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.

Adjunctive Steroids and Harm in Cryptococcal Meningitis

Posted by Joshua Allen-Dicker • February 10th, 2016

In the recent best-selling book and award-nominated movie, The Martian, astronaut and botanist Mark Watney is stranded alone on Mars.  The story follows his attempts to defy certain death and, through creativity and scientific experimentation, use his limited resources to generate oxygen, grow food, and make it home to Earth.  Recently the medical community has… Read More…

Residency Duty Hours: FIRST, do no harm

Posted by Andrea Merrill • February 2nd, 2016

When I started general surgery residency in 2011, my training program was on probation for violating the 80 hour work week as mandated by the Accreditation Council for the Graduate Medical Education (ACGME).  In addition, new regulations were being introduced that year that limited the maximum number of hours an intern and resident could work… Read More…

Belatacept and Long-Term Outcome in Kidney Transplantation

Posted by Andrea Merrill • January 27th, 2016

Medicine is a constant balance of risks and benefits.  The importance of maintaining this balance is especially evident in kidney transplantation.   While methods of immunosuppression in kidney transplantation have improved substantially since the use of total body irradiation to induce tolerance in the 1950s, current immunosuppressive agents such as calcineurin inhibitors still come with  clinically… Read More…

CDX2 as a Prognostic Biomarker in Colon Cancer

Posted by Chana Sacks • January 20th, 2016

A few weeks apart, Mr. Green and Mrs. Brown presented to their primary care doctors with intermittent rectal bleeding.  Both were referred for colonoscopies, and each was found to have a colonic mass.  With great trepidation, they awaited the results of the pathology and the CT scans that followed.  Ultimately, both were diagnosed with stage-II… Read More…

Bariatric Surgery Outcome in Adolescents

Posted by James Yeh, M.D. M.P.H. • January 13th, 2016

You are seeing Anna Boylston in your adolescent primary care clinic today.  You have been her PCP since she was 10 years-old.  She is now 14 and has a history of severe obesity (current BMI 37 kg/m2). She and her family ask you about bariatric surgery options for teenagers and the long term benefits and… Read More…

Treating Ebola with Convalescent Plasma

Posted by Bhavna Seth, M.D. • January 6th, 2016

On the eve of Christmas in 1891, Emil von Behring, the “Father of Serum Therapy,” injected Diphtheria therapeutic serum into an eight-year-old child suffering from severe diphtheria, and created history when the child was completely cured. He went on to win the Nobel Prize in 1901 for opening “a new road in the domain of medical science”… Read More…

Planned Homebirth: Should you try this at home?

Posted by MaryAnn Wilbur, M.D. M.P.H. • December 30th, 2015

Until the mid-1920s, most births in the US occurred at home.  By the mid-1950s, it was standard to deliver at the hospital. The rate of homebirths in the US remained exceedingly small until recently, when home births began to increase again. Those in favor of homebirth argue that it is a more natural experience, involves… Read More…

Risks for Second Cancer After Hodgkin’s Lymphoma Therapy

Posted by James Yeh, M.D. M.P.H. • December 23rd, 2015

You are meeting Mrs. Mason in your primary care clinic for the first time today. She has a history of Hodgkin’s lymphoma and was treated with chemotherapy and radiation therapy over 25 years ago. You wonder what is her risk for additional cancers as a result of treatment for Hodgkin’s lymphoma? While the use of radiation… Read More…

Andexanet Alpha for the Reversal of Factor Xa Inhibitor Activity

Posted by Andrea Merrill • December 14th, 2015

As a general surgery resident more than half-way through my training career, I have taken care of my fair share of trauma patients. However, the trauma patients I’m referring to aren’t the stereotypical victims of gun-shot and stab wounds seen on TV. One of my most common trauma patients is the frail 80-something year old… Read More…

Mass Drug Administration for Scabies Control

Posted by Rupa Kanapathipillai • December 9th, 2015

When Frank Sinatra crooned ‘I’ve got you under my skin’, it’s unlikely he would have anticipated the song conjuring images of scabies infection. Yet for millions of people in developing countries, the skin condition caused by Sarcoptes scabiei var hominis is a substantial cause of morbidity due not only to potentially debilitating itchiness, but also… Read More…