Malaysian pit viper venom that produces
a rapid decrease in serum fibrinogen levels. In this multicenter trial of
ancrod for the treatment of acute ischemic stroke in a sample of 500 patients
with acute or progressing ischemic neurological deficit, Sherman and colleaguesArticle
found that significantly more patients assigned to receive a 72-hour infusion
of ancrod within 3 hours of symptom onset followed by 1-hour infusions on
days 4 and 5 achieved functional independence (Barthel Index score ≥95)
at 3 months than patients assigned to placebo. Three-month mortality was similar
in the 2 treatment groups, but intracranial hemorrhage was more frequent in
the ancrod group. In an editorial, Mayberg and FurlanArticle place ancrod in the
context of current reperfusion therapies to improve cerebral microcirculation
after acute ischemic stroke.
Some epidemiological studies, including the First National Health and
Nutritional Examination Survey (NHANES I) Follow-up Study (NHEFS), 1971-1987,
based on data from 13.5 years of follow-up of the NHANES I population, have
found an association between increased serum uric acid levels and cardiovascular
mortality, but others have not. In this analysis of NHEFS data with 5 additional
years of follow-up and an increase in the number of deaths from 892 to 1593,
Fang and Alderman report that increased serum uric acid levels at baseline
were independently and significantly associated with risk of cardiovascular
mortality in men and in women and in black and white persons.
Strategies to reduce the likelihood of cesarean delivery and decrease
the risk of peripartum infection may improve women's postpartum health. Using
data from the Washington State Birth Events Record Database, 1987 through
November 1996, Lydon-Rochelle and colleagues found that 3149 (1.2%) of 256,795
primiparous women were rehospitalized within 60 days of childbirth. Rehospitalization
was significantly more likely after cesarean delivery (relative risk, 1.8)
or assisted vaginal delivery (relative risk, 1.3) than after spontaneous vaginal
delivery. In the entire cohort, the most frequent rehospitalization discharge
diagnosis was uterine infection.
Updated recommendations for the use and interpretation of antiretroviral
drug resistance testing in the management of human immunodeficiency virus
(HIV) infection in adults from an international expert panel convened by the
International AIDS Society–USA.Article In an editorial, FlexnerArticle points out
shortcomings of antiretroviral drug resistance testing, including low sensitivity
and specificity, uncertain predictive value and clinical relevance, expense,
and slow turnaround time.
A collection of essays on the state of academic health centers in the
United States: PardesArticle on economic measures needed to support teaching hospitals
and medical schools; Griner and DanoffArticle on allocation of resources for medical
education; BulgerArticle on elements for reenvisioning academic health centers as
therapeutic organizations; Saxton and coauthorsArticle on strategic planning and
organizational initiatives for innovation at one academic health center; and
FeinArticle on actions by the leadership of academic health centers that would promote
fiscal relief. In an editorial, DeAngelisArticle asserts that to resolve problems
affecting academic health centers, physicians must reclaim from business organizations
the ultimate responsibility for patient care, medical education, and research.
"Reluctance to indulge in blatant self-advertisement has not been characteristic
in the world of higher education of late." From "Naming Names."
Medical student education in the ambulatory setting: techniques and
resources for community physicians.
The Amsterdam Declaration to Stop TB addresses an international health
issue of increasing importance—the unimpeded global resurgence of tuberculosis.
Figure shows 20 high-burden TB countries.
Kasiske and coauthors for the American Society of Transplantation argue
for a system that would guarantee payment for immunosuppressive therapy after
organ transplantation to ensure that all recipients are provided with the
means to maintain functioning transplanted organs.
For your patients: Information about organ transplantation.
This Week in JAMA. JAMA. 2000;283(18):2349. doi:10.1001/jama.283.18.2349