The 100 most-cited articles in Journal watch, 2016

Sponsoring Organization: American Diabetes Association (ADA) Target Audience: All clinicians providing care to patients with diabetes Background The ADA publishes a comprehensive update entitled Standards of Medical Care in Diabetes annually. Now, Annals of Internal Medicine has published a concise 10-page synopsis of the full 2016 ADA documents, highlighting areas of particular importance to primary care physicians. The recommendations are assigned ratings of A, B, or C, depending on the quality of evidence. Key Recommendations

Zika virus, a mosquito-borne flavivirus, has been described in 26 countries in the Americas. Until the beginning of December 2015, all cases reported in the U.S. were thought to be imported from other endemic areas. However, as a result of heightened surveillance and increased testing of specimens, 30 laboratory-confirmed cases of Zika virus infection were identified in Puerto Rico, a jurisdiction of the U.S., between …

Since the initial description in 1993 of mutations in the superoxide dismutase (SOD1) gene as the first identified genetic cause of amyotrophic lateral

PD-1 blockade therapy with the anti-programmed-death-receptor-1 antibody pembrolizumab has shown promise for patients with advanced melanoma in prior

Community-acquired bacterial meningitis (CABM) is a life-threatening infection that can be complicated by neurological deficits among survivors. These outcomes have prompted interventions in prevention and treatment. These include an ever-expanding list of vaccines and adjunctive therapy, including early corticosteroid administration. Researchers conducted a prospective cohort study in the Netherlands to provide a contemporary evaluation of the disease's incidence, clinical aspects, and management. Adult (aged …

Survival from out-of-hospital cardiac arrest (OHCA) is low, and OHCA victims should not be transported if resuscitation attempts would be futile. The

Patients with rheumatoid arthritis (RA) are at excess risk for cardiovascular (CV) complications, especially coronary heart disease. This risk is

In the current report from the Netherlands, a group using Fujinon colonoscopes and silicone in the water jet noticed crystalline deposits inside a

Percutaneous endoscopic gastrostomy (PEG) provides enteral feeding to patients whose ability to swallow is impaired by obstruction, a neurologic

Dear Colleagues:NEJM Group, publisher of the New England Journal of Medicine (NEJM) and NEJM Journal Watch, is celebrating the launch of an innovative

Concerns about widespread Internet addiction, particularly associated with Internet gaming, led to the following DSM-5 proposed criteria for Internet

There are several reasons for testing folinic acid in children with autism spectrum disorder (ASD). Dietary folate must be reduced to folinic acid to

Calciphylaxis (also known as calcific uremic arteriolopathy, because it is seen mostly in patients with end-stage renal disease [ESRD]) is an uncommon

Numerous medications can prolong the QT interval and increase risk for Torsades de Pointes and sudden cardiac death. Although the U.S. FDA provides

Sponsoring Organizations: Ten American, Canadian, and European societies representing poison centers, emergency medicine, critical care, pediatrics and toxicology Target Population: Patients with calcium channel blocker (CCB) poisoning in the hospital Background and Objective CCB poisoning can be deadly, yet there have been no guidelines for care of hospitalized patients with CCB toxicity. Overall, the available evidence to support the guidelines presented here was judged as poor, and mostly …

In the more than 20 years since intravenous tissue plasminogen activator (IV TPA) was shown to improve outcomes for acute ischemic stroke, the process

The “rule of three” in dilation of esophageal strictures suggests that in a single session, no more than three bougie dilators of sequentially larger size should be passed once moderate or greater resistance is evident. (Dilators passed with no or mild resistance do not count toward this total.) Despite its ubiquity in guideline and expert recommendations, this “rule” has never been validated. In a retrospective chart review, researchers assessed the effect of the …

The accuracy of plain films for diagnosis of non-displaced elbow fractures has been studied very little. Now, Turkish investigators have compared the accuracy of point-of-care ultrasound (POCUS), plain films, and computed tomography (CT) for detection of elbow fractures in 49 patients aged 5 to 65 years. Fracture was detected by POCUS in 34 patients, by CT in 33, and by radiography in 25. Relative …

Sponsoring Organization: National Institute on Alcohol Abuse and Alcoholism, the Collaborative Initiative on Fetal Alcohol Spectrum Disorders, and the

Almost 20 years ago, Oregon became the first U.S. state to legalize physician-assisted suicide (PAS). Since then, PAS has become legal in four more

Most Internet users have searched for information regarding medical illnesses online, even though much online health information is thought to be

