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. These posts can now be found on NEJM Resident 360.

There’s Still Time to Participate in Clinical Decisions: Management of Sciatica

Posted by • April 3rd, 2017

Time hasn’t run out to participate in our last Clinical Decisions article discussion, Management of Sciatica. You have through April 5th to vote and discuss on whether you would recommend Mr. Winston, a 50-year-old bus driver who has come to your office with a 4-week history of pain in his left leg and lower back, undergo lumbar disk surgery or receive… Read More…

Posted by • March 31st, 2017

Two new articles that explore data sharing were published by NEJM this week. The first, a Sounding Board article titled Data Authorship as an Incentive to Data Sharing, explains how designating a “data author” in clinical trials could help solve the major issue of providing academic credit to investigators who gather data in these trials. The… Read More…

New Clinical Decision Article: Management of Sciatica

Posted by • March 27th, 2017

In this week’s Clinical Decision, a 50-year-old bus driver comes to you with a 4-week history of pain in his left leg and lower back. He describes a combination of severe sharp and dull pain that originated in his left buttock and radiated to the dorsolateral aspect of his left thigh, as well as vague… Read More…

An 18-Year-Old Woman with Acute Liver Failure

Posted by • January 19th, 2017

In this article by Olson et al., we learn Wilson’s disease, also known as hepatolenticular degeneration, is an autosomal recessive disease characterized by impaired copper metabolism due to a defective ATPase. Patients with Wilson’s disease may present with chronic liver disease, acute liver failure, hemolysis, and psychiatric or neurologic manifestations. It has been previously noted… Read More…

In Coronary Artery Disease, Can Nurture Override Nature?

Posted by • December 14th, 2016

Mr. Locke, a 48-year-old man with prehypertension, comes to your office for a routine visit. He has a strong family history of coronary artery disease (CAD); his father and two brothers had myocardial infarctions in their 50s. His BMI is 31 kg/m2, he is a nonsmoker, but he does not exercise routinely. You suggest that… Read More…

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…