PERSPECTIVE
Keeping Your Cool — Doing Ebola Research during an Emergency
C.J. Haug
Acting in a state of extreme uncertainty and using slightly different approaches, Médecins sans Frontières and the World Health Organization, along with national health authorities, are testing an Ebola vaccine during an outbreak in the Democratic Republic of Congo.
2353-2355
Why the VA Needs More Competition
K.H. Sheetz and D.J. Shulkin
If the Veterans Affairs health system receives funding for modernization, it can compete on quality and outcomes with the private sector. Rather than being a step toward privatization, such competition is a way of maximizing resources and promoting high-quality care.
2356-2357
Growing Ranks of Advanced Practice Clinicians — Implications for the Physician Workforce
D.I. Auerbach, D.O. Staiger, and P.I. Buerhaus
Nurse practitioners and physician assistants are providing an increasing share of health care services, and education programs have proliferated. These dynamics will have lasting effects on the health care workforce and on relationships among health professionals.
2358-2360
The Graduate Nurse Education Demonstration — Implications for Medicare Policy
L.H. Aiken, J. Dahlerbruch, B. Todd, and G. Bai
Although Medicare spends billions of dollars annually on graduate medical education, it spends very little on clinical training for nurse practitioners. The GNE Demonstration documented the success of a new model of organizing and paying for graduate nurse education.
2360-2363
ORIGINAL ARTICLES
A Randomized Trial of a Family-Support Intervention in Intensive Care Units
D.B. White and Others
In a cluster-randomized trial conducted in five ICUs, a nurse-led family-support intervention did not affect surrogates’ scores for anxiety and depression 6 months after the patients’ hospitalization, but it improved surrogates’ ratings of the patient-centeredness of care.
2365-2375
Sodium Thiosulfate for Protection from Cisplatin-Induced Hearing Loss
P.R. Brock and Others
Cisplatin is an effective treatment for hepatoblastoma but often leads to lifelong irreversible hearing loss. The addition of sodium thiosulfate 6 hours after cisplatin administration preserved the antitumor effect and led to a lower risk of hearing loss (33% vs. 63%).
2376-2385
Durable Remissions with Ivosidenib in IDH1-Mutated Relapsed or Refractory AML
C.D. DiNardo and Others
Among patients with IDH1-mutated relapsed or refractory leukemia, daily oral ivosidenib, an IDH1 inhibitor, induced molecular clearance of leukemic cells from bone marrow in 21% of patients and was associated with transfusion independence and a low rate of serious adverse events.
2386-2398
Phase 3 Trial of Ibrutinib plus Rituximab in Waldenstr?m’s Macroglobulinemia
M.A. Dimopoulos and Others
A randomized trial comparing ibrutinib plus rituximab with rituximab alone in patients with Waldenstr?m’s macroglobulinemia showed significantly higher rates of progression-free survival and overall response with the addition of ibrutinib.
2399-2410
Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts
R. Estruch and Others
This report includes the reanalysis of data from a clinical trial showing a lower rate of cardiovascular events among persons assigned to a Mediterranean diet supplemented with extra-virgin olive oil or nuts than among those assigned to a low-fat diet.
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CLINICAL PRACTICE
Subclinical Hyperthyroidism
B. Biondi and D.S. Cooper
Persons with subclinical hyperthyroidism are at increased risk for cardiovascular and skeletal conditions. Decisions regarding treatment depend on age, menopausal status in women, and the presence of symptoms of and risk factors for cardiovascular disease or bone loss.
2411-2419
IMAGES IN CLINICAL MEDICINE
Macular Hole from a Laser Pointer
S. Androudi and E. Papageorgiou
A 9-year-old boy presented with decreased vision in his left eye after gazing into the beam of a laser pointer. Funduscopy and optical coherence tomography revealed a full-thickness macular hole.
2420
Migrating Dirofilaria repens
V. Kartashev and F. Simon
A 32-year-old woman presented to an ophthalmologist with a 2-week history of nodules that moved around her face. Dirofilaria repens was surgically removed.
e35
CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL
Case 19-2018: A 15-Year-Old Girl with Acute Kidney Injury
A.Y. Kao, P. Sagar, J.E. Klig, A. Sharma, and K.J. Tomaszewski
A 15-year-old girl presented with acute kidney injury. Eight days earlier, bloody diarrhea and abdominal cramping had developed. On admission, the creatinine level was 7.71 mg per deciliter, and anemia and thrombocytopenia were present. A diagnosis was made.
