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)

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 ...

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)

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 ...

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)

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)

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

2009-11-09T14:58:22-08:00

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 ...

Emergence of Oseltamivir-Resistant Pandemic H1N1 Virus during Prophylaxis

Baz, M., Abed, Y., Papenburg, J., Bouhy, X., Hamelin, M.-E., Boivin, G. — 2009-11-11T13:52:15-08:00

(No abstract is available for this citation)

Controlling U.S. Health Care Spending -- Separating Promising from Unpromising Approaches

Hussey, P. S., Eibner, C., Ridgely, M. S., McGlynn, E. A. — 2009-11-11T13:51:32-08:00

(No abstract is available for this citation)

Getting to the Real Issues in Health Care Reform

Ginsburg, P. B. — 2009-11-11T13:51:54-08:00

(No abstract is available for this citation)

Narrowly Clearing the Next Hurdle -- Passage of the House Reform Bill

Iglehart, J. K. — 2009-11-11T13:52:40-08:00

(No abstract is available for this citation)

Dead Souls -- Comparing Dartmouth Atlas Benchmarks with CMS Outcomes Data

Langberg, M. L., Black, J. T. — 2009-11-11T13:53:04-08:00

(No abstract is available for this citation)

Looking beyond the Market

Levine, R. A. — 2009-11-11T13:51:08-08:00

(No abstract is available for this citation)

The HALTS Trial -- Halting Atherosclerosis or Halted Too Early?

Blumenthal, R. S., Michos, E. D. — 2009-11-15T15:48:12-08:00

(No abstract is available for this citation)

Statin Therapy with Ezetimibe or Niacin in High-Risk Patients

Kastelein, J. J.P., Bots, M. L. — 2009-11-15T15:48:35-08:00

(No abstract is available for this citation)

Deleterious Effects of Right Ventricular Pacing

Lindsay, B. D. — 2009-11-15T12:56:10-08:00

(No abstract is available for this citation)

Cangrelor -- A Champion Lost in Translation?

Kastrati, A., Ndrepepa, G. — 2009-11-15T04:50:49-08:00

(No abstract is available for this citation)

Biventricular Pacing in Patients with Bradycardia and Normal Ejection Fraction

2009-11-15T12:56:31-08:00

Background Observational studies suggest that conventional right ventricular apical pacing may have a deleterious effect on left ventricular function. In this study, we examined whether biventricular pacing is superior to ...

Extended-Release Niacin or Ezetimibe and Carotid Intima-Media Thickness

2009-11-15T15:48:57-08:00

Background Treatment added to statin monotherapy to further modify the lipid profile may include combination therapy to either raise the high-density lipoprotein (HDL) cholesterol level or further lower the low-density ...

Intravenous Platelet Blockade with Cangrelor during PCI

2009-11-15T04:51:40-08:00

Background Intravenous cangrelor, a rapid-acting, reversible adenosine diphosphate (ADP) receptor antagonist, might reduce ischemic events during percutaneous coronary intervention (PCI).

Methods In this double-blind, placebo-controlled study, we randomly assigned 5362 ...

Long-Term Outcome Associated with Early Repolarization on Electrocardiography

2009-11-16T12:59:00-08:00

Background Early repolarization, which is characterized by an elevation of the QRS-ST junction (J point) in leads other than V1 through V3 on 12-lead electrocardiography, has been associated with vulnerability ...

Anemia and Iron Deficiency -- New Therapeutic Targets in Heart Failure?

Dec, G. W. — 2009-11-17T04:51:04-08:00

(No abstract is available for this citation)

Rise of the Machines -- Left Ventricular Assist Devices as Permanent Therapy for Advanced Heart Failure

Fang, J. C. — 2009-11-17T04:51:28-08:00

(No abstract is available for this citation)

Ferric Carboxymaltose in Patients with Heart Failure and Iron Deficiency

2009-11-17T04:51:57-08:00

Background Iron deficiency may impair aerobic performance. This study aimed to determine whether treatment with intravenous iron (ferric carboxymaltose) would improve symptoms in patients who had heart failure, reduced left ...

Platelet Inhibition with Cangrelor in Patients Undergoing PCI

2009-11-17T14:42:58-08:00

Background Cangrelor, a nonthienopyridine adenosine triphosphate analogue, is an intravenous blocker of the adenosine diphosphate receptor P2Y12. This agent might have a role in the treatment of patients who require ...

