In this audio interview conducted on November 25, 2020, the editors look at new studies of disease transmission in closed environments and provide updates on convalescent plasma and hydroxychloroquine.
I described another option to Grandpa: he could voluntarily stop eating and drinking. He’d never considered this possibility (which reminded me again how one’s family members and clinicians contribute to inequities in end-of-life care). The option intrigued Grandpa, and during subsequent visits he reinforced his plan to pursue it. I insisted that he first move into my home. I wanted to ensure the quality of his care, knowing that I could enroll him in my health system’s hospice program. But I also wished to test his resolve, reasoning that his mind might change once his isolation ended.
For a month after he entered our home, his spirits were brighter, his gait steadier, and his appetite heartier. He joined my wife, two daughters, and me for dinner each night, typically preceded by a vodka martini that I had stirred for him — a daily pleasure he’d allowed himself for 80 years and had missed as a facility resident. He’d tell stories of the Navy, his career, and his family history and would regularly quip, “If you keep treating me this well, I might just stick around a while longer!”
But eventually he returned to his goal of hastening death. One night, he said he was ready to stop eating and drinking the next morning, but when morning came, he asked for his usual coffee and bagel. He confided that he was scared. When I asked of what, he replied, “It’s like trying to roller skate. I’m scared of starting. Though I know that once I do, I’ll probably roll.”
New England Journal of Medicine (Aug 13, 2020) – In this small, single-center, nonblinded trial involving patients with chronic edema of the leg and cellulitis, compression therapy resulted in a lower incidence of recurrence of cellulitis than conservative treatment.
The researchers have conducted a single-center, randomized, nonblinded trial that aimed to find out an association between the compression therapy and controlled incidents of chronic edema of the leg and people with cellulitis that can be defined as an infection of the skin that involves subcutaneous tissues or the innermost layer of the skin. Cellulitis can be caused by trauma or scratching of other lesions due to animal or human bites that result in fever, extreme pain, and redness of the skin.
NEJM (Aug 13, 2020) – Population-level mortality from NSCLC in the United States fell sharply from 2013 to 2016, and survival after diagnosis improved substantially. Our analysis suggests that a reduction in incidence along with treatment advances — particularly approvals for and use of targeted therapies — is likely to explain the reduction in mortality observed during this period.
“The survival benefit for patients with non-small cell lung cancer treated with targeted therapies has been demonstrated in clinical trials, but this study highlights the impact of these treatments at the population level,” said Nadia Howlader, Ph.D., of NCI’s Division of Cancer Control and Population Sciences, who led the study. “We can now see the impact of advances in lung cancer treatment on survival.”
In this audio interview conducted on June 3, 2020, the editors discuss two new studies: one comparing test swabs collected by health care workers with swabs collected by the patients themselves and one assessing hydroxychloroquine treatment in people who had been exposed to Covid-19 but weren’t yet ill.
The continuing spread of SARS-CoV-2 remains a Public Health Emergency of International Concern. What physicians need to know about transmission, diagnosis, and treatment of Covid-19 is the subject of ongoing updates from infectious disease experts at the Journal.
Eric Rubin is the Editor-in-Chief of the Journal. Lindsey Baden is a Deputy Editor of the Journal. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal.
Interview with Dr. Nicole Lurie on rapid vaccine development, including new tools to facilitate vaccine testing and manufacturing and persistent challenges.
The need to rapidly develop a vaccine against SARS-CoV-2 comes at a time of explosion in basic scientific understanding, including in areas such as genomics and structural biology, that is supporting a new era in vaccine development. Over the past decade, the scientific community and the vaccine industry have been asked to respond urgently to epidemics of H1N1 influenza, Ebola, Zika, and now SARS-CoV-2. An H1N1 influenza vaccine was developed relatively rapidly, largely because influenza-vaccine technology was well developed and key regulators had previously decided that vaccines made using egg- and cell-based platforms could be licensed under the rules used for a strain change. Although a monovalent H1N1 vaccine was not available before the pandemic peaked in the Northern Hemisphere, it was available soon afterward as a stand-alone vaccine and was ultimately incorporated into commercially available seasonal influenza vaccines.
Nicole Lurie is a strategic advisor to the CEO of the Coalition for Epidemic Preparedness Innovations. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal.
Featuring articles on deaths due to e-cigarette– or vaping-associated lung injury, apixaban for venous thromboembolism in cancer, the management of coronary disease in patients with advanced kidney disease, health-status outcomes in the ISCHEMIA-CKD trial, and ten weeks to crush the curve.
Additionally, renin–angiotensin–aldosterone system inhibitors in patients with Covid-19, and teasing the immune system to repair the heart; a review article on the care of patients with diabetic retinopathy; a case report of a man with high blood pressure, renal insufficiency, and hematuria; and Perspective articles on clinical and social risk adjustment, on prediction models, and on medical care during the pandemic.
Cardiovascular consults are way down. Is the threat of COVID-19 infection scaring people away from ED’s?
We caught up with Dr. Comilla Sasson, the American Heart Association’s VP for science and innovation. She’s an emergency physician who teaches at the University of Colorado. She’d traveled to New York City to “help with the response,” and she talked with us from a field hospital that had been set up on a tennis court in Central Park.
She had lots to say about what’s driving patients away from emergency departments these days and what’s likely to happen in medicine (hello, telemedicine!) once the pandemic abates.
Running time: 15 minutes
Patients with osteoarthritis of the knee who underwent physical therapy had less pain and functional disability at 1 year than patients who received an intraarticular glucocorticoid injection.
Osteoarthritis of the knee is a leading cause of disability.1 Current management is typically limited to the treatment of symptoms until late stages of arthritis lead to knee replacement.2 Intraarticular glucocorticoid injections are commonly used as a primary treatment for osteoarthritis of the knee,3 but there are conflicting reports regarding the extent and duration of the relief of symptoms with this therapy.4-6 Complications from these injections occur infrequently but include joint infection,7 accelerated degradation of articular cartilage,8 and subchondral insufficiency fractures.9
The physical therapy intervention, which is described in the protocol,26 included instructions and images for exercises, joint mobilizations, and the clinical reasoning underlying the priorities, dosing, and progression of treatment. During a typical clinical session, the physical therapist would implement hands-on, manual techniques immediately before the patient performed reinforcing exercises to help the patient perform the movements with little or no pain. For example, if a patient could not fully extend or flex the knee, or those movements were painful, the physical therapist would use a hands-on, passive mobilizing technique to repeatedly move the knee to reduce stiffness while altering the mechanics of the technique to avoid pain. The patient would then perform repeated active knee movements in the same direction.
NEJM talks with Dr. Julian Flores, who works in a Broward County, Florida, emergency room.
When he was interviewed, the count of Covid-19 cases stood at 412, less than 12 hours later, the new number was 505. He’s expecting the wave to hit hard there. Broward is home to Fort Lauderdale (think spring break) and Pompano Beach (think aging retirees). Couple those demographics with a lack of easy testing for the virus, and you’ve got a worrisome situation.