2010 Jun 24 - NEJM Editorial: Early TIPS to Improve Survival in Acute Variceal Bleeding

Nezam H. Afdhal, M.D., and Michael P. Curry, M.D. NEJM Volume 362:2421-2422 June 24, 2010 Number 25
Gastroesophageal varices are present in 50% of patients with cirrhosis, and variceal hemorrhage develops in up to one third of these patients.

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2010 Jun 24 - Early Use of TIPS in Patients with Cirrhosis and Variceal Bleeding

Juan Carlos García-Pagán, M.D., Karel Caca, M.D., Christophe Bureau, M.D., Wim Laleman, M.D., Beate Appenrodt, M.D., Angelo Luca, M.D., Juan G. Abraldes, M.D., Frederik Nevens, M.D., Jean Pierre Vinel, M.D., Joachim Mössner, M.D., Jaime Bosch, M.D., for the Early TIPS (Transjugular Intrahepatic Portosystemic Shunt) Cooperative Study Group. NEJM Volume 362:2370-2379 June 24, 2010 Number 25
Background Patients with cirrhosis in Child–Pugh class C or those in class B who have persistent bleeding at endoscopy are at high risk for treatment failure and a poor prognosis, even if they have undergone rescue treatment with a transjugular intrahepatic portosystemic shunt (TIPS). This study evaluated the earlier use of TIPS in such patients.

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2010 Jun 10 - Comparative Epidemiology of Pandemic and Seasonal Influenza A in Households

Benjamin J. Cowling, Ph.D., Kwok Hung Chan, Ph.D., Vicky J. Fang, M.Phil., Lincoln L.H. Lau, B.Sc., Hau Chi So, B.N.S., Rita O.P. Fung, B.N.S., Edward S.K. Ma, M.Phil., Alfred S.K. Kwong, M.B., B.S., Chi-Wai Chan, M.B., B.S., Wendy W.S. Tsui, M.B., B.S., Ho-Yin Ngai, M.B., B.S., Daniel W.S. Chu, M.B., B.S., Paco W.Y. Lee, M.B., B.S., Ming-Chee Chiu, M.B., B.S., Gabriel M. Leung, M.D., and Joseph S.M. Peiris, D.Phil. NEJM Volume 362:2175-2184 June 10, 2010 Number 23
Background There are few data on the comparative epidemiology and virology of the pandemic 2009 influenza A (H1N1) virus and cocirculating seasonal influenza A viruses in community settings.

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2010 May 27 - NEJM Correspondence:Is It Always Wrong to Perform Futile CPR?

NEJM. Volume 362:2034-2037 May 27, 2010 Number 21. Related Article by Truog, R. D.
To the Editor: In his Perspective article regarding the performance of futile cardiopulmonary resuscitation (CPR), Truog (Feb. 11 issue)1 calls attention to complexities in end-of-life care and in communicating with loved ones.

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2010 May 13 - Review: Hospital-Acquired Infections Due to Gram-Negative Bacteria

Anton Y. Peleg, M.B., B.S., M.P.H., and David C. Hooper, M.D. NEJM Volume 362:1804-1813 May 13, 2010 Number 19
Hospital-acquired infections are a major challenge to patient safety. It is estimated that in 2002, a total of 1.7 million hospital-acquired infections occurred (4.5 per 100 admissions),1 and almost 99,000 deaths resulted from or were associated with a hospital-acquired infection,1 making hospital-acquired infections the sixth leading cause of death in the United States2; similar data have been reported from Europe.3 The estimated costs to the U.S. health care budget are $5 billion to $10 billion annually.4 Approximately one third or more of hospital-acquired infections are preventable.5

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2010 May 6 - Information Technology and Global Surveillance of Cases of 2009 H1N1 Influenza

John S. Brownstein, Ph.D., Clark C. Freifeld, B.S., Emily H. Chan, M.S., Mikaela Keller, Ph.D., Amy L. Sonricker, M.P.H., Sumiko R. Mekaru, D.V.M., and David L. Buckeridge, M.D., Ph.D. NEJM Volume 362:1731-1735 May 6, 2010 Number 18
The widespread adoption of increasingly sophisticated forms of information technology has paralleled the increase in rapid and far-reaching international travel.

