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March 13, 2003 Vol. 348 No. 11
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The prevalence of peanut allergy is increasing. The authors investigated factors associated with peanut allergy in a large cohort from which both children with allergy and control children were drawn. There was an association between the presence of peanut allergy and the use on infants of skin preparations containing peanut oils; also associated with the subsequent development of peanut allergy were intake of soy milk or soy formula and the presence of an oozing, crusted rash.
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Imatinib, an inhibitor of the mutant tyrosine kinase that causes chronic myeloid leukemia (CML), is effective in patients with chronic-phase CML who have no response to the standard treatment, interferon alfa. In this study of 1106 patients with previously untreated chronic-phase CML, imatinib was superior to a combination of interferon alfa and cytarabine as initial therapy.
Carcinoid tumors release vasoactive compounds, including serotonin, which may be toxic to heart valves. Right-sided valves are especially vulnerable. In this study, the progression of heart-valve disease was associated with higher peak urinary levels of 5-hydroxyindoleacetic acid (a serotonin metabolite) and treatment with cytotoxic chemotherapy.
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A 53-year-old man awoke in the morning with acute dizziness. He staggered to the bathroom, where he vomited repeatedly. When he was seen at the local emergency department 12 hours later, he had left-beating nystagmus in all positions of gaze but otherwise no focal neurologic findings. How should he be evaluated and treated?
This article describes a method of investigating and learning from adverse events. Careful investigation and systems analysis can identify the factors that set the stage for a medical error. The author argues that the process of understanding adverse events leads to improvements in care and reductions in errors and that insensitive and inadequate handling of an incident can result in additional harm to patients and families. He outlines practical strategies to minimize the trauma resulting from adverse events.
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