Because there is no universal definition of normal sexual function, what constitutes sexual difficulty is determined by a person’s subjective definition of unsatisfactory sexual well-being. The condition is usually described as unsatisfactory interest, arousal, orgasm, or other aspects of sexuality (e.g., sexual self-image), and the symptoms often coexist. The term “sexual dysfunction” is used when at least one of the symptoms is of substantial concern to the affected person. Sexual dysfunction in women impairs quality of life and is determined by multiple factors. Treatment includes lifestyle modification, counseling and psychosexual therapies, and pharmacotherapy. Learn more in the Clinical Practice article “Sexual Dysfunction in Women” by Susan R. Davis, MB, BS, PhD, from Monash University and Alfred Health: https://nej.md/3yPp3jN
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NEJM Group brings together the people and products that have made the New England Journal of Medicine, NEJM AI, NEJM Evidence, NEJM Catalyst, NEJM Journal Watch, and NEJM CareerCenter leaders in providing the medical knowledge health care professionals need to deliver the best patient care. The goal of NEJM Group is to meet the rapidly growing demand for essential medical information and to disseminate that content in new ways to a broader global health care community than ever before. Our publications reach health care professionals around the globe — making connections between clinical science and clinical practice that advance medical knowledge, health care delivery, and patient outcomes. NEJM Group is a division of the Massachusetts Medical Society.
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A storytelling initiative launched by health care, academic, and community organizations produces narrative interventions to help heal and empower the people most deeply affected by gun violence in Boston. Ruth Rollins, president and founder of We Are Better Together, Warren Daniel Hairston Project (WAB2G), holds a photo of her son Danny, who was murdered in Boston in 2007. Driven by her personal experiences and her expertise as a domestic violence advocate, Ruth founded WAB2G in 2017 to empower women and girls affected on both sides of gun violence in the peacemaking process. Full Perspective in comments. Read the Perspective “Transforming Narratives of Gun Violence” by P.T. Masiakos et al., from Massachusetts General Hospital, the Louis D. Brown Peace Institute, and Emerson College: https://nej.md/3SSBRgd
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Chronic kidney disease (CKD) is a public health challenge that affects more than 800 million people worldwide. CKD can be caused by a variety of disease processes. Many causes are difficult to identify with the use of traditional clinical diagnostics, and precise causes often remain unknown. Globally, most cases of CKD have been attributed to diabetes mellitus or hypertension. However, genetic causes of CKD are increasingly recognized. The Kidney Disease: Improving Global Outcomes (KDIGO) organization recently highlighted the importance of genetics in the classification and management of CKD and advised clinicians to consider genetic testing in order to improve diagnostic accuracy and facilitate personalized medical management in nephrology. Asaf Vivante, M.D., Ph.D., discusses the diagnosis and management of CKD of genetic origin in adults, focusing on single-gene variants that cause or confer a substantial risk of progressive CKD. Read the Review Article “Genetics of Chronic Kidney Disease” by Asaf Vivante, M.D., Ph.D., from Sheba Medical Center and Tel Aviv University: https://nej.md/3SMFpAv
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Approximately 20 to 30% of patients with non–small-cell lung cancer (NSCLC) present with locally advanced stage III disease at the time of diagnosis. Of these patients, 60 to 90% are considered to have unresectable disease. Osimertinib is a recommended treatment for advanced NSCLC with an epidermal growth factor receptor (𝘌𝘎𝘍𝘙) mutation and as adjuvant treatment for resected 𝘌𝘎𝘍𝘙-mutated NSCLC. EGFR tyrosine kinase inhibitors have shown preliminary efficacy in unresectable stage III 𝘌𝘎𝘍𝘙-mutated NSCLC. In the LAURA trial, researchers examined the efficacy and safety of adjuvant osimertinib in patients with unresectable, stage III NSCLC that had an 𝘌𝘎𝘍𝘙 mutation. 216 adults with stage III, unresectable, 𝘌𝘎𝘍𝘙-mutated NSCLC who had not had disease progression during or after chemoradiotherapy were randomly assigned in a 2:1 ratio to receive oral osimertinib or placebo until disease progression or a serious toxic effect had occurred or until the patient wished to stop treatment. The primary end point was progression-free survival. Treatment with osimertinib resulted in significantly longer progression-free survival than placebo in patients with unresectable stage III 𝘌𝘎𝘍𝘙-mutated NSCLC. Read the full LAURA trial results and Plain Language Summary: https://nej.md/451OXwi #ClinicalTrials #MedicalResearch
