Health Care Reform — Where Do We Go from Here?
The President can legitimately claim to have already passed the first round of health care reform in 2009, with the renewal of CHIP and the stimulus bill. Gail Wilensky describes further possible steps in incremental reform.
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 March 3, 2010 (DOI: 10.1056/NEJMp1002211)
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The Democrats’ Last Ditch — Reconciliation or Bust
The Obama administration and its congressional allies are poised to go it alone on a tortuous path toward enactment of ambitious health care reforms. John Iglehart reports.
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March 3, 2010 (DOI: 10.1056/NEJMp1002479)
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Medicare’s Opportunity to Encourage Innovation in Health Care Delivery
Congressional reform proposals include a new Center for Medicare and Medicaid Innovation intended to facilitate beneficial delivery-system changes. Robert Mechanic and Stuart Altman write that the long-term effect on the U.S. health care system could be priceless.
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Ministry of Touch — Reflections on Disaster Work after the Haitian Earthquake
Dr. Annekathryn Goodman traveled with a U.S. national disaster team to Haiti, where they set up a mobile tent hospital on the sites of a devastated school and a nearby adolescent clinic. On the second day, she began what she came to call “touch rounds.”
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March 3, 2010 (DOI: 10.1056/NEJMp1002311)
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The Israeli Field Hospital in Haiti — Ethical Dilemmas in Early Disaster Response
Dr. Ofer Merin and colleagues write that every mass-casualty event raises ethical issues concerning the priorities of treatment, but the Haiti disaster was exceptional in several ways.
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March 3, 2010 (DOI: 10.1056/NEJMp1001693)
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Haitian Amputees — Lessons Learned from Sierra Leone
March 3, 2010 (DOI: 10.1056/NEJMpv1002391)
Haiti — A View from the Ship
March 3, 2010 (DOI: 10.1056/NEJMpv1002319)
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Recovering from Disaster — Partners in Health and the Haitian Earthquake
After the earthquake, Zanmi Lasante, the Haitian branch of Partners in Health, became the largest and one of the most important health care providers in Haiti. Tracy Kidder describes Zanmi Lasante’s response to Haiti’s catastrophe.
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Published Online February 17, 2010 (DOI: 10.1056/NEJMp1001705)
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Weighing Risks and Benefits of Liraglutide — The FDA’s Review of a New Antidiabetic Therapy
On January 25, the FDA approved liraglutide, a glucagon-like-peptide-1 receptor agonist that can improve glycemic control in adults with type 2 diabetes. Drs. Mary Parks and Curtis Rosebraugh discuss the benefits and potentially serious safety concerns associated with this new therapy.
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Published Online February 17, 2010 (DOI: 10.1056/NEJMp1001578)
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Collection of Data on Patients’ Race and Ethnic Group
The authors argue that physician practices should routinely collect data on the race and ethnic group of their patients. They discuss the benefit of using these data at the population level to detect disparities in care and to improve the quality of care.
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Management of Varices and Variceal Hemorrhage in Cirrhosis
This review explains the three main challenges in clinical management: primary prophylaxis to prevent a first episode of hemorrhage, the treatment of acute bleeding episodes, and secondary prophylaxis to prevent recurrence of variceal hemorrhage. (View a video describing how to measure the hepatic venous pressure gradient.)
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Stalking the Diagnosis
A 58-year-old woman presented to her primary care physician after several days of dizziness, anorexia, dry mouth, increased thirst, and frequent urination. She had also had a fever and reported that food would “get stuck” when she was swallowing.
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Dopamine versus Norepinephrine for Shock
This comparative-effectiveness trial found no significant difference in overall survival in patients with shock treated with dopamine or with norepinephrine. However, dopamine was associated with more cardiac arrhythmias and a higher mortality rate in those with cardiogenic shock.
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Step-up Therapy for Children with Uncontrolled Asthma
In this crossover trial comparing three step-up treatments, most children had a best response to the long-acting beta-agonist, but some children had a best response to an increased dose of inhaled corticosteroids or a leukotriene-receptor antagonist.
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 March 2, 2010 (DOI: 10.1056/NEJMoa1001278)
Related Editorial: Choosing Asthma Step-up Care
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Ethosuximide, Valproic Acid, and Lamotrigine in Childhood Absence Epilepsy
The findings of this randomized trial of three common treatments for childhood absence epilepsy suggest that ethosuximide has the best efficacy and safety profile.
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Glycated Hemoglobin, Diabetes, and Cardiovascular Risk in Nondiabetic Adults
As compared with fasting glucose, glycated hemoglobin was similarly associated with the risk of diabetes and more strongly associated with the risks of cardiovascular disease and death from any cause, adding to data about the use of glycated hemoglobin as a diagnostic measure.
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Pneumococcal Conjugate Vaccine in HIV-Infected Adults
In predominantly HIV-infected Malawian adults who had recently had an invasive pneumococcal infection, the 7-valent conjugated pneumococcal vaccine was found to have 74% efficacy in preventing subsequent invasive pneumococcal infection.
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Surveys about the Use of Electronic Health Information
Despite a decade’s worth of exposure to health information on the Internet, the public’s trust in physicians as their preferred source of health information increased from 2002 to 2008.
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