NEJM Original Content
Electroconvulsive Therapy for Depression – An NEJM Clinical Therapeutics Article
SH Lisanby, NEJM, November 8 2007, Vol 357 (19), 1939-45
Electroconvulsive therapy (ECT) applies electricity to the scalp to induce seizure activity as a treatment for depression. In this NEJM feature, a case vignette of a woman with a history of depression is presented, followed by extensive discussion of depression and characterization of ECT as a valid treatment alternative. The author then gives her own clinical recommendation for the patient.
Incidental Findings on Brain MRI in the General Population – An NEJM Original Article
MW Vernooij et al, NEJM, November 1 2007, Vol 357 (18), 1821-8
Magnetic resonance imaging of the brain has improved considerably over the past decade, allowing the detection of unexpected brain abnormalities such as brain tumors and aneurysms. The authors studied 2000 patients of the general population to determine the prevalence of these abnormalities. They document a surprising prevalence of incidental brain findings, suggesting a valuable role of neuroimaging in preventative treatment.
We Can Do Better—Improving the Health of the American People – An NEJM Special Article
SA Schroeder, NEJM, September 20 2007, Vol 357 (12), 1221-8
United States healthcare has been ridiculed for spending the greatest amount per capita yet achieving mediocre health results. In this special article, Dr. Shroeder of UCSF suggests that the greatest opportunities to improve health lie in improving personal behavior and addressing the health of the poor. He then speculates that lack of social advocacy for the poor and the laissez-faire health system encourages poor health outcomes.
Guilty, Afraid, and Alone—Struggling with Medical Error – A NEJM Perspective Article
T Delbanco and SK Bell, NEJM, October 25 2007, Vol 357 (17), 1682-3
Medical error creates an agonizing experience for patients, family members, and clinicians alike, and feelings of guilt or blame hinder closure and forgiveness. Dr. Delbanco describes cases of medical error and perspectives from all sides. He then suggests that honest and direct communication may be the best antidote, especially when doctors are paralyzed by shame or fear of legal repercussions, and patients and families struggle to understand their situation fully.
Human Papillomavirus DNA versus Papanicolaou Screening Tests for Cervical Cancer – An NEJM Original Article
MH Mayrand et al., NEJM, October 18 2007, Vol 357 (16), 1579-88
The sexually-transmitted human papillomavirus (HPV) is a necessary factor in almost all cases of cervical cancer, and early detection can ward off serious complications. While the Pap smear is the most common test worldwide, testing for DNA of HPV may be superior in sensitivity. Dr. Mayrand and colleagues report the first screening round comparing DNA testing and Pap testing in parallel and finds DNA testing more sensitive for detection of cervical cancer.
Disclosing Harmful Medical Errors to Patients – An NEJM Current Concepts Article
TH Gallagher et al., NEJM, June 28 2007, Vol 356 (26), 2713-9
Admitting mistakes is always difficult, but it is all the more difficult when one is in a position of trust. Because of this, physicians have a hard time admitting and disclosing errors, for fear of breaking the crucial trust in the doctor-patient relationship. This transparency, however, is crucial, and consequently, policy makers in the US and abroad have been developing different mechanisms to make reporting more standard to the profession. What does this mean for those conditions that we may consider too minor to merit a visit to the doctors? What about privacy?
Communication Between Physicians and Patients in the Era of E-Medicine – An NEJM Perspective Article
JH Stone, NEJM, June 14 2007, Vol 356 (24), 2451-4
Imagine if in addition to chatting to friends, we can chat online with our physicians. Now, that is starting to become a reality. In addition to new was of connecting patients and physicians, information technology, especially the internet, has allowed better connectivity between institutions, between patients and their doctors, and among physicians themselves.
Needlestick Injuries Among Surgeons in Training – An NEJM Original Article
MA Makary et al., NEJM, June 28 2007, Vol 356 (26), 2693-9
Since nearly all residents, by the final year, have been injured with needles, many of them have been exposed to patients with blood-borne infections such as hepatitis B and C and HIV. Of course, the fact that doctors have an occupational hazard is nothing new, but by surveying surgeons-in-training, Dr. Makary and colleagues, have found surprising patterns of reporting–or rather, non-reporting–among health service employees.
Structural Variation in the Human Genome – An NEJM Clinical Implications of Basic Research Article
R Lupski, NEJM, March 15 2007, Vol 356 (11)
Recently, biologists have found that individuals actually have many large-scale rearrangements in their genomes, such as deletions, inversions, or duplications that can affect gene fragments or even entire genes, and not just single point mutations. This “structural variation” affects the regulation of many different genes, and Dr. James Lupski explores the clinical implications of these large rearrangements.
Ethical Challenges Posed by the Solicitation of Deceased and Living Organ Donors – An NEJM Sounding Board Article
DW Hanto, NEJM, March 8 2007, Vol 356 (10)
In exploring the ethics of patients directly soliciting donations of organs from willing strangers, Douglas Hanto advocates the controversial position that organ donors and their families should not be allowed to choose what to do with the organs. Instead, he proposes forcing all donors to donate to the recipient at the top of the organ transplant lists except in those cases where a pre-existing emotional relationship exists (such as between family members).
