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This Week in JAMA
April 16, 2008

This Week in JAMA

JAMA. 2008;299(15):1745. doi:10.1001/jama.299.15.1745

Ischemia-reperfusion injury is a significant factor contributing to morbidity and mortality following coronary artery bypass graft (CABG) surgery. Pyridoxal 5′-phosphate monohydrate (MC-1), a naturally occurring pyridoxine metabolite, prevents cellular calcium overload, and some data suggest it may reduce ischemia-reperfusion injury. In the MC-1 to Eliminate Necrosis and Damage in Coronary Artery Bypass Graft Surgery II Trial (MEND-CABG II), intermediate- to high-risk patients undergoing CABG with cardiopulmonary bypass were randomly assigned to receive 250 mg/d of MC-1 or placebo immediately before and for 30 days after surgery. The MEND-CABG II investigators found no difference in the composite outcome of cardiovascular death or nonfatal myocardial infarction among patients who received MC-1 vs placebo during the 30-day follow-up.

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Valgimigli and colleagues report results of the MULTISTRATEGY randomized trial, in which patients presenting with ST-elevation myocardial infarction or new left bundle-branch block were assigned to 1 of 4 strategies of percutaneous coronary intervention: abciximab with an uncoated stent, abciximab with a sirolimus-eluting stent, tirofiban with an uncoated stent, or tirofiban with a sirolimus-eluting stent. The investigators found that tirofiban was noninferior to abciximab for achieving at least 50% resolution of ST-segment elevation at 90 minutes after the intervention. During 8 months of follow-up, patients who received sirolimus-eluting stents had a significantly lower risk of major adverse cardiac events compared with patients who received uncoated stents.

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Examination of published articles and internal Merck & Co documents that became available during litigation involving rofecoxib provide evidence that the company may have inappropriately influenced the publication and reporting of scientific research relating to rofecoxib. Ross and colleagues examined the authorship of articles on rofecoxib to assess the extent of guest authorship and ghostwriting. They found that although the articles were often prepared by Merck employees or contract medical writers, first authorship was commonly attributed to academically affiliated investigators—who may not have been involved in the conduct of the study or analysis of the reported data—and who may have failed to disclose Merck's financial support. In a second article, Psaty and Kronmal reviewed documents relating to clinical trials of rofecoxib in patients with cognitive impairment and found that the risk-benefit profile of rofecoxib described in published articles and in analyses submitted to the US Food and Drug Administration was more favorable than that revealed in Merck's internal analyses of the trial data. In an editorial, DeAngelis and Fontanarosa discuss the adverse effects of industry influence on medical research and propose policies to safeguard the integrity of medical science.

A comprehensive and multidisciplinary approach to patients with head and neck cancers, to address the physical and psychological effects associated with treatment.

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“Nearly four years since completing my residency, . . . I returned to my home country for the first time as a full-fledged internist and accidental tourist.” From “Rediscovery.”

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Critics charge that proposed federal guidelines for distributing reprints of journal articles that discuss off-label uses of drugs and devices would allow companies to continue to use the reprints as marketing tools.

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International recruitment of nurses: justice and human rights

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“Gizmo idolatry” in medicine

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Join Barbara Howard, PhD, and William Howard, MD, on May 21, 2008, from 2 to 3 PM eastern time to discuss lower blood pressure and cholesterol targets in diabetes. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl

How would you manage a 50-year-old man with chronic low back pain? Go to www.jama.com to read the case and submit your response. Your response may be selected for online publication. Submission deadline is April 30.

For your patients: Information about coronary artery bypass grafting.

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