Interesting Articles: A Weekly Review of the "Big Five" Medical Journals

This is a collection of articles I have found interesting in the weekly editions of the "big five" medical journals: NEJM, JAMA, Annals, Lancet and BMJ (a few more journals are included occasionally). The review is a weekly feature of Clinical Cases and Images - Blog. Please see the end of the post for a suggested time-efficient way to stay up-to-date with the medical literature.


Efficacy and tolerability of MK-0974 (telcagepant), a new oral antagonist of calcitonin gene-related peptide receptor (CGRP), compared with zolmitriptan for acute migraine.
Dr Tony W Ho et al. The Lancet, Volume 372, Issue 9656, Pages 2115 - 2123, 20 December 2008.

Calcitonin gene-related peptide (CGRP) probably has a role in migraine pathophysiology, and antagonism of its receptors might provide treatment without the vasoconstrictor effects of triptans. Telcagepant is an oral antagonist of CGRP receptor. In this study, telcagepant 300 mg was effective as an acute treatment for migraine with efficacy comparable to that of zolmitriptan 5 mg, but with fewer associated adverse effects.


Meta-analysis: Are 3 Questions Enough to Detect Unhealthy Alcohol Use?
Levente Kriston, MA; Lars Hölzel, MA; Ann-Kristin Weiser, BA; Michael M. Berner, MD; and Martin Härter, MD, PhD. Ann of Int Med, 16 December 2008 | Volume 149 Issue 12 | Pages 879-888

Both the 10-item Alcohol Use Disorders Identification Test (AUDIT) and its abbreviated 3-item version (Alcohol Use Disorders Identification Test–Consumption [AUDIT-C]) are considered to detect unhealthy alcohol use accurately. According to this meta-analysis, the full AUDIT may be superior to the AUDIT-C for identifying unhealthy alcohol use in adults.


Head and neck injury risks in heavy metal: head bangers stuck between rock and a hard bass.
Declan Patton et al. BMJ 2008;337:a2825.

An average head banging song has a tempo of about 146 beats per minute, which is predicted to cause mild head injury when the range of motion is greater than 75°. At higher tempos and greater ranges of motion there is a risk of neck injury. To minimise the risk of head and neck injury, head bangers should decrease their range of head and neck motion, head bang to slower tempo songs by replacing heavy metal with adult oriented rock, only head bang to every second beat, or use personal protective equipment.


Mortality on Mount Everest, 1921-2006: descriptive study.
Paul G Firth et al. BMJ 2008;337:a2654.

The authors examines patterns of mortality among climbers on Mount Everest over an 86 year period. Profound fatigue and late times in reaching the summit are early features associated with subsequent death.


Revisiting Duty-Hour Limits — IOM Recommendations for Patient Safety and Resident Education
John K. Iglehart. NEJM Volume 359:2633-2635 December 18, 2008 Number 25

The IOM committee struggled with tensions among its 3 objectives — improved patient safety, greater resident safety, and enhanced educational outcomes for residency training


Winter by Giuseppe Arcimboldo (1527-1593), Winter, 1573, Italian. Oil on canvas.
JAMA Cover Art.

Fruit, vegetables, wood, and leaves comprising allegorical portraits representing each of the four seasons. This JAMA cover features the winter.


A time efficient way to stay up-to-date with medical literature

"How do you eat in elephant? In small bites." The same rule probably applies to staying current with the ever expanding avalanche of medical literature. One can try the following approach:

1. Subscribe to the RSS feeds of the 5 major medical journals (NEJM, JAMA, BMJ, Lancet and Annals) plus 2-3 subpecialty journals in your field of interest.

Medical Journals tab: A screenshot of iGoogle with RSS feeds from the major medical journals.

2. Read the journal on the day it is published online, for example, NEJM on Wednesdays.

3. Use text-to-speech to listen to the articles you do not have time to read.

4. Listen to journal podcasts. Click here to subscribe the podcasts of the 4 major journals in iGoogle.

University of Oxford Journal Watch: Lighthearted Review of Medical Journals
5 Tips to Stay Up-to-Date with Medical Literature
Make Your Own "Medical Journal" with iGoogle Personalized Page
Share iGoogle Tabs with Medical Journals, Podcasts and Gadgets
Text-to-Speech Programs and Continuous Medical Education
Image source: OpenClipArt, public domain.

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