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This Week in JAMA
JAMA. 2006;296:899.
Fixed-Dose Unfractionated Heparin for VTE
Patients with acute venous thromboembolism (VTE) are often hospitalized for initial treatment with intravenous unfractionated heparin and coagulation monitoring by activated partial thromboplastin time (APTT). Subcutaneously administered low-molecular-weight heparin can be used in the outpatient setting and does not require APTT monitoring, which reduces costs. The Fixed-Dose Heparin trial compared the safety and efficacy of 2 treatment regimens intended for acute inpatient or outpatient treatment of VTE: fixed-dose weight-adjusted unfractionated heparin and fixed-dose weight-adjusted low-molecular-weight heparin, each combined with warfarin therapy for 3 months. In this randomized adjudicator-blinded trial reported by Kearon and colleagues, (SEE ARTICLE) similar low rates of recurrent VTE and major bleeding and comparable rates (about 70%) of outpatient treatment were achieved with either treatment. In an editorial, Carson (SEE ARTICLE) discusses the importance of assessing these treatment protocols in a double-blinded trial to ensure that safety and efficacy are not compromised by cost concerns.
Short-Chain Acyl-CoA Dehydrogenase Deficiency
Screening for short-chain acyl-coenzyme A (CoA) dehydrogenase (SCAD) deficiency, an autosomal recessive disorder with no known treatment and a poorly understood natural history, is part of many newborn metabolic screening programs. van Maldegem and colleagues (SEE ARTICLE) studied genetic, biochemical, and clinical characteristics of 39 Dutch probands and relatives with SCAD deficiency. The authors report that SCAD deficiency was more common than expected and that clinical symptoms were nonspecific, often uncomplicated, and transient and were not correlated with specific genotypes. In an editorial, Waisbren (SEE ARTICLE) discusses the design and implementation of rationale programs to screen newborns for metabolic disorders.
Multistate Outbreak of Fusarium Keratitis
Recent outbreaks of Fusarium keratitis have been reported from Singapore and Hong Kong. In this issue of JAMA, Chang and colleagues (SEE ARTICLE) report results of a multistate case-control study to determine exposures associated with Fusarium keratitis in the United States. As in previous reports, (SEE ARTICLE) the authors found that the majority of case patients wore soft contact lenses and used the lens cleaning and storage solution, ReNu with MoistureLoc. Fusarium was not recovered from unopened products provided by the case patients, nor was it found in samples collected at the manufacturing plant.
Trends in Herpes Simplex Virus Type 1 and Type 2
To assess recent trends in herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) among persons aged 14 to 49 years, Xu and colleagues compared seroprevalence data from US National Health and Nutrition Examination Surveys (NHANES) (1999-2004) with seroprevalence data from NHANES III (1988-1994) and NHANES II (1976-1980). The authors report a significant decline in HSV-2 seroprevalence between the 1988-1994 and 1999-2004 surveys—reversing a sharp increase documented in comparisons of the 1988-1994 vs 1976-1980 data. The recent decline was particularly evident among persons aged 14 to 19 years and in analyses adjusting for sexual behaviors. The authors also found that the seroprevalence of HSV-1 declined significantly from 1988-1994 compared with 1999-2004; however, cases of genital herpes caused by HSV-1 may be increasing.
(SEE ARTICLE)
A Piece of My Mind
"Every day I would ask [my mother] how her day was, and every day she would say, "I know you won't believe me, but this was the best day of my life." From "My Mother's Choice."
(SEE ARTICLE)
Medical News & Perspectives
Some experts predict that global environmental changes will have increasingly harmful effects on human health and longevity and that researchers will need to "think big" and study whole populations to track these effects.
(SEE ARTICLE)
CLINICIAN'S CORNER
Preventing Pressure Ulcers
Clinical Review
Evidence-based interventions to prevent pressure ulcers include dynamic support surfaces, patient repositioning, optimizing nutrition, and skin moisturizers.
(SEE ARTICLE)
Fusarium Keratitis
From the Archives Journals
Two articles in the Archives of Ophthalmology describe outbreaks of contact lens–associated Fusarium keratitis. Margolis and Whitcher (SEE ARTICLE) discuss these reports and an article by Chang and colleagues (SEE ARTICLE) in this issue of JAMA, and they highlight the importance of prevention and early diagnosis of Fusarium keratitis.
Medicare and Research Participation
Ethics of Medicare's coverage with evidence development program.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about pressure ulcers.
(SEE ARTICLE)
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