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Literature

Resources that summarize, explain, and put research into context

From Pages to Practice

Respiratory syncytial virus (RSV) has caused significant morbidity and mortality in infants younger than 6 months worldwide. Currently, two options are available to protect infants from RSV — a bivalent RSV prefusion F protein-based vaccine (RSVpreF) for expectant mothers and prophylaxis...

Takeaways From the RSV MAT-009 Trial

“But it’s so uncomfortable.” That’s what primary care physicians often hear from patients when they are told they need to undergo the dreaded prep the day before a screening colonoscopy. Even with stool-based tests, the collection of a sample at home...

Will Blood-Based Colorectal Cancer Screening ECLIPSE Other Noninvasive Tests?

Each fall and winter, pediatric emergency rooms fill with infants in distress due to respiratory syncytial virus (RSV). Estimates of global disease burden suggest that one in every 28 deaths in children aged 28 days to 6 months is attributable to...

Nirsevimab for a More HARMONIE-ous RSV Season in Infants

Testosterone plays a critical role in men’s skeletal health, increasing bone mineral density throughout adulthood and maintaining it as they age. Men who undergo androgen deprivation therapy to reduce testosterone levels have decreased bone mineral density and increased risk of fracture....

Testosterone and Fracture Risk

Postexposure prophylaxis is not a new concept in medicine. The administration of antibiotic or antiviral therapy after close contact with a person who may be infectious is the current standard of care for many diseases including bacterial meningitis, human immunodeficiency virus...

PEPpered with Disappointment: The dPEP Trial

Type 1 diabetes mellitus (T1DM) is a chronic disease that is primarily diagnosed in childhood and marked by the autoimmune destruction of pancreatic insulin-producing β-cells. Histopathologic studies in the 1960s showed that by the time the disease becomes clinically apparent, fewer...

PROTECTing β-Cell Function in Children with Type 1 Diabetes Mellitus

Patients with cancer often question whether the risks and adverse effects associated with a specific treatment outweigh the benefits. This decision is highly personal and dependent on individual values and goals. Many patients value independence and quality of life over cancer...

Foregoing Radiotherapy after Breast Conserving Surgery

Sickle cell disease (SCD) is the most common monogenic disorder caused by a point mutation in the <em>HBB</em> gene, which encodes β-hemoglobin. The resulting substitution of valine for glutamic acid modifies the erythrocyte morphology such that it is predisposed...

Progress in Sickle Cell Disease Gene Therapies

If you have ever looked at a pediatric chest radiograph, you may recall seeing a large thymic shadow overlying the mediastinum. That shadow disappears with age as the thymus atrophies and involutes. Children born with an absent or hypoplastic thymus, such...

Don’t Underestimate the Health Consequences of Thymus Removal in Adults

Patients with major depressive disorder (MDD) often require multiple medications trials to achieve remission. Treatment-resistant depression (TRD) — defined as lack of response to two or more medication trials — affects up to 30% of patients with MDD. Patients with...

Escaping Treatment-Resistant Depression with Esketamine

Glucagon-like peptide 1 (GLP-1) receptor agonists are gaining attention for the management of type 2 diabetes and obesity. These drugs have multifactorial effects that include stimulating glucose-dependent insulin secretion, delaying gastric emptying, and inhibiting postprandial glucagon secretion. Consequently, GLP-1 receptor agonists...

Promising Results for GLP-1 Receptor Agonists in Obesity-Related HFpEF

A 40-year-old man with bipolar I disorder who is currently on a mood stabilizer is feeling better after a recent depressive episode. During the episode, he was treated with an adjunctive antidepressant. Now that his depression is in remission, you are...

Duration of Adjunctive Antidepressants After Remission of Depression in Bipolar I Disorder

Ms. Apple is a 74-year-old woman with a history of overweight but otherwise very active and still working as a part-time schoolteacher. At a primary care visit, she explains that she is concerned about memory loss because her mother developed dementia...

