Nejm

BACKGROUND: Health research that significantly impacts global clinical practice and policy is often published in high-impact factor (IF) medical journals. These outlets play a pivotal role in the worldwide dissemination of novel medical knowledge. However, researchers identifying as women and those affiliated with institutions in low- and middle-income countries (LMIC) have been largely underrepresented in high-IF journals across multiple fields of medicine. To evaluate disparities in gender and geographical representation among authors who have published in any of five top general medical journals, we conducted scientometric analyses using a large-scale dataset extracted from the New England Journal of Medicine (NEJM) , Journal of the American Medical Association (JAMA) , The British Medical Journal (BMJ) , The Lancet , and Nature Medicine ...

OBJECTIVE: In 2020, Strait and colleagues raised awareness that the clinical images in rheumatology educational materials underrepresent people with skin of color (P-SOC). Since then, publishers of rheumatology educational materials have focused on addressing this shortcoming. This study investigates the change in representation of P-SOC following Strait's review. METHODS: We used Strait's methods to collect images from commonly referenced rheumatology educational materials and categorized the skin tones within them as "light" or "dark...

In the Review article, "Maternal Cardiovascular Health Post-Dobbs", originally published January 23, 2024 (DOI: https://doi.org/10.1056/EVIDra2300273), on Page 8 in the right-hand column, the sentence "The study reported fetal or neonatal loss in 96% of patients and 57% incidence of serious maternal mortality compared with 33% serious maternal mortality in patients presenting before…" should have read "The study reported fetal or neonatal loss in 96% of patients and 57% incidence of serious maternal morbidity compared with 33% serious maternal morbidity in patients presenting before…"...

Contemporary data collection strategies, storage capabilities, and modern statistical methodology have made retrospective analyses of observational databases commonplace. Such databases afford opportunities to learn about the effectiveness and risks of interventions or health behaviors that generally cannot be randomized. In this issue of NEJM Evidence , Cho et al.1 assemble survey data and cohort data from four countries to quantify the association between age-sex-specific smoking cessation and mortality...

Recent studies indicate that Generative Pre-trained Transformer 4 with Vision (GPT-4V) outperforms human physicians in medical challenge tasks. However, these evaluations primarily focused on the accuracy of multi-choice questions alone. Our study extends the current scope by conducting a comprehensive analysis of GPT-4V's rationales of image comprehension, recall of medical knowledge, and step-by-step multimodal reasoning when solving New England Journal of Medicine (NEJM) Image Challenges - an imaging quiz designed to test the knowledge and diagnostic capabilities of medical professionals...

The expansive scope of internal medicine can make it challenging for clinicians to stay informed about new literature that changes practice. Guideline updates and synthesis of relevant evidence can facilitate incorporation of advancements into clinical practice. The titles and abstracts from the seven general medicine journals with highest impact factors and relevance to outpatient internal medicine were reviewed by six internal medicine physicians. Coronavirus disease 19 research was excluded. The New England Journal of Medicine (NEJM), The Lancet, Journal of the American Medical Association (JAMA), The British Medical Journal (BMJ), Annals of Internal Medicine, JAMA Internal Medicine, and Mayo Clinic Proceedings were reviewed...

The thymus is the primary lymphoid organ responsible for the maturation and proliferation of T lymphocytes. During the first years of our lives, the activation and inactivation of T lymphocytes occur within the thymus, facilitating the correct maturation of central immunity. Alterations in the positive and negative selection of T lymphocytes have been studied as the possible origins of autoimmune diseases, with Myasthenia Gravis (MG) being the most representative example. Structural alterations in the thymus appear to be involved in the initial autoimmune response observed in MG, leading to the consideration of thymectomy as part of the treatment for the disease...

In the Original Article, "Targeted Inhibition of CYP11A1 in Castration-Resistant Prostate Cancer", originally published December 26, 2023 (DOI: https://doi.org/10.1056/EVIDoa2300171), in the Abstract, under "Background", the sentence "ODM-208, a novel inhibitor of cytochrome P450 17A1 …" should have read "ODM-208, a novel inhibitor of cytochrome P450 11A1…" A corrected version of the article has been posted at evidence.nejm.org.

In the Patient Platform article, "Living with Asthma in Low- and Middle-Income Countries in the Six WHO Regions", originally published December 26, 2023 (DOI: https://doi.org/10.1056/EVIDpp2300292), in the section "Aydın P. Turkey, European Region", where it reads "…there was a big earthquake in September 2023…", it should have read, "…there was a big earthquake in February 2023…". A corrected version of the article has been posted at evidence.nejm.org.

In the Original Article, "A New Look at P Values for Randomized Clinical Trials", originally published December 22, 2023 (DOI: https://doi.org/10.1056/EVIDoa2300003), the labels of the two curves in Figure 1 should have been reversed. The corrected article, including the updated figure and corresponding figure legend, has been posted at evidence.nejm.org.