Advanced Heart Failure Treated with Continuous-Flow Left Ventricular Assist Device

2009-11-17T04:52:22-08:00

Background Patients with advanced heart failure have improved survival rates and quality of life when treated with implanted pulsatile-flow left ventricular assist devices as compared with medical therapy. New continuous-flow ...

Rapid-Test Sensitivity for Novel Swine-Origin Influenza A (H1N1) Virus in Humans

Blyth, C. C., Iredell, J. R., Dwyer, D. E. — 2009-11-18T14:10:15-08:00

(No abstract is available for this citation)

The Supreme Court, Process Patents, and Medical Innovation

Kesselheim, A. S. — 2009-11-18T14:11:50-08:00

(No abstract is available for this citation)

The Consequences of "No"

Kellermann, A. L., Lewin, L. S. — 2009-11-18T14:13:01-08:00

(No abstract is available for this citation)

Industry Influence on Comparative-Effectiveness Research Funded through Health Care Reform

Selker, H. P., Wood, A. J.J. — 2009-11-18T14:13:47-08:00

(No abstract is available for this citation)

Lobbying, Campaign Contributions, and Health Care Reform

Steinbrook, R. — 2009-11-18T14:12:19-08:00

(No abstract is available for this citation)

Health Care Reform -- A Republican View

Grassley, C. — 2009-11-18T14:14:15-08:00

(No abstract is available for this citation)

Eliminating a Viable Primary Care Workforce -- A Primary Care Perspective

Sterling, M. L. — 2009-11-18T14:10:50-08:00

(No abstract is available for this citation)

Antiviral Treatment for Patients Hospitalized with 2009 Pandemic Influenza A (H1N1)

Uyeki, T. — 2009-11-18T14:11:19-08:00

(No abstract is available for this citation)

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

Chernichovsky, D. — 2009-11-18T13:56:32-08:00

In 2007, the United States spent about 15% of its gross domestic product (GDP) on health care, whereas Israel's health care spending was about 8% of its GDP (see graph, ...

Compromises and Controversies -- Moving Forward on Reform

Iglehart, J. K. — 2009-11-18T13:56:32-08:00

Accelerating progress toward the Democrats' goal of enacting health care reform legislation, House Speaker Nancy Pelosi (D-CA) unveiled a bill on October 29 that would establish a mandate for most ...

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

Blendon, R. J., Benson, J. M. — 2009-11-18T13:56:32-08:00

Congressional leaders and President Barack Obama are moving ahead to develop a single piece of major health care legislation, which will be debated, voted on by both houses of Congress, ...

Medicaid and National Health Care Reform

Rosenbaum, S. — 2009-11-18T13:56:32-08:00

Defined by a history of both achievement and controversy, Medicaid has once again become central to the U.S. health policy debate, this time figuring as a key to national health ...

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

Weissman, J. S., Bigby, J. — 2009-11-18T13:56:32-08:00

Massachusetts has long been known for its academic medical centers, biomedical research, high-quality health care, and perhaps not unrelatedly, high health care costs. In 2006, the state captured national attention ...

Mandatory Vaccination of Health Care Workers

Stewart, A. M. — 2009-11-18T13:56:32-08:00

Mandatory vaccination of health care workers raises important questions about the limits of a state's power to compel individuals to engage in particular activities in order to protect the public. ...

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

2009-11-18T13:56:32-08:00

Anemia is associated with an increased risk of cardiovascular and renal events among patients with type 2 diabetes and chronic kidney disease. This placebo-controlled trial randomly assigned such patients to receive darbepoetin alfa or placebo. The two composite end points were death or cardiovascular disease and death or end-stage renal disease. Darbepoetin alfa did not reduce either outcome and was associated with an increased risk of stroke.

Inflammatory Bowel Disease and Mutations Affecting the Interleukin-10 Receptor

2009-11-18T13:56:32-08:00

Genetic analyses showed that mutations affecting the interleukin-10 receptor are associated with early-onset colitis. Further molecular analyses showed that the mutations abrogated interleukin-10 signaling. Treatment of one of the affected children by means of allogeneic hematopoietic stem-cell transplantation was successful.

Combined Immunodeficiency Associated with DOCK8 Mutations

2009-11-18T13:56:32-08:00

This article describes a group of 11 patients between the ages of 6 and 21 years who had recurrent sinopulmonary infections, extensive cutaneous viral infections, severe allergies, and elevated serum levels of IgE; some of the patients also had asthma or reactive airway disease or susceptibility to cancer. All patients had loss-of-function mutations in the DOCK8 gene.

