CHEST Archives - Page 2 of 7 - PulmCCM
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Sep 302012
 
Treatment of Acute Deep Vein Thrombosis (DVT) of the Arm (Review/Guideline)

Acute Deep Venous Thrombosis (DVT) of the Arm: from the ACCP Guidelines, 9th Ed. The ACCP published its 9th edition of their clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE) in February 2012. PulmCCM is not affiliated with ACCP. The commentary provided here is only appropriate for use as a reference by those who have already read and are [... read more]

Sep 162012
 
Initial Treatment of Acute Deep Venous Thrombosis (DVT) of the Leg (Guidelines)

Acute Deep Venous Thrombosis (DVT) of the Leg: Initial Anticoagulant Therapy from the ACCP Guidelines, 9th Ed. The ACCP‘s 9th edition of their clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE) were published in February 2012. PulmCCM is not affiliated with ACCP. The commentary offered below is appropriate only as a reference for those already familiar with [... read more]

Aug 172012
 
Advanced bronchoscopy yields are 70% in meta-analysis (Review)

(image: Wikipedia) As one after another specialty society endorses routine lung cancer screening with chest CT scans, we all know a Nodule Storm is coming to a pulmonology clinic near you. Thankfully, smart people are asking how we can systematically and successfully handle this soon-to-be-common outpatient clinical problem. Most of these many thousands of nodules [... read more]

Aug 082012
 
CPAP gives the heart a tune-up for 1 year or 30 million beats, whichever comes first

Obstructive sleep apnea (OSA) might be the perfect disease to describe the American health care system. The condition is overwhelmingly due to our over-indulgence and under-activity; its expensive diagnosis (polysomnography) and best treatment (CPAP) help physicians and device manufacturers prosper while consternating those who pay (the government and insurance companies), who then threaten to cut off [... read more]

Jul 232012
 
Hypersensitivity Pneumonitis Update (Review)

Hypersensitivity Pneumonitis 2012 Review (More PulmCCM Topic Updates) Hypersensitivity pneumonitis (external intrinsic alveolitis) is an “orphan disease,” which means it’s uncommon and lacks any likely way to effectively “monetize” the disease with drugs or device therapy, resulting in its being largely ignored from a research funding standpoint. If you think you don’t know much about [... read more]

Jul 202012
 
Should pleurodesis or PleurX drain be 1st-line Rx for malignant pleural effusion?

(image: Wikipedia) There are an estimated 200,000 pleural effusions due to malignancy each year in the U.S. alone, and these represent an important cause of suffering and limitation in functional ability for people living with advanced cancer. Pleurodesis (using talc or other sclerosants) and placement of indwelling pleural catheters are both accepted, reasonable approaches to the [... read more]

Jul 142012
 
Talking to COPD patients about end-of-life makes them like you more?

We may see it more often, but we doctors don’t really know anything more about death than anyone else, and we find it just as scary. Yet we are expected to spontaneously discuss death-as-a-coming-event with seriously ill patients who (we assume) probably want to avoid the subject, well, like the plague. Maybe they do. But [... read more]

Jun 292012
 
Could excess ICU beds be hazardous to your health?

Everyone knows that when you’re really sick, going to the ICU–that place with all the beeping monitors, hypervigilant staff, and high-tech invasive gadgetry–might save your life. But what if in certain situations, transfer to an ICU bed could actually worsen a person’s condition, or even hasten their demise? Hannah Wunsch of Columbia U. suggests it’s [... read more]

Jun 112012
 
Prevention and Treatment of DVT/PE in Pregnant Women (Guideline)

Prevention & Treatment of DVT/PE in Pregnant Women from the ACCP Guidelines, 9th Ed. The ACCP’s recommendation classification system: 1 = “recommendation” 2 = “suggestion” A = based on strong evidence from randomized trials B = moderate evidence that may include randomized trials or observational studies C = weak evidence, mostly consensus opinion Low-Molecular Weight Heparin [... read more]

