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July 27, 2006  Vol. 355 No. 4

Audio Summary of this Issue

Perspective
337-339

Earlier this year, in one of the most dramatic corporate acquisitions in recent memory, Boston Scientific purchased Guidant Corporation. Dr. Alan Garber writes that consolidation in the medical-device industry has multiple and sometimes unpredictable ...

339-341

Illiteracy is not uncommon. However, Dr. Erin Marcus explains that many physicians and other health care workers remain unaware that their patients may have reading problems.

Original Articles
343-353

In this multicenter, randomized trial of preterm newborns with a birth weight of 1250 g or less who required ventilatory support, the initiation of inhaled nitric oxide between days 7 and 21 of life significantly reduced the risk of death or chronic lung disease and the duration of both hospitalization and supplemental oxygen therapy. Using a regimen of inhaled nitric oxide therapy different from that in the companion report by Kinsella et al., this group also found inhaled nitric oxide to be beneficial in preterm infants with respiratory failure.

354-364

In this multicenter, randomized trial of preterm newborns with a birth weight from 500 to 1250 g and with respiratory failure, low-dose inhaled nitric oxide did not significantly reduce death or bronchopulmonary dysplasia overall but reduced this risk in infants with a birth weight of 1000 g or more and reduced the risk of brain injury in the cohort overall. These results support the potential benefits of low-dose inhaled nitric oxide in preterm infants with respiratory failure.

365-374

In this randomized trial of addiction treatment in the primary care setting for patients with opioid dependence, brief counseling with once-weekly dispensing of buprenorphine–naloxone did not result in different outcomes than extended counseling and thrice-weekly medication dispensing.

Special Article
375-384

In 2004 the U.K. National Health Service introduced a pay-for-performance contract for family practitioners that pays bonuses to physicians based on 146 quality indicators. Seventy-six indicators assess clinical care for chronic diseases, and the remaining indicators focus on organization of care and patient experience. In the first year of the new program, the median reported achievement on the clinical indicators was 83 percent for U.K. family practices. Family doctors' incomes increased by an average of about $40,000.

Clinical Practice
385-392

A 70-year-old woman with a long-standing history of hypertension comes for follow-up. Her medications include atenolol (100 mg daily), hydrochlorothiazide (12.5 mg daily), lisinopril (40 mg daily), and ibuprofen (400 mg twice daily for osteoarthritis). She does not smoke or drink alcohol. Her body-mass index is 32. Her blood pressure (measured three times while she is seated) ranges from 164/92 to 170/96 mm Hg; her pulse rate is 72 per minute. Examination of her ocular fundi reveals arteriolar narrowing. The results of cardiovascular examination are normal. How should she be further evaluated and treated?

Images in Clinical Medicine
393
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This routine chest x-ray raised the possibility of an aortic-arch aneurysm. The pacemaker was functioning properly. What is the diagnosis?

Case Records of the Massachusetts General Hospital
394-402

    A 36-year-old man had numbness of the hand after an automobile accident and was found to have hypertension. Evaluation disclosed elevated catecholamine levels and a mass in the right adrenal gland. When the patient was 12 years old, a pheochromocytoma had been removed from the left adrenal gland. A diagnostic procedure was performed.

    Editorials
    404-406

    Preterm birth, especially at an extremely low gestational age, is often perilous. Despite improved survival associated with contemporary neonatal intensive care, more than one third of survivors with a birth weight of less than 1250 g have ...

    406-408

    The British sometimes have been characterized as steadfast, measured, tolerant of bus queues and surgical waiting lists, and perhaps even a bit stodgy. Parts of this portrait may be accurate, but the British adoption of pay for performance should dispel ...

    Health Policy Report
    409-415

    The author discusses the challenges and controversies surrounding the transformation of the U.K. National Health Service. In the new system, financial incentives and accountability are being introduced to improve efficiency and quality, waiting times for elective procedures are decreasing, and patients are able to choose their providers.

    Correspondence
    416-418

    To the Editor: The study by Julius et al. of the efficacy of candesartan for prehypertension (April 20 issue)1 demonstrates what seemed obvious: if patients with prehypertension receive hypotensive drugs, arterial hypertension will develop in fewer of ...

    418-421

    To the Editor: In the April 20 issue Bhatt et al. reported the results of the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) study.1 As a vascular neurologist, I want to highlight a specific ...

    421-422

    To the Editor: The medical mystery in the June 1 issue1 involved a 51-year-old woman with a 15-year history of rheumatoid arthritis, who presented with swelling and a loss of function of the right shoulder. Microscopy of the synovial fluid drawn from ...

    422-423

    To the Editor: In the Case Records presented in the April 27 issue,1 which involved a patient with liver lesions and a bone mass in the right ulna, Hasserjian states that hepatocellular carcinoma “does not typically give rise to bony metastasis.” In fact,...

    423-424

    To the Editor: An 18-year-old 12th-grade student presented with a one-month history of an ichthyosis-like dermatosis (Figure 1), which symmetrically involved the lower limbs, elbows, and hands. Blood tests demonstrated iron-deficiency anemia and ...

    Book Reviews
    425-426

    Hardly a day passes without the appearance of headlines related to the pharmaceutical industry. Whether such stories herald successes (such as advances in drug therapy) or probe unsavory issues (such as problems in drug development, pricing, or ...

    426-427

    Early European explorers sailed east and west in search of gold, silver, and rare spices, but some of the most extraordinary riches that they found were the medicinal plants of the New World. Throughout human history, cultures have identified medicinal ...

    427-428

    Challenging Nature is a clearly written, trenchant defense of biotechnology against those who seek to limit the intentional control of nature and ourselves. Silver attacks the prohibition against “playing God,” advocating instead the humanitarian use of ...

    428-429

    This book, the unifying theme of which is antimicrobial resistance, consists of 7 major sections containing a total of 40 chapters. The chapters are organized according to specific types of mechanisms of resistance and according to individual human ...

    Corrections
    429

    Progress in Human Somatic-Cell Nuclear Transfer Clinical Implications of Basic Research, N Engl J Med 2005:353;87-88.. With regard to the last two sentences in the first full paragraph on page 88, it should be noted that the embryonic stem cells used in ...

    429

    A Placebo-Controlled Trial of Itopride in Functional Dyspepsia Original Article, N Engl J Med 2006:354;832-840.. On page 832, lines 2 and 3 of the Background section of the Abstract should have read, “itopride, a dopamine D2 antagonist with anti-...

    429

    Case 7-2006: A 47-Year-Old Man with Altered Mental Status and Acute Renal Failure Case Records of the Massachusetts General Hospital, N Engl J Med 2006:354;1065-1072.. On page 1067, in the left-hand column, the formula in line 4 under the heading “The ...

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