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In this retrospective review of a real-world data set, Lloyd et al. evaluate the impact of estrogen receptor 1 (ESR1) mutations on the effectiveness of CDK4/6 inhibitors and endocrine therapy in patients with estrogen receptor–positive metastatic breast cancer. ESR1-mutated tumors demonstrated similar real-world time-to-next-treatment on CDK4/6 inhibitors compared with non-ESR1–mutated tumors. There were also no differences in duration of therapy in the first-line and subsequent treatment-line settings.
In a cluster-randomized trial in 82 community hospitals where half of the hospitals used automated statistical surveillance of microbiology data to alert infection prevention programs to respond to outbreaks, real-time alerts did not significantly reduce additional outbreak cases (intervention period vs. baseline: statistical surveillance relative rate [RR]=1.41, control RR=1.81; difference-in-differences, 0.78; 95% confidence interval, 0.40 to 1.52; P=0.46) in the context of an ongoing pandemic.
This randomized, placebo-controlled trial tested the use of intranasal oxytocin to reduce body weight in adults with obesity. Intranasal oxytocin, administered four times daily over 8 weeks, did not result in body weight change from baseline compared with placebo and was not associated with beneficial effects on body composition or resting energy expenditure from baseline to week 8. Oxytocin compared with placebo was associated with reduced caloric intake at an experimental test meal from baseline to week 6.
New guidelines supported by the Prostate Cancer Foundation aim to address longstanding health disparities in prostate cancer. Given that Black men are at highest risk for being diagnosed with and dying from prostate cancer, baseline PSA testing is recommended between 40 and 45 years of age.
Not much longer than a decade ago, the approach to the treatment of estrogen receptor (ER)–positive, human epidermal growth factor receptor 2-negative, metastatic breast cancer focused primarily on the sequential use of a limited number of endocrine agents, continuing until progressively shorter durations of progression-free intervals were observed, suggesting the emergence of endocrine-refractory disease. Although data were emerging to suggest molecular mechanisms of endocrine resistance, including deregulation of the ER pathway, alterations in cell survival signals, and activation of escape pathways, therapeutic strategies that could leverage these insights were not available.1 Thus, the approach was to pivot to chemotherapy for the remainder of a patient's journey through metastatic disease.
Health care–associated infections (HAIs) are a pervasive problem, and although decreased rates of HAIs have been clearly achieved during the past decades, most recent estimates by the Centers for Disease Control and Prevention show the prevalence of HAIs in U.S. hospitals to be about 3%.1 Many HAIs are preventable events and pose undue burdens on both patients and health care facilities. Hospitals' infection prevention teams are responsible for working to prevent HAIs, which includes identifying and managing outbreaks. Although there is no consensus on how to define an outbreak, outbreaks of infectious diseases are most efficiently controlled when they are identified early, so rapid identification is a key strategy.
The diverse roles of the hormone oxytocin in physiological homeostasis, milk let-down, maternal and social affiliative behaviors, emotion regulation, and cognition have been studied across various disciplines.1 Among them, preclinical studies have demonstrated an effect of oxytocin on ingestive behaviors. In this issue of NEJM Evidence, Plessow et al.2 report results of a well-designed, randomized, double-blind, placebo-controlled clinical trial to evaluate the effects of intranasal oxytocin (24 IU daily in divided doses) on weight loss in participants who are obese. Despite extensive preclinical studies demonstrating that oxytocin reduces food intake3 and preliminary clinical trials supporting the potential use of oxytocin as an antiobesity medication in humans.
Black men in the United States experience a substantial and disproportionate burden from prostate cancer. Compared with other racial and ethnic groups, Black men have the highest prostate cancer incidence and mortality rates, have the highest rate of distant-stage cancer, and are diagnosed with cancer at a younger age.1 Microsimulation models suggest that annually screening Black men 45 to 69 years of age could substantially reduce mortality while limiting overdiagnosis.2 The American Urological Association (AUA) and the American Cancer Society (ACS) guidelines have long recommended earlier screening for Black men, beginning at either 40 or 45 years of age depending on family history of prostate cancer.
When it comes to improving the health of populations, the use of diagnostics is critical for accurate disease tracking, prevention, and control; this article lays out five key principles for applying diagnostics to public health issues using the coronavirus disease 2019 pandemic and antimicrobial resistance as case examples. Although the integration of diagnostics into public health faces unique challenges, considering these five principles will improve the quality and utility of data available to tackle emerging public health issues.
A growing number of patients are prescribed buprenorphine, a mixed agonist–antagonist of opioid receptors, for opioid use disorder (OUD), and clinicians are often faced with the question of how to adequately manage acute pain among hospitalized patients receiving buprenorphine for OUD. This article reviews the pharmacology of buprenorphine and provides pain management recommendations for patients prescribed buprenorphine in the setting of acute surgical and nonsurgical pain.
A 73-year-old man presented for evaluation of shortness of breath, weight gain, and leg swelling that has progressively worsened in the past 4 weeks. How do you approach the evaluation, and what is the diagnosis?
We are seeking a Board Certified/Eligible Emergency Medicine Physician to join our team at Memorial Hospital. Located in North Conway, New Hampshire, Memorial Hospital is a 25-bed critical access hospital that offers a friendly team setting with a....
Danbury Hospital, a part of Nuvance Health is seeking a full-time day Adult Hospitalist at Danbury Hospital in Danbury, Connecticut to join our established and busy program. We are located about 70 miles northeast of New York City in suburban Fairfield.....
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