Maternal administration of magnesium sulfate may reduce the risk of
cerebral palsy or death in very preterm infants, but evidence has been inconsistent.
In this randomized trial of magnesium sulfate given for neuroprotection to
women at risk of preterm birth before 30 weeks' gestation, Crowther and colleaguesArticle
found that at corrected age of 2 years, total pediatric mortality,
cerebral palsy in survivors, and combined death or cerebral palsy were reduced
in the magnesium sulfate group compared with the placebo group, but none of
the differences were statistically significant. Wu and colleaguesArticle, in a case-control study of infants born at 36 or more weeks' gestation,
found that chorioamnionitis was independently associated with a significantly
increased risk of cerebral palsy. In an editorial, Tyson and GilstrapArticle urge
ongoing research in prevention and treatment of cerebral
Evidence from randomized trials indicates that warfarin reduces risk
of ischemic stroke and other thromboembolic events in patients with atrial
fibrillation, but the effectiveness and safety of warfarin therapy in usual
clinical practice settings are less clear. In this study of adults enrolled
in a health maintenance organization who had nonvalvular atrial fibrillation,
Go and colleagues found that risk of ischemic stroke and peripheral embolism
was significantly lower among patients who received warfarin than among those
who did not receive warfarin. Risk of intracranial hemorrhage, although small,
was significantly increased in the warfarin group, but risk of nonintracranial
major hemorrhage was not.
Olanzapine is widely used to treat schizophrenia, but its long-term
effectiveness and costs have not been compared in a controlled trial with
those of a standard antipsychotic medication. In this 12-month randomized
trial comparing olanzapine with haloperidol among adults with schizophrenia
or schizoaffective disorder, Rosenheck and colleagues found no significant
differences between treatment groups in symptoms of schizophrenia, quality
of life, or extrapyramidal symptoms. Olanzapine was associated with a greater
reduction in akathisia and with greater improvements in memory and motor function,
but weight gain was more frequent and costs were greater than in the haloperidol
Regionalization policies that would concentrate selected surgical procedures
at higher-volume hospitals may impose unreasonable travel burdens on surgical
patients. However, in a simulated trial based on Medicare claims for patients
undergoing esophagectomy and pancreatic resection for cancer and US road network
data, Birkmeyer and colleagues found that most patients who would be required
to have surgery at a higher-volume center would add less than 30 minutes to
their travel times, and travel times for some patients would actually decrease.
Observational studies suggest that use of a pulmonary artery catheter
(PAC) in critically ill patients may be harmful. In this randomized trial
among patients with shock, acute respiratory distress syndrome, or both, Richard
and colleaguesArticle found no significant differences in mortality
at 28 days between patients who received a PAC and those who did not. Organ
dysfunction, need for vasoactive agents, duration of mechanical ventilation,
duration of ICU stay, and duration of hospital stay were also not significantly
different. In an editorial, Fowler and CookArticle discuss
the controversy about the usefulness of the PAC in critically ill patients
and encourage additional clinical research to evaluate this technology.
Nora Volkow, MD, a groundbreaking scientist in the field of drug addiction
who recently became the director of the National Institute on Drug Abuse,
brings a passion for research and a reputation as a straight shooter to the
An investigation of an outbreak of Escherichia coli O157 infection among attendees at a county fair suggests that a contaminated
building on the fairgrounds was the source of infection.
Mrs D, a 62-year-old woman with severe chronic obstructive pulmonary
disease (COPD) and frequent acute exacerbations, is receiving maximal medical
therapy, including inhaled bronchodilators and corticosteroids, supplemental
oxygen, and intermittent noninvasive mechanical ventilation at home. Celli
discusses the natural history and management of COPD.
Papers on HIV clinical research and related basic medical science and
their application to medical practice are invited for a JAMA theme issue
on HIV/AIDS scheduled to be published in July 2004.
For your patients: Information about cerebral palsy.
This Week in JAMA. JAMA. 2003;290(20):2635. doi:10.1001/jama.290.20.2635