New England Journal of Medicine -- Recent Issues

Fiscal Responsibility and Health Care Reform

Levine, R. A. — 2009-08-26T13:56:56-07:00

(No abstract is available for this citation)

Setbacks and Fissions -- Reconsidering the Scope and Timing of Reform

Iglehart, J. K. — 2009-08-26T13:57:27-07:00

(No abstract is available for this citation)

The Tragedy of the Commons Revisited

Fadul, R. — 2009-08-26T13:55:43-07:00

(No abstract is available for this citation)

Health Care Reform and Clinical Culture

Ropper, A. H. — 2009-08-26T13:56:15-07:00

(No abstract is available for this citation)

Pandemic Influenza Vaccine Policy -- Considering the Early Evidence

Neuzil, K. M. — 2009-09-10T15:06:55-07:00

(No abstract is available for this citation)

Cross-Reactive Antibody Responses to the 2009 Pandemic H1N1 Influenza Virus

2009-09-10T15:06:33-07:00

Background A new pandemic influenza A (H1N1) virus has emerged, causing illness globally, primarily in younger age groups. To assess the level of preexisting immunity in humans and to evaluate ...

Response after One Dose of a Monovalent Influenza A (H1N1) 2009 Vaccine -- Preliminary Report

2009-09-10T15:07:25-07:00

Background A novel influenza A (H1N1) 2009 virus is responsible for the first influenza pandemic in 41 years. A safe and effective vaccine is urgently needed. A randomized, observer-blind, parallel-group ...

Trial of Influenza A (H1N1) 2009 Monovalent MF59-Adjuvanted Vaccine -- Preliminary Report

2009-09-10T15:07:54-07:00

Background The 2009 pandemic influenza A (H1N1) virus has emerged to cause the first pandemic of the 21st century. Development of effective vaccines is a public health priority.

Methods We ...

Hospitalized Patients with 2009 H1N1 Influenza in the United States, April-June 2009

2009-10-08T13:54:31-07:00

Background During the spring of 2009, a pandemic influenza A (H1N1) virus emerged and spread globally. We describe the clinical characteristics of the patients who were hospitalized with 2009 H1N1 ...

Critical Care Services and 2009 H1N1 Influenza in Australia and New Zealand

The ANZIC Influenza Investigators — 2009-10-08T13:54:10-07:00

Background Planning for the treatment of infection with the 2009 pandemic influenza A (H1N1) virus through health care systems in developed countries during winter in the Northern Hemisphere is hampered ...

Balancing Innovation, Access, and Profits -- Market Exclusivity for Biologics

Engelberg, A. B., Kesselheim, A. S., Avorn, J. — 2009-10-14T13:58:39-07:00

(No abstract is available for this citation)

Medicaid and National Health Care Reform

Rosenbaum, S. — 2009-10-14T13:59:11-07:00

(No abstract is available for this citation)

HIV Vaccine Trial Results -- An Opening for Further Research

Dolin, R. — 2009-10-20T01:40:59-07:00

(No abstract is available for this citation)

Combined Immunodeficiency Associated with DOCK8 Mutations

2009-10-20T13:23:07-07:00

Background Recurrent sinopulmonary and cutaneous viral infections with elevated serum levels of IgE are features of some variants of combined immunodeficiency. The genetic causes of these variants are unknown.

Methods ...

Vaccination with ALVAC and AIDSVAX to Prevent HIV-1 Infection in Thailand

2009-10-20T11:37:16-07:00

Background The development of a safe and effective vaccine against the human immunodeficiency virus type 1 (HIV-1) is critical to pandemic control.

Methods In a community-based, randomized, multicenter, double-blind, placebo-controlled ...

Massachusetts Health Care Reform -- Near-Universal Coverage at What Cost?

Weissman, J. S., Bigby, J. — 2009-10-21T13:59:28-07:00

(No abstract is available for this citation)

A Novel Influenza A (H1N1) Vaccine in Various Age Groups

2009-10-21T13:58:42-07:00

Background There is an urgent need for a vaccine that is effective against the 2009 pandemic influenza A (H1N1) virus.

Methods A split-virus, inactivated candidate vaccine against the 2009 H1N1 ...

Communal Responsibility for Health Care -- The Example of Benefit Assessment in Germany

Sawicki, P. T. — 2009-10-28T13:51:24-07:00

(No abstract is available for this citation)

Ensuring Progress in Primary Care -- What Can Health Care Reform Realistically Accomplish?

Chokshi, D. A. — 2009-10-28T13:52:12-07:00

(No abstract is available for this citation)

Which Medicine, Which America?

Fine, M. — 2009-10-28T13:51:04-07:00

(No abstract is available for this citation)

Primary Care and Accountable Care -- Two Essential Elements of Delivery-System Reform

Rittenhouse, D. R., Shortell, S. M., Fisher, E. S. — 2009-10-29T13:24:14-07:00

(No abstract is available for this citation)

Treatment of Anemia in Chronic Kidney Disease -- Strategies Based on Evidence

Marsden, P. A. — 2009-10-30T17:36:07-07:00

(No abstract is available for this citation)

A Trial of Darbepoetin Alfa in Type 2 Diabetes and Chronic Kidney Disease

2009-10-30T17:36:29-07:00

Background Anemia is associated with an increased risk of cardiovascular and renal events among patients with type 2 diabetes and chronic kidney disease. Although darbepoetin alfa can effectively increase hemoglobin ...

