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Perspective
HIV and Aging — Preparing for the Challenges Ahead
By 2015, half the U.S. population living with human immunodeficiency virus (HIV) infection will be older than 50 years of age. As antiretroviral therapy (ART) coverage continues to expand worldwide, this aging of the HIV epidemic will be mirrored in developing countries. In sub-Saharan Africa, ART…
- April 5, 2012
- Mills E.J., Bärnighausen T., Negin J.
- N Engl J Med 2012; 366:1270-1273
By 2015, half of HIV-infected U.S. patients will be older than 50 years of age. As antiretroviral therapy coverage expands globally, the aging of the epidemic will be mirrored in developing countries. Yet the world is unprepared to deal with an aging population with HIV.
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Original Article
Liberal or Restrictive Transfusion in High-Risk Patients after Hip Surgery
In the United States, more than 17 million red-cell units are collected annually, and 15 million units are transfused. Blood transfusions are frequently given to surgical patients and to the elderly. Yet, the indications for postoperative transfusion have not been adequately evaluated and remain…
- December 29, 2011
- Carson J.L., Terrin M.L., Noveck H., et al.
- N Engl J Med 2011; 365:2453-2462
- CME
This trial compared a restrictive hemoglobin threshold with a liberal threshold for blood transfusion among hip-surgery patients with risk factors for CVD. The liberal strategy resulted in more transfusions and did not reduce death or inability to walk independently.
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Editorial
Transfusion Thresholds in FOCUS
Even though red-cell transfusion is an accepted and widely used intervention, questions regarding which patients should receive transfusions and under what circumstances continue to spark debate. There has been limited evidence from clinical trials to inform policy. Meanwhile, concern about…
- December 29, 2011
- Barr P.J. and Bailie K.E.M.
- N Engl J Med 2011; 365:2532-2533
Even though red-cell transfusion is an accepted and widely used intervention, questions regarding which patients should receive transfusions and under what circumstances continue to spark debate. There has been limited evidence from clinical trials to ...
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Case Records of the Massachusetts General Hospital
Case 39-2011 — A Woman in Her 90s with Unilateral Ptosis
Presentation of Case. Dr. Xuemei Cai (Medicine): A woman in her 90s was seen in the emergency department at this hospital because of ptosis of the left eyelid. The patient had been in her usual health until 4 days earlier when, on awakening, she was unable to open her left eye. She reported no…
- December 22, 2011
- Venna N., Gonzalez R.G., Zukerberg L.R.
- N Engl J Med 2011; 365:2413-2422
A woman in her 90s came to the ER because of acute unilateral ptosis. During the next 8 weeks, weakness of the neck, fatigue, choking, and difficulty breathing developed, progressing to respiratory failure and death. An autopsy was performed.
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Original Article
Body-Weight–Supported Treadmill Rehabilitation after Stroke
More than 790,000 Americans have a new or recurrent stroke yearly, and two thirds of the 6.4 million survivors may have significant limitations in walking and are at high risk for falls, fractures, and further decline in mobility. Walking speed predicts the level of disability. At a walking speed…
- May 26, 2011
- Duncan P.W., Sullivan K.J., Behrman A.L., et al.
- N Engl J Med 2011; 364:2026-2036
- Free Full Text
In this randomized trial of two physical therapy interventions for patients with walking impairment after stroke, locomotor training on a treadmill including body-weight support was not superior to a home-exercise program supervised by a physical therapist.
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Perspective
The Loneliness of Visiting
"The problem is the poor chap is lonely. If they sat with him a little more, they wouldn't need to call us as much!" My harassed intern is venting her frustration with Mr. Wilson's relatives. The 76-year-old man has languished in the hospital for the past 3 months, a resident of practically every…
- May 5, 2011
- Srivastava R.
- N Engl J Med 2011; 364:1691-1693
How little must patients and their relatives really understand of our attempts to communicate with them. How many cues are missed on an average ward round? Could the way we talk make relatives feel uncomfortable instead of involved?
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Clinical Practice
Vertebral Fractures
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. A 72-year-old…
- April 28, 2011
- Ensrud K.E. and Schousboe J.T.
- N Engl J Med 2011; 364:1634-1642
- CME
- Full Text Audio
This article reviews the implications of documentation of vertebral fracture for subsequent fracture risk and its role as an adjunct to bone-density assessment. Strategies for the management of vertebral fractures are also discussed.
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Images in Clinical Medicine
Myositis Ossificans
Figure 1.
- February 24, 2011
- Martin D.A. and Senanayake S.
- N Engl J Med 2011; 364:758
- Free Full Text
A 40-year-old Korean woman who had been immobilized in bed for several weeks while recovering from tuberculous meningitis reported having pain in the right hip. Her right leg was externally rotated and flexed. She reported discomfort on any passive ...
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Original Article
A Randomized Trial of Treatment for Acute Anterior Cruciate Ligament Tears
Rupture of the anterior cruciate ligament (ACL) is a serious knee injury that affects mainly physically active young people. The injury is characterized by joint instability that leads to decreased activity, unsatisfactory knee function, and poor knee-related quality of life in the short term,, and…
- July 22, 2010
- Frobell R.B., Roos E.M., Roos H.P., Ranstam J., Lohmander L.S.
- N Engl J Med 2010; 363:331-342
- Free Full Text
- CME
In this randomized, controlled trial of young, active adults with an acute anterior cruciate ligament (ACL) injury, rehabilitation plus early ACL reconstruction was not superior to rehabilitation plus optional delayed ACL reconstruction with respect to pain, symptoms, knee function, and knee-related quality of life, and it resulted in significantly more knee reconstructions.
