To compare the safety and efficacy of early abortion by administration of methotrexate and misoprostol vs administration of misoprostol alone.

To evaluate the efficacy of currently used inactivated influenza vaccine during a severe epidemic caused by antigenically drifted influenza type A(H3N2) and well-matched type B viruses during the 1992-1993 season.

To assess the effect of priming with diphtheria and tetanus toxoid vaccine (DT) at 1 month of age on the anticapsular polyribosylribitol phosphate (PRP) antibody responses of infants vaccinated with Haemophilus influenzae type b polysaccharide-tetanus toxoid conjugate (PRP-T) or PRP oligosaccharide-cross-reactive mutant diphtheria toxin conjugate (HbOC).

To compare a rapid, office-based test with standard cell culture for screening of women for Chlamydia trachomatis infections.

To investigate the effectiveness of individualized developmental care in reducing medical and neurodevelopmental sequelae for very low-birth-weight infants.

To determine whether optimized glycemic control in type I diabetic recipients of renal allografts will prevent or delay diabetic renal lesions in the allograft.

To assess the effect of an individualized treatment regimen on the intensity and duration of medication treatment for alcohol withdrawal.

To evaluate the safety and immunogenicity of the MN strain of recombinant gp120 (MN rgp120) as a vaccine prototype to prevent human immunodeficiency virus (HIV).

To determine the durability of zidovudine-induced delay in clinical progression of asymptomatic human immunodeficiency virus (HIV) disease and to assess the relationship between this effect and the entry CD4+ cell count.

To study the association between referee characteristics and their manuscript assessments, the influence of manuscript language on referees' judgments, and the usefulness, quality, and extent of referees' free-text comments.

To study whether reviewers aware of author identity are biased in favor of authors with more previous publications.

To determine whether individuals selected for good general health, high hypnotizability, and the ability to alter skin temperature under hypnotic suggestion can influence the delayed-type hypersensitivity (DTH) response to varicella-zoster (VZ) antigen under hypnotic suggestion.

OBJECTIVE--To determine the safety and efficacy of a new combination treatment for patients with Clostridium difficile-associated disease (CDD). The treatment combines the yeast Saccharomyces boulardii with an antibiotic (vancomycin hydrochloride or metronidazole). DESIGN--A double-blind, randomized, placebo-controlled, parallel-group intervention study in patients with active CDD. Patients received standard antibiotics and S boulardii or placebo for 4 weeks, and were followed up for an additional 4 weeks after therapy. Effectiveness was determined by comparing the recurrence of CDD in the two groups using multivariate analysis to control for other risk factors for CDD. SETTING--National referral study of ambulatory or hospitalized patients from three main study coordinating centers. PATIENTS--A total of 124 eligible consenting adult patients, including 64 who were enrolled with an initial episode of CDD, and 60 who had a history of at least one prior CDD episode. Patients who were immunosuppressed due to acquired immunodeficiency syndrome or cancer chemotherapy within 3 months were not eligible. INTERVENTION--Treatment with oral S boulardii (1 g/d for 4 weeks) or placebo in combination with a standard antibiotic. MAIN OUTCOME MEASURE--Recurrence of active CDD. RESULTS--A history of CDD episodes dramatically increased the likelihood of further recurrences. Multivariate analysis revealed that patients treated with S boulardii and standard antibiotics had a significantly lower relative risk (RR) of CDD recurrence (RR, 0.43; 95% confidence interval, 0.20 to 0.97) compared with placebo and standard antibiotics. The efficacy of S boulardii was significant (recurrence rate 34.6%, compared with 64.7% on placebo; P = .04) in patients with recurrent CDD, but not in patients with initial CDD (recurrence rate 19.3% compared with 24.2% on placebo; P = .86). There were no serious adverse reactions associated with S boulardii. CONCLUSIONS--The combination of standard antibiotics and S boulardii was shown to be an effective and safe therapy for these patients with recurrent CDD; no benefit of S boulardii was demonstrated for those with an initial episode of CDD.

To further define the safety and efficacy of recombinant human interleukin 1 receptor antagonist (rhIL-1ra) in the treatment of sepsis syndrome.

To evaluate the safety and immunogenicity of a recombinant outer surface lipoprotein A (OspA) Lyme vaccine in healthy adults.

To assess prospectively the impact on survival and health-related quality of life of two follow-up protocols in patients with early breast cancer.

To evaluate the effectiveness of early detection of intrathoracic and bone metastases in reducing mortality in breast cancer patients.

OBJECTIVE--Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) appears to improve ventilation and coronary perfusion when compared with standard CPR. The objective was to evaluate potential benefits of this new CPR technique in patients with out-of-hospital cardiac arrest in St Paul, Minn. DESIGN--Ten-month, prospective, randomized parallel-group design. SETTING--St Paul, Minn, population 270,000. PATIENTS--All normothermic victims of nontraumatic cardiac arrest older than 8 years who received CPR. MAIN OUTCOME MEASURES--Return of spontaneous circulation, admission to the intensive care unit (ICU), return of baseline neurological function (alert and oriented to person, place, and time), survival to hospital discharge, survival to hospital discharge with return of baseline neurological function, and complications. RESULTS--Seventy-seven patients received standard CPR and 53 patients received ACD CPR. The mean emergency medical services call response interval was less than 3.5 minutes. When all patients were considered, a higher percentage of ACD CPR patients had a return of spontaneous circulation and were admitted to the ICU vs standard CPR (45% vs 31%, and 40% vs 26%, respectively), but these trends were not statistically significant (P < .10 and P < .10). No statistically significant differences were found between hospital discharge rates (12 [23%] of 53 for ACD CPR vs 13 [17%] of 77 for standard CPR), return to baseline neurological function (10 [19%] of 53 for ACD CPR vs 13 [17%] of 77 for standard CPR), or return to baseline neurological function at hospital discharge (nine [17%] of 53 for ACD CPR vs 12 [16%] of 77 for standard CPR). Return of spontaneous circulation, ICU admission, and neurological recovery in both CPR groups were highly correlated with downtime (time from collapse to emergency medical system personnel arrival to the scene in witnessed arrests). With less than 10 minutes' downtime, survival to the ICU was 59% (19/32) with ACD CPR and 33% (16/49) with standard CPR (P < .02), return to baseline neurological function was 31% (10/32) with ACD CPR and 20% (10/49) with standard CPR (P = .27), and hospital discharge rate was 38% (12/32) with ACD CPR and 20% (10/49) with standard CPR (P = .17). Complication rates in patients admitted to the hospital were similar in both groups. CONCLUSIONS--This study demonstrates that ACD CPR appears to be more effective than standard CPR in a well-defined subset of victims of out-of-hospital cardiac arrest during the critical early phases of resuscitation. Based on this study, a larger study should be performed to evaluate the potential long-term benefits of ACD CPR.