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NEJM—Health Policy and Reform

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Loren Adler, Henry J Aaron, Paul B Ginsburg, Matthew Fiedler
Senate Republicans are making one last attempt to pass legislation repealing major provisions of the Affordable Care Act (ACA) before September 30, when their ability to use the "budget reconciliation" procedure to prevent a Democratic filibuster expires. This effort centers on a new proposal..
September 22, 2017: New England Journal of Medicine
Steven Woloshin, Lisa M Schwartz, Brian White, Thomas J Moore
Both Congress and the Food and Drug Administration (FDA) have sought to accelerate the availability of new drugs by allowing sponsors to wait to resolve many questions about safety and benefit until after their drugs receive marketing approval. As a result, most approval letters require phase 4..
September 21, 2017: New England Journal of Medicine
Ronald Bayer, Kenneth G Castro
Once called "the captain of all these men of death," tuberculosis continues to kill 1.8 million people globally each year. In 2014, the World Health Assembly embraced an ambitious resolution to reduce deaths from tuberculosis by 95% by 2035. But despite such global concern, tuberculosis has all but..
September 21, 2017: New England Journal of Medicine
Mwango Kashoki, Cathryn Lee, Peter Stein
To the Editor: In their Perspective article in this issue of the Journal, Woloshin et al. raise concerns about the status of postmarketing studies after new statutory authority was provided to the Food and Drug Administration (FDA) in the FDA Amendments Act of 2007 (FDAAA). Although the authors..
September 21, 2017: New England Journal of Medicine
Andrew Farb, Nicole G Ibrahim, Bram D Zuckerman
The Amplatzer PFO Occluder was approved by the Food and Drug Administration (FDA) on October 28, 2016. The device is indicated for percutaneous transcatheter closure of a patent foramen ovale to reduce the risk of recurrent ischemic stroke in patients who’ve had a cryptogenic stroke that a..
September 14, 2017: New England Journal of Medicine
Harlan M Krumholz, Kun Wang, Zhenqiu Lin, Kumar Dharmarajan, Leora I Horwitz, Joseph S Ross, Elizabeth E Drye, Susannah M Bernheim, Sharon-Lise T Normand
BACKGROUND: To isolate hospital effects on risk-standardized hospital-readmission rates, we examined readmission outcomes among patients who had multiple admissions for a similar diagnosis at more than one hospital within a given year. METHODS: We divided the Centers for Medicare and Medicaid Services hospital-wide readmission measure cohort from July 2014 through June 2015 into two random samples. All the patients in the cohort were Medicare recipients who were at least 65 years of age...
September 14, 2017: New England Journal of Medicine
Gena Glickman, Elizabeth Harrison, Karen Dobkins
To the Editor: Recent outbreaks of illnesses that may be prevented by vaccines have increased public debate about vaccination behaviors (i.e. whether or not and when parents choose to vaccinate a child), and California has been a key affected state. One reason that parents choose not to have their..
September 14, 2017: New England Journal of Medicine
Atheendar S Venkataramani, Alexander C Tsai
After months of conflicting statements, President Donald Trump has announced that the Deferred Action for Childhood Arrivals (DACA) program, a landmark immigration program introduced during the Obama administration, will be rescinded as of March 2018. The announcement was made in the face of..
September 13, 2017: New England Journal of Medicine
Lisa Rosenbaum
In 2010, 5-year-old Emily Whitehead was diagnosed with acute lymphoblastic leukemia (ALL). Though her parents were told that if you had to have a kid with cancer, ALL was the best one to have, Emily’s course was hardly typical. After two rounds of chemotherapy, necrotizing fasciitis developed in..
September 13, 2017: New England Journal of Medicine
David M Nathan
The proliferation of new drug treatments for type 2 diabetes in the United States in the past 15 years, with more than 17 drugs approved in six new classes of antidiabetic drugs, has been promoted by several factors. First, the recognition of the importance of intensive glycemic control to reduce..
September 13, 2017: New England Journal of Medicine
Vindell Washington, Karen DeSalvo, Farzad Mostashari, David Blumenthal
More than a decade ago, the National Academy of Medicine outlined the serious consequences of a paper-based health system: redundant tests; increased costs; uncoordinated and fragmented care; medical decisions made with incomplete data, leading to adverse events; and potential clinical innovations..
