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New England Journal of Medicine

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https://www.readbyqxmd.com/read/28423282/good-riddance-to-big-insurance-mergers
#1
Leemore S Dafny
Eighteen months after four of the five largest U.S. health insurers announced multibillion-dollar merger deals, federal judges, siding with the Department of Justice (DOJ), have issued preliminary injunctions halting the two transactions. These decisions will cost the insurers: they spent over $2..
April 19, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28402754/disease-modification-in-acute-decompensated-heart-failure
#2
Paul J Hauptman
No abstract text is available yet for this article.
April 12, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28402745/effect-of-ularitide-on-cardiovascular-mortality-in-acute-heart-failure
#3
Milton Packer, Christopher O'Connor, John J V McMurray, Janet Wittes, William T Abraham, Stefan D Anker, Kenneth Dickstein, Gerasimos Filippatos, Richard Holcomb, Henry Krum, Aldo P Maggioni, Alexandre Mebazaa, W Frank Peacock, Mark C Petrie, Piotr Ponikowski, Frank Ruschitzka, Dirk J van Veldhuisen, Lisa S Kowarski, Mark Schactman, Johannes Holzmeister
Background In patients with acute heart failure, early intervention with an intravenous vasodilator has been proposed as a therapeutic goal to reduce cardiac-wall stress and, potentially, myocardial injury, thereby favorably affecting patients' long-term prognosis. Methods In this double-blind trial, we randomly assigned 2157 patients with acute heart failure to receive a continuous intravenous infusion of either ularitide at a dose of 15 ng per kilogram of body weight per minute or matching placebo for 48 hours, in addition to accepted therapy...
April 12, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28402707/physicians-firearms-and-free-speech-overturning-florida-s-firearm-safety-gag-rule
#4
Wendy E Parmet, Jason A Smith, Matthew Miller
In February, the full U.S. Court of Appeals for the Eleventh Circuit issued its long-awaited ruling in Wollschlaeger v. Governor, State of Florida, invalidating parts of Florida’s Firearm Owners’ Privacy Act (FOPA) and affirming that the First Amendment applies to the speech between physicians and..
April 12, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28402248/autoantibodies-against-gpihbp1-as-a-cause-of-hypertriglyceridemia
#5
Anne P Beigneux, Kazuya Miyashita, Michael Ploug, Dirk J Blom, Masumi Ai, MacRae F Linton, Weerapan Khovidhunkit, Robert Dufour, Abhimanyu Garg, Maureen A McMahon, Clive R Pullinger, Norma P Sandoval, Xuchen Hu, Christopher M Allan, Mikael Larsson, Tetsuo Machida, Masami Murakami, Karen Reue, Peter Tontonoz, Ira J Goldberg, Philippe Moulin, Sybil Charrière, Loren G Fong, Katsuyuki Nakajima, Stephen G Young
Background A protein that is expressed on capillary endothelial cells, called GPIHBP1 (glycosylphosphatidylinositol-anchored high-density lipoprotein binding protein 1), binds lipoprotein lipase and shuttles it to its site of action in the capillary lumen. A deficiency in GPIHBP1 prevents lipoprotein lipase from reaching the capillary lumen. Patients with GPIHBP1 deficiency have low plasma levels of lipoprotein lipase, impaired intravascular hydrolysis of triglycerides, and severe hypertriglyceridemia (chylomicronemia)...
April 5, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28402247/the-future-of-transgender-coverage
#6
Kellan E Baker
In tandem with the growing visibility and acceptance of transgender people in the United States, we have seen a rapid increase in insurance coverage for health care services related to gender transition. Despite ongoing court battles over federal nondiscrimination protections for transgender people..
April 5, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28402246/resident-duty-hours-and-medical-education-policy-raising-the-evidence-bar
#7
David A Asch, Karl Y Bilimoria, Sanjay V Desai
No abstract text is available yet for this article.
