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JAMA. 2002;288:2783.

Recombinant Human Erythropoietin in Critically Ill Patients
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 colleagues (SEE ARTICLE) 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, Carson (SEE ARTICLE) discusses the importance of measuring mortality, morbidity, and other clinical outcomes in studies evaluating the use of blood and blood-related products.

Collaborative Care Management of Late-Life Depression
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.

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Clinical Practice Intervention for Chlamydial Screening
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 control clinics.

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Reaerosolization of Viable Bacillus anthracis Spores
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.

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Paresis Acquired in the Intensive Care Unit
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.

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A Piece of My Mind
"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."

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Contempo Updates
A review of bariatric surgical procedures and outcomes for patients with severe obesity.

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Medical News & Perspectives
An Institute of Medicine report on US public health says the system is in disarray and requires massive changes.

CLINICIAN'S CORNER
Improving Patient Adherence
Scientific Review/Clinical Applications

Part 1 (SEE ARTICLE) of this 2-part article reviews evidence from randomized controlled trials of interventions to improve patient adherence with prescribed medications. Clinical vignettes in part 2 (SEE ARTICLE) illustrate evidence-based approaches to help patients follow prescribed treatments.

Pornography-Blocking Software
An evaluation of the extent to which software designed to block access to pornographic Web sites may also block access to health information sites.

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JAMA Patient Page
For your patients: Information about bariatric surgery.

(SEE ARTICLE)

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