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.

Trial of Continuous or Interrupted Chest Compressions during CPR

Posted by MaryAnn Wilbur, M.D. M.P.H. • December 2nd, 2015

Nearly a month ago, my husband and I were sitting on the couch watching LOST (yes, I have been living under a rock). My review of outdated pop culture was interrupted by the sound of a car crash. We ran outside. The car had been going quite slowly, and there was minimal damage. But, the… Read More…

Cardiovascular Safety of Empagliflozin in Patients with Type 2 Diabetes

Posted by James Yeh, M.D. M.P.H. • November 25th, 2015

You are a primary care provider and you’ve heard about a new class of anti-diabetic drugs called the “flozins,” including empagliflozin. You wonder what this drug class is and what we know about its safety and its effect on cardiovascular events. What is empagliflozin? Empagliflozin is a sodium-glucose transporter-2 (SGLT-2) inhibitor. Since glucose is freely filtered in… Read More…

Prospective Validation of a 21-Gene Expression Assay (OncotypeDX) in Breast Cancer

Posted by Andrea Merrill • November 18th, 2015

Imagine it is 1970. You are a 50-something year old woman and your doctor has just palpated a 1 cm mass in your left breast.  What are your options for treatment?  Unfortunately, radical mastectomy, introduced by Dr. William Halsted in 1894, remained the standard of care at that time.  Breast cancer treatment as it was… Read More…

Acetaminophen for Fevers in the Critically Ill: Good for Patients, or Are We Treating Ourselves?

Posted by Joshua Allen-Dicker • November 11th, 2015

It is 3AM and you are called about Mr. Smith, a 74-year-old man who presented to the hospital tonight with a cough and was found to have pneumonia and sepsis. You have started him on antibiotics, but he now has a temperature of 38.3°C (100.9°F). His nurse asks, “Should we give him something for that… Read More…

Blood Pressure Control: SPRINTing Towards a Lower Blood Pressure Target

Posted by James Yeh, M.D. M.P.H. • November 9th, 2015

Mrs. Weymouth has hypertension and she is at your office for a check-up. Her blood pressure is 136/72 mm Hg. What do you tell her about her blood pressure control? Hypertension affects nearly 1 out of 2 individuals world-wide between the ages of 35 and 70. The goal of blood pressure control is to reduce cardiovascular… Read More…

Advanced Renal Cancer: What is a Breakthrough Worth?

Posted by Rena Xu • November 4th, 2015

When I tell people that I am a resident in urology, they often ask me why I chose this field. There are many reasons, but one of my primary motivations was to treat renal cancer, a disease that has affected several people close to me. With early detection, surgery can be curative. Unfortunately, a third… Read More…

A Randomized Controlled Trial of Total Knee Replacement

Posted by Andrea Merrill • October 21st, 2015

Ms. Smith, as we’ll call her, was a 60-something year old woman I met on my medicine rotation during my third year of medical school. She had presented to the emergency room with fevers, chills, and pain and redness around her knee- a knee that contained hardware from her total knee replacement (TKR) three years… Read More…

Inhaled corticosteroids for neonatal BPD: The jury is still out

Posted by Rachel Wolfson • October 14th, 2015

As neonatologists have been able save more babies that have born prematurely, the problem of bronchopulmonary dysplasia (BPD) has loomed larger. BPD occurs in preterm infants (born at less than 28 weeks of gestation) or in infants with extremely low birth weight (less than 1000 grams at birth). It stems from a variety of factors,… Read More…

Remote Ischemic Preconditioning in Cardiac Surgery

Posted by Chana Sacks • October 7th, 2015

In a lab at Duke University in 1986, scientists conducted an experiment comparing two different ways to give a dog a heart attack. The investigators cut off the blood flow of the circumflex artery for 40 minutes in 12 dogs. For 7 of those dogs, they first initiated a “preconditioning” protocol that consisted of four 5-minute… Read More…

How to “Nudge” Smokers to Reduce Tobacco Use?

Posted by James Yeh, M.D. M.P.H. • September 30th, 2015

Health problems due to smoking account for 6 million deaths annually and are the leading cause of death worldwide. Despite the dramatic reduction of smoking rates in the past 50 years in the U.S., nearly 18% of adults are current smokers. Each day 2100 youth and young adults become regular daily smokers. As nicotine sustains… Read More…