Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (on-pump CABG) is associated with excellent long-term cardiac outcomes. However, on-pump CABG is associated with an increased risk of cognitive decline, and the effect of avoiding cardiopulmonary bypass (off-pump CABG) on long-term cognitive and cardiac outcomes is not known. In this issue of JAMA, van Dijk and colleagues report 5-year cardiac and cognitive outcomes for patients enrolled in the Octopus Study, in which low-risk CABG patients were randomly assigned to undergo either on-pump or off-pump CABG surgery. The study investigators found that avoiding cardiopulmonary bypass had no effect on 5-year cognitive decline or cardiovascular events, angina, or quality of life.
Identification of modifiable risk factors for atrial fibrillation (AF) could help reduce its associated morbidity and mortality. Mitchell and colleagues hypothesized that increased pulse pressure may be a risk factor for new-onset AF and tested their hypothesis using data from the Framingham Heart Study. In an analysis of the relationship of pulse pressure measured at baseline to new-onset AF, the authors found that elevated pulse pressure was an important risk factor for incident AF. The authors report a cumulative 20-year AF incidence rate of 5.6% for baseline pulse pressure of 40 mm Hg or lower (25th percentile) and 23.3% for baseline pulse pressure higher than 61 mm Hg (75th percentile).
The stage theory of grief posits that adjustment to loss progresses through the distinct stages of disbelief, yearning, anger, depression, and acceptance. Despite a lack of empirical testing, the theory has received widespread support. Maciejewski and colleagues analyzed data from a longitudinal, community-based sample of bereaved family members to assess the relative magnitudes and patterns of change over time in these 5 grief indicators and their consistency with stage theory. The authors found that acceptance and yearning were the most commonly endorsed responses to loss and that each grief response appeared to peak in the sequence specified by the stage theory.
Scott and Gretch review current molecular diagnostic tests for hepatitis C virus infection and the use of these tests to select appropriate treatment and predict the likelihood of virological response.
The January and February 2007 issues of the Archives of Ophthalmology are theme issues on ophthalmic genetics. Sieving and Collins discuss research findings, potential therapies, and advances in genetic testing reported in these 2 issues of the Archives.
While off-label drug prescribing is appropriate for treating many conditions, a number of challenges—from deciphering clinical data to overcoming reimbursement hurdles—can complicate the practice.
Ethics and regulation of biomedical research involving prisoners.
Benefits and limitations of pay-for-performance programs and opportunities for reform.
A “Peace Corps for Health” as part of a new US response to the global HIV/AIDS crisis.
Join Paul M Ridker, MD, March 21, 2007, from 2 to 3 PM eastern time to discuss an algorithm to assess global cardiovascular risk in women. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
For your patients: Information about hepatitis C.
This Week in JAMA . JAMA. 2007;297(7):673. doi:10.1001/jama.297.7.673