www.nejm.org Open in urlscan Pro
104.18.1.63  Public Scan

Form analysis
3 forms found in the DOM

GET /search?pageType=search

<form action="/search?pageType=search" method="get" class="g-nav__search-form" data-behavior="SearchSuggestions" data-searchsuggestions-action="">
  <fieldset>
    <legend>Search site</legend>
    <label for="search_1">Keyword</label>
    <div class="search_1_cont">
      <input id="search_1" type="text" name="q" value="" size="15" autocomplete="off" placeholder="Enter keyword, author, title or citation" data-provide="rac" data-required="true" data-gsearch-keyword-input="" class="ui-autocomplete-input">
      <ul id="ui-id-1" tabindex="0" class="ui-menu ui-widget ui-widget-content ui-autocomplete ui-front" style="display: none;"></ul>
    </div>
    <button aria-label="search" title="search" type="submit">
      <svg class="icon--search">
        <use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon--search"></use>
      </svg>
    </button>
  </fieldset>
</form>

GET /search?pageType=search

<form action="/search?pageType=search" method="get" data-behavior="SearchSuggestions" data-searchsuggestions-action="">
  <label class="a-label" for="search_2">Keyword</label>
  <div class="search_2_cont">
    <input id="search_2" type="text" name="q" value="" size="15" tabindex="0" autocomplete="off" placeholder="Enter keyword, author, title or citation" data-provide="rac" data-required="true" data-gsearch-keyword-input=""
      class="ui-autocomplete-input">
    <ul id="ui-id-2" tabindex="0" class="ui-menu ui-widget ui-widget-content ui-autocomplete ui-front" style="display: none;"></ul>
  </div>
  <button class="g-search__submit-btn" aria-label="search" title="search" type="submit" data-gsearch-submit="">
    <svg class="icon--search">
      <use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon--search"></use>
    </svg>
  </button>
  <a href="/medical-search" class="g-search__advanced-search-link" arialabelledby="advanced search" title="advanced search">Advanced Search</a>
</form>

Name: signInForm — POST https://mms.us.janraincapture.com/widget/traditional_signin.jsonp

