NEJM Group

Most of the 50% of Americans struggling with overweight or #obesity will start their weight loss journey with their primary care physician. The challenge to stay on top of advances in obesity management and treatment can be overwhelming. Management and Treatment of Obesity in Primary Care: An Evolving Landscape is a new CME program exploring the latest evidence on lifestyle, pharmacological, and surgical interventions, as well as recent progress in understanding the causes of obesity. Consisting of four distinct learning opportunities, each activity aims to equip primary care clinicians to navigate the complex, evolving landscape of obesity management. In this course you will learn and reinforce your understanding and skills of how to: 🔍 Examine the roles of environmental and genetic factors in obesity. 🧬 Articulate the mechanisms and pathophysiology of obesity. 📝 Review common risk factors and comorbidities associated with obesity. 📊 Assess multiple factors that influence the prevalence of obesity among diverse populations. 🩺 Evaluate the evolving landscape of nutrient-stimulated hormone-based treatment options for obesity, and management of common side effects of these medications for your clinical practice. 💡 Apply knowledge of current best practices in obesity management to confidently manage patients with obesity. Confidently manage patients with obesity. Learn more about this free CME program: https://nej.md/4crgXwz

The study of retinoblastoma has led to fundamental insights into carcinogenesis, cell-cycle regulation, the genetic basis of cancer, and tumor-suppressor genes, as well as to advances in therapy.    Shown is the spatiotemporal pattern of cone-precursor differentiation states at different embryonic postconception retinal ages, viewed as a flat-mounted left retina. Orientation is shown at week 8 (S, superior; T, temporal; I, inferior; N, nasal). The first and most central cone precursors in the presumptive fovea (asterisk) are inferred to be present at approximately week 8 and first express maturation marker ARR3 at approximately week 13. This is followed by a central-to-peripheral wave of cone-precursor birth and maturation, with the last, most peripheral cone precursors born by week 1836 and expected to initiate maturation by approximately week 34 (given initial L/M opsin expression in peripheral retina between weeks 34 and 37 and slightly earlier ARR3 than L/M opsin expression as in central retina). In vitro studies in which overexpressed MYCN induces immature cone-precursor proliferation and pRB loss induces maturing cone precursor proliferation predict the timing of the initial MYCNARB1+/+ and RB1−/− cone-precursor proliferation, signifying the initiation of each type of retinoblastoma, at each retinal position. Cone-precursor birth and maturation ages are estimated according to available data, assume that maturation occurs in a largely symmetric pattern, and were not experimentally verified.    Read the Review Article “Retinoblastoma Origins and Destinations” by David Cobrinik, M.D., Ph.D., from Children's Hospital Los Angeles (CHLA), USC Roski Eye Institute, and Keck Medicine of USC: https://nej.md/3UeqOis #Ophthalmology

The May 2024 issue of NEJM Catalyst Innovations in Care Delivery includes an in-depth look at the first year of operations of two overdose prevention centers launched by OnPoint NYC.    📌 Read the article: https://nej.md/4cUg3ce    Here are more highlights from the May issue:     𝗖𝗔𝗦𝗘 𝗦𝗧𝗨𝗗𝗜𝗘𝗦  💻️ Scaling Note Quality Assessment Across an Academic Medical Center with AI and GPT-4 https://nej.md/3vTyKMD    ⚕️ Population Health Nurse–Driven Lung Cancer Screening https://nej.md/3PVgwRx    🩺 The Alcohol Care Team Model: A Holistic Approach to Address Alcohol Dependence and Withdrawal https://nej.md/3UfTsj5    𝗔𝗥𝗧𝗜𝗖𝗟𝗘  🏥 The Case for Decentralizing Cancer Care: The Rural Oncology Home https://nej.md/3Q26Ncq    𝗖𝗢𝗠𝗠𝗘𝗡𝗧𝗔𝗥𝗬  📈 Elevating Quality, Outcomes, and Patient Experience Through Value-Based Care: CMS Innovation Center’s Quality Pathway https://nej.md/3xoXUmU    𝗜𝗡𝗦𝗜𝗚𝗛𝗧𝗦 𝗥𝗘𝗣𝗢𝗥𝗧  🌍 Climate Change Action: Important but Lagging https://nej.md/3Jm4tcg     𝗜𝗡𝗦𝗜𝗚𝗛𝗧𝗦 𝗜𝗡𝗧𝗘𝗥𝗩𝗜𝗘𝗪  🌿 The Benefits of Environmental Sustainability Efforts https://nej.md/4as3zHg     𝗙𝗥𝗢𝗠 𝗧𝗛𝗘 𝗘𝗗𝗜𝗧𝗢𝗥𝗦  📊 The Macro Trends Driving Care Delivery https://nej.md/4cSmkVY    👉 Explore the current issue: https://nej.md/4avdyM8     #HealthCare 

