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Underlying the debate over health care reform are two competing visions of medicine. According to one vision, medicine aims to care for people in their communities and to provide affordable health care that counterbalances the effects that inequities of ...
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In this study, a consortium of intensive care units (ICUs) in Australia and New Zealand reported their experience with admissions associated with infection with the 2009 H1N1 virus. The overall rate of ICU admission was estimated to be 28.7 per million persons, approximately 15 times that in previous years. During the period of peak transmission in communities, the ICU bed-occupancy rate ranged from 8.9 to 19.0%.
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Pandemic influenza A (H1N1) virus has spread rapidly around the world during the past 6 months. In this report, investigators from the Centers for Disease Control and Prevention (CDC) describe the clinical characteristics of the earliest patients who were hospitalized with the virus in the United States, during a 2-month period in the spring of 2009.
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Using stored serum samples from blood donors and subjects in previous influenza vaccine trials, CDC investigators found that vaccination with the routine trivalent seasonal influenza vaccine induced little immunity against the current pandemic H1N1 virus and that 34% of subjects born before 1950 had some immunity to this pandemic virus.
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In a clinical trial, 806 patients with renovascular disease were randomly assigned either to undergo percutaneous revascularization with medical therapy or to receive medical therapy alone. At a median follow-up of 34 months, the rate of decline in renal function (the primary end point) did not differ significantly between the two groups. Serious complications of revascularization occurred in 23 patients.
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This article compares outcomes specified in research protocols with those described in published reports for trials of off-label use of gabapentin that were sponsored by the manufacturer. The authors had access to internal company documents; the article details discrepancies between the published record and the research plans.
A 73-year-old former smoker with a history of hypertension presents with shortness of breath. His blood pressure is 160/75 mm Hg, and his serum creatinine level is 1.4 mg per deciliter. Chest auscultation reveals diffuse rales. His condition improves with diuretics. Imaging shows a diseased aorta and a high-grade ostial lesion of the left renal artery. How should he be further evaluated and treated?
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A 31-year-old woman in the 37th week of pregnancy presented to the emergency department with severe bitemporal headache and shortness of breath. Direct the investigation of the case, test your diagnostic and therapeutic skills, and compare your performance with that of others at NEJM.org.
A 60-year-old man with diabetes mellitus and a history of renal transplantation was admitted to this hospital because of mental-status changes, diarrhea, renal insufficiency, diabetic ketoacidosis, and hypotension. On examination, the patient appeared cachectic and confused. Ultrasonographic examination of the pelvis showed the transplanted kidney with a well-circumscribed, rounded, focal hypoechoic lesion within the upper pole. On the fourth hospital day, respiratory distress developed that required mechanical ventilation.
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