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November 24, 2011  Vol. 365 No. 21

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Perspective
1949-1951

A preventive-services task force omitted three key issues in recommending against PSA screening: the impossibility of addressing the probabilities and uncertainties coherently during routine visits, variable management of PSA levels, and a lack of cost-effectiveness.

1951-1953
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Evidence of a possible small benefit from PSA screening supports a grade C recommendation — not the U.S. Preventive Services Task Force's proposed grade D — for men 55 to 69 years of age, who should participate in screening decisions after discussion with a primary care provider.

1953-1955

The USPSTF's grade D recommendation contradicts the common view that PSA screening saves lives by reducing the risk of death from prostate cancer. Decisions about screening should be made by informed patients and their clinicians, weighing particular risk factors.

1955-1957

A sixth version of the MCAT will be ready in 2015, featuring revised science and verbal sections, plus a new section on behavioral and social sciences that aims to assess applicants' readiness to learn about “behavioral, social, and cultural determinants of health.”

Original Articles
1959-1968

This trial showed that two types of behavioral interventions, one based on remote, call-center support and the other on in-person support, resulted in significant weight loss among obese patients. These results provide templates for effective weight-loss programs in primary care practices.

1969-1979

This trial compared three weight-loss interventions (usual care, brief lifestyle counseling, and enhanced brief lifestyle counseling) in primary care practice. Enhanced brief lifestyle counseling was most effective, resulting in significant weight loss in about one third of patients.

1980-1989

This trial compared the combination of abciximab and unfractionated heparin with bivalirudin in patients with non–ST-segment elevation MI who were undergoing coronary stenting. The two regimens had similar efficacy, but there was more bleeding with abciximab and heparin.

1990-2001

Guidelines suggest daily inhaled glucocorticoids in young children at high risk for asthma exacerbation. These investigators found that such treatment was not superior to the intermittent use of budesonide initiated when signs and symptoms indicated an impending asthma exacerbation.

Special Article
2002-2012
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This national study estimated that nearly 100,000 elderly patients were hospitalized for adverse drug events annually from 2007 through 2009. Most resulted from use of common medications such as warfarin and insulin, and only 1% from medications designated as high-risk.

Clinical Practice
2013-2019
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Current recommendations for prostate-specific antigen testing are reviewed, as well as the initial results of two randomized trials. The potential risks of screening, including morbidity from overdiagnosis and overtreatment, are described.

Images in Clinical Medicine
2020
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A 26-year-old woman presented with painless nodular skin lesions that had first developed 7 years earlier. Skin nodules initially appeared on the anterior chest wall and progressed to involve the whole body. Her medical history and that of her family were unremarkable.

e41
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A 67-year-old man was referred to the hematology department for evaluation of monoclonal gammopathy. As part of his workup, a skeletal survey was performed. The study did not show any lytic bone lesions, but numerous “rice grain” calcifications were seen ...

Case Records of the Massachusetts General Hospital
2021-2028
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A 93-year-old woman was seen in the emergency department because of a 3-hour history of chest pain and shortness of breath. An electrocardiogram showed ST-segment elevations. A diagnostic procedure was performed.

Editorial
2030-2031

The U.S. Preventive Services Task Force recommends that clinicians arrange for their obese patients to receive intensive, multicomponent behavioral weight-loss counseling.1 However, less than 50% of primary care physicians (PCPs) report that they ...

Correspondence
2032-2035

To the Editor: Avidan and colleagues (Aug. 18 issue)1 reported that monitoring with the use of the bispectral index (BIS), as compared with the use of the end-tidal anesthetic-agent concentration (ETAC), does not reduce awareness during anesthesia (the ...

2035-2038

To the Editor: The results of the National Lung Screening Trial (NLST) (Aug. 4 issue)1 showed a relative reduction in lung-cancer mortality of 20% in former and current heavy smokers who underwent screening with low-dose computed tomography (CT), as ...

2038-2039

To the Editor: In their review article (Sept. 8 issue),1 De Matteis and Luini affirmed the importance of studying disease genes to understand the physiological functions of transport proteins. They list CAV1 (caveolin-1) as a gene whose mutations are ...

2039-2040

The new oral direct thrombin inhibitor, dabigatran, is proving to be problematic in acutely injured patients, since it may promote bleeding and its effect cannot be easily reversed.

Corrections
2040

Decompressive Craniectomy in Diffuse Traumatic Brain Injury Original Article, N Engl J Med 2011;364:1493-1502. In the first paragraph of the Discussion (page 1499), the last sentence should have referred to the Extended Glasgow Outcome Scale, rather than ...

2040

A Prospective Natural-History Study of Coronary Atherosclerosis Original Article, N Engl J Med 2011;364:226-235. In the first row of Table 2 (page 232), the number of patients listed parenthetically under All Events should have been 132, rather than 13. ...