Diet for Prevention of Cognitive Decline in Older Adults

Mr. Wang is a 73-year-old male with a history of atrial fibrillation (AF) and diabetes who presented with left-sided weakness. Head imaging showed an ischemic stroke affecting the superficial cortical branch of the right middle cerebral artery. When should he restart...

Early Anticoagulation After Stroke Due to Atrial Fibrillation Prevents Recurrent Ischemic Events

Men who receive a diagnosis of low- or intermediate-risk clinically localized prostate cancer can live for decades. Each treatment option is associated with different effects on quality of life and sexual, urinary, and bowel function. To compare the effectiveness of these...

Similarly Low 15-Year Mortality After Monitoring, Surgery, or Radiotherapy for Prostate Cancer

Pulmonary arterial hypertension (PAH) involves the obliteration of the small arterioles of the pulmonary vasculature. PAH is categorized as World Health Organization (WHO) group 1 pulmonary hypertension, based on the presence of elevated pulmonary arterial pressures, normal pulmonary capillary wedge/left heart...

Lung Story Short: A New Therapy for Pulmonary Arterial Hypertension

The perennial question of whether to use glucocorticoids to treat patients with community acquired pneumonia (CAP) continues to consume hours of discussion in intensive care units (ICUs). Pneumonia elicits an inflammatory response in the lung, which left unchecked, can lead to a deleterious decline in pulmonary function and oxygenation. Glucocorticoids...

Should Glucocorticoids Be All the Rage in the Treatment of CAP?

Some anticoagulation decisions in patients with thrombosis are straightforward, thanks to a preponderance of data. First provoked deep-vein thrombosis (DVT)? There’s a guideline for that (no less than 3 months of anticoagulation). Recurrent DVT, pulmonary embolism, or decisions between a direct...

Hydrochlorothiazide or Chlorthalidone for Hypertension?

Venous thromboembolism (VTE) is the most common cause of preventable death in hospitalized medical patients, yet pharmacologic prophylaxis remains underutilized. The Virchow’s triad of venous stasis, vascular injury, and hypercoagulability is key in the assessment of VTE risk. Based on the Padua Score — a validated risk assessment model that...

Broken Bones and Thromboprophylaxis: Is Aspirin Enough?

Opioid use disorder (OUD) continues to be a national crisis in the United States. President Biden has identified battling the opioid crisis as a top priority and the U.S. Department of Health and Human Services (HHS) has awarded $1.6 billion to...

Methadone or Buprenorphine in Mothers and Neonates: A Tale of Two Drugs for OUD

Skills

Educational and interactive tools to sharpen your diagnostic abilities

Lung transplantation has evolved from an experimental to a standard treatment. The authors review recent developments and future opportunities in the delivery of this potentially life-transforming therapy.

Lung Transplantation

A full-term infant was admitted to the neonatal intensive care unit for hypoxemic respiratory failure. During the third week, a chest radiograph showed a persistent opacity in the left lower lobe. A diagnosis was made. ...

A Newborn with Hypoxemia and a Lung Opacity

A 51-year-old man presented with 1 week of nonproductive cough and dyspnea that limited his ability to climb stairs, previously done with ease. He reported no fever, chest pain, rhinorrhea, or sore throat. ...

Two Sides to the Story

Uterine fibroids, a frequent cause of heavy bleeding and anemia, are common. Hysterectomy is the most common treatment, but safer options, such as localized ablation and oral GnRH antagonist therapies, are underused. ...

Uterine Fibroids

Chronic lead poisoning, even at low levels, is a risk factor for cardiovascular disease in adults and cognitive deficits in children. The authors review the effects of chronic, low-level lead poisoning. ...

Lead Poisoning

Among participants with obesity and pain related to knee osteoarthritis, treatment with weekly semaglutide for 68 weeks resulted in greater reductions in body weight and knee pain than placebo.

Semaglutide in Obesity and Knee Osteoarthritis

In patients with heart failure and mildly reduced or preserved ejection fraction, finerenone resulted in a lower rate of total worsening heart failure events and death from cardiovascular causes than placebo. ...

