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New England Journal of Medicine

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https://www.readbyqxmd.com/read/30230965/being-prepared-preexposure-prophylaxis-and-hiv-disparities
#1
Robert H Goldstein, Carl G Streed, Sean R Cahill
If current trends persist, one in six U.S. men who have sex with men will be infected with human immunodeficiency virus (HIV) in their lifetime, according to the Centers for Disease Control and Prevention (CDC). This prediction highlights the long road ahead if we are to end the spread of HIV in..
September 19, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30230961/payment-and-delivery-system-reform-the-next-phase
#2
Hoangmai Pham, Paul B Ginsburg
After nearly a decade of experimentation with value-based payment (VBP), U.S. health care payers, providers, and purchasers are confronting uneven adoption of new care guidelines, modest early results, and still-unacceptable gaps in spending and quality. In determining what comes next, we believe..
September 19, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30221597/effect-of-aspirin-on-cardiovascular-events-and-bleeding-in-the-healthy-elderly
#3
John J McNeil, Rory Wolfe, Robyn L Woods, Andrew M Tonkin, Geoffrey A Donnan, Mark R Nelson, Christopher M Reid, Jessica E Lockery, Brenda Kirpach, Elsdon Storey, Raj C Shah, Jeff D Williamson, Karen L Margolis, Michael E Ernst, Walter P Abhayaratna, Nigel Stocks, Sharyn M Fitzgerald, Suzanne G Orchard, Ruth E Trevaks, Lawrence J Beilin, Colin I Johnston, Joanne Ryan, Barbara Radziszewska, Michael Jelinek, Mobin Malik, Charles B Eaton, Donna Brauer, Geoff Cloud, Erica M Wood, Suzanne E Mahady, Suzanne Satterfield, Richard Grimm, Anne M Murray
Background Aspirin is a well-established therapy for the secondary prevention of cardiovascular events. However, its role in the primary prevention of cardiovascular disease is unclear, especially in older persons, who have an increased risk. Methods From 2010 through 2014, we enrolled community-dwelling men and women in Australia and the United States who were 70 years of age or older (or ≥65 years of age among blacks and Hispanics in the United States) and did not have cardiovascular disease, dementia, or disability...
September 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30221596/effect-of-aspirin-on-disability-free-survival-in-the-healthy-elderly
#4
John J McNeil, Robyn L Woods, Mark R Nelson, Christopher M Reid, Brenda Kirpach, Rory Wolfe, Elsdon Storey, Raj C Shah, Jessica E Lockery, Andrew M Tonkin, Anne B Newman, Jeff D Williamson, Karen L Margolis, Michael E Ernst, Walter P Abhayaratna, Nigel Stocks, Sharyn M Fitzgerald, Suzanne G Orchard, Ruth E Trevaks, Lawrence J Beilin, Geoffrey A Donnan, Peter Gibbs, Colin I Johnston, Joanne Ryan, Barbara Radziszewska, Richard Grimm, Anne M Murray
Background Information on the use of aspirin to increase healthy independent life span in older persons is limited. Whether 5 years of daily low-dose aspirin therapy would extend disability-free life in healthy seniors is unclear. Methods From 2010 through 2014, we enrolled community-dwelling persons in Australia and the United States who were 70 years of age or older (or ≥65 years of age among blacks and Hispanics in the United States) and did not have cardiovascular disease, dementia, or physical disability...
September 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30221595/effect-of-aspirin-on-all-cause-mortality-in-the-healthy-elderly
#5
John J McNeil, Mark R Nelson, Robyn L Woods, Jessica E Lockery, Rory Wolfe, Christopher M Reid, Brenda Kirpach, Raj C Shah, Diane G Ives, Elsdon Storey, Joanne Ryan, Andrew M Tonkin, Anne B Newman, Jeff D Williamson, Karen L Margolis, Michael E Ernst, Walter P Abhayaratna, Nigel Stocks, Sharyn M Fitzgerald, Suzanne G Orchard, Ruth E Trevaks, Lawrence J Beilin, Geoffrey A Donnan, Peter Gibbs, Colin I Johnston, Barbara Radziszewska, Richard Grimm, Anne M Murray
Background In the primary analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial, now published in the Journal, we report that the daily use of aspirin did not provide a benefit with regard to the primary end point of disability-free survival among older adults. A numerically higher rate of the secondary end point of death from any cause was observed with aspirin than with placebo. Methods From 2010 through 2014, we enrolled community-dwelling persons in Australia and the United States who were 70 years of age or older (or ≥65 years of age among blacks and Hispanics in the United States) and did not have cardiovascular disease, dementia, or disability...
