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.

A New Combination Therapy to Help Prevent COPD Exacerbations?

Posted by • June 8th, 2016

You walk into your office to see, once again, Mr. Jones, at 64-year-old male who suffers from chronic obstructive pulmonary disorder (COPD). Mr. Jones is recovering from a recent visit to the ED due to his third COPD exacerbation event this year. He’s frustrated with his recurrent COPD exacerbations, and wants to know if his… Read More…

Catheter-Associated Urinary Tract Infections

Posted by • June 2nd, 2016

In your role as Unit Medical Director, you regularly meet with nursing leadership for 6-West.  Today, they bring to your attention several cases from the last month: a 67-year old female admitted for severe pneumonia who initially rapidly improved on antibiotics, but then developed a new fever and was found to have a urinary tract… Read More…

Primary Prevention of Cardiovascular Events — A Pragmatic Approach

Posted by • May 25th, 2016

Ms. Barnstable is a 66 year-old woman who is seeing you for an annual physical check-up today.  She does not take any medications and is a smoker.  She asks if there are drugs that she should be taking to lower her risks for heart attacks and strokes. Besides smoking cessation counseling, what do you tell… Read More…

Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery

Posted by • May 18th, 2016

Whether you are a resident on the cardiology, surgery, or general medicine service, encountering patients with atrial fibrillation is common. Many patients, particularly after cardiac surgery, go in and out of atrial fibrillation so often that residents caring for them often ignore the blinking lights and loud alarms from telemetry machines after a while. However,… Read More…

COPD Is Not the Whole Story

Posted by • May 11th, 2016

Many diagnostic guidelines use black or white parameters – either patients meet the criteria and have the disease, or they don’t. While guidelines like this can be useful for developing clear definitions, in practice many patients fall within a gray area. The current diagnosis of Chronic Obstructive Pulmonary Disease (COPD), for example, relies on spirometry… Read More…

Scaling the ALPS — Antiarrhythmic Drugs in Out-of-Hospital Cardiac Arrest

Posted by • May 4th, 2016

Imagine you are out for an evening jog when a young man, who is running ahead of you, collapses. You rush over and a rapid assessment suggests that he is unresponsive, has no pulse, and is not breathing. You start chest compressions and a bystander calls 911. EMS arrives soon, however, after 5 cycles of… Read More…

Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients

Posted by • April 27th, 2016

I’ve sometimes wondered if I’m embarking on the field of surgery in the wrong era.  As a medical student, and now as a resident, the big open operations have always seemed to be the most exhilarating and rewarding.  It always seems more thrilling to have your hands deep in a patient’s abdomen or chest than… Read More…

Déjà Voodoo: Readmission or Observation after the Affordable Care Act

Posted by • April 20th, 2016

The hospital where I work has one of the busiest emergency departments in Boston. Patients come in with everything you might imagine, from heart attacks to rabbit bites. A number of these patients, after being evaluated and treated, can be discharged home from the emergency department; others need to be admitted for further management. For… Read More…

Fusion for Lumbar Spinal Stenosis?

Posted by • April 13th, 2016

Back pain does not respect traditional boundaries in healthcare.  Patients with back pain are present in our emergency rooms, our minute clinics, our surgical subspecialty offices, and our inpatient units.  As such, many of us—orthopedist or internist, rheumatologist or advanced practitioner—have had to think about advising the patient with lumbar spinal stenosis or lumbar spondylolisthesis,… Read More…

Betamethasone for Women at Risk for Preterm Delivery

Posted by • April 6th, 2016

A term delivery occurs on or after 37 weeks gestation.  Any delivery prior is considered “preterm” and those   between 34 weeks, 0 days and 36 weeks, 6 days are often referred to as “late preterm.”  The standard of care has been to recommend antenatal glucocorticoids (typically, betamethasone 12.5mg IM q24 hours x 2 doses) to… Read More…