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Original Article
graphic Niacin or Ezetimibe and Carotid Intima–Media Thickness
In patients who have, or are at risk for, coronary artery disease, niacin added to statin therapy resulted in regression of the carotid intima–media thickness. In contrast, ezetimibe added to statin therapy paradoxically resulted in progression of the carotid intima–media thickness. CME Exam

Published Online November 15, 2009 (DOI: 10.1056/NEJMoa0907569)

Original Article
graphic Biventricular Pacing in Patients with Bradycardia and Normal Ejection Fraction
In this comparative-effectiveness trial, biventricular pacing prevented the reduction in left ventricular ejection fraction that is seen with right ventricular pacing. CME Exam

Published Online November 15, 2009 (DOI: 10.1056/NEJMoa0907555)

Original Article
graphic A Novel Antibody Associated with Autoimmune Pancreatitis
The cause of autoimmune pancreatitis is unknown, and distinguishing autoimmune pancreatitis from pancreatic cancer can be difficult. The authors identified an antibody that they were able to detect in about 95% of patients with autoimmune pancreatitis but in only about 5% of patients with pancreatic cancer.
Original Article
graphic Rituximab, B-Lymphocyte Depletion, and Preservation of Beta-Cell Function
This phase 2 study evaluated the role of B-lymphocyte depletion with rituximab in type 1 diabetes mellitus. Rituximab partially preserved beta-cell function over a 1-year period, suggesting that B lymphocytes contribute to the pathogenesis of type 1 diabetes mellitus.
Original Article
graphic A Sensitive Cardiac Troponin T Assay in Stable Coronary Artery Disease
This retrospective analysis used a new, highly sensitive assay for cardiac troponin T. At levels well below the limit of detection of the conventional assay, troponin T concentrations correlated significantly with the subsequent risk of cardiovascular death and heart failure but not with the risk of myocardial infarction. Free Full Text

Online FirstNovember 25, 2009 (DOI: 10.1056/NEJMoa0805299)

Drug Therapy
graphic Use of Diuretics in Patients with Hypertension
This review focuses on thiazides, the diuretics most often indicated for long-term therapy for hypertension. Thiazide diuretics reduce blood pressure when administered as monotherapy; thiazides also enhance the efficacy of other antihypertensive agents and can reduce hypertension-related morbidity and mortality. CME Exam
Case Records of the Massachusetts General Hospital
graphic A Woman with Chronic Renal Failure, Leg Swelling, and Skin Changes
A 46-year-old woman with chronic kidney disease and a history of deep venous thrombosis presented with swelling of the leg and skin changes. Thickening and erythema of the skin of both legs developed, leading to difficulty walking, sitting, and bending.
Perspective
Forestalling a Filibuster — Senate Reform Bill Cleared for Floor Debate
Senate Democrats, joined by two independents, closed ranks in a rare Saturday session on November 21 to advance consideration of a vast health care reform bill. The day-long debate offered a preview of what promises to be a bruising, full-scale war over reform. John Iglehart reports. Free Full Text

Online OnlyNovember 25, 2009 (DOI: 10.1056/NEJMp0911439)

Perspective
graphic On Mammography — More Agreement Than Disagreement
Updated breast-cancer screening recommendations have sparked substantial controversy and have had a polarizing effect in the breast-cancer community. Drs. Ann Partridge and Eric Winer write that the intensity of the controversy is unfortunate, because there is far more agreement than disagreement. Free Full Text

Online FirstNovember 25, 2009 (DOI: 10.1056/NEJMp0911288)

Perspective
Screening Mammography and the “R” Word
New recommendations on screening for breast cancer include delaying the onset of routine screening mammography from 40 to 50 years of age. Dr. Robert Truog writes that the recommendations raise concerns about access to potentially life-saving care. Free Full Text

Online FirstNovember 25, 2009 (DOI: 10.1056/NEJMp0911447)

Perspective
Cervical-Cancer Screening — New Guidelines and the Balance between Benefits and Harms
New guidelines for cervical-cancer screening were issued on November 20. Dr. George Sawaya discusses major changes that are designed to minimize screening harms while preserving high benefit. Free Full Text

Online FirstNovember 25, 2009 (DOI: 10.1056/NEJMp0911380)

Perspective
graphic Australia’s Winter with the 2009 Pandemic Influenza A (H1N1) Virus
Dr. James Bishop and colleagues write that key lessons from Australia’s experience with the spread of H1N1 suggest that important elements of a response were a national coordination of efforts and the use and modification of a national pandemic plan framework. Free Full Text

Online FirstNovember 25, 2009 (DOI: 10.1056/NEJMp0910445)

Perspective
The Emotional Epidemiology of H1N1 Influenza Vaccination
Dr. Danielle Ofri describes the fascinating and frustrating shift in public sentiment over the course of the H1N1 epidemic. Free Full Text

Online FirstNovember 25, 2009 (DOI: 10.1056/NEJMp0911047)

Perspective
graphic A Difficult Balance — Pain Management, Drug Safety, and the FDA
Dr. Janet Woodcock describes the FDA’s ongoing effort to strike the right balance between two important goals: providing access to pain medications for those who need them and managing the variety of risks posed by analgesic drugs.
Perspective
Getting to the Real Issues in Health Care Reform
Paul Ginsburg writes that the House and Senate proposals are likely to differ in important details. Free Full Text

Published Online November 11, 2009 (DOI: 10.1056/NEJMp0910678)

Perspective
graphic Controlling U.S. Health Care Spending — Separating Promising from Unpromising Approaches
Peter Hussey and colleagues identify several policy options that have the potential to reduce health care spending in the United States.
Free Full Text

Published Online November 11, 2009 (DOI: 10.1056/NEJMp0910315)

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Dyspnea on Exertion

A 57-year-old woman presented with a 4-month history of leg swelling and dyspnea on exertion. Physical examination revealed a grade 3/6 holosystolic murmur at the right upper sternal border and an early diastolic decrescendo murmur at the left lower sternal border. (View video.)

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A Crisis in Late Pregnancy

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HEALTH CARE REFORM CENTER

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Health Care Reform 2009
A source for health care policy news, opinion, and commentary.