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Care of an Unresponsive Patient with a Poor Prognosis
This interactive feature presents the case of a 56-year-old homeless man with hemorrhage from a ruptured cerebral aneurysm. A second, unruptured aneurysm was found, but the risk associated with treatment would be high. At best, his prognosis would be severe disability and dependence on care by others. Three care options are presented. Vote on the option you would recommend, and submit a comment about your clinical decision.
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Read the Case Vignette, consider Options for Care, then cast your Vote.
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Fighting On
Conflicting wishes and demands regarding end-of-life care are a common problem, but one with no clear solution. Drs. Jeffrey Drazen, Nihar Desai, and Philip Green write that those of us on the front lines can’t help but wonder: for whom do we “fight on,” and why do we do it?
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Gene Therapy for Immunodeficiency Due to Adenosine Deaminase Deficiency
Deficiency of adenosine deaminase causes a form of severe combined immunodeficiency disease. This study shows that gene therapy can restore immune function in patients with the disease.
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Long-Term Consequences of Kidney Donation
Survival and the risk of end-stage renal disease among carefully screened kidney donors appear to be similar to those in the general population. Most donors who were studied had a preserved glomerular filtration rate, normal albumin excretion, and an excellent quality of life.
CME Exam
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Deletion of IKZF1 and Prognosis in ALL
This study investigated genetic abnormalities in children with high-risk and low-risk acute lymphoblastic leukemia (ALL). The evidence suggests that the loss of function of IKZF1 has a role in resistance to chemotherapy in ALL.
Published Online January 7, 2009 (DOI: 10.1056/NEJMoa0808253)
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Weight Loss to Treat Urinary Incontinence in Women
This study randomly assigned overweight and obese women with urinary incontinence to an intensive 6-month weight-loss intervention or to a structured education program. More intervention-group participants had clinically relevant reductions in the frequency of episodes of any incontinence, stress incontinence, and urge incontinence.
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A Surgical Safety Checklist in a Global Population
In eight hospitals throughout the world, implementation of a 19-item surgical safety checklist was associated with improved outcomes.
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Published Online January 14, 2009 (DOI: 10.1056/NEJMsa0810119)
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Limits on Medicare’s Ability to Control Spending on Cancer Drugs
The price of cancer drugs and the spending for cancer treatments by Medicare have increased dramatically. Dr. Peter Bach outlines the usual tools Medicare uses to control its spending on drugs and discusses the policies that make cancer drugs a special case and prohibit the regulation of their prices and utilization.
(View interactive graphic.)
 January 27, 2009 (DOI: 10.1056/NEJMhpr0807774), in Print February 5, 2009
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Behavioral Management for Anorexia Nervosa
Behavioral therapy for anorexia nervosa includes direct supervision of eating, establishment of weight-gain goals, and implementation of contingencies if goals are not achieved. The most important adverse effect of such programs is the risk of the refeeding syndrome.
CME Exam
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Blood-Pressure Measurement
Evaluation of blood pressure is used in assessing cardiovascular health, in screening for hypertension, and in monitoring the effectiveness of treatment. This video demonstrates the appropriate technique for the indirect measurement of blood pressure in adults.
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A Pregnant Woman with Fever after a Trip to Africa
A 39-year-old pregnant woman was seen at 14 weeks of gestation because of persistent fevers. She had recently traveled to Africa to adopt a child. On examination, there was a maculopapular rash over the trunk, arms, and legs, as well as a slightly enlarged liver.
CME Exam
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A Proteomic Analysis of Ischemic Preconditioning
Proteomic analysis of heart tissue in animal models of myocardial infarction shows that phosphorylation of an aldehyde dehydrogenase protects against ischemic insults.
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Universal Health Insurance Coverage or Economic Relief — A False Choice
Some argue that universal coverage is a luxury that we must do without in order to make way for other programs that will stimulate the economy. Jonathan Gruber writes that this argument presents a false choice.
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Antibiotic-Resistant Bugs in the 21st Century — A Clinical Super-Challenge
Drs. Cesar Arias and Barbara Murray write that we have arrived at a point as frightening as the preantibiotic era: for patients infected with multidrug-resistant bacteria, there is no magic bullet. (View slide presentation.)
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Gene Therapy Fulfilling Its Promise
Cautious Optimism Concerning Long-Term Safety of Kidney Donation
Acute Lymphoblastic Leukemia — On the Wings of IKAROS
Published Online January 8, 2009 (DOI: 10.1056/NEJMe0809819)
Insulin Therapy in Very-Low-Birth-Weight Infants
Effectiveness of Maternal Influenza Immunization Free Full Text
Uric Acid and Cardiovascular Risk
The Statins in Preventive Cardiology
Eculizumab for Atypical Hemolytic–Uremic Syndrome
Eculizumab for Congenital Atypical Hemolytic–Uremic Syndrome
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