Learning Lab NEJM Quick Take Videos

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?

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.

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?

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?

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?

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?

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?

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?

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? 

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? 

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. 

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? 

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

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. 

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?

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?

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?

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?

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

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?

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?

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?

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?

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

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?

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

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?

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?

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

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.

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

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

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?

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

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

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?

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

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

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

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?

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

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

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.

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?

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

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

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?

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?

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

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.

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?

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

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.

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

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

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

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.

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

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

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.

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.

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.

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.

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.

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.

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.

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.