September 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30220235/nintedanib-plus-sildenafil-in-patients-with-idiopathic-pulmonary-fibrosis
#6
Martin Kolb, Ganesh Raghu, Athol U Wells, Jürgen Behr, Luca Richeldi, Birgit Schinzel, Manuel Quaresma, Susanne Stowasser, Fernando J Martinez
Background Nintedanib is an approved treatment for idiopathic pulmonary fibrosis (IPF). A subgroup analysis of a previously published trial suggested that sildenafil may provide benefits regarding oxygenation, gas exchange as measured by the diffusion capacity of the lungs for carbon monoxide (DlCO ), symptoms, and quality of life in patients with IPF and severely decreased DlCO . That idea was tested in this trial. Methods We randomly assigned, in a 1:1 ratio, patients with IPF and a DlCO of 35% or less of the predicted value to receive nintedanib at a dose of 150 mg twice daily plus sildenafil at a dose of 20 mg three times daily (nintedanib-plus-sildenafil group) or nintedanib at a dose of 150 mg twice daily plus placebo three times daily (nintedanib group) for 24 weeks...
September 15, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30207831/ending-sexual-harassment-in-academic-medicine
#7
Victor J Dzau, Paula A Johnson
No abstract text is available yet for this article.
September 12, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30207825/time-s-up-for-medicine-only-time-will-tell
#8
Esther K Choo, Jane van Dis, Dara Kass
No abstract text is available yet for this article.
September 12, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30205746/phase-2-trial-of-selective-tyrosine-kinase-2-inhibition-in-psoriasis
#9
Kim Papp, Kenneth Gordon, Diamant Thaçi, Akimichi Morita, Melinda Gooderham, Peter Foley, Ihab G Girgis, Sudeep Kundu, Subhashis Banerjee
Background Tyrosine kinase 2 (TYK2) signaling pathways, which mediate cytokine signaling, are implicated in the pathophysiology of psoriasis. Selective inhibitors of TYK2 may be effective in treating psoriasis. Methods We conducted a phase 2, double-blind trial of a TYK2 inhibitor, BMS-986165, in adults with moderate-to-severe psoriasis, excluding patients with a previous lack of response to agents targeting cytokine signaling through the same tyrosine kinase pathway. Patients were randomly assigned to receive the drug orally at a dose of 3 mg every other day, 3 mg daily, 3 mg twice daily, 6 mg twice daily, or 12 mg daily or to receive placebo...
September 11, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30200806/unveiling-the-rna-world
#10
Judy Lieberman
No abstract text is available yet for this article.
September 10, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30184442/-precision-public-health-between-novelty-and-hype
#11
Merlin Chowkwanyun, Ronald Bayer, Sandro Galea
In May 2018, the National Institutes of Health (NIH) began enrollment for a vast medical research cohort. Named "All of Us," it’s meant to include 1 million U.S. volunteers, who will be studied over 10 years at a cost of $1.45 billion. The project promises to "lay the scientific foundation for a..
September 5, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30156992/-transparency-as-mask-the-epa-s-proposed-rule-on-scientific-data
#12
Joel Schwartz
The Environmental Protection Agency (EPA) recently proposed excluding from consideration in setting environmental standards any studies whose raw, individual-level data are not publicly available. This proposal was preceded by the wholesale exclusion from the EPA’s scientific advisory boards of..
