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New England Journal of Medicine

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https://www.readbyqxmd.com/read/28636844/clonal-hematopoiesis-and-risk-of-atherosclerotic-cardiovascular-disease
#1
Siddhartha Jaiswal, Pradeep Natarajan, Alexander J Silver, Christopher J Gibson, Alexander G Bick, Eugenia Shvartz, Marie McConkey, Namrata Gupta, Stacey Gabriel, Diego Ardissino, Usman Baber, Roxana Mehran, Valentin Fuster, John Danesh, Philippe Frossard, Danish Saleheen, Olle Melander, Galina K Sukhova, Donna Neuberg, Peter Libby, Sekar Kathiresan, Benjamin L Ebert
Background Clonal hematopoiesis of indeterminate potential (CHIP), which is defined as the presence of an expanded somatic blood-cell clone in persons without other hematologic abnormalities, is common among older persons and is associated with an increased risk of hematologic cancer. We previously found preliminary evidence for an association between CHIP and atherosclerotic cardiovascular disease, but the nature of this association was unclear. Methods We used whole-exome sequencing to detect the presence of CHIP in peripheral-blood cells and associated such presence with coronary heart disease using samples from four case-control studies that together enrolled 4726 participants with coronary heart disease and 3529 controls...
June 21, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28636834/implementation-of-medical-homes-in-federally-qualified-health-centers
#2
Justin W Timbie, Claude M Setodji, Amii Kress, Tara A Lavelle, Mark W Friedberg, Peter J Mendel, Emily K Chen, Beverly A Weidmer, Christine Buttorff, Rosalie Malsberger, Mallika Kommareddi, Afshin Rastegar, Aaron Kofner, Lisa Hiatt, Ammarah Mahmud, Katherine Giuriceo, Katherine L Kahn
Background From 2011 through 2014, the Federally Qualified Health Center Advanced Primary Care Practice Demonstration provided care management fees and technical assistance to a nationwide sample of 503 federally qualified health centers to help them achieve the highest (level 3) medical-home recognition by the National Committee for Quality Assurance, a designation that requires the implementation of processes to improve access, continuity, and coordination. Methods We examined the achievement of medical-home recognition and used Medicare claims and beneficiary surveys to measure utilization of services, quality of care, patients' experiences, and Medicare expenditures in demonstration sites versus comparison sites...
June 21, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28636833/chip-ping-away-at-atherosclerosis
#3
John F Keaney
No abstract text is available yet for this article.
June 21, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28636831/health-insurance-coverage-and-health-what-the-recent-evidence-tells-us
#4
Benjamin D Sommers, Atul A Gawande, Katherine Baicker
No abstract text is available yet for this article.
June 21, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28636481/turmoil-in-the-individual-insurance-market-where-it-came-from-and-how-to-fix-it
#5
Henry J Aaron, Matthew Fiedler, Paul B Ginsburg, Loren Adler, Alice M Rivlin
No abstract text is available yet for this article.
June 21, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28614039/controlling-the-cost-of-medicaid
#6
K John McConnell, Michael E Chernew
The federal–state Medicaid program is facing the possibility of the largest and most consequential changes to its funding since its inception in 1965. The American Health Care Act (AHCA), H.R. 1628, as adopted by the House of Representatives on May 4, would replace the current federal matching..
June 14, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28613992/alternative-science-and-human-reproduction
#7
R Alta Charo
Human reproduction has become the victim of alternative science, rife with alternative definitions of well-understood medical conditions and characterized by rejection of the scientific method as the standard for generating and evaluating evidence. Alternative science begins with alternative facts..
June 14, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28605608/canagliflozin-and-cardiovascular-and-renal-events-in-type-2-diabetes
#8
Bruce Neal, Vlado Perkovic, Kenneth W Mahaffey, Dick de Zeeuw, Greg Fulcher, Ngozi Erondu, Wayne Shaw, Gordon Law, Mehul Desai, David R Matthews
Background Canagliflozin is a sodium-glucose cotransporter 2 inhibitor that reduces glycemia as well as blood pressure, body weight, and albuminuria in people with diabetes. We report the effects of treatment with canagliflozin on cardiovascular, renal, and safety outcomes. Methods The CANVAS Program integrated data from two trials involving a total of 10,142 participants with type 2 diabetes and high cardiovascular risk. Participants in each trial were randomly assigned to receive canagliflozin or placebo and were followed for a mean of 188...
