Learning Lab NEJM Quick Take Videos

A genetic assay predicts a benefit of chemotherapy if the score is high and a low risk of recurrence without chemotherapy if it is low, but the benefit of chemotherapy for those with a midrange score is unknown. New research findings are summarized in a short video.

Smallpox was declared eradicated in 1980, but variola virus, which causes smallpox, still exists, and there is no known effective treatment. New research findings are summarized in a short video.

Despite treatment, approximately 20% of patients with asthma have uncontrolled, moderate-to-severe disease, with substantially reduced lung function and the risk of further loss of function over time. New research findings are summarized in a short video.

Cisplatin is part of standard therapy for hepatoblastoma, a rare liver cancer, but hearing loss is a serious and permanent side effect. New research findings are summarized in a short video.

Many treatment protocols for diabetic ketoacidosis in children advocate slow rehydration to prevent brain injury, but whether the speed of administration of intravenous fluids influences outcomes remains unclear. New research findings are summarized in a short video.

Medical management of early pregnancy loss with prostaglandin analogues allows for planned, expedited expulsion of the nonviable tissue, but the rate of failure of this strategy diminishes its clinical usefulness. New research findings are summarized in a short video.

Observational studies have suggested that endovenous treatment of varicose veins — which may be particularly appropriate for the elderly population with venous leg ulcers — may improve ulcer healing. New research findings are summarized in a short video.

Conventional therapy for X-linked hypophosphatemia is associated with incomplete healing of rickets, skeletal deformity, persistent short stature, gastrointestinal side effects, and metabolic and endocrine abnormalities. New research findings are summarized in a short video.

Patients with mild asthma often use low-dose inhaled glucocorticoid maintenance therapy and β2 -agonists for symptom relief, but poor adherence to maintenance treatment is a major problem. New research findings are summarized in a short video.

Given the severe clinical consequences of ZIKV infection, large numbers of asymptomatic travelers, and reports of transmission through transfusion, would screening of donated blood be a cost-effective way to minimize risk? New research findings are summarized in a short video.

Studies have shown that triple inhaled therapy has benefits in patients at risk for frequent or severe exacerbations, but the therapy has required the use of multiple inhalers several times a day. New research findings are summarized in a short video.

Would mass distribution of a broad-spectrum antibiotic agent reduce childhood mortality in sub-Saharan Africa? New research findings are summarized in a short video.

The current standard of care for patients with β-thalassemia — lifelong, regular red-cell transfusions and iron chelation — is associated with a risk of serious complications. New research findings are summarized in a short video.

Prevention of metastases to bones and other sites is a key treatment goal in prostate cancer, but resistance to standard therapy develops in almost all men with the disease. New research findings are summarized in a short video.

Approximately 75% of patients with advanced renal-cell carcinoma have an intermediate or poor prognosis, with a low rate of response to standard treatment with sunitinib and a high rate of toxic effects. New research findings are summarized in a short video.

Six months of chemotherapy with oxaliplatin plus a fluoropyrimidine is standard in stage III colon cancer, but oxaliplatin is associated with cumulative neurotoxicity. Would a shorter course be effective? New research findings are summarized in a short video.

Helicobacter pylori infection is a major cause of gastric cancer, but whether patients with early disease undergoing endoscopic resection would benefit from H. pylori eradication therapy has been unknown. New research findings are summarized in a short video.

Since the emergence of the Zika epidemic in 2015, infection during pregnancy has been shown to cause severe birth defects, with risk estimates ranging from 6% to 42%. New research findings are summarized in a short video.

Early signs of loss of asthma control can signal an impending exacerbation. Escalation of treatment has been considered as a way to prevent full-blown exacerbations, but evidence to support this approach is limited. New research findings are summarized in a short video.

Intravenous administration of isotonic crystalloid fluids is one of the most common medical therapies, but whether the composition of the fluid has an effect on outcomes has not been known. New research findings are summarized in a short video.

Direct oral anticoagulants are commonly used for extended prophylaxis against venous thromboembolism after total hip or knee arthroplasty. Trials and metaanalyses have suggested that aspirin may be equally effective. New research findings are summarized in a short video.

Daily injection with low-molecular-weight heparin is the recommended treatment for cancer-associated venous thromboembolism; the safety and efficacy of direct oral anticoagulants have not been established. New research findings are summarized in a short video.

