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Free Live Webinar: Patient-Centered Innovation: Key Steps for Clinicians, Purchasers & Payers    Patient-centered innovation requires designing health care delivery to meet the needs, preferences, and challenges of patients. To achieve this innovation, there are key steps that clinicians, purchasers, and payers can take, including actively engaging with patients to understand their expectations, embracing technology such as #ArtificialIntelligence (AI) to draw out common themes, looking for ways to reduce friction in the patient experience all the way through to insurance coverage and payment, and more.    Join NEJM Catalyst for a free webinar with an international panel of speakers who will discuss what really matters to patients in 2024; how to adopt a patient-focused mindset, and what an end-to-end view of the patient journey looks like, and why adopting technology like AI can provide insights into the patient experience.    📅 June 27, 2024, 12:00–2:00 PM ET   🔗 https://nej.md/44wQhat      #HealthCare

In the latest Case Record of the Massachusetts General Hospital, a 45-year-old woman was evaluated in the oncology clinic of this hospital because of metastatic triple-negative breast cancer.    The patient had been well until 6 years before the current presentation, when she noticed a mass in the right breast. She was evaluated in the oncology clinic of another hospital, and mammography and ultrasonography of the right breast confirmed the presence of a mass. A core-needle biopsy was performed, and pathological examination of the specimen revealed invasive ductal carcinoma with no lymphovascular invasion. Lumpectomy of the right breast, along with sentinel-node biopsy of the right axilla, was performed.    Read more about the case in “A 45-Year-Old Woman with Metastatic Breast Cancer,” which includes differential and final diagnoses from guest physicians based on evidence from the test results, by Neelima Vidula, M.D., Karen Rodriguez, M.D., Alexandra K. Wong, M.D., and Baris Boyraz, M.D., Ph.D.: https://nej.md/4e1UZ4l   

Although many treatments exist, at least a third of patients do not have a response after two or more trials of antidepressant drugs and are considered to have treatment-resistant #depression (Kim et al., July 4, 2019, https://nej.md/2HOppbO).    In the third episode of a four-part Double Take video miniseries on #depression from the New England Journal of Medicine, Gerard Sanacora, PhD, MD, Sina Nikayin, MD, and Mario Cristancho, MD, discuss the role neuroplasticity may play in the pathogenesis of depression and the benefits to patients of advanced therapies for treatment-resistant depression, such as electroconvulsive therapy and transcranial magnetic stimulation. An overview of emerging evidence for the use of ketamine, esketamine, and psilocybin as new or potential treatments is also examined.    📺 Watch the full video: https://nej.md/3X3YdOO    For further reading, the following articles, referenced in the video, are available at NEJM.org:  • Esketamine for Treatment-Resistant Depression — First FDA-Approved Antidepressant in a New Class (July 4, 2019) https://nej.md/2HOppbO   • Electroconvulsive Therapy (February 17, 2022) https://nej.md/3Jp3hDa   • Psilocybin in Treatment-Resistant Depression (November 3, 2022) https://nej.md/3WmnDEb   • Single-Dose Psilocybin for a Treatment-Resistant Episode of Major Depression (November 3, 2022) https://nej.md/3WcfLFp   • Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression (June 22, 2023) https://nej.md/3ODZMPc   • Esketamine Nasal Spray versus Quetiapine for Treatment-Resistant Depression (October 5, 2023, issue) https://nej.md/46vdMAc  

Mesoderm: The middle layer of the three layers of germ cells (ectoderm, mesoderm, and endoderm) formed during early gastrulation. The mesoderm develops into muscle, the skeletal system, and the circulatory system.     To learn more about this NEJM Illustrated Glossary term, read the Review Article “Reassessing Human Adipose Tissue” by Aaron Cypess, MD, PhD: https://nej.md/3HbAmB9     Explore more terms: https://nej.md/glossary  

#ASCO24 Round Up: Six Original Articles were simultaneously published in NEJM and presented at this year’s American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago:     Asciminib in Newly Diagnosed Chronic Myeloid Leukemia https://nej.md/4bNNr3c    Belantamab Mafodotin, Bortezomib, and Dexamethasone for Multiple Myeloma https://nej.md/3wTS3pA     Belantamab Mafodotin, Pomalidomide, and Dexamethasone in Multiple Myeloma https://nej.md/3R0I5tt    Osimertinib after Chemoradiotherapy in Stage III EGFR-Mutated NSCLC https://nej.md/451OXwi    Neoadjuvant Nivolumab and Ipilimumab in Resectable Stage III Melanoma https://nej.md/3wSo3uk    Isatuximab, Bortezomib, Lenalidomide, and Dexamethasone for Multiple Myeloma https://nej.md/44YCFox   

