Policy, Ethics, Education Archives - Page 3 of 9 - PulmCCM
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Policy, Ethics, Education Articles

Feb 192013
 
Time to retire routine replacement of peripheral IVs

Time to Retire Routine Replacement of Peripheral IVs Study question:  Do peripheral I.V.s need to be changed every 72-96 hours per the CDCs recommendations or can they be changed as clinically indicated? How many times as a resident did you receive a call at 4 a.m., often at the very moment you were about to [... read more]

Dec 312012
 
Adherence with low tidal volumes for ARDS is poor at top centers; reduces survival

(image: Wikipedia) Anyone with the keys to a ventilator knows, or should, that low tidal volume ventilation (~6 mL/kg ideal body weight) for patients with ARDS can be lifesaving: as many as one in 11 people with ARDS treated by low tidal volume ventilation may have their lives saved or extended while in the hospital. [... 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 282012
 
ACCP, ATS only weakly recommend lung cancer CT screening, warn of harms

The American College of Chest Physicians (ACCP) has issued its long-awaited recommendations on lung cancer screening with chest CT — and far from a ringing endorsement of screening, they are conservative and subdued, emphasizing the potential risks of an uncontrolled approach to lung cancer screening in the general population. The American Society of Clinical Oncology [... read more]

Dec 282012
 
American Lung Association recommends CT screening for lung cancer

The American Lung Association has become the largest advisory body to recommend lung cancer screening for high-risk people, advising nearly all people aged 55-74 with a 30+ pack-year smoking history (the entry criteria for the National Lung Screening Trial, or NLST) to undergo low-dose CT scanning to detect early lung cancer. The National Comprehensive Cancer Network, [... 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 232012
 
Blood banks recommend restrictive transfusions in ward patients

The American Association of Blood Blanks (AABB) announced upcoming new guidelines in the March online Annals of Internal Medicine, recommending against transfusion for adults and children with stable illness and hemoglobin levels above 7-8 g/dL. They made it a 1A recommendation (strong recommendation with high quality evidence). Jeffrey Carson et al reviewed literature from 1950 to 2011 and [... read more]

Dec 212012
 
Moderate pot smokers' lung function better than nonsmokers

Smoking marijuana moderately over years is strongly associated with small improvements in lung function, even compared to people who have never smoked cigarettes or marijuana, according to a study in JAMA. But the popular news media and the study authors downplayed that finding of the study, apparently to avoid sending a pro-marijuana message. Mark Pletcher, [... read more]

Dec 162012
 
Long-acting beta agonist safety for asthma (Review)

Just How “Dangerous” Are Long-Acting Beta-Agonists, Really? Gustavo Rodriguez and Jose Castro-Rodriguez reviewed 20 systematic reviews and databases reporting on the incidence of adverse events with long-acting beta-agonist (LABA) therapy for asthma, for the April 2012 Thorax. They conclude the following: LABAs as monotherapy significantly increase the risk for adverse effects and bad outcomes from [... read more]

Dec 112012
 
Predicting survival from COPD exacerbations: DECAF score shows promise

DECAF Score Predicts COPD Exacerbation Mortality, But Needs Validation By Brett Ley, MD Despite improvements in care, death during hospitalization for acute exacerbation of COPD (AECOPD) is not uncommon. In the UK in 2008, almost 1 in 12 people admitted with a COPD exacerbation died in-hospital. In the U.S. in 1996, about 1 in 40 [... 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]

Aug 022012
 
How many times has giving empiric antibiotics saved your professional behind?

Physicians who liberally prescribe empiric antibiotics are often maligned as irresponsible or unthinking by condescending colleagues and policy wonks. But are these doctors actually courageous and prudent, saving countless lives every year by refusing to bend to misguided pressure from antibiotic-conserving paper-pushers? As antibiotic resistance has emerged, many hospitals have begun requiring physicians to provide [... 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 302012
 
Ventilator bundles (VAP bundles) not evidence-based, shouldn't be standard care

(image: Wikipedia) Anyone who has ever rounded in an ICU with a nurse manager knows that challenging or questioning the utility of the ventilator associated pneumonia (VAP) bundle is a losing proposition — one likely to get you labeled as a wiseguy troublemaker. Thanks to ventilator bundles’ endorsement by the nonprofit Institute for Healthcare Improvement, [... 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 222012
 
Palliative care exploding in U.S. hospitals (AP)

Hospitals added palliative care services at a feverish pace throughout the 2000s, the Associated Press reported in a piece picked up by news outlets across the U.S. in June. While 658 hospitals reported having palliative care programs in 2000, 1,568 reported they offered palliative care services in 2009 — that’s over 60% of the hospitals [... read more]

Jun 142012
 
Most clinical trials are too small, often underpowered

The past decade has seen an explosion in the number of clinical trials; there are now more than 10,000 new trials registered each year. Although clinical trials’ quality is improving somewhat, most are still small and single-center and a large proportion do not adhere with reporting requirements, raising serious questions as to what we are [... read more]

Jun 092012
 
COPD self-care program fail; unexplained deaths at VA hospitals (RCT)

Chronic diseases like chronic obstructive pulmonary disease (COPD) account for at least 2/3 of medical care spending in the U.S. Policy makers, payers, and many physicians recognize that the outpatient clinic-based model is poorly suited to provide support in between physician visits, when most complications or exacerbations occur. Many hospitalizations and decline in function could [... read more]