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New England Journal of Medicine

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https://www.readbyqxmd.com/read/29151359/osimertinib-in-untreated-egfr-mutated-advanced-non-small-cell-lung-cancer
#1
Jean-Charles Soria, Yuichiro Ohe, Johan Vansteenkiste, Thanyanan Reungwetwattana, Busyamas Chewaskulyong, Ki Hyeong Lee, Arunee Dechaphunkul, Fumio Imamura, Naoyuki Nogami, Takayasu Kurata, Isamu Okamoto, Caicun Zhou, Byoung Chul Cho, Ying Cheng, Eun Kyung Cho, Pei Jye Voon, David Planchard, Wu-Chou Su, Jhanelle E Gray, Siow-Ming Lee, Rachel Hodge, Marcelo Marotti, Yuri Rukazenkov, Suresh S Ramalingam
Background Osimertinib is an oral, third-generation, irreversible epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) that selectively inhibits both EGFR-TKI-sensitizing and EGFR T790M resistance mutations. We compared osimertinib with standard EGFR-TKIs in patients with previously untreated, EGFR mutation-positive advanced non-small-cell lung cancer (NSCLC). Methods In this double-blind, phase 3 trial, we randomly assigned 556 patients with previously untreated, EGFR mutation-positive (exon 19 deletion or L858R) advanced NSCLC in a 1:1 ratio to receive either osimertinib (at a dose of 80 mg once daily) or a standard EGFR-TKI (gefitinib at a dose of 250 mg once daily or erlotinib at a dose of 150 mg once daily)...
November 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29140760/emergency-legal-authority-and-the-opioid-crisis
#2
Lainie Rutkow, Jon S Vernick
Opioid-overdose deaths in the United States have steadily increased for the past 15 years, with more than 33,000 such deaths reported in 2015. The epidemic is unfolding on two fronts: use of prescription opioid pain relievers (OPRs) accounts for approximately half of opioid-overdose deaths, and..
November 15, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29140752/the-quiet-room
#3
Peter T Masiakos, Cornelia Griggs
At the end of an inconspicuous hallway and strategically placed far from the controlled chaos of the trauma room lies a dimly lit waiting area that we in the medical field call "the quiet room." It is a bland spot; a few soft chairs surround a table that holds a box of crisp institutional tissues...
November 15, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29130845/restrictive-or-liberal-red-cell-transfusion-for-cardiac-surgery
#4
C David Mazer, Richard P Whitlock, Dean A Fergusson, Judith Hall, Emilie Belley-Cote, Katherine Connolly, Boris Khanykin, Alexander J Gregory, Étienne de Médicis, Shay McGuinness, Alistair Royse, François M Carrier, Paul J Young, Juan C Villar, Hilary P Grocott, Manfred D Seeberger, Stephen Fremes, François Lellouche, Summer Syed, Kelly Byrne, Sean M Bagshaw, Nian C Hwang, Chirag Mehta, Thomas W Painter, Colin Royse, Subodh Verma, Gregory M T Hare, Ashley Cohen, Kevin E Thorpe, Peter Jüni, Nadine Shehata
Background The effect of a restrictive versus liberal red-cell transfusion strategy on clinical outcomes in patients undergoing cardiac surgery remains unclear. Methods In this multicenter, open-label, noninferiority trial, we randomly assigned 5243 adults undergoing cardiac surgery who had a European System for Cardiac Operative Risk Evaluation (EuroSCORE) I of 6 or more (on a scale from 0 to 47, with higher scores indicating a higher risk of death after cardiac surgery) to a restrictive red-cell transfusion threshold (transfuse if hemoglobin level was <7...
November 12, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29130810/outcomes-after-angiography-with-sodium-bicarbonate-and-acetylcysteine
#5
Steven D Weisbord, Martin Gallagher, Hani Jneid, Santiago Garcia, Alan Cass, Soe-Soe Thwin, Todd A Conner, Glenn M Chertow, Deepak L Bhatt, Kendrick Shunk, Chirag R Parikh, Edward O McFalls, Mary Brophy, Ryan Ferguson, Hongsheng Wu, Maria Androsenko, John Myles, James Kaufman, Paul M Palevsky
Background Intravenous sodium bicarbonate and oral acetylcysteine are widely used to prevent acute kidney injury and associated adverse outcomes after angiography without definitive evidence of their efficacy. Methods Using a 2-by-2 factorial design, we randomly assigned 5177 patients at high risk for renal complications who were scheduled for angiography to receive intravenous 1.26% sodium bicarbonate or intravenous 0.9% sodium chloride and 5 days of oral acetylcysteine or oral placebo; of these patients, 4993 were included in the modified intention-to-treat analysis...
