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A 4-Year Trial of Tiotropium in COPD
These investigators compared outcomes in patients with chronic obstructive pulmonary disease treated with once-daily inhalation of tiotropium or placebo. There was no benefit of treatment on the rate of loss of lung function over time, although benefits were observed in some secondary end points.
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| Published Online October 5, 2008 (DOI: 10.1056/NEJMoa0805800) |
Effect of Maternal Influenza Immunization on Mothers and Infants
In pregnant women in Bangladesh, influenza vaccination during pregnancy was found to decrease laboratory-proven influenza infection in neonates by 63% and febrile respiratory illness in the mothers by more than a third.
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| Published Online September 17, 2008 (DOI: 10.1056/NEJMoa0708630) |
Long-Term Follow-up after Control of Blood Pressure in Diabetes
Follow-up of patients with type 2 diabetes who had been assigned to tight or less-tight blood-pressure control revealed that benefits of previously improved control were not sustained when between-group blood-pressure differences equalized.
CME Exam
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| Published Online September 10, 2008 (DOI: 10.1056/NEJMoa0806359) |
10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes
Despite an early loss of glycemic differences, continued microvascular risk reduction and emergent risk reductions for myocardial infarction and death from any cause were observed.
CME Exam
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| Published Online September 10, 2008 (DOI: 10.1056/NEJMoa0806470) |
GAD Treatment and Insulin Secretion in Recent-Onset Type 1 Diabetes
This trial assessed the ability of alum-formulated GAD (GAD-alum) to reverse recent-onset type 1 diabetes in patients. At month 15 (the primary end point), C-peptide levels had declined in both the treatment group and the control group, without significant between-group differences. After 30 months, levels in the treatment group had declined significantly more slowly.
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 October 8, 2008 (DOI: 10.1056/NEJMoa0804328), in Print October 30, 2008
Related Editorial: Immunotherapy on Trial for New-Onset Type 1 Diabetes
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Breast Reconstruction after Mastectomy
A 45-year-old woman with breast cancer elects to undergo mastectomy and is referred to a plastic surgeon for evaluation for postmastectomy breast reconstruction. For some patients, breast reconstruction restores body image and sexuality and improves the quality of life.
CME Exam
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Umbilical Vascular Catheterization
Placement of umbilical catheters is an important skill for the treatment of critically ill neonates. This video demonstrates the placement of both umbilical-artery and umbilical-vein catheters.
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A Man with Chest Pain, Arthralgias, and a Mediastinal Mass
A 39-year-old man was admitted to the hospital because of chest pain, arthralgias, and a mediastinal mass. On examination, the first heart sound was absent, the second was loud with a prominent split, and there was a new systolic ejection murmur at the left upper sternal border. (See echocardiographic videos.)
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Management of Skin and Soft-Tissue Infection — Polling Results
This interactive feature presented the case of a 20-year-old basketball player with acute onset of a red, painful area on his right buttock over the previous 2 days. Readers were invited to vote for one of three possible treatment options. Polling results are now available, including results by country (see interactive map) and over 350 comments from readers.
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Inflammation and Influenza
Lethality caused by the H5N1 influenza virus is partly attributed to a “cytokine storm” in the lung, mediated by prostaglandin E2 (PGE2). A recent study shows that mice infected with the virus and treated with an antiviral agent and a PGE2 inhibitor are better able to survive than mice treated with an antiviral agent alone.
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Modern Health Care for All Americans
Doctors and other health care providers work in extraordinary times and have unrivaled abilities, but increasingly our health care system gets in the way of their sound medical judgment. Senator Barack Obama writes that reform must emphasize prevention, not just treatment of the sick; reduce medical errors and malpractice claims; and make the practice of medicine rewarding again.
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Published Online September 24, 2008 (DOI: 10.1056/NEJMp0807677)
Related Perspective: Symptomatic Relief, but No Cure — The Obama Health Care Reform |
Access to Quality and Affordable Health Care for Every American
Americans deserve leadership for real health care reform that provides access to high-quality medical care and ends spiraling costs. Senator John McCain writes that our challenge is to protect and improve the care that doctors, nurses, and hospitals deliver, while increasing the availability and affordability of health insurance.
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Published Online September 24, 2008 (DOI: 10.1056/NEJMp0807607)
Related Perspective: Primum Non Nocere — The McCain Plan for Health Insecurity |
Antigenically Distinct MF59-Adjuvanted Vaccine to Boost Immunity to H5N1
The authors report on an open-label study of an MF59-adjuvanted vaccine against avian influenza. The findings indicate that priming subjects with H5 antigen induces a rapidly mobilized, long-lasting immune memory after the administration of low-dose, antigenically distinct vaccine.
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COPD and Declining FEV1 — Time to Divide and Conquer?
Published Online October 5, 2008 (DOI: 10.1056/NEJMe0807387)
UKPDS and the Legacy Effect
Vasopressors in Cardiopulmonary Resuscitation
Reducing Injuries from Falls
Sudden Death in Myotonic Dystrophy
Merkel-Cell Carcinoma
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