In previously treated patients with multiple myeloma, daratumumab added to standard therapy has prolonged progression free-survival, but its efficacy in newly diagnosed myeloma has been unknown. New research findings are summarized in a short video.

Chronic kidney disease and ESRD are increasing in prevalence worldwide, but the long-term outcomes of childhood kidney diseases remain largely unknown. New research findings are summarized in a short video.

Several studies have advanced the hypothesis that influenza may trigger acute cardiovascular events, but most were underpowered or limited by inaccurate diagnostic methods or had designs that were susceptible to bias. New research findings are summarized in a short video.

Household contacts of persons with active tuberculosis are at increased risk for contracting the disease, but a lack of high-quality evidence for screening contacts has been a barrier to widespread implementation. New research findings are summarized in a short video.

Median progression-free survival in patients with advanced non–small-cell lung cancer treated with EGFR tyrosine kinase inhibitors is 11 months. Is there a more efficacious treatment? New research findings are summarized in a short video.

Trials have shown that endovascular thrombectomy within 6 hours after the onset of ischemic stroke symptoms has a clinical benefit, but the effect after more than 6 hours is not known. New research findings are summarized in a short video.

Prophylactic treatment of severe hemophilia A with factor VIII can necessitate frequent infusions that may fail to achieve adequate hemostasis to prevent breakthrough bleeding and that affect quality of life. New research findings are summarized in a short video.

In sub-Saharan Africa, a large number of infants are affected by hydrocephalus that develops after neonatal ventriculitis and is often associated with poor developmental outcomes. New research findings are summarized in a short video.

The global incidence of diabetes is rising, and in most patients with type 1 diabetes, insulin therapy alone is not sufficient to achieve adequate glycemic control. New research findings are summarized in a short video.

For patients with hemophilia, the goal is to develop a therapeutic intervention that can achieve sustained clotting factor levels that are adequate to prevent bleeding, without the need for further treatment. New research findings are summarized in a short video.

Patients with chronic migraine have functional impairment and reduced quality of life. Preventive treatment is recommended but may be underused or ineffective. New research findings are summarized in a short video.

Persons with high levels of circulating Loa loa microfilariae may have serious adverse events, including death, after mass administration of ivermectin. 

Most patients with stage III, locally advanced, unresectable non–small-cell lung cancer have disease progression despite chemotherapy with concurrent radiation.

The incidence of cutaneous melanoma has continued to increase in recent years; patients with stage III disease are at risk of post-resection recurrence and death from metastatic melanoma.

SMA is a progressive motor neuron disease with an onset during infancy that results in failure to meet motor milestones and in death or the need for mechanical ventilation by 2 years of age. 

Current treatment guidelines for COPD recommend triple therapy with inhaled glucocorticoids, long-acting β2 agonists, and long-acting muscarinic-receptor antagonists, but 30 to 40% of patients continue to have moderate or severe exacerbations. 

Triple therapy (oral anticoagulation plus two antiplatelet agents) is the standard of care after PCI in patients with atrial fibrillation, but it is associated with a high risk of major bleeding.

Fragility fractures are common in postmenopausal women with osteoporosis; treatment has focused on increasing bone formation and decreasing bone resorption to reduce risk.

Most patients with follicular lymphoma will eventually have a relapse, and early progression is associated with shorter survival. Is there a safe and effective way to prolong progression-free survival?

Supplemental oxygen has been routinely recommended for patients with suspected acute MI, but too much oxygen may contribute to reperfusion injury. Is routine use of oxygen warranted?

Canakinumab targets a proinflammatory cytokine implicated in the development of atherothrombotic plaques. Whether reducing inflammation without lowering cholesterol would prevent cardiovascular events is unclear.

The global emergence of antibiotic-resistant TB has led to increased transmission of disease. Prompt point-of-care testing to determine the most effective treatment is needed. New research findings are summarized in a short video. 

Measles–mumps–rubella vaccination typically consists of two doses administered in childhood, but mumps outbreaks among young adults continue to occur. New research findings are summarized in a short video.

Treatment of hemophilia A, an inherited bleeding disorder, includes infusions that may result in the development of antibodies that can inhibit efficacy and increase morbidity. New research findings are summarized in a short video.

The prevalence of rheumatic heart disease has declined worldwide during recent decades, especially in higher-income countries. What is the current global burden? New research findings are summarized in a short video.