In the latest Case Record of the Massachusetts General Hospital, a 58-year-old woman was transferred to this hospital because of progressively worsening confusion and evolving changes on magnetic resonance imaging (MRI) of the head.    Figure 1 from the case shows the MRI of the head and magnetic resonance spectroscopy on admission.     An axial T2-weighted fluid-attenuated inversion recovery image (Panel A) shows the presence of hyperintense signal abnormalities in both temporal lobes. An axial T1-weighted contrast-enhanced image (Panel B) shows the presence of abnormal subcortical enhancement in the insulae and in the left posterior gyrus rectus (arrows). Magnetic resonance spectroscopy targeting the signal hyperintensities in the left temporal lobe (voxel indicated by the blue box in Panel C) was performed with the use of a single voxel technique with a long echo time (270 msec) (Panel D). This technique shows the presence of a positive doublet at 1.3 ppm, which is compatible with a lactate peak (Panel D, arrow). Magnetic resonance spectroscopy targeting the central brain parenchyma and lateral ventricles was performed with the use of a multivoxel technique with a short echo time (30 msec) (Panel F); the spectroscopy grid (green grid), volume of interest (white box), and a small target voxel (blue box) are shown in Panel E. This technique also shows a marked elevation in the lactate level, with a positive doublet at 1.3 ppm (Panel F, arrow), in the chosen voxel in the anterior splenium and adjacent right ventricular atrium. Cho denotes choline, Cr creatine, and NAA N-acetylaspartate. Read more about the case in “A 58-Year-Old Woman with Confusion, Aphasia, and Abnormal Head Imaging,” which includes differential and final diagnoses from guest physicians based on evidence from the test results, by Jenny Linnoila, M.D., Ph.D., et al., from the University of Pittsburgh School of Medicine and elsewhere: https://nej.md/49DGwrP  

Should your patients be reaching for albuterol when their asthma flares up? What does the evidence say, and what do the results of the MANDALA trial tell us? Find out in the fifth episode of Beyond Journal Club, a collaboration between CoreIM and NEJM Group. This new podcast series puts research into context, telling the story of how we arrived at the current standard of care, appreciating the clinical questions posed by the trial at hand, and interpreting what the findings may mean for patients. Listen now: https://nej.md/3UdZf8P Read the full MANDALA trial results published in NEJM: https://nej.md/3Me7344 #ClinicalTrials #MedicalResearch

Most trials that have shown a benefit of beta-blocker treatment after myocardial infarction included patients with large myocardial infarctions and were conducted in an era before modern biomarker-based diagnosis of myocardial infarction and treatment with percutaneous coronary intervention, antithrombotic agents, high-intensity statins, and renin–angiotensin–aldosterone system antagonists. The REDUCE-AMI trial concludes that, among patients with an acute myocardial infarction and preserved ejection fraction, long-term treatment with beta-blockers did not lead to a lower risk of death or myocardial infarction than no beta-blocker treatment. Learn more about this study by reading the Original Article "Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction": https://nej.md/4akVhRx #ClinicalTrials #Cardiology