Adaptive clinical trials allow researchers to make preplanned modifications based on accumulating data from an ongoing trial while preserving the trial's integrity and validity. These modifications may include early termination in cases of successes or lack of efficacy, refining the sample size, altering treatments or doses, or focusing recruitment efforts on individuals most likely to benefit. In this issue of NEJM Evidence , Geisler et al.1 report results from the Apixaban for Treatment of Embolic Stroke of Undetermined Source (ATTICUS) trial, a multicenter randomized trial of apixaban compared with aspirin in patients with cardioembolism risk factors...

In this issue of NEJM Evidence , Gaudet et al. present the safety profile and pharmacodynamics of ARO-APOC3, a small interfering RNA therapeutic that inhibits apolipoprotein C-III (APOC3) mRNA expression in a phase I trial.1 Assignment to treatment was based on fasting levels of triglycerides. The trial included two double-blinded cohorts with 52 randomly assigned healthy participants and 40 patients with hypertriglyceridemia assigned to escalating doses of ARO-APOC3 at 10, 25, 50, or 100 mg or placebo in a single- and/or repeat-dose (days 1 and 29) regimen...

In this issue of NEJM Evidence, we see the results of a randomized clinical trial of dapagliflozin or saxagliptin in pediatric type 2 diabetes (T2D). In children and adolescents with T2D, dapagliflozin achieved significant improvements in glycemia in the trial.1 In June 2023, following another pivotal trial, the U.S. Food and Drug Administration (FDA) approved empagliflozin and the combination of empagliflozin and metformin as additions to diet and exercise to improve blood sugar control in children 10 years and older with T2D...

In this issue of NEJM Evidence , Gaudet et al.1 report on safety and efficacy of a strategy targeting apolipoprotein C-III (APOC3) using a silencing ribonucleic acid (RNA; ARO-APOC3). In a phase I trial comprising 52 healthy volunteers (triglycerides [TG], >80 mg/dl), 40 patients with hypertriglyceridemia (TG, >300 mg/dl), and 20 patients with chylomicronemia (TG, >880 mg/dl), ARO-APOC3 or placebo was administered subcutaneously either once or twice, with doses given on days 1 and 29...

In the randomized phase 2 SEQUENCE trial in patients with metastatic pancreatic cancer, reported in this issue of NEJM Evidence , the authors compared therapy with alternating FOLFOX and nab-paclitaxel/gemcitabine chemotherapy versus standard-of-care, single-regimen nab-paclitaxel/gemcitabine therapy.1 They were testing the idea that because most tumor cells express both basal and classic markers, alternating treatment would target both cell populations and thus confer a survival benefit. The trial, which enrolled 157 patients, met the primary end point of an overall survival rate at 12 months of 55...

In Volume 2, Number 4 of NEJM Evidence , we published an article entitled, "Osmotic Demyelination Syndrome in Patients Hospitalized with Hyponatremia" by MacMillan et al. The article was accompanied by an editorial entitled "Hyponatremia Treatment Guidelines - Have They Gone Too Far?" by Ayus and Moritz. After these articles were published, a group of readers shared feedback about the data presented and the conclusions drawn; their comments are detailed as "Remarks from Readers." We relayed these points to the authors of the original article and the editorial; their responses follow...

In this issue of NEJM Evidence , Sheehy et al.1 report the results of a prospective cohort study that examined the association between hypertensive disorders of pregnancy (HDOP) and the risk of stroke among Black women in the United States. Using data from 42,924 participants in the Black Women's Health Study (BWHS) who were free of cardiovascular disease at baseline, they compared the rates of stroke between women with HDOP and those who did not have HDOP over a median follow-up of 22 years.

The development of fluorescence imaging in oncology led to the possibility of using intraoperative devices to improve the precision of surgical techniques.1 In this issue of NEJM Evidence, Smith et al.2 report results from a prospective multicenter trial evaluating the ability of intravenous pegulicianine with an optical head device and software to intraoperatively identify lumpectomy margins with residual cancer and excise them immediately. Identifying these margins intraoperatively avoids the need for a second surgery, which is required when margins are positive on the final pathology...

In this edition of NEJM Evidence , Lohmander et al.1 report on the 11-year follow-up for a randomized clinical trial (KANON [Knee Anterior Cruciate Ligament Nonsurgical vs. Surgical Treatment]) of early anterior cruciate ligament reconstruction (ACLR) versus optional delayed ACLR in young, active adults. This is the third publication reporting on this trial, which enrolled 121 participants from February 2002 through June 2006. A 2010 article2 reported on the 2-year follow-up, and a 2013 article3 reported on the 5-year follow-up...

In this issue of NEJM Evidence , Maher et al.1 report the results of a randomized, controlled, 22-day treatment crossover trial comparing the antitussive effect of extended-release nalbuphine, an opioid agonist-antagonist, with placebo in a cohort of patients with definite or probable idiopathic pulmonary fibrosis (IPF). In this small, short-term trial of 38 evaluable patients, the active drug was associated with a 75.1% reduction in daytime objective cough frequency (the primary outcome) compared with a 22...