August 29, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30156965/the-supreme-court-s-crisis-pregnancy-center-case-implications-for-health-law
#13
Wendy E Parmet, Micah L Berman, Jason A Smith
States frequently compel health professionals and commercial entities to disclose information relevant to patient or consumer decision making. For many years, such laws were presumed to be constitutional, despite the First Amendment’s protection of free speech. But after the Supreme Court’s..
August 29, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30152252/partial-oral-versus-intravenous-antibiotic-treatment-of-endocarditis
#14
Kasper Iversen, Nikolaj Ihlemann, Sabine U Gill, Trine Madsen, Hanne Elming, Kaare T Jensen, Niels E Bruun, Dan E Høfsten, Kurt Fursted, Jens J Christensen, Martin Schultz, Christine F Klein, Emil L Fosbøll, Flemming Rosenvinge, Henrik C Schønheyder, Lars Køber, Christian Torp-Pedersen, Jannik Helweg-Larsen, Niels Tønder, Claus Moser, Henning Bundgaard
Background Patients with infective endocarditis on the left side of the heart are typically treated with intravenous antibiotic agents for up to 6 weeks. Whether a shift from intravenous to oral antibiotics once the patient is in stable condition would result in efficacy and safety similar to those with continued intravenous treatment is unknown. Methods In a randomized, noninferiority, multicenter trial, we assigned 400 adults in stable condition who had endocarditis on the left side of the heart caused by streptococcus, Enterococcus faecalis, Staphylococcus aureus, or coagulase-negative staphylococci and who were being treated with intravenous antibiotics to continue intravenous treatment (199 patients) or to switch to oral antibiotic treatment (201 patients)...
August 28, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30146935/rivaroxaban-in-patients-with-heart-failure-sinus-rhythm-and-coronary-disease
#15
Faiez Zannad, Stefan D Anker, William M Byra, John G F Cleland, Min Fu, Mihai Gheorghiade, Carolyn S P Lam, Mandeep R Mehra, James D Neaton, Christopher C Nessel, Theodore E Spiro, Dirk J van Veldhuisen, Barry Greenberg
Background Heart failure is associated with activation of thrombin-related pathways, which predicts a poor prognosis. We hypothesized that treatment with rivaroxaban, a factor Xa inhibitor, could reduce thrombin generation and improve outcomes for patients with worsening chronic heart failure and underlying coronary artery disease. Methods In this double-blind, randomized trial, 5022 patients who had chronic heart failure, a left ventricular ejection fraction of 40% or less, coronary artery disease, and elevated plasma concentrations of natriuretic peptides and who did not have atrial fibrillation were randomly assigned to receive rivaroxaban at a dose of 2...
August 27, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30145927/percutaneous-repair-or-medical-treatment-for-secondary-mitral-regurgitation
#16
Jean-François Obadia, David Messika-Zeitoun, Guillaume Leurent, Bernard Iung, Guillaume Bonnet, Nicolas Piriou, Thierry Lefèvre, Christophe Piot, Frédéric Rouleau, Didier Carrié, Mohammed Nejjari, Patrick Ohlmann, Florence Leclercq, Christophe Saint Etienne, Emmanuel Teiger, Lionel Leroux, Nicole Karam, Nicolas Michel, Martine Gilard, Erwan Donal, Jean-Noël Trochu, Bertrand Cormier, Xavier Armoiry, Florent Boutitie, Delphine Maucort-Boulch, Cécile Barnel, Géraldine Samson, Patrice Guerin, Alec Vahanian, Nathan Mewton
Background In patients who have chronic heart failure with reduced left ventricular ejection fraction, severe secondary mitral-valve regurgitation is associated with a poor prognosis. Whether percutaneous mitral-valve repair improves clinical outcomes in this patient population is unknown. Methods We randomly assigned patients who had severe secondary mitral regurgitation (defined as an effective regurgitant orifice area of >20 mm2 or a regurgitant volume of >30 ml per beat), a left ventricular ejection fraction between 15 and 40%, and symptomatic heart failure, in a 1:1 ratio, to undergo percutaneous mitral-valve repair in addition to receiving medical therapy (intervention group; 152 patients) or to receive medical therapy alone (control group; 152 patients)...
