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In this study, adults with progressive chronic kidney disease and an estimated glomerular filtration rate between 10 and 15 ml per minute per 1.73 m2 (stage V chronic kidney disease) were randomly assigned to early or late initiation of dialysis. Early initiation of dialysis was not associated with an improvement in survival or clinical outcomes.
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The use of marrow stem cells to treat seven children with severe epidermolysis bullosa caused by loss-of-function mutations in COL7A, the gene encoding type VII collagen (C7), was examined. The investigators observed increases in C7 deposition, the presence of donor cells in the skin, and an amelioration of symptoms.
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Investigators examined whether the intensity of treatment can be reduced in patients with early-stage Hodgkin's lymphoma without compromising antitumor efficacy. In a comparison of two with four cycles of ABVD chemotherapy plus either 20 or 30 Gy of involved-field radiation therapy, no significant differences were noted in disease-free or overall survival between the most and the least intensive regimens.
A 31-year-old woman originally from Nepal presented to her physician after unsuccessful attempts at pregnancy for the past 18 months. She had no history of sexually transmitted diseases, pelvic inflammatory diseases, use of an intrauterine device, exposure to diethylstilbestrol, abnormal Papanicolaou smears, or previous pregnancies. What diagnostic and management steps do you choose? Direct the investigation of the case, test your diagnostic and therapeutic skills, and compare your performance with that of others at NEJM.org.
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A 56-year-old woman was admitted because of the sudden onset of dyspnea and hypotension. At 16 years of age, she had received combination chemotherapy and extended-field radiation therapy for Hodgkin's lymphoma. On admission, an electrocardiogram showed an acute myocardial infarction. A stent was placed, but hypotension and acidosis persisted, and the patient died.
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The authors argue that quality measures in health care should be based on strong evidence that a care process directly improves outcomes, should capture the actual performance of a process, should address a process proximate to the desired outcome, and should not have unintended adverse consequences.
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