Posts in the ‘From Pages to Practice’ Category

From Pages to Practice posts are brief stories about NEJM content, written by young clinicians 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 may be included at the end to stimulate thinking and discussion. These posts can now be found on NEJM Resident 360.

Romosozumab Treatment in Postmenopausal Women with Osteoporosis

Posted by • October 19th, 2016

You are seeing one of your patients, a vivacious and active 60-year-old woman who works full time. She underwent bone densitometry testing, and the results show a T score of -2.7 at the femoral neck. Further, a short sentence on the report confirms a diagnosis of osteoporosis. Knowing that osteoporosis can lead to both vertebral… Read More…

Breast Cancer Tumor Size, Mammography, and Screening Effectiveness

Posted by • October 12th, 2016

A good screening test is capable of identifying a precursor or early-stage disease in an asymptomatic patient and targets a disease for which early treatment is available to improve the patient’s ultimate outcome. Controversies about mammography screening guidelines for early detection of breast cancer include the appropriate age to start and stop screening, the frequency… Read More…

Learning More About Living Longer After Myocardial Infarction

Posted by • October 5th, 2016

To practice medicine is often to be inundated in metrics. Institutions may spend immense resources collecting data on readmission rates, time to treatment, and adherence to therapy. We know that appropriate measurement is key to health care improvement, improved rankings, and reimbursement. However, for many of these metrics, the connection between short-term performance and long-term… Read More…

Drug-Eluting or Bare-Metal Stents for Coronary Artery Disease

Posted by • September 26th, 2016

Mr. Patrick is a 59-year-old man admitted to the hospital with a non-ST elevation myocardial infarction (NSTEMI). You start him on an aspirin, P2Y12 inhibitor, statin, and heparin, and discuss the need for cardiac catheterization and possible stent placement. Mr. Patrick has heard that there are different types of stents available and wants to know… Read More…

Reversal of Factor Xa Inhibitor-Associated Acute Major Bleeding

Posted by • September 23rd, 2016

Use of anticoagulants It is estimated that slightly more than 1 in 7 strokes is due to atrial fibrillation. The use of anticoagulants reduces this risk of thromboembolism. In recent years, a number of direct oral anticoagulants (such as apixaban, rivaroxaban, and edoxaban) that inhibit active coagulation factor X have been approved for stroke prevention in… Read More…

Adalimumab in Patients with Active Non-Infectious Uveitis

Posted by • September 8th, 2016

A 44-year-old woman with type 2 diabetes mellitus and sarcoidosis presents with a 3-week history of severe visual disturbance in both eyes. After referral to an ophthalmologist, she is diagnosed with idiopathic posterior uveitis. Her symptoms improved while receiving oral steroids over the course of 5 months. However, after completing steroid treatment, her glycemic control… Read More…

Are Long-Acting Beta-Agonists Safe to Add to Treatment Regimens for Asthma in Children?

Posted by • August 31st, 2016

Janine is a 9-year-old girl who you’ve been seeing in your clinic for years. She struggles with asthma despite treatment with low-dose inhaled glucocorticoids. You wonder if any other medications can be added to her treatment regimen, and peruse the literature on long-acting beta-agonists (LABAs). The literature is mixed – it seems clear that LABAs,… Read More…

The 70-Gene Signature as an Aid to Treatment Decisions in Early Breast Cancer

Posted by • August 24th, 2016

“Your cancer has been successfully removed with surgery, but there may be a role for chemotherapy to protect you in the future.” This message is expressed by oncologists in consulting rooms all over the world. In women with early-stage breast cancer, adjuvant chemotherapy may be offered as an insurance policy against cancer recurrence. Risk of… Read More…

Closed-Loop Insulin Delivery during Pregnancy in Women with Type 1 Diabetes

Posted by • August 17th, 2016

A 32-year-old woman with type 1 diabetes mellitus presents to your office. She is 8 weeks pregnant. Her blood sugar has been well controlled on a standard insulin pump, but she understands that blood sugar can be more difficult to control during pregnancy.  You have previously discussed the importance of tight glucose control in pregnancy… Read More…

Randomized Trial of Thymectomy in Myasthenia Gravis

Posted by • August 10th, 2016

As a third-year medical student in my neurology clerkship, I went to the emergency room to evaluate Ms. B, who presented with eyelid weakness and fatigue. She was a 45-year-old woman who was diagnosed 2 years earlier with myasthenia gravis (MG). This was her third hospitalization for exacerbation of the disease. At the time of… Read More…