Review Articles Archives - Page 3 of 13 - PulmCCM
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Review Articles Articles

Jan 052013
 
Tranexamic acid saves lives, reduces transfusions. So why does no one use it? (Review)

Tranexamic Acid: Underused for Uncontrolled Bleeding? Tranexamic acid is a simple little molecule, just a synthetic derivative of the amino acid lysine. But it’s also a potent pro-hemostatic drug that binds plasminogen and plasmin and stops the degradation of fibrin (the stuff in blood clots). In the U.S., tranexamic acid is sold as Lysteda (oral) [... read more]

Jan 042013
 
Antibiotics (azithromycin) to prevent COPD exacerbations (Review)

(image: Rxhealthdrugs.com) Azithromycin for Prevention of COPD Exacerbations Azithromycin taken daily prevents exacerbations of chronic obstructive pulmonary disease (COPD exacerbations), but seems to also carry risks for cardiovascular death and hearing loss. The true balance of risks and benefits with use of azithromycin to prevent COPD exacerbations is unknown, but physicians who choose to prescribe [... read more]

Jan 042013
 
Femoral lines might not be so bad after all for infection risk

“We’ve got to get that femoral line out of there!” The attending’s face as he says it shadowed with a simmer of fear, a dash of anger. How could the moonlighter have been so incompetent or lazy as to choose the benighted femoral site for a central venous line when the internal jugular and subclavian [... read more]

Jan 032013
 
Can procalcitonin help guide therapy for suspected pneumonia & other infections? (Review)

Procalcitonin to Guide Treatment of Pneumonia (More PulmCCM Topic Reviews) With mounting evidence for its utility as a biomarker for pneumonia, procalcitonin is one of the hottest 2012 topics in pulmonary & critical care. Procalcitonin tends to rise quickly as bacterial infections (but not viral infections) develop, increase with the severity of infection, and decline [... read more]

Dec 302012
 
Azithromycin associated with cardiovascular death

(image: Rxhealthdrugs.com) People taking 5 days of azithromycin had a very small absolute increased risk of death, especially due to cardiovascular causes, compared to people taking amoxicillin, in a retrospective cohort review by Wayne Ray, Katherine Murray, and C. Michael Stein published in the May 17 New England Journal of Medicine. Erythromycin and clarithromycin (the other [... 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 262012
 
New IPF staging and prognosis model announced

(image: Wikipedia) Access the online GAP Score Calculator for IPF Although idiopathic pulmonary fibrosis (IPF) has a poor prognosis — a median survival of only 3 years — there is wide heterogeneity among individual patients. Some have a precipitous decline and die within months of diagnosis; others live for a decade or longer, with little [... read more]

Dec 242012
 
Let's be honest: quitting smoking usually does make you fatter

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]

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 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]

Nov 162012
 
Supraventricular Tachycardia (SVT): Initial Diagnosis and Treatment (Review)

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]

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]

Sep 302012
 
Treatment of Acute Deep Vein Thrombosis (DVT) of the Arm (Review/Guideline)

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. PulmCCM is not affiliated with ACCP. The commentary provided here is only appropriate for use as a reference by those who have already read and are [... read more]

Sep 262012
 
How to take care of older people with COPD (Review)

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]

Sep 162012
 
Initial Treatment of Acute Deep Venous Thrombosis (DVT) of the Leg (Guidelines)

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. PulmCCM is not affiliated with ACCP. The commentary offered below is appropriate only as a reference for those already familiar with [... read more]

Aug 302012
 
Surviving Sepsis Guidelines: Criteria for diagnosis of sepsis

Surviving Sepsis Guidelines’ Criteria for Sepsis Diagnosis See all the Surviving Sepsis Guidelines According to the Surviving Sepsis Guidelines, a sepsis diagnosis requires the presence of infection, which can be proven or suspected, and 2 or more of the following criteria: Hypotension (systolic blood pressure < 90 mm Hg or fallen by >40 from baseline, [... read more]

Aug 172012
 
Advanced bronchoscopy yields are 70% in meta-analysis (Review)

(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]

Aug 112012
 
Intubation & Airway Management Review (LITFL)

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]

Aug 032012
 
Non-small cell lung cancer (NSCLC): Advances in Diagnosis and Treatment (Update/Review)

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]

Jul 272012
 
Idiopathic Pulmonary Fibrosis 2014 Update (Review)

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]