This Graphic Perspective follows a “Dreamer” as he pursues his dream of becoming a physician in the United States — and faces the limits of his ability to help his undocumented immigrant family.    Read the Graphic Perspective “unDOCumented — On Becoming an Undocumented Doctor in the United States” by Felippe O. Marcondes, M.D., M.P.H., and illustrated by Emily Ling, M.A.: https://nej.md/4ah4slU 

On April 20, 1999, in Colorado, two high school students shot and killed 12 of their fellow students and a teacher. At the time, it was the deadliest school shooting in U.S. history. What has happened in the quarter-century since then?     During the first year after the Columbine massacre, writes David Hemenway, Ph.D., in a new Perspective, the most constructive response was the announcement that — in part to reduce possible tort liability — Smith and Wesson had agreed to upgrade its products and practices to help reduce the harms caused by its guns. Since a common cause of unintentional shootings is incorrectly believing that the gun is unloaded, its pistols would have chamber load indicators, and magazine disconnects would be available. The company would provide “ballistic fingerprints” on new firearms to help law-enforcement agencies trace guns. It would sell its guns only to dealers who had a plan for preventing gun theft and — to reduce gun trafficking — would agree to limit multiple-handgun sales to any individual buyer. The dealers would also have to agree not to sell large-capacity magazines. But the firearms industry immediately began boycotting the company, and its chief executive officer was forced to retire.    Since then, the gun problem in the United States has worsened, and the Supreme Court’s new interpretations of the Second Amendment don’t help. But there are some reasons for hope.    Read the Perspective “Twenty-Five Years after Columbine — Firearms and Public Health in the United States” by David Hemenway, Ph.D., from Harvard T.H. Chan School of Public Health: https://nej.md/3Jgudab    Watch these Double Take videos on #FirearmSafety:  Reducing Harm — Having Conversations about Firearm Storage https://nej.md/3SmdNmf  Improving Trauma-Informed Care in the Face of Firearm Violence: https://nej.md/3R2PJDV    #CommunityHealth

Poor nutrition is a major risk factor for and a leading preventable cause of chronic disease in the United States. Suboptimal diets contribute to one in five deaths worldwide. “Food is medicine” interventions are being increasingly studied as a means of preventing and treating multiple chronic diseases. Unlike traditionally approved medicines for which molecular targets are well established, dietary intake comprises a large variety of food ingredients, and their functions are spread out over a lifetime. Providing recommendations to patients, specifically those with chronic diseases, on what and how much to eat is thus more complex than most health recommendations. Here we present an overview of contemporary nutritional concepts, with a specific focus on energy and macronutrients.    Continue reading “Guidance on Energy and Macronutrients across the Life Span,” the first review in a new series on nutrition, by Steven Heymsfield, M.D., and Sue Shapses, Ph.D., R.D.N., from the Pennington Biomedical Research Center, Rutgers University, and Rutgers Robert Wood Johnson Medical School: https://nej.md/43V6ypp 

In the latest Case Records of the Massachusetts General Hospital, an 82-year-old woman was admitted to this hospital because of difficulty walking, falls, and cognitive decline.    The patient had been in her usual state of health, living independently with her husband and participating in a walking club, until 8 months before the current presentation, when generalized weakness developed. She began to walk more slowly and was no longer active with her walking club; she felt limited by pain in her feet.    Computed tomography (CT) of the head, performed without the administration of intravenous contrast material, revealed moderate ventriculomegaly that was out of proportion to the enlargement of the cerebral sulci (shown in figure). Read more about the case in “An 82-Year-Old Woman with Falls and Cognitive Decline” which includes differential and final diagnoses from guest physicians based on evidence from the test results, by Sharon Chung, M.D., et al., from University of California, San Francisco, and elsewhere: https://nej.md/4aLNcoK