Posts in the ‘From Pages to Practice’ Category

From Pages to Practice posts are brief stories about NEJM content, written by young clinicians 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 may be included at the end to stimulate thinking and discussion.

Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery

Posted by • December 7th, 2016

On the first day of my second year of residency, I showed up to the cardiac surgery intensive care unit (CSICU) terrified for what awaited me.  It wasn’t uncommon for patients recovering from cardiac surgery to be on three different vasopressors while intubated with four chest tubes and pacing wires. Even after a year of… Read More…

Reduction in HIV Transmission with Dapivirine Vaginal Ring – Is it Enough?

Posted by • November 30th, 2016

While you are working for one month in a health center in South Africa, a 19-year-old woman comes to the clinic and asks for your advice: She is HIV-negative, and is unsure of her partner’s HIV status. Is there anything she can do to prevent her from acquiring HIV? Preexposure prophylaxis (PrEP) with oral tenofovir-emtricitabine is… Read More…

Thresholds for Abdominal Aortic Aneurysm Repair in England and the United States

Posted by • November 23rd, 2016

Imagine you are assessing a relatively healthy 85-year-old man who was brought to the hospital after a fall at home. Due to concern for spinal fractures, he underwent CT scans of his head, C-spine, chest, abdomen, and pelvis. Although no traumatic injuries were found, an incidental finding of a 5.5 cm infrarenal abdominal aortic aneurysm… Read More…

Effect of Short-Term vs. Long-Term Blood Storage on Mortality after Transfusion

Posted by • November 16th, 2016

The FDA currently allows donated units of blood to be stored for 42 days. However, questions remain about whether older blood (within the 42-day limit) is harmful. Laboratory studies have shown that older blood has decreased levels of 2,3-diphosphoglycerate, decreased nitric oxide metabolism, impaired membrane deformability, and increased adherence to the endothelium, all of which… Read More…

Nivolumab for Recurrent Squamous-Cell Carcinoma of the Head and Neck

Posted by • November 9th, 2016

A 62-year-old man with a history of smoking and excess alcohol use presented with a two-month history of hoarseness and dysphagia and was diagnosed with laryngeal squamous cell carcinoma. Five months after completing concurrent cisplatin and radiation therapy, he returns to his oncologist with lung metastases. He asks about additional therapeutic options for his cancer… Read More…

Fulminant Myocarditis with Combination Immune Checkpoint Blockade

Posted by • November 2nd, 2016

Oncologists and patients with cancer eagerly await new therapies that efficiently target cancer and avoid damage to normal tissues. In 2015, a randomised controlled trial investigated the role of two immune checkpoint inhibitors: ipilimumab — an anti-cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) antibody — and nivolumab — an anti-programmed death-1 (PD-1) antibody. Patients with untreated metastatic… Read More…

Public-Access Defibrillation and Out-of-Hospital Cardiac Arrest in Japan

Posted by • October 26th, 2016

You are walking in a mall when you notice a crowd of people around a man lying unconscious on the ground. You run to him. No pulse. You start CPR (counting aloud, “1, 2, 3…”). You look around for an automated external defibrillator (AED) and see a bystander bringing it over. You pull off the… Read More…

Romosozumab Treatment in Postmenopausal Women with Osteoporosis

Posted by • October 19th, 2016

You are seeing one of your patients, a vivacious and active 60-year-old woman who works full time. She underwent bone densitometry testing, and the results show a T score of -2.7 at the femoral neck. Further, a short sentence on the report confirms a diagnosis of osteoporosis. Knowing that osteoporosis can lead to both vertebral… Read More…

Breast Cancer Tumor Size, Mammography, and Screening Effectiveness

Posted by • October 12th, 2016

A good screening test is capable of identifying a precursor or early-stage disease in an asymptomatic patient and targets a disease for which early treatment is available to improve the patient’s ultimate outcome. Controversies about mammography screening guidelines for early detection of breast cancer include the appropriate age to start and stop screening, the frequency… Read More…

Learning More About Living Longer After Myocardial Infarction

Posted by • October 5th, 2016

To practice medicine is often to be inundated in metrics. Institutions may spend immense resources collecting data on readmission rates, time to treatment, and adherence to therapy. We know that appropriate measurement is key to health care improvement, improved rankings, and reimbursement. However, for many of these metrics, the connection between short-term performance and long-term… Read More…