<form id="capture_signIn_signInForm" name="signInForm" data-capturefield="signInForm" action="https://mms.us.janraincapture.com/widget/traditional_signin.jsonp" class="capture_form capture_signInForm" method="POST" novalidate="novalidate"
  data-transactionid="nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" target="captureIFrame_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" accept-charset="UTF-8" next="{&quot;noop&quot;:&quot;&quot;}">
  <div id="capture_signIn_signInForm_defaultSavedProfileMessage"></div>
  <div id="capture_signIn_signInForm_errorMessages"></div><input id="capture_signIn_utf8" data-capturefield="undefined" value="✓" type="hidden" class="capture_utf8" name="utf8"><input
    id="capture_signIn_screen_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" data-capturefield="undefined" value="signIn" type="hidden" class="capture_screen_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" name="capture_screen"><input
    id="capture_signIn_js_version_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" data-capturefield="undefined" value="d445bf4" type="hidden" class="capture_js_version_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" name="js_version"><input
    id="capture_signIn_transactionId_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" data-capturefield="undefined" value="nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" type="hidden" class="capture_transactionId_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61"
    name="capture_transactionId"><input id="capture_signIn_form_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" data-capturefield="undefined" value="signInForm" type="hidden" class="capture_form_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" name="form"><input
    id="capture_signIn_flow_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" data-capturefield="undefined" value="standard" type="hidden" class="capture_flow_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" name="flow"><input
    id="capture_signIn_client_id_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" data-capturefield="undefined" value="qsra7g4d6jwdsgn3zbe6udp6r6278mr9" type="hidden" class="capture_client_id_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" name="client_id"><input
    id="capture_signIn_redirect_uri_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" data-capturefield="undefined" value="https://www.nejm.org" type="hidden" class="capture_redirect_uri_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" name="redirect_uri"><input
    id="capture_signIn_response_type_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" data-capturefield="undefined" value="code" type="hidden" class="capture_response_type_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" name="response_type"><input
    id="capture_signIn_flow_version_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" data-capturefield="undefined" value="20210629180053571925" type="hidden" class="capture_flow_version_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" name="flow_version"><input
    id="capture_signIn_settings_version_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" data-capturefield="undefined" value="" type="hidden" class="capture_settings_version_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" name="settings_version"><input
    id="capture_signIn_locale_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" data-capturefield="undefined" value="en-US" type="hidden" class="capture_locale_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" name="locale"><input
    id="capture_signIn_recaptcha_version_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" data-capturefield="undefined" value="2" type="hidden" class="capture_recaptcha_version_nhz19libnr0hpviun46x8if4ijs3mzjrn9if2o61" name="recaptchaVersion">
  <div class="ucc-form-inner-wrapper">
    <div id="capture_signIn_form_item_signInEmailAddress" class="capture_form_item capture_email capture_form_item_signInEmailAddress" data-capturefield="undefined"><label for="capture_signIn_signInEmailAddress">Email Address</label><input
        id="capture_signIn_signInEmailAddress" data-capturefield="signInEmailAddress" value="" type="email" class="capture_signInEmailAddress capture_required capture_text_input" placeholder="Email Address" name="signInEmailAddress">
      <div class="capture_tip" style="display:none;"></div>
      <div class="capture_tip_validating" data-elementname="signInEmailAddress">Validating</div>
      <div class="capture_tip_error" data-elementname="signInEmailAddress"></div>
    </div>
    <div id="capture_signIn_form_item_currentPassword" class="capture_form_item capture_password capture_form_item_currentPassword" data-capturefield="undefined"><label for="capture_signIn_currentPassword">Password</label><input
        id="capture_signIn_currentPassword" data-capturefield="currentPassword" value="" type="password" class="capture_currentPassword capture_required capture_text_input" placeholder="Password" name="currentPassword">
      <div class="capture_tip" style="display:none;"></div>
      <div class="capture_tip_validating" data-elementname="currentPassword">Validating</div>
      <div class="capture_tip_error" data-elementname="currentPassword"></div>
    </div>
    <div style="padding-top:10px;">
      <div class="capture_form_item capture_form_rememberme">
        <label class="ucc-form-checkbox">
          <input checked="checked" id="ucc-remember-me-cb" name="ucc-remember-me-cb" type="checkbox" value="true">
          <span>Remember Me</span>
        </label>
      </div>
      <div class="capture_form_item capture_form_forgotpwd">
        <a role="button" class="ucc-anchor-button" data-capturescreen="forgotPassword">Forgot your password?</a>
      </div>
    </div>
    <div class="capture_form_item">
      <button id="ucc-sign-in-submit" class="capture_primary capture-full-width-btn" type="submit">Sign In</button>
    </div>
    <div class="capture_form_item">
      <div class="ucc-no-acct-msg">Don't have an account?</div>
      <div class="ucc-no-acct-msg-2" id="signInModalCreateAccountLink">
        <a role="button" class="ucc-anchor-button" onclick="mmsWidgets.closeSignIn(event); mmsWidgets.showRegAuto(event);">Create Account</a>
        <span></span><a href="https://store.nejm.org/nejm?promo=ONF4NRS1">Subscribe</a>
      </div>
      <div class="ucc-no-acct-msg-2" id="signInModalCloseLink" style="display:none">
        <a role="button" class="ucc-anchor-button" onclick="mmsWidgets.closeSignIn(event);">Create Account</a>
        <span></span><a href="https://store.nejm.org/nejm?promo=ONF4NRS1">Subscribe</a>
      </div>
    </div>
    <div class="capture_form_item capture_form_submit">
    </div>
  </div>
</form>

Text Content

logo-32 logo-40 logo-60
Skip to main content

New England Journal of Medicine
 * NEJM Group
 * Follow Us
    * Facebook. opens in new tab
    * Twitter. opens in new tab
    * Instagram. opens in new tab
    * YouTube. opens in new tab
    * LinkedIn. opens in new tab

Prepare to become a physician, build your knowledge, lead a health care
organization, and advance your career with NEJM Group information and services.

