- N Engl J Med 2022; 386:1732-1740
Nonspecific low back pain is diagnosed by ruling out other causes, usually by means of history taking and physical examination; imaging is not routinely indicated. Patients with acute nonspecific low back pain should receive education about the condition and advice to remain active; most recover within weeks. Exercise therapy and...
- N Engl J Med 2022; 386:1443-1451
Cancer-associated hypercalcemia often occurs late in the course of solid-tumor development and is associated with a poor prognosis. Treatment includes intravenous hydration followed by antiresorptive agents, typically intravenous bisphosphonates. Successful management ultimately depends on effective treatment of the underlying cancer.
- N Engl J Med 2022; 386:1155-1164
Management of type 1 diabetes mellitus in children involves close family support and glucose monitoring. Improved means of insulin administration include newer pumps or smart pens that receive data from continuous glucose monitoring and can assist in calculation of insulin doses.
- N Engl J Med 2022; 386:869-878
Chronic pancreatitis, often associated with alcohol use, smoking, or genetic risk factors, may be complicated by pseudocysts, biliary strictures, pancreatic insufficiency, bone loss, and pancreatic cancer. Aspects of management include structural and nonstructural interventions for pain and treatment with pancreatic-enzyme replacement.
- N Engl J Med 2022; 386:264-272
RDTs for SARS-CoV-2 — either molecular nucleic acid amplification tests or antigen-based immunoassays to detect proteins — are approved for persons with Covid-19 symptoms and asymptomatic persons with known exposure to SARS-CoV-2 or those in a high-transmission setting. Antigen-based tests have lower sensitivity than PCR tests, but they may correlate...
- N Engl J Med 2021; 385:2554-2561
The determination of brain death is typically made on the basis of clinical assessment (shown in a video) and requires demonstration of the permanent loss of all brain function, including brainstem function, in the absence of factors that may confound the assessment. If these factors cannot be eliminated, or if...
- N Engl J Med 2021; 385:2271-2280
Persons with risk factors for Mycobacterium tuberculosis exposure or for progression to tuberculosis disease should be tested for M. tuberculosis infection, preferably with an interferon-γ release assay. After tuberculosis disease is ruled out, those at increased risk for progression should be treated, preferably with a rifamycin-based...
- N Engl J Med 2021; 385:1690-1698
Repair of abdominal aortic aneurysm is recommended in men with an aneurysm of 5.5 cm or more and in women with an aneurysm of 5.0 cm or more. In randomized trials, endovascular aortic aneurysm repair was associated with a lower risk of perioperative complications and death than open surgical repair,...
- N Engl J Med 2021; 385:1116-1123
Treatment for acute uncomplicated appendicitis may involve appendectomy or nonoperative care (pain control, antibiotics, and careful follow-up). The advantages and disadvantages of each should be discussed with the patient. Over 5 years, 30 to 40% of patients who received antibiotics will undergo appendectomy, although the range may vary, depending on...
- N Engl J Med 2021; 385:539-547
Age-related macular degeneration is the leading cause of vision loss in older persons in industrialized nations. Micronutrient supplementation can reduce the risk of progression to advanced AMD. Treatment of neovascular AMD with anti–vascular endothelial growth factor pharmacotherapy reduces vision loss.
- N Engl J Med 2021; 385:251-263
A detailed history taking and an eyewitness account are important in diagnosing a seizure. Antiseizure medication is generally not prescribed after a single seizure, except for patients with a high risk of recurrence. The medication choice varies according to the type of seizure and the patient’s coexisting conditions and childbearing...
- N Engl J Med 2021; 384:2428-2436
Stress incontinence is common among women but underdiagnosed. Effective initial interventions include weight loss in overweight or obese women and pelvic-floor muscle exercises. Other options include pessaries or surgery (most commonly midurethral mesh sling surgery) for women with bothersome symptoms not responsive to other interventions.
- N Engl J Med 2021; 384:2131-2143
Universal screening for HIV infection is recommended, with repeat testing in persons at high risk. Infected persons should be promptly referred for a comprehensive assessment, including screening for associated infections and attention to social factors that may hinder adherence to treatment, and antiretroviral therapy should be initiated.
- N Engl J Med 2021; 384:1542-1551
An adrenal mass discovered in testing for another condition (an “incidentaloma”) warrants biochemical tests to detect pheochromocytoma, excess cortisol, and, in a patient with hypertension, primary hyperaldosteronism. Imaging may distinguish benign from malignant lesions. Small nonfunctioning adrenal tumors with low CT attenuation generally do not warrant intervention or long-term follow-up.
- N Engl J Med 2021; 384:1248-1260
In patients with type 2 diabetes and established cardiovascular disease (or in those with a high risk of cardiovascular disease) in whom glycemic goals are not achieved with metformin, agents from the GLP-1 receptor agonist or SGLT2 inhibitor classes with demonstrated cardiovascular benefit constitute the recommended treatment.
- N Engl J Med 2021; 384:944-951
Initial management of epistaxis involves digital compression of the lower third of the nose for 15 to 20 minutes. Anterior bleeding not controlled with compression can usually be controlled with topical vasoconstrictors, tranexamic acid, cautery, or anterior nasal packing. If epistaxis continues, posterior packing, arterial ligation, or embolization may be...
- N Engl J Med 2021; 384:353-361
Management of atrial fibrillation includes therapy for treatable risk factors, anticoagulation based on estimated stroke risk, rate control, and in appropriate circumstances, catheter ablation or antiarrhythmic drugs to maintain sinus rhythm.
- N Engl J Med 2021; 384:51-59
Knee osteoarthritis is highly prevalent among older adults. Treatments include exercise, weight management, training in self-efficacy and pain-coping skills, and medications (commonly topical or oral NSAIDs, the latter often with a proton-pump inhibitor).