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.

After the STAMPEDE: Surgical versus Medical Treatment for Obese Patients with Diabetes

Posted by Rena Xu • May 21st, 2014

Today the perils of obesity hardly remain a mystery.  Many patients who are obese also have Type 2 diabetes, a condition that can be difficult and expensive to manage, and the search for effective treatment options has become a public health priority. In 2012, an article in NEJM reported the results of the Surgical Treatment… Read More…

Keeping up with Novel Hepatitis C Genotype 1 Trials

Posted by Joshua Allen-Dicker • May 14th, 2014

This week’s NEJM features two studies (ION-1 and ION-3) that examine ledipasvir, a NS5A inhibitor, and sofosbuvir, a nucleotide polymerase inhibitor, for previously untreated HCV infection.  A recent search of the New England Journal of Medicine archives for the term “HCV” returned 45 original research articles from the last 5 years. For many of us,… Read More…

A Randomized Trial of Protocol-Based Care for Early Septic Shock

Posted by Daniela Lamas • April 30th, 2014

Over a decade ago, a trial revolutionized how patients with septic shock are treated in the early hours of their hospital stay. In 2001, with the premise that existing interventions in septic shock occur too late in a patient’s course, Emanuel Rivers and colleagues reported that patients treated in the emergency department with a protocol… Read More…

Risks and Benefits Associated with High vs. Low Target Blood Pressure in Septic Shock Patients

Posted by Rachel Wolfson • April 23rd, 2014

Mr. G is a 59-year-old patient with a history of chronic hypertension who presents to the ICU with septic shock. As his physician, you want to make the best decisions to manage his complicated condition. You recall that the Surviving Sepsis Campaign has guidelines for this very situation, and they recommend reversal of his initial… Read More…

Take the Critical Care Challenge

Posted by Jennifer Zeis • April 18th, 2014

In this month’s Critical Care Challenge, our  77-year-old patient is on mechanical ventilation in the ICU after an emergency colon resection, complicated by septic shock and acute liver failure. Since it appears his stay in the ICU will be prolonged, what measures would you take to optimize his long-term recovery? Participate in the poll and… Read More…

Ledipasvir–Sofosbuvir for Previously Treated HCV

Posted by Carla Rothaus • April 16th, 2014

The old adage, “The more things change, the more they stay the same,” simply does not apply when it comes to the treatment of hepatitis C virus (HCV). The mainstay of HCV treatment for many years has included interferon (peginterferon, since 2001) and ribavirin. While relatively effective for patients with HCV genotypes 2 and 3,… Read More…

Fibrinolysis for Acute Intermediate-Risk Pulmonary Embolism

Posted by Gelareh Homayounfar • April 10th, 2014

For anyone with an acute pulmonary embolism (PE), your prompt diagnosis and treatment can save a life. In patients with high-risk PE and signs of hemodynamic compromise, fibrinolysis is an established, clear choice that can reduce pulmonary artery resistance, prevent PE recurrence, and reduce mortality. Although fibrinolytic therapy is known to carry risks of major… Read More…

Sepsis, Albumin, and the Therapeutic Potential of Improving Oncotic Pressure

Posted by John Staples • April 9th, 2014

In physiology, as in all other sciences, no discovery is useless … we may be certain that every advance achieved in the quest of pure knowledge will sooner or later play its part in the service of man. —    Dr Ernest Henry Starling, The Linacre Lecture on the Law of the Heart (1915) Modern sepsis… Read More…

Adenoma Detection Rate and Colorectal Cancer

Posted by Daniela Lamas • April 2nd, 2014

Your patient recently celebrated her 50th birthday. After a few weeks of partying, she’s ready to turn to the less glamorous work that comes with having lived half a century.  First up is the colonoscopy. She’s impressively well informed and so it’s not a surprise when she comes to your primary care office with a… Read More…

Prevalence of Health Care–Associated Infections

Posted by Joann Schulte • March 26th, 2014

Over 30 years ago, Dr. Robert Haley, now a professor of medicine at UT Southwestern in Dallas, led the CDC in pioneering work to apply epidemiology methods to hospital infection control.  The Study on the Efficacy of Nosocomial Infection Control Project (SENIC), published in 1985, found that hospitals with active infection control programs had 32%… Read More…