The Emergency Use Authorization of Peramivir for Treatment of 2009 H1N1 Influenza

Birnkrant, D., Cox, E. — 2009-11-03T08:05:38-08:00

(No abstract is available for this citation)

Interleukin-10 in Inflammatory Bowel Disease

Kelsall, B. — 2009-11-04T13:58:05-08:00

(No abstract is available for this citation)

The American Public and the Next Phase of the Health Care Reform Debate

Blendon, R. J., Benson, J. M. — 2009-11-04T14:00:58-08:00

(No abstract is available for this citation)

Not "Socialized Medicine" -- An Israeli View of Health Care Reform

Chernichovsky, D. — 2009-11-04T13:59:35-08:00

(No abstract is available for this citation)

Mandatory Vaccination of Health Care Workers

Stewart, A. M. — 2009-11-04T14:00:25-08:00

(No abstract is available for this citation)

Compromises and Controversies -- Moving Forward on Reform

Iglehart, J. K. — 2009-11-04T14:00:03-08:00

(No abstract is available for this citation)

Inflammatory Bowel Disease and Mutations Affecting the Interleukin-10 Receptor

2009-11-04T13:58:34-08:00

Background The molecular cause of inflammatory bowel disease is largely unknown.

Methods We performed genetic-linkage analysis and candidate-gene sequencing on samples from two unrelated consanguineous families with children who were ...

Cost Expansion versus Cost Control -- Lessons from the Canadian System

Liao, J., Choi, K. — 2009-11-04T13:59:05-08:00

(No abstract is available for this citation)

Reform and the Health Care Workforce -- Current Capacity, Future Demand

Iglehart, J. K. — 2009-11-04T13:56:29-08:00

As Democrats press to enact health care reform legislation, they have emphasized their commitment to greatly expanding coverage, slowing the growth of medical spending, and more tightly regulating private insurers, ...

Physicians' Views of the Massachusetts Health Care Reform Law -- A Poll

2009-11-04T13:56:29-08:00

In 2006, Massachusetts enacted the country's first law mandating near-universal health care coverage,1 and the state now has the lowest proportion of uninsured residents in the United States. The Massachusetts ...

Doctors, Patients, and the Need for Health Care Reform

Baucus, M. — 2009-11-04T13:56:29-08:00

One Montanan wrote to me recently about her father's death. Six months away from qualifying for Medicare coverage, he did not have health insurance or the cash to pay for ...

Litigation amidst Reform -- The Boston Medical Center Case

Parmet, W. E. — 2009-11-04T13:56:29-08:00

Nearly 175 years ago, Alexis de Tocqueville wrote in Democracy in America, "There is hardly a political question in the United States which does not sooner or later turn into ...

Payment Reform for Safety-Net Institutions -- Improving Quality and Outcomes

Wang, C. J., Conroy, K. N., Zuckerman, B. — 2009-11-04T13:56:29-08:00

In the U.S. health care system today, many hospitals have the market power to raise the prices of their services without showing evidence of improvements in the quality of care.1 ...

Novel H1N1 Influenza and Respiratory Protection for Health Care Workers

Shine, K. I., Rogers, B., Goldfrank, L. R. — 2009-11-04T13:56:29-08:00

Your hospital has been seeing a large number of patients with influenza-like symptoms, many of whom turn out to be infected with the novel H1N1 influenza A virus. You have ...

On-Pump versus Off-Pump Coronary-Artery Bypass Surgery

2009-11-04T13:56:29-08:00

This comparative-effectiveness trial showed that clinical outcomes at 1 year were better with on-pump than with off-pump coronary-artery bypass grafting (CABG), and there was also better graft patency. There were no significant differences in neuropsychological outcomes.

Vaccination against HPV-16 Oncoproteins for Vulvar Intraepithelial Neoplasia

2009-11-04T13:56:29-08:00

In this single-group study involving women with grade 3 vulvar intraepithelial neoplasia associated with human papillomavirus type 16 (HPV-16), vaccination against HPV-16 infection with a peptide vaccine was related to a clinical response in 15 of 19 patients (79%) at 1 year. This clinical response was associated with induction of HPV-16-specific T cells.

A Peptide-Based Erythropoietin-Receptor Agonist for Pure Red-Cell Aplasia

2009-11-04T13:56:29-08:00

This trial enlisted 14 patients with pure red-cell aplasia and antierythropoietin antibodies that were induced by treatment with conventional erythropoiesis-stimulating agents. The patients were treated with a peptide-based erythropoietin-receptor agonist that simulates the action of erythropoietin. Of the 14 subjects, 13 achieved a hemoglobin concentration above 11 g per deciliter and over the 28-month course of the study lost the need for regular transfusions.

Brief Report: Normal Spermatogenesis in a Man with Mutant Luteinizing Hormone

2009-11-04T13:56:29-08:00

The presence of a partially inactivating mutation in LHB, the gene encoding the beta subunit of luteinizing hormone, in a man with normal spermatogenesis suggests that high levels of intratesticular testosterone may not be necessary for the development of sperm.

Mechanisms of Disease: Myelodysplastic Syndromes

Tefferi, A., Vardiman, J. W. — 2009-11-04T13:56:29-08:00

This review gives an account of the clinical and hematologic features of the myelodysplastic syndromes. It supplies the latest classification of these disorders, discusses the cytogenetic and molecular genetic changes that occur, and analyzes how some of these conditions convert to acute myeloid leukemia.

