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Revisiting Duty-Hour Limits — IOM Recommendations for Patient Safety and Resident Education
On December 2, the Institute of Medicine (IOM) issued a report recommending that further measures be taken to ensure that hospitals provide safer conditions for patients and trainees while maintaining rigorous teaching programs. As John Iglehart writes, the IOM acknowledges that the two largest barriers to implementing its recommendations are the cost and the difficulty of finding an adequate number of other health care professionals to do the work of residents.
 December 3, 2008 (DOI: 10.1056/NEJMp0808736), in Print December 18, 2008
Residents’ Duty Hours and the IOM Report
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Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients
This double-blind trial showed that benazepril plus amlodipine was superior to benazepril plus hydrochlorothiazide in reducing cardiovascular events in high-risk patients with hypertension.
CME Exam
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Prolonged Therapy of Advanced Chronic Hepatitis C with Low-Dose Peginterferon
Patients with chronic hepatitis C who did not have a sustained viral response to peginterferon and ribavirin were randomly assigned to receive low-dose peginterferon or no treatment for 3.5 years. The clinical and histologic outcomes were not better in patients treated with peginterferon.
CME Exam
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Tenofovir Disoproxil Fumarate versus Adefovir Dipivoxil for Chronic Hepatitis B
In this randomized comparison of treatment with tenofovir disoproxil fumarate or adefovir dipivoxil for 48 weeks in patients with chronic hepatitis B, tenofovir was more likely to result in viral suppression.
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Irbesartan in Patients with Heart Failure and Preserved Ejection Fraction
In a multicenter trial, patients who had heart failure with a preserved ejection fraction received irbesartan or placebo and were followed for a mean of 49.5 months. There were no significant differences in death or hospitalization for heart failure.
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| Published Online November 11, 2008 (DOI: 10.1056/NEJMoa0805450) |
Outbreak of Adverse Reactions Associated with Contaminated Heparin
Last winter, unfractionated heparin contaminated with oversulfated chondroitin sulfate (OSCS) caused an outbreak of adverse reactions in patients in 13 states. This report from the CDC details reactions in 113 patients and further supports the conclusion that OSCS contamination was the cause of the outbreak.
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| December 3, 2008 (DOI: 10.1056/NEJMoa0806450), in Print December 18, 2008 |
Prothrombin Time for Detection of Contaminated Heparins
Researchers report on the use of prothrombin time to detect oversulfated chondroitin sulfate contamination in both unfractionated heparin and low-molecular-weight heparins.
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| December 3, 2008 (DOI: 10.1056/NEJMc0807070), in Print December 18, 2008 |
Levodopa for Parkinson’s Disease
A 62-year-old man presents with Parkinson’s disease, and treatment with levodopa is recommended. Levodopa is considered the most effective drug available for Parkinson’s disease. However, after several years of therapy, serious side effects, including motor fluctuations and dyskinesias, may occur.
CME Exam
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Taken Out of Context
A 25-year-old woman with a history of depression, mitral-valve prolapse, and migraine headaches presented with a 3-day history of subjective fever, diffuse arthralgia, and a severe generalized headache that was not characteristic of her previous migraines.
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Cyclosporine and the Podocyte
A direct effect on the podocyte, rather than on the lymphocyte, may underlie the therapeutic effect of cyclosporine in some nephropathies.
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Home Delivery — Bringing Primary Care to the Housebound Elderly
As baby boomers enter their 60s, their increasing medical needs and a worsening shortage of primary care doctors are expected to fuel a crisis in health care for the elderly. Dr. Susan Okie reports that meeting their medical needs will most likely require increasing reliance on midlevel providers (nurse practitioners and physician’s assistants), as well as the use of multidisciplinary teams.
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More on Primary Care
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Circumcision — A Surgical Strategy for HIV Prevention in Africa
Drs. Ingrid Katz and Alexi Wright report that, in a radical departure from earlier strategies, public health officials are now arguing that circumcision of men should be a key weapon in the fight against infection with HIV in Africa. Skeptics argue that efforts to “scale-up” circumcision programs on the continent that has the fewest physicians per capita may draw funds away from other necessary public health programs.
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Physicians and the First Amendment Free Full Text
Published Online November 19, 2008 (DOI: 10.1056/NEJMe0809669)
Does It Matter How Hypertension Is Controlled?
Chronic Hepatitis B — New Goals, New Treatment
Adalimumab in Juvenile Rheumatoid Arthritis
Sorafenib in Advanced Hepatocellular Carcinoma Free Full Text
Initial Management of Epilepsy
A Man with Abdominal Pain, Nausea, and an Elevated Creatinine Level
More on Anti–Glomerular Basement Membrane Disease after Alemtuzumab
Osteosarcoma Derived from Donor Stem Cells Carrying
the Norrie’s Disease Gene
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