Professor
Brian Andrews NEJM Recommendations
Week
of August 13th 2005 (#3)
University
of Notre Dame Australia, Fremantle
Tuesday, 19 January 2016
NEJM Week of August 13th 2015 (#3)
The Paternalism Preference - Choosing Unshared
Decision Making
http://www.nejm.org/doi/full/10.1056/NEJMp1508418
This is a must read perspective for all years,
involving paternalism in the context of informed consent. The final paragraph
should be carefully read and reflected upon.
Perspective
Differential Taxes for Differential Risks -
Toward Reduced Harm from Nicotine-Yielding Products
http://www.nejm.org/doi/full/10.1056/NEJMp1505710
An interesting perspective on smoking and
public health for all years. This discusses differential taxes for differential
risks. It suggests that in order to convert from higher risk nicotine products
(cigarettes) to lower risk nicotine products (electronic nicotine-delivery
systems), the tax rate must be lower, though high enough to discourage new
smokers.
Troponin and Cardiac Events in Stable Ischemic
Heart Disease and Diabetes
Editorial
Cardiac Troponin and Risk Stratification in
Ischemic Heart Disease
http://www.nejm.org/doi/full/10.1056/NEJMe1506298
This article and editorial discuss 1st
generation and 2nd generation cardiac troponin T assays and
myocardial damage. While the authors consider the advantages (very sensitive)
and potential disadvantages (less specific) of the 2nd generation
assay over the 1st generation assay, 2nd generation
assays are now being routinely used in the Perth area.
This study addresses a specific patient group,
namely those with stable ischaemic heart disease and type II diabetes mellitus.
Although troponin levels above 14 ng/litre failed to identify a subgroup of
patients that would benefit from coronary revascularization, the cardiac
troponin T level was a clear independent predictor of death from cardiovascular
causes, myocardial infarction and stroke in the study patients. Recommended for
MED300 and MED400.
Review: Ischemic Limb Gangrene with Pulses
http://www.nejm.org/doi/full/10.1056/NEJMra1316259
An excellent review article of causes and
pathology of limb gangrene in patients with palpable or Doppler positive
pulses. Great pictures to review. Do not forget the entity of cholesterol embolic disease. Worth
saving the link in Evernote. Recommended for MED300 and MED400.
Elotuzumab Therapy for Relapsed or Refractory
Multiple Myeloma
http://www.nejm.org/doi/full/10.1056/NEJMoa1505654
An interesting, but not essential, article
discussing an interesting monoclonal antibody which binds to a cellular
receptor (SLAMF7) on natural killer (NK) cells and stimulates the cells to
selectively kill myeloma cells. While the antibody also binds to myeloma cells,
it fails to stimulate the myeloma cells due to the absence of an adapter
protein (EAT-2) which is coupled to SLAMF7 and necessary for receptor
activation of the cell.
Review the International Grading System for
Adverse Events and how Australia manages this area.
Taking Patients’ Narratives about Clinicians
from Anecdote to Science
http://www.nejm.org/doi/full/10.1056/NEJMsb1502361
This is an interesting commentary on consumer
(patient) comments regarding their treating doctor in such vehicles as Angie’s List and Yelp. Up until now in Australia these vehicles appear to have
focussed on restaurant reviews, but if this follows the US experience you will
invariably find yourself and your practice on one or more of these sites. The
data indicate the 65-90% of comments are positive, but it also means that
10-35% are negative. You may find negative comments such as “always late”,
“non-responsive to e-mails”, “a little distant”, “never has the time to talk”,
“no empathy”, “cold”, “would never go back to him/her” or “the front office
staff are rude and always make mistakes in the billing.”
Regardless, the doctor always has the right of
rebuttal on the site, but will it be too late.
