Recent data suggest that red blood cell transfusions may be associated
with worse clinical outcomes in some critically ill patients. In this randomized
placebo-controlled trial of recombinant human erythropoietin (rHuEPO) in critically
ill patients, Corwin and colleaguesArticle found that the percentage of patients
who received a red blood cell transfusion was significantly lower in the group
of patients who received weekly administration of rHuEPO than in the placebo
group. In an editorial, CarsonArticle discusses the importance of measuring mortality,
morbidity, and other clinical outcomes in studies evaluating the use of blood
and blood-related products.
Few older adults with major depression receive effective treatment in
primary care settings. Unützer and colleagues conducted a randomized
trial to determine the effectiveness of the Improving Mood—Promoting
Access to Collaborative Treatment (IMPACT) program, a primary care–based
collaborative care treatment program for late-life depression that includes
key components of evidence-based models for chronic illness care. At 12 months,
patients assigned to the IMPACT intervention had higher rates of treatment
response, lower depression severity, higher rates of depression treatment,
greater satisfaction with depression care, less health-related functional
impairment, and higher quality of life than patients who received usual care.
Screening programs for detection of cervical Chlamydia
trachomatis have been shown to reduce morbidity and costs associated
with C trachomatis infection, but the proportion
of at-risk adolescent girls and young women being screened is low. Shafer
and colleagues tested the effectiveness of a system-level clinical practice
improvement intervention designed to increase C trachomatis screening among sexually active adolescent girls during routine checkups
at pediatric clinics in a large health maintenance organization. By months
16 to 18 of the study, C trachomatis screening rates
were significantly increased in the intervention clinics compared with the
On October 15, 2001, Bacillus anthracis spores
contained in a letter were released in the mail handling area of the Hart
Senate Office Building, Washington, DC. Information about primary aerosolization
of B anthracis spores has been previously reported.
In this article, Weis and colleagues report on the nature and extent of secondary
aerosolization of viable B anthracis spores under
both quiescent and active office conditions.
Acquired neuromuscular dysfunction has been described in patients after
admission to the intensive care unit (ICU). To assess the incidence, risk
factors, and outcomes of ICU-acquired paresis, De Jonghe and colleagues conducted
a prospective study of ICU patients who underwent mechanical ventilation for
7 days or more. Among patients who achieved satisfactory awakening and comprehension,
25% had severe motor weakness. Median duration of ICU-acquired paresis was
21 days. Independent predictors of ICU-acquired paresis included female sex,
the number of days with dysfunction in 2 or more organs, duration of mechanical
ventilation, and administration of corticosteroids before awakening.
"For the Haitian poor, the folklore of the loup garou can help to explain
the unexplainable, to deal with the fear, the guilt, and the helplessness
generated by the loss of a child." From "Beyond Folklore."
A review of bariatric surgical procedures and outcomes for patients
with severe obesity.
An Institute of Medicine report on US public health says the system
is in disarray and requires massive changes.
Scientific Review/Clinical Applications
Part 1Article of this 2-part article reviews evidence from randomized controlled trials
of interventions to improve patient adherence with prescribed medications.
Clinical vignettes in part 2Article illustrate evidence-based approaches to help
patients follow prescribed treatments.
An evaluation of the extent to which software designed to block access
to pornographic Web sites may also block access to health information sites.
For your patients: Information about bariatric surgery.
This Week in JAMA. JAMA. 2002;288(22):2783. doi:10.1001/jama.288.22.2783