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𝗘𝗻𝗱𝗼𝗰𝘆𝘁𝗼𝘀𝗶𝘀 is a process by which cells actively internalize extracellular substances by invagination of the cellular membrane and subsequent formation of vesicles. Types of endocytosis are phagocytosis (e.g., microorganisms), pinocytosis (e.g., fluid), and receptor-mediated endocytosis (e.g., binding of extracellular molecules to specific receptors). To learn more about this NEJM Illustrated Glossary term, read the editorial “Inhibiting IgG in Hemolytic Disease of the Fetus” by Emeline Maisonneuve, M.D., Alice Panchaud, Ph.D., and David Baud, M.D., Ph.D.: https://nej.md/3YS7Scb Explore more terms: https://nej.md/glossary
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The September 2024 issue of NEJM Catalyst Innovations in Care Delivery includes an in-depth look at the African American Transplant Access Program (Northwestern Medicine), which is working to help Black patients with end-stage kidney disease receive access to transplantation. Read the article: https://nej.md/3YTnvA5 Here are more highlights from the September issue: 𝗖𝗔𝗦𝗘 𝗦𝗧𝗨𝗗𝗜𝗘𝗦 ⚖️ The Journey to an Incentive-Based Health Equity Quality Index https://nej.md/3yCbNyV 💡 A Physician-Created Platform to Speed Clinical Decision-Making and Referral Workflow https://nej.md/3WNYWSj 𝗔𝗥𝗧𝗜𝗖𝗟𝗘𝗦 🏥 How a Robust Community Clinical Practice Arm Can Support an Academic Health System’s Tripartite Mission https://nej.md/3X9ZkuL 🌐 Comparable Real-World Patient-Reported Outcomes Data Across Health Conditions, Settings, and Countries: The PROMIS International Collaboration https://nej.md/4ct9EDI 𝗖𝗢𝗠𝗠𝗘𝗡𝗧𝗔𝗥𝗬 🩺 Longitudinal Care Management for Diabetes and Hypertension https://nej.md/4dJn92R 𝗜𝗡𝗦𝗜𝗚𝗛𝗧𝗦 𝗥𝗘𝗣𝗢𝗥𝗧 🛡️ Quality and Patient Safety Improvement Is Never Finished https://nej.md/3X5dK0d 𝗙𝗥𝗢𝗠 𝗧𝗛𝗘 𝗘𝗗𝗜𝗧𝗢𝗥𝗦 📈 Novel Approaches and Actionable Insights to Improve Outcomes https://nej.md/3yTEYNU Explore the current issue: https://nej.md/3YTnvA5 #CareDelivery
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This editorial describes the science behind reports of communication facilitated by brain–computer interfaces. Card et al. describe the acquisition of at-home recordings to decode speech in a person with dysarthria (Panel A). Cortical signals were first acquired from a penetrating interface, comprising 256 electrodes, implanted in the precentral gyrus. The signals were then filtered to extract the neural activity features related to intended speech. A computational algorithm translated the neural activity into specific speech sounds, called phonemes, at each time point. The sequence of phoneme predictions was assembled and integrated with a statistical model of language to generate text sentences on a screen. ALS denotes amyotrophic lateral sclerosis. Vansteensel et al. describe a person with anarthria who was fitted with a wireless brain–computer interface (BCI) for at-home independent use (Panel B). Low-channel-count cortical signals were recorded from electrodes on the brain surface for click and call-caregiver commands and click spelling. Recordings were performed for 8 years, and the person relied on this communication brain–computer interface as she became progressively weaker. HFB denotes high-frequency band, and LFB low-frequency band. In the future, communication neuroprosthetics will integrate current knowledge for high performance and robustness over decades, with the goal of retaining autonomy and societal participation of persons with severe motor impairments. Read the editorial “Brain–Computer Interfaces for Restoring Communication” by Edward Chang, M.D., from the University of California, San Francisco: https://nej.md/46ZSpc5 𝗙𝗨𝗥𝗧𝗛𝗘𝗥 𝗥𝗘𝗔𝗗𝗜𝗡𝗚 📄 “Cognitive Motor Dissociation in Disorders of Consciousness” by Yelena Bodien, Ph.D., et al.: https://nej.md/3X2abYs 📄 “An Accurate and Rapidly Calibrating Speech Neuroprosthesis” by Nicholas Card, Ph.D., et al.: https://nej.md/3yBmrWC 📄 “Longevity of a Brain–Computer Interface for Amyotrophic Lateral Sclerosis” by MJ Vansteensel et al.: https://nej.md/4dbofER
