New England Journal of Medicine - Clinical Medicine

1. Evidence-Based Work Design — Bridging the Divide

   Taking a more evidence-based approach to work design may help to bridge the growing divide between U.S. clinicians and organizational leaders, reducing “administrative harm.”

2. What I Wish I Had Done for a Grieving Father

   Having lost trust in physicians when he lost his daughter, a man with newly diagnosed cancer declines care, leaving the oncologist to consider past failures of communication, connection, and trust.

3. Thin Skin in Cushing’s Syndrome

   A woman with a history of metastatic small-cell lung cancer and Cushing’s syndrome was found to have reduced skin thickness, a possible result of antianabolic effects of excess cortisol. Methods of measuring skin thickness are shown in videos.

4. Remibrutinib in Chronic Spontaneous Urticaria

   In two trials involving patients with chronic spontaneous urticaria, remibrutinib led to significantly greater reductions than placebo in itching and hives at week 12.

5. Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis

   The addition of combined oral and topical antimicrobial therapy for male partners to treatment of women for bacterial vaginosis resulted in a lower rate of recurrence within 12 weeks than treatment of the woman alone.

6. Tirzepatide for Obesity Treatment and Diabetes Prevention

   A 3-year study of tirzepatide in participants with obesity and prediabetes showed substantial and sustained weight reduction and decreased risk of progression to diabetes with tirzepatide, as compared with placebo.

7. Nutrition in Medicine: Micronutrients — Assessment, Requirements, Deficiencies, and Interventions

   One third of people worldwide have at least one micronutrient deficiency. National surveys provide cross-sectional data, but inferring causality between deficiency and disease is difficult.

8. Unveiling the Unforeseen

   A 57-year-old woman presented with a 3-day history of altered mental status. Three weeks earlier, fever, weakness, cough, and diarrhea had developed, followed by intermittent visual hallucinations, tremors, and unsteadiness.

9. Answering the Call — Sustaining Equity Efforts in the Face of Regression

   A study of a health equity curriculum is stopped in its tracks by the ban on diversity, equity, and inclusion efforts in federal agencies. The study’s leaders see the sudden halt as a call to action.

10. Facing Political Attacks on Medical Education — The Future of Diversity, Equity, and Inclusion in Medicine

    The deluge of legislative and policy attacks on diversity, equity, and inclusion efforts threatens the integrity of the health care workforce and will ultimately worsen the health of the populace.

11. Mitral Regurgitation from Ischemic Papillary-Muscle Rupture

    A 59-year-old woman presented with progressive dyspnea. There was a pansystolic murmur at the cardiac apex. Echocardiography (shown in videos) showed rupture of the anterolateral papillary muscle and severe mitral regurgitation.

12. Bacterial Vaginosis — Time to Treat Male Partners

    Bacterial vaginosis, the most common cause of vaginal discharge in reproductive-age women,1 is associated with multiple consequential adverse outcomes, including an increased risk of adverse birth outcomes, acquisition of human immunodeficiency virus and other sexually transmitted infections (STIs), pelvic inflammatory disease, and a high incidence of symptomatic recurrence.

13. Emphysematous Vertebral Osteomyelitis

    A 62-year-old man presented to the ED with a 5-day history of low back pain and a 1-day history of lethargy. Imaging of the spine showed gas within L4.

14. Pulse Oximetry and Skin Tone in Children

    Simultaneous measurements in children revealed overestimation of arterial saturation by pulse oximetry that was attributable to spectrophotometric measures of skin tone.

15. NEJM Outbreaks Update — H5N1

    In this audio interview for NEJM Outbreaks Update, Editor-in-Chief Eric Rubin and Deputy Editor Lindsey Baden speak with Yoshihiro Kawaoka.

16. Tezepelumab in Adults with Severe Chronic Rhinosinusitis with Nasal Polyps

    In patients with chronic severe rhinosinusitis and nasal polyps, tezepelumab therapy led to greater reductions in polyp size and nasal congestion and less use of surgery and glucocorticoids than placebo.

17. Embolization of the Middle Meningeal Artery for Chronic Subdural Hematoma

    Among patients receiving surgical or nonsurgical standard treatment for chronic subdural hematoma, adjunctive middle meningeal artery embolization reduced the risk of treatment failure within 180 days.

18. Oral Infigratinib Therapy in Children with Achondroplasia

    A phase 2 dose-finding study evaluated the safety and efficacy of infigratinib, an orally bioavailable FGFR1–3 selective tyrosine kinase inhibitor, in children with achondroplasia.

19. Carceral Health Care

    Medical, behavioral, and socio-structural factors contribute to poor health among people who are incarcerated. Health risks are magnified by conditions of confinement and lack of access to quality health care.

20. Middle Meningeal Artery Embolization and Nonacute Subdural Hematoma

    Nonacute subdural hematoma is common among older persons. With an aging population and increasing use of antiplatelet and anticoagulant agents, subdural hematoma is projected to become the most common cranial neurosurgical disease by 2030.1 Standard treatments — including glucocorticoids and statins for milder cases, with the addition of...