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.

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…

Asthma Risk, Farming, and Innate Immunity

Posted by • August 3rd, 2016

Mrs. Newton and Janice, her 2-year-old daughter, are seeing you for a child wellness check-up.  Mrs. Newton asks you about asthma risks and reports that she’s read somewhere in a parenting magazine that letting children play in the dirt and be exposed to animals reduces risks of asthma and allergies.  She asks what you know… Read More…

Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage

Posted by • July 27th, 2016

What is the ideal blood pressure goal for spontaneous cerebral hemorrhage? Results of the ATACH-2 trial are discussed. As a surgery resident, one of the first concepts I learned was that high blood pressure was bad in a patient who was actively bleeding.  This meant that for a trauma patient with a large liver or splenic… Read More…

Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting

Posted by • July 13th, 2016

Patients are fearful of nausea and vomiting during the course of cancer treatment, as it is an expected side effect of chemotherapy. Senior oncology physicians describe the early days of cancer treatment when large bowls lined the ward, positioned close to each patient. In the present age, we are still concerned about chemotherapy-induced nausea and… Read More…

Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit

Posted by • July 6th, 2016

Ms. G is a 42-year-old woman admitted to your ICU with septic shock in the setting of a urinary tract infection.  She was started on a norepinephrine infusion in the emergency room. Her labs reveal a creatinine of 3.0 mg/dL, increased from a prior baseline of 0.6 mg/dL; pH is 7.3 and potassium is 4.9… Read More…