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This Week in JAMA
June 15, 2005

This Week in JAMA

JAMA. 2005;293(23):2831. doi:10.1001/jama.293.23.2831
Mechanical Reperfusion and Acute STEMI

Schömig and colleaguesArticle report results of a clinical trial that enrolled patients with acute ST-segment elevation myocardial infarction (STEMI), diagnosed 12 to 48 hours after symptom onset and without persistent symptoms, and randomly assigned them to either coronary stenting with adjunctive use of abciximab or conventional noninvasive treatment. The investigators found that final left ventricular infarct size was significantly smaller and risks of death, recurrent myocardial infarction, or stroke at 30 days were similar in patients who received the invasive strategy compared with patients receiving noninvasive treatment. In an editorial, Gibbons and GrinesArticle urge prompt treatment of all patients with STEMI rather than liberal adoption of an urgent invasive strategy.

Adolescent Weight Management With Orlistat

In a randomized controlled trial to assess the effect of orlistat vs placebo, combined with diet, exercise, and behavioral therapy, in the treatment of obese adolescents, Chanoine and colleaguesArticle found that adolescents who received orlistat had a greater reduction in body mass index compared with those receiving placebo at the 1-year study’s conclusion. In an editorial, JoffeArticle discusses the need for safe, comprehensive, and individualized treatment of adolescent obesity.

Fish Oil Supplements and Cardiac Arrhythmia

A diet high in omega-3 polyunsaturated fatty acids (omega-3 PUFAs) has been associated with a lower risk of sudden cardiac death, and it has been hypothesized that omega-3 PUFAs may have antiarrhythmic properties. Raitt and colleaguesArticle randomly assigned patients receiving an implantable cardioverter defibrillator (ICD) to either a fish oil supplement or a placebo and assessed the time to first ICD treatment of ventricular tachycardia or ventricular fibrillation (VT/VF). They found no evidence that fish oil supplementation reduced the risk of VT/VF, with some data suggesting fish oil intake may increase the risk in these patients.

Apolipoprotein E and Chronic Kidney Disease

Apolipoprotein E (APOE) allelic variations are implicated in diabetic nephropathy, but whether these are associated with other forms of chronic kidney disease is not known. Hsu and colleaguesArticle assessed the risk of chronic kidney disease progression associated with APOE in a population-based cohort and found a moderately increased risk with the ε2 allelic variation and a decreased risk with variant ε4, independent of diabetes, race, and lipid and nonlipid risk factors.

QIOs and Quality of Care

In a retrospective review of medical records in 5 states, Snyder and AndersonArticle compared quality of care in hospitals voluntarily participating with Medicare quality improvement organizations (QIOs) with quality of care in nonparticipating hospitals. They found that participating hospitals showed no greater improvement than nonparticipating hospitals on 14 of 15 quality indicators targeted by the QIOs.

Invasive Strategies in Acute Coronary Syndromes

In a meta-analysis of data from trials comparing outcomes following routine early invasive vs selective (conservative) invasive strategies in patients with acute coronary syndromes (ACS), Mehta and colleaguesArticle found that a routine invasive strategy was superior to a conservative approach in reducing myocardial infarction, severe angina, and rehospitalization but carried a higher risk of early mortality. In an editorial, BhattArticle discusses optimal care of patients with ACS.

A Piece of My Mind

“I must find something personal, something fully human about this stranger; something that will make it possible to yield to his plan . . . to voluntarily place my heart, my life in his hands.” From “Informed Consent.”

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Medical News & Perspectives

Advances in brain imaging are allowing researchers to visualize “pain memories,” the changes that occur in the brain due to pain, revealing how physiological and behavioral therapies may offer patients relief.

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CLINICIAN’S CORNER

Contempo Updates

A review of susceptibility testing for malignant hyperthermia.

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Heritability of Recurrent Tonsillitis

From the Archives Journals

Results of a survey of twins reported in the Archives of Otolaryngology–Head & Neck Surgery suggest a genetic predisposition for recurrent tonsillitis.

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Clinical Trial Registration

A statement from the International Committee of Medical Journal Editors.

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JAMA Patient Page

For your patients: Information about malignant hyperthermia.

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