Policy, Ethics, Education Archives - Page 3 of 10 - PulmCCM
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Policy, Ethics, Education Articles

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]

Sep 052013
 

Following “Surviving Sepsis” Guidelines Not Always the Best Care By Dr. Philippe Rola First of all, I would like to commend those involved in the Surviving Sepsis Campaign’s Guidelines. It is a tremendous endeavour that, without a doubt, has heightened awareness and their growing implementation has and will save many lives. I would, however, also [… read more]

Aug 112013
 
USPSTF Recommends Lung Cancer Screening CT; Obamacare Pays

USPSTF Endorses Lung Cancer Screening CT; New Standard of Care Begins Lung cancer screening CT took its most important step toward widespread implementation last week, when the U.S. Preventive Services Task Force (USPSTF) released a draft of its forthcoming recommendation that the 9 million U.S. people meeting entry criteria for the National Lung Screening Trial [… read more]

Jul 192013
 
Intensivists overnight in the ICU don't help, if you're already good

Nighttime Intensivist Staffing Does Not Help (Again) As I’ve said before, probably past the point of being annoying, we intensivists perform a vital service for humanity — just ask us. Numerous studies have concluded that a specialized intensivist’s presence in an intensive care unit during the day saves lives and results in better use of health [… read more]

Jul 042013
 
Many people with metastatic lung cancer think radiation can cure

image: cancer.gov Patients With Metastatic Lung Cancer Often Believe Radiation Could Cure Among 384 patients with metastatic lung cancer who answered a survey, two in five expressed belief that radiation therapy was “very likely” or “somewhat likely” to cure them. Eighty percent thought radiation therapy would allow them to live longer, and only one-third admitted [… read more]

Jun 262013
 
FDA warns against use of Hetastarch in ICU

U.S. FDA Advises Against Hetastarch Use in ICU European Agency Recommends Ban It was probably only a matter of time. In the wake of large randomized trials suggesting hydroxyethyl starches (HES or hetastarch) cause kidney injury and death in critically ill patients from sepsis and other causes, and the European Medicines Agency formally suggesting this month [… read more]

Jun 162013
 
Decontaminate all incoming ICU patients to reduce infections, says RCT

“Decolonizing” New ICU Patients Reduces Bloodstream Infections: NEJM This article had an erratum posted in NEJM: read more here. In humankind’s battle against bacteria, the ICU is the front line. And with MRSA infection rates doubling in the past 5 years, and the more recent and scary spread of lethal pan-resistant Enterobacteriae, lately the bugs have [… read more]

May 232013
 
New lung cancer prediction tool promises better use of screening CT

New Prediction Model Selects Best Lung Cancer Screening Candidates In the National Lung Screening Trial (NLST), screening for lung cancer with low-dose chest CT scans resulted in a 20% reduction in death from lung cancer. The consumer-serving American Lung Association recommended outright that older people with heavy smoking histories should get lung cancer screening; leading [… read more]