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.

Naloxegol for Opioid-Induced Constipation

Posted by John Staples • June 18th, 2014

Did opioid-induced constipation contribute to Elvis Presley’s death? Would he still be making music today if he’d won the battle with his bowels? Though many disagree, Elvis’ former personal physician thinks that a cure for the King’s constipation might have spared his life. If this kind of conjecture from suspicious minds leaves you all shook… Read More…

Pharmacology and the Treatment of Complicated Skin and Skin-Structure Infections

Posted by Daniela Lamas • June 11th, 2014

Treating skin and soft tissue infections isn’t the most glamorous job in medicine. But as these infections – ranging from cellulitis to abscess and often accompanied by fever and other signs of systemic illness – lead to nearly 900,000 hospital admissions annually, it’s an essential one. And with the emergence of strains of methicillin-resistant Staphylococcus… Read More…

Antibiotic Prophylaxis for Vesicoureteral Reflux

Posted by Joann Schulte • June 6th, 2014

Are Charlie’s kidneys backed up?  Does he need antibiotics?  His parents want to know if 2-year-old Charlie is going to be on long-term antibiotics to prevent any new bladder infections.  He’s just finished treatment for a urinary tract infection (UTI).    You explain that a voiding cystourethrogram will need to be done first to categorize the… Read More…

A New Hope for Idiopathic Pulmonary Fibrosis

Posted by Daniela Lamas • May 28th, 2014

It seemed benign at first. But the dry cough didn’t go away, despite a course of antibiotics and a prescription for an inhaler. Then your 55-year-old patient started to get winded while walking up the stairs at his home, and a work-up – chest x-ray, CT scan and pulmonary function testing – led to a… Read More…

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…