2010 Dec 23 - Clinical Practice: Glycemic Control in the ICU

Brian P. Kavanagh, M.B., and Karen C. McCowen, M.D. N Engl J Med 2010; 363:2540-2546December 23, 2010
Stage: A 42-year-old man is admitted to the intensive care unit (ICU) with an acute exacerbation of asthma associated with community-acquired pneumonia. He is treated with cefotaxime and azithromycin, nebulized albuterol, and intravenous hydrocortisone.

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2010 Dec 16 - Perspective: NDM-1 — A Cause for Worldwide Concern

Robert C. Moellering, Jr., M.D. N Engl J Med 2010; 363:2377-2379, December 16, 2010
The past several years have seen a number of reports of superbugs: methicillin-resistant Staphylococcus aureus, the so-called ESKAPE organisms (an acronym for Enterococcus faecium, S. aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and enterobacter species), and others.1

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2010 Nov 4 - Hemodialysis

Jonathan Himmelfarb, M.D., and T. Alp Ikizler, M.D. N Engl J Med 2010; 363:1833-1845, November 4, 2010
Fifty years ago, Belding Scribner and his colleagues at the University of Washington developed a blood-access device using Teflon-coated plastic tubes, which facilitated the use of repeated hemodialysis as a life-sustaining treatment for patients with uremia.1,2

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2010 Nov 4 - Safety of Recombinant Activated Factor VII in Randomized Clinical Trials

Marcel Levi, M.D., Jerrold H. Levy, M.D., Henning Friis Andersen, M.Sc., and David Truloff, D.V.M. N Engl J Med 2010; 363:1791-1800, November 4, 2010
Background
The use of recombinant activated factor VII (rFVIIa) on an off-label basis to treat life-threatening bleeding has been associated with a perceived increased risk of thromboembolic complications. However, data from placebo-controlled trials are needed to properly assess the thromboembolic risk. To address this issue, we evaluated the rate of thromboembolic events in all published randomized, placebo-controlled trials of rFVIIa used on an off-label basis.

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2010 Sep 23 - CLINICAL THERAPEUTICS: Targeted Temperature Management for Comatose Survivors of Cardiac Arrest

Michael Holzer, M.D. N Engl J Med 2010; 363:1256-1264September 23, 2010
A 62-year-old man collapses on the street, and emergency medical personnel who are called to the scene find that he is not breathing and that he has no pulse. The first recorded cardiac rhythm is ventricular fibrillation. Advanced cardiac life-support measures, including intubation, a total dose of 2 mg of epinephrine, and six defibrillation attempts, restore spontaneous circulation 22 minutes after the onset of the event.

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2010 Sep 16 - NEJM Editorial: Neuromuscular Blocking Agents in ARDS

Arthur S. Slutsky, M.D. N Engl J Med 2010; 363:1176-1180, September 16, 2010
In this issue of the Journal, Papazian and colleagues1 present intriguing results of their study examining neuromuscular blockade in patients with severe, early acute respiratory distress syndrome (ARDS). The investigators randomly assigned 340 patients to receive the neuromuscular blocking agent cisatracurium or placebo for a period of 48 hours.

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2010 Sep 16 - Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome

Laurent Papazian, M.D., Ph.D., Jean-Marie Forel, M.D., Arnaud Gacouin, M.D., Christine Penot-Ragon, Pharm.D., Gilles Perrin, M.D., Anderson Loundou, Ph.D., Samir Jaber, M.D., Ph.D., Jean-Michel Arnal, M.D., Didier Perez, M.D., Jean-Marie Seghboyan, M.D., Jean-Michel Constantin, M.D., Ph.D., Pierre Courant, M.D., Jean-Yves Lefrant, M.D., Ph.D., Claude Guérin, M.D., Ph.D., Gwenaël Prat, M.D., Sophie Morange, M.D., and Antoine Roch, M.D., Ph.D. for the ACURASYS Study Investigators. N Engl J Med 2010; 363:1107-1116September 16, 2010
Background
In patients undergoing mechanical ventilation for the acute respiratory distress syndrome (ARDS), neuromuscular blocking agents may improve oxygenation and decrease ventilator-induced lung injury but may also cause muscle weakness. We evaluated clinical outcomes after 2 days of therapy with neuromuscular blocking agents in patients with early, severe ARDS.

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2010 Sep 9 - Rapid Molecular Detection of Tuberculosis and Rifampin Resistance

Catharina C. Boehme, M.D., Pamela Nabeta, M.D., Doris Hillemann, Ph.D., Mark P. Nicol, Ph.D., Shubhada Shenai, Ph.D., Fiorella Krapp, M.D., Jenny Allen, B.Tech., Rasim Tahirli, M.D., Robert Blakemore, B.S., Roxana Rustomjee, M.D., Ph.D., Ana Milovic, M.S., Martin Jones, Ph.D., Sean M. O'Brien, Ph.D., David H. Persing, M.D., Ph.D., Sabine Ruesch-Gerdes, M.D., Eduardo Gotuzzo, M.D., Camilla Rodrigues, M.D., David Alland, M.D., and Mark D. Perkins, M.D. N Engl J Med 2010; 363:1005-1015September 9, 2010
Background
Global control of tuberculosis is hampered by slow, insensitive diagnostic methods, particularly for the detection of drug-resistant forms and in patients with human immunodeficiency virus infection. Early detection is essential to reduce the death rate and interrupt transmission, but the complexity and infrastructure needs of sensitive methods limit their accessibility and effect.