Preterm preeclampsia is an important cause of maternal and perinatal death and complications. Low-dose aspirin has been recommended for pregnant women considered to be at high risk. New research findings are summarized in a short video.

Measurement of circulating DNA has been studied as a way to find residual disease in cancer patients. But can cell-free DNA be used to screen asymptomatic persons? New research findings are summarized in a short video.

Vasodilatory shock is a life-threatening syndrome that requires immediate treatment; conventional vasopressors have a narrow therapeutic window and toxicities at high doses. New research findings are summarized in a short video.

Giant-cell arteritis causes headaches, vision loss, jaw claudication, and stroke, and it often relapses as glucocorticoids are tapered. New research findings are summarized in a short video.

The protein angiopoietin-like 3 is an experimental target for therapy to reduce lipid levels and cardiovascular disease risk. New research findings are summarized in a short video.

Clonal hematopoiesis of indeterminate potential (or CHIP) increases mortality and coronary heart disease. Could CHIP also cause atherosclerosis? New research findings are summarized in a short video.

Obesity and overweight are increasing in prevalence, but the overall effect on global health has been uncertain. New research findings are summarized in a short video.

These investigators analyzed consultations from five major airlines to a physician-directed communications center to study the epidemiology of 11,920 in-flight medical emergencies.

This trial assessed the efficacy and safety of radium-223 as compared with placebo in men with castration-resistant prostate cancer and bone metastases, a frequent and serious complication of prostate cancer.

Using data from two large screening trials, the authors identified factors associated with malignancy on follow-up of nodules first found on low-dose CT screening for lung cancer.

Twin birth is associated with a higher risk of adverse perinatal outcomes than singleton birth. This international trial compared planned vaginal birth and planned cesarean section in 2804 women carrying twins.

This study found an association between nut consumption and reduced risk of major chronic diseases, including cardiovascular disease and type 2 diabetes mellitus, in two large cohorts of health professionals.

In a study of novice and experienced drivers, the authors found significant associations between secondary tasks (e.g., cell-phone dialing) and the risk of a crash or near-crash, particularly among novice drivers.

As the incidence of malaria diminishes, a better understanding of nonmalarial fever is important for effective management of illness in children. This study explores the spectrum of causes of fever in African children.

The current guidelines for recommended salt intake and the risks of cardiovascular disease and death related to salt consumption are described in a short animation.

LCZ696 was compared with enalapril in patients with advanced heart failure. LCZ696 was superior to enalapril in all outcomes, as summarized in this video.

Your 17-year-old patient tells you she’s terrified of becoming pregnant. How can you help her?

Patients who had received a drug-eluting stent and then dual antiplatelet therapy for 12 months were randomly assigned to 18 more months of therapy or aspirin alone. Continued therapy resulted in lower rates of stent thrombosis and major adverse cardiovascular events but more bleeding.

In this trial involving smokers who called the New Zealand national quitline, cytisine was superior to nicotine-replacement therapy in helping smokers quit.

In patients with acute ischemic stroke due to a proximal intracranial arterial occlusion, intraarterial treatment within 6 hours improved functional outcome at 90 days.

This study assessed prevention strategies in young women in South Africa, Uganda, and Zimbabwe using oral or vaginal antiretroviral agents. No approach was found to be effective.

A community-wide treatment program for yaws in Papua New Guinea, in which a single dose of azithromycin was administered, showed substantial disease control.

This study assessed children 4 to 11 months of age who were at high risk for development of peanut allergy. Peanut allergy was more than five times as likely to develop in children assigned to peanut avoidance.

Air pollution in southern California has been decreasing for several decades. How has this affected lung function in children?

Current treatments for Crohn’s disease, a chronic inflammatory illness, can increase the risk of infection and cancer and are ineffective in a third of patients. Is there anything more promising on the horizon?

The composite of death, myocardial infarction, or target-vessel revascularization occurred more frequently in patients treated with PCI with everolimus-eluting stents for multivessel coronary artery disease.

How does the duration of red-cell storage affect outcomes in patients undergoing cardiac surgery?

Alcoholic hepatitis can develop in patients with a history of heavy alcohol use, and mortality is high. Pentoxifylline and prednisolone are two commonly recommended treatments. Which treatment is more effective?

In patients with complicated intraabdominal infection, is a short, fixed-duration course of antibiotics as effective as a course that continues through the resolution of fever and other abnormalities?

In a randomized trial, financial incentives were more effective than usual care in achieving smoking cessation.

