{"id":21,"date":"2006-10-26T14:49:28","date_gmt":"2006-10-26T13:49:28","guid":{"rendered":"http:\/\/resource.bmj.com\/bmj\/2006\/10\/26\/jama-18-oct-2006\/"},"modified":"2006-10-26T14:49:28","modified_gmt":"2006-10-26T13:49:28","slug":"jama-18-oct-2006","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2006\/10\/26\/jama-18-oct-2006\/","title":{"rendered":"JAMA 18 Oct 2006"},"content":{"rendered":"<p><a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/15\/1851\">Coronary artery bypass grafting<\/a><strong> <\/strong>has become the commonest major  surgical procedure in the developed world. But since it tends to be needed most  in people who are old, have smoked, got fat, and\/or become diabetic, there is a  sizeable risk of <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/15\/1851\"> post-operative pulmonary complications<\/a>. A team from Utrecht sensibly <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/15\/1851\"> wondered<\/a> if these might be reduced by training the least fit to breathe  properly by the use of <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/15\/1851\"> preoperative intensive inspiratory muscle training<\/a>.<!--more--> They <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/15\/1851\"> demonstrate<\/a> that this intervention cuts post-operative pneumonia by more  than half, and the average hospital stay by a day. Maybe some hospital trusts  will decide it is cost-effective, unless they have already sacked all their  respiratory physiotherapists.<\/p>\n<p>You can\u2019t do medicine without <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/15\/1858\"> poisoning people<\/a>, though you can try to reduce the risk of <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/15\/1858\"> adverse drug events<\/a><strong> <\/strong>(ADEs), or adverse drug reactions (ADRs) as we  tend to call them over here. This <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/15\/1858\"> survey<\/a> looks at 21 298 ADEs presenting to US emergency departments and gives  an excellent general overview of the classes of drug and the kinds of reaction.  Insulin and warfarin provide the biggest problems, as you\u2019d expect.<\/p>\n<p>Like childhood cancer, <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/15\/1867\"> dilated cardiomyopathy in children<\/a><strong> <\/strong>strikes randomly, and a proportion  of it may be caused by viruses. A predisposing condition can only be identified  in a third of cases, and of these, half have myocarditis. Overall, 31% die  within a year (or, rarely, get transplanted); at five years, the figure is 46%.  (Commercial plug: for a discussion of the issues around the care of children and  young people dying from heart failure, see the excellent chapter by Hayley Pryse-Hawkins  in <em>Heart Failure and Palliative Care <\/em>eds. Johnson and Lehman, Radcliffe  2006).<\/p>\n<p>Should we <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/15\/1885\"> eat fish<\/a>?<strong> <\/strong>You betcha. Especially with large quantities of dairy-based  sauces, in case people suspect you of being a <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/15\/1885\"> health<\/a><strong> <\/strong>freak.<strong> <\/strong>Dover sole with<strong> <\/strong><em>b\u00e9arnaise<\/em>; skate  in black butter; turbot with cream and sorrel; trout with buttered <em>c\u00e8pes<\/em>; <em>Matjesfilets <\/em>of salted raw herring with heaps of sour cream: the list is  as wide as the ocean. Warning: may contain traces of <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/15\/1885\"> methylmercury<\/a>. This rather dour  <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/15\/1885\"> clinical review<\/a><em> <\/em>(\u201cevaluating the risks and the benefits<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Coronary artery bypass grafting has become the commonest major surgical procedure in the developed world. But since it tends to be needed most in people who are old, have smoked, [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2006\/10\/26\/jama-18-oct-2006\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38363,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[111],"tags":[],"class_list":["post-21","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-lehmans-weekly-review-of-medical-journals"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>JAMA 18 Oct 2006 - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2006\/10\/26\/jama-18-oct-2006\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"JAMA 18 Oct 2006 - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Coronary artery bypass grafting has become the commonest major surgical procedure in the developed world. But since it tends to be needed most in people who are old, have smoked, [...]More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmj\/2006\/10\/26\/jama-18-oct-2006\/\" \/>\n<meta property=\"og:site_name\" content=\"The BMJ\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/bmjdotcom\/\" \/>\n<meta property=\"article:published_time\" content=\"2006-10-26T13:49:28+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/richard-lehman.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"540\" \/>\n\t<meta property=\"og:image:height\" content=\"350\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:site\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2006\\\/10\\\/26\\\/jama-18-oct-2006\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2006\\\/10\\\/26\\\/jama-18-oct-2006\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"JAMA 18 Oct 2006\",\"datePublished\":\"2006-10-26T13:49:28+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2006\\\/10\\\/26\\\/jama-18-oct-2006\\\/\"},\"wordCount\":351,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2006\\\/10\\\/26\\\/jama-18-oct-2006\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2017\\\/02\\\/richard-lehman.jpg\",\"articleSection\":[\"Richard Lehman's weekly review of medical journals\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2006\\\/10\\\/26\\\/jama-18-oct-2006\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2006\\\/10\\\/26\\\/jama-18-oct-2006\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2006\\\/10\\\/26\\\/jama-18-oct-2006\\\/\",\"name\":\"JAMA 18 Oct 2006 - 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