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Classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is a rare autosomal recessive disorder characterized by impaired synthesis of cortisol and often aldosterone. To control androgen excess in children with CAH, supraphysiologic doses of glucocorticoids are often required. However, this treatment can adversely affect growth and other outcomes. Crinecerfont — a new oral corticotropin-releasing factor type 1 receptor antagonist — might reduce androstenedione, a key adrenal androgen, while limiting the need for supraphysiologic doses of glucocorticoids. In the CAHtalyst Pediatric trial, researchers assessed the efficacy of crinecerfont in lowering androstenedione levels and reducing the need for supraphysiologic glucocorticoid doses in children with classic 21-hydroxylase deficiency CAH. 103 children 2 to 17 years of age with classic CAH who were receiving supraphysiologic glucocorticoid doses were assigned in a 2:1 ratio to receive oral crinecerfont (25 mg, 50 mg, or 100 mg, depending on body weight) or placebo twice daily for 28 weeks. A stable glucocorticoid dose was maintained for 4 weeks; the dose was then lowered to a target of 8 to 10 mg per square meter of body-surface area per day, provided that androstenedione was controlled. The primary efficacy end point was the change in the androstenedione level from baseline to week 4. In children with classic CAH, crinecerfont was superior to placebo in lowering elevated androstenedione levels and allowed for reductions in glucocorticoid doses while androstenedione control was maintained. Read the full CAHtalyst Pediatric trial results and Plain Language Summary: https://nej.md/4aAQKcR #ClinicalTrials #MedicalResearch
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Communication is a priority for people with dysarthria from neurologic disorders such as stroke and amyotrophic lateral sclerosis (ALS). People with diseases that impair communication have an increased risk of isolation, depression, and decreased quality of life; losing communication may determine whether a person will pursue or withdraw life-sustaining care in advanced ALS. Although augmentative and assistive communication technologies such as eye trackers (also called eye-gaze–tracking devices) or head trackers are available, they have low information-transfer rates and become increasingly difficult to use as patients lose voluntary muscle control. Brain–computer interfaces are a promising type of communication technology that can directly decode the user’s intended speech from neural signals. In a man with impaired speech from amyotrophic lateral sclerosis, an intracortical speech neuroprosthesis achieved more than 97% accuracy in decoding his intended speech and making it audible in his natural voice. Read the full results in the Original Article “An Accurate and Rapidly Calibrating Speech Neuroprosthesis” by Nicholas Card, Ph.D., et al., from the University of California, Davis, and elsewhere: https://nej.md/3yBmrWC #MedicalResearch
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Guideline Watch 2024, an exclusive collection of 12 clinical guideline summaries that will directly impact how you practice medicine, is available to download for free for a limited time. The annual collection, curated by NEJM Journal Watch physician-editors, includes 12 new and updated guideline summaries to help you stay informed and confident in your practice. Inside Guideline Watch 2024: 📋 Updated Guideline for Management of Lower Extremity Peripheral Artery Disease 🩺 Managing Acute Pancreatitis 🌿 Managing Cannabis Hyperemesis Syndrome 🔍 Prostate Cancer Screening Guidelines for Black Men 🩻 USPSTF Releases New Breast Cancer Screening Guidelines 🩸 The Role of Imaging in Managing Patients with Gastrointestinal Bleeding 📉 Managing Patient Deterioration Outside of the ICU 🧠 Managing Post-Traumatic Stress Disorder ❤️ Best Practices for Advanced Cardiac Life Support 🦠 Management of HIV During Pregnancy 🫁 Managing Acute Respiratory Distress Syndrome 💉 Updated Guidelines for Use of Pneumococcal Vaccines in Adults Get your copy: https://nej.md/4dnWMj0