There’s no use in sugar-coating the truth: Nicotine is an appetite suppressant, and smoking prevents weight gain. Not wanting to gain weight is a common reason why body-obsessed teenage girls say they smoke–and as far as we know, they’re “right:” teens who smoke gain slightly less weight than teens who don’t. It’s also long been believed [... read more]
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]
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]
Supraventricular Tachycardia, Initial Diagnosis and Treatment When supraventricular tachycardia (SVT) causes symptoms, it requires immediate medical attention. Although many physicians believe that the precise type of SVT must be identified before providing treatment, this is not true: treatment can often be started safely and effectively without knowing the exact SVT, by tailoring it to the [... read more]
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]
Probiotics for Prevention of Ventilator-Associated Pneumonia (VAP) Do probiotics prevent ventilator-associated pneumonia (VAP)? There’s a good biologic rationale: administering friendly commensal bacteria like Lactobacillus into the GI tract could suppress the emergence of more virulent gut bacteria like Pseudomonas, Klebsiella and Citrobacter, which travel up the esophagus and sneak around endotracheal tube cuffs during mechanical [... read more]
Acute Deep Venous Thrombosis (DVT) of the Arm: from the ACCP Guidelines, 9th Ed. The ACCP published its 9th edition of their clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE) in February 2012, and we’re summarizing the 801-page long document by topic. (See also the other sections of the 9th edition ACCP recommendations.) Here we review the section on [... read more]
Caring For Older Folks With COPD Terri Fried, Carlos Fragoso, and Michael Rabow argue in the September 26, 2012 JAMA that older adults (age ~80 or above) with COPD and significant dyspnea are a distinct, complex group of patients with unique features and needs, and their doctors should think broadly and be willing to go [... read more]
Acute Deep Venous Thrombosis (DVT) of the Leg: Initial Anticoagulant Therapy from the ACCP Guidelines, 9th Ed. The ACCP‘s 9th edition of their clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE) were published in February 2012, and we’re summarizing the 801-page long document piece by piece. (See also the other sections of the 9th edition ACCP recommendations.) Here [... read more]
Anemia in the ICU: 2012 Review (More 2012 Topic Updates) This document will be updated periodically to incorporate new research findings. To suggest an article for inclusion, please comment below. SUMMARY: Anemia is almost inevitable during many episodes of critical illness, and has been associated with worsened outcomes and prognosis. However, the preponderance of evidence suggests that correcting anemia [... read more]
(image: Wikipedia) As one after another specialty society endorses routine lung cancer screening with chest CT scans, we all know a Nodule Storm is coming to a pulmonology clinic near you. Thankfully, smart people are asking how we can systematically and successfully handle this soon-to-be-common outpatient clinical problem. Most of these many thousands of nodules [... read more]
When it comes to airway management skills, muscle memory rules, and there’s no substitute for hands-on experience. But in between intubations and endotracheal tube changes, what’s the best way to bolster your skills and knowledge base? Reading textbooks and journal articles provides truthful information, but I suspect it gets filed away and stashed in your [... read more]
Advances in Diagnosis and Treatment of Non-Small Cell Lung Cancer (NSCLC) This review document is periodically updated and reposted as new information is published. Please comment below with your suggestions for inclusion in upcoming updates of this review. (More PulmCCM topic reviews) The diagnosis and treatment of non-small cell lung cancer (NSCLC) is rapidly evolving, [... read more]
Idiopathic Pulmonary Fibrosis (IPF) 2012 Review (More PulmCCM Topic Updates) This document is updated periodically as new research findings in IPF are published. What Causes IPF? (Etiology/Pathogenesis of IPF) Since it’s still called “idiopathic,” you probably figured out already that the cause(s) of IPF remain unknown. Researchers use a paradigm for studying idiopathic pulmonary fibrosis called [... read more]
Alpha-1 Antitrypsin Deficiency: 2012 Review & Update More 2012 Topic Updates This alpha-1 antitrypsin review is periodically updated and reposted as new research findings are published. Alpha-1 antitrypsin deficiency is underrecognized and by implication undertreated, according to James Stoller and Loutfi Aboussouan of the Cleveland Clinic in their excellent concise clinical review in the Blue [... read more]
Hypersensitivity Pneumonitis 2012 Review (More PulmCCM Topic Updates) Hypersensitivity pneumonitis (external intrinsic alveolitis) is an “orphan disease,” which means it’s uncommon and lacks any likely way to effectively “monetize” the disease with drugs or device therapy, resulting in its being largely ignored from a research funding standpoint. If you think you don’t know much about [... read more]
(image: Wikipedia) There are an estimated 200,000 pleural effusions due to malignancy each year in the U.S. alone, and these represent an important cause of suffering and limitation in functional ability for people living with advanced cancer. Pleurodesis (using talc or other sclerosants) and placement of indwelling pleural catheters are both accepted, reasonable approaches to the [... read more]
Superior Vena Cava Syndrome: A Cancer-Related Medical Emergency (More PulmCCM Topic Updates) Multiple cancers are expected to rise in prevalence in the U.S. over the coming decades, and so is the risk for cancer-related medical emergencies. For a few, superior vena cava syndrome (SVC syndrome) will be the first manifestation of their cancer. It’s important [... read more]
Pulmonologists become fairly good semi-professional chest radiologists simply by showing up, paying attention and working hard during their training, and making an effort to keep learning throughout their careers. We have the advantage over radiologists of actually being able to “clinically correlate” the findings with what’s really going on, and to integrate that into our understanding [... read more]
Pulmonary Hypertension And Pulmonary Vascular Disease Review 2012 (More PulmCCM Topic Updates) This document is periodically updated as new research findings are published. The published date reflects the most current update. Please suggest articles for inclusion in future versions of this document in the comments or by e-mail. Chronic Thromboembolic Pulmonary Hypertension Update The mechanism [... read more]