Two drugs are better than one, when young children are feverish and fussy, according to a study published in the February issue of the Archives of Pediatric and Adolescent Medicine. Israeli researchers compared the safety and effectiveness of three different drug regimens in acutely febrile children ages six months to 36 months: one of acetaminophen alone, one of ibuprofen alone, and one of acetaminophen alternated with ibuprofen. In all three groups, half of the children received an initial loading dose of acetaminophen and half received ibuprofen. The 434 children were followed daily for three days. They were then checked at days 5 and 10 and thereafter weekly for 12 weeks.

The alternating regimen produced significantly better outcomes than did either antipyretic alone (this held true regardless of which medication was used for the initial loading dose): fevers and stress scores came down more quickly, with fewer doses given, and caregivers missed fewer days of work.

Significant gains in eliminating ventilator-associated pneumonia (VAP). The Institute of Healthcare Improvement (IHI) reported that 14 hospitals have successfully eliminated VAP in ICUs or hospital wide over a one-year period. Preventing VAP is one of the six quality-improvement areas in the IHI's 100,000 Lives Campaign, an initiative that began in January 2005 to improve hospital care by implementing evidence-based practices. The IHI maintains that if hospitals instituted these measures, they could save 100,000 lives by June 14, 2006. For more information go to http://www.ihi.org/campaign.

Oregon's Death with Dignity Act upheld. The U.S. Supreme Court ruled on January 17 that the U.S. attorney general does not have the authority to discipline or prosecute physicians who prescribe (but do not administer) a lethal dose of a medication to an incurably ill patient who requests it. Former U.S. attorney general John Ashcroft had argued that these prescriptions, which usually involve a controlled substance, were not written for "a legitimate medical purpose" and were thus illegal. The Supreme Court ruled that medical practice is regulated by the states except where Congress has passed specific legislation, and that Congress's intent in passing the Controlled Substances Act was to combat drug abuse as it is conventionally understood, not to address the complex moral and legal issues surrounding assisted suicide.

Spending on trauma treatment rose dramatically from 1996 to 2003, making it the highest single source of health care expenditures in the United States, exceeding spending on either heart disease or cancer. According to the Agency for Healthcare Research and Quality, in 1996 $37 billion was spent treating 38 million Americans for trauma-related conditions. In 2003 $72 billion-94%more-was spent treating 36 million people-5%fewer-for trauma. In contrast, the relative cost of treating heart disease did not change. The number of people treated for cancer, now the third most expensive condition, increased 18% from 9 million to 11 million, while spending on cancer treatment increased 21%, from $38 billion to $48 billion.