This randomized, double-blind trial of prophylaxis to prevent invasive fungal infections was conducted in 600 patients with severe graft-versus-host disease after hematopoietic stem-cell transplantation. Posaconazole, an extended-spectrum triazole, was as effective as fluconazole in preventing invasive fungal infections (incidence, 5.3% and 9.0%, respectively). With posaconazole, there were fewer cases of invasive aspergillosis infections.

In this randomized trial of patients undergoing treatment for acute myelogenous leukemia or the myelodysplastic syndrome, prophylaxis with posaconazole resulted in fewer fungal infections and longer survival than did prophylaxis with fluconazole or itraconazole. The difference was primarily due to a lower rate of invasive aspergillosis in the posaconazole group.

In this multicenter, randomized trial of outcomes of uterine-artery embolization versus surgery for symptomatic fibroids, there were no differences between groups in quality of life at 1 year. Women who underwent embolization had a shorter duration of hospitalization and a shorter interval until the resumption of normal activities but were more likely to require rehospitalization for adverse outcomes or to need reintervention owing to treatment failure.

A previous study reported in the Journal showed an association between serum antimyelin antibodies (detected by Western blot analysis) and an increased risk of multiple sclerosis in patients with the first evidence of neurologic abnormalities that were suggestive, but not diagnostic, of multiple sclerosis. This prospective study of 462 patients did not reproduce these findings but instead showed that serum antibodies against myelin oligodendrocyte glycoprotein and myelin basic protein were not associated with an increased risk of progression to clinically definite multiple sclerosis.

A 37-year-old woman who has never been pregnant and her 40-year-old husband have been attempting to conceive a child for the past 3 years. An infertility evaluation has shown no cause for the difficulty. She is ovulating regularly, and a hysterosalpingogram shows that her reproductive tract is anatomically normal. He has a normal sperm count; he has not fathered any children. They are frustrated and want to proceed with in vitro fertilization. What should you advise?

This article in the Medical Education series provides a conceptual framework for and a brief update on commonly used and emerging methods of assessment, discusses the strengths and limitations of each method, and identifies several major challenges in assessing professional competence and performance.

A 3-year-old boy was admitted to the hospital because of recurrent episodes of respiratory insufficiency. Episodes of wheezing developed at 9 months of age; between 2 and 3 years of age, three episodes of tachypnea and hypoxemia occurred that required admission to the intensive care unit, with intubation and assisted ventilation on two occasions. The episodes were associated with anemia and pulmonary infiltrates. A diagnostic procedure was performed.