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.

Déjà Voodoo: Readmission or Observation after the Affordable Care Act

Posted by • April 20th, 2016

The hospital where I work has one of the busiest emergency departments in Boston. Patients come in with everything you might imagine, from heart attacks to rabbit bites. A number of these patients, after being evaluated and treated, can be discharged home from the emergency department; others need to be admitted for further management. For… Read More…

Fusion for Lumbar Spinal Stenosis?

Posted by • April 13th, 2016

Back pain does not respect traditional boundaries in healthcare.  Patients with back pain are present in our emergency rooms, our minute clinics, our surgical subspecialty offices, and our inpatient units.  As such, many of us—orthopedist or internist, rheumatologist or advanced practitioner—have had to think about advising the patient with lumbar spinal stenosis or lumbar spondylolisthesis,… Read More…

Betamethasone for Women at Risk for Preterm Delivery

Posted by • April 6th, 2016

A term delivery occurs on or after 37 weeks gestation.  Any delivery prior is considered “preterm” and those   between 34 weeks, 0 days and 36 weeks, 6 days are often referred to as “late preterm.”  The standard of care has been to recommend antenatal glucocorticoids (typically, betamethasone 12.5mg IM q24 hours x 2 doses) to… Read More…

Therapy for Symptoms Attributed to Lyme Disease

Posted by • March 30th, 2016

PLEASE, may we understand persistent symptoms attributable to Lyme disease? There are few diseases that have created divisions between the medical establishment and some patients, or that have engaged political interest, as much as chronic Lyme disease has. In their recent NEJM article, Berende et al have provided evidence to guide the major controversy regarding the… Read More…

Early versus Late Parenteral Nutrition in Critically Ill Children

Posted by • March 23rd, 2016

During our intensive care unit rotations as residents, patient nutrition is a daily talking point. While it is easy to get lost in the details of the critical illnesses that bring patients to the ICU, we are regularly asked by attendings, nurses, and others, “how are we going to feed this patient?” Indeed, nutrient deficiencies… Read More…

Motivating Change in Physicians’ Prescribing Behavior

Posted by • March 16th, 2016

High-risk prescribing Drug prescribing is one of the armamentarium in a physician’s tool box to help manage disease and alleviate suffering. However, the risks of certain drugs in particular clinical contexts outweigh the benefits and may lead to preventable drug-related morbidity and mortality. Such high-risk prescribing is a common concern. What is the safer prescribing trial about? In… Read More…

Carotid artery stenting versus carotid endarterectomy: Results of two randomized trials

Posted by • March 14th, 2016

As a 4th year medical student I rotated on the vascular surgery service at a local hospital. One of the vascular surgeons loved music (all music!) and would quiz me on the musicians as each song came on. I usually got them wrong and longed for him to just ask me an anatomy question instead… Read More…

Another LEAP Forward: Testing the Stability of Peanut Tolerance after Early Peanut Exposure

Posted by • March 7th, 2016

Over the past few decades, allergies have been on the rise worldwide, particularly in the United States. Immunotherapy (or allergy shots), in which incremental exposure to allergens sensitizes the immune system to the allergen, have been effective for some allergies, such as dust mites. For food allergies, the effectiveness of oral exposure in infancy to… Read More…

Randomized Trial of Skin Antiseptics at Cesarean Delivery

Posted by • February 17th, 2016

Cesarean section is the most common major abdominal surgery performed in the US and a substantial part of my work as an obstetrician.  So, I was excited about the article just published  in NEJM on skin antisepsis for these procedures.   This article reports a well-executed, randomized controlled trial with a very simple design that included… Read More…

Adjunctive Steroids and Harm in Cryptococcal Meningitis

Posted by • 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…