November 12, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29129157/thrombectomy-6-to-24-hours-after-stroke-with-a-mismatch-between-deficit-and-infarct
#6
Raul G Nogueira, Ashutosh P Jadhav, Diogo C Haussen, Alain Bonafe, Ronald F Budzik, Parita Bhuva, Dileep R Yavagal, Marc Ribo, Christophe Cognard, Ricardo A Hanel, Cathy A Sila, Ameer E Hassan, Monica Millan, Elad I Levy, Peter Mitchell, Michael Chen, Joey D English, Qaisar A Shah, Frank L Silver, Vitor M Pereira, Brijesh P Mehta, Blaise W Baxter, Michael G Abraham, Pedro Cardona, Erol Veznedaroglu, Frank R Hellinger, Lei Feng, Jawad F Kirmani, Demetrius K Lopes, Brian T Jankowitz, Michael R Frankel, Vincent Costalat, Nirav A Vora, Albert J Yoo, Amer M Malik, Anthony J Furlan, Marta Rubiera, Amin Aghaebrahim, Jean-Marc Olivot, Wondwossen G Tekle, Ryan Shields, Todd Graves, Roger J Lewis, Wade S Smith, David S Liebeskind, Jeffrey L Saver, Tudor G Jovin
Background The effect of endovascular thrombectomy that is performed more than 6 hours after the onset of ischemic stroke is uncertain. Patients with a clinical deficit that is disproportionately severe relative to the infarct volume may benefit from late thrombectomy. Methods We enrolled patients with occlusion of the intracranial internal carotid artery or proximal middle cerebral artery who had last been known to be well 6 to 24 hours earlier and who had a mismatch between the severity of the clinical deficit and the infarct volume, with mismatch criteria defined according to age (<80 years or ≥80 years)...
November 11, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29129127/a-new-dawn-for-imaging-based-selection-in-the-treatment-of-acute-stroke
#7
Werner Hacke
No abstract text is available yet for this article.
November 11, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29116879/health-care-professionals-and-law-enforcement
#8
Arthur R Derse
Health care professionals generally have a respectful, sometimes even friendly, attitude toward law enforcement. We may feel we’re on the same team as the police when we’re treating victims of crime, and police may be called to protect us from people who seek to harm us in the hospital. Some health..
November 8, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29091553/understanding-the-planned-parenthood-divide-albert-lasker-and-women-s-health
#9
Lisa Rosenbaum
Albert Lasker, considered the "father of modern advertising," transformed product marketing from an endeavor based on the simple presentation of facts to one finely tuned to consumer psychology, particularly as it pertained to women. At a time when discussion of menstruation was taboo, for example,..
November 1, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29083965/back-to-the-future-in-cardiogenic-shock-initial-pci-of-the-culprit-lesion-only
#10
Judith S Hochman, Stuart Katz
No abstract text is available yet for this article.
October 30, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29083953/pci-strategies-in-patients-with-acute-myocardial-infarction-and-cardiogenic-shock
#11
Holger Thiele, Ibrahim Akin, Marcus Sandri, Georg Fuernau, Suzanne de Waha, Roza Meyer-Saraei, Peter Nordbeck, Tobias Geisler, Ulf Landmesser, Carsten Skurk, Andreas Fach, 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, Stefano Savonitto, Patrizia Torremante, Christiaan Vrints, Steffen Schneider, Steffen Desch, Uwe Zeymer
Background In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients with cardiogenic shock have multivessel disease, and whether PCI should be performed immediately for stenoses in nonculprit arteries is controversial. Methods In this multicenter trial, we randomly assigned 706 patients who had multivessel disease, acute myocardial infarction, and cardiogenic shock to one of two initial revascularization strategies: either PCI of the culprit lesion only, with the option of staged revascularization of nonculprit lesions, or immediate multivessel PCI...
October 30, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29081267/delayed-versus-immediate-cord-clamping-in-preterm-infants
#12
William Tarnow-Mordi, Jonathan Morris, Adrienne Kirby, Kristy Robledo, Lisa Askie, Rebecca Brown, Nicholas Evans, Sarah Finlayson, Michael Fogarty, Val Gebski, Alpana Ghadge, Wendy Hague, David Isaacs, Michelle Jeffery, Anthony Keech, Martin Kluckow, Himanshu Popat, Lucille Sebastian, Kjersti Aagaard, Michael Belfort, Mohan Pammi, Mohamed Abdel-Latif, Graham Reynolds, Shabina Ariff, Lumaan Sheikh, Yan Chen, Paul Colditz, Helen Liley, Margo Pritchard, Daniele de Luca, Koert de Waal, Peta Forder, Lelia Duley, Walid El-Naggar, Andrew Gill, John Newnham, Karen Simmer, Katie Groom, Philip Weston, Joanna Gullam, Harshad Patel, Guan Koh, Kei Lui, Neil Marlow, Scott Morris, Arvind Sehgal, Euan Wallace, Roger Soll, Leslie Young, David Sweet, Susan Walker, Andrew Watkins, Ian Wright, David Osborn, John Simes
Background The preferred timing of umbilical-cord clamping in preterm infants is unclear. Methods We randomly assigned fetuses from women who were expected to deliver before 30 weeks of gestation to either immediate clamping of the umbilical cord (≤10 seconds after delivery) or delayed clamping (≥60 seconds after delivery). The primary composite outcome was death or major morbidity (defined as severe brain injury on postnatal ultrasonography, severe retinopathy of prematurity, necrotizing enterocolitis, or late-onset sepsis) by 36 weeks of postmenstrual age...
