Posts in the ‘Insights’ Category

Insights are brief stories about NEJM content, written by contributors appointed by NEJM editorial staff. While the posts often include quotes from editors, and are approved by editors, these blog posts about NEJM content are not published in NEJM, and should not be considered NEJM editorials or commentary. They are intended to provide insight into the clinical significance of interesting content found on NEJM.org, and where it may lead us in practice and research. Questions are included at the end to stimulate thinking and discussion.

Atenolol versus Losartan in Children and Young Adults with Marfan’s Syndrome

Posted by Daniela Lamas • November 25th, 2014

When French pediatrician Antoine-Bernard Marfan first described the syndrome that would bear his name in 1896, doctors knew little about the management and prognosis of the connective tissue disorder. In the century since that first description, what was once a fatal syndrome due to the risk of aortic dissection is now a condition that can… Read More…

Mortality in Type 1 Diabetes

Posted by Joshua Allen-Dicker • November 19th, 2014

There are moments during every physician’s day when she or he gives medical advice based on well-established evidence– “The data show that starting medication A for this disease will reduce the risk of death by 20%.”   There are also moments when she or he may give advice just because it seems like the right thing… Read More…

Dual Antiplatelet Therapy after Drug-eluting Stents

Posted by Chana Sacks • November 16th, 2014

“Well, doc, it’s been a year!  Now what?” You first met your patient 12 months ago when he presented to the emergency department having a heart attack.  He was rushed to the cardiac catheterization lab, where a drug-eluting stent was placed to open the blocked coronary artery responsible for his crushing chest pain. He has… Read More…

Vaccination and Pneumococcal Disease in South Africa

Posted by Brian Honeyman • November 12th, 2014

Since the beginning of medical school I, like most of us, have been bombarded by medical questions from friends, family, and even brand-new acquaintances.  If I had a dollar for every rash that I’ve been asked to “take a quick look at” my loans would be a bit less daunting.  One question often posed by… Read More…

The Good Word: Improving Patient Handoffs

Posted by Rena Xu • November 5th, 2014

Starting at six in the evening, the surgery residents at my hospital gather for sign-out.  This is when residents from the day shift hand over care of their patients to those working overnight.  Sign-out takes place in the residents’ lounge — a room furnished with computers, couches, and a makeshift ping-pong table — and tends… Read More…

Feed Me: Early Nutritional Support in Intensive Care

Posted by Rena Xu • October 29th, 2014

What is the best way to feed a critically ill patient?  Nutrition can be delivered either parenterally — directly into the veins – or enterally, e.g., via a tube that runs from the nose to the stomach.  Both have potential and well-reported adverse consequences, along with potential benefits.  It’s commonly believed that, if given the… Read More…

Less is not more for TB treatment

Posted by Rachel Wolfson • October 22nd, 2014

Shorter regimens fail to be non-inferior to the standard tuberculosis treatment plans One third of the world’s population is currently infected with tuberculosis (TB), and, in 2012, there were 1.3 million TB-related deaths (Centers for Disease Control and Prevention). Moreover, in 2012, 450,000 people worldwide developed multi-drug resistant TB (MDR TB), which is resistant to… Read More…

Malpractice Reform and Emergency Department Care

Posted by Chana Sacks • October 15th, 2014

A 67-year-old woman presents to your Emergency Department (ED) with a headache for the last 48 hours.  She describes herself as “a headachy” person since her late teens, but this one is particularly bad, throbbing, associated with nausea and photophobia.  She is afebrile without neck stiffness. Your thorough neurologic exam reveals no focal deficits. You… Read More…

No Effect of Transfusion Threshold on Sepsis Survival

Posted by Rupa Kanapathipillai • October 8th, 2014

Yet who would have thought the old man to have had so much blood in him? (Macbeth Act V, Scene 1) Our fascination with blood dates back to the dawn of time.   Poets, writers and philosophers have waxed lyrical about it.  Blood as a life source, elixir and contagion  – it is an entity that… Read More…

Eliminating Barriers to Teen Contraception

Posted by John Staples • October 1st, 2014

Unplanned pregnancy can be a lucrative topic for Hollywood, with movies like Precious, Boyhood, Juno and Knocked Up collectively making hundreds of millions of dollars. Yet what’s profitable for producers comes at great socioeconomic cost to teen mothers and their children. Watching a movie about this public health problem isn’t likely to help. Is there… Read More…