For young women, attending university means confronting the risk of sexual assault. Are there effective interventions?

Treatment with statins reduces LDL cholesterol and lowers the risk of cardiovascular events. Would the addition of ezetimibe further improve outcomes with statins after acute coronary syndromes?

Is there an effective medical treatment to combat obesity? New research findings on liraglutide, a glucagon-like peptide-1 analogue approved for the treatment of type 2 diabetes.

In this study, kidneys from deceased donors who were randomly assigned to receive mild hypothermia showed a lower frequency of delayed graft function.

Venous thromboembolism is sometimes the first sign of cancer. But how often is that so?

Patients with atrial fibrillation are at increased risk of stroke. Warfarin anticoagulation is often used to reduce risk, but it is usually stopped perioperatively. Temporary “bridging” with heparin is common, but is it necessary?

Neonatal jaundice is a common threat to newborns worldwide. Expensive phototherapy equipment is impractical in developing countries. Is sunlight an effective alternative?

Thousands of couples struggle with unexplained infertility. The typical approach to treatment begins with ovarian stimulation. Which agent is most effective for this purpose?

If the nicotine content of cigarettes were lower, would smokers consume more cigarettes per day, or fewer?

Remote ischemic preconditioning has been reported to reduce biomarkers of ischemia and reperfusion injury in patients who undergo cardiac surgery. But does it really improve clinical outcomes?

Hypoglycemia is common in neonates; in severe cases, it can cause neurologic impairment. But how low is too low?

Is the benefit of TKR worth the postoperative pain and possible long-term complications?

Genetic testing is not currently part of the treatment algorithm for prostate cancer. But could DNA-repair defects influence the response to prostate cancer treatment?

Can malignant transformation of parasite cells cause neoplasms in an immunosuppressed host?

PCI is known to relieve angina in patients with stable ischemic heart disease, but does it prolong survival?

Reduced leaflet motion was detected on computed tomography in 22 patients in a clinical trial of transcatheter aortic-valve replacement (TAVR) and in 17 patients in two registries. The condition resolved with anticoagulation.

For blood-pressure control, is intensive or standard treatment more effective at reducing the rate of cardiovascular events in high-risk patients?

Daily use of preventive ART by gay and bisexual men has been shown to reduce the risk of acquiring HIV, but adherence has been a challenge. Would starting prophylaxis when sexual activity begins reduce risk?

Scabies affects as many as a hundred million people worldwide and can lead to serious complications. In areas where scabies is endemic, would mass administration of anti-scabies drugs reduce prevalence?

Andexanet, a small-molecule factor Xa fragment, rapidly reversed the anticoagulant activity of rivaroxaban and apixaban in older healthy volunteers.

Although treatments for Hodgkin’s lymphoma have a high cure rate, survivors are at a substantial risk of secondary cancers. Have changes in treatment implemented since the 1980s reduced this excess risk?

Chronic hepatitis C virus infection causes progressive liver fibrosis, which can lead to cirrhosis and hepatocellular carcinoma. Is there an effective oral regimen?

Allogeneic hematopoietic stem-cell transplantation is used to treat leukemia and other bone marrow disorders, but chronic GVHD is a leading cause of late morbidity and mortality. Would a modified regimen decrease GVHD without increasing infections and relapses?

Up to a third of patients with tuberculous meningitis die despite treatment. Standard treatment is based on data for pulmonary TB but may not achieve sufficient drug concentrations in CSF. Would a modified regimen improve outcomes?

The usefulness of adjuvant chemotherapy after surgery for stage II colon cancer is unclear; many patients are treated to benefit a few. Are there biomarkers that might indicate which patients are at greatest risk of relapse?

Immunosuppressive therapy in patients with kidney transplants has reduced the incidence of allograft rejection, but standard therapy may not adequately preserve allograft function. Would a different regimen improve outcomes?

In 1999, the WHO recommended routine antibiotics for children with severe acute malnutrition, which is often complicated by bacterial infection. Is such treatment beneficial?

Acquired thrombotic thrombocytopenic purpura is a microvascular thrombosis with high morbidity and mortality. Is there a way to improve outcomes?

Testosterone levels in men decrease with age, contributing to a decline in physical mobility, sexual function, and energy. Would treatment with testosterone be beneficial for older men?

ACGME work-hour policies were created to minimize long shifts for residents and reduce potential harm to patients. Do the policies affect patient outcomes or residents’ learning experience?

