The best pharmacologic strategy to prevent progression of acute myocardial
infarction (AMI) in patients awaiting percutaneous coronary intervention (PCI)
is not clear. Kastrati and colleaguesArticle conducted an open-label,
randomized trial of patients with AMI to determine whether a combined regimen
of abciximab—an antiplatelet agent—plus reteplase—a fibrinolytic
agent—prior to PCI would result in less myocardial damage than that
with abciximab alone. Several hours after drug administration, patients receiving
combination therapy had superior blood flow through the involved vessel, but
final infarct size did not differ between the 2 groups. In an editorial,
LincoffArticle discusses pharmacologic and interventional therapies for
myocardial preservation and the benefits and risks of combining the 2
The value of self-measured, home blood pressure monitoring to adjust
hypertension treatment is not known. Staessen and colleagues randomized patients
with diastolic hypertension to either multiple daily home measurements for
a week or physician office measurement. Results were reviewed at bimonthly
office visits and treatment adjustments were made by a physician blinded to
study assignment. After a year of follow-up, patients monitoring at home were
more likely to have stopped antihypertensive medications, incurring slightly
lower hypertension-related health care costs. The 2 groups experienced no
differences in left ventricular mass or overall feelings of well-being, but
the home-monitored patients had higher systolic and diastolic measurements
at study end.
Results of several open-label and small, placebo-controlled studies
suggest that the antiepileptic drug topiramate may be effective in preventing
migraine headaches. Brandes and colleagues conducted a randomized controlled
trial testing topiramate in patients experiencing an average of 3 to 12 migraines
a month. They found that compared with patients receiving placebo, patients
receiving either 100 or 200 mg/d of topiramate experienced a significant reduction
in migraine frequency within the first month of treatment and had no loss
of effect over the 26-week study; they also experienced significantly fewer
days of migraine per month and required less rescue medication. Paresthesia,
nausea, and fatigue were the most frequently reported adverse events, leading
some patients to drop out of the study.
Duplicate publications are articles with substantially similar content,
but little is known about specific characteristics of these published articles.
von Elm and colleagues systematically reviewed articles in the analgesia and
anesthesia literature to categorize patterns of duplicate publication and
to describe characteristics of publication, including journal impact factor,
citation rates, and the time elapsed between publication of a duplicate and
its main article. Six categories of duplicate publication were identified;
duplicates were published in journals with slightly lower impact factors and
an average of a year after publication of the main article, but duplicates
and main articles had comparable citation rates.
"Poor patient-physician communication definitely leads to irritability,
probably on both sides." From "Irritability (Yours and Theirs)."
Use of preimplantation genetic diagnosis is raising complex ethical
Risks associated with ear cartilage piercing are highlighted in an investigation
of Pseudomonas aeruginosa infections in clients of
a piercing establishment in Oregon.
Part 1Article of this 2-part article reviews factors
associated with urinary incontinence in women and various treatment options.
Part 2Article details patient assessment and treatment concerns
through discussion of 2 illustrative cases.
Authors are invited to submit manuscripts for a theme issue about Medical
Applications of Biotechnology.
For your patients: Information about body piercing.
This Week in JAMA. JAMA. 2004;291(8):913. doi:10.1001/jama.291.8.913