PulmCCM - Page 20 of 46 - All the best in pulmonary & critical care
Advertisement
Jul 142012
 
Talking to COPD patients about end-of-life makes them like you more?

We may see it more often, but we doctors don’t really know anything more about death than anyone else, and we find it just as scary. Yet we are expected to spontaneously discuss death-as-a-coming-event with seriously ill patients who (we assume) probably want to avoid the subject, well, like the plague. Maybe they do. But [… read more]

Jul 122012
 
New molecular test predicts lung cancer survival better than staging

Non-small cell lung cancer (NSCLC) unfortunately recurs even more often than other cancers, even when early stage and apparently completely resected. The explanation, of course, is it wasn’t completely resected: there was residual metastatic disease hiding out somewhere, but in such microscopic quantities as to be undetectable by our improving but still crude techniques (i.e., [… 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]

Jul 092012
 
Meropenem + moxifloxacin: no improvement over meropenem alone in severe sepsis (RCT)

In the first randomized trial of its kind, patients with severe sepsis or septic shock who were given meropenem alone had equivalent clinical outcomes to patients who were given combination therapy including meropenem and moxifloxacin. The results, reported in JAMA, provide ethical support to critical care physicians who prefer to be conservative antibiotic stewards. But [… read more]

Jul 082012
 
Cancer-Related Medical Emergencies: Tumor Lysis Syndrome

Cancer-Related Medical Emergencies: Acute Tumor Lysis Syndrome (More PulmCCM Topic Updates) The prevalence of multiple cancers are expected to rise in the United States over the coming decades. Despite improved survival with some cancers, some people with malignancy will develop cancer related emergencies; for a few, this will be the first manifestation of their cancer. [… read more]

Jul 072012
 
GM-CSF (Leukine) for acute lung injury & ARDS (RCT)

Human recombinant granulocyte macrophage colony stimulating factor (GM-CSF or Leukine) did not reduce ventilator-days in patients with acute lung injury / ARDS in a randomized trial published in the January 2012 Critical Care Medicine. Why would it have? Interestingly, patients with ARDS with higher levels of GM-CSF in their BAL fluid are more likely to survive. GM-CSF maintains [… read more]

Jul 062012
 
NSCLC: Anti-PD-L1 immunotherapy breaks ground, buys time for some

Immunotherapy — creating antibodies to tumor markers, then activating the immune system to selectively kill cancer cells — is the newest and most-hyped frontier of oncology. And with some justification: the mechanism is cleaner and kinder than chemotherapy, and being a whole new treatment modality, can complement and augment traditional therapies. Results of immunotherapy in [… read more]

Jul 042012
 
Blood pressure cuffs vs arterial lines for hypotensive patients

If you and your team just can’t get an arterial line into your critically ill, hypotensive patient for continuous invasive blood pressure measurement, you may be somewhat comforted by the findings of Karim Lakhal, Christine Macq, Xavier Capdevila et al in the April 2012 Critical Care Medicine. They found that among 150 critically ill patients [… 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 272012
 
Pertussis underdiagnosed; adult booster-vaccine prevents "whoop" & infant deaths

This gentleman (not pictured in the photo) graciously allowed himself to be videotaped in the midst of a severe whooping cough episode caused by Bordetella pertussis; the video is posted on the New England Journal’s website. He had not been vaccinated: vaccination during childhood greatly reduces the risk of severe or life-threatening pertussis infection, and reduces [… read more]

Jun 232012
 
Acupuncture improved COPD in a "real" randomized trial

Acupuncture has danced on the fringes of mainstream Western medical therapy for decades. Acupuncture has been shown to improve numerous conditions –for example, reducing dyspnea in patients with cancer, asthma and chronic obstructive pulmonary disease (COPD) in a few randomized trials. But — unsurprisingly, given complementary medicine’s lack of funding and acceptance among traditional academics — [… read more]

Jun 222012
 
Palliative care exploding in U.S. hospitals (AP)

Hospitals added palliative care services at a feverish pace throughout the 2000s, the Associated Press reported in a piece picked up by news outlets across the U.S. in June. While 658 hospitals reported having palliative care programs in 2000, 1,568 reported they offered palliative care services in 2009 — that’s over 60% of the hospitals [… 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]