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This Week in JAMA
May 19, 2004

This Week in JAMA

JAMA. 2004;291(19):2285. doi:10.1001/jama.291.19.2285
Complement Inhibition in Cardiac Surgery

Inflammation is associated with perioperative myocardial infarction (MI) and mortality following coronary artery bypass graft (CABG) surgery, but it is not known whether pharmacologic intervention to block proinflammatory physiologic responses might improve CABG surgery outcomes. Verrier and colleagues report results of a randomized, placebo-controlled trial of pexelizumab, an inhibitor of complement activation, in patients undergoing CABG surgery. For their primary end point of death or MI within 30 days of CABG surgery (without concomitant valve surgery), the authors found a nonstatistically significant benefit of pexelizumab compared with placebo. In analyses examining reductions in risk for all CABG surgery patients and for the risk of perioperative MI alone, pexelizumab was superior to placebo.

Preventing Contrast-Induced Nephropathy

Cases of acute renal failure from ischemia and from radiographic contrast are believed to have similar origins, and in animal models of ischemic renal failure, pretreatment with sodium bicarbonate appears to be protective. However, whether sodium bicarbonate might prevent contrast-induced nephropathy has not been determined. Merten and colleaguesArticleconducted a randomized trial in which patients with renal insufficiency received either sodium chloride or sodium bicarbonate infusions before and after procedures involving radiocontrast. The investigators found a significantly reduced risk of contrast-induced nephropathy in patients receiving sodium bicarbonate hydration. In an editorial,ArticleChertow reviews prior strategies to prevent contrast-induced nephropathy and the demonstrated benefits of sodium bicarbonate.

Recovery After Hematopoietic Cell Transplantation

Hematopoietic cell transplantation (HCT) can be curative for some patients with leukemia and lymphoma, but factors predicting the time course of physical and emotional recovery after HCT have not been well defined. Syrjala and colleagues assessed physical limitations, mental health, and return to work in a 5-year, longitudinal follow-up of patients undergoing HCT. They found that only 19% of patients had recovered within the first year, and most patients required 3 to 5 years to recover. Greater social support and experience with cancer treatment before HCT were associated with a more rapid recovery. Those who were depressed before HCT had a longer recovery time.

Pharmacy Benefits and Use of Prescribed Drugs

Increasing pharmacy co-payments is one way health plans have responded to the increase in expenditures for drugs, but it is not known how changes in cost-sharing affect the use of commonly prescribed drugs. Goldman and colleagues analyzed pharmacy claims data and health plan benefits to examine the relationship of rising co-payments with drug use. They found that a doubling of the copayment resulted in significant reductions in the use of drugs in 8 common therapeutic drug classes. The greatest reductions were seen for possibly "nonessential" nonsteroidal anti-inflammatory drugs and antihistamines and drugs with an over-the-counter substitute.

Declines in Hepatitis B Vaccination

For a 2-month period in 1999, it was recommended that the usual birth dose of hepatitis B vaccine be delayed until 2 to 6 months of age. Using data from the National Immunization Survey for children born before, during, and after the birth-dose vaccination suspension, Luman and colleagues assessed the effect of this change in vaccine administration on hepatitis—and overall pediatric—vaccination coverage. They found a significant decline in the proportion of infants who received the hepatitis B vaccine at birth and who completed the 3-dose series by age 19 months, beginning during the suspension period and persisting after the suspension was lifted but no declines in other recommended vaccinations.

Medical News & Perspectives

Some chemical modifications to an individual's DNA can silence genes that normally safeguard against cancer. Scientists are exploring how to shut down cancer cells by awakening these silenced genes.

Clinician's corner

Clinical Review

Intravenous immunoglobulin (IVIG) is effective in treating many autoimmune neuromuscular diseases.

Enhancing Participatory Decision Making

The Patient-Physician Relationship

Methods for communicating clinical evidence to enhance patient participation in care decisions are discussed.

Benefits of Early Cochlear Implantation

From the Archives Journals

Improvements in speech and language development in children undergoing early cochlear implant placement are reported on in the Archives of Otolaryngology–Head & Neck Surgery.

JAMA Patient Page

For your patients: Information about cochlear implants.