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This Week in JAMA
JAMA. 2002;287:3173.
JAMA-EXPRESS
Fluvastatin for Prevention of Cardiac Events After PCI
Most patients who undergo percutaneous coronary intervention (PCI) experience short-term improvement in ischemic symptoms, but three fifths of patients at 5 years and only a third of patients at 10 years remain free of major adverse cardiac events. Serruys and colleagues (SEE ARTICLE) conducted a randomized controlled trial to determine whether lipid-lowering therapy with fluvastatin initiated within days after successful completion of a first PCI would improve cardiac disease–free survival among patients with average cholesterol levels. After a median follow-up of 3.9 years, survival time free of major adverse cardiac events was significantly longer among patients who received fluvastatin than among patients who received placebo. In an editorial, Sopko (SEE ARTICLE) reviews the biological mechanisms underlying restenosis following PCI, and discusses mechanisms by which statin therapy might help to prevent this complication.
Antioxidant Intake and Risk of Alzheimer Disease
Evidence suggests that oxidative stress may be important in the pathogenesis of Alzheimer disease (AD). Two prospective studies in this issue of THE JOURNAL investigated whether dietary intake of antioxidants is associated with risk of AD. In the Rotterdam Study, a population-based study of individuals aged 55 years or older at baseline, Engelhart and colleagues (SEE ARTICLE) found that high intake of vitamin C and vitamin E from food was associated with lower risk of incident AD after a mean follow-up of 6 years, although statistical significance of the association was borderline. Morris and colleagues (SEE ARTICLE) , in the Chicago Health and Aging Project study of individuals aged 65 years or older, found that high intake of vitamin E from food was associated with reduced risk of AD after a mean follow-up of 3.9 years, but only among individuals without the APOE  4 allele. Intake of vitamin E, vitamin C, and beta carotene from supplements, however, was not significantly associated with risk of AD. In an editorial, Foley and White (SEE ARTICLE) discuss several methological issues that must be considered in observational studies evaluating whether antioxidant vitamin intake reduces the risk of AD.
NPPV and Prevention of Reintubation
Noninvasive positive-pressure ventilation (NPPV) has been shown to prevent the need for endotracheal intubation in patients with acute respiratory failure. In this randomized controlled trial, Keenan and colleagues evaluated whether NPPV would reduce the rate of endotracheal reintubation in high-risk patients who develop respiratory distress during the first 48 hours after extubation compared with standard medical therapy. The rate of reintubation in the NPPV group was not significantly different from that in the standard medical therapy group. Hospital mortality, duration of mechanical ventilation, or length of hospital or ICU stay were also not significantly different.
(SEE ARTICLE)
Evaluation of Antivaccination Web Sites
Wolfe and colleagues used an Internet metasearch program to identify Web sites that oppose childhood vaccinations and evaluated the content of these sites using a standardized instrument to assess antivaccination claims and other attributes. Twelve antivaccination Web sites were identified. All of these sites claimed that vaccines cause idiopathic illness and provided links to other antivaccination sites. More than 90% of the sites claimed that adverse vaccine reactions are underreported, that vaccines erode immunity, and that vaccination policy is motivated by profit. More than half provided information for legally avoiding immunizations.
(SEE ARTICLE)
A Piece of My Mind
"I have been forced to confront my own feelings about crime and punishment and working with men who have committed barbaric, heinous crimes but who are also human." From "Dead Man Talking."
(SEE ARTICLE)
Contempo Updates
Pathogenesis and management of preeclampsia.
(SEE ARTICLE)
Medical News & Perspectives
An eagerly awaited report on macroeconomics and health, presented at this year's World Health Assembly in Geneva, clearly defines the urgent need for rich countries to help poor ones improve their prevention and treatment of disease.
(SEE ARTICLE)
CLINICIAN'S CORNER
A 23-Year-Old Man With Schizophrenia
Clinical Crossroads
Mr X is a 23-year-old man who began treatment for paranoid schizophrenia with clozapine at age 18 years early in the course of his illness. His second hospitalization for an episode of acute paranoid schizophrenia occurred 2 months ago after he began using ecstasy, cocaine, and alcohol and discontinued his medication. Goff discusses diagnostic criteria for schizophrenia and the epidemiology, course, pathophysiology, and treatment of this condition.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about intensive care units.
(SEE ARTICLE)
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