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

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]

Feb 092014
 
Should limited email ads finance PulmCCM's future? SURVEY RESULTS

Hello colleagues, PulmCCM has been doing great traffic-wise, but that hasn’t translated into financial health. PulmCCM took a net loss of $1,600 for 2013, including my annual salary of $700 (nope, no omitted zeroes there). That’s OK — making money has never been what this project is about. However, PulmCCM does need continuous funding to [... read more]

Feb 012014
 
Spiriva and heart attack risk: new safety kerfuffle

Last year, PulmCCM reported on the TIOSPIR safety trial comparing the Spiriva dry-powder HandiHaler against the Respimat mist-delivery device. TIOSPIR showed no difference in all-cause mortality or composite cardiovascular risk endpoints between either Spiriva preparation. But this week, a group of drug safety researchers report their granular analysis of TIOSPIR data shows the Respimat device [... read more]

Jan 292014
 
Choosing Wisely's five top "no-no's" in critical care

Choosing Wisely is an initiative of the American Board of Internal Medicine (ABIM) with the stated goal of “promoting conversations between physicians and patients by helping patients choose care that is supported by evidence, not duplicative, free from harm, and truly necessary.” Sounds good, huh? Politically, ABIM’s Choosing Wisely seeks to demonstrate to policymakers responsible [... read more]

Jan 262014
 
US Gov't pronounces lung cancer screening the standard of care

It’s official: the U.S. Preventive Services Task Force (USPSTF) announced its formal recommendation for yearly low-dose chest CT screening for lung cancer in high-risk individuals on December 30, 2013. The final grade B recommendation (“Suggestion: offer or provide this service”) was virtually unchanged from the draft recommendations the USPSTF made in July 2013. It advises [... read more]

Jan 072014
 
Brain death equals death: says who?

Scott Aberegg, M.D., M.P.H. Oh, my, what a predicament.  Jahi McMath has been released from Oakland Hospital to the custody of the coroner and her family.  She has been issued a death certificate.  And she’s being transferred to an undisclosed care center, where it is hoped she will begin receiving artificial nutrition.  This is the height [... read more]

Dec 152013
 
Overdiagnosis rate with lung cancer screening CT is 18%

Low-dose CT screening reduced death from lung cancer by about 20% in the National Lung Screening Trial, and the U.S. Preventive Services Task Force signaled it would recommend CT screening for most people with a heavy smoking history. The Affordable Care Act stipulates that USPSTF-recommended screening tests be completely free to consumers, so lung cancer screening will [... read more]

Nov 062013
 
Breath tests can accurately diagnose lung cancer

Diagnosing lung cancer without a biopsy may seem like science fiction, but breath testing to identify lung cancer has made steady gains in accuracy in recent years. A study abstract presented by Peter Mazzone et al at Chest 2013 in Chicago shows just how far one of the new technologies — volatile organic compound analysis [... read more]

Oct 302013
 
"Choosing Wisely" campaign targets pulmonary hypertension drugs' off-label use

Choosing Wisely, the initiative for medical cost-effectiveness (don’t call it rationing!) of the American Board of Internal Medicine, included the use of vasodilators for pulmonary hypertension owing to left heart disease or hypoxemic lung disease (WHO Groups II and III) as #2 on its top five “no-no’s” in its new pulmonology section. The ”Five Things Physicians and [... read more]

Oct 222013
 

Ultrasound-guided central venous catheter insertion: Standard of care, or preventing procedural skills? By Dr. Philippe Rola Ok, so let me preface this with the fact that I walk around with a handheld ultrasound rather than a stethoscope, and that I examine ALL patients with a focused cardiopulmonary and abdominal exam. My bias towards bedside ultrasound is [... read more]

Oct 192013
 
Overnight intensivists unnecessary in well-staffed ICUs? (Meta-analysis)

24/7 Intensivist Coverage Does Not Improve Outcomes: Meta-Analysis The debate over whether ICUs should be staffed around the clock by intensivist physicians has simmered for more than 20 years, with opinions on both sides driven more by values and personal biases than evidence. Recent studies have confirmed the benefit of daytime intensivists in ICUs but failed [... read more]

Oct 182013
 
Riociguat (Adempas) approved for PAH and CTEPH (pulmonary hypertension)

Riociguat (Adempas) Gets FDA Indications for Pulmonary Hypertension That was fast. The US Food and Drug Administration (FDA) approved riociguat (brand name Adempas, by Bayer) for the treatment of pulmonary arterial hypertension (PAH) and the treatment of chronic thromboembolic pulmonary hypertension (CTEPH), on October 8 2013. Adempas is the first of a class of drugs for pulmonary hypertension [... read more]

Oct 172013
 
Home testing for sleep apnea bankrupting U.S. sleep centers

Home Sleep Apnea Testing: New Standard is Bad Deal for Sleep Docs Sleep doctors in the U.S. have been doubling up on their Prilosec and putting their accountants on speed-dial since the federal government and insurers began signaling they plan to eventually run the $2,000-per-sleep-study gravy train off its rails. With an estimated 18 million people [... read more]

Oct 162013
 
Spiriva Respimat inhaler as safe as HandiHaler (TIOSPIR)

Tiotropium: Safe In Either Form Tiotropium (Spiriva) comes in two devices: the Respimat in Europe delivers a mist, while the Handihaler in the U.S. delivers a dry powder. The Respimat has been bronchodilating under a dark cloud in Europe for the past 2 years, since a BMJ meta-analysis suggested there was a 52% increased risk of [... read more]

Oct 062013
 
Pulmonary rehabilitation: no benefit at one year, even with extended Rx? (Review)

Pulmonary Rehabilitation: No Benefit After 12 Months Light, Infrequent Workouts Don’t Sustain Fitness Gains Pulmonary rehabilitation (“pulmonary rehab”) is a dressed-up name for what are essentially supervised exercise programs for people living with chronic lung disease. Although pulmonary rehab programs often include multidimensional support (nutrition, education, breathing exercises and psychological counseling), it’s the exercise that produces [... read more]

Sep 282013
 
Intubation Checklists -- are theirs better than yours?

Intubation Checklists in the ICU and ED Can They Save Lives? Endotracheal intubation in the ICU or emergency department is often challenging, to understate by a lot. Intubations outside the operating room are often emergent rush jobs on crashing, hypotensive, severely hypoxemic patients, or people with who have just self-extubated. Pulmonologists’ and emergency physicians’ familiarity [... read more]

Sep 222013
 
E-cigarettes prove effective for smoking cessation

E-Cigarettes Shown Effective as Smoking Cessation Aids Electronic cigarettes or e-cigarettes use battery power to vaporize a solution, usually containing nicotine dissolved in propylene glycol, glycerin, or polyethylene glycol, creating a puff of “smoke” that dissipates harmlessly. E-cigarettes deliver a hit of nicotine (about 1/4 to 1/2 that of a cigarette puff), but their vapor [... read more]