2421-2429
EDITORIAL
Nurse-Led Communication in the Intensive Care Unit
D. Lamas
We examine him each day — the elderly patient, intubated, sedated, with a bewildered wife at his bedside. We should sit down with his wife before we ask her to make hard decisions about her husband’s care, but the unit is so busy that we find ourselves ...
2431-2432
HEALTH LAW, ETHICS, AND HUMAN RIGHTS
Informed Consent and the Role of the Treating Physician
H. Fernandez Lynch, S. Joffe, and E.A. Feldman
In 2017, the Pennsylvania Supreme Court ruled that informed consent must be obtained directly by the treating physician. The authors discuss the potential implications of this ruling and argue that a team-based approach to consent is better for patients and physicians.
2433-2438
CLINICAL IMPLICATIONS OF BASIC RESEARCH
Stemming Lung Disease?
B. Hogan
Functioning of the alveoli of the lung depends largely on their constituent epithelial cells. Recent studies delineate a mechanism through which these cells are restored after injury.
2439-2440
CORRESPONDENCE
Retraction and Republication: Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med 2013;368:1279-90.
To the Editor: Because of irregularities in the randomization procedures, we wish to retract the following article: Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med 2013;368:1279-90. DOI: 10.1056/NEJMoa1200303.1 We have ...
2441-2442
Molecular Minimal Residual Disease in Acute Myeloid Leukemia
To the Editor: Jongen-Lavrencic and colleagues (March 29 issue)1 highlight the clinical usefulness of a next-generation sequencing panel to identify minimal residual disease in patients with acute myeloid leukemia (AML) during complete remission. The ...
2442-2443
High-Flow Oxygen Therapy in Infants with Bronchiolitis
To the Editor: In the article by Franklin et al. (March 22 issue),1 in which infants with bronchiolitis were assigned to receive low-flow oxygen (standard-therapy group) or high-flow oxygen (high-flow group) through a nasal cannula, the primary outcomes ...
2444-2447
Are We Prepared for Nuclear Terrorism?
To the Editor: Gale and Armitage (March 29 issue)1 provide detailed scenarios of intentional exposure of the public to ionizing radiation. Such an incident of any size would be a disaster, and the detonation of an improvised nuclear device would be ...
2447-2450
CORRECTIONS
High-Dose Atorvastatin after Stroke or Transient Ischemic Attack
High-Dose Atorvastatin after Stroke or Transient Ischemic Attack (N Engl J Med 2006;355:549-559). In the first footnote below Table 1 (page 553), the first sentence should have read, “Plus–minus values are means ±SE,” rather than “…are means ±SD in the ...
2450
Horse versus Rabbit Antithymocyte Globulin in Acquired Aplastic Anemia
Horse versus Rabbit Antithymocyte Globulin in Acquired Aplastic Anemia (N Engl J Med 2011;365:430-438). In the footnote below Table 1 (page 432), the first sentence should have read, “Plus–minus values are means ±SE,” rather than “… ±SD.” The article is ...
2450
Extended Antiretroviral Prophylaxis to Reduce Breast-Milk HIV-1 Transmission
Extended Antiretroviral Prophylaxis to Reduce Breast-Milk HIV-1 Transmission (N Engl J Med 2008;359:119-129). In Table 1 (page 124), the first footnote should have read, “Plus–minus values are means ±SD,” rather than “… ±SE.” The article is correct at ...
2450
Treatment of Periodontitis and Endothelial Function
Treatment of Periodontitis and Endothelial Function (N Engl J Med 2007;356:911-920). In Table 1 (page 915), in the t-PA — ng/ml row, the values for the control group and the intensive group should have been 6.5±4.5 and 6.8±3.2, respectively, rather than ...
2450
Effect of Bronchoconstriction on Airway Remodeling in Asthma
Effect of Bronchoconstriction on Airway Remodeling in Asthma (N Engl J Med 2011;364:2006-2015). In Table 1 (page 2010), the first footnote should have read, “Plus–minus values are means ±SD,” rather than “… ±SE.” The article is correct at NEJM.org. . . .
2450