. opens in new tab
 * NEJM Evidence
   NEW! A digital journal for innovative original research and fresh, bold ideas
   in clinical trial design and clinical decision-making. . opens in new tab
 * NEJM Catalyst
   NEW! Peer-reviewed journal featuring in-depth articles to accelerate the
   transformation of health care delivery. . opens in new tab
 * NEJM Journal Watch
   Concise summaries and expert physician commentary that busy clinicians need
   to enhance patient care. . opens in new tab
 * NEJM Knowledge+
   The most effective and engaging way for clinicians to learn, improve their
   practice, and prepare for board exams. . opens in new tab
 * NEJM Resident 360
   Information, resources, and support needed to approach rotations - and life
   as a resident. . opens in new tab
 * NEJM Healer
   The most advanced way to teach, practice, and assess clinical reasoning
   skills. . opens in new tab
 * NEJM 医学前沿
   The authorized source of trusted medical research and education for the
   Chinese-language medical community. . opens in new tab
 * NEJM Career Center
   Valuable tools for building a rewarding career in health care. . opens in new
   tab
 * NEJM Library Hub
   Information and tools for librarians about site license offerings. . opens in
   new tab
 * The New England Journal of Medicine
   The most trusted, influential source of new medical knowledge and clinical
   best practices in the world. . opens in new tab

 * 
 * 

 * Sign In
 * Create Account
 * Subscribe

 *  * Sign In
    * Create Account
    * Renew subscription
    * Subscribe

 * 
 * 

Stay connected to what's important in medical research and clinical practice

Create Account

Subscribe to the most trusted
and influential source of
medical knowledge

Subscribe

Already a subscriber? Renew or Sign in

Subscribe
or Renew

Search site Keyword

 * New England Journal of Medicine
 * Search
 * Home
 * Specialties
   Specialties
   
   Selected specialties
   
    * Allergy/Immunology
    * Cardiology
    * Clinical Medicine
    * Dermatology
    * Emergency Medicine
    * Endocrinology
    * Gastroenterology
    * Genetics
    * Geriatrics/Aging
    * Hematology/Oncology
    * Infectious Disease
    * Nephrology
    * Neurology/Neurosurgery
    * Obstetrics/Gynecology
    * Pediatrics
    * Psychiatry
    * Pulmonary/Critical Care
    * Rheumatology
    * Surgery
    * View all specialties
   
   View all specialties
   
    * Cardiology
    * Hematology/Oncology
    * Infectious Disease

 * Topics
   Topics
   
   Selected Topics
   
    * Health Policy
    * Medicine and Society
    * Gray Matters
    * AI in Medicine
    * Fundamentals of Health Law
    * Fundamentals of Public Health
    * Coronavirus
    * Race and Medicine
    * Climate Crisis and Health
    * Data Sharing
    * Pain Management
    * View all topics
   
   View all topics
   
    * Coronavirus
    * Health Policy
    * Medicine and Society

 * Multimedia
   Multimedia
   
   Selected Multimedia
   
    * Podcasts
       * Audio Interviews
       * Audio Weekly Summaries
       * Intention to Treat
       * Not Otherwise Specified
   
    * Double Takes
    * Illustrated Glossary
    * Image Challenge
    * Interactive Medical Cases
    * Quick Takes
    * Research Summaries
    * Videos in Clinical Medicine
    * View all multimedia
   
   View all multimedia
   
    * Blinatumomab in Infant Lymphoblastic Leukemia
    * Balancing Innovation and Access
    * Toxidrome Recognition and Response
    * Thinking outside the Heart

