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Surgeons’ Dispatch from Cange, Haiti
With most of the hospitals in the capital city devastated by the earthquake, a rural clinic in Cange has become a destination of choice for people injured in the capital. Dr. Stephen Sullivan and colleagues describe their experience providing surgical care at the Cange hospital.
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 February 3, 2010 (DOI: 10.1056/NEJMp1000976)
Coordinating and Prioritizing Aid in Haiti
Dr. Louise Ivers and Kimberly Cullen from Partners in Health argue that there is a critical need for disaster-relief organizations on the ground in Haiti to coordinate efforts, both during this acute phase of the response and moving forward.
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February 3, 2010 (DOI: 10.1056/NEJMpv1001326)
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Risking Big Changes with Small Reforms
Seemingly modest reforms could profoundly alter the health care system, warns Stuart Butler.
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 February 3, 2010 (DOI: 10.1056/NEJMp1001054)
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Giving Teeth to Comparative-Effectiveness Research — The Oregon Experience
In 1989, the state of Oregon set out to develop an evidence-based coverage policy that would allay concerns over “rationing” of health care. Dr. Somnath Saha and colleagues describe Oregon’s prioritized list of health care services.
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February 3, 2010 (DOI: 10.1056/NEJMp0912938)
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Medicare and Medical Technology — The Growing Demand for Relevant Outcomes
In deciding whether to pay for new medical technologies, the Centers for Medicare and Medicaid Services is becoming more specific about its requirements for evidence of improved health outcomes. Drs. Peter Neumann and Sean Tunis describe the benefits of this shift.
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Published Online January 20, 2010 (DOI: 10.1056/NEJMp0912062)
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Withholding Information from Patients — When Less Is More
Drs. Ronald Epstein, David Korones, and Timothy Quill reflect on the circumstances in which physicians consciously (and sometimes unconsciously) withhold from patients information about their conditions, treatments, and outcomes. They write that the right to autonomy must be balanced with the ethical obligations to do good for patients and not to harm them.
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Launching HITECH
In the last days of 2009, the government took several critical steps toward a nationwide and secure electronic health information system. Dr. David Blumenthal, National Coordinator for Health Information Technology, describes the key elements of the HITECH Act.
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Published Online December 30, 2009 (DOI: 10.1056/NEJMp0912825)
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Comparative Effectiveness and Health Care Spending — Implications for Reform
The authors argue that health care costs can be reduced without a negative effect on quality by reducing spending on interventions that are not cost-effective.
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Published Online January 6, 2010 (DOI: 10.1056/NEJMsb0911104)
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Jet Lag
A 55-year-old physician is planning a trip from Los Angeles to London to attend a scientific conference. He wants to know what he can do to avoid jet lag. What would you advise?
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Under Pressure
A 25-year-old woman with a 2-year history of progressive shortness of breath presented to her local hospital with dyspnea.
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Willful Modulation of Brain Activity in Disorders of Consciousness
In patients in a vegetative or minimally conscious state, the use of functional MRI to assess responses during mental-imagery tasks showed that 5 patients were able to willfully modulate their brain activation. These findings suggest that functional MRI can be used to demonstrate evidence of awareness and cognition that cannot be detected by means of clinical assessment.
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February 3, 2010 (DOI: 10.1056/NEJMoa0905370)
Related Editorial: Cogito Ergo Sum by MRI
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Placebo-Controlled Study of Oral Fingolimod in Relapsing Multiple Sclerosis
In patients with relapsing–remitting multiple sclerosis, oral fingolimod reduced the rates of relapse and disability progression, as compared with placebo. Adverse events included bradycardia, atrioventricular conduction block, macular edema, elevations in liver-enzyme levels, and mild hypertension.
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Published Online January 20, 2010 (DOI: 10.1056/NEJMoa0909494)
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Oral Fingolimod or Intramuscular Interferon for Relapsing Multiple Sclerosis
In patients with relapsing–remitting multiple sclerosis, oral fingolimod was more effective than intramuscular interferon beta-1a in reducing relapse rates. Adverse events included herpesvirus infections (two fatal infections), atrioventricular block, macular edema, skin cancer, and liver-enzyme elevation.
Published Online January 20, 2010 (DOI: 10.1056/NEJMoa0907839)
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Cladribine or Placebo for Relapsing Multiple Sclerosis
Oral cladribine reduced relapse rates and lowered the risk of sustained disability in patients with relapsing–remitting multiple sclerosis. Patients had large reductions in lymphocyte counts and more infections, including herpes zoster and one death from reactivation of tuberculosis.
Published Online January 20, 2010 (DOI: 10.1056/NEJMoa0902533)
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Acyclovir and Transmission of HIV-1 from Persons Infected with HIV-1 and HSV-2
In African couples who were discordant in serologic status for HIV-1 and HSV-2, daily treatment with acyclovir did not reduce the frequency of HIV-1 transmission, despite a reduction in HIV-1 RNA levels and a 73% reduction in the occurrence of HSV-2–positive genital ulcers.
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Published Online January 20, 2010 (DOI: 10.1056/NEJMoa0904849)
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A Wii Fracture
A 14-year-old girl presented to the emergency department with an injury to her right foot and associated difficulty in mobilization. She had been playing on her Wii Fit balance board and had fallen off, sustaining an inversion injury.
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Hematemesis
A 52-year-old man with cirrhosis presented to the emergency department with hematemesis and lightheadedness. He was alert and oriented, with a pulse rate of 140 beats per minute, a blood pressure of 90/60 mm Hg, and a hematocrit of 21%. He underwent emergency upper endoscopy. (View video.)
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