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This Week in JAMA
September 2, 2009

This Week in JAMA

JAMA. 2009;302(9):923. doi:10.1001/jama.2009.1290

Early invasive intervention is recommended for patients with high-risk acute coronary syndromes (ACS), but the optimal timing of intervention is uncertain. Montalescot and colleagues, writing for the ABOARD (Angioplasty to Blunt the Rise of Troponin in Acute Coronary Syndromes Randomized for an Immediate or Delayed Intervention) study investigators, report that a strategy of immediate intervention compared with delayed intervention (next working day) did not result in a difference in myocardial infarction as defined by peak troponin level.

To assess the efficacy of laparoscopic uterosacral nerve ablation (LUNA) for relief of chronic pelvic pain, Daniels and colleagues randomly assigned women with chronic pelvic pain who were having diagnostic laparoscopy to undergo bilateral LUNA or no denervation. The authors found no significant difference in pelvic pain severity or in quality-of-life measures among women who underwent laparoscopy with LUNA vs laparoscopy alone during a median 69-month follow-up.

Mass administration of oral azithromycin is a major component of trachoma elimination programs. In an analysis of data from a cluster-randomized clinical trial of trachoma control through mass azithromycin administration in rural Ethiopia, Porco and colleagues found that mortality among children aged 1 to 9 years was significantly lower in treated compared with untreated communities—an unintended but beneficial consequence.

In a survey of life-science research faculty at 50 academic medical centers with high levels of extramural research funding from the National Institutes of Health, Zinner and Campbell Article assessed the type of research conducted (eg, basic, translational, clinical trials, health services research/epidemiology), funding sources and amounts, publications, professional activities, patent applications, and industry relationships. Among the authors' findings was that the research function of academic medical centers is active and diverse and includes a substantial number of faculty who are conducting research and publishing without sponsorship. In an editorial, Moses Article discusses the interplay of investigators, research funds, and priorities.

Since 2005, registration of randomized controlled trials (RCTs) has been a precondition for publication of trial results in member journals of the International Committee of Medical Journal Editors. In a review of 323 registered trials published in 10 high-impact medical journals in 2008, Mathieu and colleagues examined the adequacy of trial registration, including specification of primary trial outcomes. Among the authors' findings was that only 147 (45.5%) of the trials were adequately registered and of these, 46 (31%) showed some evidence of discrepancy between the primary outcomes registered and those published.

In a systematic review and meta-analysis, de Almeida and colleagues Article assessed the association of corticosteroid and antiviral treatment with facial recovery in patients with Bell palsy. The authors report that treatment with corticosteroids reduced the risk of unsatisfactory facial recovery and antiviral agents administered with corticosteroids (but not alone) may be associated with additional benefit. In an editorial, Steiner Article discusses the implications of these findings for patient care.

“As I see it, medical decisions should be made dispassionately. But both the physician and the patient have emotions. The physician must set this emotion aside and make a decision based on logic.” From “Howard.”

An innovative program at high schools in New York City and Boston provides low-income and minority students a gateway to careers in medicine and science.

Is there a future for systems medicine?

Assessing the appropriateness of care

Cost shifting and health care costs

Join Thomas H. Gallager, MD, Wednesday, September 16, from 2 to 3 PM eastern time to discuss the medical error review involving a woman who experienced wrong-site surgery for skin cancer. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 52-year-old woman with morbid obesity? Go to www.jama.com to read the case and submit your response, which may be selected for online publication. Submission deadline is September 6.

For your patients: Information about trachoma.