New England Archives - Page 4 of 8 - PulmCCM
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New England Articles

Jan 042013
 
Antibiotics (azithromycin) to prevent COPD exacerbations (Review)

(image: Rxhealthdrugs.com) Azithromycin for Prevention of COPD Exacerbations Azithromycin taken daily prevents exacerbations of chronic obstructive pulmonary disease (COPD exacerbations), but seems to also carry risks for cardiovascular death and hearing loss. The true balance of risks and benefits with use of azithromycin to prevent COPD exacerbations is unknown, but physicians who choose to prescribe [… read more]

Jan 032013
 
Inhaled corticosteroids stunt growth of America's youth by a half-inch

Daily Inhaled Steroids Stunt Kids’ Growth, Study Shows If you’re a half-inch shy of six feet, the next time you’re getting your jump shot blocked by your non-asthmatic friend, you can blame the inhaled corticosteroids your Mom made you take as a kid. Studies have consistently showed children’s height slows down for a few years [… read more]

Jan 022013
 
Adding tiotropium (Spiriva) helped some with uncontrolled asthma (RCT)

Spiriva (Tiotropium) for Uncontrolled Asthma Most people with asthma can achieve good control with inhaled corticosteroids (ICS) and a long-acting beta-agonist (LABA). Some people living with asthma, though, experience persistent symptoms despite maximum doses of these inhaled medications. Fairly or not, LABAs have also been sullied with an FDA black-box warning for worsening bronchospasm in a [… read more]

Jan 012013
 
Hydroxyethyl starch fries kidneys in another large trial (RCT)

Hydroxyethyl Starch (Voluven) Causes Kidney Failure In Large Trial Hydroxyethyl starch (HES) was already wearing a scarlet letter as an potentially dangerous volume resuscitation agent for patients in shock, after evidence emerged this year that hydroxyethyl starch kills people with severe sepsis. Now, another huge, convincing trial shows that hydroxyethyl starch (Voluven) damages kidneys and [… read more]

Dec 302012
 
Azithromycin associated with cardiovascular death

(image: Rxhealthdrugs.com) People taking 5 days of azithromycin had a very small absolute increased risk of death, especially due to cardiovascular causes, compared to people taking amoxicillin, in a retrospective cohort review by Wayne Ray, Katherine Murray, and C. Michael Stein published in the May 17 New England Journal of Medicine. Erythromycin and clarithromycin (the other [… read more]

Dec 292012
 
Xigris' epitaph: "I Never Worked a Day in My Life" (PROWESS-SHOCK)

Recombinant human activated protein C or dotrecogin alfa — better known as Xigris, by Eli Lilly — seemed a godsend when it was first approved for treatment of severe sepsis in 2001. Xigris’ FDA approval (despite an evenly split 10-10 vote) was based solely on the Eli Lilly-funded PROWESS study, a phase 3 randomized trial [… read more]

Dec 292012
 
Xarelto (rivaroxaban) gets FDA indication for DVT and PE; no heparin bridging needed

Xarelto (rivaroxaban): New FDA Indication for DVT, PE The U.S. Food and Drug Administration (FDA) approved Bayer’s Xarelto (rivaroxaban) for a new indication for treating deep vein thrombosis (DVT) or pulmonary embolism (PE), and for long-term prophylaxis of recurrent DVT and PE. Xarelto already had FDA approval for prevention of DVTs and PEs after knee or [… read more]

Dec 292012
 
Oral rivaroxaban (Xarelto) noninferior to warfarin for PE (RCT)

(image: InPharm) Rivaroxaban (Xarelto) was noninferior to standard treatment (heparin and warfarin) in preventing recurrent VTE in patients with acute pulmonary embolism (PE), in the large EINSTEIN-PE randomized trial published in the April 5 New England Journal of Medicine. A once-daily oral factor Xa inhibitor that has already been demonstrated to be noninferior for treatment [… read more]

Dec 292012
 
An aspirin a day keeps recurrent DVT and PE away (RCT)

(image: Rex Parker) Among people with unprovoked deep venous thrombosis (DVT) or pulmonary embolism (PE), 1 in 5 will experience another DVT or PE within 2 years after stopping anticoagulation with warfarin (Coumadin). For this reason, the ACCP’s recommendations for treatment of unprovoked proximal DVT or PE suggest consideration of an “indefinite” period of anticoagulation [… read more]

Dec 252012
 
Go back to bed; overnight intensivists don't reduce mortality

We intensivists are a scarce and valuable commodity — just ask us, we’ll tell you. It’s been consistently shown, for example, that involved intensivists in an ICU during the day correlates with improved mortality and efficiencies in care. Now that’s something we can all cheer (ourselves) about. Many intensivists also like to sleep, and may [… read more]