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2010 May 6 - Clinical Aspects of Pandemic 2009 Influenza A (H1N1) Virus Infection

Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza. NEJM Volume 362:1708-1719 May 6, 2010 Number 18
During the spring of 2009, a novel influenza A (H1N1) virus of swine origin caused human infection and acute respiratory illness in Mexico.1,2

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2010 Apr 22 - NEJM Editorial: Improving the Treatment of Necrotizing Pancreatitis — A Step Up

Andrew L. Warshaw, M.D. Volume 362:1535-1537 April 22, 2010 Number 16
Acute pancreatitis in most patients is self-limited and resolves without complications or the need for invasive procedures or surgical intervention. In a minority of patients, perhaps 10%, necrosis of the pancreatic and peripancreatic tissues opens the door to multiple organ failure, infection of the necrotic tissue, or both, with a greatly increased risk of death; this risk has been estimated to be 20 to 30%.

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2010 Apr 22 - NEJM Videos in Clinical Medicine: Ultrasound-Guided Internal Jugular Vein Cannulation

Rafael Ortega, M.D., Michael Song, M.D., Christopher J. Hansen, M.A., and Paul Barash, M.D. Volume 362:e57 April 22, 2010 Number 16

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2010 Apr 22 - A Step-up Approach or Open Necrosectomy for Necrotizing Pancreatitis

Hjalmar C. van Santvoort, M.D., Marc G. Besselink, M.D., Ph.D., Olaf J. Bakker, M.D., H. Sijbrand Hofker, M.D., Marja A. Boermeester, M.D., Ph.D., Cornelis H. Dejong, M.D., Ph.D., Harry van Goor, M.D., Ph.D., Alexander F. Schaapherder, M.D., Ph.D., Casper H. van Eijck, M.D., Ph.D., Thomas L. Bollen, M.D., Bert van Ramshorst, M.D., Ph.D., Vincent B. Nieuwenhuijs, M.D., Ph.D., Robin Timmer, M.D., Ph.D., Johan S. Laméris, M.D., Ph.D., Philip M. Kruyt, M.D., Eric R. Manusama, M.D., Ph.D., Erwin van der Harst, M.D., Ph.D., George P. van der Schelling, M.D., Ph.D., Tom Karsten, M.D., Ph.D., Eric J. Hesselink, M.D., Ph.D., Cornelis J. van Laarhoven, M.D., Ph.D., Camiel Rosman, M.D., Ph.D., Koop Bosscha, M.D., Ph.D., Ralph J. de Wit, M.D., Ph.D., Alexander P. Houdijk, M.D., Ph.D., Maarten S. van Leeuwen, M.D., Ph.D., Erik Buskens, M.D., Ph.D., Hein G. Gooszen, M.D., Ph.D., for the Dutch Pancreatitis Study Group. Volume 362:1491-1502 April 22, 2010 Number 16

Background Necrotizing pancreatitis with infected necrotic tissue is associated with a high rate of complications and death. Standard treatment is open necrosectomy. The outcome may be improved by a minimally invasive step-up approach.

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2010 Apr 11 - Endovascular Repair of Aortic Aneurysm in Patients Physically Ineligible for Open Repair: The United Kingdom EVAR Trial Investigators

Published at www.nejm.org April 11, 2010 (10.1056/NEJMoa0911056)
Background Endovascular repair of abdominal aortic aneurysm was originally developed for patients who were considered to be ineligible for open surgical repair. Data are lacking on the question of whether endovascular repair reduces the rate of death among these patients.

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2010 Apr 11 - Endovascular versus Open Repair of Abdominal Aortic Aneurysm: The United Kingdom EVAR Trial Investigators

Published at www.nejm.org April 11, 2010 (10.1056/NEJMoa0909305) 
Background Few data are available on the long-term outcome of endovascular repair of abdominal aortic aneurysm as compared with open repair.

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2010 Apr 1 - NEJM Editorial: Reversing the Code Status of Advance Directives?

