Dernières entêtes d'Actus
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Building a Bridge from Fragmentation to Accountability -- The Prometheus Payment Model
Mercredi 09 Septembre 2009 - 08:56 - 6 mois, 1 semaine depuis - Santé - New England Journal of Medicin In the current debate over health care reform, many observers are proposing new delivery structures to move U.S. health care away from fragmentation, poor performance, and dysfunction toward accountability for ... |
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The End of Fee-for-Service Medicine? Proposals for Payment Reform in Massachusetts
Mercredi 09 Septembre 2009 - 08:56 - 6 mois, 1 semaine depuis - Santé - New England Journal of Medicin Health care reform has multiple goals, including expanding insurance coverage, improving quality and access to care, and controlling costs. Since Massachusetts enacted reforms in 2006, the proportion of residents lacking ... |
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Reform, Regulation, and Research -- An Interview with Gail Wilensky
Mercredi 09 Septembre 2009 - 08:56 - 6 mois, 1 semaine depuis - Santé - New England Journal of Medicin Gail Wilensky, Ph.D., is an economist who served in the administration of President George H.W. Bush, first as the administrator of the Health Care Financing Administration (forerunner to the Centers ... |
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Focus on Research: Reemergence of PML in Natalizumab-Treated Patients -- New Cases, Same Concerns
Mercredi 09 Septembre 2009 - 08:56 - 6 mois, 1 semaine depuis - Santé - New England Journal of Medicin When progressive multifocal leukoencephalopathy (PML), a rare demyelinating disease induced by JC virus, appeared in 2004 as a complication of natalizumab treatment for multiple sclerosis, a more common demyelinating disease, ... |
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Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes
Mercredi 09 Septembre 2009 - 08:56 - 6 mois, 1 semaine depuis - Santé - New England Journal of Medicin In a multicenter, randomized trial, ticagrelor -- a reversible inhibitor of the adenosine diphosphate receptor P2Y12 -- was compared with clopidogrel in patients who had an acute coronary syndrome with or without ST-segment elevation. At 12 months, the primary end point of death from vascular causes, myocardial infarction, or stroke occurred less often with ticagrelor. Ticagrelor was not associated with an increase in the risk of major bleeding. |
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Recurring Mutations Found by Sequencing an Acute Myeloid Leukemia Genome
Mercredi 09 Septembre 2009 - 08:56 - 6 mois, 1 semaine depuis - Santé - New England Journal of Medicin A comparison of the genomic sequence of a tumor sample from a patient with acute myeloid leukemia (AML) and that of a normal skin sample from the same patient revealed an estimated 750 somatic mutations, of which 12 were in the coding sequences of genes and 52 were in conserved regions or regions with regulatory potential. Four mutations were found to be recurrent in AML, including mutations in NRAS, NPM1, IDH1, and a conserved region on chromosome 10. |
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Asymptomatic Reactivation of JC Virus in Patients Treated with Natalizumab
Mercredi 09 Septembre 2009 - 08:56 - 6 mois, 1 semaine depuis - Santé - New England Journal of Medicin Progressive multifocal leukoencephalopathy (PML) is a rare complication of natalizumab treatment and is caused by the JC virus. In this study of 19 patients with multiple sclerosis who had no symptoms of PML, the prevalence of JC virus in blood and urine increased after treatment with natalizumab. JC virus regulatory-region sequences were similar to those usually found in PML. |
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Brief Report: Treatment of Progressive Multifocal Leukoencephalopathy Associated with Natalizumab
Mercredi 09 Septembre 2009 - 08:56 - 6 mois, 1 semaine depuis - Santé - New England Journal of Medicin This report describes a 52-year-old patient with multiple sclerosis in whom progressive multifocal leukoencephalopathy developed after 12 months of natalizumab therapy. He was treated with plasma exchange and immunoadsorption to eliminate natalizumab. After initial clinical improvement, immune-reconstitution inflammatory syndrome developed and the patient deteriorated clinically, but he survived and improved neurologically. |
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Brief Report: Progressive Multifocal Leukoencephalopathy after Natalizumab Monotherapy
Mercredi 09 Septembre 2009 - 08:56 - 6 mois, 1 semaine depuis - Santé - New England Journal of Medicin This report describes progressive multifocal leukoencephalopathy in a patient who was receiving natalizumab therapy for multiple sclerosis. Plasma exchange was used to accelerate the clearance of natalizumab. Three weeks after plasma exchange, the patient's condition worsened neurologically because of the development of an immune-reconstitution inflammatory syndrome, but his condition improved after several weeks. |
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Parenteral Nutrition in the Critically Ill Patient
Mercredi 09 Septembre 2009 - 08:56 - 6 mois, 1 semaine depuis - Santé - New England Journal of Medicin A 67-year-old woman with type 2 diabetes mellitus undergoes extensive bowel resection for mesenteric ischemia. Tube feedings are associated with adverse effects, and central venous parenteral nutrition is recommended. The appropriate use of parenteral nutrition is controversial, though in selected circumstances it can be beneficial. Control of hyperglycemia is essential. Overfeeding and the refeeding syndrome are potential adverse effects. |
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