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.

Take the Critical Care Challenge

Posted by Jennifer Zeis • April 18th, 2014

In this month’s Critical Care Challenge, our  77-year-old patient is on mechanical ventilation in the ICU after an emergency colon resection, complicated by septic shock and acute liver failure. Since it appears his stay in the ICU will be prolonged, what measures would you take to optimize his long-term recovery? Participate in the poll and… Read More…

Ledipasvir–Sofosbuvir for Previously Treated HCV

Posted by Carla Rothaus • April 16th, 2014

The old adage, “The more things change, the more they stay the same,” simply does not apply when it comes to the treatment of hepatitis C virus (HCV). The mainstay of HCV treatment for many years has included interferon (peginterferon, since 2001) and ribavirin. While relatively effective for patients with HCV genotypes 2 and 3,… Read More…

Fibrinolysis for Acute Intermediate-Risk Pulmonary Embolism

Posted by Gelareh Homayounfar • April 10th, 2014

For anyone with an acute pulmonary embolism (PE), your prompt diagnosis and treatment can save a life. In patients with high-risk PE and signs of hemodynamic compromise, fibrinolysis is an established, clear choice that can reduce pulmonary artery resistance, prevent PE recurrence, and reduce mortality. Although fibrinolytic therapy is known to carry risks of major… Read More…

Sepsis, Albumin, and the Therapeutic Potential of Improving Oncotic Pressure

Posted by John Staples • April 9th, 2014

In physiology, as in all other sciences, no discovery is useless … we may be certain that every advance achieved in the quest of pure knowledge will sooner or later play its part in the service of man. —    Dr Ernest Henry Starling, The Linacre Lecture on the Law of the Heart (1915) Modern sepsis… Read More…

Adenoma Detection Rate and Colorectal Cancer

Posted by Daniela Lamas • April 2nd, 2014

Your patient recently celebrated her 50th birthday. After a few weeks of partying, she’s ready to turn to the less glamorous work that comes with having lived half a century.  First up is the colonoscopy. She’s impressively well informed and so it’s not a surprise when she comes to your primary care office with a… Read More…

Prevalence of Health Care–Associated Infections

Posted by Joann Schulte • March 26th, 2014

Over 30 years ago, Dr. Robert Haley, now a professor of medicine at UT Southwestern in Dallas, led the CDC in pioneering work to apply epidemiology methods to hospital infection control.  The Study on the Efficacy of Nosocomial Infection Control Project (SENIC), published in 1985, found that hospitals with active infection control programs had 32%… Read More…

Remove the Skull: Hemicraniectomy after Massive Strokes

Posted by Rena Xu • March 19th, 2014

Your seventy-year-old patient has just suffered a large stroke. The circumstances are not good: an extensive middle-cerebral-artery (MCA) infarction and massive brain edema, which mean an eighty-percent chance of mortality in the first week. For younger patients, a hemicraniectomy — the removal of half the skull — has been shown to help relieve pressure and… Read More…

Idelalisib in Relapsed CLL and Indolent Lymphoma

Posted by Daniela Lamas • March 12th, 2014

It’s been five years since weakness and fatigue brought your patient, then seventy years old, to see his doctor. A routine blood test revealed an abnormally elevated white blood cell count. Doctors quickly diagnosed him with chronic lymphocytic leukemia. Soon afterward, he was started on his first of three treatment regimens that took him from… Read More…

Surgery Versus Watchful Waiting for Localized Prostate Cancer: the 18-Year Debate

Posted by Joshua Allen-Dicker • March 5th, 2014

In 2013, over 238,000 men were diagnosed with prostate cancer in the United States.  Each of these patients and their physicians has undoubtedly been faced with a vexing series of decisions: What should I do next?  Will the treatment help, or will the cure be worse than the disease?  The publication of the 18-year follow-up… Read More…

DNA Sequencing versus Standard Prenatal Aneuploidy Screening

Posted by Carla Rothaus • February 26th, 2014

As every expectant woman will tell you, the foremost question on her mind is, “Will my child be healthy?” Recent advances in prenatal screening techniques may change the way that concern is addressed, particularly with regard to screening for aneuploidy. Prenatal screening for fetal abnormalities began decades ago, limited initially to rudimentary ultrasound evaluation for… Read More…