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This Week in JAMA
JAMA. 2007;297:1625.
JAMA-EXPRESS
Tilarginine in Patients With MI and Cardiogenic Shock
Cardiogenic shock in patients with acute myocardial infarction (MI) may be a consequence of systemic inflammation, expression of inducible nitric oxide synthetase (NOS), and generation of excess nitric oxide. The effect of NOS inhibition in patients with cardiogenic shock was assessed in the Tilarginine Acetate Injection in a Randomized International Study in Unstable MI Patients With Cardiogenic Shock (TRIUMPH) trial. TRIUMPH was terminated early based on a prespecified futility analysis. The TRIUMPH investigators (SEE ARTICLE) report that in the 398 patients who were enrolled and randomly assigned to infusion of tilarginine or placebo, there were no differences in 30-day all-cause mortality, resolution of shock, or duration of shock; New York Heart Association functional class; or 6-month mortality rates. In an editorial, Ndrepepa and colleagues (SEE ARTICLE) discuss possible reasons tilarginine was not associated with improved outcomes in this clinical trial.
Dialysis Facility Ownership and Epoetin Dosing
Medicare reimbursement of epoetin for patients undergoing dialysis is based on the amount of drug administered, and between 1991 and 2005 the mean dose of epoetin increased approximately 4-fold. Thamer and colleagues (SEE ARTICLE) hypothesized that dialysis facility organizational status influences epoetin dosing patterns, and they tested their hypothesis in an analysis of data from Medicare-eligible patients with end-stage renal disease. The authors found that compared with patients treated in nonprofit dialysis facilities, patients treated in large, for-profit and chain-affiliated dialysis facilities received higher doses of epoetin regardless of hemoglobin levels. In an editorial, Coyne (SEE ARTICLE) discusses anemia management in patients with end-stage renal disease and the financing of epoetin therapy.
JAMA-EXPRESS
Reconstituted HDL Infusions and Atherosclerosis
Preliminary data have suggested that infusion of reconstituted high-density lipoprotein (HDL) cholesterol induces regression of coronary atherosclerosis. In the Effect of rHDL on Atherosclerosis-Safety and Efficacy (ERASE) trial, patients with a recent history of acute coronary syndromes and at least 1 narrowing of at least 20% on coronary angiography were randomly assigned to receive 4 weekly infusions of either reconstituted HDL or placebo. A target artery was assessed with intravenous ultrasound at baseline and 2 to 3 weeks after the last study infusion. Tardif and colleagues, writing for the ERASE investigators, report that compared with placebo, reconstituted HDL infusions did not reduce target vessel atheroma volume but did result in statistically significant improvements in the plaque characterization index and coronary score on quantitative coronary angiography.
(SEE ARTICLE)
Efficacy and Risk of Pediatric Antidepressant Therapy
Bridge and colleagues conducted a meta-analysis of data from randomized clinical trials of second-generation antidepressants for patients younger than 19 years with major depressive disorder (MDD), obsessive-compulsive disorder (OCD), or non-OCD anxiety disorders. The authors found that compared with placebo, antidepressant medications were efficacious in the 3 disorders, with the strongest effect in anxiety disorders, an intermediate effect in OCD, and a modest effect in MDD. Although the risks of suicidal ideation/suicide attempt were higher in patients taking antidepressants vs placebo, the differences were not statistically significant.
(SEE ARTICLE)
A Piece of My Mind
"You feel the rage that William Carlos Williams must have felt when trying to pry open the mouth of that little girl with the gray veil of diphtheria over her tonsils." From "Holding."
(SEE ARTICLE)
Medical News & Perspectives
Early data support the efficacy of mental health courts, judicial bodies that divert individuals with mental illnesses from the criminal justice system to treatment.
(SEE ARTICLE)
CLINICIAN'S CORNER
Acupuncture for Knee Pain
Clinical Crossroads
Mrs A, a physically active and healthy 60-year-old woman, is considering acupuncture for chronic, progressive knee pain. Berman discusses the effectiveness of acupuncture compared with other nonpharmacological and pharmacological treatments of knee osteoarthritis.
(SEE ARTICLE)
Emergency Preparedness
Critical components of public health emergency preparedness are not resolved by the Pandemic and All-Hazards Preparedness Act.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about knee pain.
(SEE ARTICLE)
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