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.

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…

Effects of Red-Cell Storage Duration on Patients Undergoing Cardiac Surgery

Posted by Chana Sacks • April 8th, 2015

“Age,” the great boxer Muhammad Ali famously said, “is whatever you think it is. You are as old as you think you are.” The role that aging plays in vitality, strength, and wisdom has long been debated, but more recently the question of whether younger is better has been raised about red blood cells.  Currently, blood… Read More…

Initial Antibiotic Choice for Community Acquired Pneumonia

Posted by John Staples • April 2nd, 2015

The basic symptoms which occur in pneumonia … are as follows: acute fever, sticking pain in the side, short rapid breaths, serrated pulse and cough.   – Maimonides (1138–1204 AD) Antibiotic treatment of community-acquired pneumonia (CAP) is one of the most remarkable medical developments of the 20th century, yet the choice of initial antibiotics is not… Read More…

Detecting Trisomy

Posted by Rena Xu • April 1st, 2015

A simple prenatal blood test made national headlines last year after a study published in NEJM reported its superiority to standard prenatal screening. The test, called cell-free fetal DNA (cfDNA), identified common trisomies (21, 18, and 13) by detecting fragments of fetal DNA in maternal blood. Screening could be done early in a pregnancy and… Read More…

The Final Nail in Early Goal Directed Therapy’s Coffin?

Posted by Joshua Allen-Dicker • March 24th, 2015

You are called to evaluate Ms. Smith urgently.  She reports several days of progressive malaise, weakness and a new cough. On your exam she is tachycardic, tachypneic and febrile.  You diagnose Ms. Smith with sepsis and explain the importance of quickly treating this life-threatening condition.  In the United States, situations like this—presentations leading to the… Read More…

CABG or PCI in Patients with Coronary Disease?

Posted by Chana Sacks • March 16th, 2015

The great singer Whitney Houston posed a question over 25 years ago that many still ponder today.  “Where,” she asked, “do broken hearts go?” Of course, her classic song asks us to imagine a destination for the pain wrought by the dissolution of love.  Physicians, however, have more concrete possibilities in mind when asking where to… Read More…