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.

Lactic Acidosis

Posted by Carla Rothaus • December 11th, 2014

When lactic acidosis accompanies low-flow states or sepsis, mortality rates increase sharply. A new review summarizes our current understanding of the pathophysiological aspects of lactic acidosis, as well as the approaches to its diagnosis and management. Lactic acidosis results from the accumulation of lactate and protons in the body fluids and is often associated with… Read More…

Join the conversation on the NEJM Group Open Forum

Posted by Karen Buckley • December 9th, 2014

Two active conversations await your participation on the NEJM Group Open Forum, powered by Medstro, a social professional network for physicians. Dr. Julian Seifter, author of the recent Review Article, “Integration of Acid-Base and Electrolyte Disorders,” is on hand to answer your questions on this topic. Meet “Fascinating Physician” Andrey Ostrovsky, a Pediatrics Senior Resident at Boston Children’s Hospital… Read More…

D Is for Delay

Posted by Carla Rothaus • December 5th, 2014

In the latest Clinical Problem-Solving article, a 47-year-old homeless man presented to the emergency department with intermittent pain and a pins-and-needles sensation in his legs. One month earlier, paresthesias had developed in his toes, which spread gradually to his shins. Pellagra (or “rough skin,” from the Italian pelle agra) is rare in the United States,… Read More…

Conduct Disorder

Posted by Carla Rothaus • December 5th, 2014

Children with repetitive rule-breaking, aggression, and disregard for others are at increased risk for substance abuse, educational disruption, and criminal behavior. Progress is being made toward understanding the clinical and neurocognitive features of youth conduct disorders.  Read the new review article on this topic. The term “conduct problems” refers to a pattern of repetitive rule-breaking… Read More…

Atenolol versus Losartan in Children and Young Adults with Marfan’s Syndrome

Posted by Daniela Lamas • November 25th, 2014

When French pediatrician Antoine-Bernard Marfan first described the syndrome that would bear his name in 1896, doctors knew little about the management and prognosis of the connective tissue disorder. In the century since that first description, what was once a fatal syndrome due to the risk of aortic dissection is now a condition that can… Read More…

Mortality in Type 1 Diabetes

Posted by Joshua Allen-Dicker • November 19th, 2014

There are moments during every physician’s day when she or he gives medical advice based on well-established evidence– “The data show that starting medication A for this disease will reduce the risk of death by 20%.”   There are also moments when she or he may give advice just because it seems like the right thing… Read More…

Dual Antiplatelet Therapy after Drug-eluting Stents

Posted by Chana Sacks • November 16th, 2014

“Well, doc, it’s been a year!  Now what?” You first met your patient 12 months ago when he presented to the emergency department having a heart attack.  He was rushed to the cardiac catheterization lab, where a drug-eluting stent was placed to open the blocked coronary artery responsible for his crushing chest pain. He has… Read More…

Vaccination and Pneumococcal Disease in South Africa

Posted by Brian Honeyman • November 12th, 2014

Since the beginning of medical school I, like most of us, have been bombarded by medical questions from friends, family, and even brand-new acquaintances.  If I had a dollar for every rash that I’ve been asked to “take a quick look at” my loans would be a bit less daunting.  One question often posed by… Read More…

The Good Word: Improving Patient Handoffs

Posted by Rena Xu • November 5th, 2014

Starting at six in the evening, the surgery residents at my hospital gather for sign-out.  This is when residents from the day shift hand over care of their patients to those working overnight.  Sign-out takes place in the residents’ lounge — a room furnished with computers, couches, and a makeshift ping-pong table — and tends… Read More…

Feed Me: Early Nutritional Support in Intensive Care

Posted by Rena Xu • October 29th, 2014

What is the best way to feed a critically ill patient?  Nutrition can be delivered either parenterally — directly into the veins – or enterally, e.g., via a tube that runs from the nose to the stomach.  Both have potential and well-reported adverse consequences, along with potential benefits.  It’s commonly believed that, if given the… Read More…