Policy, Ethics, Education Archives - PulmCCM
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Policy, Ethics, Education Articles

Mar 052015
 
E-cigarettes double smokers' quit rates vs placebo: meta-analysis

Electronic cigarettes containing nicotine can double smokers’ rates of quitting at one year, compared to e-cigarettes without nicotine (placebo), according to a new small meta-analysis published in the Cochrane Database of Systematic Reviews. The rates of smoking cessation using nicotine-containing e-cigarettes (9%) were roughly comparable to that seen with other forms of nicotine replacement therapy in past trials. The [… read more]

Mar 042015
 
Lung-RADS launches: New system for lung cancer screening chest CTs

The American College of Radiology has started implementing its new system for risk-stratifying the findings on low dose chest CTs performed for lung cancer screening. The ACR’s new system is called Lung-RADS™, and it emulates the ACR’s familiar Bi-RADS’s 0-4 scoring system for mammography: Lung-RADS 0: Incomplete, meaning previous chest CTs are still being located [… read more]

Feb 132015
 
The PulmCCM App Re-Re-Launches, Again

Longtime readers of PulmCCM will remember, there once was an app for iPhone and Android phones. Then, one day, there wasn’t. Technical difficulties, etc. Then, just when everyone had almost forgotten about it, the app was back! Most people had moved on with their lives, but a few were touched by this digital comeback story. Then — [… read more]

Feb 122015
 
FDA approves ceftolozane/tazobactam (Zerbaxa); 4th new antibiotic in 2014

The U.S. FDA continued its flurry of new antibiotic approvals to close out 2014, giving the nod to ceftolozane with tazobactam. The drug will be marketed as Zerbaxa by the pharmaceutical company Cubist. Ceftolozane is a novel cephalosporin, combined with the existing β-lactamase inhibitor tazobactam in the new product. Zerbaxa has broad activity against gram-negative [… read more]

Feb 112015
 
Medicare will pay for lung cancer screening chest CT -- now up to age 77

Medicare will pay for annual low-dose chest CT for lung cancer screening, for former and current heavy smokers between the ages of 55 and 77. The Centers for Medicare and Medicaid Services (CMS) announced the decision last week. CMS had previously signaled they would set the upper age limit at 74, the same as in the National Lung Screening Trial [… read more]

Feb 062015
 
E-cigarettes fuss over formaldehyde: don't believe the hype (yet)

Electronic cigarettes (e-cigarettes) work via a heating element that the user activates while inhaling. Nicotine, along with a liquid solvent (usually propylene glycol), flavorings and whatever else is in the solution are vaporized (aerosolized, really) at the high temperature and inhaled by the user. E-cigarette sales are now a $1.5 billion/year business, growing by an [… read more]

Jan 252015
 

Hot off the blog-press is PulmCCM’s new Educational Resources section. This exciting new endeavor will be a forum for sharing your knowledge with the world. If you’ve created a useful educational clinical resource, why limit your audience to your colleagues at your local institution? Increase your impact exponentially by posting your work on PulmCCM where thousands can learn and benefit. [… read more]

Jan 192015
 
Should video-guided intubation be standard training in critical care? (And should anesthesiologists teach it?)

Image: Airwaycam Endotracheal intubation is a routine but high-stakes maneuver, performed uneventfully thousands of times daily throughout the developed world. In the U.S., elective (routine) intubation is almost exclusively the domain of anesthesiologists, who become masters of the technique through thousands of iterations throughout training and their careers. The vast majority of these intubations take [… read more]

Dec 192014
 
Age-adjusted D-dimer to rule out PE: coming of age?

Put a CT scanner in every U.S. emergency department, add the non-specific signs and symptoms of pulmonary embolism, stir in its potential lethality and morbidity, and line up a few thousand lawyers on the sidelines ready to capitalize on any missed diagnoses, and it’s no wonder that the use of CT-angiograms to rule out pulmonary embolism has risen 11-fold [… read more]

Dec 072014
 

Ignoring its advisory panel, the Centers for Medicare and Medicaid Services (CMS) announced that annual low-dose CT lung cancer screening for high-risk individuals will be covered by Medicare. However, CMS applied restrictions that will limit access to screening, avoiding the chaotic marketplace free-for-all that would have resulted from an unrestricted approval. Medicare will pay for one lung cancer [… read more]

Oct 312014
 
Life after sepsis protocols: What now? (You decide.)

