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Original Article
Renal-Replacement Therapy in Acute Kidney Injury
S.D. Barbar and Others
A multicenter, randomized, controlled trial compared early with delayed strategies of renal-replacement therapy in patients with early-stage septic shock who had severe acute kidney injury. There was no significant between-group difference in overall mortality at 90 days.
Oct 11
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Original Article
Drilling Down on Diagnostic Method
K. Splinter and Others
The Undiagnosed Diseases Network, an NIH-funded network of seven U.S. sites, accepted 601 patients for evaluation over a 20-month period. Of the 382 patients who had a complete evaluation, 132 (35%) received a diagnosis; 15 of the diagnoses (11%) were made by clinical review alone and 98 (74%) by exome or genome sequencing.
Oct 10 -
Original Article
Genetic Classification of Myeloproliferative Neoplasms
J. Grinfeld and Others
Genetic analysis involving 2035 patients with a myeloproliferative disorder identified eight genomic subgroups with distinct clinical phenotypes, risk of leukemic transformation, and event-free survival.
Oct 11
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Original Article
Drilling Down on Diagnostic Method
K. Splinter and Others
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Perspective
Trauma-Informed Care
E. Rittenberg
Stories of abuse, of trauma inflicted by people with power, have permeated a primary care physician’s sessions with patients over recent weeks. Many patients name the Kavanaugh hearings as a source of dread: the news has brought back memories of their own experiences.
Oct 10
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Perspective
Trauma-Informed Care
E. Rittenberg
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Perspective
The Next Phase of Human Gene-Therapy Oversight
F.S. Collins and S. Gottlieb
As gene therapy continues to change, so must the federal framework set up to oversee it. As new biotechnologies continue to emerge, the NIH and the FDA are proposing reductions in duplicative oversight and changes to the role of the Recombinant DNA Advisory Committee.
Oct 11
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Perspective
The Next Phase of Human Gene-Therapy Oversight
F.S. Collins and S. Gottlieb
Original Research
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Original Article
Assessing Drug Susceptibility in Tuberculosis
The CRyPTIC Consortium and the 100,000 Genomes Project
Proper treatment of tuberculosis requires a combination of drugs to which the causative organism is susceptible. In this report, genotypic assessment of antimicrobial susceptibility of more than 10,000 M. tuberculosis isolates was correlated with phenotypic test results.
Oct 11
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Original Article
Brief Report
Treatment of PML with BK Virus–Specific T Cells
M. Muftuoglu and Others
Three patients with progressive multifocal leukoencephalopathy who were treated with third-party–produced, cryopreserved, partially HLA-matched T cells specific for BK virus had clinical improvement or stabilization of PML and reduction in JC viral load.
Oct 11 -
Correspondence
Video Telemedicine Integrated with Clinical Care
M.E. Reed and Others
An integrated delivery system introduced video-visit capability for all clinicians in 2014. More than 150,000 patients participated in video visits from 2015 through 2017. Patient satisfaction was high; 93% of surveyed patients reported that their video visit met their needs.
Oct 11
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Original Article
Brief Report
Treatment of PML with BK Virus–Specific T Cells
M. Muftuoglu and Others
Clinical Practice and Review
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Case Records of the Massachusetts General Hospital
A Man with a Self-Inflicted Gunshot Wound
C.A. Sacks and Others
A 37-year-old man was admitted to the surgical intensive care unit because of a self-inflicted gunshot wound to the face. Management decisions were made.
Oct 11 -
Clinical Implications of Basic Research
Histone Methylation in Neuroblastoma
S.G. DuBois and J.R. Park
A recent study of inhibitors of histone demethylases in vitro and in an animal model of neuroblastoma underscores the potential of a new pharmacologic approach to treatment.
Oct 11 -
Perspective
A Seat at the Table
L. Caulley
After a long struggle, the health care team won a victory that bore a frightening resemblance to an ultimatum, and Ms. S.’s sons signed a DNR order for their 70-year old mother. I chalked up the nauseated feeling in the pit of my stomach to my inexperience in the field.
Oct 11
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Case Records of the Massachusetts General Hospital
A Man with a Self-Inflicted Gunshot Wound
C.A. Sacks and Others
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Review Article
Ontologies, Phenotypes, and Big Data
M.A. Haendel, C.G. Chute, and P.N. Robinson
Data-organizing methods have been in place for centuries, but very large data sets have come into being relatively recently. The authors describe terminologies, ontologies, and the changes needed to permit analyses of “big data” that might better serve medical decision making.
Oct 11 -
Perspective
The Name of the Dog
T. Safder
The resident presented a patient admitted for chest pain after walking his dog. The attending asked, “What was the name of his dog?” The resident was stumped. Four years later, he’s not sure anything he’s carried from residency has been more useful than that question.
Oct 04
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Commentary
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National Coverage Analysis of CAR-T Therapies
P.B. Bach -
The Coming of Age of Drug-Susceptibility Testing for Tuberculosis
H. Cox and V. Mizrahi -
“Precision” Public Health
M. Chowkwanyun, R. Bayer, and S. Galea -
The Next Phase of Human Gene-Therapy Oversight
F.S. Collins and S. Gottlieb -
A Seat at the Table
L. Caulley -
ECMO for Severe ARDS — Polling Results
M.Y. Mi, M.A. Matthay, and A.H. MorrisRead the interim polling results analysis, located in the Comments.
Correspondence
- Real-Time Patient–Provider Video Telemedicine Integrated with Clinical Care
- Venetoclax in a Patient with a Blastic Plasmacytoid Dendritic-Cell Neoplasm
- Safety Trials of Long-Acting β2-Agonists
- Endovenous Ablation in Venous Ulceration
- Subclinical Hyperthyroidism
- Informed Consent and the Role of the Treating Physician
What are the top two biggest barriers to providing excellent care in urban/suburban versus rural settings?
- Distance/travel time to facilities
- Adverse social determinants of health
- Primary care physician availability
- Lack of or inadequate health insurance
- High cost of capital
- Suboptimal use of telehealth
- Difficulty of patient engagement
- Recruitment/retention of nurses
- Recruitment/retention of physicians
- Higher incidence of chronic diseases (e.g., type 2 diabetes)
- Don’t know