October 29, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29069551/how-to-think-about-medicare-for-all
#13
James A Morone
In April 1946, President Harry Truman introduced a single-payer health plan and met the same reaction that would greet Senator Bernie Sanders (I-VT) and his colleagues when they proposed "Medicare for All" in September 2017. "It is believed by competent Congressional observers to have little chance..
October 25, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29069550/is-there-merit-in-merit-aid
#14
Roy C Ziegelstein, Charles G Prober, Lloyd B Minor, George Q Daley, Paul B Rothman, Edward M Hundert
In 2016, the average cost of attending medical school (including tuition and fees) in the United States was $253,720 for in-state graduates and $313,897 for out-of-state graduates. Nearly three in four graduates had educational debt, and the median educational debt was $190,000. Average debt..
October 25, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29068760/which-road-to-universal-coverage
#15
Henry J Aaron
According to a June 2017 poll, Americans agree by a 60-to-39 margin that the federal government bears a responsibility to ensure health care for all Americans; 33% said that they favored a "single-payer" health system, 12% more than in 2014. The prevailing belief that the government should actively..
October 25, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29045802/using-medicare-prices-toward-equity-and-affordability-in-the-aca-marketplace
#16
Zirui Song
As the U.S. Congress debates the future of the Affordable Care Act (ACA), the public has increasingly called for bipartisan solutions on health care reform. An immediate challenge is stabilizing the ACA marketplace, where 10.3 million people enroll in coverage. Given that certain areas of the..
October 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29045196/lessons-from-the-latest-aca-battle
#17
Jeanne M Lambrew
At the end of the 2017 Obamacare repeal-and-replace legislative battle (and before the next one begins), it is worth taking stock of why — defying the odds — the Affordable Care Act (ACA) still stands. From my perspective as an Obama administration veteran of every near-death experience of the law..
October 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29045195/strengthening-the-aca-for-the-long-term
#18
Linda J Blumberg, John Holahan
Most complaints about the Affordable Care Act (ACA) (e.g. high and rising insurance premiums, large deductibles, and insurer exits) relate to nongroup insurance markets. These markets, the ones that were the most dysfunctional before the ACA, provide coverage to just 7% of the nonelderly population..
October 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28976850/safety-and-immunogenicity-of-an-anti-zika-virus-dna-vaccine-preliminary-report
#19
Pablo Tebas, Christine C Roberts, Kar Muthumani, Emma L Reuschel, Sagar B Kudchodkar, Faraz I Zaidi, Scott White, Amir S Khan, Trina Racine, Hyeree Choi, Jean Boyer, Young K Park, Sylvie Trottier, Celine Remigio, Diane Krieger, Susan E Spruill, Mark Bagarazzi, Gary P Kobinger, David B Weiner, Joel N Maslow
Background Although Zika virus (ZIKV) infection is typically self-limiting, other associated complications such as congenital birth defects and the Guillain-Barré syndrome are well described. There are no approved vaccines against ZIKV infection. Methods In this phase 1, open-label clinical trial, we evaluated the safety and immunogenicity of a synthetic, consensus DNA vaccine (GLS-5700) encoding the ZIKV premembrane and envelope proteins in two groups of 20 participants each. The participants received either 1 mg or 2 mg of vaccine intradermally, with each injection followed by electroporation (the use of a pulsed electric field to introduce the DNA sequence into cells) at baseline, 4 weeks, and 12 weeks...
October 4, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28899222/effects-of-sotagliflozin-added-to-insulin-in-patients-with-type-1-diabetes
#20
Satish K Garg, Robert R Henry, Phillip Banks, John B Buse, Melanie J Davies, Gregory R Fulcher, Paolo Pozzilli, Diane Gesty-Palmer, Pablo Lapuerta, Rafael Simó, Thomas Danne, Darren K McGuire, Jake A Kushner, Anne Peters, Paul Strumph
Background In most patients with type 1 diabetes, adequate glycemic control is not achieved with insulin therapy alone. We evaluated the safety and efficacy of sotagliflozin, an oral inhibitor of sodium-glucose cotransporters 1 and 2, in combination with insulin treatment in patients with type 1 diabetes. Methods In this phase 3, double-blind trial, which was conducted at 133 centers worldwide, we randomly assigned 1402 patients with type 1 diabetes who were receiving treatment with any insulin therapy (pump or injections) to receive sotagliflozin (400 mg per day) or placebo for 24 weeks...
September 13, 2017: New England Journal of Medicine
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