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.

Niacin with Laropiprant in High-Risk Patients

Posted by Daniela Lamas • July 16th, 2014

Your patient, a 70-year-old man with a history of a heart attack three years ago, sits across from you at his regular outpatient follow-up appointment. He’s doing well. He’s exercising and taking the medications you prescribed, including his statin, but he’s wondering if there’s anything more he should be doing to lower his “bad,” or… Read More…

Dupilumab as a Treatment for Atopic Dermatitis

Posted by Rachel Wolfson • July 9th, 2014

For thousands of years, our knowledge of medications has largely been based on trial and error: we haphazardly used substances and learned from the effects. Within the last half a century, however, rational drug design slowly took to the forefront as scientific discoveries improved our understanding of the underlying pathogenesis of diseases. While there have… Read More…

Glucocorticoid Injections for Spinal Stenosis

Posted by Daniela Lamas • July 2nd, 2014

Spinal stenosis is a pain – both for those who suffer it, and the doctors who treat it. As surgery is a potentially risky option with uncertain benefit, many doctors turn to glucocorticoid injections for their patients, to decrease pain and increase mobility.  An estimated ten to eleven million such injections are performed in the… Read More…

Dying with Dignity in the Intensive Care Unit

Posted by Sara Fazio • June 27th, 2014

It is common for patients to have an expected death in an ICU. The final review in the Critical Care series covers issues related to the end of life in the absence of discordance between the patient’s family and caregivers. The traditional goals of intensive care are to reduce the morbidity and mortality associated with… Read More…

Atrial Fibrillation in Cryptogenic Stroke

Posted by Carla Rothaus • June 25th, 2014

Your 69-year-old patient has just had an ischemic stroke. Fortunately, he should make a good recovery. And yet, you feel unsettled. A standard post-stroke work up – 12-lead ECG, ambulatory 24-hour Holter ECG monitoring, brain and neurovascular imaging, and echocardiography – failed to reveal a cause for his stroke, putting it in the “cryptogenic” stroke… Read More…

Naloxegol for Opioid-Induced Constipation

Posted by John Staples • June 18th, 2014

Did opioid-induced constipation contribute to Elvis Presley’s death? Would he still be making music today if he’d won the battle with his bowels? Though many disagree, Elvis’ former personal physician thinks that a cure for the King’s constipation might have spared his life. If this kind of conjecture from suspicious minds leaves you all shook… Read More…

Pharmacology and the Treatment of Complicated Skin and Skin-Structure Infections

Posted by Daniela Lamas • June 11th, 2014

Treating skin and soft tissue infections isn’t the most glamorous job in medicine. But as these infections – ranging from cellulitis to abscess and often accompanied by fever and other signs of systemic illness – lead to nearly 900,000 hospital admissions annually, it’s an essential one. And with the emergence of strains of methicillin-resistant Staphylococcus… Read More…

Antibiotic Prophylaxis for Vesicoureteral Reflux

Posted by Joann Schulte • June 6th, 2014

Are Charlie’s kidneys backed up?  Does he need antibiotics?  His parents want to know if 2-year-old Charlie is going to be on long-term antibiotics to prevent any new bladder infections.  He’s just finished treatment for a urinary tract infection (UTI).    You explain that a voiding cystourethrogram will need to be done first to categorize the… Read More…

A New Hope for Idiopathic Pulmonary Fibrosis

Posted by Daniela Lamas • May 28th, 2014

It seemed benign at first. But the dry cough didn’t go away, despite a course of antibiotics and a prescription for an inhaler. Then your 55-year-old patient started to get winded while walking up the stairs at his home, and a work-up – chest x-ray, CT scan and pulmonary function testing – led to a… Read More…

After the STAMPEDE: Surgical versus Medical Treatment for Obese Patients with Diabetes

Posted by Rena Xu • May 21st, 2014

Today the perils of obesity hardly remain a mystery.  Many patients who are obese also have Type 2 diabetes, a condition that can be difficult and expensive to manage, and the search for effective treatment options has become a public health priority. In 2012, an article in NEJM reported the results of the Surgical Treatment… Read More…