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Revisiting Duty-Hour Limits — IOM Recommendations for Patient Safety and Resident Education
On December 2, the Institute of Medicine (IOM) issued a report recommending that further measures be taken to ensure that hospitals provide safer conditions for patients and trainees while maintaining rigorous teaching programs. As John Iglehart writes, the IOM acknowledges that the two largest barriers to implementing its recommendations are the cost and the difficulty of finding an adequate number of other health care professionals to do the work of residents.
 December 3, 2008 (DOI: 10.1056/NEJMp0808736), in Print December 18, 2008
Residents’ Duty Hours and the IOM Report
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Innovation in Primary Care — Staying One Step Ahead of Burnout
Creativity is needed as physicians and managers struggle to make professional life sustainable for the country’s shrinking pool of primary care doctors. Dr. Susan Okie reports on strategies to help office-based physicians “work smarter, not harder.”
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Pay Now, Benefits May Follow — The Case of Cardiac CT Angiography
Drs. Rita Redberg and Judith Walsh argue that the continued unrestrained use of new technology, in the absence of evidence-based criteria, portends a bleak future for Medicare and our health care system. They discuss cardiac CT angiography as a recent example.
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Revisiting the Medicare Story
Recently released Oval Office tapes suggest that President Lyndon Johnson played a larger role in the passage of Medicare and Medicaid in 1965 than historians have reported. Dr. David Blumenthal and James Morone believe that successful enactment of major health care reform will require strong commitment and speedy action on the part of our next president.
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Primary Retinal Detachment
A 57-year-old man noted flashing lights in his right eye, followed by a cluster of dark floaters. Over the next week, he noted a progressive loss of the nasal visual field, with an eventual striking loss of central acuity. Examination of the fundus showed a retinal detachment involving the temporal retina, including the macula. How should his case be managed?
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Infection in the Pathogenesis and Course of COPD
New molecular, cellular, and immunologic techniques used to study host–pathogen interactions have led to a reexamination of the role of infection in chronic obstructive pulmonary disease (COPD). Considerable evidence suggests that a vicious circle of infection and inflammation leads to exacerbations of the disease.
CME Exam
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A Boy with a Pituitary Tumor and Skull Abnormalities
A 17-year-old boy had a 5-year history of increasingly frequent and severe headaches, which were associated with progressive vision loss, mood changes, worsening school performance, and weight gain. MRI revealed a cystic lesion in the sellar and suprasellar region and a heterogeneous, destructive bone lesion at the base of the skull.
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Stromal Gene Signatures in Large-B-Cell Lymphomas
In this study, microarrays of stromal-cell RNA showed one signature that correlated with extracellular-matrix deposition and monocytic infiltration and another that reflected tumor blood-vessel density.
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Diagnostic Coronary Angiography by 64-Row CT
In this study, coronary angiography by means of 64-row multidetector computed tomography (CT) accurately identified obstructive coronary lesions, but the positive and negative predictive values were inadequate for this technology to replace conventional coronary angiography.
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Genetic Association with Language Impairment
This study shows an association between variants of CNTNAP2 and a diminished ability to repeat nonsense words, a behavioral marker of specific language impairment, suggesting a common susceptibility factor for this disorder and autism.
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| Published Online November 5, 2008 (DOI: 10.1056/NEJMoa0802828) |
Emergence of Extensive Resistance during Treatment for MDR Tuberculosis
This report from Uzbekistan describes the development of fluoroquinolone-resistant and extensively drug-resistant tuberculosis during second-line treatment for multidrug-resistant (MDR) tuberculosis. Exogenous reinfection with extensively drug-resistant strains may occur during treatment of MDR tuberculosis.
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Microenvironmental Protection in Diffuse Large-B-Cell Lymphoma
The Genetics of Speech and Language Impairments
Published Online November 5, 2008 (DOI: 10.1056/NEJMe0807813)
Extensively Drug-Resistant Tuberculosis Free Full Text
Nodal Dissection for Gastric Cancer
Gastric Cancer in Japan
Management of Acute Cutaneous Wounds
Triglyceride Deposit Cardiomyovasculopathy
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