 * Current Issue
   Current Issue
   
   Current Issue
   
    * Current Issue
    * April 27, 2023  Vol. 388  No. 17
   
   Recent Issues
   
    * April 20, 2023  Vol. 388  No. 16
    * April 13, 2023  Vol. 388  No. 15
    * April 6, 2023  Vol. 388  No. 14
    * Browse full issue index
    * Browse recently published
   
   Browse full issue index
   
   Recently Published Articles
   
    * Xylazine — Medical and Public Health Imperatives  R. Gupta et al.
    * Traumatic Acute Subdural Hematoma — Should the Bone Flap Be Removed or
      Replaced?  S. Gopinath
    * Decompressive Craniectomy versus Craniotomy for Acute Subdural Hematoma
       P.J. Hutchinson et al.
    * Falling Insulin Prices — What Just Happened?  L.S. Dafny
    * Durability of Bivalent Boosters against Omicron Subvariants  D.-Y. Lin et
      al.
    * Dostarlimab for Primary Advanced or Recurrent Endometrial Cancer  M.R.
      Mirza et al.
   
   Browse recently published

 * Learning/CME
   Learning/CME
    * CME
       * Case 13-2023: A 25-Year-Old Woman with Abdominal Pain and Jerking
         Movements
       * Blinatumomab Added to Chemotherapy in Infant Lymphoblastic Leukemia
       * Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for
         Prostate Cancer
   
    * Clinical Cases Resource Center
      * Interactive Medical Cases
      * Image Challenge
    * Videos in Clinical Medicine
    * NEJM Resident 360
    * NEJM Knowledge+
    * View all learning/CME
   
   View all learning/CME
   
   Other NEJM Group Learning
   
    * Hand Hygiene
    * Essential information students and residents need to approach residency
      with confidence: practical training information, career guidance,
      insightful discussions.
    * Effective, adaptive learning that helps you prepare for certification,
      maintain competency, and sharpen clinical decision-making while earning
      CME and MOC.

 * Author Center
 * Covid-19
   

 * Subscribe
   or Renew

Keyword

Advanced Search

ATTENTION:Due to global market conditions, you may experience a delivery delay
for your print issue of the New England Journal of Medicine. Your subscription
also includes full access to the NEJM.org website. We regret any print delays
and are working to ensure all issues are delivered as soon as possible. Thank
you for your patience..

 * * Original Article 15-Year Follow-up of Prostate Cancer Therapies F.C. Hamdy
     and Others
     
     In men with prostate cancer on PSA screening, radical treatments led to
     half the incidence of metastasis and local progression as active monitoring
     without affecting disease-specific or overall survival.
     
     Apr 27
     
     Editorial Localized Prostate Cancer — Then and Now
     Perspective Waiting on Prostate Cancer
 * * Editorial Covid-19 Update for April 24 Preparing for the Next Pandemic E.J.
     Rubin and Others
     
     In this audio interview conducted on April 24, the editors are joined by
     international infectious disease experts Quarraisha Abdool Karim, Salim
     Abdool Karim, and Richard Wenzel to discuss preparing for the next
     pandemic.
     
     Apr 27
   * Perspective Double Take Toxidrome Recognition and Response G.R. Ciottone,
     D. Longo, and D. Taichman
     
     This short, animated video provides an overview of how first responders use
     knowledge of toxidromes and mitigation techniques to deal with a fictional
     terrorist attack.
     
     Apr 27

 * * Perspective Xylazine — Medical and Public Health Imperatives R. Gupta, D.R.
     Holtgrave, and M.A. Ashburn
     
     Use of xylazine, most often in combination with other drugs such as
     fentanyl, is a rapidly growing health threat. People being harmed by this
     drug deserve rapid, comprehensive, and high-quality care.
     
     Apr 26
   * Perspective Fundamentals of Health Law Access to Biomedical Innovation A.K.
     Rai
     
     The U.S. legal system governing access to biomedical innovation comprises
     multiple interacting parts, and parts of this system are clearly mismatched
     and out of balance.
     
