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.
Posts in the ‘Insights’ Category
Norovirus Steals the Crown from Rotavirus
Posted by Sushrut Jangi • March 20th, 2013
A decade ago, if a young child with profuse diarrhea and vomiting was brought into the pediatrician’s office, the doctor would think immediately: rotavirus. No longer, says Daniel Payne, author of a new study in NEJM this week. According to their results, norovirus has displaced rotavirus as the predominant cause of acute infectious gastroenteritis in… Read More…
Med Student’s Perspective: Family Presence during Cardiac Resuscitation
Posted by Natalie Volkes • March 18th, 2013
Physicians have traditionally helped close the curtain around hospital death, ushering families away during the attempt at resuscitation. Separating them from their sick relative may spare the family a trauma and protect the physician’s professional engagement with the experience. But increasingly, it seems physicians might be doing our patients and their families a disservice. Because… Read More…
Radiotherapy and Subsequent Heart Disease
Posted by Daniela Lamas • March 13th, 2013
The 65-year old woman in your clinic was diagnosed with breast cancer five years ago, when a radiologist noted a suspicious shadow on a routine mammogram. She was lucky. Her cancer was treated with lumpectomy and radiation and now – half a decade later – she is thrilled when you tell her that she remains… Read More…
Endovascular Therapy after Stroke: A Penumbra of Doubt
Posted by Rena Xu • March 6th, 2013
In the acute window after an ischemic stroke, you have two options. You can give tissue plasminogen activator (t-PA) to dissolve the clot, or you can use endovascular therapy to remove the clot. The probability of recanalization is 46% with t-PA, and greater than 80% with endovascular treatment. Which option do you choose? It might… Read More…
New evidence that high-frequency oscillation not beneficial for ARDS patients (and may even be harmful)
Posted by Rachel Wolfson • February 27th, 2013
In the 1980s, a paradigm shift in the treatment of acute respiratory distress syndrome (ARDS) occurred: researchers found that decreasing tidal volumes provided by mechanical ventilation still allowed for adequate ventilation while, perhaps, avoiding excess lung injury. Based on this principle, high-frequency oscillatory ventilation (HFOV), which provides very small tidal volumes (1 to 2 ml… Read More…
Two novel agents for extended treatment of venous thromboembolism
Posted by Jamie Colbert • February 20th, 2013
Venous thromboembolic disease (VTE) and pulmonary embolism have been major causes of human morbidity and mortality for thousands of years, yet our understanding of the pathobiology of this disease was rudimentary until the 1840s when German pathologist Rudolf Virchow discovered that blood clots in large veins of the lower legs could travel through the right… Read More…
Plug it in, turn it on … and feel better? Neurostimulation for Early Parkinson’s Disease
Posted by John Staples • February 13th, 2013
Although treating a disease by implanting an electrode into a patient’s brain and flicking a switch may seem like the stuff of science fiction, subthalamic neurostimulation is already an established treatment for advanced Parkinson’s disease. In patients with severe motor complications, neurostimulation can help manage motor fluctuations and dyskinesias, restore function, and improve quality of… Read More…
Antisepsis in the ICU – Chlorhexadine and Patient Bathing
Posted by Sushrut Jangi • February 6th, 2013
When I was an intern in the ICU, there were only a few minutes in the early mornings to examine patients before the attending arrived to hear our presentations. During those frantic moments, I frequently walked into a patient’s room to find the nurses bathing the patients with a wash-cloth. “Come back in a bit,”… Read More…
Active Treatment for Localized Prostate Cancer: Navigating a Sea of Adverse Effects
Posted by Deborah Doroshow, Ph.D. • February 5th, 2013
A 70 year-old gentleman comes to see you after a recent diagnosis of localized prostate cancer. He has decided to forgo watchful waiting and pursue active treatment, but he has heard that the two options he is considering – external beam radiation therapy and prostatectomy – are both associated with adverse effects. Your patient explains… Read More…
Doctors Turned Ecologists: Infusion of Donor Feces for Recurrent C. Difficile
Posted by Sushrut Jangi • January 30th, 2013
The Ecology of the Gut During birth, the fetus emerges into the world almost completely sterile of bacterial life. But the end of the first day, the baby has been held to her mother’s breast, has been lifted by nurses and doctors, has taken the first breaths of the air in the maternity ward, and by… Read More…