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2010 Sep 2 - NEJM Editorial: Fine-Tuning Therapy for Acute Coronary Syndromes

Valentin Fuster, M.D., Ph.D. N Engl J Med 2010; 363:976-977, September 2, 2010
Aspirin and clopidogrel are mainstays of therapy for patients presenting with an acute coronary syndrome. National guidelines dictate that at the time of the patient's presentation to an emergency department, these therapies should be given expeditiously, whether or not percutaneous coronary intervention is planned.

In this issue of the Journal, Mehta et al. report on the results of the Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent Events–Seventh Organization to Assess Strategies in Ischemic Syndromes (CURRENT–OASIS 7) trial, which evaluated alternative dosing regimens for both of these agents.1

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2010 Sep 2 - Dose Comparisons of Clopidogrel and Aspirin in Acute Coronary Syndromes

The CURRENT–OASIS 7 Investigators. N Engl J Med 2010; 363:930-942, September 2, 2010
Background
Clopidogrel and aspirin are widely used for patients with acute coronary syndromes and those undergoing percutaneous coronary intervention (PCI). However, evidence-based guidelines for dosing have not been established for either agent.

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2010 Aug 19 - Case Records of the Massachusetts General Hospital:Case 25-2010 — A 24-Year-Old Woman with Abdominal Pain and Shock

Mark S. Klempner, M.D., Elizabeth A. Talbot, M.D., Susanna I. Lee, M.D., Ph.D., Sherif Zaki, M.D. and Mary Jane Ferraro, Ph.D., M.P.H. N Engl J Med 2010; 363:766-777, August 19, 2010
Dr. Franklin W. Huang (Medicine): A 24-year-old woman was transferred to this hospital because of abdominal pain, vomiting, ascites, and shock.

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2010 Jul 29 - Images in Clinical Medicine: Pneumothorax — An Uncommon Complication of a Common Procedure

Tahir Nazir, M.R.C.P. and Shuja Punekar, F.R.C.P. N Engl J Med 2010; 363:462July 29, 2010
A 92-year-old woman was admitted to the hospital with a severe left-sided ischemic stroke causing altered mental status (i.e., a score of 9 on the Glasgow Coma Scale, on which scores range from 3 to 15, with higher scores indicating increased consciousness), weakness on the right side, and dysphagia.

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2010 Jul 29 - Compression-Only CPR or Standard CPR in Out-of-Hospital Cardiac Arrest

Leif Svensson, M.D., Ph.D., Katarina Bohm, R.N., Ph.D., Maaret Castrèn, M.D., Ph.D., Hans Pettersson, Ph.D., Lars Engerström, M.D., Johan Herlitz, M.D., Ph.D. and Mårten Rosenqvist, M.D., Ph.D. N Engl J Med 2010; 363:434-442July 29, 2010
Background
Emergency medical dispatchers give instructions on how to perform cardiopulmonary resuscitation (CPR) over the telephone to callers requesting help for a patient with suspected cardiac arrest, before the arrival of emergency medical services (EMS) personnel. A previous study indicated that instructions to perform CPR consisting of only chest compression result in a treatment efficacy that is similar or even superior to that associated with instructions given to perform standard CPR, which consists of both compression and ventilation. That study, however, was not powered to assess a possible difference in survival. The aim of this prospective, randomized study was to evaluate the possible superiority of compression-only CPR over standard CPR with respect to survival.

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2010 Jul 29 - NEJM Editorial: In CPR, Less May Be Better

Myron L. Weisfeldt, M.D. N Engl J Med 2010; 363:481-483July 29, 2010
Fifty years have passed since Kouwenhoven, Jude, and Knickerbocker1 proposed external chest compression to provide circulation of blood to the brain and heart after cardiac arrest.

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2010 Jul 29 - CPR with Chest Compression Alone or with Rescue Breathing

Thomas D. Rea, M.D., Carol Fahrenbruch, M.S.P.H., Linda Culley, B.A., Rachael T. Donohoe, Ph.D., Cindy Hambly, E.M.T., Jennifer Innes, B.A., Megan Bloomingdale, E.M.T., Cleo Subido, Steven Romines, M.S.P.H. and Mickey S. Eisenberg, M.D., Ph.D. N Engl J Med 2010; 363:423-433July 29, 2010
Background
The role of rescue breathing in cardiopulmonary resuscitation (CPR) performed by a layperson is uncertain. We hypothesized that the dispatcher instructions to bystanders to provide chest compression alone would result in improved survival as compared with instructions to provide chest compression plus rescue breathing.

