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Feb 262012
 

I knew I smelled something fishy about this paper when I read and commented on it last year.  Now, Chest reports they’re giving this study a burial at sea, after the authors could not produce actual data supporting the trial. To help set the record straight: Chest published a retrospective study in March 2011, “Chest Tube [… read more]

Feb 232012
 
For most, plane flights add no DVT/PE risk (just stretch your legs)

As we were all taught in med school, long-distance flights, or even a long car trip, greatly increase your risk for deep venous thrombosis and pulmonary embolism … right? (I feel like I’ve answered about 8 board questions featuring this scenario.) The CDC even has a whole page of guidelines detailing the travel-DVT-risk-connection and the [… read more]

Feb 232012
 

GlaxoSmithKline has a new once-daily inhaled corticosteroid called fluticasone furoate; it has enhanced affinity for glucocorticoid receptors and a longer duration of action compared to the commonly-used fluticasone propionate, which must be taken twice daily to achieve a steady bioavailable concentration. In the January Thorax, William Busse et al report the findings of a Phase [… read more]

Feb 222012
 
Restrictive blood transfusion was fine for high-CV-risk patients after hip fracture repair (RCT, NEJM)

There’s not much data to guide the transfusion of red blood cells. In 1999, there was the beautifully executed and practice-changing Transfusion Requirements in Critical Care (TRICC) trial, which showed that a restrictive transfusion strategy (hemoglobin trigger of 7 g/dL) in ICU patients resulted in a non-stat.significantly lower mortality (19% vs. 23%) compared to a [… read more]

Feb 212012
 
Amoxicillin speeds resolution of acute sinus infections, but imperceptibly? (RCT, JAMA)

Amoxicillin may hasten the recovery from acute sinusitis (sinus infections), with more patients feeling just a tiny bit better after a week of amoxicillin compared to placebo, according to a clinical trial published in the February 15 JAMA. After 10 days, those taking placebo felt as well as those taking antibiotics. You may have heard [… read more]

Feb 192012
 

Traditional bronchoscopy with transbronchial biopsy (TBBx) has only a 34% sensitivity at diagnosing peripheral pulmonary nodules < 2 cm in size. Transthoracic needle aspiration (TTNA)’s superior sensitivity of 90% for diagnosing peripheral lesions makes it the standard of care for peripheral lesions, but TTNA carries a considerable risk for pneumothorax. A huge proportion of patients experience [… read more]

Feb 182012
 

Please also see the newer post describing the final results of PANTHER-IPF, published in NEJM 2012. PANTHER-IPF, a landmark clinical trial testing commonly used therapies for idiopathic pulmonary fibrosis, was stopped in October 2011 for apparent harm caused to patients by prednisone and azathioprine. This news was released back then, but maybe you missed it, as [… read more]

Feb 172012
 
Tobacco warnings, free speech, and "in-activist" judges (NEJM)

Legal eagle Kevin Outterson explains the latest twists in the saga of the FDA’s quest to get large, scary pictures on every cigarette package under its new regulatory muscle of the 2009 Obama-authorized Tobacco Control Act. R.J. Reynolds sued, and federal judge Richard Leon took their side in November 2011, deciding to apply the more [… read more]

Feb 162012
 

Do you conduct original investigations in respiratory medicine? Are you tired of publishing your work in The New England Journal of Medicine, Science and Nature? Well, Lancet has been feeling left out. They’d like to publish your manuscript(s) in a September 2012 issue to coincide with the European Respiratory Society meeting. They’ve issued a call for [… read more]

Feb 142012
 

Chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are common and together contribute enormously to the global burden of chronic disease. Although surely these conditions overlap and interact, surprisingly little study has been given to their interrelationship. Macchia et al prospectively evaluated and followed two cohorts of patients aged > 59, recruited from [… read more]

Feb 112012
 

My post featured on KevinMD: Obama health reform adviser Ezekiel Emanuel has been writing regularly in the lay and medical press to soften up physicians and the public for the coming of the mysterious accountable care organizations. But are rank-and-file docs buying the party line? Will physicians buy into ACOs? (KevinMD) http://www.kevinmd.com/blog/2012/02/physicians-buy-acos.html

Feb 102012
 

The Cochrane Collaboration smells a rat around Pharma’s handling of its data on oseltamivir (Tamiflu) and zanamivir (Relenza). They’re taking the unusual step of publicly calling for Roche (Tamiflu) and GlaxoSmithKline (Relenza) to make available their data from the original clinical studies that led to approval of the two blockbuster drugs. They point out that [… read more]

Feb 092012
 

Allergic rhinitis is mostly just an annoyance for 400 million people worldwide, but the condition can predispose to frequent upper respiratory infections, and worsen asthma; Alexander Greiner et al tell you what you need to know in this review in Lancet. Incidence peaks in the teenage years. The nasal inflammation of allergic rhinitis synergizes with [… read more]

Feb 082012
 

One-third of smokers try to quit each year, but few stay quit. Even with varenicline (Chantix), the most effective smoking cessation aid to date, only 10% are abstinent at one year. Anne Joseph, Steven Fu, Dorothy Hatsukami et al wonder if that’s partly because our (fee-for-service-driven) intermittent-visit model of patient care and counseling leaves craving [… read more]

Feb 062012
 

Januel et al report findings of a systematic review and meta-analysis to estimate the total incidence of acute symptomatic venous thromboembolism (symptomatic DVT or pulmonary embolism) among patients receiving proper thromboprophylaxis after hip or knee replacements. They came up with rates of 1.1% after knee replacements, and 0.5% after hip replacements. The rate of pulmonary [… read more]

Feb 052012
 
Systemic steroids for severe sepsis and septic shock (Review)

The benefits of corticosteroids as a treatment for severe sepsis and septic shock (if any) are unknown: Although adrenal suppression is common in sepsis, it is still unclear how to assess adrenal function, or whether it should be done at all. The sensitivity and specificity of the cosyntropin (ACTH) stimulation test are unknown, and its [… read more]

Feb 032012
 

Jean-Pierre Tourtier and Sophie Cottez of the Military Hospital Val-de-Grâce, Paris share the case of a 61-year-old man who underwent vertebroplasty after a therapeutic laminectomy for resection of a vertebral hemangioma. Cement made it into his paravertebral vascular system, and thence to his systemic circulation and pulmonary arteries, where it made for some interesting radiographic pictures. [… read more]