The WHO classification of hematopoietic and lymphoid tumors, last published in 2008, is the international diagnostic standard for all lymphoid and

During the past few years, several immunotherapy approaches have been approved for the treatment of patients with locally advanced and metastatic

Vaccine refusal in specific immigrant communities (e.g., measles, mumps, rubella vaccine refusal among Somali families in Minnesota) leads to increased

When should hemodialysis be started for a critically ill patient? Previous small trials and a meta-analysis have yielded mixed messages. Early hemodialysis lowers inflammatory mediators, maintains acid-base equilibrium, and helps avoid volume overload; however, if dialysis is started too early, some patients who would never need it are exposed to its potential complications. In a single-center study from Germany, investigators randomized 231 critically ill postoperative patients with stage 2* KDIGO (Kidney Disease: Improving Global Outcomes) acute kidney injury (AKI) to early (within 8 …

Sponsoring Organization: American College of Gastroenterology (ACG) Audience: Gastroenterologists, primary care providers Background and Objective In this new comprehensive guideline, researchers developed graded recommendations on diagnosis, management, and prevention of acute diarrheal infections based on a systematic review of evidence. Key Recommendations

Even though corticosteroid immunosuppressive and anti-inflammatory medications are commonly prescribed, little is known about the risk for infection

Sponsoring Organizations: The National Tuberculosis Controllers Association and the Association of Public Health LaboratoriesTarget Audience: State and

Routine management of asthma exacerbations in emergency department patients includes a 5-day course of prednisone. Dexamethasone has a longer half-life, and prior research has suggested that a 1- or 2-day course of dexamethasone might be as good as a 5-day course of prednisone. Investigators randomized adults with mild-to-moderate acute asthma exacerbations to …

Bariatric surgery generally leads to substantial weight loss that often is maintained. However, whether bariatric surgery is associated with durable

Sponsoring Organization: The American Academy of Dermatology Target Audience: Primary care clinicians, pediatricians, dermatologists Background Acne affects an estimated 50 million individuals in the United States with a cost that exceeds $3 billion/year. Although the mortality from the disease is virtually nonexistent, it can cause extensive scarring and inflict significant emotional damage, especially on adolescents. The American Academy of Dermatology has revised its guidelines for the management of this disease. Key Points

Researchers in an urban pediatric emergency department assessed the reliability of telemedicine using a commercially available computer tablet device (Apple iPad [720 HD, fourth generation] with FaceTime application) to assess seriously ill children. They compared agreement between simultaneous bedside and telemedicine evaluations of 132 infants and children …

Diagnostic evaluation of peripheral lung nodules is challenging. To evaluate the yields of different bronchoscopy techniques, investigators used a multicenter U.S. registry to study 581 patients who had undergone bronchoscopy with transbronchial biopsy for peripheral nodules or masses. The lung periphery was defined as “the segmental bronchus or beyond, such that the lesion required transbronchial …

Maternal exposure to alcohol during pregnancy can cause damage to the fetus beyond morphological abnormalities, resulting in fetal alcohol spectrum

Following publication of the phase Ib KEYNOTE-001 study (NEJM JW Oncol Hematol Jun 2015, and N Engl J Med 2015; 372:2018), pembrolizumab (MK-3475), an IgG4 monoclonal antibody to PD-1, was granted accelerated FDA approval for evaluation in chemorefractory non–small-cell lung cancer (NSCLC) that expresses PD-L1. Now, investigators have conducted an industry-funded, international phase II/III, randomized, controlled, open-label trial (KEYNOTE-010), in which previously treated NSCLC patients who expressed PD-L1 in at least 1% of tumor cells received one of three …

Antidepressants are commonly used for depression and vasomotor symptoms in breast cancer patients treated with tamoxifen. However, many antidepressants

Dear Readers,It has been a remarkable year for practice-changing medical breakthroughs. This year has seen myriad advances and challenges, including a

Dear Readers,The past year was filled with new evidence-based information that impacts our practices and will lead to improved health in our patients.

