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Table of contents for

November 18, 2010  Vol. 363 No. 21

Audio Summary of this Issue

Perspective
1981-1985
A Flood of Opioids, a Rising Tide of Deaths
S. Okie
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Faced with an epidemic of drug abuse and overdose deaths, the FDA has proposed a Risk Evaluation and Mitigation Strategy for prescription opioid pain relievers, involving improved education for physicians and patients about risks associated with long-acting opioids.

1985-1988
Geographic Variation in the Quality of Prescribing
Y. Zhang, K. Baicker, and J.P. Newhouse
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To assess U.S. geographic variation in the management of medication in elderly patients, the authors examined performance on two quality measures: the use of medications considered to be high-risk for the elderly and potentially harmful drug–disease interactions.

1988-1989
Up in the Air — Suspending Ethical Medical Practice
D.M. Shaner
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  • Comments

First I will define what I conceive medicine to be. In general terms, it is to do away with the sufferings of the sick, to lessen the violence of their diseases, and to refuse to treat those who are overmastered by their disease, realizing that in such ...

Original Articles
1991-2003
Effect of VX-770 in Persons with Cystic Fibrosis and the G551D-CFTR Mutation
F.J. Accurso and Others
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  • CME

In vitro studies have indicated that a molecule, VX-770, potentiates the activity of a mutant cystic fibrosis transmembrane conductance regulator (CFTR) protein. This trial involving persons with a copy of the mutant allele showed improvement in those who received the drug.

2004-2014
Outcomes of Kidney Transplantation in HIV-Infected Recipients
P.G. Stock and Others
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  • CME

In this trial of kidney transplantation involving HIV-infected patients, rates of patient and graft survival were high at 1 and 3 years, with no HIV-associated complications. However, unexpectedly high rejection rates were an important concern.

2015-2026
n–3 Fatty Acids and Cardiovascular Events after Myocardial Infarction
D. Kromhout, E.J. Giltay, and J.M. Geleijnse
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In this clinical trial involving patients who had had an MI, supplementation with low doses of n−3 fatty acids in margarine did not have a significant effect on the risk of subsequent cardiovascular events.

Clinical Therapeutics
2027-2035
Bisphosphonates for Osteoporosis
M.J. Favus

    A 67-year-old woman is referred by her primary care physician for treatment of osteoporosis and progressive bone loss. Oral bisphosphonate therapy is recommended. Bisphosphonates suppress bone resorption by interfering with osteoclast activity. Several of these agents have been shown to prevent fractures and increase bone mineral density in patients with osteoporosis. Long-term bisphosphonate therapy has been associated with osteonecrosis of the jaw and atypical femur fractures.

    Review Article
    2036-2044
    Current Concepts: Influenza Vaccines for the Future
    L.C. Lambert and A.S. Fauci
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    • CME

    New technologies can revolutionize influenza vaccine design, production, and delivery. In the near future, advances should reduce vaccine production time, provide enhanced protection, and end mismatches between vaccine strains and circulating viruses.

    Images in Clinical Medicine
    2045
    Meckel's Diverticulum
    B.T. Bucher and M.S. Keller
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    A 10-year-old boy presented to the emergency department with increasing periumbilical and epigastric pain after a 3-week period of intermittent abdominal discomfort. After clinical evaluation, computed tomography showed a proximal small-bowel ...

    e32
    The Jaw-Thrust Maneuver
    E. Albrecht and P. Schoettker
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    In unconscious patients, including those under general anesthesia, the posterior displacement of the tongue against the pharyngeal wall, soft palate, and epiglottis tends to obstruct the upper airway. The resulting hypoventilation may lead to hypercarbia ...

    Case Records of the Massachusetts General Hospital
    2046-2054
    Case 35-2010 — A 56-Year-Old Man with Cough, Hypoxemia, and Rash
    W.A. Kormos, C.C. Wu, J.A. Branda, and A. Piris

      A 56-year-old man was admitted to the hospital because of cough, hypoxemia, and rash. Nine days before admission, myalgias, chills, sweats, fatigue, and a dry cough developed, with a rash over the chest and flanks.

