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This Week in JAMA
December 5, 2001

This Week in JAMA

JAMA. 2001;286(21):2635. doi:10.1001/jama.286.21.2635
Aptiganel in Acute Ischemic Stroke

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.

Survival After Lung Transplantation in Patients With CF

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.

Survival and Morning vs Afternoon Dialysis

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.

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Trends in School-Associated Violent Deaths

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.

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Assessing Delirium in Mechanically Ventilated Patients

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.

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Quarantine After Biological Terrorism

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.

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Humanitarian Crisis in Afghanistan

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.

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Future directions in tobacco control: legislative and regulatory actions.

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JAMA Patient Page

For your patients: Information about school violence.

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