2010 Feb - NEJM Perspective: Is It Always Wrong to Perform Futile CPR?
Although there is currently much debate about the types of care to which patients are entitled, one thing on which everyone can agree is that nonbeneficial care should be eliminated. Although such care can be hard to define, in some circumstances experienced clinicians can be virtually certain that attempts at resuscitation will fail. In these cases, many argue that hospitals should adopt policies that allow physicians to refuse when families demand futile cardiopulmonary resuscitation (CPR).
2010 Feb 4 - NEJM Correspondence: Intensity of Continuous Renal-Replacement Therapy
To the Editor: In the Randomized Evaluation of Normal versus Augmented Level (RENAL) Replacement Therapy Study (Oct. 22 issue),1 investigators compared low-intensity versus high-intensity renal-replacement therapy. One of the secondary outcomes was the development of new organ failure. However, the criteria for "nonrenal organ failure" were not provided.
2010 Jan 21 - NEJM Clinical Practice: Systolic Heart Failure
A 74-year-old man with a history of hypertension and myocardial infarction that occurred 5 years previously presents with breathlessness on exertion. His current medications include a statin and aspirin. On examination, his pulse is 76 beats per minute and regular, and his blood pressure is 121/74 mm Hg. There is jugular venous distention, lateral displacement of the apex beat, and edema in . . .
2010 Jan 21 - NEJM Editorial: Clostridium difficile — Beyond Antibiotics
In this decade, the prevention and control of Clostridium difficile infection in health care settings has become a global public health challenge. Infection rates have increased dramatically, and several large outbreaks associated with toxinotype III BI/NAP1/027 strains have been described.1
2010 Jan 21 - Treatment with Monoclonal Antibodies against Clostridium difficile Toxins
Figure. Pseudomembranous colitis
Background New therapies are needed to manage the increasing incidence, severity, and high rate of recurrence of Clostridium difficile infection.
2010 Jan 14 - Images in Clinical Medicine: Postoperative Tracheal Stenosis
NEJM. Volume 362:e5 January 14, 2010 Number 2
A 45-year-old woman presented for an assessment of breathlessness. She had been receiving inhaled bronchodilators and corticosteroids for years without improvement. Her medical history was notable for prolonged endotracheal intubation 8 years earlier. Examination revealed a biphasic wheeze. Pulmonary-function testing showed ....
2010 Jan 7 - NEJM Correspondence: Intravenous Zanamivir for Oseltamivir-Resistant 2009 H1N1 Influenza
To the Editor: A 10-year-old girl with acute lymphoblastic leukemia was transferred to our hospital on August 31. The patient required mechanical ventilation for worsening lobar pneumonia, despite the administration of broad-spectrum antibiotics (for details, see the Supplementary Appendix, available with the full text of this letter at NEJM.org). Two weeks earlier, she had completed 5 days of oseltamivir for an upper respiratory tract infection caused by influenza A virus (with positive results on rapid antigen testing). On August 27, she had presented with lobar pneumonia (with negative results on rapid antigen testing).
2010 Jan 7 - Preventing Surgical-Site Infections in Nasal Carriers of Staphylococcus aureus
Background Nasal carriers of Staphylococcus aureus are at increased risk for health care–associated infections with this organism. Decolonization of nasal and extranasal sites on hospital admission may reduce this risk.
2009 Dec 31 - NEJM Medical Therapeutics: Activated Protein C for Sepsis
A 55-year-old man is brought to the emergency department with abdominal pain, fever (temperature, 102.9°F), and dyspnea. His medical history includes an appendectomy 8 years earlier. Abdominal radiography shows free air as well as signs of small-bowel ileus. An . . . [Full Text of this Article]
2009 Dec 24 - NEJM Correspondence: Sensitive Cardiac Troponin Assays
To the Editor: Keller et al.1 and Reichlin et al.2 (Aug. 27 issue) unequivocally report the superiority of new sensitive troponin assays over standard assays in the diagnosis of acute myocardial infarction.
2009 Dec 24 - NEJM Images in Clinical Medicine: Coughing and Masks
Coughing can transmit infectious agents, such as influenza virus, and it has been assumed that wearing a mask limits transmission of these agents.
2009 Dec 24 - NEJM Correspondence: Holiday Spikes in Pneumococcal Disease among Older Adults
To the Editor: Rates of invasive pneumococcal disease in the United States increase dramatically, or "spike," during winter holidays.1 We analyzed population-based surveillance data to determine whether spikes may be caused by increased transmission from children to older adults.
2009 Dec 23 - NEJM Correspondence: Intravenous Zanamivir for Oseltamivir-Resistant 2009 H1N1 Influenza
To the Editor: A 10-year-old girl with acute lymphoblastic leukemia was transferred to our hospital on August 31. The patient required mechanical ventilation for worsening lobar pneumonia, despite the administration of broad-spectrum antibiotics (for details, see the Supplementary Appendix, available with the full text of this letter at NEJM.org). Two weeks earlier, she had completed 5 days of oseltamivir for an upper respiratory tract infection caused by influenza A virus (with positive results on rapid antigen testing). On August 27, she had presented with lobar pneumonia (with negative results on rapid antigen testing).
2009 Dec 24 - Case 40-2009 — A 29-Year-Old Man with Fever and Respiratory Failure
Presentation of Case:
Dr. Wilson Tak-Yu Kwong (Medicine): A 29-year-old man was admitted in July 2009 to the critical care unit of this hospital because of fever and respiratory failure.
The patient had been well until 9 days earlier, when a nonproductive cough and myalgias in his legs developed.
2009 Dec 23 - Pediatric Hospitalizations Associated with 2009 Pandemic Influenza A (H1N1) in Argentina
Background While the Northern Hemisphere experiences the effects of the 2009 pandemic influenza A (H1N1) virus, data from the recent influenza season in the Southern Hemisphere can provide important information on the burden of disease in children.
2009 Dec 23 - Severe 2009 H1N1 Influenza in Pregnant and Postpartum Women in California
Background Like previous epidemic and pandemic diseases, 2009 pandemic influenza A (H1N1) may pose an increased risk of severe illness in pregnant women.
2009 Dec 9 - NEJM Correspondence: A Community Cluster of Oseltamivir-Resistant Cases of 2009 H1N1 Influenza
To the Editor: Oseltamivir-resistant infection with the 2009 pandemic influenza A (H1N1) virus has so far been described only rarely and is conferred by the H275Y substitution in the neuraminidase enzyme.1
2009 Dec 9 - Clinical Features of the Initial Cases of 2009 Pandemic Influenza A (H1N1) Virus Infection in China
Background The first case of 2009 pandemic influenza A (H1N1) virus infection in China was documented on May 10. Subsequently, persons with suspected cases of infection and contacts of those with suspected infection were tested. Persons in whom infection was confirmed were hospitalized and quarantined, and some of them were closely observed for the purpose of investigating the nature and duration of the disease.
2009 Nov 25 - The Emotional Epidemiology of H1N1 Influenza Vaccination
Last spring, when 2009 H1N1 influenza first came to our attention, my patients were in a panic. Our clinic was flooded with calls and walk-in patients, all with the same question: "When will there be a vaccine?"
2009 Nov 25 - NEJM Perspective: Australia's Winter with the 2009 Pandemic Influenza A (H1N1) Virus
When the World Health Organization declared a "public health emergency of international concern" on April 25, 2009, after the emergence in Mexico of pandemic influenza A (H1N1) virus, Australia activated its well-rehearsed plan for response to pandemic influenza.1