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.

Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery

Posted by Ravi Parikh, M.D., M.P.P. • May 18th, 2016

Whether you are a resident on the cardiology, surgery, or general medicine service, encountering patients with atrial fibrillation is common. Many patients, particularly after cardiac surgery, go in and out of atrial fibrillation so often that residents caring for them often ignore the blinking lights and loud alarms from telemetry machines after a while. However,… Read More…

COPD Is Not the Whole Story

Posted by Rachel Wolfson • May 11th, 2016

Many diagnostic guidelines use black or white parameters – either patients meet the criteria and have the disease, or they don’t. While guidelines like this can be useful for developing clear definitions, in practice many patients fall within a gray area. The current diagnosis of Chronic Obstructive Pulmonary Disease (COPD), for example, relies on spirometry… Read More…

Scaling the ALPS — Antiarrhythmic Drugs in Out-of-Hospital Cardiac Arrest

Posted by Bhavna Seth, M.D. • May 4th, 2016

Imagine you are out for an evening jog when a young man, who is running ahead of you, collapses. You rush over and a rapid assessment suggests that he is unresponsive, has no pulse, and is not breathing. You start chest compressions and a bystander calls 911. EMS arrives soon, however, after 5 cycles of… Read More…

Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients

Posted by Andrea Merrill • April 27th, 2016

I’ve sometimes wondered if I’m embarking on the field of surgery in the wrong era.  As a medical student, and now as a resident, the big open operations have always seemed to be the most exhilarating and rewarding.  It always seems more thrilling to have your hands deep in a patient’s abdomen or chest than… Read More…

Déjà Voodoo: Readmission or Observation after the Affordable Care Act

Posted by Rena Xu • April 20th, 2016

The hospital where I work has one of the busiest emergency departments in Boston. Patients come in with everything you might imagine, from heart attacks to rabbit bites. A number of these patients, after being evaluated and treated, can be discharged home from the emergency department; others need to be admitted for further management. For… Read More…

Fusion for Lumbar Spinal Stenosis?

Posted by Joshua Allen-Dicker • April 13th, 2016

Back pain does not respect traditional boundaries in healthcare.  Patients with back pain are present in our emergency rooms, our minute clinics, our surgical subspecialty offices, and our inpatient units.  As such, many of us—orthopedist or internist, rheumatologist or advanced practitioner—have had to think about advising the patient with lumbar spinal stenosis or lumbar spondylolisthesis,… Read More…

Betamethasone for Women at Risk for Preterm Delivery

Posted by MaryAnn Wilbur, M.D. M.P.H. • April 6th, 2016

A term delivery occurs on or after 37 weeks gestation.  Any delivery prior is considered “preterm” and those   between 34 weeks, 0 days and 36 weeks, 6 days are often referred to as “late preterm.”  The standard of care has been to recommend antenatal glucocorticoids (typically, betamethasone 12.5mg IM q24 hours x 2 doses) to… Read More…

Therapy for Symptoms Attributed to Lyme Disease

Posted by Bhavna Seth, M.D. • March 30th, 2016

PLEASE, may we understand persistent symptoms attributable to Lyme disease? There are few diseases that have created divisions between the medical establishment and some patients, or that have engaged political interest, as much as chronic Lyme disease has. In their recent NEJM article, Berende et al have provided evidence to guide the major controversy regarding the… Read More…

Early versus Late Parenteral Nutrition in Critically Ill Children

Posted by Ravi Parikh, M.D., M.P.P. • March 23rd, 2016

During our intensive care unit rotations as residents, patient nutrition is a daily talking point. While it is easy to get lost in the details of the critical illnesses that bring patients to the ICU, we are regularly asked by attendings, nurses, and others, “how are we going to feed this patient?” Indeed, nutrient deficiencies… Read More…

Motivating Change in Physicians’ Prescribing Behavior

Posted by James Yeh, M.D. M.P.H. • March 16th, 2016

High-risk prescribing Drug prescribing is one of the armamentarium in a physician’s tool box to help manage disease and alleviate suffering. However, the risks of certain drugs in particular clinical contexts outweigh the benefits and may lead to preventable drug-related morbidity and mortality. Such high-risk prescribing is a common concern. What is the safer prescribing trial about? In… Read More…