Phosphodiesterase Type 5 Inhibitors for Pulmonary Arterial Hypertension

Archer, S. L., Michelakis, E. D. — 2009-11-04T13:56:29-08:00

A 46-year-old-woman presents with exertional dyspnea and syncope and receives a diagnosis of idiopathic pulmonary arterial hypertension. Treatment with sildenafil is recommended. Sildenafil and tadalafil are phosphodiesterase type 5 inhibitors that ameliorate pulmonary arterial hypertension by increasing levels of cyclic guanosine monophosphate in the smooth-muscle cells of the pulmonary artery.

Ankle-Brachial Index for Assessment of Peripheral Arterial Disease

Grenon, S. M., Gagnon, J., Hsiang, Y. — 2009-11-04T13:56:29-08:00

Figure

Although other methods exist to assess the peripheral vasculature, measurement of the ankle-brachial index remains a simple, reliable method for diagnosing peripheral arterial disease. This video presents the indications for use of the ankle-brachial index and demonstrates how it is measured.

Peripartum Diastasis of the Symphysis Pubis

Parker, J. M., Bhattacharjee, M. — 2009-11-04T13:56:29-08:00

A 21-year-old primigravida at nearly 40 weeks' gestation presented with a spontaneous onset of pelvic pain and difficulty in walking. After a rapid delivery, the postpartum physical examination revealed pain ...

Injection-Site Lipoatrophy

Sackey, A. H. — 2009-11-04T13:56:29-08:00

A 13-year-old girl with a 20-month history of type 1 diabetes mellitus presented with depressed areas of skin at the sites of insulin injection (Panel A, arrows). The patient had ...

A Bloody Mystery

Cuker, A., Connors, J. M., Katz, J. T., Levy, B. D., Loscalzo, J. — 2009-11-04T13:56:29-08:00

A 62-year-old woman presented to the urgent care clinic with gingival bleeding after periodontal scaling of her lower-right second molar 5 hours earlier. Bleeding had persisted despite the application of pressure and ice. The patient recalled a similar episode approximately 6 months earlier, also after a periodontal procedure.

Uniform Format for Disclosure of Competing Interests in ICMJE Journals

2009-11-04T13:56:29-08:00

Disclosure of financial associations of authors of articles published in biomedical journals has become common practice. The information provided in these disclosures helps the reader to understand the relationships between ...

Innovation and Comparative-Effectiveness Research in Cardiac Surgery

Peterson, E. D. — 2009-11-04T13:56:29-08:00

Cardiac surgery has always been a unique combination of art and science. The field is advanced by those who push the envelope by suggesting innovations. Yet promising techniques need to ...

Human Papillomavirus Vaccine for Cancer Prevention

Finn, O. J., Edwards, R. P. — 2009-11-04T13:56:29-08:00

Cancer immunoprevention has become synonymous with the vaccines that have been approved for the prevention of infection with highly transmissible strains of human papillomavirus (HPV) that establish chronic infection and ...

End Run around Epo

Bunn, H. F. — 2009-11-04T13:56:29-08:00

Recombinant human erythropoietin is arguably the most successful therapeutic application of recombinant DNA technology to date. Since the initial reports -- which appeared 22 and 23 years ago1,2 -- documented ...

The Microcytic Red Cell and the Anemia of Inflammation

Keel, S. B., Abkowitz, J. L. — 2009-11-04T13:56:29-08:00

A recent description of an alternative messenger RNA transcript of the iron-export protein ferroportin opens the door to understanding how duodenal cells maintain dietary-iron absorption when the body is iron deficient and how mean corpuscular volume is regulated in the contexts of iron deficiency and inflammatory disorders.

Endoscopic versus Open Vein-Graft Harvesting

2009-11-04T13:56:29-08:00

To the Editor: Lopes and colleagues (July 16 issue)1 report data on vein-graft harvesting techniques from the Project of Ex-vivo ...

Perioperative Safety and Bariatric Surgery

2009-11-04T13:56:29-08:00

To the Editor: Flum and colleagues (July 30 issue)1 report on the Longitudinal Assessment of Bariatric Surgery (LABS) consortium study ...

Risk of Confusion in Dosing Tamiflu Oral Suspension in Children

Parker, R. M., Wolf, M. S., Jacobson, K. L., Wood, A. J.J. — 2009-11-04T13:56:29-08:00

To the Editor: The medical community should be made aware of the serious potential for dosing errors in children prescribed ...

CDC and FDA Response to Risk of Confusion in Dosing Tamiflu Oral Suspension

Budnitz, D. S., Lewis, L. L., Shehab, N., Birnkrant, D. — 2009-11-04T13:56:29-08:00

To the Editor: On September 23, Parker et al.1 described a case in which Tamiflu (oseltamivir) for oral suspension was ...

Long-Term Effect of Diabetes and Its Treatment on Cognitive Function

2009-11-04T13:56:29-08:00

Long-Term Effect of Diabetes and Its Treatment on Cognitive Function . In Figure 1 (page 1849), the bars for Cognitive Domain 5 should have been inverted in all three panels ...

Denosumab for Prevention of Fractures in Postmenopausal Women with Osteoporosis

2009-11-04T13:56:29-08:00

Denosumab for Prevention of Fractures in Postmenopausal Women with Osteoporosis . In the Appendix (page 764), the names of some of the investigators were incomplete. The article has been corrected ...

DNA Damage, Aging, and Cancer

2009-11-04T13:56:29-08:00

DNA Damage, Aging, and Cancer . In Figure 3 (page 1479), the label in the top right corner of the figure should have read "RNA polymerase" rather than "DNA polymerase." ...