June 12, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28605603/efficacy-and-safety-of-degludec-versus-glargine-in-type-2-diabetes
#9
Steven P Marso, Darren K McGuire, Bernard Zinman, Neil R Poulter, Scott S Emerson, Thomas R Pieber, Richard E Pratley, Poul-Martin Haahr, Martin Lange, Kirstine Brown-Frandsen, Alan Moses, Simon Skibsted, Kajsa Kvist, John B Buse
Background Degludec is an ultralong-acting, once-daily basal insulin that is approved for use in adults, adolescents, and children with diabetes. Previous open-label studies have shown lower day-to-day variability in the glucose-lowering effect and lower rates of hypoglycemia among patients who received degludec than among those who received basal insulin glargine. However, data are lacking on the cardiovascular safety of degludec. Methods We randomly assigned 7637 patients with type 2 diabetes to receive either insulin degludec (3818 patients) or insulin glargine U100 (3819 patients) once daily between dinner and bedtime in a double-blind, treat-to-target, event-driven cardiovascular outcomes trial...
June 12, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28604226/global-health-effects-of-overweight-and-obesity
#10
Edward W Gregg, Jonathan E Shaw
No abstract text is available yet for this article.
June 12, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28604169/health-effects-of-overweight-and-obesity-in-195-countries-over-25-years
#11
(no author information available yet)
Background Although the rising pandemic of obesity has received major attention in many countries, the effects of this attention on trends and the disease burden of obesity remain uncertain. Methods We analyzed data from 68.5 million persons to assess the trends in the prevalence of overweight and obesity among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body-mass index (BMI), according to age, sex, cause, and BMI in 195 countries between 1990 and 2015...
June 12, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28591520/targeting-unconscionable-prescription-drug-prices-maryland-s-anti-price-gouging-law
#12
Jeremy A Greene, William V Padula
Why, in the early 21st century, are so many drugs that were cheaply available in the 20th century becoming prohibitively expensive? The past few years have seen a series of dramatic price hikes on essential off-patent medications, from albendazole to albuterol, digoxin to naloxone, Daraprim to..
June 7, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28591519/cyberattack-on-britain-s-national-health-service-a-wake-up-call-for-modern-medicine
#13
Rachel Clarke, Taryn Youngstein
As you would expect in a pandemic, the headlines were alarmist: we were reportedly locked in a race against time to protect millions of patients from a new virus of unprecedented virulence that had crippled the United Kingdom’s National Health Service (NHS) and was spreading rapidly across the..
June 7, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28586279/alectinib-versus-crizotinib-in-untreated-alk-positive-non-small-cell-lung-cancer
#14
Solange Peters, D Ross Camidge, Alice T Shaw, Shirish Gadgeel, Jin S Ahn, Dong-Wan Kim, Sai-Hong I Ou, Maurice Pérol, Rafal Dziadziuszko, Rafael Rosell, Ali Zeaiter, Emmanuel Mitry, Sophie Golding, Bogdana Balas, Johannes Noe, Peter N Morcos, Tony Mok
Background Alectinib, a highly selective inhibitor of anaplastic lymphoma kinase (ALK), has shown systemic and central nervous system (CNS) efficacy in the treatment of ALK-positive non-small-cell lung cancer (NSCLC). We investigated alectinib as compared with crizotinib in patients with previously untreated, advanced ALK-positive NSCLC, including those with asymptomatic CNS disease. Methods In a randomized, open-label, phase 3 trial, we randomly assigned 303 patients with previously untreated, advanced ALK-positive NSCLC to receive either alectinib (600 mg twice daily) or crizotinib (250 mg twice daily)...
June 6, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28581356/adjuvant-pertuzumab-and-trastuzumab-in-early-her2-positive-breast-cancer
#15
Gunter von Minckwitz, Marion Procter, Evandro de Azambuja, Dimitrios Zardavas, Mark Benyunes, Giuseppe Viale, Thomas Suter, Amal Arahmani, Nathalie Rouchet, Emma Clark, Adam Knott, Istvan Lang, Christelle Levy, Denise A Yardley, Jose Bines, Richard D Gelber, Martine Piccart, Jose Baselga
Background Pertuzumab increases the rate of pathological complete response in the preoperative context and increases overall survival among patients with metastatic disease when it is added to trastuzumab and chemotherapy for the treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer. In this trial, we investigated whether pertuzumab, when added to adjuvant trastuzumab and chemotherapy, improves outcomes among patients with HER2-positive early breast cancer. Methods We randomly assigned patients with node-positive or high-risk node-negative HER2-positive, operable breast cancer to receive either pertuzumab or placebo added to standard adjuvant chemotherapy plus 1 year of treatment with trastuzumab...