April 5, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28402245/thyroid-hormone-therapy-for-older-adults-with-subclinical-hypothyroidism
#8
David J Stott, Nicolas Rodondi, Patricia M Kearney, Ian Ford, Rudi G J Westendorp, Simon P Mooijaart, Naveed Sattar, Carole E Aubert, Drahomir Aujesky, Douglas C Bauer, Christine Baumgartner, Manuel R Blum, John P Browne, Stephen Byrne, Tinh-Hai Collet, Olaf M Dekkers, Wendy P J den Elzen, Robert S Du Puy, Graham Ellis, Martin Feller, Carmen Floriani, Kirsty Hendry, Caroline Hurley, J Wouter Jukema, Sharon Kean, Maria Kelly, Danielle Krebs, Peter Langhorne, Gemma McCarthy, Vera McCarthy, Alex McConnachie, Mairi McDade, Martina Messow, Annemarie O'Flynn, David O'Riordan, Rosalinde K E Poortvliet, Terence J Quinn, Audrey Russell, Carol Sinnott, Jan W A Smit, H Anette Van Dorland, Kieran A Walsh, Elaine K Walsh, Torquil Watt, Robbie Wilson, Jacobijn Gussekloo
Background The use of levothyroxine to treat subclinical hypothyroidism is controversial. We aimed to determine whether levothyroxine provided clinical benefits in older persons with this condition. Methods We conducted a double-blind, randomized, placebo-controlled, parallel-group trial involving 737 adults who were at least 65 years of age and who had persisting subclinical hypothyroidism (thyrotropin level, 4.60 to 19.99 mIU per liter; free thyroxine level within the reference range). A total of 368 patients were assigned to receive levothyroxine (at a starting dose of 50 μg daily, or 25 μg if the body weight was <50 kg or the patient had coronary heart disease), with dose adjustment according to the thyrotropin level; 369 patients were assigned to receive placebo with mock dose adjustment...
April 3, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28402244/medical-liability-prospects-for-federal-reform
#9
Michelle M Mello, Allen Kachalia, David M Studdert
Medical malpractice reform appears to be back on the federal policy agenda. The appointment of Tom Price, a long-time proponent of tort reform, as secretary of health and human services, in conjunction with Republican control of both houses of Congress, has created fertile conditions for several..
March 29, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28402243/use-of-the-national-heart-lung-and-blood-institute-data-repository
#10
Sean A Coady, George A Mensah, Elizabeth L Wagner, Miriam E Goldfarb, Denise M Hitchcock, Carol A Giffen
Background Research on data sharing from clinical trials has focused on elucidating perceptions, barriers, and attitudes among trialists and study participants with respect to sharing data. However, little information exists regarding utilization or associated publication of articles once clinical trial data have been widely shared. Methods We analyzed administrative records of investigator requests for data access, linked publications, and bibliometrics to describe the use of the National Heart, Lung, and Blood Institute data repository...
March 29, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28402240/scientific-drought-golden-eggs-and-global-leadership-why-trump-s-nih-funding-cuts-would-be-a-disaster
#11
Ingrid T Katz, Alexi A Wright
On March 16, 2017, President Donald Trump submitted his budget titled "America First," with a proposal to cut the 2018 National Institutes of Health (NIH) budget by 18.3%, or approximately $5.8 billion. It is the first time a president has proposed a cut of this magnitude since the NIH received its..
March 29, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28402239/device-thrombosis-with-bioresorbable-scaffolds
#12
Debabrata Mukherjee
No abstract text is available yet for this article.
March 29, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28402238/data-authorship-as-an-incentive-to-data-sharing
#13
Barbara E Bierer, Mercè Crosas, Heather H Pierce
Data from well-designed and well-executed research not only are useful for the original purpose and secondary analyses by the original researchers but also can be repurposed for a variety of applications, including independent replication, avoidance of duplicative studies, generation or testing of..
March 29, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28402237/bioresorbable-scaffolds-versus-metallic-stents-in-routine-pci
#14
Joanna J Wykrzykowska, Robin P Kraak, Sjoerd H Hofma, Rene J van der Schaaf, E Karin Arkenbout, Alexander J IJsselmuiden, Joëlle Elias, Ivo M van Dongen, Ruben Y G Tijssen, Karel T Koch, Jan Baan, M Marije Vis, Robbert J de Winter, Jan J Piek, Jan G P Tijssen, Jose P S Henriques
Background Bioresorbable vascular scaffolds were developed to overcome the shortcomings of drug-eluting stents in percutaneous coronary intervention (PCI). We performed an investigator-initiated, randomized trial to compare an everolimus-eluting bioresorbable scaffold with an everolimus-eluting metallic stent in the context of routine clinical practice. Methods We randomly assigned 1845 patients undergoing PCI to receive either a bioresorbable vascular scaffold (924 patients) or a metallic stent (921 patients)...
