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Infectious Diseases
In 1995, Constance Wofsy, who had been a leader in San Francisco's response to AIDS in the 1980s, recalled the way she and other physicians had been drawn to the nascent epidemic. "How gripped we were," she said, "How separate we were from everyone who wasn't part of the thing. There were the involved and uninvolved, and they just didn't understand one another."
New England Journal of Medicine - Thu, 30 November 2006
http://www.nejm.org
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Infectious Diseases
Long-term antiretroviral therapy for the treatment of human immunodeficiency virus infection is associated with a substantial rate of complications. Structured interruption of antiretroviral therapy, in the setting of a preserved CD4+ count, has been considered in order to minimize these side effects. In this randomized study of 5472 patients, CD4+ count-guided intermittent use of antiretroviral drugs was found to be associated with increased rates of opportunistic disease, death from any cause, and severe adverse events, as compared with the continuous use of antiretroviral therapy.
New England Journal of Medicine - Thu, 30 November 2006
http://www.nejm.org
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Hepatology
In this placebo-controlled, randomized trial of pioglitazone in subjects with nonalcoholic steatohepatitis, pioglitazone was associated with improvements in the results of liver-function tests, hepatic fat content, and hepatic insulin sensitivity. As compared with placebo, pioglitazone significantly reduced the histologic abnormalities of steatohepatitis but did not significantly reduce fibrosis.
New England Journal of Medicine - Thu, 30 November 2006
http://www.nejm.org
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Cardiology
Hospitals have a variety of strategies to reduce the time from arrival at the hospital to intracoronary balloon inflation (door-to-balloon time) for patients who have acute myocardial infarction with ST-segment elevation. In a study of 365 hospitals, 28 institutional strategies were identified with the use of a field-tested questionnaire. These strategies were correlated with door-to-balloon times for individual patients as reported to the Centers for Medicare and Medicaid Services. Six strategies were associated with a significant reduction in the door-to-balloon time. The use of these strategies may improve outcomes for patients.
New England Journal of Medicine - Thu, 30 November 2006
http://www.nejm.org
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Obstetrics and Gynecology
A 51-year-old woman is having frequent and distressing hot flushes that interfere with her work and sleep, and vaginal dryness that makes sexual intercourse uncomfortable. She is otherwise healthy. How should her case be managed?
New England Journal of Medicine - Thu, 30 November 2006
http://www.nejm.org
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Gastroenterology
A 68-year-old woman with severe postmenopausal osteoporosis was referred because of a 6-month history of erosive mucositis of the hard palate, accompanied by intense pain and dysphagia.
New England Journal of Medicine - Thu, 30 November 2006
http://www.nejm.org
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Orthopaedics
A 54-year-old man with a 3-year history of IgG myeloma, complicated by hypercalcemia, who was being treated with dexamethasone, lenalidomide, filgrastim, darbepoetin alfa, and pamidronate, presented with a 1-month history of severe bilateral jaw pain.
New England Journal of Medicine - Thu, 30 November 2006
http://www.nejm.org
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Orthopaedics
Nitrogen-containing bisphosphonates are used widely for the management of metastatic cancer in bone (intravenous zoledronic acid or pamidronate), for the prevention and treatment of osteoporosis (oral alendronate, risedronate, and ibandronate and intravenous ibandronate), for the treatment of Paget's disease of bone (intravenous pamidronate and oral alendronate and risedronate), and for the short-term management of acute hypercalcemia (intravenous zoledronic acid and pamidronate).
New England Journal of Medicine - Thu, 30 November 2006
http://www.nejm.org
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General medicine
In this survey of institutional review board (IRB) members, 36% of those surveyed reported having relationships with industry. Although 86% believed that such relationships never adversely affected IRB-related decisions, a small number acknowledged that they had voted on a protocol sponsored by a company or a competitor to a company with which they had an association.
New England Journal of Medicine - Thu, 30 November 2006
http://www.nejm.org
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General medicine
In this survey of patients enrolled in cancer trials, most were not worried about possible financial ties between researchers or medical centers and drug companies. Many patients wanted to be informed about financial ties or about the oversight system to protect against conflicts of interest, but few thought knowledge of financial ties would have influenced their decision to participate in the trial.
New England Journal of Medicine - Thu, 30 November 2006
http://www.nejm.org