A Novel Protective Prion Protein Variant that Colocalizes with Kuru Exposure

2009-11-18T13:56:32-08:00

Kuru, a neurodegenerative disease associated with endocannibalism in Papua New Guinea, is the classic example of prion disease. Certain polymorphisms at codon 129 of the prion protein gene (PRNP) are highly associated with susceptibility to the development of kuru. In this report, further investigation involving kuru-exposed survivors in Papua New Guinea shows that certain polymorphisms in PRNP codon 127 lead to genetic resistance to kuru.

Mechanisms of Disease: Inflammatory Bowel Disease

Abraham, C., Cho, J. H. — 2009-11-18T13:56:32-08:00

This review gives an account of recent advances in our knowledge of the intestinal immune system and how it becomes perturbed in Crohn's disease and ulcerative colitis. The importance of genetic factors in these diseases has been increasingly recognized, and this article emphasizes their roles.

Air in the Portal and Mesenteric Veins

de Mendoza-Asensi, D., Planas, K. — 2009-11-18T13:56:32-08:00

A 73-year-old man with history of smoking, hypertension, chronic obstructive pulmonary disease, and type 2 diabetes mellitus presented with respiratory distress. The trachea was intubated, and the patient was admitted ...

Gouty Tophi

Wiesner, T., Fried, I. — 2009-11-18T13:56:32-08:00

A 77-year-old man presented with a 5-day history of painful swelling of his right elbow, which was also red, warm, and tender. When pressure was applied, a toothpastelike, white, chalky ...

Case 36-2009 -- A 23-Year-Old Man with Cough, Hoarseness, and Abnormalities on Chest Imaging

Choy, E., Digumarthy, S. R., Koplin, S. A. — 2009-11-18T13:56:32-08:00

A 23-year-old man was transferred to this hospital because of cough, hoarseness, fever, and abnormalities on chest imaging. One month before admission, a nonproductive cough developed, followed by hoarseness, dyspnea on exertion, and fever. Imaging studies at another facility showed pulmonary and mediastinal masses and a lesion in the pelvis. Positron-emission tomographic scans obtained at this hospital showed 18F-fluorodeoxyglucose-avid lesions. A diagnostic procedure was performed.

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

Marsden, P. A. — 2009-11-18T13:56:33-08:00

Anemia associated with chronic kidney disease and end-stage renal disease is due, in large part, to reduced production of renal erythropoietin and abnormalities in extracellular-fluid volume homeostasis.1 Moreover, anemia and ...

Interleukin-10 in Inflammatory Bowel Disease

Kelsall, B. — 2009-11-18T13:56:33-08:00

In this issue of the Journal, Glocker et al.1 provide the first substantial support for a functional role for the immunosuppressive cytokine interleukin-10 in the pathogenesis of inflammatory bowel disease ...

The Hedgehog Pathway and Pancreatic Cancer

Hidalgo, M., Maitra, A. — 2009-11-18T13:56:33-08:00

Treatment of a mouse model of aggressive pancreatic cancer with an inhibitor of the hedgehog pathway enhanced tumor sensitivity to gemcitabine and resulted in the stabilization of disease.

Trials of Vertebroplasty for Vertebral Fractures

2009-11-18T13:56:33-08:00

To the Editor: In the August 6 issue, Kallmes et al.1 report on the Investigational Vertebroplasty Safety and Efficacy Trial ...

Apixaban or Enoxaparin for Thromboprophylaxis

2009-11-18T13:56:33-08:00

To the Editor: Lassen and colleagues (Aug. 6 issue)1 state that apixaban and enoxaparin had similar efficacy, based on the ...

Alpha1-Antitrypsin Deficiency

2009-11-18T13:56:33-08:00

To the Editor: In their Clinical Practice article (June 25 issue),1 Silverman and Sandhaus mention two small trials of augmentation ...

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

Liao, J., Choi, K. — 2009-11-18T13:56:33-08:00

The health care reform effort in the United States is driven by the desires for cost control and expanded coverage. However, as Daniel Callahan recently wrote, "cost controls that are ...

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

2009-11-18T13:56:33-08:00

(No abstract is available for this citation)

CME: Inflammatory Bowel Disease

2009-11-18T13:56:33-08:00

(No abstract is available for this citation)

CME: Case 36-2009: A 23-Year-Old Man with Cough, Hoarseness, and Abnormalities on Chest Imaging

2009-11-18T13:56:33-08:00

(No abstract is available for this citation)

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

Sawicki, P. T. — 2009-11-11T13:56:05-08:00

Many German observers are bewildered over the U.S. health care reform debate. Most Europeans see affordable health insurance for everyone as a fundamental element of a stable and prosperous society ...