March 29, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28320259/levosimendan-for-hemodynamic-support-after-cardiac-surgery
#15
Giovanni Landoni, Vladimir V Lomivorotov, Gabriele Alvaro, Rosetta Lobreglio, Antonio Pisano, Fabio Guarracino, Maria G Calabrò, Evgeny V Grigoryev, Valery V Likhvantsev, Marcello F Salgado-Filho, Alessandro Bianchi, Vadim V Pasyuga, Massimo Baiocchi, Federico Pappalardo, Fabrizio Monaco, Vladimir A Boboshko, Marat N Abubakirov, Bruno Amantea, Rosalba Lembo, Luca Brazzi, Luigi Verniero, Pietro Bertini, Anna M Scandroglio, Tiziana Bove, Alessandro Belletti, Maria G Michienzi, Dmitriy L Shukevich, Tatiana S Zabelina, Rinaldo Bellomo, Alberto Zangrillo
Background Acute left ventricular dysfunction is a major complication of cardiac surgery and is associated with increased mortality. Meta-analyses of small trials suggest that levosimendan may result in a higher rate of survival among patients undergoing cardiac surgery. Methods We conducted a multicenter, randomized, double-blind, placebo-controlled trial involving patients in whom perioperative hemodynamic support was indicated after cardiac surgery, according to prespecified criteria. Patients were randomly assigned to receive levosimendan (in a continuous infusion at a dose of 0...
March 21, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28320242/early-goal-directed-therapy-for-septic-shock-a-patient-level-meta-analysis
#16
(no author information available yet)
Background After a single-center trial and observational studies suggesting that early, goal-directed therapy (EGDT) reduced mortality from septic shock, three multicenter trials (ProCESS, ARISE, and ProMISe) showed no benefit. This meta-analysis of individual patient data from the three recent trials was designed prospectively to improve statistical power and explore heterogeneity of treatment effect of EGDT. Methods We harmonized entry criteria, intervention protocols, outcomes, resource-use measures, and data collection across the trials and specified all analyses before unblinding...
March 21, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28317415/uninterrupted-dabigatran-versus-warfarin-for-ablation-in-atrial-fibrillation
#17
Hugh Calkins, Stephan Willems, Edward P Gerstenfeld, Atul Verma, Richard Schilling, Stefan H Hohnloser, Ken Okumura, Harvey Serota, Matias Nordaby, Kelly Guiver, Branislav Biss, Marc A Brouwer, Massimo Grimaldi
Background Catheter ablation of atrial fibrillation is typically performed with uninterrupted anticoagulation with warfarin or interrupted non-vitamin K antagonist oral anticoagulant therapy. Uninterrupted anticoagulation with a non-vitamin K antagonist oral anticoagulant, such as dabigatran, may be safer; however, controlled data are lacking. We investigated the safety of uninterrupted dabigatran versus warfarin in patients undergoing ablation of atrial fibrillation. Methods In this randomized, open-label, multicenter, controlled trial with blinded adjudicated end-point assessments, we randomly assigned patients scheduled for catheter ablation of paroxysmal or persistent atrial fibrillation to receive either dabigatran (150 mg twice daily) or warfarin (target international normalized ratio, 2...
