Top 5 papers in medicine, 2010

The year's most highly ranked articles in all of medicine, according to the Faculty of 1000

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Which treatment works best under which conditions? It's one of the most important questions medical researchers ever ask, and this year is no exception. Studies of treatment options for a type of lung cancer, how far to lower blood pressure in diabetics, and surgical or non-surgical options for stenosis all topped this year's list of the most important papers in the medical field, as reviewed and ranked by members of the Faculty of 1000.linkurl:5. Early palliative care helps in advanced cancer;http://f1000.com/4929959?key=rnr30w57fzggfr9 linkurl:The paper:;http://www.ncbi.nlm.nih.gov/sites/entrez/20818875?dopt=Abstract&holding=f1000%2Cf1000m J.S. Temel, et al., "Early palliative care for patients with metastatic non-small-cell lung cancer," N Engl J Med, 363:733-42, 2010.

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Patients with inoperable, metastatic non-small-cell lung cancer may benefit from early palliative care, reporting a better quality of life, and less depression than those who did not receive palliative care. Median survival also improved in those receiving early palliative care, even though they were less likely to receive aggressive treatment at the end of their lives. linkurl:4. Skip the surgery?;http://f1000.com/5489956?key=59jyh10s9d7rgdv linkurl:The paper:;http://www.ncbi.nlm.nih.gov/sites/entrez/20961243?dopt=Abstract&holding=f1000%2Cf1000m M.B. Leon, et al., "Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery," N Engl J Med, 2010.A new, nonsurgical treatment for patients with severe aortic stenosis, a type of heart disease characterized by the narrowing of the aortic valve opening, may provide an alternative for patients who are not candidates for open-heart surgery. The treatment, known as transcatheter aortic-valve implantation -- which replaces the aortic valve through a catheter -- was associated with 20 percent lower mortality, as well as reduced rates of hospitalization and cardiac symptoms. However, the procedure also resulted in a higher incidence of major strokes and vascular complications. linkurl:3. In diabetes, less is not always more;http://f1000.com/2638966?key=9vn24hpz3nzylhz linkurl:The paper:;http://www.ncbi.nlm.nih.gov/sites/entrez/20228401?dopt=Abstract&holding=f1000%2Cf1000m W.C. Cushman, et al., "Effects of intensive blood-pressure control in type 2 diabetes mellitus," N Engl J Med, 362:1575-85, 2010.Contrary to expectations, in type 2 diabetes, a normal blood pressure (with systolic levels below 120 mm Hg) is not associated with a fewer cardiovascular events than a slightly above-normal blood pressure of 140 mm Hg or below, forcing clinicians to reevaluate blood pressure goals in these patients.linkurl:2. Drug helps - not hurts - in serious lung disease;http://f1000.com/5240957?key=09p5z453y7rgx27 linkurl:The paper:;http://www.ncbi.nlm.nih.gov/sites/entrez/20843245?dopt=Abstract&holding=f1000%2Cf1000m L. Papazian, et al., "Neuromuscular blockers in early acute respiratory distress syndrome," N Engl J Med, 363:1107-16. 2010.Doctors have hesitated to give neuromuscular blocking agents to patients with the life-threatening lung condition called acute respiratory distress syndrome, out of fear the drugs could cause muscle weakness. But a clinical trial found patients who took a neuromuscular blocker were more likely than those on a placebo to survive 90 days, and showed no increase in muscle weakness. (Some faculty members, however, disagreed with the paper's conclusions, arguing narcotics are more appropriate in these patients.) linkurl:1. To stent or not;http://f1000.com/3636963?key=1y6gdb7648stksq linkurl:The paper:;http://www.ncbi.nlm.nih.gov/sites/entrez/20505173?dopt=Abstract&holding=f1000%2Cf1000m T.G. Brott, et al., "Stenting versus endarterectomy for treatment of carotid-artery stenosis," N Engl J Med, 363:11-23, 2010.A large randomized trial demonstrates that stenting and surgical clearing of arteries are safe and equally effective ways of treating the narrowing of the carotid arteries, called stenosis.
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