Hypertrophic cardiomyopathy (HCM) is one of the most common genetic heart diseases worldwide; safe and effective therapies are needed.     Aficamten is an oral selective cardiac myosin inhibitor that reduces contractility of the left ventricle. Whether aficamten improves exercise capacity and reduces symptoms in patients with obstructive HCM is unknown.     In the SEQUOIA-HCM trial, researchers evaluated the efficacy and safety of aficamten in adult patients with symptomatic obstructive HCM.     282 patients with a confirmed clinical diagnosis of obstructive HCM were randomly assigned to receive oral aficamten (starting dose, 5 mg; maximum dose, 20 mg) or placebo once daily for 24 weeks, in addition to standard drug treatment. Cardiopulmonary exercise testing was used to assess the primary end point: the change in peak oxygen uptake from baseline to week 24.     In patients with symptomatic obstructive HCM, treatment with aficamten resulted in a significantly greater improvement in peak oxygen uptake over a 24-week treatment period than placebo.    Read the full SEQUOIA-HCM trial results and Plain Language Summary: https://nej.md/3wmDzyl    #ClinicalTrials #MedicalResearch 

In the latest Case Record of the Massachusetts General Hospital, a 20-year-old man was evaluated in the emergency department of this hospital because of a diffuse pustular rash that had progressed over a period of several days.    Three days before the current evaluation, the patient noticed a pustular rash on the left forearm that stung while he was taking a shower. He was a student athlete and was evaluated by an athletic trainer, who referred him to the student health clinic. The next day, the rash had progressed to involve the right arm. He received prescriptions for oral trimethoprim–sulfamethoxazole and topical mupirocin.    Read more about the case in “A 20-Year-Old Man with a Pustular Rash,” which includes differential and final diagnoses from guest physicians based on evidence from the test results, by Demetre Daskalakis, MD, MPH, Howard M. Heller, MD, MPH, Erica S. Shenoy, MD, PhD, and Katherine Hsu, MD, MPH: https://nej.md/3KnFhmg 

In response to Jean Buridan, a Parisian 14th century philosopher who wrote about the inability to choose between two courses of action if both are judged to be equally good, a thought experiment was proposed wherein a donkey with equal levels of hunger and thirst placed precisely midway between a stack of hay and a pail of water would die owing to this inability to choose. (This theoretical donkey is now known as Buridan’s ass.) This concept remained an interesting but untestable philosophical thought experiment until Richman and colleagues developed what they dubbed “Buridan’s assay,” shown in panels A and B in the figure.    In Buridan’s assay, a food- and water-restricted mouse is provided with two equally accessible reward spouts that contain liquid food in one and water in the other. Panels A and B are adapted from Richman et al. In Panel A, the “energy landscape” with wells for hunger and thirst represent a model explaining choice. If hunger and thirst are equal, the wells have equal depth and the initial choice between eating and drinking in this mouse model is random. As one urge starts to become satisfied, the landscape shifts, favoring the other urge; the mouse acts accordingly and alternates between drinking and eating until both urges are fully satisfied, as shown in Panel B. Richman et al. monitored the activity of mice deprived of food and water. After an olfactory cue, the mice could lick toward either food or water. The x axis in Panel B denotes trials across a session, and the y axis shows the cumulative number of licks after each olfactory cue. The bursts of licks for food, alternating with those for water, are consistent with a shifting energy landscape. Panel C shows a boy with X-linked nephrogenic diabetes insipidus at presentation (with a severe cachectic appearance) and after treatment. The photographs are reproduced from Perry et al. With respect to Buridan’s assay, malnutrition may be due to persistent thirst because of the urinary water losses, whereby water intake is favored over food intake.    Learn more in the Clinical Implications of Basic Research article “Thirst, Hunger, and Nephrogenic Diabetes Insipidus” by Daniel G. Bichet, M.D., and Detlef Bockenhauer, M.D., Ph.D.: https://nej.md/4bZMPHB 

Recent progress in generative #ArtificialIntelligence (AI) has given rise to large language models (LLMs) that can be prompted to craft persuasive essays, pass professional competency examinations, and write patient-friendly empathetic messages.     Amid growing recognition of the capabilities of LLMs, many people have expressed concerns about their use in medicine and health care, citing known risks of confabulation, fragility, and factual inaccuracy.    As LLMs and other AI models are used more in medicine, ethical dilemmas can arise depending on how the model was trained. A user must understand how human decisions and values can shape model outputs. Medical decision analysis offers lessons on measuring human values.    Learn more in the latest review in the #AIinMedicine series as the authors explore how human values influence the outputs of LLMs and other AI models: https://nej.md/4aNpf04 

Gene: The fundamental physical and functional unit of heredity. A gene is an ordered sequence of nucleotides located in a particular position on a particular chromosome that encodes a specific functional product (i.e., a protein or an RNA molecule).    To learn more about this NEJM Illustrated Glossary term, read “Shooting the Messenger to Treat Hypertriglyceridemia” by Gerald F. Watts, DSc, MD, PhD: https://nej.md/4aKpdpQ     Explore more terms: https://nej.md/glossary