In 2016, several industry-sponsored randomized trials suggested that the glucagon-like peptide-1 [GLP-1] analogues liraglutide (Victoza) and

European and American guidelines on diagnosis and evaluation of patients with syncope barely mention pulmonary embolism (PE) as a diagnostic

2016 saw a flood of research into Zika virus infection, as this previously obscure flavivirus (related to the agents of dengue and yellow fever)

Whether patients should undergo screening for prostate cancer remains controversial. When patients elect screening and are found to have localized

In 2016, two trials were published in which researchers examined established uses of supplemental oxygen. These results raise questions about our

Over the years, U.S. studies have suggested that black patients tend to receive more aggressive medical intervention than white patients near the end

Patients with obstructive sleep apnea (OSA) are at excess risk for adverse cardiovascular (CV) events. In 2016, two new studies shed light on the

Compiling a list of the year's “top stories” is always a difficult task. NEJM Journal Watch covered many studies in 2016 didn't quite merit our “Year

In February 2016, the European Society of Intensive Care Medicine and the Society of Critical Care Medicine Third International Consensus Task Force

The heterogeneity of major depression has limited our ability to predict course and treatment outcome and to personalize treatment of our depressed

The search continues for nonpharmacological treatments for pediatric depression that are effective and maintain benefits a year posttreatment. These

Brain-derived neurotrophic factor (BDNF) is a potential marker both for the presence of psychiatric illnesses and for changes in clinical status, particularly mood disorders. Particularly intriguing are the increases in BDNF associated with neurogenesis and clinical improvement. Investigators conducted the first “transdiagnostic” study of BDNF in 236 consecutively admitted psychiatric inpatients (mean age, 45; 57% female) and …

Dear Readers,I am pleased to present the NEJM Journal Watch Women's Health Top Stories of 2016. The trends highlighted by these stories include

Each year, the editors of NEJM Journal Watch General Medicine choose the year's most important thematic areas in clinical research. We try to strike a

Cannabis use is linked with alcohol use, but the effects of cannabis use remains unclear, including whether it increases or decreases alcohol use. To

Understanding long-term prognosis following first episodes of psychotic disorders is important in planning interventions. In a 20-year prospective

Dear Readers,What a remarkable year — for pediatrics and for our country. This has been the year of Zika, precision medicine, and the cancer moon shot.

Dear Readers,Below are this year's NEJM Journal Watch Infectious Diseases most important stories as selected by the editorial board.As in 2015, major

This year in cardiovascular research has had some solid contributions to the field, and I am pleased to share with you the NEJM Journal Watch

Dear Readers,I am pleased to introduce this year's NEJM Journal Watch Neurology Top Stories of 2016. As in years past, I have made these selections

This year, our list of NEJM Journal Watch Oncology and Hematology top stories includes studies on malignant and benign hematology as well as breast,

Evidence is mixed on whether α-blockers, such as tamsulosin, doxazosin, and terazosin, promote passage of ureteral stones (kidney stones that have

Evidence suggests that, in people with previous colorectal neoplasia, aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) lower risk for

On behalf of the editors of NEJM Journal Watch Psychiatry , I am pleased to present the Psychiatry Top Stories of 2016. The selection of the 10 best stories was, as always, difficult, with more than 200 summaries published in the past year that inform and improve the clinician's practice of psychiatry, whether by enhancing assessment or improving treatment options. Our six Editorial Board members of NEJM Journal Watch Psychiatry have always prioritized stories about promising new treatments for our patients. Seven of our top 10 this year provide information that could change a clinician's practice:

Dear Readers, We are pleased to bring you our 2016 NEJM Journal Watch Hospital Medicine Top Stories. As usual, our list focuses on inpatient and intensive care topics that most of us see in our daily practice. We hope that you find this list …

Not infrequently, chest computed tomography (CT) — whether done to evaluate pulmonary symptoms or for other reasons — reveals interstitial lung

Ketamine is coming into wider use as an analgesic. In a randomized, double-blind, controlled trial, investigators in Iran compared the efficacy of

The incidence of acute cholecystitis continues to increase. Its diagnosis in the emergency department (ED) is often made by clinician gestalt based on

Air pollution from cooking with biomass fuels is associated with more than 4 million premature deaths annually, including half a million young

Women with diabetes require focused contraceptive counseling, as unplanned pregnancy in such women is associated with excess risk for adverse maternal

The recommended duration of antimicrobial therapy for acute otitis media in children has historically been 10 days. However, the recognition that

Preeclampsia can affect the retina during pregnancy, but what about in subsequent years? To evaluate the relation between preeclampsia and risk for

The Disease Transmission Advisory Committee, a voluntary reporting system of the Organ Procurement and Transplantation Network (OPTN), investigated 14

Sponsoring Organizations: Infectious Diseases Society of America and American Society of Tropical Medicine and HygieneTarget Audience: Internists,