The risk of stillbirth is higher among older pregnant women. Would induction of labor to reduce the risk of stillbirth increase the risk of cesarean delivery?

Malaria infection during pregnancy may increase the risk of fetal loss and maternal death. Data on artemisinin-based therapy in pregnant women are limited. Are such therapies efficacious and safe for pregnant women?

Pregnant women with a short cervix have an increased risk of premature delivery. Placement of a cervical pessary has been used to help prevent this, but evidence supporting the effectiveness of this approach has been mixed. 

In this trial, withholding parenteral nutrition from critically ill children was clinically superior to providing early parenteral nutrition.

Lyme disease is a tickborne illness that can cause persistent arthralgia, fatigue, and neurologic and cognitive disturbances despite appropriate initial treatment with antibiotics. Would longer-term treatment improve outcomes? 

Gliomas are a heterogeneous group of tumors that arise from the glia, the supporting cells of the CNS. Previousevidence has shown that chemotherapy added to radiation can prolong progression-free survival. 

Spinal stenosis can cause back and leg pain and severely impair quality of life. Decompressive laminectomy relieves pressure on spinal nerve roots but can cause instability. Does spinal fusion performed along with decompression surgery improve outcomes? 

The elevated risk of stroke or acute coronary syndrome after a transient ischemic attack can be estimated with a scoring system in which a high score indicates the need for urgent evaluation. Has this approach led to a reduction in risk? 

Transcatheter aortic-valve replacement is a less invasive alternative to open surgery for high-risk patients with severe aortic stenosis. Could TAVR criteria be expanded to include patients at low or intermediate risk?

Previous studies showed that introducing peanuts to infants at high risk for allergy reduces the incidence of allergy. But does early introduction of other allergenic foods have a similar effect?

Smokers are at high risk for COPD, but some smokers with COPD symptoms do not meet the diagnostic criteria for COPD. How often do smokers with normal lung-function results have severe respiratory exacerbations?

Telomeres shorten with DNA replication, and shorter telomeres are linked to disease. Androgenic hormones regulate expression of the telomerase gene. Would treatment with synthetic androgen slow the shortening of telomeres?

Severe hemophilia A is often treated with infusions of factor VIII. But the infusions are burdensome, and antibodies develop in about 30% of patients. Would emicizumab, which mimics the function of factor VIII, reduce these problems?

Indwelling urinary catheters are commonly used in hospitals and can lead to preventable catheter-associated UTI. How can rates of catheter-associated UTI be reduced in hospitals?

Catheter ablation is recommended for drug-refractory atrial fibrillation. Radiofrequency ablation makes limited use of fluoroscopy, but it requires specialized training. Cryoablation, which requires more fluoroscopic guidance, is simpler, but is it safe and effective? New research findings are summarized in a short video.

The EPA sets air-quality standards to protect the health of the U.S. population. Are current standards stringent enough? New research findings are summarized in a short video.

Small, nonrandomized studies have shown that body positioning after an acute stroke may affect outcomes. New research findings are summarized in a short video.

Babies who were exposed to opioids in utero are at risk for neonatal abstinence syndrome. New research findings are summarized in a short video.

Although completion lymph-node dissection has been recommended in patients with melanoma and sentinel node metastases, its effect on survival has been unclear. New research findings are summarized in a short video.

Patients who have had a first clinical demyelinating event have a high rate of conversion to MS. Is there a way to prevent or delay onset? New research findings are summarized in a short video.

Low cardiac output syndrome is a common complication of cardiac surgery and is associated with increased mortality. Levosimendan has been shown in small studies to be an effective therapy.

Does exercise improve physical function in obese older adults? New research findings are summarized in a short video.

In patients with coronary artery disease undergoing PCI, hyperemic agents such as adenosine, used to reduce distal microvascular resistance, may have side effects. New research findings are summarized in a short video.

Little is known about long-term outcomes after bystander CPR and defibrillation in cases of out-of-hospital cardiac arrest. New research findings are summarized in a short video.

Catheter ablation is an invasive procedure; patients usually receive periprocedural anticoagulants for several weeks. New research findings are summarized in a short video.

Ustekinumab, which targets a subunit of IL-23, has shown efficacy and safety in patients with psoriasis. But is there a more effective IL-23 inhibitor? New research findings are summarized in a short video.