2014 has been a rough year for advocates of sepsis protocols. First, the long-awaited ProCESS trial did not show any benefit from use of the original early goal-directed therapy (EGDT) protocol used in the single-center 2001 trial by Rivers et al that, despite criticism, became the standard of care for the following decade. Patients cared for in the 2 non-EGDT arms [… read more]

Oct 172014
 
FDA approves pirfenidone (Esbriet) and nintedanib (Ofev) for IPF

The U.S. FDA approved the first two drugs proven to slow progression of idiopathic pulmonary fibrosis (IPF): pirfenidone (Esbriet by Roche, which bought Intermune) and nintedanib (Ofev by Boehringer Ingelheim) on Wednesday October 15. Both drugs will offer new hope for patients, and new pain to the insurance companies and the government who pay for them. Pirfenidone [… read more]

Jul 302014
 
What are Ventilator-Associated Events (and why should you care)?

Have you heard of ventilator-associated events (VAEs)? Like it or not, this neologism of healthcare-speak is coming to an ICU near you soon. Here’s the lowdown on VAEs and why they matter to the practicing intensivist. What are Ventilator-Associated Events? Ventilator-associated events are an invention of the Centers for Disease Control and Prevention (CDC), created in [… read more]

May 222014
 
Medicare bucks USPSTF, denies coverage for lung cancer screening

The Centers for Medcare and Medcaid Services sent lung cancer screening’s forward momentum into a tailspin last month, when Medicare’s advisory panel shocked observers by voting  against covering lung cancer screening with annual low dose chest CT as a standard benefit. The U.S. Preventive Services Task Force (USPSTF) had already recommended lung cancer screening be [… read more]

May 082014
 
Red blood cell transfusions increase hospital-acquired infections (meta-analysis)

Red Cell Transfusions Increase Risk for Nosocomial Infection: Meta-Analysis Transfusing blood to anemic patients has an almost irresistible intuitive and theoretical appeal both to physicians and the patients who get transfused. It’s perhaps the archetypal example of the “find it – fix it” approach to doctoring: correct all laboratory abnormalities and ipso facto, the patient [… read more]

May 072014
 
FDA approves implantable tongue-buzzer for obstructive sleep apnea treatment

Image: Inspire Med Systems Hypoglossal Nerve Stimulation for Sleep Apnea Wins FDA Approval The U.S. Food and Drug Administration approved Inspire Medical Systems’ pacemaker-like hypoglossal nerve stimulator for patients with moderate to severe obstructive sleep apnea (OSA) who cannot tolerate continuous positive airway pressure (CPAP). The Inspire device stimulates key airway muscles controlled by the hypoglossal [… read more]

Mar 252014
 

May 10th and 11th (pre-congress courses on may 9th), Montreal. Great speakers, great topics, great city, great weather (well…hopefully no snow!). Do you know how to use ultrasound to help you diagnose or manage coma, bowel obstruction, CHF, dyspnea, swollen joints and renal failure, among other things?  No matter how good you are at the [… read more]

Feb 282014
 
Bloggers correct the New England Journal on ICU decontamination article

Blogger Peer Review Corrects NEJM Article’s Error In June 2013, PulmCCM unquestioningly reported the results of a major randomized trial in the New England Journal of Medicine by Susan S. Huang et al, showing that decontaminating patients upon arrival to the ICU with chlorhexidine baths and nasal mupirocin resulted in a dramatic drop in nosocomial infections [… read more]

Feb 222014
 
Epitaph for nitric oxide for ARDS

Image: Dartmouth Nitric Oxide: No Benefit Even in Severe ARDS Giving inhaled nitric oxide to people with acute respiratory distress syndrome (ARDS) improves oxygenation, but has never been demonstrated to improve survival. Not many physicians seem to use nitric oxide for ARDS anymore, except possibly as salvage therapy in life-threatening refractory disease. Even that well-meaning [… read more]

Feb 162014
 
PulmCCM Journal Launches: Your Submissions Welcome

Dear colleagues, I am excited to announce the launch of PulmCCM Journal, a new online, open access, peer-reviewed journal serving the practicing physician in critical care and respiratory medicine. PulmCCM Journal’s primary mission will be publishing high-quality, highly useful reviews of important clinical topics to improve decision-making and the quality of care worldwide. Case reports, [… read more]