Dec 242012
 
Hydroxyethyl starches kill people with severe sepsis; use crystalloid instead (RCT)

Colloids are believed to be more effective expanders of plasma volume than crystalloids, making them a tempting therapy to use for patients in septic shock and other causes of hemodynamic instability. Problem is, some colloid solutions seem to kill people. The VISEP Trial using hydroxyethyl starch 200 kDa/0.5 demonstrated that this high molecular weight HES [… read more]

Dec 232012
 
Nicotine patches don't help in pregnancy, esp. if you don't wear them (RCT)

(image: Smokersworld.info) You never see pregnant women smoking in public, but surveys say 12-25% of pregnant women in developed countries smoke during pregnancy. Of course they know they shouldn’t — with smoking’s increased risks for miscarriage, low birth weight, premature birth, birth defects, and even sudden infant death after delivery. Most pregnant women want badly [… read more]

Dec 202012
 
CPAP cures metabolic syndrome in obstructive sleep apnea (Retracted)

CPAP Improves Metabolic Syndrome in Obstructive Sleep Apnea This paper has been RETRACTED! Continuous positive airway pressure (CPAP) therapy reversed elements of the high cardiovascular risk profile known as metabolic syndrome in a substantial minority of Indians with treatment-naive obstructive sleep apnea, according to this article in the New England Journal of Medicine. More than [… read more]

Dec 182012
 
Enoxaparin prophylaxis: no effect on mortality or fatal pulmonary embolism (RCT)

Does Enoxaparin Prophylaxis Really Help Most Hospitalized Patients? A huge randomized trial (LIFENOX) stunned experts by showing no benefit of enoxaparin prophylaxis in preventing pulmonary embolism or all-cause mortality in acutely ill medical patients, compared to knee-length graduated compression stockings alone. Ajay Kakkar, Claudio Cimminiello, Jean-Francois Bergmann et al report their surprising results in the [… read more]

Dec 042012
 
Linezolid (Zyvox) good for MDR, XDR tuberculosis (RCT)

Linezolid (Zyvox) for XDR-TB: New Hope, New Caution Approved by the FDA in 2000 for drug-resistant gram positive bacterial infections, linezolid (Zyvox, Pfizer) has in clinical practice been mainly used for skin infections and the occasional pneumonia due to methicillin-resistant Staph aureus (MRSA). Now linezolid looks to be effective as an adjunct therapy for multi-drug resistant [… read more]

Nov 202012
 
New pleural mesothelioma biomarker can speed diagnosis

(image: Wikipedia) Pleural Mesothelioma Biomarker Fibulin-3: Could It Improve Care? Pleural mesothelioma (malignant mesothelioma) has a dismally sad prognosis of about a year after diagnosis. Earlier detection of this lethal pleural cancer could conceivably result in earlier treatment and some improvement in life expectancy. Researchers report in the October 11, 2012 New England Journal of [… read more]

Nov 162012
 
Supraventricular Tachycardia (SVT): Initial Diagnosis and Treatment (Review)

Supraventricular Tachycardia, Initial Diagnosis and Treatment When supraventricular tachycardia (SVT) causes symptoms, it requires immediate medical attention.  Although many physicians believe that the precise type of SVT must be identified before providing treatment, this is not true: treatment can often be started safely and effectively without knowing the exact SVT, by tailoring it to the [… read more]

Nov 142012
 
New lung tissue growth can occur in adults, defying previous belief

New Lung Tissue Growth Discovered: Is Some Lung Regeneration Possible? Lung regeneration has never been thought possible in adults. But Steven Mentzer et al from Brigham and Women’s at Harvard reported a case of a 33 year old woman who had an apparent 64% increase in the number of functioning alveoli in her left lung, during [… read more]

Oct 312012
 
Hospital-acquired infections: stopping Gov't payment did not reduce their incidence

Preventing Hospital Acquired Infections: Stopping Payment Had No Effect In October 2008, the U.S. Centers for Medicare and Medicaid Services (CMS) stopped paying for two hospital-acquired infections: urinary infections due to indwelling catheters (UTIs) and central catheter-associated bloodstream infections (CABSI). At the time the policy was announced years ago, it was described as an incentive [… read more]

Sep 042012
 
Hyperosmolar Therapy for Increased Intracranial Pressure (Review)

Hypertonic Saline & Mannitol for Raised Intracranial Pressure (More PulmCCM Topic Updates) Acute brain injuries of all sorts increase the pressure inside the skull (intracranial pressure). Traumatic brain injury, bleeding in or around the brain, severe ischemic stroke, and acute hepatic failure all raise intracranial pressure, and increased intracranial pressure often becomes the most severe [… read more]