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Despite the hours spent gaining knowledge and skills training in medical school, little time is spent preparing a resident to teach. Yet, on day one residents are expected to do just that. So, how should a resident prepare for this role? This new NEJM Resident 360 blog post reviews high-yield skills and behaviors of effective clinical teachers. [ Resident360.nejm.org Link ]

The New England Journal of Medicine

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Original Article: Safety and Efficacy of a Dapivirine Vaginal Ring for #HIV Prevention in Women.

Preventing HIV-1 infection, especially with female-controlled approaches, is a high priority. In this trial in South Africa and Uganda, a dapivirine vaginal ring was associated with a rate of acquisition of HIV-1 infection that was approximately 30% lower than that with placebo. [ Nej.md Link ]...
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Safety and Efficacy of a Dapivirine Vaginal Ring for HIV Prevention in Women — NEJM

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Answer to yesterday’s quiz:

Which one of the following choices describes the action of niraparib?
A. A cytotoxic T-lymphocyte antigen 4 (CTLA-4) inhibitor.
B. An indoleamine 2,3-dioxygenase (IDO) inhibitor.
C. A poly(adenosine diphosphate [ADP]–ribose) polymerase (PARP) 1/2 inhibitor.
D. A programmed death 1 (PD-1) inhibitor.

The correct answer is C. Niraparib is a highly selective...
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Niraparib Maintenance Therapy in Ovarian Cancer | NEJM Resident 360

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Original Article: Venous Thromboembolism Prevention for Knee Arthroscopy and Lower Leg Casting (POT-KAST/POT-CAST)

In two studies of patients undergoing knee arthroscopy and lower leg casting, low molecular weight heparin was employed as clot prophylaxis. The incidence of clinically apparent venous thromboembolism was low and anticoagulation did not influence it.

This article was released...
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Venous Thromboembolism Prevention for Knee Arthroscopy and Lower Leg Casting (POT-KAST/POT-CAST)

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Original Article: Crizanlizumab for the Prevention of Pain Crises in Sickle Cell Disease (SUSTAIN)

A double-blind randomized placebo-controlled yearlong trial has shown that an antibody to P-selectin, crizanlizumab, can reduce the rate of painful crises in patients with sickle cell disease by 45% and delay their onset. Modest toxicities include arthralgia, diarrhea, and pruritus.

This...
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Crizanlizumab for the Prevention of Pain Crises in Sickle Cell Disease (SUSTAIN)

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Physicians-In-Training Quiz:

Which one of the following choices describes the action of niraparib?
A. A cytotoxic T-lymphocyte antigen 4 (CTLA-4) inhibitor.
B. An indoleamine 2,3-dioxygenase (IDO) inhibitor.
C. A poly(adenosine diphosphate [ADP]–ribose) polymerase (PARP) 1/2 inhibitor.
D. A programmed death 1 (PD-1) inhibitor.

Read the study associated with this question on NEJM Resident...
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Niraparib Maintenance Therapy in Ovarian Cancer | NEJM Resident 360

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Physicians-In-Training: Among patients with platinum-sensitive, recurrent ovarian cancer, the use of niraparib, a PARP inhibitor, was associated with a significantly longer duration of progression-free survival than placebo, with moderate bone marrow toxicity. NEJM Resident 360 has Clinical Pearls, Morning Report Questions, and free access to the article. [ Nej.md Link ]

Niraparib Maintenance Therapy in Ovarian Cancer | NEJM Resident 360

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Perspective: Permanent Supportive Housing for #Homeless People.

Advocates claim that providing permanent supportive housing to chronically homeless people will deliver net savings by reducing the use of jails, shelters, and hospitals. It won’t. Rather than focus on costs, we should consider the best way to meet this population’s needs. [ Nej.md Link ]

Listen to the related Perspective audio...
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Permanent Supportive Housing for Homeless People — Reframing the Debate — NEJM

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This week's From Pages to Practice post on NEJM Resident 360 looks at the Ring study and the ASPIRE study. 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? [ Nej.md Link ]

Reduction in HIV Transmission with Dapivirine Vaginal Ring – Is it Enough? | NEJM Resident 360

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Images in Clinical Medicine: Neurogenic Megacolon in Spinal Cord Injury

A 44-year-old man with quadriplegia presented with symptoms of urinary tract infection. Extremely large, intermittent waves of peristalsis, shown in a video, were noted. CT revealed massive dilation of the transverse, descending, and sigmoid colon. [ Nej.md Link ]

Neurogenic Megacolon in Spinal Cord Injury — NEJM

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Perspective from Richard J. Baron, M.D., and Clarence H. Braddock III, M.D., M.P.H. on improving maintenance of certification:

How do physicians know if they are keeping up with changing foundational knowledge? None of us are good at knowing what we don’t know. Maintenance of certification supports our professional responsibility to ensure that our clinical knowledge is current.

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Knowing What We Don’t Know — Improving Maintenance of Certification — NEJM

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This video shows extremely large, intermittent waves of peristalsis in a 44-year-old man with quadriplegia who presented with symptoms of urinary tract infection. CT revealed massive dilation of the transverse, descending, and sigmoid colon. Full Images in Clinical Medicine description: [ Nej.md Link ]
Perspective from the U.S. Food and Drug Administration (FDA) on clarifying #StemCell therapy’s benefits and risks:

To ensure that the emerging field of stem-cell therapy fulfills its promise to patients, we must first understand its risks and benefits and develop therapeutic approaches based on sound science. That requires a commitment to the principles of evidence generation.

Full article:
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Clarifying Stem-Cell Therapy’s Benefits and Risks — NEJM

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Announcing the panel of judges for the SPRINT Data Analysis Challenge, comprised of trialists, data analysts, patient advocates, and leaders from the health care industry. Meet the judges: challenge.nejm.org/judges

Read the news release: [ Nej.md Link ]

The SPRINT Data Analysis Challenge | Judges

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Images in Clinical Medicine: A 68-year-old woman was admitted to the ICU with respiratory failure and hypotension. Her blood pressure was 70/50 mm Hg, and her heart rate was 125 beats per minute. Physical examination revealed skin mottling on the legs. [ Nej.md Link ]
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? New research findings are summarized in this short video. See the two studies and related editorial on the NEJM Infectious Disease specialty page: [ Nejm.org...
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An 18-year-old Fijian woman presented with a 3-year history of a concentric scaly rash on her trunk and upper and lower limbs. Her brother had similar skin findings. What’s the diagnosis? Take the new Image Challenge now! [ Nej.md Link ]

NEJM - Image Challenge

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Join us now to discuss "Competitive Compensation — How To Get Paid What You’re Worth." In this NEJM CareerCenter Conversation, we're exploring resources and information for physician compensation nationwide. How and why does compensation vary from rural to urban? Head to Medstro now to discuss tips and pitfalls for salary negotiations and other issues related to compensation. [ Nej.md Link ]

NEJM CareerCenter Conversations: Competitive Compensation -- How To Get Paid What You’re Worth. • NEJM Group Open Forum • Medstro

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As MACRA likely begins taking hold in the coming months, what should U.S. clinicians expect? Read NEJM Catalyst's five questions and answers from the field to find out:

The MACRA Final Rule: Five Crucial Questions - NEJM Catalyst

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