     Apr 27
 * * Clinical Decisions Dietary Sodium Restriction in Patients with Heart
     Failure L.L. Chang and Others
     
     This feature about a patient with heart failure offers a case vignette
     accompanied by two essays, one supporting recommendation of a low-sodium
     diet and the other recommending no sodium restriction. Cast your vote.
     
     Apr 27
   * Perspective Racial Affinity Group Caucusing in Medical Education L. Lewis
     and Others
     
     Racial affinity group caucuses — facilitated sessions for learners who join
     groups according to self-identified racial or ethnic identity — can help
     integrate antiracism curricula into clinical practice.
     
     Apr 27

Image Challenge



What is the diagnosis?

Answer



Sponsored by



Image of the Week



A Painful Scalp Rash — A previously healthy 47-year-old man presented with a
7-month of history of a painful rash on his head.



Most Viewed

 * Correspondence May 19, 2022
   Current Causes of Death in Children and Adolescents in the United States
   J. E. Goldstick, R. M. Cunningham, and P. M. Carter
 * Images in Clinical Medicine Apr 20, 2023
   Desquamative Interstitial Pneumonia
   M. Al-Halawani and R. K. Stevens


ORIGINAL RESEARCH

 * * Original Article Blinatumomab in Infant Acute Lymphoblastic Leukemia I.M.
     van der Sluis and Others
     
     In this study, the addition of blinatumomab to standard chemotherapy
     improved disease-free and overall survival among infants with
     KMT2A-rearranged ALL, with minimal additional toxic effects.
     
     Apr 27
 * * Original Article Deciphering Developmental Disorders C.F. Wright and Others
     
     The DDD study recruited more than 13,500 families with probands with
     severe, probably monogenic disorders in the United Kingdom and Ireland and
     obtained a genetic diagnosis in approximately 41% of probands.
     
     Apr 27
     
     Editorial Genomics in Clinical Practice
   
   * Original Article BCG Vaccination against Covid-19 L.F. Pittet and Others
     
     The bacille Calmette–Guérin vaccine may enhance generic antiviral immunity.
     In an international, randomized, controlled trial, health care workers
     received BCG vaccination or placebo. The BCG vaccine did not reduce
     Covid-19 risk.
     
     Apr 27

 * * Correspondence Genetic Events in Adult-Onset Inflammatory Disease E. De
     Langhe and Others
     
     The case of a patient with adult-onset inflammatory disease is reported.
     Two somatic genetic events accounted for the disease and its onset in
     adulthood.
     
     Apr 27
 * * Correspondence SARS-CoV-2 Variants and MIS-C B.W. McCrindle and Others
     
     Multisystem inflammatory syndrome in children has been less severe with
     each subsequent SARS-CoV-2 variant. However, critical illness in
     hospitalized patients with MIS-C remains prevalent.
     
     Apr 27

. opens in new tab
PHYSICIAN JOBS
April 28, 2023
Burlington, Massachusetts
Urgent Care
Adult Urgent Care Burlington
New York
Hematology / Oncology
Hematologists/Oncologists - Suffolk County, NY
Belleville, New Jersey
Obstetrics & Gynecology
Obstetrician and Gynecology Physician- Riverside Medical Group - Belleville, NJ
Redmond, Washington State
Pediatrics, General
Pediatrician
Corpus Christi, Texas
Hospitalist
Hospitalist Physician - Wellmed Networks, Inc. - Corpus Christi, TX
Utica, New York
Family Medicine
Family Medicine Physician



CLINICAL PRACTICE AND REVIEW

 * * Case Records of the Massachusetts General Hospital A Woman with Abdominal
     Pain and Jerking Movements L.H. Simmons, M. Nisavic, and A.K. Dickey
     
     A 25-year-old woman with a history of acute intermittent porphyria was
     admitted with abdominal pain and jerking movements of the arm and leg.
     Symptoms did not abate with hemin treatment. What is the diagnosis?
     
