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In this multicenter, randomized, double-blind, placebo-controlled trial involving patients with one or two painful osteoporotic vertebral fractures, vertebroplasty did not result in greater improvement than a sham procedure in overall pain, physical functioning, or quality of life at 3 or 6 months after treatment.
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This noninferiority trial compared enoxaparin, a subcutaneously administered, low-molecular-weight heparin, with apixaban, an orally active inhibitor of factor Xa, for thromboprophylaxis after major knee surgery. Statistically, the noninferiority of apixaban was not demonstrated, but its use was associated with lower rates of clinically relevant bleeding.
A 55-year-old man collapses while jogging through the park. A bystander finds him unconscious and without a pulse and initiates cardiopulmonary resuscitation while an ambulance is summoned. On arrival in the emergency room, the patient is in ventricular fibrillation. Spontaneous circulation is reestablished, but he remains comatose with absent pupillary reflexes. He remains unconscious after treatment with hypothermia for 24 hours. What would you advise regarding his neurologic prognosis?
A 56-year-old woman presented to the emergency room with a 4-week history of malaise. The patient reported no dyspnea, chest pain, weight loss, nausea, abdominal pain, hematuria, myalgias, or arthralgias. For many years, she periodically had an urticarial rash on her arms; the most recent episode was 4 weeks previously. Her medical history was notable only for autoimmune thyroiditis and vitiligo.
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In this Sounding Board article, the author proposes major reform of health care in the United States by means of establishing universal coverage pools to pay for hospitalizations and the management of chronic illness. Ambulatory care not related to chronic illness would be paid for through a system organized around primary care physicians and emphasizing economic incentives, flexibility, and choice for patients and providers.
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