Large infrastructure disruptions during major marathons are likely to affect the delivery of medical care to nonparticipants who live near marathon routes, but data on the effects have been lacking. New research findings are summarized in a short video.

Studies have shown the importance of intensive glucose lowering, blood-pressure control, and use of statins to reduce cardiovascular risk and mortality in patients with diabetes, but long-term trends in such patients are unknown. New research findings are summarized in a short video.

In patients with severe, symptomatic aortic stenosis, transcatheter aortic-valve replacement has become the preferred therapy for patients at high surgical risk; efficacy and safety in lower-risk patients are unclear. New research findings are summarized in a short video.

HPV causes genital warts and cervical and other anogenital cancers. The HPV vaccine is recommended for girls and women 9 to 26 years of age to reduce infections, but information on safety in pregnant women is limited. New research findings are summarized in a short video.

Sub-Saharan Africa has the highest rate of death associated with rotavirus. Current oral rotavirus vaccines require refrigeration, which makes transportation and storage challenging. Is there a low-cost, heat-stable alternative? New research findings are summarized in a short video.

Urothelial carcinomas affect parts of the urinary system. The prognosis for advanced disease is poor, and after failure of first-line platinum-based combination chemotherapy, treatment options are limited. Is there an effective second-line therapy? New research findings are summarized in a short video.

Chronic myeloid leukemia, a myeloproliferative neoplasm, is associated with the Philadelphia chromosome. Imatinib targets the product of the chromosome, but little has been known about long-term safety and efficacy.

Subclinical hypothyroidism or hypothyroxinemia during pregnancy may be associated with impaired cognitive function in offspring. Do screening and treatment improve outcomes? New research findings are summarized in a short video.

Patients with hereditary angioedema with C1 inhibitor deficiency may have recurrent, unpredictable swelling episodes that require immediate treatment, but current options are limited by side effects. Is there a safe and effective therapy? New research findings are summarized in a short video.

EGFR tyrosine kinase inhibitors are standard treatment for non–small-cell lung cancer. Despite high tumor response rates, disease progresses in most patients after 9 to 13 months. Is there a way to lengthen progression free survival? New research findings are summarized in a short video.

Patients who undergo arthroscopic knee surgery and lower-leg casting are thought to be at increased risk for venous thromboembolism, but the benefits and risks of preventive anticoagulation are not clear. New research findings are summarized in a short video.

Patients with sickle cell disease may experience pain crises related to P-selectin, which contributes to vaso-occlusion. Would an antibody that blocks binding to P-selectin reduce the frequency of pain crises? New research findings are summarized in a short video.

Clostridium difficile is a common cause of infectious diarrhea in hospitalized patients; recurrent infection can be difficult to treat and may lead to rehospitalization. Is there an agent to prevent recurrence?

In July 2016, emergency services in Brooklyn responded to a scene of mass intoxication of 33 persons who had been exposed to an “herbal incense” product. How was the cause of their zombielike behavior identified?

More than 6 million U.S. children and adolescents have migraine headaches, but there is little evidence to support any specific therapy for prevention. Are the most commonly used medications beneficial or harmful?

High LDL cholesterol is a major risk factor for cardiovascular disease. Reducing circulating PCSK9 levels with PCSK9 antibodies has been shown to reduce LDL cholesterol but has a short duration of effect. Is there a longer-acting agent? .

NSAIDS such as ibuprofen and naproxen can provide pain relief but may increase the risk of GI bleeding. Previous studies showed that high doses of celecoxib increased cardiovascular harm, but the safety of modest doses was unclear.

Acute otitis media is the most common indication for which U.S. children receive antibiotics, usually for 10 days. Given growing concern about antimicrobial resistance, can treatment duration be shortened without changing outcomes?

In pregnant women, acute Zika virus infection has been associated with fetal death and fetal brain defects. What is the extent of abnormal CNS findings in affected infants during the first months of life?

Babesia microti causes babesiosis, an infection that can be severe in some patients. Transmission occurs primarily by tick bites, but infections from blood transfusion may be underestimated. Would effective screening of donated blood reduce risk?

Rates of new HIV infection in women are high in sub-Saharan Africa. Antiretroviral pills and gels have not lowered rates, possibly owing to low adherence. Would a monthly vaginal ring inserted by women themselves reduce new infections?

Patients with brainstem strokes or degenerative disorders such as ALS may have normal cognition without the ability to move or speak. Could a brain–computer interface enable autonomous communication?

