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.

Does sleep deprivation have any effect on elective daytime operations performed by attending surgeons?

Posted by Andrea Merrill • August 26th, 2015

“How do you stay awake?” I am often asked from friends outside the medical field upon explaining my schedule and frequent 24 hour call shifts. When asked this question, my replies run the gamut from, “You get used to it” to, “Coffee!” or, “I’m a surgeon, we don’t need sleep!” and finally, “You’re so busy… Read More…

Blood Clots and Buried Cancers

Posted by Rena Xu • August 19th, 2015

An unprovoked blood clot presents a dilemma. Deep vein thrombosis or pulmonary embolism may be the presenting sign of occult cancer, which makes it tempting to search high and low for a source. Early detection could enable prompt treatment and perhaps a better prognosis, in addition to changing the type of anticoagulation a patient receives…. Read More…

Troponin and Cardiac Events in Stable Ischemic Heart Disease and Diabetes

Posted by James Yeh, M.D. M.P.H. • August 12th, 2015

Ischemic heart disease is one of the leading causes of death world-wide. The ability to risk stratify those at increased risk for cardiovascular events would be beneficial. A number of previous studies have shown that routine troponin elevation may serve as a marker of poor prognosis independent of the traditional cardiovascular risk factors (e.g., hypertension,… Read More…

Idarucizumab for Dabigatran Reversal — The RE-VERSE AD Trial

Posted by Joshua Allen-Dicker • August 5th, 2015

Despite the increasing frequency of direct oral anticoagulant use, some clinicians may remain uncertain about their safety. Direct oral anticoagulants are easier to use, and for certain patients they may have a decreased risk of bleeding. But there is one major concern: how to rapidly reverse the effects of direct oral anticoagulants when there is… Read More…

Outcomes of Therapeutic Hypothermia in Deceased Organ Donors on Delayed Graft Function

Posted by Andrea Merrill • July 29th, 2015

While many think of surgery as messy, gory, or even medieval at times, there are certain operations that are simply beautiful to observe and perform, requiring both elegance and finesse. For me, kidney transplants fall into this category, demanding gentle handling of the arterial, venous and ureteral anastomoses by the surgeon with the help of… Read More…

Loss of FEV1 and the pathogenesis of COPD

Posted by Rachel Wolfson • July 8th, 2015

For years, the dominant model for the pathogenesis of chronic obstructive pulmonary disease (COPD) has been that exposure to particulate matter (usually tobacco smoke) leads to a rapid decline in lung function, i.e., more than 40ml of FEV1 per year. This paradigm has recently come into question, but a careful study to test this model… Read More…

Advanced Dementia

Posted by Carla Rothaus • June 26th, 2015

Advanced dementia is a leading cause of death in the United States. A new Clinical Practice article covers treatment decisions guided by the goals of care — comfort is usually the primary goal, and tube feeding is not recommended. In 2014, Alzheimer’s disease affected approximately 5 million persons in the United States, a number that is… Read More…

Permissive Underfeeding in the ICU

Posted by Rena Xu • June 17th, 2015

Nutrition among critically ill patients is widely considered important, but the ideal caloric targets remain a subject of debate.  Some believe higher caloric intake is helpful and can reduce mortality; others argue the exact opposite, pointing to studies linking caloric restriction to lower morbidity, as long as protein intake is adequate. This debate has prompted… Read More…

Early CPR in Out-of-Hospital Cardiac Arrests — Outcomes and Evaluation of a Mobile-Dispatch System

Posted by Andrea Merrill • June 10th, 2015

The first time I ever performed CPR was on my 19th birthday.  My official title was “summer employee,” a minimum wage job that encompassed a variety of menial but necessary tasks in the emergency department of a busy rural hospital.  One of the accompanying benefits of my job was the chance to learn CPR, and… Read More…

Ezetimibe and Cardiovascular Outcomes

Posted by Chana Sacks • June 3rd, 2015

As you walk into Mr. R’s room to see if he has last-minute questions about his discharge medications, you can’t believe how different – how much better – he looks dressed in his usual clothes, instead of an errantly-snapped hospital gown.   You met him 4 days ago, when he was wheeled, pale and groggy, onto… Read More…