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October 3, 2002  Vol. 347 No. 14

Perspective
1054-1055

Carbon monoxide poisoning is the most common type of accidental poisoning in the United States, accounting for thousands of emergency department visits and some 800 deaths annually. Carbon monoxide, an insidious byproduct of incomplete hydrocarbon ...

Original Articles
1057-1067
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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.

1068-1074

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.

1075-1078

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.

Images in Clinical Medicine
1079
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Figure 1. A 71-year-old woman with bronchiectasis was admitted with a two-week history of increasing shortness of breath and a cough productive of small amounts of yellow sputum. She had received antibiotics from her primary physician without clinically ...

e4
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The video shows a large mass crossing the tricuspid valve.

Special Articles
1080-1086
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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.

1087-1093

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).

Review Article
1094-1103

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.

Editorials
1105-1106

Carbon monoxide appears to be the leading cause of injury and death due to poisoning worldwide.1 A colorless, odorless, tasteless gas, carbon monoxide is produced by the incomplete combustion of any carbon-containing fuel. Prevention of carbon monoxide ...

1106-1109

Prevention and cessation are the two principal strategies in the battle against tobacco. Prevention efforts are aimed at discouraging people — generally children and youth — from starting to smoke. Prevention strategies include antitobacco education, ...

Clinical Implications of Basic Research
1110-1111

The use of susceptibility testing to identify appropriate antimicrobial agents has long been an important element of the practice of infectious-disease medicine. In most clinical settings, the finding that a strain of bacteria is susceptible to a specific ...

Correspondence
1112-1115

To the Editor: Two randomized trials reported by Lederle et al.1 and the United Kingdom Small Aneurysm Trial Participants2 (May 9 issue) revealed that early surgery in patients with small abdominal aortic aneurysms can only be expected to have a benefit ...

1115-1116

To the Editor: The results of the Diabetes Prevention Trial–Type 1 Diabetes Study (DPT-1) (May 30 issue)1 show that parenteral insulin therapy does not prevent type 1 diabetes in the relatives of patients with the disease. We made a similar observation ...

1116-1117

To the Editor: The report by Herold et al. (May 30 issue)1 on the use of anti-CD3 monoclonal antibody in patients with new-onset type 1 diabetes and the accompanying editorial by Gale2 leave important questions unanswered. The authors suggest that ...

1117

To the Editor: Case 16-2002 (May 23 issue)1 describes a 41-year-old woman with generalized headache and a hemorrhagic lesion on neuroimaging; on brain biopsy, her condition was diagnosed as cerebral venous thrombosis. Several factors, however, suggest ...

1118
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To the Editor: The change in the Journal's policy on authorship (July 4 issue),1 which previously restricted the number of authors for an article, is appropriate and is to be welcomed. However, this change does not protect persons who have contributed ...

1118-1119

To the Editor: The findings reported by Needleman and colleagues (May 30 issue)1 provide further evidence of what hospital nurses have feared for quite some time: there are too few registered-nurse (R.N.) staff members, and there is too little support to ...

1119
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To the Editor: The commentary by Lo et al. (May 9 issue)1 demonstrates concern about the impact of the California Supreme Court's decision in the Wendland case2 and provides some welcome advice for physicians with regard to their responses to that ...

1119-1121

To the Editor: Massive organophosphorus-compound intoxication is relatively common. Although uncommon, delayed neurotoxicity may also occur in humans.1 Persons with organophosphorus-compound poisoning have acute toxic effects, with a cholinergic crisis ...

Book Reviews
1122

Viscusi may be the most prominent academic critic of current public health approaches to smoking, often serving as an expert witness for cigarette companies. He is perhaps best known for his conclusion that smokers provide governments with net economic ...

1123

It is a challenging enterprise to assemble a comprehensive textbook on prostate cancer that goes beyond what other books afford. Although there have been at least a dozen other treatises on the same or similar subjects, Prostate Cancer: Principles and ...

1124

Gastrointestinal oncology has long been dominated by the competing interests of various specialists. Recent advances have now begun to lead to the integration of many of these groups and have led to the recognition of gastrointestinal oncology as a ...

1124-1125

A multidisciplinary approach to the evaluation and treatment of patients with solid tumors gives the best chance for a favorable outcome. New diagnostic, staging, and therapeutic advances require collaboration among experts in several areas. This book ...

Corrections
1126

Rapid Measurement of B-Type Natriuretic Peptide in the Emergency Diagnosis of Heart Failure Original Article, N Engl J Med 2002:347;161-167.. The editors inadvertently failed to disclose that Drs. Nowak, McCord, Hollander, Duc, Omland, Storrow, Abraham, ...

1126

Mechanical Extraction of a Basilar-Artery Embolus with the Use of Flow Reversal and a Microbasket Correspondence, N Engl J Med 2002:347;769-770.. The orientation and labeling of Figure 1 were incorrect. The corrected figure appears below. We regret the ...