Finerenone for Heart Failure with Preserved EF

A 71-year-old woman with a history of myasthenia gravis was admitted because of confusion and aphasia. Magnetic resonance imaging of the head revealed a mass lesion in the brain. A diagnosis was made. ...

A Woman with Confusion, Aphasia, and a Brain Mass

Cryoglobulinemia is caused by the precipitation of immunoglobulin molecules when plasma or blood cools to 4°C. The term is routinely applied to two distinct disease entities that need to be distinguished from one another. ...

Cryoglobulinemia

A 72-year-old woman with a history of dyspnea on exertion and edema in both legs was admitted to the hospital with dysarthria and rapidly evolving respiratory failure. A diagnosis was made. ...

A Woman with Dyspnea, Dysphagia, and Dysarthria

Hairy-cell leukemia, a rare B-cell cancer driven by a <em>BRAF</em> mutation and manifesting with cytopenias and splenomegaly, is responsive to purine analogue chemotherapy and to BRAF inhibitors combined with anti-CD20 antibodies. ...

Hairy-Cell Leukemia

A 37-year-old man was transferred to the hospital because of fever, myalgia, and hypoxemia. Evaluation revealed leukocytosis, acute kidney failure, and conjugated hyperbilirubinemia. A diagnosis was made.

A Man with Fever, Myalgia, Jaundice, and Respiratory Failure

Prolonged grief disorder can follow the death of a loved one, especially the loss of a child or partner or death by violence or suicide. Evidence-based psychotherapy is the first-line treatment. ...

Prolonged Grief

Excess adiposity is a reversible etiologic risk factor for obstructive sleep apnea. In this trial, tirzepatide reduced the apnea–hypopnea index of participants with obstructive sleep apnea and obesity.

Tirzepatide for Treatment of Obstructive Sleep Apnea

Neuroleptic malignant syndrome, characterized by fever, muscular rigidity, and dysautonomia, occurs with exposure to dopamine-blocking agents. Management, especially in critical care contexts, is described.

Neuroleptic Malignant Syndrome

A 45-year-old woman was evaluated in the rheumatology clinic because of possible IgG4-related disease. She had polyclonal hypergammaglobulinemia, as well as kidney and bone lesions. A diagnosis was made.

A Woman with Kidney Lesions and Lytic Bone Disease

CNS vasculitis exists in medium- and large-vessel, small-vessel, and amyloiddeposition forms. Diagnosis is difficult, but the typical symptoms include acute focal deficits, cognitive impairment, and headache.

Central Nervous System Vasculitis

A 47-year-old man was admitted to the hospital because of confusion, pneumonia involving the right lower lobe, and acute kidney failure. The creatine kinase level was 28,581 U per liter. A diagnosis was made. ...

A Man with Confusion and Kidney Failure

A 75-year-old woman with rheumatoid arthritis and multiple myeloma was admitted to the hospital with abdominal pain. She had proteinuria that was in the nephrotic range. A diagnosis was made.

A Woman with Edema, Arthritis, and Proteinuria

Firearm-related injury and death are preventable. The authors review clinical approaches to reduce patient risk with anticipatory counseling and tailored guidance for those at increased risk.

Clinical Firearm Injury Prevention

<h3 style="font-style: normal; font-weight: 600; font-size: 22px; line-height: 26px; letter-spacing: -0.01em;"><strong>Pain Management and Opioids&nbsp;</strong></h3>
<ul style="font-style: normal; font-weight: 400; line-height: 24px; /* or 156% *//* blacks / 100 */color: #000000;">
<li style="color: #000000;">Meets the MATE Act educational training criteria for he one-time, 8-hour training requirement for DEA-registered practitioners.</li>
<li style="color: #000000;">Includes learning resources that can be viewed or downloaded for later reference.</li>
<li style="color: #000000;">Is written by clinicians &mdash; pain management experts and addiction specialists &mdash; to reflect the types of clinical cases you experience in everyday practice.</li>
<li style="color: #000000;">Offers ABIM and ABP MOC points.</li>
</ul>
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Knowledge Promo Box - Home

Resources that summarize, explain, and put research into context.

