In this shocking retrospective look at robust Medicare data (54,771 person-years) by Barnato et al, 72.5% of the 534 beneficiaries undergoing mechanical ventilation (MV) died within one year of that hospitalization. An additional 12.5% of survivors were in nursing homes the following year. Survivors of MV had a slightly higher disability burden than those surviving [... read more]
Faced with steadily rising costs of medical care insurance, more and more U.S. employers are insisting that smokers pay a higher share of the premiums of their employer-sponsored insurance, according to a Towers Watson survey of 248 businesses. 19% of companies with >1,000 employees have increased smokers’ share of medical care insurance premiums, double the rate from [... read more]
Research suggests e-cigarettes (those smokeless, cigarette-like nicotine delivery devices sold at convenience stores and elsewhere) can help people quit smoking, or at least dramatically cut back. So why does the FDA have a hatchet out for e-cigarettes — first trying to block their sale and distribution as illegal marketing of a drug delivery device — [... read more]
Doctors are generally lousy at predicting death in terminally ill patients, and in ICU patients with indeterminate outcomes. Mortality prediction models have proliferated to improve our performance, but in the critical care literature, have mostly shown high predictive accuracy only at the tail ends of probability (high probability of survival or death). Siontis et al (led [... read more]
A nice pro/con soundoff between Gerard Silvestri (con) and James Jett & David Midthun (pro) over whether lung cancer screening with chest CT should be national policy, in the wake of the positive findings of the National Lung Screening Trial. Silvestri (of MUSC) argues that we don’t have a handle on the harms of screening [... read more]
25% of smokers undergoing chest CT have incidentally discovered pulmonary nodules. As questions of national policy re: lung cancer screening with chest CT are considered, Soylemez Wiener et al report the complication rates of 15,865 adults who had transthoracic needle biopsy of a pulmonary nodule in 4 states over the past decade, using a database [... read more]
Poor people have higher rates of obesity. There are those who believe that’s because the poor lack self-control and discipline, overeating when they should be pulling themselves up by their bootstraps. That hard-core personal responsibility ethic is hard to refute, maybe because it contains a grain of truth, maybe because it lets all us non-poor [... read more]
Lucassen et al sharpened their pencils and tried to combine in a meta-analysis 52 studies (n=55,268) that examined the success of methods of using “gestalt” (subjective impression) or clinical decision rules (Wells, Geneva or revised Geneva scores) to diagnose acute pulmonary embolism. The punchline (and their unstated but implied conclusion) is, we just can’t safely [... read more]
The U.S. Department of Health and Human Services published its 696 page rule on how accountable care organizations, the new medical care deilvery model, should structure themselves to qualify for reimbursement under the Affordable Care Act. The New England Journal published commentary by Don Berwick, current head of the Centers for Medicare and Medicaid, explaining [... read more]
Other than referring early to a lung transplant center, there are no strong expert recommendations on how to help patients with idiopathic pulmonary fibrosis (IPF). Trials of therapies have been a trail of tears. So you might think, since there are no treatments, it shouldn’t matter who’s doing the non-treating. But it just might, say [... read more]
In 2006, Medicare (we) spent 25% of our dollars on treatment for people in their last year of life. The debate rages, waged with euphemism in public and painful, conflicting emotions in private: how can we let Grandma go peacefully and with dignity, without feeling too guilty or ending up in front of a Senate subcommittee? [... read more]
Being one of the 50 million Americans without medical care insurance has long been associated with an increased risk of death in the ICU, but as Sarah Lyon, Jeremy Kahn et al point out, most of the studies were single-center and insufficiently controlled for patient factors. They give the field a shot in the arm [... read more]
Smoking cessation counseling is a nightmare for physicians because 1) it feels like a waste of the enormous time and effort required; and 2) it’s not: evidence shows that it’s exactly what we should do, every patient, every time. Even a 90% failure rate results in millions more lives saved than not attempting. Fiore and Baker give the [... read more]
Zhang et al pooled 20 studies that compared ultrasound, chest X-ray, or both against a reference standard (usually CT scan) for the diagnosis of pneumothorax. Chest X-ray had a pooled sensitivity of 52% and specificity 99% for diagnosis of pneumothorax. Ultrasound’s pooled sensitivity was 88% and specificity, 100%. Unsurprisingly, the accuracy of ultrasonography to diagnose [... read more]
People with asthma have an impressive and frustrating variability in their response to treatment, with corticosteroids and other drugs. As many as 40% of people with asthma don’t respond to inhaled steroids. Asthma’s familial basis is well-known: 60% of the variability in the response to albuterol may be inherited, and more than 80% of the treatment response to [... read more]
Hunt et al used the Beach method (I can’t find what that is) to ascertain the degree of U.K. adolescents’ exposure to moviestars’ smoking in films. Those teens who went to a lot of movies that had smoking were twice as likely to smoke as those with low exposure to film smoking. Those with parental [... read more]
It sounds like a doctor must have been pretty rude to Chicago’s Ms. Carolyn Bucksbaum 20+ years ago. She’s giving $42 million of her and her husband’s shopping-mall fortune to the University of Chicago, to create an institute devoted to improving medical students’ bedside mannerisms. Their beloved personal U. of C. physician, Mark Siegler, will [... read more]
Combining 58 studies into a meta-analysis, Leonardi-Bee et al report that children in the U.K. are more likely to start smoking if both parents smoke (odds ratio 2.7), a brother or sister (OR 2.3), only their mother smokes (OR 2.2), or only their father (OR 1.7). If only their Aunt Haggie smokes, the effects are [... read more]
Gershon et al used Canadian health administrative databases to identify all new diagnoses of COPD in Ontario from 1996-2010, a cohort of 13 million people. Lifetime risk of COPD (by age 80) was 27.6%. Smoking status was not available/included in the analysis. These were physicians’ diagnoses of COPD (using a validated case definition); there was [... read more]
Two kids under 5, one in Indiana and the other in Pennsylvania, have contracted a new reassorted swine flu: H3N2. The Pennsylvania child had had direct contact with a pig at an agricultural fair; the Indiana kid had been cared for by someone who had come in contact with a pig recently. Both children recovered [... read more]