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This Week in JAMA
JAMA. 2000;283:2349.
JAMA-EXPRESS
Ancrod Therapy for Acute Ischemic Stroke
Ancrod is a protease derived from Malaysian pit viper venom that produces a rapid decrease in serum fibrinogen levels. In this multicenter trial of ancrod for the treatment of acute ischemic stroke in a sample of 500 patients with acute or progressing ischemic neurological deficit, Sherman and colleagues (SEE ARTICLE) found that significantly more patients assigned to receive a 72-hour infusion of ancrod within 3 hours of symptom onset followed by 1-hour infusions on days 4 and 5 achieved functional independence (Barthel Index score  95) at 3 months than patients assigned to placebo. Three-month mortality was similar in the 2 treatment groups, but intracranial hemorrhage was more frequent in the ancrod group. In an editorial, Mayberg and Furlan (SEE ARTICLE) place ancrod in the context of current reperfusion therapies to improve cerebral microcirculation after acute ischemic stroke.
Uric Acid Levels and Risk of Cardiovascular Mortality
Some epidemiological studies, including the First National Health and Nutritional Examination Survey (NHANES I) Follow-up Study (NHEFS), 1971-1987, based on data from 13.5 years of follow-up of the NHANES I population, have found an association between increased serum uric acid levels and cardiovascular mortality, but others have not. In this analysis of NHEFS data with 5 additional years of follow-up and an increase in the number of deaths from 892 to 1593, Fang and Alderman report that increased serum uric acid levels at baseline were independently and significantly associated with risk of cardiovascular mortality in men and in women and in black and white persons.
(SEE ARTICLE)
Maternal Rehospitalization After Childbirth
Strategies to reduce the likelihood of cesarean delivery and decrease the risk of peripartum infection may improve women's postpartum health. Using data from the Washington State Birth Events Record Database, 1987 through November 1996, Lydon-Rochelle and colleagues found that 3149 (1.2%) of 256,795 primiparous women were rehospitalized within 60 days of childbirth. Rehospitalization was significantly more likely after cesarean delivery (relative risk, 1.8) or assisted vaginal delivery (relative risk, 1.3) than after spontaneous vaginal delivery. In the entire cohort, the most frequent rehospitalization discharge diagnosis was uterine infection.
(SEE ARTICLE)
Antiretroviral Drug Resistance Testing in HIV Infection
Updated recommendations for the use and interpretation of antiretroviral drug resistance testing in the management of human immunodeficiency virus (HIV) infection in adults from an international expert panel convened by the International AIDS Society–USA. (SEE ARTICLE) In an editorial, Flexner (SEE ARTICLE) points out shortcomings of antiretroviral drug resistance testing, including low sensitivity and specificity, uncertain predictive value and clinical relevance, expense, and slow turnaround time.
Perspectives on the Plight of Academic Health Centers
A collection of essays on the state of academic health centers in the United States: Pardes (SEE ARTICLE) on economic measures needed to support teaching hospitals and medical schools; Griner and Danoff (SEE ARTICLE) on allocation of resources for medical education; Bulger (SEE ARTICLE) on elements for reenvisioning academic health centers as therapeutic organizations; Saxton and coauthors (SEE ARTICLE) on strategic planning and organizational initiatives for innovation at one academic health center; and Fein (SEE ARTICLE) on actions by the leadership of academic health centers that would promote fiscal relief. In an editorial, DeAngelis (SEE ARTICLE) asserts that to resolve problems affecting academic health centers, physicians must reclaim from business organizations the ultimate responsibility for patient care, medical education, and research.
A Piece of My Mind
"Reluctance to indulge in blatant self-advertisement has not been characteristic in the world of higher education of late." From "Naming Names."
(SEE ARTICLE)
Contempo Updates
Medical student education in the ambulatory setting: techniques and resources for community physicians.
(SEE ARTICLE)
Medical News & Perspectives
The Amsterdam Declaration to Stop TB addresses an international health issue of increasing importance—the unimpeded global resurgence of tuberculosis. Figure shows 20 high-burden TB countries.
(SEE ARTICLE)
Paying for Therapy After Organ Transplant
Kasiske and coauthors for the American Society of Transplantation argue for a system that would guarantee payment for immunosuppressive therapy after organ transplantation to ensure that all recipients are provided with the means to maintain functioning transplanted organs.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about organ transplantation.
(SEE ARTICLE)
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