Aptiganel hydrochloride, a selective ligand for the ion-channel site
of the N-methyl-D-aspartate subtype of glutamate
receptor, has been shown to improve neurological outcomes in animal models
of focal brain ischemia. Albers and colleaguesArticle report, however, that aptiganel
administered within 6 hours of onset of symptoms of acute ischemic stroke
did not improve patient outcomes compared with placebo and may be harmful.
In an editorial, Becker and TirschwellArticle discuss the complexities of conducting
and monitoring large clinical trials and question how well some acute stroke
trials protect the safety of study participants.
Selection of patients with cystic fibrosis (CF) for lung transplantation
is often based on a survival model that uses FEV1 as a predictive
marker, but evidence suggests that the FEV1 criterion fails to
identify patients with high mortality risk. In this retrospective analysis,
Liou and colleaguesArticle applied a 9-parameter prediction model to stratify individuals
in a large cohort of patients with CF into 5 categories of predicted survival.
They compared 5-year posttransplant survival to 5-year survival of patients
in the cohort who did not undergo transplantation and found that lung transplantation
provided a survival advantage only for the minority of patients with the lowest
predicted 5-year survival (<30%) as estimated by this model. In an editorial,
MauerArticle identifies key elements for development of prediction models to improve
selection of patients with CF for lung transplantation.
Differences in response to treatment as a function of time-of-day of
treatment administration have been demonstrated for several medical interventions.
Bliwise and colleagues report that in a cohort of elderly patients with end-stage
renal disease undergoing in-center hemodialysis, survival of patients who
were dialyzed on the morning shift was significantly longer than that of patients
dialyzed on the afternoon shift.
Using population-based surveillance data, Anderson and colleagues collected
information on all identified school-associated violent deaths between 1994
and 1999 in the United States. They found that the rate of single-victim student
homicides decreased in recent years, but an increase in the rate of multiple-victim
student homicides increased the overall school-associated student homicide
rate. The authors describe common features of these events and potential risk
factors for perpetration and victimization.
Mechanically ventilated patients in the intensive care unit (ICU) are
at high risk for the development of delirium, which has been associated with
several adverse outcomes. In this validation study of an instrument to diagnose
delirium in mechanically ventilated ICU patients, Ely and colleagues found
that delirium occurred in 83% of mechanically ventilated adult medical ICU
patients. Compared with reference standard evaluations by delirium experts,
the 2-minute assessment instrument as administered by 2 critical care study
nurses had sensitivities of 93% and 100%, specificities of 98% and 100%, and
high interrater reliability.
A review of the scientific basis of large-scale quarantine—the
compulsory sequestration of persons possibly exposed to an infectious agent
within specified geographic areas to prevent spread of contagious disease—and
discussion of the feasibility, legal issues, and possible adverse consequences
of quarantine as a disease containment strategy following biological terrorism.
A survey in April 2001 in the Kohistan district of Faryab province in
Afghanistan indicates that by the time of the survey, a humanitarian emergency
characterized by significant excess mortality, elevated rates of malnutrition,
and late-stage food coping mechanisms already existed in this region of Afghanistan.
Future directions in tobacco control: legislative and regulatory actions.
For your patients: Information about school violence.
This Week in JAMA. JAMA. 2001;286(21):2635. doi:10.1001/jama.286.21.2635