Blockade of the ER signaling pathway is a common therapeutic strategy in advanced breast cancer, but resistance may occur. Palbociclib appears to be safe in combination with endocrine therapy such as letrozole; does the combination improve outcomes?

The FDA requires manufacturers to assess the cardiovascular risk of all new therapies for type 2 diabetes.Semaglutide, a glucagon like peptide-1 analogue, lowers blood glucose, but does it increase cardiovascular risk?

Antiretroviral medications are used to prevent perinatal transmission of HIV from a mother to her baby, but doesthe benefit outweigh the potential toxicity and adverse pregnancy outcomes associated with such therapy?

In patients with COPD and severe resting hypoxemia, long-term use of supplemental oxygen outside the hospitalis known to reduce mortality. Does long-term oxygen also benefit COPD patients with less severe hypoxemia?

Syncope is the transient loss of consciousness due to cerebral hypoperfusion. Various conditions can lead to syncope, including pulmonary embolism. How common is pulmonary embolism in patients with syncope?

PSA testing often detects localized prostate cancers that progress slowly. Current management can includesurveillance, surgery, or radiotherapy. Which approach is associated with better outcomes and fewer side effects?

Although endemic transmission of measles was declared eliminated in the United States in 2000, outbreaks still occur, especially in clusters of unvaccinated persons, as a result of travel. What are the features of such an outbreak?

The risk of infection with cesarean delivery is 5 to 10 times that with vaginal delivery, even with a cephalosporingiven before incision. Ureaplasma organisms are thought to be the culprit. Would addition of azithromycin reducerisk?

Intracranial pressure after traumatic brain injury can be lowered with medical treatment or with decompressivecraniectomy, but whether craniectomy helps patients with persistently elevated pressure despite medical treatment is unclear.

Herpes zoster can severely impact quality of life, and the risk increases with age. A previous study showed that a subunit vaccine significantly reduced risk in adults 50 or older. How efficacious is it in those 70 or older?

Patients with acute leukemia or myelodysplastic syndrome may need hematopoietic-cell transplants. HLA-identicalsiblings are often unavailable as donors. Can umbilical-cord blood from an unrelated donor be used successfully?

An interim analysis showed that early initiation of antiretroviral therapy achieved a 96% reduction in the incidence of HIV-1 infection in serodiscordant couples. Is the protection offered by ART durable in such couples?

Medications reduce symptoms of essential tremor in some patients, but in others the symptoms are debilitating.Neurosurgery targeting the thalamus can effectively suppress tremor; could focused ultrasound provide anoninvasive alternative?

Observational studies have suggested an association between the use of acetaminophen and asthma exacerbations in children, but the association has not been rigorously examined. Is ibuprofen a better choice?

For decades, thymectomy has been a mainstay in the treatment of myasthenia gravis, but there has been no rigorous evidence of its benefit. Does thymectomy improve clinical outcomes?

The U.S. Amish and Hutterite populations share a common ancestry, and both live in farming communities, yet asthma is four times as common among the Hutterites. Can farming techniques and exposure to animals explain the difference?

Liraglutide lowers blood glucose and is associated with weight loss, lowered BP, and an increase in heart rate.Would treatment with liraglutide have a beneficial effect on cardiovascular outcomes in patients with diabetes?

International travel can be fun and exciting, but over 25% of travelers report an illness during their trip. Pretravel health consultation with a physician is advised, but what should the consultation look like?

Recurrent ventricular tachycardia is associated with high mortality and morbidity. An ICD can be effective, but theshocks are painful and upsetting. Antiarrhythmic drugs and catheter ablation can suppress tachycardia; whichstrategy is better?

Ticagrelor is an antiplatelet therapy that is an alternative to aspirin for preventing recurrent stroke. Does ticagrelor produce better outcomes than aspirin?

Evidence is emerging that the efficacy of malaria vaccination can wane over time, resulting in an eventual rebound in malaria cases. Is this “age shift” true in the case of the RTS,S/AS01 malaria vaccine?

Patients with advanced Hodgkin’s are often treated with one of two chemotherapy regimens associated with similar survival but different toxicities. Could escalating or de-escalating therapy according to interim PET findingsimprove outcomes?

Taenia solium infects humans who have eaten contaminated pork. Larvae migrate to tissues, which can lead to neurocysticercosis, a major cause of seizures in developing countries. Can transmission be stopped on a population level?