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.

The role of nurse practitioners in primary care

Posted by Jamie Colbert • May 16th, 2013

Sara is a 31-year-old healthy female professional living in Boston who gets her medical care at a large, multi-provider primary care clinic. When Sara goes to the clinic for a routine visit, she sees a nurse practitioner (NP) about 75% of the time.  Sara says that she chooses to see the NP rather than an… Read More…

Prophylactic Platelet Transfusions: Are They Really Necessary?

Posted by Rena Xu • May 8th, 2013

Many patients with hematologic malignancies develop dangerously low platelet counts due to their disease, their treatment, or both. To mitigate the risk of bleeding, such patients have historically received prophylactic platelet transfusions. Recently, however, the value of this practice has been called into question. Does it really help to give platelets on a preventative basis?… Read More…

Meniscal tear: Operate or PT?

Posted by Rachel Wolfson • May 1st, 2013

Mr. Richardson is a 55-year-old man who comes into your clinic complaining of knee pain. He used to enjoy going on long jogs, but as the years have gone by the pain in his joint has increased and he’s lost a lot of mobility. He’s frustrated by the weight that he’s put on due to… Read More…

Global Health Author Q&A: ANU’s Anthony McMichael on globalization and climate change

Posted by Jennifer Zeis • April 25th, 2013

In a new feature for Now@NEJM, we ask the authors of the new Global Health review article series — all with different backgrounds, experiences, and perspectives — the same set of questions.  Answers from Anthony J. McMichael, M.B., B.S., Ph.D., of the National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia. Dr. McMichael… Read More…

Diabetes Care Goals: Are We Making Progress?

Posted by Jamie Colbert • April 24th, 2013

As a medical resident in primary care over the past three years, I cared for a large number of diabetic patients, and each one seemed to present a unique challenge. For instance, Walter, who was legally blind, lived alone, and required daily treatment with insulin. After numerous discussions with our clinic pharmacist and social worker,… Read More…

Global Health Author Q&A: HSPH’s David Hunter and IOM’s Harvey Fineberg

Posted by Jennifer Zeis • April 18th, 2013

In this first installment of a new Now@NEJM feature, we ask authors of the new Global Health review article series to answer the same four questions regarding global health. Each expert brings their own unique perspective and experience to the questions. Global Health series co-editors David J. Hunter, M.B., B.S., Sc.D., M.P.H., and Harvey V…. Read More…

Reduced Cortisol Breakdown in Critical Illness

Posted by Daniela Lamas • April 17th, 2013

The 65-year old woman’s stomach started to hurt about a week ago. She thought nothing much of it at first, but the pain intensified and she started spiking fevers, feeling weak and dizzy. When she couldn’t get out of bed, her husband called for an ambulance. By the time she arrives at the hospital, her… Read More…

Measuring Pain using Functional MRI

Posted by Sushrut Jangi • April 10th, 2013

The moment we find a useful biomarker, our ability to manage a condition improves:  we treat diabetes by following the glycemic index, we treat HIV by following a viral load and a CD4 count. Conditions without biomarkers often frustrate treatment – after all, like the business adage – “you can’t manage what you don’t measure.”… Read More…

PREDIMED: Supplemented Mediterranean Diets and the Prevention of Cardiovascular Events

Posted by John Staples • April 3rd, 2013

Mr. Smith decided to get serious about his cardiovascular health when he turned sixty. He comes to your clinic one day to tell you that he’s stopped smoking and that he’s been more attentive to the treatment of his hypertension and dyslipidemia over the last few months. “I’m really turning things around, Doc,” he tells… Read More…

Circulating Tumor DNA

Posted by Jamie Colbert • March 27th, 2013

Fifty years ago, oncologists relied upon the clinical exam to follow breast cancer patients with metastatic disease. Patients were treated with chemotherapy, and then the physicians waited for symptoms to return before deciding on the next treatment course. Some patients could go months or even years without symptoms, but during this time they played a… Read More…