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This Week in JAMA
JAMA. 2004;291:275.
Ranolazine Added to Standard Antianginal Therapy
Ranolazine is a new type of antianginal drug that generates more adenosine triphosphate for each molecule of oxygen consumed by increasing glucose oxidation through partial inhibition of fatty acid oxidation. Chaitman and colleagues (SEE ARTICLE) conducted a randomized trial among patients with symptomatic chronic angina despite standard doses of atenolol, amlodipine, or diltiazem to assess the antianginal effects of ranolazine when added to background antianginal therapy. Increases in treadmill exercise duration from baseline at trough ranolazine levels were significantly greater in the groups receiving twice daily 750 mg or 1000 mg of ranolazine than in the placebo group. Frequency of angina attacks and nitroglycerin use were also significantly reduced in the ranolazine groups. In an editorial, (SEE ARTICLE) Berger discusses the role of antianginal medical therapy in an era when revascularization procedures have become safer and increasingly durable.
Memantine Plus Donepezil for Alzheimer Disease
Monotherapy with memantine, a low- to moderate-affinity, uncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, has been shown to be efficacious and safe in patients with moderate to severe Alzheimer disease. Tariot and colleagues conducted a placebo-controlled randomized trial among patients with moderate to severe Alzheimer disease receiving a stable dose of donepezil to assess the efficacy and safety of combining memantine with cholinesterase inhibitor treatment. After 24 weeks, cognitive, functional, and global outcomes were significantly better in the memantine group than in the placebo group.
(SEE ARTICLE)
Surveillance of Medical Device–Related Adverse Events
To determine whether computer-based surveillance can reliably identify adverse events related to medical devices, Samore and colleagues (SEE ARTICLE) compared computer-based surveillance with several other methods of detection of device-related problems at a tertiary teaching hospital that had an established computer-based system for detecting adverse drug events. Intensive surveillance methods, including computer-based surveillance and International Classification of Diseases, Ninth Revision discharge codes, yielded higher rates of medical device problems than did routine voluntary incident reporting. Few adverse medical device events were detected by more than 1 surveillance method. The overall incidence of adverse medical device events detected by at least 1 surveillance method was 83.7 per 1000 admissions. In an editorial, (SEE ARTICLE) Small considers ways to improve surveillance techniques for capturing information on medical device safety.
Vascular Disease Risk Factors in Adults With Diabetes
Control of glycemia, blood pressure, and cholesterol levels reduces the risk of vascular complications associated with diabetes mellitus. In this analysis of data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) and NHANES 1999-2000, Saydah and colleagues found that control of total cholesterol improved significantly between the 2 surveys, but not control of blood glucose levels or blood pressure. Only 7.3% of adults with diabetes in NHANES 1999-2000 attained recommended goals for all 3 vascular disease risk factors.
(SEE ARTICLE)
Restraint Use and Car Occupant Death in Crashes
In a motor vehicle crash, a car occupant could be killed if struck by another occupant in the same car who was catapulted forward, backward, or sideways. Cummings and Rivara analyzed data from the Fatality Analysis Reporting System on US traffic crashes from 1988 through 2000 and found that a person's risk of death in a motor vehicle crash was associated with the restraint use of other occupants. Risk of death was lowest when all occupants were restrained.
(SEE ARTICLE)
A Piece of My Mind
"Sometimes a white coat is a security blanket . . . and a comforter." From "Stitches."
(SEE ARTICLE)
Medical News & Perspectives
Researchers say that an understanding at the molecular level of how individuals respond to injury and infection has the potential to greatly improve critical care medicine.
(SEE ARTICLE)
Arterial Puncture Closing Devices
A meta-analysis of 30 trials assesses the safety and efficacy of arterial puncture closing devices compared with standard manual compression in patients undergoing coronary angiography or percutaneous vascular interventions.
(SEE ARTICLE)
CLINICIAN'S CORNER
Neuroprotection in Parkinson Disease
A critical review of trials of putative neuroprotective therapies for Parkinson disease examines whether the clinical and imaging end points used in these trials measure disease progression.
(SEE ARTICLE)
Access to JAMA Content Online
Beginning in February 2004, JAMA will increase free online access to major articles and editorials.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about Parkinson disease.
(SEE ARTICLE)
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