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.

Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage

Posted by • July 27th, 2016

What is the ideal blood pressure goal for spontaneous cerebral hemorrhage? Results of the ATACH-2 trial are discussed. As a surgery resident, one of the first concepts I learned was that high blood pressure was bad in a patient who was actively bleeding.  This meant that for a trauma patient with a large liver or splenic… Read More…

Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting

Posted by • July 13th, 2016

Patients are fearful of nausea and vomiting during the course of cancer treatment, as it is an expected side effect of chemotherapy. Senior oncology physicians describe the early days of cancer treatment when large bowls lined the ward, positioned close to each patient. In the present age, we are still concerned about chemotherapy-induced nausea and… Read More…

Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit

Posted by • July 6th, 2016

Ms. G is a 42-year-old woman admitted to your ICU with septic shock in the setting of a urinary tract infection.  She was started on a norepinephrine infusion in the emergency room. Her labs reveal a creatinine of 3.0 mg/dL, increased from a prior baseline of 0.6 mg/dL; pH is 7.3 and potassium is 4.9… Read More…

Extending Aromatase-Inhibitor Treatment in Breast Cancer

Posted by • June 29th, 2016

I am approaching the end of my general surgery residency and trying to decide on a sub-specialty going forward.  Over the past 2 years I have found myself drawn to the field of breast surgery, in large part due to the large breadth of research being done in the field.  Research in breast cancer has… Read More…

Sudden Cardiac Death in the Young

Posted by • June 22nd, 2016

Fatal heart conditions are shocking and tragic when they are sudden and unexpected, and especially when they occur in the young. Occasionally the public is reminded of this via a news story of a high school or professional athlete who collapses suddenly and dies during a sporting event. Often, the first manifestation of a serious… Read More…

Is It Time to Be Dis-ENCHANTED with Low Dose Alteplase in Acute Ischemic Stroke?

Posted by • June 15th, 2016

Ms. M, is hustled in to your emergency room, a septuagenarian with a history of hypertension. She was last noted to be well and playing with her grandchildren 1 hour ago, when her family noticed she began to slur her words, her face drooped to the left and she felt a heaviness & inability to… Read More…

A New Combination Therapy to Help Prevent COPD Exacerbations?

Posted by • June 8th, 2016

You walk into your office to see, once again, Mr. Jones, at 64-year-old male who suffers from chronic obstructive pulmonary disorder (COPD). Mr. Jones is recovering from a recent visit to the ED due to his third COPD exacerbation event this year. He’s frustrated with his recurrent COPD exacerbations, and wants to know if his… Read More…

Catheter-Associated Urinary Tract Infections

Posted by • June 2nd, 2016

In your role as Unit Medical Director, you regularly meet with nursing leadership for 6-West.  Today, they bring to your attention several cases from the last month: a 67-year old female admitted for severe pneumonia who initially rapidly improved on antibiotics, but then developed a new fever and was found to have a urinary tract… Read More…

Primary Prevention of Cardiovascular Events — A Pragmatic Approach

Posted by • May 25th, 2016

Ms. Barnstable is a 66 year-old woman who is seeing you for an annual physical check-up today.  She does not take any medications and is a smoker.  She asks if there are drugs that she should be taking to lower her risks for heart attacks and strokes. Besides smoking cessation counseling, what do you tell… Read More…

Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery

Posted by • May 18th, 2016

Whether you are a resident on the cardiology, surgery, or general medicine service, encountering patients with atrial fibrillation is common. Many patients, particularly after cardiac surgery, go in and out of atrial fibrillation so often that residents caring for them often ignore the blinking lights and loud alarms from telemetry machines after a while. However,… Read More…