October 3, 2002
Hyperbaric Oxygen for Acute Carbon Monoxide Poisoning
Cognitive sequelae often occur after acute carbon monoxide poisoning. This double-blind, randomized trial assigned subjects either to three sessions in a hyperbaric-oxygen chamber or to one normobaric-oxygen treatment plus two sessions of exposure to normobaric room air, all administered within 24 hours after the end of exposure to carbon monoxide. Cognitive sequelae six weeks later were less frequent among persons who received hyperbaric-oxygen therapy (25.0 percent) than among those who received normobaric-oxygen treatment (46.1 percent, P=0.007). Differences were sustained 12 months after the episode of acute carbon monoxide poisoning. Hyperbaric-oxygen treatments within 24 hours after acute carbon monoxide poisoning should be the standard of care.
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Prevention of Functional Decline in Frail, Elderly Persons
This randomized, controlled trial assessed the efficacy of a home-based program to prevent functional decline among 188 frail, elderly persons. The program, which involved physical therapy and focused on improving underlying impairments in physical abilities, was more effective than an educational program in slowing the progression of disability with respect to activities of daily living. A home-based intervention targeted to impairments in physical abilities may reduce the progression of disability in frail, elderly patients, but it remains unclear whether it can ultimately reduce the need for nursing home care in this population.
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Brief Report: Salmonella Sepsis after a Platelet Transfusion
Two patients had salmonella sepsis after receiving platelet transfusions, and the source of the infection was traced to the pet snake of the platelet donor. The donor was asymptomatic, but Salmonella enterica serotype enteritidis was cultured from his pet boa constrictor. The isolate was identical to the isolates from the two patients with sepsis.
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Special Article: State Expenditures for Tobacco-Control Programs
One of the goals of the legal settlement between the tobacco industry and the states was to promote public health. In this study, the authors examined state spending on tobacco-control programs. In 2001 the average state received $164 million from the tobacco settlement but allocated only 6 percent of these funds to tobacco-control programs. Only six states exceeded the minimal level of funding for tobacco-control programs recommended by the Centers for Disease Control and Prevention. Program funding was not higher in states with more tobacco-related health problems. States are directing only a small percentage of tobacco-settlement funds to tobacco-control programs. These findings suggest that the tobacco settlement represents an unrealized opportunity to reduce morbidity and mortality from smoking.
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Special Article: Real-World Effectiveness of a Telephone Quitline for Smokers
Telephone counseling for smoking cessation has been effective in clinical trials, and many states have established "quitlines." This randomized study of 3282 smokers was designed to evaluate the real-world effectiveness of the California Smokers' Helpline. Smokers who were randomly assigned to counseling received up to seven counseling sessions that focused on motivation, self-efficacy, social support, planning for quitting, and relapse prevention. At 12 months of follow-up, smoking-cessation rates were somewhat higher for subjects who received telephone counseling than for those who received only self-help materials (7.5 percent vs. 4.1 percent). Most smokers who called the quitline continued to smoke; however, telephone counseling was effective in helping some smokers to quit. This study did not evaluate the costs of the program. Given the enormous suffering and costs associated with smoking, the benefit achieved by the quitline is likely to outweigh the cost of this low-intensity intervention.
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Drug Therapy: Analgesics for the Treatment of Pain in Children
The treatment of pain in infants and children has often been insufficient, owing to lack of information and understanding of how to use analgesic agents in the very young. This review discusses the development of nociception; the differences in metabolism of analgesics among infants, children, and adults; and agents that can be used for pain control in a variety of settings. Infants and children can receive analgesia and anesthesia safely, provided proper age-related adjustments are made in clinical practice and dosage.
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