Beyond Journal Club Podcast from Core IM

Does colonoscopy prevent colon cancer, and does it save lives? There has never been a randomized controlled trial on the effect of screening colonoscopies before the NordICC trial, even though screening colonoscopy is a guideline-based recommendation for everyone over age 45....

The NordICC Trial: Does invitation to screening colonoscopy save lives?

Should your patients be reaching for albuterol when their asthma flares up? Some of us may have been treating asthma exacerbations incorrectly for many years… What is the right approach? Tune in to the fifth episode of Beyond Journal Club, a...

The MANDALA Trial: What is the Best Rescue Medication for Asthma?

How do you counsel patients eligible for the RSV vaccines? What do the results of the RENOIR and AReSVi trials tell us and how do they compare? How should we interpret vaccine trials in the first place? Tune in to the...

The RENOIR and AReSVi Trials: RSV & What Makes Vaccine Trials Different?

In community-acquired pneumonia, can steroids improve mortality? Past studies of steroids in CAP have been conflicting, with some showing a mortality benefit and others showing no difference. How does the CAPE COD trial change how we think about patients hospitalized with...

The CAPE COD Trial: Do Steroids Have a Role in Community-Acquired Pneumonia?

What is the difference between semaglutide (Ozempic, Wegovy, Rybelsus) and tirzepatide (Mounjaro) in metabolic outcomes and mechanism? How did we find out diabetes medications can help with weight loss? SURMOUNT-1 asked the question, "Does tirzepatide, a once weekly injectable drug used...

The SURMOUNT-1 Trial: How Did Diabetes Medications Become Weight Loss Meds?

Does adding revascularization by percutaneous coronary intervention (PCI) to optimal medical therapy improve survival and heart failure hospitalizations in patients with severe ischemic left ventricular systolic dysfunction? Some evidence suggests that patients with low ejection fraction benefit from revascularization by PCI....

The REVIVED Trial: Does PCI Save Lives in Heart Failure and CAD?

Clinical Pearls & Morning Report

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Rotation Prep

Curated and distilled information to get you up to speed fast

Featured Rotation

Michael R. Flaherty, DO, is an attending intensivist in the pediatric intensive care unit at MassGeneral Hospital for Children. He is also Associate Program Director for the Pediatric Critical Care Medicine Fellowship at Massachusetts General Hospital, and Instructor in Pediatrics at Harvard Medical School.

The sickest children in the hospital are in the pediatric intensive care unit (PICU). Many PICUs provide care for both medical and postsurgical patients with a multidisciplinary team of intensivists, surgeons, subspecialists, specially trained nurses, and technical personnel. In this rotation...

Pediatric Critical Care

Work & Life

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Guidance for navigating your career and life

The New England Journal of Medicine invites applications from physicians at any career stage for a one-year, full-time, paid editorial fellowship beginning in July 2025. Several fellows will be selected for the 2025–26 year; applications are due by August 1, 2024. Learn more about the NEJM editorial fellowship and how...

The NEJM Editorial Fellowship

Most physicians remember the day they discovered where they would spend the next several years in residency training. Many also remember the moment elation gave way to reality as they began to calculate the cost of living and loans (averaging nearly $200,000) and realize it was more than their future...

Valuing the Resident Physician: Advocating for Change

In the first part of this series, Improving Feedback Exchanges with Residents: Can You Hear Me Now? , we reviewed basic knowledge and skills related to feedback exchanges in medical training. We defined the difference between feedback and assessment, highlighted the key components of high-quality feedback, identified barriers to feedback...

How to Receive and Deliver High-Quality Feedback

Feedback is defined as information describing an individual’s performance in a given activity that is intended to guide their future performance. Medical trainees are becoming increasingly aware that feedback is a critical component of clinical training. In a two-part series on improving formal feedback exchanges, we will focus on the...