June 5, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28581347/questioning-our-aphinity-for-more
#16
Kathy D Miller
No abstract text is available yet for this article.
June 5, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28578607/abiraterone-plus-prednisone-in-metastatic-castration-sensitive-prostate-cancer
#17
Karim Fizazi, NamPhuong Tran, Luis Fein, Nobuaki Matsubara, Alfredo Rodriguez-Antolin, Boris Y Alekseev, Mustafa Özgüroğlu, Dingwei Ye, Susan Feyerabend, Andrew Protheroe, Peter De Porre, Thian Kheoh, Youn C Park, Mary B Todd, Kim N Chi
Background Abiraterone acetate, a drug that blocks endogenous androgen synthesis, plus prednisone is indicated for metastatic castration-resistant prostate cancer. We evaluated the clinical benefit of abiraterone acetate plus prednisone with androgen-deprivation therapy in patients with newly diagnosed, metastatic, castration-sensitive prostate cancer. Methods In this double-blind, placebo-controlled, phase 3 trial, we randomly assigned 1199 patients to receive either androgen-deprivation therapy plus abiraterone acetate (1000 mg daily, given once daily as four 250-mg tablets) plus prednisone (5 mg daily) (the abiraterone group) or androgen-deprivation therapy plus dual placebos (the placebo group)...
June 4, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28578601/olaparib-for-metastatic-breast-cancer-in-patients-with-a-germline-brca-mutation
#18
Mark Robson, Seock-Ah Im, Elżbieta Senkus, Binghe Xu, Susan M Domchek, Norikazu Masuda, Suzette Delaloge, Wei Li, Nadine Tung, Anne Armstrong, Wenting Wu, Carsten Goessl, Sarah Runswick, Pierfranco Conte
Background Olaparib is an oral poly(adenosine diphosphate-ribose) polymerase inhibitor that has promising antitumor activity in patients with metastatic breast cancer and a germline BRCA mutation. Methods We conducted a randomized, open-label, phase 3 trial in which olaparib monotherapy was compared with standard therapy in patients with a germline BRCA mutation and human epidermal growth factor receptor type 2 (HER2)-negative metastatic breast cancer who had received no more than two previous chemotherapy regimens for metastatic disease...
June 4, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28578639/abiraterone-for-prostate-cancer-not-previously-treated-with-hormone-therapy
#19
Nicholas D James, Johann S de Bono, Melissa R Spears, Noel W Clarke, Malcolm D Mason, David P Dearnaley, Alastair W S Ritchie, Claire L Amos, Clare Gilson, Rob J Jones, David Matheson, Robin Millman, Gerhardt Attard, Simon Chowdhury, William R Cross, Silke Gillessen, Christopher C Parker, J Martin Russell, Dominik R Berthold, Chris Brawley, Fawzi Adab, San Aung, Alison J Birtle, Jo Bowen, Susannah Brock, Prabir Chakraborti, Catherine Ferguson, Joanna Gale, Emma Gray, Mohan Hingorani, Peter J Hoskin, Jason F Lester, Zafar I Malik, Fiona McKinna, Neil McPhail, Julian Money-Kyrle, Joe O'Sullivan, Omi Parikh, Andrew Protheroe, Angus Robinson, Narayanan N Srihari, Carys Thomas, John Wagstaff, James Wylie, Anjali Zarkar, Mahesh K B Parmar, Matthew R Sydes
Background Abiraterone acetate plus prednisolone improves survival in men with relapsed prostate cancer. We assessed the effect of this combination in men starting long-term androgen-deprivation therapy (ADT), using a multigroup, multistage trial design. Methods We randomly assigned patients in a 1:1 ratio to receive ADT alone or ADT plus abiraterone acetate (1000 mg daily) and prednisolone (5 mg daily) (combination therapy). Local radiotherapy was mandated for patients with node-negative, nonmetastatic disease and encouraged for those with positive nodes...
June 3, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28564552/prospects-for-health-care-reform-in-the-u-s-senate
#20
John E McDonough
The acid test of any nation’s health care reform happens with a change in national administration. Only when a president or minister who instigated reform departs and a new regime assumes power can we judge the durability of any reform law or program. Like it or not, now is that moment for the..
May 31, 2017: New England Journal of Medicine
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