The New England journal of medicine
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Long-term use of a left ventricular assist device for end-stage heart failure.
Implantable left ventricular assist devices have benefited patients with end-stage heart failure as a bridge to cardiac transplantation, but their long-term use for the purpose of enhancing survival and the quality of life has not been evaluated. ⋯ The use of a left ventricular assist device in patients with advanced heart failure resulted in a clinically meaningful survival benefit and an improved quality of life. A left ventricular assist device is an acceptable alternative therapy in selected patients who are not candidates for cardiac transplantation.
-
Randomized Controlled Trial Clinical Trial
Early goal-directed therapy in the treatment of severe sepsis and septic shock.
Goal-directed therapy has been used for severe sepsis and septic shock in the intensive care unit. This approach involves adjustments of cardiac preload, afterload, and contractility to balance oxygen delivery with oxygen demand. The purpose of this study was to evaluate the efficacy of early goal-directed therapy before admission to the intensive care unit. ⋯ Early goal-directed therapy provides significant benefits with respect to outcome in patients with severe sepsis and septic shock.
-
Randomized Controlled Trial Multicenter Study Clinical Trial
Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation.
Radiotherapy prevents local recurrence of breast cancer after breast-conserving surgery. We evaluated the effect of a supplementary dose of radiation to the tumor bed on the rates of local recurrence among patients who received radiotherapy after breast-conserving surgery for early breast cancer. ⋯ In patients with early breast cancer who undergo breast-conserving surgery and receive 50 Gy of radiation to the whole breast, an additional dose of 16 Gy of radiation to the tumor bed reduces the risk of local recurrence, especially in patients younger than 50 years of age.
-
Randomized Controlled Trial Clinical Trial
Intensive insulin therapy in critically ill patients.
Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes. Whether the normalization of blood glucose levels with insulin therapy improves the prognosis for such patients is not known. ⋯ Intensive insulin therapy to maintain blood glucose at or below 110 mg per deciliter reduces morbidity and mortality among critically ill patients in the surgical intensive care unit.
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after elective major knee surgery.
Despite thromboprophylaxis, major knee surgery carries a high risk of venous thromboembolism. Fondaparinux, the first of a new class of synthetic antithrombotic agents, may reduce this risk. ⋯ In patients undergoing elective major knee surgery, postoperative treatment with 2.5 mg of fondaparinux once daily was significantly more effective in preventing deep-vein thrombosis than 30 mg of enoxaparin twice daily.