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

Chokshi, D. A. — 2009-11-11T13:56:05-08:00

In the current political environment, forging consensus on health care reform has proven challenging. Yet the value of a strengthened primary care infrastructure is one apparent zone of agreement among ...

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

Engelberg, A. B., Kesselheim, A. S., Avorn, J. — 2009-11-11T13:56:05-08:00

Twenty-five years ago, Congress enacted the Waxman-Hatch Act to facilitate the approval by the Food and Drug Administration (FDA) of low-cost generic drugs that are bioequivalent to approved brand-name drugs. ...

Global Health: Defeating Rotavirus? The Global Recommendation for Rotavirus Vaccination

Danchin, M. H., Bines, J. E. — 2009-11-11T13:56:05-08:00

This past April, the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) on Immunization announced a global recommendation that rotavirus vaccines be included in national immunization programs. The ...

The Service

Srivastava, R. — 2009-11-11T13:56:05-08:00

This morning, I came upon an intern engrossed at the computer.

"I am looking up the diseases Mr. Crosby died of," she explained.

The octogenarian had been on our unit ...

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

The ANZIC Influenza Investigators — 2009-11-11T13:56:06-08:00

In this study, a consortium of intensive care units (ICUs) in Australia and New Zealand reported their experience with admissions associated with infection with the 2009 H1N1 virus. The overall rate of ICU admission was estimated to be 28.7 per million persons, approximately 15 times that in previous years. During the period of peak transmission in communities, the ICU bed-occupancy rate ranged from 8.9 to 19.0%.

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

2009-11-11T13:56:06-08:00

Pandemic influenza A (H1N1) virus has spread rapidly around the world during the past 6 months. In this report, investigators from the Centers for Disease Control and Prevention (CDC) describe the clinical characteristics of the earliest patients who were hospitalized with the virus in the United States, during a 2-month period in the spring of 2009.

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

2009-11-11T13:56:06-08:00

Using stored serum samples from blood donors and subjects in previous influenza vaccine trials, CDC investigators found that vaccination with the routine trivalent seasonal influenza vaccine induced little immunity against the current pandemic H1N1 virus and that 34% of subjects born before 1950 had some immunity to this pandemic virus.

Revascularization versus Medical Therapy for Renal-Artery Stenosis

The ASTRAL Investigators — 2009-11-11T13:56:06-08:00

In a clinical trial, 806 patients with renovascular disease were randomly assigned either to undergo percutaneous revascularization with medical therapy or to receive medical therapy alone. At a median follow-up of 34 months, the rate of decline in renal function (the primary end point) did not differ significantly between the two groups. Serious complications of revascularization occurred in 23 patients.

Outcome Reporting in Industry-Sponsored Trials of Gabapentin for Off-Label Use

Vedula, S. S., Bero, L., Scherer, R. W., Dickersin, K. — 2009-11-11T13:56:06-08:00

This article compares outcomes specified in research protocols with those described in published reports for trials of off-label use of gabapentin that were sponsored by the manufacturer. The authors had access to internal company documents; the article details discrepancies between the published record and the research plans.

Renal-Artery Stenosis

Dworkin, L. D., Cooper, C. J. — 2009-11-11T13:56:06-08:00

A 73-year-old former smoker with a history of hypertension presents with shortness of breath. His blood pressure is 160/75 mm Hg, and his serum creatinine level is 1.4 mg per deciliter. Chest auscultation reveals diffuse rales. His condition improves with diuretics. Imaging shows a diseased aorta and a high-grade ostial lesion of the left renal artery. How should he be further evaluated and treated?

Extensive Bowel Infarction

Cheng, J., Pande, G. — 2009-11-11T13:56:06-08:00

A 45-year-old man presented to the emergency room with abdominal pain that had been increasing over the previous week and hematemesis and melena that had begun in the preceding 12 ...

Geographic Tongue

Masferrer, E., Jucgla, A. — 2009-11-11T13:56:06-08:00

A 61-year-old man was referred for treatment of painless white lesions on his tongue that had appeared 1 month earlier. He had been treated with topical and systemic antifungal drugs ...