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2010 Jul 15 - Rituximab versus Cyclophosphamide for ANCA-Associated Vasculitis

John H. Stone, M.D., M.P.H., Peter A. Merkel, M.D., M.P.H., Robert Spiera, M.D., Philip Seo, M.D., M.H.S., Carol A. Langford, M.D., M.H.S., Gary S. Hoffman, M.D., Cees G.M. Kallenberg, M.D., Ph.D., E. William St. Clair, M.D., Anthony Turkiewicz, M.D., Nadia K. Tchao, M.D., Lisa Webber, R.N., Linna Ding, M.D., Ph.D., Lourdes P. Sejismundo, R.N., B.S.N., Kathleen Mieras, C.C.R.P., David Weitzenkamp, Ph.D., David Ikle, Ph.D., Vicki Seyfert-Margolis, Ph.D., Mark Mueller, B.S., C.C.R.P., Paul Brunetta, M.D., Nancy B. Allen, M.D., Fernando C. Fervenza, M.D., Ph.D., Duvuru Geetha, M.D., Karina A. Keogh, M.D., Eugene Y. Kissin, M.D., Paul A. Monach, M.D., Ph.D., Tobias Peikert, M.D., Coen Stegeman, M.D., Ph.D., Steven R. Ytterberg, M.D., Ulrich Specks, M.D., for the RAVE–ITN Research Group. NEJM Volume 363:221-232 July 15, 2010 Number 3
Background Cyclophosphamide and glucocorticoids have been the cornerstone of remission-induction therapy for severe antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis for 40 years. Uncontrolled studies suggest that rituximab is effective and may be safer than a cyclophosphamide-based regimen.

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2010 Jul 15 - Rituximab versus Cyclophosphamide in ANCA-Associated Renal Vasculitis

Rachel B. Jones, M.R.C.P., M.D., Jan Willem Cohen Tervaert, M.D., Ph.D., Thomas Hauser, M.D., Raashid Luqmani, D.M., F.R.C.P., F.R.C.P.(E.), Matthew D. Morgan, M.R.C.P., Ph.D., Chen Au Peh, F.R.A.C.P., Ph.D., Caroline O. Savage, Ph.D., F.R.C.P., F.Med.Sci., Mårten Segelmark, M.D., Ph.D., Vladimir Tesar, M.D., Ph.D., Pieter van Paassen, M.D., Ph.D., Dorothy Walsh, B.S.C.N., Michael Walsh, M.D., F.R.C.P.(C.), Kerstin Westman, M.D., Ph.D., David R.W. Jayne, M.D., F.R.C.P., for the European Vasculitis Study Group. NEJM Volume 363:211-220 July 15, 2010 Number 3
Background Cyclophosphamide induction regimens for antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis are effective in 70 to 90% of patients, but they are associated with high rates of death and adverse events. Treatment with rituximab has led to remission rates of 80 to 90% among patients with refractory ANCA-associated vasculitis and may be safer than cyclophosphamide regimens.

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2010 Jul 15 - Review: Acute Pulmonary Embolism

Giancarlo Agnelli, M.D., and Cecilia Becattini, M.D., Ph.D. NEJM Volume 363:266-274 July 15, 2010 Number 3
The clinical presentation of acute pulmonary embolism ranges from shock or sustained hypotension to mild dyspnea.

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2010 Jul 1 - Immunotherapy for Sepsis — A New Approach against an Ancient Foe

Richard S. Hotchkiss, M.D., and Steven Opal, M.D. NEJM Volume 363:87-89 July 1, 2010 Number 1
Septic shock is traditionally viewed as an excessive systemic inflammatory reaction to invasive microbial pathogens, yet efforts to improve the outcome of patients with sepsis by means of inhibitors of proinflammatory cytokines and mediators have been unsuccessful.

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2010 Jul 1 - Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis

Thomas G. Brott, M.D., Robert W. Hobson, II, M.D., George Howard, Dr.P.H., Gary S. Roubin, M.D., Ph.D., Wayne M. Clark, M.D., William Brooks, M.D., Ariane Mackey, M.D., Michael D. Hill, M.D., Pierre P. Leimgruber, M.D., Alice J. Sheffet, Ph.D., Virginia J. Howard, Ph.D., Wesley S. Moore, M.D., Jenifer H. Voeks, Ph.D., L. Nelson Hopkins, M.D., Donald E. Cutlip, M.D., David J. Cohen, M.D., Jeffrey J. Popma, M.D., Robert D. Ferguson, M.D., Stanley N. Cohen, M.D., Joseph L. Blackshear, M.D., Frank L. Silver, M.D., J.P. Mohr, M.D., Brajesh K. Lal, M.D., James F. Meschia, M.D., for the CREST Investigators. NEJM Volume 363:11-23 July 1, 2010 Number 1
Background Carotid-artery stenting and carotid endarterectomy are both options for treating carotid-artery stenosis, an important cause of stroke.

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