NEJM 12 Dec 2013 Vol 369 2283 This week most of the NEJM is taken up with trials of genotyping to guide starting doses of vitamin K antagonists. Fair enough: this is a common clinical problem, and warfarin initiation is an important test case for genotyping as the gateway to personalised therapeutics. Dosing people with […]
NEJM 5 Dec 2013 Vol 369 2183 Respect: this trial collected nearly a thousand patients who survived out-of-hospital cardiac arrest and ended up in one of 36 intensive care units spread across Europe and Australia. They were then randomised to treatment involving hypothermia to 33 deg celsius—as recommended by current guidelines—or without hypothermia. This logistic […]
NEJM 28 Nov 2013 Vol 369 2083 I like it that the NEJM has chosen to start this week’s firework show with a dud. Stand ready to be awed and deafened by the Mighty Thunderboosh! Pssh, sputter, pop. Sorry folks, that was it. So rather than the vaccine that heralds the end of HIV, we […]
NEJM 21 Nov 2013 Vol 369 1981 “The 2011 outbreak in China showed that poliomyelitis-free countries remain at risk for outbreaks while the poliovirus circulates anywhere in the world. Global eradication of poliomyelitis will benefit all countries, even those that are currently free of poliomyelitis.” So concludes a study of the said Chinese outbreak, which […]
NEJM 14 Nov 2013 Vol 369 1880 As the Affordable Care Act splutters into action in the USA, JAMA devotes a whole issue to discussing the problems of healthcare in America. But for sheer gut-wrenching impact, there is nothing to beat this free-access article in the NEJM, Dead Man Walking. An uninsured man has just […]
NEJM 7 Nov 2013 Vol 369 1783 When you’ve already tried dasatinib and nilotinib, should your thoughts be turning to ponatinib? In case you’re wondering what I’m talking about, these drugs are tyrosine kinase inhibitors and are used to treat chronic lymphatic leukaemia, and acute lymphatic leukaemia if it is Philadelphia chromosome positive. Ponatinib has […]
JAMA Intern Med 28 Oct 2013 Vol 173 1770 There is very little in the journals this week: JAMA is taking a week off and even JAMA Intern Med has thin pickings. Two trials tell us what we expected. It’s a very obvious fact that poorly educated black women in the USA are often obese. […]
NEJM 24 Oct 2013 Vol 369 1577 Two years ago I unexpectedly found myself in the USA amongst good and great people who were determined to open up hidden data about human trials. It was an odd position for a retired British country town GP to be in, and I concluded that my most useful […]
NEJM 17 Oct 2013 Vol 369 1491 “Tiotropium (Spiriva, Boehringer Ingelheim), a long-acting inhaled anticholinergic bronchodilator, improves lung function, quality of life, and exercise endurance and reduces exacerbations in patients with chronic obstructive pulmonary disease (COPD).” I quote not from an advertisement for Spiriva, but from the start of a paper comparing one delivery method […]
NEJM 10 Oct 2013 Vol 369 1395 It’s been known for at least four thousand years that the heart has two ventricles, but what they actually did was a source of confusion until William Harvey began to sort things out in the seventeenth century. In the twenty-first century, cardiologists remain obsessed with the left ventricle […]