CME: On-Pump versus Off-Pump Coronary-Artery Bypass Surgery

2009-11-04T13:56:29-08:00

(No abstract is available for this citation)

CME: Vaccination against HPV-16 Oncoproteins for Vulvar Intraepithelial Neoplasia

2009-11-04T13:56:29-08:00

(No abstract is available for this citation)

CME: Phosphodiesterase Type 5 Inhibitors for Pulmonary Arterial Hypertension

2009-11-04T13:56:29-08:00

(No abstract is available for this citation)

The Baucus Bill and the Hope for Reform

Iglehart, J. K. — 2009-10-28T14:06:26-07:00

After months of wrangling with Republicans over the appropriate role of government in health care, the Senate Finance Committee's 13 Democrats were joined by a lone Republican, Senator Olympia Snowe ...

Lost in Transmission -- FDA Drug Information That Never Reaches Clinicians

Schwartz, L. M., Woloshin, S. — 2009-10-28T14:06:26-07:00

The 2009 federal stimulus package included $1.1 billion to support comparative-effectiveness research about medical treatments. No money has been allocated -- and relatively little would be needed -- to disseminate ...

Four Health Care Reforms for 2009

Fuchs, V. R. — 2009-10-28T14:06:26-07:00

Prospects for the enactment of some reform look good, but comprehensive, sustainable reform of the health care system must wait for another day. Republican support for President Barack Obama's ambitious ...

Implementing Evidence-Based Health Policy in Washington State

Franklin, G. M., Budenholzer, B. R. — 2009-10-28T14:06:26-07:00

The Obama administration's infusion of stimulus funds into enhanced comparative-effectiveness research (CER) is in keeping with the conclusion of a recent Commonwealth Fund report that, of the top 15 ways ...

A Homozygous CARD9 Mutation in a Family with Susceptibility to Fungal Infections

2009-10-28T14:06:26-07:00

Homozygous mutations in the CARD9 gene, with a premature termination codon, are associated with chronic mucocutaneous candidiasis in an Iranian family. Dysfunction of CARD9 impairs the innate signaling of dectin-1, an antifungal pattern-recognition receptor.

Three-Year Efficacy of Complex Insulin Regimens in Type 2 Diabetes

2009-10-28T14:06:26-07:00

In this 3-year multicenter trial, patients with suboptimal glycated hemoglobin levels while receiving metformin and sulfonylurea therapy were randomly assigned to add biphasic, prandial, or basal insulin. During the first year, sulfonylurea therapy was replaced by additional insulin for unacceptable hyperglycemia or subsequently for a glycated hemoglobin level of more than 6.5%. Basal- or prandial-based insulin regimens more often achieved glycated hemoglobin targets. Fewer hypoglycemic episodes and less weight gain occurred with regimens initiated with basal insulin.

Antibiotic Prophylaxis and Recurrent Urinary Tract Infection in Children

2009-10-28T14:06:26-07:00

This study from four Australian centers examined whether low-dose, continuous oral antibiotic therapy would prevent urinary tract infection in children (under the age of 18 years) who had already had one or more microbiologically proven urinary tract infections. Long-term, low-dose trimethoprim-sulfamethoxazole was associated with a modest decrease in the number of urinary tract infections in predisposed children.

Brief Report: Human Dectin-1 Deficiency and Mucocutaneous Fungal Infections

2009-10-28T14:06:26-07:00

A family with recurrent mucocutaneous candidiasis was evaluated for a potential genetic cause. An early-stop-codon mutation in the {beta}-glucan receptor dectin-1 was found in the affected family members. These data suggest an important role of dectin-1 in mucosal antifungal defense.

Postexposure Prophylaxis for HIV Infection

Landovitz, R. J., Currier, J. S. — 2009-10-28T14:06:26-07:00

A 24-year-old man presents to an outpatient clinic, reporting that 36 hours previously he had receptive anal intercourse without the use of a condom with an anonymous male partner. The patient is known to the clinical practice and has had several negative tests for human immunodeficiency virus infection, most recently 6 months previously. How should he be evaluated and treated?

Current Concepts: Norovirus Gastroenteritis

Glass, R. I., Parashar, U. D., Estes, M. K. — 2009-10-28T14:06:26-07:00

Noroviruses are now recognized as the leading cause of epidemics of gastroenteritis and an important cause of sporadic gastroenteritis among both children and adults. In the United States, more than 90% of the outbreaks of gastroenteritis for which the cause could not previously be identified can now be attributed to this virus. Understanding the nature of immunity to the norovirus is a key determinant for future improvements in the control and prevention of this viral infection.

Central Nervous System Hemorrhage

Klein, J. P., Ryther, R. C. — 2009-10-28T14:06:26-07:00

A 68-year-old man who had hypertension, diabetes, and atrial fibrillation and was being treated with warfarin was discovered snoring and unarousable at home. He had been in his usual state ...

A Swinging Heart

Kapoor, J. R., McConnell, M. V. — 2009-10-28T14:06:26-07:00

A 39-year-old woman with a 1-year history of Stage IV melanoma presented with progressive shortness of breath, fatigue, and edema in the legs, which had developed over the course of ...

Case 34-2009 -- A 20-Year-Old Man with Sore Throat, Fever, and Rash

Taylor, C. R., Gandhi, R. T., Handwerker, J., Duncan, L. M. — 2009-10-28T14:06:26-07:00

A 20-year-old man was admitted to this hospital because of sore throat, fever, and a diffuse rash for 1 week. Testing for streptococcal pharyngitis and mononucleosis was negative. Amoxicillin and clavulanate were prescribed, and the next day, a red, itchy rash developed on the medial surface of his right arm; the lesions became raised, enlarged, and painful and spread from his arms to his legs, back, hands, feet, and perioral area, without mucosal involvement. Examination disclosed a diffuse eruption of tender violaceous-pink papulovesicles, which progressed to hemorrhagic crusting. A diagnostic procedure was performed.