September 7, 2017: New England Journal of Medicine
John D Halamka, Micky Tripathi
At a high level, the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 accomplished something miraculous: the vast majority of U.S. hospitals and physicians are now active users of electronic health record (EHR) systems. No other sector of the U.S. economy of..
September 7, 2017: New England Journal of Medicine
Brigg Reilley, Jessica Leston
In light of ongoing debates about health care budgets and rising drug prices, a current public health crisis can provide useful insights. For patients who get their health care through two separate federal agencies, the hepatitis C virus (HCV) epidemic is unfolding in vastly different ways. In..
August 31, 2017: New England Journal of Medicine
Alan Dow, George Thibault
"This might have been the most important thing I did in medical school," the fourth-year student said. "It felt like we had an impact." The student was reflecting on a program during his final semester of medical school in which he collaborated with a team of students from nursing, pharmacy, social..
August 31, 2017: New England Journal of Medicine
Ranjana Srivastava
"Hospice. It’s where people go to die," she says, surprising me with her sudden lucidity. "And also for symptom management," I add gently. "Like my headache," she notes. And your homelessness, I think — the fact that your one-bedroom, upstairs council flat just won’t do anymore. "I could go home,"..
August 31, 2017: New England Journal of Medicine
David A Watkins, Catherine O Johnson, Samantha M Colquhoun, Ganesan Karthikeyan, Andrea Beaton, Gene Bukhman, Mohammed H Forouzanfar, Christopher T Longenecker, Bongani M Mayosi, George A Mensah, Bruno R Nascimento, Antonio L P Ribeiro, Craig A Sable, Andrew C Steer, Mohsen Naghavi, Ali H Mokdad, Christopher J L Murray, Theo Vos, Jonathan R Carapetis, Gregory A Roth
BACKGROUND: Rheumatic heart disease remains an important preventable cause of cardiovascular death and disability, particularly in low-income and middle-income countries. We estimated global, regional, and national trends in the prevalence of and mortality due to rheumatic heart disease as part of the 2015 Global Burden of Disease study. METHODS: We systematically reviewed data on fatal and nonfatal rheumatic heart disease for the period from 1990 through 2015. Two Global Burden of Disease analytic tools, the Cause of Death Ensemble model and DisMod-MR 2...
August 24, 2017: New England Journal of Medicine
Alison B Rapoport, Christopher F Rowley
On our infectious diseases (ID) consult service, we recently cared for Mr. C. a young man with Staphylococcus aureus tricuspid valve endocarditis, septic arthritis, and empyema that were consequences of his opioid use disorder (OUD). Several years earlier, he had started taking oxycodone at..
August 24, 2017: New England Journal of Medicine
Maxwell M Krem
Tom has been my patient since my fellowship, and now he is dying. He has been a constant in my career journey as much as I have been in his treatment, for 5 years and more than 80 treatment cycles. As an oncology fellow, I told him of his diagnosis of colon cancer with lung and liver metastases. I..
August 24, 2017: New England Journal of Medicine
Adam P Bress, Brandon K Bellows, Jordan B King, Rachel Hess, Srinivasan Beddhu, Zugui Zhang, Dan R Berlowitz, Molly B Conroy, Larry Fine, Suzanne Oparil, Donald E Morisky, Lewis E Kazis, Natalia Ruiz-Negrón, Jamie Powell, Leonardo Tamariz, Jeff Whittle, Jackson T Wright, Mark A Supiano, Alfred K Cheung, William S Weintraub, Andrew E Moran
BACKGROUND: In the Systolic Blood Pressure Intervention Trial (SPRINT), adults at high risk for cardiovascular disease who received intensive systolic blood-pressure control (target, <120 mm Hg) had significantly lower rates of death and cardiovascular disease events than did those who received standard control (target, <140 mm Hg). On the basis of these data, we wanted to determine the lifetime health benefits and health care costs associated with intensive control versus standard control...
August 24, 2017: New England Journal of Medicine
Eloi Marijon, David S Celermajer, Xavier Jouven
Rheumatic heart disease ranks as one of the most serious cardiovascular scourges of the past century. As a result of improvements in living conditions and the introduction of penicillin, the disease was almost eradicated in the developed world by the 1980s. However, it remains a force to be..
August 24, 2017: New England Journal of Medicine
2017-08-25 05:15:03
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