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NEJM Editorial Fellow Abigail Schubach, M.D., shares why she decided to apply for an NEJM editorial fellowship, what NEJM fellows typically work on during their one-year term, what she's learned during her time, and how this fellowship will help further her career.    Applications for the 2025–26 NEJM editorial fellowship are now open. NEJM will accept applications for several one-year, full-time, paid editorial fellowships that begin July 2025. Applications are due Thursday, August 1, 2024.    For more reflections from prior NEJM fellows and for more information, visit https://nej.md/421foPx 

🎉 We now have 100,000 followers on Threads! 🎉    Thank you to our dedicated readers, researchers, and health care professionals for your continued support and engagement.     Follow us for the latest advancements in medical knowledge and improvements in patient care: https://lnkd.in/efMqAY2x 

Malnutrition is an imbalance between the growth and breakdown of body tissues and nutrient stores, resulting in loss of muscle and organ mass, diminished physical and mental functioning, and impaired clinical outcomes. Over the past 50 years, malnutrition has been increasingly recognized as a deleterious consequence of chronic and acute disease. On the basis of the cause of malnutrition, three subtypes are recognized: disease-related malnutrition in the absence of underlying inflammation, disease-related malnutrition with underlying inflammation, and starvation due to inadequate access to food (i.e., food insecurity) (shown in figure).    Malnutrition occurs in up to 10% of community-dwelling older people and contributes to morbidity and mortality. The two main pathologic pathways are nutrient deprivation and inflammation-induced tissue catabolism with anorexia.    Read “Malnutrition in Adults,” the latest Review Article in the Nutrition in Medicine series, by Tommy Cederholm, M.D., Ph.D., and Ingvar Bosaeus, M.D., Ph.D.: https://nej.md/3RY29gs 

Whether proton-pump inhibitors are beneficial or harmful for stress ulcer prophylaxis in critically ill patients undergoing invasive ventilation is unclear.     In the REVISE trial, researchers compared the effect of a proton-pump inhibitor on the risk of gastrointestinal bleeding with that of placebo in patients undergoing mechanical ventilation.     4821 critically ill adults undergoing invasive mechanical ventilation were assigned to receive infusions of either 40 mg of pantoprazole or placebo daily for up to 90 days.      The primary efficacy outcome was clinically important upper gastrointestinal bleeding, and the primary safety outcome was death from any cause at 90 days.     Among patients undergoing invasive ventilation, pantoprazole resulted in a significantly lower risk of clinically important upper gastrointestinal bleeding than placebo, with no significant effect on mortality.     Read the full REVISE trial results and Plain Language Summary: https://nej.md/3KD01Xp 

An 𝗲𝗺𝗯𝗿𝘆𝗼𝗶𝗱 𝗯𝗼𝗱𝘆 is a floating three-dimensional aggregate of differentiating pluripotent stem cells containing mixtures of tissue precursors.    To learn more about this NEJM Illustrated Glossary term, read the 2019 Review Article “Organoids — Preclinical Models of Human Disease” by Mo Li, Ph.D., and Juan Carlos Izpisua Belmonte, Ph.D.: https://nej.md/2HUTMAL    Explore more terms: https://nej.md/glossary 

In the practice of medicine, lifelong learning is a requirement, and the importance of real-life clinical practice scenarios provides invaluable insight into clinical decisions.    A new collection, curated by NEJM physician-editors, introduces new ways to practice and expand your diagnostic decision-making skills with novel and challenging case-based articles that integrate real-life clinical practice scenarios across multiple specialties and levels of expertise.    🔍 View 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗣𝗿𝗮𝗰𝘁𝗶𝗰𝗲 cases for common clinical problems through the lens of an expert. 📘 Study 𝗜𝗺𝗮𝗴𝗲𝘀 𝗶𝗻 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗠𝗲𝗱𝗶𝗰𝗶𝗻𝗲 featuring common and unusual conditions seen in daily practice. 👥 Shadow an expert in 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗣𝗿𝗼𝗯𝗹𝗲𝗺-𝗦𝗼𝗹𝘃𝗶𝗻𝗴 cases that provide relevant background, recommendations and reasons behind their decisions. 📝 Manage a real peer-reviewed case with 𝗜𝗻𝘁𝗲𝗿𝗮𝗰𝘁𝗶𝘃𝗲 𝗠𝗲𝗱𝗶𝗰𝗮𝗹 𝗖𝗮𝘀𝗲𝘀 that present patient history; step-by-step series of questions; and exercises testing diagnostic and therapeutic skills. 🎓 Learn from 𝗖𝗮𝘀𝗲 𝗥𝗲𝗰𝗼𝗿𝗱𝘀 𝗼𝗳 𝘁𝗵𝗲 𝗠𝗮𝘀𝘀𝗮𝗰𝗵𝘂𝘀𝗲𝘁𝘁𝘀 𝗚𝗲𝗻𝗲𝗿𝗮𝗹 𝗛𝗼𝘀𝗽𝗶𝘁𝗮𝗹 conference presentations describing diagnosis management, insights into medical decision-making, and progressive workup and treatment options. 📚 Consider differing expert opinions with our 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗗𝗲𝗰𝗶𝘀𝗶𝗼𝗻𝘀 articles introducing clinical cases with essays from experts defending differing courses of action.    Download your free copy now: https://nej.md/3RQbDu1 