Yeast Infections -- Human Genetics on the Rise

Holland, S. M., Vinh, D. C. — 2009-10-28T14:06:26-07:00

We lead inextricably mycotic lives: yeasts leaven our bread, ferment our wine and beer, and inhabit our skins, mouths, and gastrointestinal tracts; however, not all is harmony. Hippocrates reported aphthous ...

Optimal Insulin Treatment in Type 2 Diabetes

Roden, M. — 2009-10-28T14:06:26-07:00

Patients with type 2 diabetes have peripheral insulin resistance and inadequate insulin secretion by pancreatic beta cells. During meals, reduced first-phase insulin secretion results in postprandial hyperglycemia and in a ...

Antimicrobial Prophylaxis for Urinary Tract Infection in Children

Hoberman, A., Keren, R. — 2009-10-28T14:06:26-07:00

Approximately one third of children who have a urinary tract infection -- the most frequent serious bacterial infection in young febrile children -- have vesicoureteral reflux, a congenital condition in ...

Artemisinin Resistance in Plasmodium falciparum Malaria

2009-10-28T14:06:26-07:00

To the Editor: Dondorp et al. (July 30 issue)1 describe artemisinin-resistant Plasmodium falciparum, based on a prolonged parasite clearance time, ...

Peginterferon Alfa-2b or Alfa-2a with Ribavirin for Hepatitis C

Hsu, C.-S., Kao, J.-H., Albrecht, J., McHutchison, J., Sulkowski, M. — 2009-10-28T14:06:26-07:00

To the Editor: McHutchison et al. (Aug. 6 issue)1 report a similar rate of sustained virologic response among patients who ...

Hearing Improvement after Bevacizumab for Neurofibromatosis Type 2

2009-10-28T14:06:26-07:00

To the Editor: Plotkin et al. (July 23 issue)1 report a sustained tumor-volume reduction in 4 of 10 patients and ...

Death in a Gene-Therapy Trial

Zaia, J. A., Federoff, H. J., Hage, C. A., Bowyer, S., Kleiman, M. B. — 2009-10-28T14:06:26-07:00

To the Editor: Frank et al. (July 9 issue)1 do not discuss the issue of therapeutic misconception2 -- namely, the ...

Cumulative Live-Birth Rates in a Trial of Single-Embryo or Double-Embryo Transfer

Thurin-Kjellberg, A., Olivius, C., Bergh, C. — 2009-10-28T14:06:26-07:00

To the Editor: We previously reported in the Journal1 the results of a randomized, controlled trial comparing pregnancy outcomes in ...

Mutations in SYNGAP1 in Autosomal Nonsyndromic Mental Retardation

2009-10-28T14:06:27-07:00

Mutations in SYNGAP1 in Autosomal Nonsyndromic Mental Retardation . In the author list (page 599), "Elizabeth Perreault-Linck, M.Sc." should have been "Elizabeth Perreau-Linck, M.Sc." The article has been corrected at ...

Apixaban or Enoxaparin for Thromboprophylaxis after Knee Replacement

2009-10-28T14:06:27-07:00

Apixaban or Enoxaparin for Thromboprophylaxis after Knee Replacement . In the disclosure statement (page 604), Astellas should have been included in the list of companies from which Dr. Lassen reports ...

Atypical Antipsychotic Drugs and the Risk of Sudden Cardiac Death

2009-10-28T14:06:27-07:00

Atypical Antipsychotic Drugs and the Risk of Sudden Cardiac Death . In Table 3 (page 233), the values listed in the columns "No. of Person-Years" and "No. of Sudden Deaths" ...

CME: Three-Year Efficacy of Complex Insulin Regimens in Type 2 Diabetes

2009-10-28T14:06:27-07:00

(No abstract is available for this citation)

CME: Postexposure Prophylaxis for HIV Infection

2009-10-28T14:06:27-07:00

(No abstract is available for this citation)

CME: Norovirus Gastroenteritis

2009-10-28T14:06:27-07:00

(No abstract is available for this citation)

How Health Care Reform Can Benefit Children and Adolescents

Palfrey, J. S. — 2009-10-21T13:56:09-07:00

Medical and scientific advances have reduced the rates of acute childhood illnesses and childhood mortality and increased the positive outcomes of a wide variety of serious childhood illnesses; nevertheless, children's ...

Poor Substitutes -- Why Cooperatives and Triggers Can't Achieve the Goals of a Public Option

Hacker, J. S. — 2009-10-21T13:56:09-07:00

According to a recent survey, a majority of U.S. physicians support health care reform that includes a new national public health insurance plan, which would compete with private plans.1 Polls ...

Group Health Cooperative -- One Coverage-and-Delivery Model for Accountable Care

Larson, E. B. — 2009-10-21T13:56:09-07:00

"On January 1, 1947, Group Health Cooperative of Puget Sound began delivering a new kind of healthcare. Consumers paid flat monthly dues for comprehensive care. Members elected the board of ...

When Diseases Disappear -- The Case of Familial Dysautonomia

Lerner, B. H. — 2009-10-21T13:56:09-07:00

The success of genetic-screening programs raises an intriguing possibility: some dread diseases of the 20th century may soon become history. A representative example is familial dysautonomia, a severe neurologic condition, ...

Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients

The RENAL Replacement Therapy Study Investigators — 2009-10-21T13:56:09-07:00

This multicenter, randomized trial compared the effect of continuous renal-replacement therapy at two different levels of intensity on 90-day mortality among critically ill adults with acute kidney injury. The higher-intensity therapy did not reduce mortality at 90 days.

Strict Blood-Pressure Control and Progression of Renal Failure in Children

The ESCAPE Trial Group — 2009-10-21T13:56:09-07:00

This study assessed the long-term renoprotective effect of intensified blood-pressure control among children receiving a fixed high dose of an angiotensin-converting-enzyme inhibitor. Intensified blood-pressure control, achieved with additional medication, to reach a targeted 24-hour blood pressure in the low range of normal appeared to confer a substantial benefit with respect to a delay in the progression of renal disease among children with chronic kidney disease. However, reappearance of proteinuria after initial successful pharmacologic control was common.

Multicenter Analysis of Glucocerebrosidase Mutations in Parkinson's Disease

2009-10-21T13:56:09-07:00

In this international collaborative study, mutations in the gene for glucocerebrosidase (GBA), a deficiency of which causes Gaucher's disease, were much more likely to be detected in patients with Parkinson's disease than in controls, confirming that there is a strong association between GBA mutations and Parkinson's disease.

Cisplatin versus Cisplatin plus Doxorubicin for Standard-Risk Hepatoblastoma

2009-10-21T13:56:09-07:00

In this randomized trial involving children with standard-risk hepatoblastoma, treatment with cisplatin alone caused fewer adverse events and achieved rates of complete resection and survival that were similar to rates achieved with treatment with cisplatin plus doxorubicin. These findings suggest that doxorubicin is not needed in treating children with hepatoblastoma who are not at high risk for a poor outcome.

Brief Report: X-Linked Thrombophilia with a Mutant Factor IX (Factor IX Padua)

2009-10-21T13:56:09-07:00

A 23-year-old man with deep-vein thrombosis was found to have a gain-of-function mutation in his factor IX gene. The plasma level of factor IX was normal, but the coagulant activity of the mutant protein was approximately eight times the normal level. A younger brother with the same mutation also had a mutant factor IX with increased coagulant activity.

Medical Progress: Atypical Hemolytic-Uremic Syndrome

Noris, M., Remuzzi, G. — 2009-10-21T13:56:09-07:00

The hemolytic-uremic syndrome, which is characterized by nonimmune hemolytic anemia, thrombocytopenia, and renal impairment, occurs most frequently in young children. Most cases are secondary to infection with Escherichia coli O157:H7 and other Shiga-toxin-producing strains. However, approximately 10% of cases are atypical and not associated with infection. This article reviews current concepts about the pathobiology of atypical hemolytic-uremic syndrome and its diagnosis and management.

Bronchial Obstruction after Pneumonectomy

Harris, L. J. — 2009-10-21T13:56:09-07:00

A 42-year-old woman underwent right pneumonectomy because of extensive parenchymal destruction due to tuberculosis. Five years after resection, she reported increasing shortness of breath, wheezing, and dyspnea on exertion. A ...

Thoracic Kidney

Doi, Y., Sakamoto, A. — 2009-10-21T13:56:09-07:00

A 74-year-old man with diabetes and hypertension was referred to our hospital for evaluation of a mass in the right side of the chest, identified on a radiograph (Panel A, ...

Case 33-2009 -- A 35-Year-Old Woman with Fever, Abdominal Pain, and Hypotension after Cesarean Section

2009-10-21T13:56:09-07:00

A 35-year-old woman was transferred to this hospital because of abdominal pain, fever, and hypotension 3 days after an elective cesarean section. On examination, she appeared acutely ill. The temperature was 39.2{degrees}C, the blood pressure 70/52 mm Hg, and the pulse 149 beats per minute. The abdomen was distended and very tender, with rebound. There was erythema and edema in the region of the surgical incision, extending to the left flank, with no drainage. A diagnostic procedure was performed.

Renal Support in Acute Kidney Injury -- How Much Is Enough?

Palevsky, P. M. — 2009-10-21T13:56:09-07:00

Decrements in kidney function occur in more than two thirds of hospitalized patients with critical illness,1 and severe acute kidney injury complicates the care of more than 5% of patients ...

Blood-Pressure Control and Delay in Progression of Kidney Disease in Children

Ingelfinger, J. R. — 2009-10-21T13:56:09-07:00

Many children with chronic kidney disease, even those in whom the disease is discovered very early, ultimately lose renal function; some ultimately progress to stage 5 chronic kidney disease (end-stage ...

The Index Lesion and the Origin of Prostate Cancer

Ahmed, H. U. — 2009-10-21T13:56:09-07:00

Genomic "signatures" of prostate cancer and its metastases suggest that the latter are all derived from a single clone in the prostate gland.

Inhibition of Poly(ADP-Ribose) Polymerase in BRCA Mutation Carriers

Li, S., Yap, T. A., Kaye, S. B., de Bono, J. S. — 2009-10-21T13:56:09-07:00

To the Editor: Fong et al. (July 9 issue),1 who used the poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibitor olaparib to ...

In-Hospital Cardiopulmonary Resuscitation

2009-10-21T13:56:09-07:00

To the Editor: The outcomes of in-hospital resuscitations in elderly patients are given a thorough presentation in the article by ...

