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JAMA. 1999;282:303.

HSV-2 Vaccine Fails to Prevent Disease Acquisition
Control of herpes simplex virus type 2 (HSV-2) infection is of major public health importance in view of the increasing prevalence of HSV-2 infection in adults associated with an increase in reported cases of neonatal herpes. In 2 multicenter trials of a recombinant subunit HSV-2 vaccine in at-risk HSV-2–seronegative adults, Corey and coworkers found that the rate of HSV-2 acquisition was significantly lower among vaccine recipients than among subjects who received placebo during the initial 5 months of follow-up, but after 1 year of follow-up, rates of HSV acquisition were similar in the 2 groups. In an editorial, Mascola discusses possible explanations for the failure of this subunit vaccine to protect against acquisition of HSV-2 and implications for future HSV-2 vaccine research.

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Reperfusion Therapy and Survival After AMI in Elderly
To determine optimal reperfusion therapy after acute myocardial infarction (AMI) specifically in elderly patients, Berger and colleagues analyzed clinical outcome data from 20,683 Medicare beneficiaries older than 65 years enrolled in the Cooperative Cardiovascular Project. Study subjects presented at a hospital with AMI within 12 hours of symptom onset, had no contraindications to thrombolysis, and received either primary percutaneous transluminal coronary angioplasty (PTCA) or thrombolysis therapy within 6 hours of hospital arrival. Primary PTCA was associated with significantly lower 30-day and 1-year mortality rates than was thrombolysis. However, in a subgroup analysis of subjects considered to be ideal for reperfusion therapy, 1-year mortality rates were similar after primary PTCA or thrombolysis.

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Privileges Actions Reporting to the NPDB
Hospitals are required to report actions that limit medical staff privileges for 31 days or more and all denials of clinical privileges when peer review actions are involved to the National Practitioner Data Bank (NPDB). In this retrospective analysis of privileges action reports by 4743 short-term, nonfederal, general medical/surgical hospitals, Baldwin and colleagues found that the rate of privileges actions decreased from 2.61 per 100,000 admissions to 2.19 between 1991 and 1995 and the proportion of hospitals reporting 1 or more privileges actions decreased from 11.6% to 10.0%. In an editorial, Brennan considers several options for maintaining oversight of health care quality and asserts that anonymous reporting may be necessary to achieve full reporting.

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Eicosanoid Levels and Onset of Preeclampsia
The pathogenesis of preeclampsia may involve decreased production of vasodilating eicosanoids early in pregnancy and increased vasoconstricting effects relative to vasodilating effects before the onset of clinical disease. Among women enrolled in the control arm of the Calcium for Preeclampsia Prevention Trial who developed preeclampsia, Mills and colleagues found that levels of urinary metabolites of the vasodilating eicosanoid prostacyclin (PGI₂) were significantly lower throughout pregnancy compared with matched controls. Overall, levels of urinary metabolites of the vasoconstrictor eicosanoid thromboxane A₂ (TxA₂) were not significantly different between cases and controls and the ratio of TxA₂ to PGI₂ urinary metabolites was significantly higher throughout pregnancy in women with preeclampsia.

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A 43-Year-Old Woman Coping With Cancer
Mrs K is a 43-year-old woman with metastatic breast cancer who uses stress reduction techniques to help her cope with having cancer. She practices qi gong, participates in a cancer support group, and acts as a peer counselor for others with cancer. Spiegel discusses coping strategies and social support for individuals with life-threatening illness and the evidence that such strategies affect clinical outcomes.

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A Piece of My Mind
"This beautiful little girl, serene and mostly somnolent, pale but princess-like, lying still in bed, was close to death." From "Can an Amulet Cure Leukemia?"

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Contempo 1999
Advances in the understanding of the paradoxical thrombosis that may be induced by anticoagulant therapy.

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Medical News & Perspectives
At least half of all "failures" to normalize high blood pressure may be traced to unrecognized lapses in taking prescribed drugs, says a new study. Electronic pillboxes that record each time a patient takes a dose may help unmask the problem.

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Consensus Statement
From the National Vaccine Advisory Committee: An update on progress in improving childhood immunization coverage since the Childhood Immunization Initiative of 1991 and recommendations on measures to achieve a sustainable childhood immunization delivery system.

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JAMA Patient Page
For your patients: Treatment for heart attack.

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