Gentile, Bryon A.; Tighe, Dennis A.
doi: 10.1056/NEJMicm1811002pmid: 31189040
A 66-year-old man presented with cough and pain in his chest and on the left side of his abdomen. Physical examination and imaging revealed situs inversus totalis.
doi: 10.1056/NEJMc1902945pmid: 31189054
To the Editor: In the Proactive IV Iron Therapy in Haemodialysis Patients (PIVOTAL) trial conducted by Macdougall et al. (Jan. 31 issue),1 the reactive, low-dose iron regimen (in which intravenous iron was administered if the ferritin concentration was <200 μg per liter or the transferrin saturation was <20%) resulted in iron deficiency anemia and harmed the patients. Nearly half the patients had a transferrin saturation of less than 20%, and approximately 25% of the patients had a serum ferritin concentration of less than 100 μg per liter. This culminated in persistent thrombocytosis and a drop in the hemoglobin level. Despite . . .
doi: 10.1056/NEJMc1905064pmid: 31189044
To the Editor: In the iCOMPARE (Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education) trial, Silber et al. (March 7 issue)1 prespecified an unreasonable noninferiority threshold based on an increase in 30-day mortality from 12.5% to 13.5%. Even the highest estimates2 would project that fewer than a quarter of deaths (and probably far fewer) in hospitals are due to medical errors.2,3 An absolute increase of 1 percentage point in error-related mortality (i.e., from approximately 3% to approximately 4%) would therefore represent an increase of more than 30% in error-related mortality. It was unreasonable to set such a . . .
doi: 10.1056/NEJMp1901771pmid: 31116915
India’s health reform, Ayushman Bharat (“long life for India”), has two pillars: health insurance covering up to $7,000 of care per year for the poorest 500 million people (regardless of preexisting conditions) and reinvestment in primary care.
doi: 10.1056/NEJMc1904412pmid: 31189056
To the Editor: Miller and McCaw (Feb. 28 issue)1 offer a reminder of the importance of intimate partner violence in association with a variety of psychiatric and medical conditions. The consequences of intimate partner violence are frequently overlooked by health care providers, and opportunities for intervention and prevention are missed. That said, the term “intimate partner violence” should be recognized as identifying a dyadic process that involves both a victim (a person experiencing intimate partner violence) and a perpetrator (a person who uses intimate partner violence), often in a pathologic psychosocial context. Although the review article focuses on the victim, . . .
Wadhera, Rishi K.; Yeh, Robert W.; Joynt Maddox, Karen E.
doi: 10.1056/NEJMp1901225pmid: 31091367
Some policymakers have pushed for the HRRP to be expanded to cover all conditions treated in inpatient settings. Others, including many clinicians and researchers, have expressed skepticism regarding the program’s effects and concerns about unintended consequences.
Dowell, Deborah; Haegerich, Tamara; Chou, Roger
doi: 10.1056/NEJMp1904190pmid: 31018066
The CDC’s 2016 Guideline for Prescribing Opioids for Chronic Pain has largely been embraced by the medical and health policy communities. Unfortunately, some policies and practices purportedly derived from the guideline have been inconsistent with its recommendations.
doi: 10.1056/NEJMp1901351pmid: 31189034
The elderly woman has demand-related ischemia and needs a transfusion, but she’s a Jehovah’s Witness. Soon, her hospital room becomes the site of a fraught battle between her family members and representatives of her church, and it’s up to the intern to intervene.
doi: 10.1056/NEJMtwj190613pmid: N/A
Issue Highlights, June 13, 2019Canagliflozin and Renal Outcomes in DiabetesAntisense Inhibition in Huntington’s DiseaseAnterior Cruciate Ligament TearManagement of BurnsNo Shortcuts to Safer Opioid Prescribing
Perkovic, Vlado; Jardine, Meg J.; Neal, Bruce; Bompoint, Severine; Heerspink, Hiddo J.L.; Charytan, David M.; Edwards, Robert; Agarwal, Rajiv; Bakris, George; Bull, Scott; Cannon, Christopher P.; Capuano, George; Chu, Pei-Ling; de Zeeuw, Dick; Greene, Tom;
Showing 1 to 10 of 22 Articles
doi: 10.1056/NEJMoa1811744pmid: 30990260
BackgroundType 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes.MethodsIn this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically.ResultsThe trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture.ConclusionsIn patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years. (Funded by Janssen Research and Development; CREDENCE ClinicalTrials.gov number, NCT02065791.)