Policy, Ethics, Education Archives - Page 7 of 9 - PulmCCM
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Policy, Ethics, Education Articles

Nov 022011
 

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]

Nov 012011
 

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]

Oct 312011
 

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]

Oct 302011
 

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]

Oct 202011
 

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]

Oct 112011
 

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]

Oct 092011
 

Smoking cessation counseling may feel like a waste of the time and effort required, since most smokers don’t quit. But evidence shows that even the <10% success rate of smoking cessation counseling saves millions of lives, compared to doing nothing. According to a recent smoking cessation review in the NEJM: Even those not ready to quit do 8% of the time [… read more]

Oct 072011
 

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]

Oct 072011
 

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]

Oct 022011
 

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]

Oct 012011
 

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]

Sep 262011
 

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]

Sep 242011
 

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]

Sep 222011
 

Observational epidemiologic data on 132 California kids who caught pertussis (of 15,000 in a cohort), presented at the American Society for Microbiology meeting last week, suggested that protection from pertussis vaccination may wane as soon as 3 years after the last dose. Kids age 8-12 were most at risk (the last dose is given at [… read more]

Sep 132011
 

West et al report survey and in-service exam data from 16,394 internal medicine residents nationwide, 2008-2009. Almost 15% reported that their lives “suck” or “profoundly suck” (I’m paraphrasing slightly). About half reported emotional exhaustion or feeling burned-out. Almost 30% were in a disconnected, fugue-like state. The really depressed ones did worse on their in-service exams, [… read more]

Sep 132011
 
Millions of adults quit smoking since 2005 (MMWR)

From 2005 to 2010, the percent of U.S. adults identifying themselves as smokers fell from 20.9% to 19.3% — about 3 million fewer smokers than would be expected. The results come from the CDC’s national telephone health surveys. More remarkably, adults reported smoking far fewer cigarettes: The proportion of adults reporting smoking more than a [… read more]

Aug 142011
 

Accountability for Medical Error: Moving Beyond Blame to Advocacy. CHEST 2011;140:519-526.  Bell et al’s great essay on the dysfunctional mechanics and culture of liability / safety / blame surrounding medical errors in hospitals and our medical care system in general. They propose steps toward “collective accountability,” e.g., we MDs should sit on hospital safety committees. But [… read more]

Jul 252011
 

Under mandate by the FDA to answer lingering questions about long-acting beta agonists’ safety for treatment of asthma, four major pharma firms will launch five large randomized trials comparing inhaled corticosteroid / long-acting beta agonist combination products vs. ICS alone. The trials (4 in adults, 1 in kids) will enroll >50,000 people starting this year, [… read more]

Jul 222011
 

Widespread beliefs among physicians that people with mental illness are more addicted, or less desirous or capable of quitting smoking, are wrong and perpetuate a deadly problem, argues J.J. Prochaska. You should nag mentally ill folks to quit smoking as you would anyone else, she urges. NEJM 2011;365:196-198. FULL FREE TEXT