Jun 012012
 
Bronchodilator reversibility testing in COPD: Bill for it, but don't believe it

(image: flickrCC) Why do we test chronic obstructive pulmonary disease (COPD) patients for bronchodilator responsiveness (besides getting to charging a few extra bucks for it)? If I am reading this article right, the answer is, there’s no good reason. Consider this: Bronchodilator responsiveness (BDR) or the lack thereof does not distinguish COPD from asthma. Bronchodilator [... read more]

May 212012
 
Diagnosis of Lower-Extremity DVT (Guideline)

Diagnosis of Deep Venous Thrombosis (DVT) of the Lower Extremity from the ACCP / Chest Guidelines, 9th Ed. PulmCCM is not affiliated with ACCP; this commentary is appropriate only for those who have read the original ACCP document, which is linked below. Diagnosis of DVT of the leg should incorporate these principles of safety: Reducing overall [... read more]

May 102012
 
How to bill for palliative care in the ICU ... legally (Chest)

Reimbursement for Palliative Care in the ICU By Intensivists To an intensivist, providing palliative care often means having multiple time-consuming and emotionally challenging interactions with families struggling to cope with the impending loss of their loved one. The emotional content of these interactions can be strongly positive, negative, or somewhere in between, but frequently it’s [... read more]

Apr 282012
 
Inferior vena cava filters for acute PE and DVT (ACCP Guidelines)

Inferior Vena Cava Filters for Prevention of Pulmonary Embolism from the ACCP Guidelines, 9th Ed. Inferior vena cava filters should generally be placed in patients with acute pulmonary embolism (PE) or deep venous thrombosis (DVT) who have a contraindication to anticoagulation, according to the ACCP’s recommendations. The ACCP recommends against placing an IVC filter in patients [... read more]

Apr 242012
 
How to make $25,000 on each EBUS (Chest)

(image: flickrCC) Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA), when performed by skilled physicians, reduces the need for mediastinoscopy and unnecessary thoracotomies with their associated morbidity, and is poised to permanently alter the landscape of lung cancer diagnosis and staging. Prior to 2008, Medicare seemed to recognize the potential value of EBUS by paying hospitals [... read more]

Apr 232012
 
Thrombolytics for acute pulmonary embolism (Guidelines)

Thrombolytics for Acute Pulmonary Embolism from the ACCP Guidelines, 9th Ed. PulmCCM is not affiliated with ACCP. These are PulmCCM’s interpretation of the ACCP guidelines. They are appropriate only for those who have read and are familiar with the original ACCP guideline document, which is linked below. The ACCP’s recommendation classification system: 1 = “recommendation” 2 [... read more]

Apr 222012
 
Should you check pleural manometry during thoracentesis? (Pro/Con, Chest)

(image: Cardinal Health) Should you routinely check pleural pressures with bedside manometry during thoracentesis? David Feller-Kopman of Johns Hopkins says, of course: it’s zero risk, zero cost, only seconds of extra time, and provides potentially useful clinical information. Specifically, one can identify people with “entrapped lung” and “trapped lung”: Identifying “Entrapped Lung” by Pleural Pressures [... read more]

Apr 212012
 
Pneumothorax in the ICU (Review, Chest)

From the excellent review by Lonny Yarmus and David Feller-Kopman in the April 2012 Chest, along with the British Thoracic Society and ACCP’s consensus statements: Mechanisms of Pneumothorax in the Critically Ill Air can accumulate in the pleural space in three ways: Rupture of the visceral pleura allowing air to travel from alveoli to the [... read more]

Apr 092012
 
Treating acute pulmonary embolism with anticoagulant therapy (Guideline)

Treating Acute Pulmonary Embolism with Anticoagulant Therapy from the ACCP Guidelines, 9th Ed.   The ACCP‘s new 9th edition of their authoritative clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE) were published in February 2012. PulmCCM’s commentary is only appropriate as a reference for those who have read and are familiar with the original document, which is linked [... read more]

Mar 242012
 

(Comments by first author James T. Good follow this post.) For 58 patients with refractory asthma at National Jewish, James Good et al devised a systematic, bronchoscopy-driven approach that they feel resulted in improved asthma symptoms and identification of potential phenotypes of refractory asthma among the enrolled subjects. Their methodology was highly detailed and time- and labor-intensive. It included using [... read more]