Muriel R. Gillick, M.D. Volume 362:1239-1240 April 1, 2010 Number 13
Twenty years ago, Congress passed the Patient Self-Determination Act, hoping to improve end-of-life care through the use of advance directives. The statute stimulated the development of a cornucopia of planning documents.

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2010 Apr 1 - Advance Directives and Outcomes of Surrogate Decision Making before Death

Maria J. Silveira, M.D., M.P.H., Scott Y.H. Kim, M.D., Ph.D., and Kenneth M. Langa, M.D., Ph.D. Volume 362:1211-1218 April 1, 2010 Number 13. Editorial by Gillick, M. R.
Background Recent discussions about health care reform have raised questions regarding the value of advance directives.

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2010 Mar 18 - Nationwide Public-Access Defibrillation in Japan

Tetsuhisa Kitamura, M.D., Taku Iwami, M.D., Takashi Kawamura, M.D., Ken Nagao, M.D., Hideharu Tanaka, M.D., Atsushi Hiraide, M.D., for the Implementation Working Group for the All-Japan Utstein Registry of the Fire and Disaster Management Agency. NEJM, Volume 362:994-1004 March 18, 2010 Number 11

Figure. An automatic external defribrillator (AED) in a Japan railway station

Background It is unclear whether dissemination of automated external defibrillators (AEDs) in public places can improve the rate of survival among patients who have had an out-of-hospital cardiac arrest.

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2010 Mar 4 - NEJM Editorial: Treating Shock — Old Drugs, New Ideas

Jerrold H. Levy, M.D. NEJM Volume 362:841-843 March 4, 2010 Number 9
Circulatory shock is a medical emergency that is characterized by hypotension and decreased tissue perfusion; if left untreated, it can lead to irreversible cellular injury and death.

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2010 Mar 4 - Comparison of Dopamine and Norepinephrine in the Treatment of Shock

Daniel De Backer, M.D., Ph.D., Patrick Biston, M.D., Jacques Devriendt, M.D., Christian Madl, M.D., Didier Chochrad, M.D., Cesar Aldecoa, M.D., Alexandre Brasseur, M.D., Pierre Defrance, M.D., Philippe Gottignies, M.D., Jean-Louis Vincent, M.D., Ph.D., for the SOAP II Investigators. NEJM Volume 362:779-789 March 4, 2010 Number 9

Figure. The catecholamines pathway (Click image to enlarge)
Background Both dopamine and norepinephrine are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other.

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2010 Feb 18 - Dose of Prophylactic Platelet Transfusions and Prevention of Hemorrhage

Sherrill J. Slichter, M.D., Richard M. Kaufman, M.D., Susan F. Assmann, Ph.D., Jeffrey McCullough, M.D., Darrell J. Triulzi, M.D., Ronald G. Strauss, M.D., Terry B. Gernsheimer, M.D., Paul M. Ness, M.D., Mark E. Brecher, M.D., Cassandra D. Josephson, M.D., Barbara A. Konkle, M.D., Robert D. Woodson, M.D., Thomas L. Ortel, M.D., Ph.D., Christopher D. Hillyer, M.D., Donna L. Skerrett, M.D., Keith R. McCrae, M.D., Steven R. Sloan, M.D., Ph.D., Lynne Uhl, M.D., James N. George, M.D., Victor M. Aquino, M.D., Catherine S. Manno, M.D., Janice G. McFarland, M.D., John R. Hess, M.D., Cindy Leissinger, M.D., and Suzanne Granger, M.S. NEJM Volume 362:600-613 February 18, 2010 Number 7

Background We conducted a trial of prophylactic platelet transfusions to evaluate the effect of platelet dose on bleeding in patients with hypoproliferative thrombocytopenia.

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2010 Feb - NEJM Perspective: Is It Always Wrong to Perform Futile CPR?

Robert D. Truog, M.D. Volume 362:477-479 February 11, 2010 Number 6 
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).

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2010 Feb 4 - NEJM Correspondence: Intensity of Continuous Renal-Replacement Therapy

Volume 362:466-468 February 4, 2010 Number 5
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.

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