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This Week in JAMA
June 25, 2008

This Week in JAMA

JAMA. 2008;299(24):2827. doi:10.1001/jama.299.24.2827

Many patients with hypertension do not achieve adequate control. In a randomized trial of patients with essential hypertension not controlled with medication, Green and colleagues Article assessed changes in systolic and diastolic blood pressure (BP) and hypertension control in patients who were assigned to either usual care, home BP monitoring and training in use of Web-based health resources (Web services), or BP monitoring and Web services plus pharmacist care management delivered via Web communication. At the 12-month assessment, the authors found that compared with usual care and BP monitoring and Web services, patients who were assigned to BP monitoring and Web services plus pharmacist care management had significant improvements in BP control. In an editorial, Jones and Peterson Article discuss implications of the study findings for the care of patients with hypertension.

Drug-eluting stents have been associated with a lower risk of coronary artery restenosis compared with bare-metal stents, but some recent studies have raised concerns that drug-eluting stents may be associated with an increased risk of late thrombosis. To further assess the safety and efficacy of drug-eluting stents, Malenka and colleagues compared rates of coronary revascularization, ST-elevation myocardial infarction, and survival among Medicare beneficiaries who underwent nonemergent coronary stenting before and after the availability of drug-eluting stents. The authors report that compared with a time when bare-metal stents were the only option, the adoption of drug-eluting stents into routine practice has been associated with lower rates of revascularization procedures and similar 2-year risks of death or ST-elevation myocardial infarction.

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Some evidence suggests that epigenetic marks, or modifications in DNA, such as DNA methylation, may play a role in the etiology of common human diseases, including late onset of disease. To investigate whether there are longitudinal changes in DNA methylation and to evaluate whether methylation maintenance demonstrates familial clustering, Bjornsson and colleagues measured DNA methylation from samples collected on average 11 years and 16 years apart in cohorts from Iceland and Utah, respectively. The authors found time-dependent, intra-individual changes in DNA methylation loss and gain in both populations studied, as well as familial clustering of the changes.

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Technology, such as bar coding or radio frequency identification, has been proposed to improve patient safety and tracking of medical equipment and devices. However, whether electromagnetic interference from radio frequency identification could also compromise patient safety is not clear. Under controlled, nonclinical conditions and using recommended, industry-standard test methods, van der Togt and colleagues Article assessed electromagnetic interference by radio frequency identification on critical care equipment. The authors report that in 123 electromagnetic interference tests involving 41 medical devices, radio frequency identification induced 34 EMI incidents—defined as unintended changes in function of a medical device—of which 22 were classified as hazardous and 2 as significant. In an editorial, Berwick Article discusses the recognition and mitigation of technology's adverse effects.

“Hospitalization is stressful for patients and their families, full of the uncertainty of illness and fear of the known and unknown.” From “Touched.”

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New research presented at the American Thoracic Society's annual meeting examines cardiovascular risks associated with obstructive sleep apnea, including risks to airline passengers with this condition.

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Evidence suggests the optimal level of protein intake for adults is greater than the current recommended dietary allowance.

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Unintentional bias and conflicts of interest.

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Join Sherita Hill Golden, MD, MHS, July 16 from 2 to 3 PM eastern time to discuss the bidirectional association between depressive symptoms and 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.

For your patients: Information about hypertension.

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