     Apr 27
   * Interactive Medical Case Thinking outside the Heart R.A. Denu and Others
     
     A 50-year-old woman presented to the ED with pleuritic chest pain and
     shortness of breath. Test your diagnostic and therapeutic skills.
     
     Apr 27
   * Perspective Helping People Stop Smoking N.L. Benowitz and Others
     
     The FDA could take steps to encourage the development and marketing of
     consumer-desirable, effective smoking-cessation aids, which would represent
     an important contribution to public health.
     
     Apr 22
 * * Review Article AI in Medicine Advances in AI for Infectious-Disease
     Surveillance J.S. Brownstein and Others
     
     This article in the AI in Medicine series addresses the use of AI and
     machine-learning tools to identify and track disease outbreaks and monitor
     mitigation strategies.
     
     Apr 27
   * Case Records of the Massachusetts General Hospital A Woman with Muscle
     Weakness and Myalgia M.B. Bolster and Others
     
     A 44-year-old woman with rheumatoid arthritis was evaluated because of
     proximal muscle weakness and myalgia. She had difficulty raising her arms
     above her head. What is the diagnosis?
     
     Apr 20

. opens in new tab
. opens in new tab

Which one of the following laboratory findings is most likely in an 18-year-old
woman with arthritis, quotidian fever, a faint pink rash on her chest, and a
negative test for antinuclear antibodies?

 * Positive antineutrophil cytoplasmic antibody test
 * Positive rheumatoid factor test
 * Elevated serum cryoglobulin level
 * Positive anti–double-stranded DNA antibody test
 * Elevated serum ferritin level




FEATURED MULTIMEDIA

Quick Take

MONITORING, SURGERY, OR RADIOTHERAPY FOR PROSTATE CANCER



01:44
Quick Take

BCG VACCINATION TO PROTECT AGAINST COVID-19 IN HEALTH CARE WORKERS



01:46
Quick Take

BLINATUMOMAB IN INFANT LYMPHOBLASTIC LEUKEMIA



02:30
Quick Take

SOTATERCEPT FOR PULMONARY ARTERIAL HYPERTENSION



02:19
Quick Take

BIVALENT RSV PREFUSION F VACCINE IN OLDER ADULTS



02:25
Quick Take

CEREBRAL OXIMETRY FOR EXTREMELY PRETERM INFANTS



01:40
Quick Take

MATERNAL VACCINATION AGAINST RSV ILLNESS IN INFANTS



02:09
Quick Take

TRANEXAMIC ACID AFTER CESAREAN DELIVERY



01:35
More Multimedia


COMMENTARY

 * Perspective Apr 27 Access to Biomedical Innovation
   A.K. Rai
 * Perspective Apr 27 Helping People Stop Smoking
   N.L. Benowitz and Others
 * Editorial Apr 27 Localized Prostate Cancer — Then and Now
   O. Sartor
 * Editorial Apr 27 Genomics in Clinical Practice
   J.E. Posey and J.R. Lupski
 * Perspective Apr 27 Racial Affinity Group Caucusing in Medical Education
   L. Lewis and Others
 * Perspective Apr 26 Xylazine — Medical and Public Health Imperatives
   R. Gupta, D.R. Holtgrave, and M.A. Ashburn


CORRESPONDENCE

 * SARS-CoV-2 Variants and Multisystem Inflammatory Syndrome in Children
 * TET2-Driver and NLRC4-Passenger Variants in Adult-Onset Autoinflammation
 * Extent of Surgery for Stage IA Non–Small-Cell Lung Cancer
 * Lecanemab in Early Alzheimer’s Disease

. opens in new tab
. opens in new tab

What are the top three biggest barriers to successful patient care transitions?

