Review Articles Archives - Page 4 of 13 - PulmCCM
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Jul 232012
 
Hypersensitivity Pneumonitis Update (Review)

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]

Jul 202012
 
Should pleurodesis or PleurX drain be 1st-line Rx for malignant pleural effusion?

(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]

Jul 152012
 
Superior Vena Cava Syndrome Review

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]

Jul 102012
 
Sharpen your eye with these free online radiology tutorials

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]

Jun 302012
 
Ventilator bundles (VAP bundles) not evidence-based, shouldn't be standard care

(image: Wikipedia) Anyone who has ever rounded in an ICU with a nurse manager knows that challenging or questioning the utility of the ventilator associated pneumonia (VAP) bundle is a losing proposition — one likely to get you labeled as a wiseguy troublemaker. Thanks to ventilator bundles’ endorsement by the nonprofit Institute for Healthcare Improvement, [... read more]

Jun 292012
 
Could excess ICU beds be hazardous to your health?

Everyone knows that when you’re really sick, going to the ICU–that place with all the beeping monitors, hypervigilant staff, and high-tech invasive gadgetry–might save your life. But what if in certain situations, transfer to an ICU bed could actually worsen a person’s condition, or even hasten their demise? Hannah Wunsch of Columbia U. suggests it’s [... read more]

Jun 212012
 
Smoking is bad, quitting is good -- even for Great-Grandma

Most studies on smoking and its well-known health risks have been performed in middle-aged adults (younger than 60). In a large epidemiological study published in the June 11, 2012 Archives of Internal Medicine, Carolin Gellert, Ben Schottker, and Hermann Brenner showed that (spoiler alert!!) smoking’s excess risks extend to older adults, as well. Just as importantly, [... read more]

Jun 142012
 
Most clinical trials are too small, often underpowered

The past decade has seen an explosion in the number of clinical trials; there are now more than 10,000 new trials registered each year. Although clinical trials’ quality is improving somewhat, most are still small and single-center and a large proportion do not adhere with reporting requirements, raising serious questions as to what we are [... read more]

Jun 132012
 
No increased risk detected from smoking cessation just before surgery

Remember that weird advice we were taught as physicians-in-training to give to smoking patients before an upcoming surgery? “You should quit smoking, but not within the 2 weeks just before your surgery.” (It sounds off-key to me even as I write it now.) Based on … what? Some medical lore passed down from a decades-old study [... read more]

Jun 112012
 
Prevention and Treatment of DVT/PE in Pregnant Women (Guideline)

Prevention & Treatment of DVT/PE in Pregnant Women from the ACCP Guidelines, 9th Ed. The ACCP’s recommendation classification system: 1 = “recommendation” 2 = “suggestion” A = based on strong evidence from randomized trials B = moderate evidence that may include randomized trials or observational studies C = weak evidence, mostly consensus opinion Low-Molecular Weight Heparin [... read more]

Jun 012012
 
Bronchodilator reversibility testing in COPD: Bill for it, but don't believe it

(image: flickrCC) Why do we test chronic obstructive pulmonary disease (COPD) patients for bronchodilator responsiveness (besides getting to charging a few extra bucks for it)? If I am reading this article right, the answer is, there’s no good reason. Consider this: Bronchodilator responsiveness (BDR) or the lack thereof does not distinguish COPD from asthma. Bronchodilator [... read more]

May 212012
 
Diagnosis of Lower-Extremity DVT (Guideline)

Diagnosis of Deep Venous Thrombosis (DVT) of the Lower Extremity from the ACCP / Chest Guidelines, 9th Ed. PulmCCM is not affiliated with ACCP; this commentary is appropriate only for those who have read the original ACCP document, which is linked below. Diagnosis of DVT of the leg should incorporate these principles of safety: Reducing overall [... read more]

May 132012
 
Chantix: no excess cardiovascular risk in new meta-analysis (BMJ)

(image: People’s Pharmacy) Sure to re-light controversy around Pfizer’s varenicline (Chantix): a new study concludes the smoking cessation drug likely carries no increased risk for cardiovascular events.  Judith Prochaska and Joan Hilton (University of California – San Francisco) report the results in the May 4 BMJ. Sonal Singh (Johns Hopkins) et al’s previous meta-analysis, reported in CMAJ [... read more]

May 122012
 
Mechanical Ventilation in ARDS: 2014 Update

Mechanical Ventilation in ARDS: 2014 Review (More 2012 Topic Updates) People with acute respiratory distress syndrome (ARDS) are by definition severely hypoxemic, and nearly all require invasive mechanical ventilation. Yet mechanical ventilation itself can further injure damaged lungs (so-called ventilator-induced lung injury); minimizing any additional damage while maintaining adequate gas exchange (“compatible with life”) is the [... read more]

May 102012
 
How to bill for palliative care in the ICU ... legally (Chest)

Reimbursement for Palliative Care in the ICU By Intensivists To an intensivist, providing palliative care often means having multiple time-consuming and emotionally challenging interactions with families struggling to cope with the impending loss of their loved one. The emotional content of these interactions can be strongly positive, negative, or somewhere in between, but frequently it’s [... read more]

May 062012
 
Chronic obstructive pulmonary disease 2014 update (COPD Review, Lancet)

Chronic Obstructive Pulmonary Disease (COPD) 2014 Review Epidemiology of COPD Globally, ~10% of people older than 40 have airflow limitation of GOLD stage 2 or worse (FEV1 < 80% predicted); up to 25% may have GOLD stage 1 (FEV1 ≥ 80% predicted but FEV1/FVC < 0.7). Up to 60-85% of people with COPD (mostly mild/moderate [... read more]

Apr 282012
 
Inferior vena cava filters for acute PE and DVT (ACCP Guidelines)

Inferior Vena Cava Filters for Prevention of Pulmonary Embolism from the ACCP Guidelines, 9th Ed. Inferior vena cava filters should generally be placed in patients with acute pulmonary embolism (PE) or deep venous thrombosis (DVT) who have a contraindication to anticoagulation, according to the ACCP’s recommendations. The ACCP recommends against placing an IVC filter in patients [... read more]

Apr 232012
 
Thrombolytics for acute pulmonary embolism (Guidelines)

Thrombolytics for Acute Pulmonary Embolism from the ACCP Guidelines, 9th Ed. PulmCCM is not affiliated with ACCP. These are PulmCCM’s interpretation of the ACCP guidelines. They are appropriate only for those who have read and are familiar with the original ACCP guideline document, which is linked below. The ACCP’s recommendation classification system: 1 = “recommendation” 2 [... read more]