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Cardiac-resynchronization therapy is recommended for patients with advanced, symptomatic heart failure. This clinical trial found benefit in asymptomatic patients, but since the rate of death was not affected, it remains to be seen whether clinical guidelines will be modified to include asymptomatic patients.
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In this randomized trial of treatment versus no treatment for mild gestational diabetes mellitus, rates of the primary outcome (a composite of stillbirth or perinatal death and neonatal hyperbilirubinemia, hypoglycemia, hyperinsulinemia, or birth trauma) did not differ significantly between groups. However, there were significant reductions with treatment in several secondary outcomes, including the frequency of large-for-gestational-age infants, shoulder dystocia, cesarean delivery, and hypertension in pregnancy.
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In this randomized trial involving newborn infants with asphyxial encephalopathy, hypothermic therapy did not significantly reduce the rate of the primary outcome (i.e., death or severe neurodevelopmental disability) but did result in improvement in several prespecified secondary neurologic outcomes among survivors.
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Three children who received a liver transplant for bile salt export pump (BSEP) deficiency had recurrent disease accompanied by high titers of anti-BSEP antibody, and remission was achieved through the use of an intensified immunosuppressive regimen. This result suggests that disease recurring after transplantation may be caused by an immune reaction against BSEP in the transplanted liver.
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In this analysis of more than 84,000 surgical patients enrolled in a prospective quality-improvement study, hospitals with increased postoperative rates of death had similar rates of postoperative complications as other hospitals but higher mortality after complications. These findings suggest that a reduction in mortality will require both prevention of complications and improved care of patients who have complications.
Whether it is caused by herpes simplex virus (HSV) type 1 or type 2, neonatal HSV infection is a devastating disease if untreated, and more than 30% of pregnant women in the United States have genital infection with HSV. This review summarizes the current facts on this disease and its early identification and treatment, as well as the prospects for more effective prevention.
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A 52-year-old man presented to the emergency department with a 5-week history of abdominal discomfort. The pain worsened after eating and was associated with nausea and bloating. Two weeks before presentation, the patient's pain localized more to the periumbilical area and was accompanied by early satiety and vomiting. He had no fever, diarrhea, tenesmus, melena, or hematochezia.
The authors argue that in the context of appropriate efforts to reduce medical errors by correcting problems in care-delivery systems, health care organizations have underemphasized individual responsibility. They propose punishing providers who repeatedly do not adhere to procedures for improving patient safety, such as hand washing.
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