Professor Brian Andrews NEJM Recommendations for Medical Students and
Tutors
Week of the 19th November 2015 (#17)
University of Notre Dame Australia
(Fremantle campus)
Occasional Editorial
Comments
While many articles in this issue may be of great
interest to selected groups (malarial vaccine, agent to treat RSV, sub-clinical
leaflet thrombosis in biosynthetic aortic valves), I have not included these as
recommendations.
Articles Recommended for Medical Students
CLINICAL
PRACTICE
Generalized Anxiety Disorder
http://www.nejm.org/doi/full/10.1056/NEJMcp1502514
Persistent anxiety and uncontrollable worry
for at least 6 months characterize generalized anxiety disorder. First-line
treatments are cognitive behavioral therapy or pharmacotherapy with a selective
serotonin-reuptake or serotonin–norepinephrine reuptake inhibitor.
This
is a very good review on generalized anxiety disorder, developed in the context
of a clinical scenario. The management section is covered well as is the
section on areas of uncertainty. This is recommended reading particularly for
MED400 but also for all other years as many medical students may suffer
intermittently from this disorder.
Recommended learning: Generalized
anxiety disorder, acute anxiety reactions
Perspective
(must read)
BECOMING
A PHYSICIAN
Graduate Medical Education in the Freddie Gray
Era
In the wake of the death of Freddie Gray and
the protests over unjust treatment of black Americans, the internal medicine
residency program at Johns Hopkins launched a curriculum aiming to provide
tools for improving population health and reducing health disparities
This is a
heart-lifting article that details what was achieved in the general area of
public health in a specific residency training program in the US (Baltimore,
Johns Hopkins). My words cannot add to those in the article, but suffice it to
say there is a strong parallel between the poor in some areas of Baltimore and
the Aboriginal population in Australia. You should read every word in this
article.
Important Articles Related to Mechanisms of Disease and Translational
Research
None
Other areas which could be of interest to medical students
ORIGINAL
ARTICLE
Prospective Validation of a 21-Gene Expression
Assay in Breast Cancer
Patients with early-stage
estrogen-receptor–positive, node-negative breast cancer whose 21-gene Oncotype
DX profile suggested a low risk of recurrence were safely treated with
endocrine therapy alone and were spared exposure to adjuvant chemotherapy
EDITORIAL
Biology before Anatomy in Early Breast Cancer —
Precisely the Point
This is a
reverse-transcriptase-PCR 21-gene assay using RNA extracted from formalin-fixed
paraffin-embedded tissue looking at various genes associated with breast
cancer. At this stage from an enormous clinical and pathological data base,
this is an assay looking for validation. At last the authors appear to have
found a patient super-subset in which the assay may be useful with incredible
restrictive parameters. Using multiple arbitrary parameters (I read this to
generate a positive statistical outcome), the authors derive a ”recurrence
score” which, if it falls between 0-10, indicate that at 5 years patients will
have an extremely low rate of recurrence (local and distal) and a 98% survival
rate. These patients who were HR positive by definition, required endocrine
therapy alone.
Genetic studies in
cancer, with some obvious exceptions, have a long way to go before they can
predict specific treatment responsiveness and predict the subsequent outcomes.
This is one study on a very long journey.