A Crisis in Late Pregnancy

Ross, J. J., Desai, A. S., Chutkow, W. A., Economy, K. E., Dec, G. W. — 2009-11-11T13:56:06-08:00

A 31-year-old woman in the 37th week of pregnancy presented to the emergency department with severe bitemporal headache and shortness of breath. Direct the investigation of the case, test your diagnostic and therapeutic skills, and compare your performance with that of others at NEJM.org.

Case 35-2009 -- A 60-Year-Old Male Renal-Transplant Recipient with Renal Insufficiency, Diabetic Ketoacidosis, and Mental-Status Changes

Baden, L. R., Digumarthy, S. R., Guimaraes, A. S.R., Branda, J. A. — 2009-11-11T13:56:06-08:00

A 60-year-old man with diabetes mellitus and a history of renal transplantation was admitted to this hospital because of mental-status changes, diarrhea, renal insufficiency, diabetic ketoacidosis, and hypotension. On examination, the patient appeared cachectic and confused. Ultrasonographic examination of the pelvis showed the transplanted kidney with a well-circumscribed, rounded, focal hypoechoic lesion within the upper pole. On the fourth hospital day, respiratory distress developed that required mechanical ventilation.

Preparing for 2009 H1N1 Influenza

Wenzel, R. P., Edmond, M. B. — 2009-11-11T13:56:06-08:00

In 1743, when disease was presumed to be astral in origin, European newspapers reported on a contagious influence (influenza in Italian) that was being visited on the citizens of Rome. ...

Isolated Tumor Cells in Breast Cancer

2009-11-11T13:56:06-08:00

To the Editor: In their article, de Boer et al. (Aug. 13 issue)1 suggest that adjuvant systemic therapy may improve ...

Age-Related Memory Decline and the APOE {epsilon}4 Effect

2009-11-11T13:56:06-08:00

To the Editor: Cognitive decline is a complex multifactorial process, and so it is important to exclude as many potentially ...

AGC1 Deficiency and Cerebral Hypomyelination

Wolf, N. I., van der Knaap, M. S., Kucinski, T., Palmieri, F., Wedell, A. — 2009-11-11T13:56:06-08:00

To the Editor: Wibom et al. (July 30 issue)1 suggest that impaired function of mitochondrial aspartate-glutamate carrier isoform 1 (AGC1) ...

Neurologic Prognosis after Cardiac Arrest

Nesseler, N., Leurent, G., Seguin, P., Grundmann, S., Busch, H.-J., Young, G. B. — 2009-11-11T13:56:06-08:00

To the Editor: We are concerned that Young (Aug. 6 issue)1 did not emphasize the considerable help provided by the ...

Older Age and a Reduced Likelihood of 2009 H1N1 Virus Infection

2009-11-11T13:56:06-08:00

To the Editor: Early epidemiologic reports regarding the 2009 pandemic influenza A (H1N1) virus suggest that cases of infection and ...

Pathological Changes Associated with the 2009 H1N1 Virus

2009-11-11T13:56:06-08:00

To the Editor: Between April 23, 2009, and May 15, 2009, we performed 15 autopsies on deceased patients in whom ...

Which Medicine, Which America?

Fine, M. — 2009-11-11T13:56:06-08:00

Underlying the debate over health care reform are two competing visions of medicine. According to one vision, medicine aims to care for people in their communities and to provide affordable ...

Gossypiboma in the Pouch of Douglas

2009-11-11T13:56:06-08:00

Gossypiboma in the Pouch of Douglas . The third sentence of the legend should have read, "Magnetic resonance imaging, T2 sagittal view, of the abdomen," rather than "Computed tomography of ...

A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee

2009-11-11T13:56:06-08:00

A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee . In the legend for Figure 2 (page 1102), the third sentence should have read, "Error bars indicate the ...

Five-Year Risk of Colorectal Neoplasia after Negative Screening Colonoscopy

2009-11-11T13:56:06-08:00

Five-Year Risk of Colorectal Neoplasia after Negative Screening Colonoscopy . In the References (page 1224), reference 24 should have read: "Brenner H, Hoffmeister M, Stegmaier C, Brenner G, Altenhofen L, ...

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

2009-11-11T13:56:06-08:00

(No abstract is available for this citation)

CME: Renal-Artery Stenosis

2009-11-11T13:56:06-08:00

(No abstract is available for this citation)

CME: Case 35-2009: A 60-Year-Old Male Renal-Transplant Recipient with Renal Insufficiency, Diabetic Ketoacidosis, and Mental-Status Changes

2009-11-11T13:56:06-08:00

(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)