August 27, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30146969/six-month-outcomes-after-restrictive-or-liberal-transfusion-for-cardiac-surgery
#17
C David Mazer, Richard P Whitlock, Dean A Fergusson, Emilie Belley-Cote, Katherine Connolly, Boris Khanykin, Alexander J Gregory, Étienne de Médicis, François M Carrier, Shay McGuinness, Paul J Young, Kelly Byrne, Juan C Villar, Alistair Royse, Hilary P Grocott, Manfred D Seeberger, Chirag Mehta, François Lellouche, Gregory M T Hare, Thomas W Painter, Stephen Fremes, Summer Syed, Sean M Bagshaw, Nian-Chih Hwang, Colin Royse, Judith Hall, David Dai, Nikhil Mistry, Kevin Thorpe, Subodh Verma, Peter Jüni, Nadine Shehata
Background We reported previously that, in patients undergoing cardiac surgery who were at moderate-to-high risk for death, a restrictive transfusion strategy was noninferior to a liberal strategy with respect to the composite outcome of death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis by hospital discharge or 28 days after surgery, whichever came first. We now report the clinical outcomes at 6 months after surgery. Methods We randomly assigned 5243 adults undergoing cardiac surgery to a restrictive red-cell transfusion strategy (transfusion if the hemoglobin concentration was <7...
August 26, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30146932/effects-of-n-3-fatty-acid-supplements-in-diabetes-mellitus
#18
(no author information available yet)
Background Increased intake of n-3 fatty acids has been associated with a reduced risk of cardiovascular disease in observational studies, but this finding has not been confirmed in randomized trials. It remains unclear whether n-3 (also called omega-3) fatty acid supplementation has cardiovascular benefit in patients with diabetes mellitus. Methods We randomly assigned 15,480 patients with diabetes but without evidence of atherosclerotic cardiovascular disease to receive 1-g capsules containing either n-3 fatty acids (fatty acid group) or matching placebo (olive oil) daily...
August 26, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30146931/effects-of-aspirin-for-primary-prevention-in-persons-with-diabetes-mellitus
#19
(no author information available yet)
Background Diabetes mellitus is associated with an increased risk of cardiovascular events. Aspirin use reduces the risk of occlusive vascular events but increases the risk of bleeding; the balance of benefits and hazards for the prevention of first cardiovascular events in patients with diabetes is unclear. Methods We randomly assigned adults who had diabetes but no evident cardiovascular disease to receive aspirin at a dose of 100 mg daily or matching placebo. The primary efficacy outcome was the first serious vascular event (i...
August 26, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30145971/one-year-outcomes-after-pci-strategies-in-cardiogenic-shock
#20
Holger Thiele, Ibrahim Akin, Marcus Sandri, Suzanne de Waha-Thiele, Roza Meyer-Saraei, Georg Fuernau, Ingo Eitel, Peter Nordbeck, Tobias Geisler, Ulf Landmesser, Carsten Skurk, Andreas Fach, Alexander Jobs, Harald Lapp, Jan J Piek, Marko Noc, Tomaž Goslar, Stephan B Felix, Lars S Maier, Janina Stepinska, Keith Oldroyd, Pranas Serpytis, Gilles Montalescot, Olivier Barthelemy, Kurt Huber, Stephan Windecker, Lukas Hunziker, Stefano Savonitto, Patrizia Torremante, Christiaan Vrints, Steffen Schneider, Uwe Zeymer, Steffen Desch
Background Among patients with acute myocardial infarction, cardiogenic shock, and multivessel coronary artery disease, the risk of a composite of death from any cause or severe renal failure leading to renal-replacement therapy at 30 days was found to be lower with percutaneous coronary intervention (PCI) of the culprit lesion only than with immediate multivessel PCI. We evaluated clinical outcomes at 1 year. Methods We randomly assigned 706 patients to either culprit-lesion-only PCI or immediate multivessel PCI...
August 25, 2018: New England Journal of Medicine
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