Some evidence suggests that testosterone use, which has risen dramatically in recent years, is associated with elevated risk for venous thromboembolism

Although physical and cognitive rest are universally recommended elements of concussion treatment (NEJM JW Emerg Med Sep 2014 and Ontario Neurotrauma

In nonmutated non–small-cell lung cancer (NSCLC), activation of the MET pathway has been identified as a possible mechanism of resistance to the

In reproductive-age women with early-stage invasive cervical cancer, surgery or radiation is associated with favorable prognosis. National

Sexually transmitted infection (STI) is the most common group of infections in the U.S., which has the highest incidence of these infections of

Major stroke is an uncommon but well-described complication of transcatheter aortic valve replacement (TAVR). In addition, subclinical new ischemic

Target Population: Clinicians, laboratory workers, staff in medical offices, academic training programs, medical schools, and others involved in the

Hyperkalemia is a clinical challenge in patients with heart failure and reduced ejection fraction (HFrEF), because the guideline-recommended regimen

A motor neuron disease (MND) similar to amyotrophic lateral sclerosis (ALS) has been reported in HIV-infected patients. Patients typically present with

FODMAPs (fermentable, oligo-, di-, monosaccharides, and polyols) are poorly absorbed short-chain carbohydrates that include fructose, lactose, fructans

Use of selective serotonin reuptake inhibitors (SSRIs) has been associated with excess risk for bleeding, presumably due to the antiplatelet effect of

The Sydney EMR Recurrence Tool (SERT) is a prediction model for recurrence at follow-up after endoscopic mucosal resection (EMR) of large, lateral-spreading tumors. To develop the tool, researchers prospectively assessed 1178 lesions ≥20 mm in size at piecemeal EMR and first follow-up colonoscopy. The overall rate of endoscopically detectable recurrence was 19.4%. Visible endoscopic recurrence had a negative predictive value of 99.2% and a positive predictive value of 66.1% based on histologic determination. Predictors of endoscopic recurrence were size ≥40 mm (odds ratio, 2.47), intraprocedural bleeding (OR, 1.78), and high-grade dysplasia (OR, 1.72); these predictors contributed 2 …

Research into biological correlates of social behaviors has yielded many insights. Twin and family studies have shown genetic influences on

The T790M epidermal growth factor receptor (EGFR) mutation confers resistance to first- and second-generation EGFR tyrosine kinase inhibitors (TKIs).

How do leaders and colleagues whom we believed to be honorable end up conducting major acts of dishonesty? A clever series of computer-based

Studies of patients with severe alcoholic hepatitis (AH) have shown an overall mortality benefit of short-term corticosteroid therapy (NEJM JW

Many published studies have examined specific single-session psychotherapies for children. Now, for a first-ever meta-analysis, investigators conducted

Investigators addressed the question of whether therapeutic hypothermia (TH) is beneficial for comatose patients after in-hospital cardiac arrest,

Parkinson disease (PD) and other synucleinopathies have been associated with orthostatic hypotension (OH), which can be both asymptomatic and linked to

The incidence of hepatocellular cancer (HCC) is steadily increasing in the U.S., and HCC is the second leading cause of cancer-related death globally.

The paradox of pediatric emergency care is that while most children are seen in general emergency departments (EDs) by general emergency physicians,

Sweet solutions, such as those containing sucrose or glucose, have been shown to induce endogenous opioid analgesic mechanisms and improve pain for

Because inflammation and serotonin signaling have been implicated in both Alzheimer disease (AD) and depression, which frequently accompanies AD,

Previous research has shown that HIV infection is an independent risk factor for lung cancer, after accounting for traditional factors such as age,

Patients taking thienopyridines (clopidogrel, ticlopidine) have an increased risk for bleeding from peptic ulcers. Proton-pump inhibitors (PPIs) can

Neurofibrillary tangles are associated with tau pathology in Alzheimer disease (AD). To investigate the safety and efficacy of leuco-methylthioninium

A second examination of the right colon is suggested as a strategy to reduce missed precancerous polyps. Two randomized, controlled trials have found that a second examination of the right colon in the forward view is just as effective as a second examination in retroflexion. In the current study comprising 1020 patients, gastroenterologists performed two forward examinations of the right colon, each lasting up to 2 minutes, followed by a third exam in retroflexion. All examinations were performed using an instrument with the short cap on the scope. The success of …

Previous studies show that performing colonoscopy for a positive imaging test (computed tomographic colonography or double contrast barium enema) leads