Pay for Performance and Quality of Care in England

Kearney, L., O'Neill, D. — 2009-10-21T13:56:09-07:00

To the Editor: A residual concern regarding the use of pay-for-performance incentives (July 9 issue)1 is that they will not ...

Psoriasis

Salem, C. B., Hmouda, H., Bouraoui, K., Nestle, F. O., Kaplan, D., Barker, J. — 2009-10-21T13:56:09-07:00

To the Editor: In their review of psoriasis, Nestle et al. (July 30 issue)1 focus only on the genetic aspect ...

FOXP3 Forkhead Domain Mutation and Regulatory T Cells in the IPEX Syndrome

2009-10-21T13:56:09-07:00

To the Editor: The immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome, a rare disorder characterized by multiorgan autoimmunity, often results ...

Use of Ribavirin to Treat Influenza

Chan-Tack, K. M., Murray, J. S., Birnkrant, D. B. — 2009-10-21T13:56:09-07:00

To the Editor: Ribavirin, an antiviral drug with in vitro activity against both DNA and RNA viruses, is approved in ...

The Serotonin Syndrome

2009-10-21T13:56:09-07:00

The Serotonin Syndrome . The fourth sentence in the penultimate paragraph of the Management section (page 1119) should have begun, "Bromocriptine, a dopamine agonist" instead of "Bromocriptine, a dopamine antagonist." ...

Adjuvant Chemotherapy in Older Women with Early-Stage Breast Cancer

2009-10-21T13:56:09-07:00

Adjuvant Chemotherapy in Older Women with Early-Stage Breast Cancer . In the author list (page 2055), "Gutav Magrinat, M.D." should have been "Gustav Magrinat, M.D." In the affiliations (page 2055) ...

Artemisinin Resistance in Plasmodium falciparum Malaria

2009-10-21T13:56:09-07:00

Artemisinin Resistance in Plasmodium falciparum Malaria . The support statement (page 467) should have read, "Supported by grants from the Wellcome Trust of Great Britain (Major Overseas Programme-Thailand Unit Core ...

CME: Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients

2009-10-21T13:56:09-07:00

(No abstract is available for this citation)

CME: Atypical Hemolytic-Uremic Syndrome

2009-10-21T13:56:09-07:00

(No abstract is available for this citation)

CME: Case 33-2009: A 35-Year-Old Woman with Fever, Abdominal Pain, and Hypotension after Cesarean Section

2009-10-21T13:56:09-07:00

(No abstract is available for this citation)

Perspective Roundtable: Health Care Reform in Perspective

Epstein, A. M., Aaron, H. J., Baicker, K., Hacker, J. S., Pauly, M. V. — 2009-10-14T13:56:09-07:00

President Barack Obama has placed U.S. health care reform at the top of his domestic agenda, and months of legislative work on the issue have resulted in five bills -- ...

Senator Kennedy's Legacy to U.S. Health and Health Care

Sarfaty, M. — 2009-10-14T13:56:09-07:00

Edward M. Kennedy, the long-serving senior senator from Massachusetts who died on August 25, 2009, had a major impact on Americans who deliver or receive health care services and left ...

Follow the Money -- Controlling Expenditures by Improving Care for Patients Needing Costly Services

Bodenheimer, T., Berry-Millett, R. — 2009-10-14T13:56:09-07:00

In the United States today, 10% of patients account for 70% of total health care expenditures. Many patients who require high-cost care are people with multiple chronic conditions, many medications, ...

American Roulette -- Contaminated Dietary Supplements

Cohen, P. A. — 2009-10-14T13:56:09-07:00

In one of the most dangerous cities in the United States, one portly police sergeant has more to worry about than crime. His doctor had been encouraging him for years ...

Drug Shortages and Public Health

Steinbrook, R. — 2009-10-14T13:56:09-07:00

Because the public discussion of drugs is dominated by considerations of their safety, effectiveness, and cost, it is easy to forget that medications have to be manufactured from raw materials ...

The Clinical Course of Advanced Dementia

2009-10-14T13:56:09-07:00

This study examined mortality among patients with advanced dementia who resided in nursing homes. More than half the patients died in 6 months. Pneumonia, febrile episodes, and eating problems were frequent harbingers of death.

Functional Status of Elderly Adults before and after Initiation of Dialysis

2009-10-14T13:56:09-07:00

Whether functional status before dialysis therapy is maintained after its initiation in elderly patients with end-stage renal disease is unclear. This study assessed functional status in all nursing home residents in the United States who began to undergo dialysis between June 1998 and October 2000. The initiation of dialysis in such residents was associated with a substantial and sustained decline in functional status.

Interleukin-2 Therapy in Patients with HIV Infection

The INSIGHT-ESPRIT Study Group and SILCAAT Scientific Committee — 2009-10-14T13:56:09-07:00

In patients infected with human immunodeficiency virus (HIV), an increase in the CD4+ cell count through control of the HIV virus with antiretroviral therapy has emerged as an important surrogate marker of improved health. In two prospective, randomized studies, the addition of interleukin-2 to antiretroviral therapy to increase the CD4+ cell count was not associated with clinical benefit.

Bacterial Diarrhea

DuPont, H. L. — 2009-10-14T13:56:09-07:00

A 47-year-old man reports a 1-week history of diarrhea, with grossly bloody stools for the past 5 days. He reports no history of travel, contacts with sick persons, or underlying gastrointestinal disease. How should he be evaluated and treated for an infectious cause of his illness?

