0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
This Week in JAMA |

This Week in JAMA FREE

JAMA. 2007;298(10):1129. doi:10.1001/jama.298.10.1129.
Text Size: A A A
Published online

EFFECTS OF HOMOCYSTEINE LOWERING IN RENAL DISEASE

High homocysteine levels are a risk factor for vascular complications and mortality in patients with chronic and end-stage renal disease. In a randomized placebo-controlled trial, Jamison and colleagues Article investigated whether treatment to lower homocysteine levels with a combination of high-dose folic acid and vitamins B6 and B12 is associated with a reduction in mortality, cardiovascular events, or amputations in patients with advanced renal disease. The authors report significant reductions in homocysteine levels among patients in the intervention group but no improvement in all-cause survival or incidence of vascular disease compared with patients receiving placebo. In an editorial, Baigent and Clarke Article discuss the evidence linking elevated homocysteine levels to vascular disease risk and possible reasons that reductions in homocysteine levels have not been associated with improved outcomes.

CARVEDILOL IN PEDIATRIC HEART FAILURE

In the prospective, randomized Pediatric Carvedilol Study, investigators assessed the effect of adding carvedilol vs placebo to conventional treatment of children and adolescents with symptomatic systolic heart failure. Shaddy and colleagues Article writing for the trial investigators report that in contrast to the documented benefits of β-blockers in adults with heart failure, there was no significant difference in a composite measure of heart failure outcomes between the children and adolescents randomly assigned to carvedilol vs placebo. In an editorial, Gidding Article discusses the importance of clinical trials in pediatric cardiology and lessons from this study for the design of future investigations.

THIAZOLIDINEDIONES AND CARDIOVASCULAR EVENT RISKS

The thiazolidinediones pioglitazone and rosiglitazone are effective in improving glycemic control among patients with type 2 diabetes mellitus, but recent evidence has suggested a possible increased risk of cardiovascular events associated with these drugs. Two articles in this issue provide additional data to assess these risks. Lincoff and colleagues Article analyzed pooled data from 19 randomized clinical trials of pioglitazone and found that compared with patients receiving placebo or a comparator drug, patients who received pioglitazone had a significantly lower risk of death, myocardial infarction, or stroke but experienced an increased risk of serious heart failure. Singh and colleagues Article analyzed pooled data from 4 randomized trials of rosiglitazone and found that patients receiving rosiglitazone for at least 12 months had a significantly increased risk of myocardial infarction and heart failure compared with patients receiving a placebo or comparator drug. In an editorial, Solomon and Winkelmayer Article discuss these findings in the context of measures to improve drug safety.

CLINICIAN'S CORNER

Perspectives on Care at the Close of Life

Mr Q, a 50-year-old man with metastatic esophageal cancer treated with palliative chemotherapy, was admitted to the hospital with intractable nausea and vomiting. Wood and colleagues discuss the pathophysiology of intractable nausea and vomiting and present a mechanism-based approach to the evaluation and treatment of this symptom complex.

A PIECE OF MY MIND

“Perhaps it is reverence for knowledge that has fostered so many of my happy years of teaching medicine.” From “On Knowledge.”

MEDICAL NEWS & PERSPECTIVES

Evidence that electroconvulsive therapy is an effective and safe treatment for severe major depression is helping to overcome inaccurate perceptions of the technique that have stigmatized its use.

APPLYING TRIAL DATA TO INDIVIDUALS

Multivariate risk-stratified analysis of clinical trial data can identify important treatment differences among patients with varying levels of baseline risk.

AUTHOR IN THE ROOM TELECONFERENCE

Join Douglas R. Lowy, MD, on September 19 from 2 to 3 PM eastern time to discuss human papillomavirus vaccine among young women with preexisting infection. To register, go to http://www.ihi.org/AuthorintheRoom.

AUDIO COMMENTARY

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

JAMA PATIENT PAGE

For your patients: Information about chronic kidney disease.

Tables

References

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

942 Views
0 Citations

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
×