A thorough history and physical examination, the judicious administration of analgesia, effective use of imaging, and timely surgical consultation can lead to the appropriate diagnosis of the acute abdomen. Clinicians must remain mindful of their biases so that they do not incite processing errors and result in incorrect diagnoses that can lead to morbidity and death.    The Ishikawa fishbone diagram (shown in figure) depicts a cause-and-effect approach, which incorporates attributions and considerations that are essential for achieving a desirable patient-centered outcome. This fishbone diagram represents our how-to guide for achieving a timely evaluation and diagnosis of acute abdominal pain. The diagram shows multiple factors and relates them to one major effect. The main branches identify the primary causes of the effect. The stems of each main branch indicate contributing factors. For example, the surgical consultation branch has a stem labeled “experience.” Other factors could be added, such as the year of residency training or the specialty of the first responder.    Learn more in the Review Article “Acute Abdomen in the Modern Era” by Selwyn O. Rogers Jr., M.D., M.P.H., and Orlando Kirton M.D.: https://nej.md/4cK1QOd 

The human monoclonal antibody dupilumab is approved to treat eosinophilic esophagitis in adults and adolescents. Data on the efficacy and safety of dupilumab in children younger than 12 years of age are needed.    In a new trial, researchers evaluated whether dupilumab would improve histologic outcomes in children 1 to 11 years of age with eosinophilic esophagitis.    In Part A of the trial, 102 children 1 to 11 years of age with eosinophilic esophagitis that was unresponsive to proton-pump inhibitors were randomly assigned to higher-exposure (HE) or lower-exposure (LE) subcutaneous dupilumab regimens (tiered according to body weight) or to placebo for 16 weeks.     In Part B, eligible patients who completed Part A continued the same dupilumab regimen or switched from placebo to HE or LE dupilumab for an additional 36 weeks. The primary end point was histologic remission (≤6 eosinophils per high-power field) at week 16.    In children 1 to 11 years of age with eosinophilic esophagitis, weight-tiered dupilumab treatment regimens led to histologic remission in a significantly higher percentage of children than placebo.    Read the full trial results and Plain Language Summary: https://nej.md/3VVnWYE 

Climate change is causing a global increase in average temperatures and increasing the frequency, duration, and intensity of extreme heat events, resulting in unprecedented levels of heat exposure.     In the latest Double Take video, NEJM Editorial Fellow Julie Barzilay, M.D., reviews the range of acute heat-related illnesses, including their symptoms, complications, and management. Risk factors associated with increased morbidity and mortality from heat-related illnesses and strategies for primary care clinicians to reduce risk are also examined. Watch the video: https://nej.md/3zjVyq9    Further reading: Treatment and Prevention of Heat-Related Illness (Sorensen and Hess, September 28, 2022, NEJM) https://nej.md/3xV787u 

𝗫𝗲𝗻𝗼𝘁𝗿𝗮𝗻𝘀𝗽𝗹𝗮𝗻𝘁𝗮𝘁𝗶𝗼𝗻 is the transplantation of cells, tissue, or organs to a recipient organism of a different species. The example illustrates a partially humanized pig organ (purple dots) transplanted into a human patient.     To learn more about this NEJM Illustrated Glossary term, read the Review Article “Risks of Infectious Disease in Xenotransplantation” by Jay Fishman, M.D.: https://nej.md/3W9bH7S     Explore more terms: https://nej.md/glossary