Mechanisms of Disease: Cell Death

Hotchkiss, R. S., Strasser, A., McDunn, J. E., Swanson, P. E. — 2009-10-14T13:56:09-07:00

This review is a primer on the three main mechanisms of cell death: apoptosis, autophagy-associated cell death, and necrosis. The authors discuss the clinical implications of each of these types of cell death and indicate where advances in our understanding have inspired new forms of therapy.

Living with One Hemisphere -- A Large Porencephalic Cyst

Trabacca, A., DiCuonzo, F. — 2009-10-14T13:56:09-07:00

A 2-year-old girl presented with gait disturbance and difficulty using her right hand. She had been born by normal spontaneous delivery at 38 weeks of gestation after an uncomplicated pregnancy. ...

Keratoconus Complicated by Acute Corneal Hydrops

Suzuki, H., Minarcik, J. R. — 2009-10-14T13:56:09-07:00

A 21-year-old woman with a history of myopia presented with the acute onset of foggy vision in her right eye and associated photophobia and mild sensation of the presence of ...

A Bloody Mystery

Connors, J. M., Britton, K. A. — 2009-10-14T13:56:09-07:00

Figure

This interactive Journal feature presents the case of a 62-year-old woman who visits an urgent care clinic with persistent gingival bleeding 5 hours after periodontal scaling. Direct the investigation of the case, test your diagnostic and therapeutic skills, and compare your performance with that of others at NEJM.org.

Case 32-2009 -- A 27-Year-Old Man with Progressive Dyspnea

Tager, A. M., Sharma, A., Mark, E. J. — 2009-10-14T13:56:09-07:00

A 27-year-old man was seen at this hospital because of progressive dyspnea and decreased exercise tolerance during the past 2 years. Imaging studies showed diffuse pulmonary fibrosis. The patient had lighter skin than many in his family, although he reported that several family members had light skin and respiratory problems. He had a history of easy bruising. On examination, his skin was pale, and there was clubbing of the fingers and toes, normal breath sounds, pigmented irises, and horizontal nystagmus. A diagnostic procedure was performed.

Dying from Dementia

Sachs, G. A. — 2009-10-14T13:56:09-07:00

As a teenager, I had the unfortunate but ultimately career-shaping experience of watching my maternal grandmother decline from Alzheimer's disease. She resided in a nursing home, where her final months ...

Dialysis in Frail Elders -- A Role for Palliative Care

Arnold, R. M., Zeidel, M. L. — 2009-10-14T13:56:09-07:00

The methods and availability of dialysis and transplantation have improved, and patients who are beginning to undergo dialysis have become sicker and more debilitated than in the past.1 Increased numbers ...

The Public Health and Economic Benefits of Taxing Sugar-Sweetened Beverages

2009-10-14T13:56:09-07:00

Consumption of sugar-sweetened beverages has increased in recent decades; evidence suggests that consumption of these beverages contributes to obesity and adverse health outcomes. The authors discuss the potential public health and economic benefits of taxing sugar-sweetened beverages.

Lung-Cancer Staging with PET-CT

2009-10-14T13:56:09-07:00

To the Editor: In their assessment of the usefulness of combined positron-emission tomography and computed tomography (PET-CT) in the preoperative ...

Capsule Endoscopy versus Colonoscopy

2009-10-14T13:56:09-07:00

To the Editor: The article by Van Gossum et al. (July 16 issue)1 and the corresponding editorial by Bretthauer2 describe ...

HPV Vaccination

Leiner, S., Kahn, J. A. — 2009-10-14T13:56:09-07:00

To the Editor: In her review of human papillomavirus (HPV) vaccination (July 16 issue),1 Kahn neglects to discuss one key ...

A Fragile Balance

Gallagher, G. T., Bitton, A., Katz, J. T., Loscalzo, J. — 2009-10-14T13:56:09-07:00

To the Editor: In their description of a patient with osteogenesis imperfecta, Bitton et al. (July 2 issue)1 allude to ...

Loss of Independence in Patients Starting Dialysis at 80 Years of Age or Older

Jassal, S. V., Chiu, E., Hladunewich, M. — 2009-10-14T13:56:09-07:00

To the Editor: We report a negative effect of initiation of dialysis on independent living by patients 80 years of ...

Estimation of the Warfarin Dose with Clinical and Pharmacogenetic Data

2009-10-14T13:56:09-07:00

Estimation of the Warfarin Dose with Clinical and Pharmacogenetic Data . In Table 2 (page 758), the mean absolute errors in both cohorts should have been expressed as means with ...

The Ethics of Interrogation -- The U.S. Military's Ongoing Use of Psychiatrists

2009-10-14T13:56:09-07:00

The Ethics of Interrogation -- The U.S. Military's Ongoing Use of Psychiatrists . The authors (page 1090) should have been listed as "Jonathan H. Marks, M.A., B.C.L., and M. Gregg ...

Medical Mystery: A 71-Year-Old Man with Pancytopenia -- The Answer

2009-10-14T13:56:09-07:00

Medical Mystery: A 71-Year-Old Man with Pancytopenia -- The Answer . The end of the second sentence in the letter (page 2845) should have read, "and a reticulocyte count of ...

CME: The Clinical Course of Advanced Dementia

2009-10-14T13:56:09-07:00

(No abstract is available for this citation)

CME: Functional Status of Elderly Adults before and after Initiation of Dialysis

2009-10-14T13:56:09-07:00

(No abstract is available for this citation)

CME: Bacterial Diarrhea

2009-10-14T13:56:09-07:00

(No abstract is available for this citation)