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.

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

Posted by Andrea Merrill • 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 Rachel Wolfson • 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 MaryAnn Wilbur, M.D. M.P.H. • 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 Joshua Allen-Dicker • 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…

Residency Duty Hours: FIRST, do no harm

Posted by Andrea Merrill • February 2nd, 2016

When I started general surgery residency in 2011, my training program was on probation for violating the 80 hour work week as mandated by the Accreditation Council for the Graduate Medical Education (ACGME).  In addition, new regulations were being introduced that year that limited the maximum number of hours an intern and resident could work… Read More…

Belatacept and Long-Term Outcome in Kidney Transplantation

Posted by Andrea Merrill • January 27th, 2016

Medicine is a constant balance of risks and benefits.  The importance of maintaining this balance is especially evident in kidney transplantation.   While methods of immunosuppression in kidney transplantation have improved substantially since the use of total body irradiation to induce tolerance in the 1950s, current immunosuppressive agents such as calcineurin inhibitors still come with  clinically… Read More…

CDX2 as a Prognostic Biomarker in Colon Cancer

Posted by Chana Sacks • January 20th, 2016

A few weeks apart, Mr. Green and Mrs. Brown presented to their primary care doctors with intermittent rectal bleeding.  Both were referred for colonoscopies, and each was found to have a colonic mass.  With great trepidation, they awaited the results of the pathology and the CT scans that followed.  Ultimately, both were diagnosed with stage-II… Read More…

Bariatric Surgery Outcome in Adolescents

Posted by James Yeh, M.D. M.P.H. • January 13th, 2016

You are seeing Anna Boylston in your adolescent primary care clinic today.  You have been her PCP since she was 10 years-old.  She is now 14 and has a history of severe obesity (current BMI 37 kg/m2). She and her family ask you about bariatric surgery options for teenagers and the long term benefits and… Read More…

Treating Ebola with Convalescent Plasma

Posted by Bhavna Seth, M.D. • January 6th, 2016

On the eve of Christmas in 1891, Emil von Behring, the “Father of Serum Therapy,” injected Diphtheria therapeutic serum into an eight-year-old child suffering from severe diphtheria, and created history when the child was completely cured. He went on to win the Nobel Prize in 1901 for opening “a new road in the domain of medical science”… Read More…

Planned Homebirth: Should you try this at home?

Posted by MaryAnn Wilbur, M.D. M.P.H. • December 30th, 2015

Until the mid-1920s, most births in the US occurred at home.  By the mid-1950s, it was standard to deliver at the hospital. The rate of homebirths in the US remained exceedingly small until recently, when home births began to increase again. Those in favor of homebirth argue that it is a more natural experience, involves… Read More…