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.

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…

High-Flow Oxygen Therapy: a Lifesaver for Patients with Acute Hypoxemic Respiratory Failure

Posted by Rachel Wolfson • June 2nd, 2015

For hospitalists and residents across the country, this is an all too familiar scenario: a 60-year-old man is admitted to the hospital with pneumonia. Unfortunately, his course is complicated by acute hypoxemic respiratory failure secondary to the pneumonia, and he is transferred to the ICU. Physicians would like to avoid intubation if possible due to… Read More…

The Increasing Rate of Neonatal Withdrawal

Posted by Rena Xu • May 27th, 2015

When expecting mothers use opioids, their babies are exposed to the drugs in utero and, after birth, are at risk of withdrawal. The neonatal abstinence syndrome frequently necessitates admission to a Neonatal Intensive Care Unit (NICU) for treatment and monitoring. As the rate of opioid use among pregnant women has risen, the incidence of neonatal… Read More…

Antimicrobial Therapy for Intraabdominal Infection

Posted by Chana Sacks • May 20th, 2015

When the paramedics wheeled Mr. L into the Emergency Department, you knew exactly what to do.  Low blood pressure: establish good IV access and start fluids. Fever of 102 and left lower quadrant abdominal pain: obtain blood cultures, order antibiotics, and get him to the CT scanner once his vitals stabilize. In medical school, you think… Read More…

Incentive Programs to Urge Smokers to Quit: Lessons from Behavioral Science

Posted by Rachel Wolfson • May 13th, 2015

Many of the major public health issues currently threatening our population, including smoking and obesity, require lifestyle and behavioral changes. Effecting these changes in patients has been challenging, but a deeper understanding of the forces that drive human behavior could inspire the design of better programs leading to behavioral change. For example, behavioral scientists have… Read More…

Prednisolone or Pentoxifylline for Alcoholic Hepatitis

Posted by Chana Sacks • April 22nd, 2015

Intern year, they say, is about learning to distinguish “sick” from “not sick.” As the intern on-call overnight, you call the Emergency Department physician for pass off on Mr. Jones; when you hear “46-year-old man with heavy alcohol use disorder presenting with new jaundice and mild confusion,” it takes you only a split second to recognize… Read More…