      Editorials
      2056-2057
      Targeting the Basic Defect in Cystic Fibrosis
      M.J. Welsh

        Therapies for cystic fibrosis have been limited to alleviating clinical manifestations, and although the duration and quality of patients' lives have improved, cystic fibrosis continues to inflict major burdens and shorten lives.1 In this issue of the ...

        2058-2059
        Tackling the Unknowns in HIV-Related Kidney Diseases
        L.A. Szczech

          The advancements that have been made in the treatment of human immunodeficiency virus (HIV) infection over the past three decades are nothing short of astounding. In a search of medical history, one would be hard-pressed to find an area that has developed ...

          Health Law, Ethics, and Human Rights
          2060-2067
          Medical Malpractice Liability in the Age of Electronic Health Records
          S.S. Mangalmurti, L. Murtagh, and M.M. Mello
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          EHRs can improve the quality of care and reduce medical-liability risks; this review includes a discussion of the malpractice-liability implications of computerized order entry, clinical-decision support, electronic messaging with patients, and the transition to EHRs.

          Clinical Implications of Basic Research
          2068-2069
          Proteinuria, the Podocyte, and Insulin Resistance
          A. Fornoni

            Diabetic nephropathy is a chronic progressive disease that affects 20 to 40% of patients with diabetes mellitus. Clinical trials have shown that strict control of hyperglycemia and hypertension can slow the progression of diabetic nephropathy and that ...

            Correspondence
            2070-2071
            Sensor-Augmented Insulin-Pump Therapy in Type 1 Diabetes
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            To the Editor: In their report on the Sensor-Augmented Pump Therapy for A1C Reduction (STAR) 3 study, Bergenstal et al. (July 22 issue) report that sensor-augmented insulin-pump therapy was more effective in lowering glycated hemoglobin levels than ...

            2072-2074
            Rituximab or Cyclophosphamide in ANCA-Associated Renal Vasculitis
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            To the Editor: In the studies by Jones et al.1 and Stone et al.2 (July 15 issue), the effectiveness of treatment of antineutrophil cytoplasmic antibody (ANCA)−associated vasculitides with either a rituximab-based regimen or a cyclophosphamide-based ...

            2075-2076
            More on Physician Cost Profiling
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            To the Editor: In their article on cost profiling of physicians, Adams et al. (March 18 issue)1 question the reliability of using episode-grouping software for profiling. In response, the American Medical Association released an open letter stating that “...

            2076-2077
            Genomewide Association Studies and Assessment of Risk of Disease
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            To the Editor: In her review of genomewide association studies, Manolio (July 8 issue)1 states that “An estimated 10 million common SNPs [single-nucleotide polymorphisms] — those with a minor-allele frequency of at least 5% — are transmitted across ...

            Corrections
            2078
            Nausea and Vomiting in Pregnancy
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            Nausea and Vomiting in Pregnancy Clinical Practice, N Engl J Med 2010;363:1544-1550. There were several errors in Table 1 (page 1547), including the frequency of administration of vitamin B6–doxylamine combination (under Oral Dose) and the organization of ...

            2078
            Three-Year Efficacy of Complex Insulin Regimens in Type 2 Diabetes
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            Three-Year Efficacy of Complex Insulin Regimens in Type 2 Diabetes Original Article, N Engl J Med 2009;361:1736-1747. In the Results section of the Abstract (page 1736), the second sentence should have ended, “. . . with 67.7%, 73.6%, and 81.6%, ...

            2078
            Optimal Insulin Treatment in Type 2 Diabetes
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            Optimal Insulin Treatment in Type 2 Diabetes Editorial, N Engl J Med 2009;361:1801-1803. In the second paragraph (page 1801), the fifth sentence should have read, “In another study, about twice as many patients who received the basal long-acting analogue ...

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