 * Fragmentation of care delivery (e.g., poor handoffs)
 * Poor communication between providers (e.g., inadequate discharge summary)
 * Challenges related to social determinants of health
 * Clinical workforce shortages
 * Inadequate insurance coverage
 * Lack of timely provider follow-up
 * Lack of access to care (e.g., to specialists)
 * Poor provider communication with patients
 * Insurance denials
 * Medication errors

Learn about
the Insights Council. opens in new tab

catalyst.nejm.org. opens in new tab

Tap into groundbreaking research and clinically relevant insights

 * Subscribe

Already a subscriber? Sign In or Renew



Back to top


ARTICLE CATEGORIES

 * Research
 * Reviews
 * Clinical Cases
 * Perspective
 * Commentary
 * Other
 * Browse all Articles
 * Current Issue
 * Issue Index


RESOURCES

 * Authors & Reviewers
 * Submit a Manuscript
 * Subscribers
 * Institutions. opens in new tab
 * Media
 * Advertisers
 * Agents
 * Permissions
 * Reprints
 * NEJM CareerCenter. opens in new tab


ABOUT US

 * About NEJM
 * Products & Services
 * Editors & Publishers
 * Advertising Policies
 * Contact Us
 * Accessibility
 * FAQs
 * Help
 * Site Feedback


SUBSCRIPTIONS

 * Subscribe
 * Renew
 * Activate Subscription
 * Create Account
 * Manage Account
 * Pay Bill
 * Special Content


STAY CONNECTED

 * Email Alerts
 * Create Account
 * Apps
 * NEJM CareerCenter. opens in new tab
 * Podcasts
 * RSS Feed
 * Remote Access


FOLLOW US

 * Facebook . opens in new tab
 * Twitter . opens in new tab
 * Instagram . opens in new tab
 * YouTube . opens in new tab
 * LinkedIn . opens in new tab

JOURNALS

 * The New England Journal of Medicine. opens in new tab
 * NEJM Catalyst Innovations in Care Delivery. opens in new tab
 * NEJM Evidence. opens in new tab

 * Copyright © 2023 Massachusetts Medical Society.
 * All rights reserved.
 * Electronic ISSN 1533-4406.
 * Print ISSN 0028-4793.
 * The content of this site is intended for health care professionals.
 * Copyright. opens in new tab
 * Terms. opens in new tab
 * Privacy Policy. opens in new tab

. opens in new tab


SIGN IN

{* #signInForm *}
{* signInEmailAddress *} {* currentPassword *}
Remember Me
Forgot your password?
Sign In
Don't have an account?
Create Account Subscribe

{* /signInForm *}


FORGOT PASSWORD

Enter the email address associated with your account then click Continue. We
will email you a link to a page where you can easily create a new password.

{* #forgotPasswordForm *}
{* forgotPasswordEmailAddress *} {* captcha *}

{* /forgotPasswordForm *}


CREATE NEW PASSWORD

We've sent an email with instructions to create a new password. Your existing
password has not been changed.

CLOSE

To reset your password, enter a new password twice and click the 'Reset
Password' button.

{* #changePasswordFormNoAuth *} {* newPassword *} {* newPasswordConfirm *}

{* /changePasswordFormNoAuth *}

Your password has been reset. You will need to sign in again using your new
password to access site content and features.



{* #resetPasswordForm *}
The link that you followed to reset your password has expired.

Enter the email address associated with your account then click Continue. We
will email you a link to a page where you can easily create a new password.

{* signInEmailAddress *}

{* /resetPasswordForm *}

If the address matches an existing account, you will receive an email with
instructions to reset your password.











THIS SITE USES COOKIES to personalize content, to measure website and
advertising performance, and to present relevant advertising.
By continuing to use our site, you accept the use of these cookies. To learn
more, please visit our Cookie Information. opens in new tab page.
Sign in using your account with
 * AOL
 * OpenID

 * Yahoo!

Social Login by Janrain. opens in new tab

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz0123456789-_~

x

X


SIGN IN

Email Address

Validating

Password

Validating

Remember Me
Forgot your password?
Sign In
Don't have an account?
Create Account Subscribe
Create Account Subscribe