Ranolazine is a new type of antianginal drug that generates more adenosine
triphosphate for each molecule of oxygen consumed by increasing glucose oxidation
through partial inhibition of fatty acid oxidation. Chaitman and colleaguesArticleconducted a randomized trial among patients with symptomatic
chronic angina despite standard doses of atenolol, amlodipine, or diltiazem
to assess the antianginal effects of ranolazine when added to background antianginal
therapy. Increases in treadmill exercise duration from baseline at trough
ranolazine levels were significantly greater in the groups receiving twice
daily 750 mg or 1000 mg of ranolazine than in the placebo group. Frequency
of angina attacks and nitroglycerin use were also significantly reduced in
the ranolazine groups. In an editorial,ArticleBerger discusses
the role of antianginal medical therapy in an era when revascularization procedures
have become safer and increasingly durable.
Monotherapy with memantine, a low- to moderate-affinity, uncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist,
has been shown to be efficacious and safe in patients with moderate to severe
Alzheimer disease. Tariot and colleagues conducted a placebo-controlled randomized
trial among patients with moderate to severe Alzheimer disease receiving a
stable dose of donepezil to assess the efficacy and safety of combining memantine
with cholinesterase inhibitor treatment. After 24 weeks, cognitive, functional,
and global outcomes were significantly better in the memantine group than
in the placebo group.
To determine whether computer-based surveillance can reliably identify
adverse events related to medical devices, Samore and colleaguesArticlecompared computer-based surveillance with several other methods of detection
of device-related problems at a tertiary teaching hospital that had an established
computer-based system for detecting adverse drug events. Intensive surveillance
methods, including computer-based surveillance and International
Classification of Diseases, Ninth Revision discharge codes, yielded
higher rates of medical device problems than did routine voluntary incident
reporting. Few adverse medical device events were detected by more than 1
surveillance method. The overall incidence of adverse medical device events
detected by at least 1 surveillance method was 83.7 per 1000 admissions. In
an editorial,ArticleSmall considers ways to improve surveillance
techniques for capturing information on medical device safety.
Control of glycemia, blood pressure, and cholesterol levels reduces
the risk of vascular complications associated with diabetes mellitus. In this
analysis of data from the Third National Health and Nutrition Examination
Survey (NHANES III, 1988-1994) and NHANES 1999-2000, Saydah and colleagues
found that control of total cholesterol improved significantly between the
2 surveys, but not control of blood glucose levels or blood pressure. Only
7.3% of adults with diabetes in NHANES 1999-2000 attained recommended goals
for all 3 vascular disease risk factors.
In a motor vehicle crash, a car occupant could be killed if struck by
another occupant in the same car who was catapulted forward, backward, or
sideways. Cummings and Rivara analyzed data from the Fatality Analysis Reporting
System on US traffic crashes from 1988 through 2000 and found that a person's
risk of death in a motor vehicle crash was associated with the restraint use
of other occupants. Risk of death was lowest when all occupants were restrained.
"Sometimes a white coat is a security blanket . . . and a comforter."
Researchers say that an understanding at the molecular level of how
individuals respond to injury and infection has the potential to greatly improve
critical care medicine.
A meta-analysis of 30 trials assesses the safety and efficacy of arterial
puncture closing devices compared with standard manual compression in patients
undergoing coronary angiography or percutaneous vascular interventions.
A critical review of trials of putative neuroprotective therapies for
Parkinson disease examines whether the clinical and imaging end points used
in these trials measure disease progression.
Beginning in February 2004, JAMA will increase free online access
to major articles and editorials.
For your patients: Information about Parkinson disease.
This Week in JAMA. JAMA. 2004;291(3):275. doi:10.1001/jama.291.3.275