Improving Feedback Exchanges with Residents: Can You Hear Me Now?

Whether you are a student, resident, or faculty member, no doubt you have attended obligatory talks on well-being and burnout. The attention to high rates of burnout in the U.S. health care workforce, and its unsurprising increase during the pandemic , has been beneficial, but concerns have been raised that...

It’s OK to Not Be OK

When you dedicate years to studying and practicing medicine, you learn that certain steps are required to maintain good health and prevent illness and disease. However, the concept of systematically and proactively cultivating good habits applies to many aspects of life,...

Five Steps to Improve Your Financial Health in Residency

Conflict is a natural part of everyday life; disagreements are bound to happen when we interact with others. As physicians, we often work in time-pressured, high-stakes circumstances and engage with teams comprised of people with different backgrounds and perspectives.

Conflict Management and Resolution as a Resident

Welcome new doctors! Yesterday you were medical students and today you are physicians! What a scary feeling. Remember that everyone shares similar concerns and fears as they start their residency and wants to succeed. Getting into residency is the beginning of an incredible journey. Savor it, relax, enjoy the ride,...

Surviving the First Month as a Doctor: Advice from the Community

Physician burnout and well-being are hot topics among medical professionals throughout the health care delivery and educational continuum — for good reason. Current estimates of the impact of physician burnout approach or exceed 50%, and most experts suggest that the percentage is growing.

Connection and Meaning: Resident Leadership to Combat Burnout

The fields of precision medicine and digital health have the potential to transform medicine by increasing access to health-related data at the touch of a finger, seamlessly sharing electronic medical records among institutions, improving the efficiency of healthcare delivery, and providing access to unprecedented granularity of patient data...

Precision Medicine: Help Pave the Way

The global effort to share data and resources about the ongoing Covid-19 pandemic has led to a flood of information as infections peak at different times around the world. 

Using Artificial Intelligence to Help Manage the Covid-19 Data Burden

Quality improvement (QI) is a disciplined effort to make healthcare delivery safer, more effective, patient-centered, timely, equitable, and efficient (less wasteful). These six domains were established by the National Academy of Medicine in 1999 as the tenets of... ...

What Is Quality Improvement?

Although every resident develops his or her own style for each of these roles, the following practical strategies were discussed in a NEJM Resident 360 discussion (How to Lead a Team on the Wards: The Art to Being an Effective Resident).

The Art of Leading with the Right Balance as a Senior Resident

The last time you stepped inside an operating room may have been the third year of medical school, but during residency you will care for many patients who require surgery, either electively or emergently. Calling a surgical consult can be daunting or intimidating, especially if the problem or situation is...

Advice for Calling a Surgical Consult

Notes are often the last thing standing between you and (finally) going home.  In one large-scale survey of internal medicine residents, two-thirds reported spending more than 4 hours per day on medical record documentation and clerical duties; only one-third...

Note to Self: Principles for Better Documentation

Internship and residency are incredibly demanding intellectually, emotionally, physically, and socially. This post addresses ways to establish habits that will lead to a successful and healthy transition to the practice of medicine during residency.    ...

Addressing Wellness in Residency: Ready, Set, Go!

Dr. Richard Brian Gunderman offers guidance for preventing burnout in residency.

Recognizing and Surviving Burnout

After many long nights huddled over textbooks, agonizing over the brachial plexus, committing childhood exanthems to memory, and making surgical knots of any loose fiber within arm’s reach, you have finally received the news of a lifetime: You’re accepted to a...

Prepping for PGY-1

Dr. Carol McLaughlin, director of the Global Health Equities Track in the internal medicine residency program at the University of Pennsylvania, writes about what it takes to pursue a career in global health and how can you plan for it during residency.

Opportunities in Global Health for Residents 

When most people think of librarians, they picture the stereotypical older woman with glasses and a bun who shushes them for talking too loudly. In the past, librarians were the keepers of information but have now evolved to become navigators of...