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This Week in JAMA
February 25, 2004

This Week in JAMA

JAMA. 2004;291(8):913. doi:10.1001/jama.291.8.913
Combination Therapy to Limit Infarct Size

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 approaches.

Home Blood Pressure Monitoring to Adjust Treatment

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.

Preventing Migraine With Topiramate

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.

Characteristics of Duplicate Publication

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.

A Piece of My Mind

"Poor patient-physician communication definitely leads to irritability, probably on both sides." From "Irritability (Yours and Theirs)."

Medical News & Perspectives

Use of preimplantation genetic diagnosis is raising complex ethical issues.

Ear Piercing Infections

Risks associated with ear cartilage piercing are highlighted in an investigation of Pseudomonas aeruginosa infections in clients of a piercing establishment in Oregon.

Clinician's corner

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.

Biotechnology in Medicine

Authors are invited to submit manuscripts for a theme issue about Medical Applications of Biotechnology.

JAMA Patient Page

For your patients: Information about body piercing.