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Editorial
Is Early Reconstruction Necessary for All Anterior Cruciate Ligament Tears?
The anterior cruciate ligament (ACL) is necessary to prevent knee instability (giving way) during sports activities, in particular those that require planting and pivoting-type maneuvers. Episodes of giving way typically occur during athletic activity but can also occur with activities of daily…
- July 22, 2010
- Levy B.A.
- N Engl J Med 2010; 363:386-388
The anterior cruciate ligament (ACL) is necessary to prevent knee instability (giving way) during sports activities, in particular those that require planting and pivoting-type maneuvers. Episodes of giving way typically occur during athletic activity but ...
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Editorial
Brain Repair after Stroke
Stroke is the second leading cause of death worldwide. A majority of patients survive stroke, however, making this disorder a major source of human disability. Although most patients have some spontaneous behavioral improvements after a stroke, the recovery is generally incomplete. Compounding this…
- May 13, 2010
- Cramer S.C.
- N Engl J Med 2010; 362:1827-1829
Stroke is the second leading cause of death worldwide. A majority of patients survive stroke, however, making this disorder a major source of human disability. Although most patients have some spontaneous behavioral improvements after a stroke, the ...
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Original Article
Robot-Assisted Therapy for Long-Term Upper-Limb Impairment after Stroke
Stroke is a leading cause of long-term disability in the United States, affecting an estimated 6.4 million Americans. Long-term disability is often associated with persistent impairment of an upper limb. Despite the development of many programs for recovery after stroke, the effectiveness of…
- May 13, 2010
- Lo A.C., Guarino P.D., Richards L.G., et al.
- N Engl J Med 2010; 362:1772-1783
- Free Full Text
- Video
In this randomized study evaluating rehabilitative therapies in patients with long-term upper-limb impairment after stroke, outcomes at 12 weeks were similar with robot-assisted therapy, intensive comparison therapy, and usual care. In secondary analyses, modest improvements were observed over 36 weeks in both intensive-therapy groups, as compared with the usual-care group.
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Images in Clinical Medicine
Cycling for Freezing of Gait
Figure 1.
- April 1, 2010
- Snijders A.H. and Bloem B.R.
- N Engl J Med 2010; 362:e46
- Free Full Text
- Video
A 58-year-old man with Parkinson's disease presented with an incapacitating freezing of gait. Despite this, the patient's ability to ride a bicycle was remarkably preserved.
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Clinical Practice
Rehabilitation after Stroke
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A 66-year-old…
- April 21, 2005
- Dobkin B.H.
- N Engl J Med 2005; 352:1677-1684
A 66-year-old man was suddenly unable to speak, follow directions, or move his right arm and leg. He received tissue plasminogen activator within 90 minutes. Four days later, his speech was limited to effortful answers of yes or no. He could not walk or use his right arm, and self-care tasks required maximal assistance. What advice would you offer him and his family regarding rehabilitation for his disabilities?
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Special Article
The Effect of Medicare's Payment System for Rehabilitation Hospitals on Length of Stay, Charges, and Total Payments
In the past decade, the field of inpatient rehabilitation has grown dramatically. From 1986 through 1994, the number of Medicare-certified rehabilitation hospitals and units increased by 87 percent, from 545 to 1019. In addition, between 1985 and 1989, the annual percentage of all patients…
- October 2, 1997
- Chan L., Koepsell T.D., Deyo R.A., et al.
- N Engl J Med 1997; 337:978-985
- Free Full Text
In the past decade, the field of inpatient rehabilitation has grown dramatically. From 1986 through 1994, the number of Medicare-certified rehabilitation hospitals and units increased by 87 percent, from 545 to 1019.¹ In addition, between 1985 and 1989, ...
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Special Article
Effectiveness of a Geriatric Evaluation Unit — A Randomized Clinical Trial
INCREASED attention has been directed to the plight of disabled elderly patients being discharged from hospitals. One response has been the development of specialized geriatric evaluation and treatment programs. Initially patterned after models developed in the United Kingdom,, such programs…
- December 27, 1984
- Rubenstein L.Z., Josephson K.R., Wieland G.D., et al.
- N Engl J Med 1984; 311:1664-1670
INCREASED attention has been directed to the plight of disabled elderly patients being discharged from hospitals. One response has been the development of specialized geriatric evaluation and treatment programs. Initially patterned after models developed ...
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Massachusetts Department of Public Health
The Economic Costs of Stroke in Massachusetts
The morbid and mortal harm of strokes may be reduced by public-health programs addressed to the underlying risk factors — particularly the early diagnosis and control of hypertension — as well as by medical management of the condition. The benefits of such programs are alleviation of both the…
- August 24, 1978
- Mills E. and Thompson M.
- N Engl J Med 1978; 299:415-418
The morbid and mortal harm of strokes may be reduced by public-health programs addressed to the underlying risk factors — particularly the early diagnosis and control of hypertension — as well as by medical management of the condition. The benefits of ...
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Original Article
Residual Disability in Survivors of Stroke — The Framingham Study
THE residual effect of stroke on the health of the community depends on the disability remaining in survivors after maximal clinical and functional recovery has taken place. Precise knowledge of the magnitude and pattern of long-term stroke disability in the general population is useful for two…
- November 6, 1975
- Gresham G.E., Fitzpatrick T.E., Wolf P.A., et al.
- N Engl J Med 1975; 293:954-956
THE residual effect of stroke on the health of the community depends on the disability remaining in survivors after maximal clinical and functional recovery has taken place. Precise knowledge of the magnitude and pattern of long-term stroke disability in ...
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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