The use of implantable cardioverter–defibrillators (ICDs) prolongs survival for some patients with heart failure. However, it has been suggested that ICD implantation may adversely affect the quality of life. In this trial, the evaluation of several quality-of-life measures disclosed no long-term effect, although a temporary adverse effect was evident within 1 month after an ICD shock.

In the Sudden Cardiac Death in Heart Failure Trial, 811 patients were randomly assigned to receive implantable cardioverter–defibrillators (ICDs). Of these patients, 269 (33.2%) received at least one ICD shock over a median follow-up period of 45.5 months. The occurrence of ICD shocks, whether appropriate or inappropriate, was associated with a significant increase in the subsequent risk of death from all causes.

The Model for End-Stage Liver Disease (MELD) uses bilirubin, the international normalized ratio for prothrombin time, and creatinine to estimate the risk of death in patients waiting for liver transplantation. This analysis of about 14,000 registrants on the waiting list showed that the addition of the serum sodium concentration to the MELD score improves prognostic accuracy and may reduce mortality among patients on the waiting list who have low MELD scores and serum sodium levels.

A 19-year-old woman presents to the emergency department with light-headedness, severe abdominal pain, and intractable nausea and vomiting that began 12 hours earlier. The patient reports previous episodes of abdominal pain and swelling of her hands and feet that have been attributed possibly to food allergies, which have recently become more frequent. How should her case be evaluated and treated?

The primary goal in the management of wounds is to achieve rapid healing with optimal functional and cosmetic results. In this review, the authors summarize the current treatments for lacerations, including abrasions, skin tears, puncture wounds, and bite wounds, and for burns. A video demonstrates techniques for the application of topical skin adhesives and surgical tapes, as well as for the irrigation of wounds and the treatment of subungual hematomas.

A 50-year-old man presented to the emergency room with severe right-sided abdominal and flank pain for the previous 18 hours.

This interactive Journal feature presents the case of an otherwise healthy 20-year-old basketball player with acute onset of a red, painful area on his right buttock over the previous 2 days. Three possible treatment options, any of which could be considered correct, are presented. Which option do you recommend? At www.nejm.org you can vote for one and then, if you wish, submit a comment about your clinical decision. Voting results and a broad selection of comments will be posted on the Web site.