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August 6, 2009  Vol. 361 No. 6

Audio Summary of this Issue

Perspective
549-551

The thought of “corporate medicine” makes patients and providers panic. And yet the current economic situation is almost certain to increase the importance of corporate medicine. David Cutler writes that providers and patients alike can benefit from the ...

551-553
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New payment models reward health care providers for producing outcomes rather than for performing procedures. Drs. Richard Bohmer and Thomas Lee examine the implications of this shift for the mission and operations of health care organizations.

554-555

Drs. Pamela Hartzband and Jerome Groopman write that two major movements, the medical humanism movement and evidence-based practice, will now play out in the context of national health care reform. Today, when it is most important for these two movements ...

e7
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The legislative process is one of ebb and flow, particularly when politicians are confronted with issues that demand tough choices and divide the voters who elected them. Both currents were at work recently as one Senate committee and two House committees ...

e8

William Beveridge, the economist whose 1942 report led to the founding of Britain's National Health Service (NHS), famously said that “a revolutionary moment in the world's history is a time for revolutions, not for patching.”1 Given the combination of ...

Original Articles
557-568

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.

569-579

In this randomized trial involving patients with osteoporotic vertebral compression fractures, patients who underwent vertebroplasty had improvements in pain and disability measures that were similar to those in patients who underwent a sham procedure.

580-593

In this randomized comparison of treatment with peginterferon alfa-2a, standard-dose peginterferon alfa-2b, and low-dose peginterferon alfa-2b in patients infected with hepatitis C genotype 1, the rates of sustained virologic response and adverse events were similar for all three regimens.

594-604

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.

Clinical Practice
605-611

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?

Images in Clinical Medicine
612
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A 54-year-old man was referred because of a 6-month history of lower urinary tract symptoms, microhematuria, and dull pain in the right flank. He had undergone shock-wave lithotripsy for the treatment of a 20-mm renal stone on the right side 12 years ...

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A 34-year-old Brazilian man presented with a 24-year history of prominent, progressively dilating superficial veins. Gynecomastia, splenomegaly, and bilateral varicoceles also developed. There was no evidence of liver failure. Ultrasonography of the ...

Clinical Problem-Solving
613-617

    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.

    Editorials
    619-621

    Worldwide there are approximately 1.4 million persons with vertebral compression fractures.1 In the United States, there are approximately 750,000; only one third receive treatment.2 Prevalence estimates are imprecise because of heterogeneity in how ...

    622

    Each year thousands of reviewers contribute their expertise to peer review, a process that contributes critically to the quality of the Journal. The editors and the authors of the papers submitted to the Journal are grateful for the help of all our ...

    Sounding Board
    623-628

    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.

    Correspondence
    629-630

    To the Editor: Meador et al. (April 16 issue)1 suggest that children who had been exposed to valproate in utero had significantly lower IQ scores than those who had been exposed to other antiepileptic drugs. However, the results of their study should be ...

    630-631

    To the Editor: Bockenhauer et al. (May 7 issue)1 report on a unique constellation of multiorgan signs and symptoms — epilepsy, ataxia, sensorineural deafness, and a renal salt-losing tubulopathy, which they term the EAST syndrome — associated with the ...

    631-632

    To the Editor: Boyer et al. (May 14 issue)1 report that among children with neurotoxic effects of scorpion envenomation, scorpion-specific F(ab′)2 antivenom resolved the clinical syndrome within 4 hours. In 1999, we published the results of a negative ...

    633-634

    To the Editor: In the Clinical Therapeutics article on minimally invasive total knee arthroplasty for osteoarthritis, Leopold (April 23 issue)1 does not offer advice regarding weight reduction to ideal levels as part of his recommendations for a female ...

    634-636

    The results indicate that mirror therapy effectively reduces pain and enhances motor function in the arm of patients with stroke and chronic complex regional pain syndrome type 1 in the arm.

    636-637

    To the Editor: A magnitude 8.0 earthquake hit the densely populated region of Sichuan, China, on May 12, 2008, causing an estimated 374,643 injuries. By July 23, 2008, a total of 2728 wounded patients had been treated at the nearest major university ...

    Book Reviews
    638

    On June 15, 1591, in the spectacular closing of the infamous North Berwick witch trials, Euphemia Maclean (also known as Eufame MacAlyane or Ewfame Mackallean) was burned alive on Castle Hill in Edinburgh by the order of King James VI because, among other ...

    638-639

    A woman pregnant with twins, already the mother of a healthy 3-year-old daughter, suddenly finds herself in unstoppable labor at 23 weeks of gestation. Knowing the high morbidity and mortality for babies born at this point of gestation, she decides to ...