March 19, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28316276/levosimendan-in-patients-with-left-ventricular-dysfunction-undergoing-cardiac-surgery
#18
Rajendra H Mehta, Jeffrey D Leimberger, Sean van Diepen, James Meza, Alice Wang, Rachael Jankowich, Robert W Harrison, Douglas Hay, Stephen Fremes, Andra Duncan, Edward G Soltesz, John Luber, Soon Park, Michael Argenziano, Edward Murphy, Randy Marcel, Dimitri Kalavrouziotis, Dave Nagpal, John Bozinovski, Wolfgang Toller, Matthias Heringlake, Shaun G Goodman, Jerrold H Levy, Robert A Harrington, Kevin J Anstrom, John H Alexander
Background Levosimendan is an inotropic agent that has been shown in small studies to prevent or treat the low cardiac output syndrome after cardiac surgery. Methods In a multicenter, randomized, placebo-controlled, phase 3 trial, we evaluated the efficacy and safety of levosimendan in patients with a left ventricular ejection fraction of 35% or less who were undergoing cardiac surgery with the use of cardiopulmonary bypass. Patients were randomly assigned to receive either intravenous levosimendan (at a dose of 0...
March 19, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28317458/use-of-the-instantaneous-wave-free-ratio-or-fractional-flow-reserve-in-pci
#19
Justin E Davies, Sayan Sen, Hakim-Moulay Dehbi, Rasha Al-Lamee, Ricardo Petraco, Sukhjinder S Nijjer, Ravinay Bhindi, Sam J Lehman, Darren Walters, James Sapontis, Luc Janssens, Christiaan J Vrints, Ahmed Khashaba, Mika Laine, Eric Van Belle, Florian Krackhardt, Waldemar Bojara, Olaf Going, Tobias Härle, Ciro Indolfi, Giampaolo Niccoli, Flavo Ribichini, Nobuhiro Tanaka, Hiroyoshi Yokoi, Hiroaki Takashima, Yuetsu Kikuta, Andrejs Erglis, Hugo Vinhas, Pedro Canas Silva, Sérgio B Baptista, Ali Alghamdi, Farrel Hellig, Bon-Kwon Koo, Chang-Wook Nam, Eun-Seok Shin, Joon-Hyung Doh, Salvatore Brugaletta, Eduardo Alegria-Barrero, Martijin Meuwissen, Jan J Piek, Niels van Royen, Murat Sezer, Carlo Di Mario, Robert T Gerber, Iqbal S Malik, Andrew S P Sharp, Suneel Talwar, Kare Tang, Habib Samady, John Altman, Arnold H Seto, Jasvindar Singh, Allen Jeremias, Hitoshi Matsuo, Rajesh K Kharbanda, Manesh R Patel, Patrick Serruys, Javier Escaned
Background Coronary revascularization guided by fractional flow reserve (FFR) is associated with better patient outcomes after the procedure than revascularization guided by angiography alone. It is unknown whether the instantaneous wave-free ratio (iFR), an alternative measure that does not require the administration of adenosine, will offer benefits similar to those of FFR. Methods We randomly assigned 2492 patients with coronary artery disease, in a 1:1 ratio, to undergo either iFR-guided or FFR-guided coronary revascularization...
March 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28317438/instantaneous-wave-free-ratio-versus-fractional-flow-reserve-to-guide-pci
#20
Matthias Götberg, Evald H Christiansen, Ingibjörg J Gudmundsdottir, Lennart Sandhall, Mikael Danielewicz, Lars Jakobsen, Sven-Erik Olsson, Patrik Öhagen, Hans Olsson, Elmir Omerovic, Fredrik Calais, Pontus Lindroos, Michael Maeng, Tim Tödt, Dimitrios Venetsanos, Stefan K James, Amra Kåregren, Margareta Nilsson, Jörg Carlsson, Dario Hauer, Jens Jensen, Ann-Charlotte Karlsson, Georgios Panayi, David Erlinge, Ole Fröbert
Background The instantaneous wave-free ratio (iFR) is an index used to assess the severity of coronary-artery stenosis. The index has been tested against fractional flow reserve (FFR) in small trials, and the two measures have been found to have similar diagnostic accuracy. However, studies of clinical outcomes associated with the use of iFR are lacking. We aimed to evaluate whether iFR is noninferior to FFR with respect to the rate of subsequent major adverse cardiac events. Methods We conducted a multicenter, randomized, controlled, open-label clinical trial using the Swedish Coronary Angiography and Angioplasty Registry for enrollment...
March 18, 2017: New England Journal of Medicine
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