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.

Feed Me: Early Nutritional Support in Intensive Care

Posted by Rena Xu • October 29th, 2014

What is the best way to feed a critically ill patient?  Nutrition can be delivered either parenterally — directly into the veins – or enterally, e.g., via a tube that runs from the nose to the stomach.  Both have potential and well-reported adverse consequences, along with potential benefits.  It’s commonly believed that, if given the… Read More…

Less is not more for TB treatment

Posted by Rachel Wolfson • October 22nd, 2014

Shorter regimens fail to be non-inferior to the standard tuberculosis treatment plans One third of the world’s population is currently infected with tuberculosis (TB), and, in 2012, there were 1.3 million TB-related deaths (Centers for Disease Control and Prevention). Moreover, in 2012, 450,000 people worldwide developed multi-drug resistant TB (MDR TB), which is resistant to… Read More…

Malpractice Reform and Emergency Department Care

Posted by Chana Sacks • October 15th, 2014

A 67-year-old woman presents to your Emergency Department (ED) with a headache for the last 48 hours.  She describes herself as “a headachy” person since her late teens, but this one is particularly bad, throbbing, associated with nausea and photophobia.  She is afebrile without neck stiffness. Your thorough neurologic exam reveals no focal deficits. You… Read More…

No Effect of Transfusion Threshold on Sepsis Survival

Posted by Rupa Kanapathipillai • October 8th, 2014

Yet who would have thought the old man to have had so much blood in him? (Macbeth Act V, Scene 1) Our fascination with blood dates back to the dawn of time.   Poets, writers and philosophers have waxed lyrical about it.  Blood as a life source, elixir and contagion  – it is an entity that… Read More…

Eliminating Barriers to Teen Contraception

Posted by John Staples • October 1st, 2014

Unplanned pregnancy can be a lucrative topic for Hollywood, with movies like Precious, Boyhood, Juno and Knocked Up collectively making hundreds of millions of dollars. Yet what’s profitable for producers comes at great socioeconomic cost to teen mothers and their children. Watching a movie about this public health problem isn’t likely to help. Is there… Read More…

Take the Fluids and Electrolytes Challenge

Posted by Karen Buckley • September 30th, 2014

A 22-year-old woman has received 6 liters of isotonic saline and is awaiting transfer to the operating room for stabilization of injuries suffered in a car accident. The lab values include blood pH 7.28, PaCO2 39 mm Hg, sodium 135 mmol per liter, potassium 3.8 mmol per liter, chloride 115 mmol per liter, and bicarbonate 18 mmol… Read More…

Anti–Interleukin-5 Monoclonal Antibody to Treat Severe Eosinophilic Asthma

Posted by Daniela Lamas • September 24th, 2014

Most asthma patients who come to your pulmonary office get better. With a regimen of inhaled therapies and possibly a short course of oral corticosteroids, the wheeze and cough and shortness of breath remit. But the patient you are seeing in clinic today is still struggling. She’s tried every inhaler at its maximum dose and… Read More…

Portrait of a Stone: CT versus Ultrasonography for Acute Nephrolithiasis

Posted by Rena Xu • September 17th, 2014

This summer, I started my residency in urology. My job for the first month was to see patients in the emergency department with urologic problems. Nephrolithiasis was one of the most frequently encountered diagnoses, and I soon learned the “drill” for working up kidney stones– check a white blood cell count, send off a urinalysis… Read More…

Influenza Vaccination in Pregnancy

Posted by Rupa Kanapathipillai • September 3rd, 2014

As the days get shorter and cooler, you have an increasing sense of dread that Winter Is Coming – and with it comes flu season.   Once you stop daydreaming of the halcyon days of summer, you notice that in your waiting room are two pregnant patients, one HIV positive, one HIV negative. You take a… Read More…

PARADIGM-HF Prompts a New Line of Thinking about Heart Failure

Posted by Chana Sacks • August 30th, 2014

Your patient – a 65-year-old man with an ischemic cardiomyopathy – presents to clinic one week after discharge from another hospitalization for a heart-failure exacerbation. He is doing much better. He remains at his discharge weight and reports good adherence to a low-salt diet and to the extensive medication regimen that you have prescribed: he… Read More…